From Cambodia to Crisis Care: My Journey in Global Health and Human Rights with Dr. Scott Allen's 🏥🚨

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in this episode of xat experts we have a truly remarkable guest with us Dr Scott Allen a recognized physician on the
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field of Health and Human Rights whose early career took him to the front lines of the Cambodian Refugee crisis in
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Thailand we'll be discussing his experience as an expert during this difficult times and later in the episode
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will'll delve into his current work addressing healthc care challenges in US prisons and immigration detention
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centers this is expat experts the podcast that dives into the fascinating lives of those who've lived and worked
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across borders exploring the challenges experiences and insights they've gained along the
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please visit our website exper experts podcast.com or check the link in the
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description the expat Scott
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Allen in this part of the episode of the expat I would like to uh well thank you
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again for for accepting the invitation to be in the podcast Scott uh it's it's really incredible I'm happy
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here um it has been some years when you lived
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abroad but uh I think it's a it's a very relevant experience what you what you lived in Thailand and I I think we can
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dig a little bit deeper in this first part into what happened what motivated you to go there you actually I think you
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you wrote a book uh recently about it also about the experience around there um um we can of course talk about the
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book itself also later I think you have it behind you yes I do um so yeah without further Ado I
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would I would say we can start with this first part of the episode um what initially motivated you to to to
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leave your home country United States and and moving to a such complex uh
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situation like a refugee crisis in in in another country what what was the motivation behind
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that well uh it's a great first question it and uh yes it took me a book length
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to answer it adequately in the Memoir I just published across a bridge of fire but
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the short answer is that I was burned in an accident at age 10 uh about a third
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of my body uh affected by thir degree burns and in short that experience and
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uh my recovery in a burn Hospital in Boston a pediatric burn hospital changed
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the way I looked at the world so that by the time I I was in my teens um 17 to be
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specific and the u news of the world was focusing on the Cambodian refugees
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hitting the Border I just felt an overpowering uh urge to to do something
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and I had no illusions that I had any skills I I mean I knew I had nothing to offer but I felt um I just had to be
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there so such began a very unlikely journey of running away from home getting a oneway ticket um and getting
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myself to Thailand and miraculously uh was able to get work as a initially as a
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relief worker and uh in within months I was working with the US Embassy so it's
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a sort of uncommon beginning of a journey but uh you know it it it changed
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my life can I imagine of course like it's a
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i it's surprising also how how something so early in your life can Mark you know like if if from age 10 until 17 you are
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seven years in there that you've lived your you had your kind of difficult experience let's say like this for an
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early age and that marked you and motivated you to to to help others um
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yes which I suppose it also marked the rest of your career afterwards also because you became a physician a doctor
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and and that's didn't end in in Thailand the helping people correct it's it is
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all clearly related it all is a journey and I don't you know even though my story I think is fairly unique uh but I
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don't think that aspect is atypical at all I think we you know in some way or another we're all sort of reacting to
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particularly things that happened to us in our youth um and then everything that happens after it sort of you know to
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some extent you're reacting with what life throws at you and adjusting to it so you know I think that's the universal
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part of my story um yes peculiarities come you know to the particular
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childhood injury and and what I did with it and where I went uh and then certainly yes as we'll probably focus on
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in our conversation today the experience in Thailand also really I'm still quite
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young I'm 17 uh when I land in Thailand um and and work there on and off for the
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next uh four or five years it uh obviously tremendously impacted my life
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and career Direction going forward till this day can I imagine
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um what was it like when you landed as a very young as a teenager actually uh in
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Thailand what what did you find there well I you know I I was a fairly good
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student but I can't say I really knew much about other cultures my grasp of
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History was really very cursory and I had no idea what to expect I I land in
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Bangkok uh at midnight the the door of the plane opens uh the it's it's not a
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jetway it's the stairs rolled up to the plane down onto the tarmac that the humidity like I've never experienced
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it's midnight but it's still probably 90 something degrees 100% humidity um from
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that moment and really for you know months that would follow it was like I
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had uh consumed you know 20 cups of of uh espresso you know it was it was just
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tremendous sensory stimulation takes excitement really the one word I can use
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is I was overwhelmed um but in a in a in an exciting way when you're young that's
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not necessarily a bad feeling and and I knew I was kind of jumping in the deep
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end of the pool compared to my skills and my abilities and my experience so
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you know I I I knew that I was challenging myself so yeah uh everything
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was you know back in those days I used to maybe say to my friends it's sort of like in The Wizard of Oz when the when
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the house lands in Oz it's like everything I'm looking at is fresh and new and unfamiliar and I have to and you
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know constantly be trying to catch up and adjust and learn um and that you
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know that most of that was Youth and me I me I think most people who would travel now do a little homework and plus
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we can also talk about we're talking about a story that happened 44 years ago uh this is pre- internet right I mean
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even if I had been more diligent I would have been reading outof dat books in a library about Thailand you know wouldn't
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have quite prepared me and the way that someone who's looking at Living overseas now um has a lot more resources can
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learn a lot more about the country before they before they depart but part of it was my maybe youthful laziness
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about you know being organized in my learning um the other were you know what the time there weren't the resources
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weren't there I mean it's something that I want to to ask you also like because how much
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did you know of where you were going when you decided to go there like because of course you have some social
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media I some some media not social media media channels probably newspapers TV
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talking about the Cambodian situation it was it was a very rough situation after
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a civil war with Paul po the whole Kam
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Rock uh A system that was like really tortur in people that there was a lot of that
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around so you know a part of it but I suppose the reality that you encounter when you arrived there and the refugees
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that you find there it's it's a it's another level it's not the same thing that you know from
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media yes and I would say you're absolutely correct so the media to bring it back to the late 70s you know we we
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certainly there was plenty of attention even though I didn't follow the news like I do now um you know I was keenly
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aware of the Vietnam War there were a lot of touch points you know people in my community served and so forth and the
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News um but it really the Cambodian story was little bit on TV but mostly
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what was arriving in the newspapers and the magazines of of the time there was a cover story on Time magazine that really
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you know gave me some background and some coverage in the New York Times that I was following um so I had you know
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basic orientation to what was going on really basic but you know that's again such a small window of orientation to
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have and then really I didn't understand and how Thailand you know related to Cambodia they're different countries
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they have different languages right so you're living and based in Thailand but you make it up to the Cambodian border
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you know two different languages to think about you know related somewhat similar cultures but really quite distinct so you know it was and and then
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you know there were other um Refugee populations there there were other ethnicities and so forth and then in
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working with an international team you know it really threw a lot at me all in a good way my by the way I hope what you
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know my story just adds to the growing wealth of stories your other guests share about how enriching it is to have
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the opportunity to live in another country and and so this was you know this was the best in my my uh impression
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is the best it could have been under under very trying
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circumstances responding to something something really uh horrible but in a in
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a way that brought out the best in the people who shut up yeah I can imagine you met very you
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met people who were you had strong connections with and that you shared moments that were hard but of course
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that build you as a person um it's also something that I wanted to ask you about like how much this or you you entered a
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little bit already into it but how much your work in the in the refugee camps shaped the decision afterwards to to to
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become involved with a with becoming a decision and involving yourself a lot
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with health and human rights as you are involved right now well I think it had everything to do
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with that I I I will say uh the decision to be a physician really uh was
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solidified from the burn injury I even at you know 12:30 well in the hospital I decided I wanted to be a a physician um
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and that was I and I never you know departed from that but it was certainly
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reinforced when I worked in the refugee camps initially as a relief worker and
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then later as a resettlement worker you know I looked with great admiration at the medical operations and the people
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who were doing medical work and I you know I really feel like that's ultimately where I want to be let me
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also just you know pause here if I may and share with you and the listeners um you might wonder I'm I'm already sharing
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my enthusiasm with a life abroad and living abroad and why are am I not
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living abroad now and why actually have I lived abroad for an extended period for over 30 years there is a simple
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answer um My First Son who's now 30 uh was born with profound developmental
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disabilities and medical needs so he cannot travel internationally and I I
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bring that up to just say that at any age if you have the opportunity to live
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overseas certainly it's going to be great but but consider doing things when
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you're young because life develops comp lications you know when you're young you don't have entanglements um you don't
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have as many responsibilities um and and maybe in some ways you're less set in your way so
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you're more open to the experience so uh boy if I if I could I think I still
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would be living internationally if if if it could be safe for my son um but uh
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any anyway so uh so a very circular way of coming back to
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the question you asked when I realized I could wouldn't uh continue working
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overseas um I looked around for things that had the similar challenge unmet
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need marginalization poor resources um maybe even biases against the population you
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know and I found that in both uh jail prison and immigration detention work I
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also did some work in state um mental health institutions so the the same skills and perspective that I developed
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working overseas um really help me navigate and be successful when I turn
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um to other populations
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wonderful um I wanted to ask you because you commented a couple of uh things you did
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in in the refugee camps like what was your work in there um maybe two questions like for the
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people who doesn't know how does this work like how right even now or back
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then how do you arrive to a refugee camps who do you contact like through
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who which organization or like how what's the process to use arrive to there and then who assigns you the work
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that you need to do and and what is the work that you did back then great really good question and you know it's one of
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those do as I say not as I do um I did not do it the right way at 17 I knew I wasn't doing it the right way the right
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way is if you want to do Refugee work is there are numerous International
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agencies um non-government organizations um that are well established in doing
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Refugee relief work um I actually at 17 was able to figure that out and I did reach out to uh a number of them not
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surprisingly they say you're 17 haven't even finished high school have no language skills have no medical training
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thank you kid call us in a couple years when you graduate from college um but that would be you know the place to
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start in my case it was I you know I did uh to some extent uh benefit from the
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chaos of the moment and and my instincts at 17 were not wrong as crazy as they
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were I thought well if I get myself there and I show up and I say you know
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you can argue whether I should have done this but here I am I'm here to help um and really not because I had much to
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offer did they uh put me in a van send me out to the board it was a small um
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non-governmental organization that I first worked with um you know they they just looked at me with sympathy and said
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okay kid you know you're here uh hop in the van we'll find something for you to do so they were being kind to me I I I
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they they had no illusions that I had much to offer but they they let me tag along uh and and then you know as soon
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as I was there I had to find out how to be useful on once you're in the camps I
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I think this would be still true even though we're talking 40 years ago I think the basic operations are the same
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there is usually an international coordinate coordinating agency and it depends on the conflict it defends on
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the Zone but um not atypically in those days it was the United Nations High
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Commissioner for refugees usually working in close coordination with the host country government host country being Thailand in this case and their
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military um to set up camps and coordinate them and then they in turn
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work with the international agencies um in coordinating the delivery free of care so it's not redundant like someone
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gets assigned you're bringing in food someone's bringing clean water someone's responsible for setting up shelters
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someone that's s responsible for setting up Medical Care
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Etc well sounds like a difficult work also to do because especially for you if
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you didn't know like what were you going to do especially know I suppose someone who goes with a medical degree on their
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hands and they arrive there and they know that they will be taking care of the health of the of the people but I
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assume there is thousands of other work administrative but also like uh
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organization uh that needs to be done and it also requires volunteers that are not at the level of like I don't know
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being doctors for example or being nurses there is a lot of other roles involved in a refugee
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camp absolutely yeah and I think you know uh
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when I think if I make the analogy I had a job back in the United States even though I was still in high school I was working at a company you know in in
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Connecticut and you know I had the job there of sort of being a gopher you know you know someone who they send on
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errands and you know fill in can you help out here can you help this person do this um it was really analogous they
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just said okay you know you're a body you're um and and an expat body because there are some there they certainly used
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a lot of refugee workers and they used thae workers but there were some limitations both political and otherwise on what the
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those um workers could do so occasionally you needed that expat worker um you know whether it's right or
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wrong and and certainly at that time you had a different status in in the camp you could do things that you could get
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away with that maybe other people couldn't um so so they used me you know in a in a variety of things but I got to
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tell you the early months working there um it was more of them letting me hang
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out than me really making a major contribution but I hustled during that time to try to learn a little Cambodian
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language um which not many Americans in that era had any familiarity with
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language um such that maybe through that I could be a little bit helpful and indeed even with really rudimentary
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conversational Cham that I picked up cim is the the language of Cambodia um in
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the in the first you know few months um when I did show up uh on the doorstep of
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the embassy 3 months later when my initial agency closed up shop because these are very unstable work
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environments um the embassy was a little bit surprised that I spoke any Cambodian
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and they said we were about to start working with cambodians they hadn't yet been allowed into the Cambodian camp but
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they were preparing for it they said boy you've been on the border and you speak little chare we could use you so it
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wasn't much but it was enough to get a toe hole
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so that was one of the questions that I wanted to ask you also language wise and culture-wise how do you adapt it but
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maybe before we jump to that I have last question about your you going there as
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as a person what is the reaction of your parents and your family back in United States when you say hey I'm leaving to
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to Thailand to go into help to do home raring
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work well uh thanks for asking that and and that I'll point back to the book I I I think I do a good job telling that
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story uh because a lot of my friends and family who who basically know the outlines to the story in reading the
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full story say boy we didn't realize how wonderful your parents handled this and
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I want to Echo that sentiment um you know when I discussed it as a general idea I I'd like to go and help out they
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were en they're enormously supportive and they encouraged that first stage where they said why don't you call some agencies and see if you can get a job uh
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even as a volunteer and we'll support you you but when that didn't work I I
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then said well maybe I'll just go there myself and you know they said you know we can't let you do that that's highly
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risky you know it is a war zone you can't go there by yourself that's crazy
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and I don't blame them so when I then because the compulsion was so strong
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when I leave a note and say I'm on a plane and I'm headed to to Thailand um
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which which I knew would be I mean a cruel thing to do to them I wasn't
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unaware of that as young as I was um the first call I made from when I got to
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Thailand I'd wait a couple days and go to the general post office again pre- cell phone pre- internet have to wait in
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a line in a phone bank and get this very echoey line that cost $100 for three
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minutes uh which know I did collect because I had no money in my pocket and the first thing my father said to me is
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well talk about how you did what you did later but now that you're there know
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that your mother and I support what you are doing and and do what you went there to do um enormously um wonderful parents
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I have they're still alive um thank goodness and um and you know by now I've
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apologized to them uh profusely for decades now but I'll never make it up to them so yeah it was a big big shock for
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them ultimately I think they're very happy how things turned out within that first year of working in Thailand they
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did um uh come out and visit which which wasn't a small accomplishment they were
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both teachers they didn't have a lot of income it was a big trip to undertake but um you know that's how much they
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supported what I did incredible like a lot of parents
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will not react like that that's for sure so no so true true it's it's good that your parents reacted like that because
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that built the the man that you're now today no I suppose so uh I think so
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a big thanks to to your parents also for for being those that supportive um so
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maybe going again or returning a little bit on the cultural and language side
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like yeah how did you find the the the people
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in the camps like what was the the the situation in there I assume that a lot of refugees are coming from different
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ethnicities because Cambodia was like the people who were persecuted in Cambodia were coming from very different
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backgrounds do you find a very very segregated uh population or or it's a
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little bit like everyone together and and and or there is refugee camps where
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there is more like okay people from from a Muslim background versus people from a
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from an uh from a pure Cambodian uh the ethnicity separated in
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there yeah so when the population first sort of spilled across the border I mean
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the tie had been trying to hold them back and maybe we should set the scene a little bit for your listeners this is um
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you know I arrive early 1980 but in late 1979 uh um actually at the end of
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1978 the Vietnamese um who were to the east invade Cambodia a communist country
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after the the Vietnam War invades another communist country to overthrow
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the cir rou because uh there's all sorts of reasons they're not Happ happy with the commish and the commish on the
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border and there have been some skirmishes and they finally make the decision to invade and that pushes the
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kir Rouge fleen with the captive population that they had enslaved to the border and then
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on the border you have that you know the ti lined up military uh defending their
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border so there's a sandwich of refugees in between the advancing Vietnamese forces the retreating Mar Rouge some
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non-communist Cambodian resistance groups armed and uh then there's the
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refugees and then there's uh the time military really sort of very volatile um
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area but heavily mined border I should add because that's very relevant to the refugee story
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landmines and um so initially there were mixing of these
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populations and the chaos of the initial spillover but you are correct there were
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different um as much as I would say ethnic maybe some of it's also social so
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you know the C Rouge largely Drew from rural um less educated peoples and their
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uh people they oppressed during that regime uh and persecuted were people
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from the cities um and certainly included ethnicities that were non CH or
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at least K Mech so Sino K Chinese C and and um you know Leos are Vietnamese
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living in in the cities um by the time I get to the camp I go to which is really
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the southernmost camp on that border uh myud a fairly small camp they had
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literally segregated sections or camps really they're two two small camps when
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I got there one was C rou and in fact there were C rou who had fled from a
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purge so from turmoil of a purge in like 1977 78 and then there was the new camp
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and the new camp were the type of people who were uh most victimized by the K
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Rouge um you know during their their reign from 1975 to 79 so so there was
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that sort of segregation um what did I feel when when you know how when I first
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interacted um you know again the word overwhelm comes to mind in terms of
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hearing the story the survival stories which started flooding over me almost from the moment I walked through the the
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uh the gate of the camp but at the same time what really struck me and still to
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this day I love is you know the Cambodian people are a very friendly
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people they're very polite they're very welcoming um and in in light of what had
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just happened they had uh you know resilience uh that was pable so uh you
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know really in in in the most trying of circumstances what I'm really picking up and and and taking away is how wonderful
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you know these people are um and how much I have to learn from
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them yeah I suppose like when people pass
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through struggles and then they're still I don't know happy
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and they're still able to share thing no that's that's when you realize that not
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all it's lost let's say like this um it it is very curious that the fact no like
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or like in the Cambodian uh crisis moment or the refugee the fact that
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there is also part of who are the peners or like there is victims people who are
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part of the system who was like also like persecuting specific ethnicities or
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specific uh targets of society let's say like this but they are also fleeing because the system is so brutal that it
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even Purge the themsel um how absolutely how was this tension how how do you live
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with this tension knowing that the next the camp the other small camp next to you or the neighbor next to you it's
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belonging to the group that has forced you to leave your own home did you feel this tension inside of the camps a
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absolutely uh you know there was space between them but they you could literally look from the fence of one
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camp and see uh the other camp now the chamir Rouge even though they had been victims of a party Purge they were still
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wearing the black pajamas and rubber tire sandals that you might have seen in pictures from that era they you know
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they still remained sort of loyal to the cause and and uh you know I I wasn't was
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maybe on purpose being one of the few Americans there they did not assign me to work in regularly in the Old Camp
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although I did have occasions to visit it and go in it and you know particularly the men in the Old Camp
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they you know viewed me with suicied and didn't really want to have much to do with me interesting the women were more
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approachable and friendly but in contrast you know everyone in the the new camp well you know I had a crowd
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around me all the time and people were very affectionate and generous uh but they would look across and see you know
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their oppressors you know that close and it really almost symbolized how how uh
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tenuous the situation was you know looking back and I I uh talk about in
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the book there's two I be friend that I am very close with to this day 44 years
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later you know who did eventually make it to the United States and Canada um to safety but you know in that moment we
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had every reason to believe that they could be pushed back across the border into minefields into uncertain future
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into violence at any moment you know no one you know they really Hanging On by fingernails on the border so to look to
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have to do that while looking across the way and seeing the C Rouge that close um
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was I think a great source of stress for the residents of the camp and and to me was you know just a dramatic thing to
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witness yeah I suppose in every Refugee crisis there is always this Insurgency of like if the H country can throw you
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back because it happens it really happens sometimes absolutely absolutely in fact fairly
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commonly unfortunately uh people who suffer suffer more even when they think that
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they arrive to SA uh that's right that's right and and and in the in the in the Cambodian case
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there was a very famous episode that had happened by the time I arrived where the Thai forced thousands of people over a
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cliff through a Minefield back into Thailand that's the incident at PR here
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so the refugees knew that story so it wasn't a theoretical possibility had actually happened um with with great
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suffering and death so yeah not a theoretical um and not uncommon uh in in
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Refuge situations you said you befriend people
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in there full families incredible that you still have the contact with them
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that's that's uh very very nice like that you you still have like the the the
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the capability of reaching them out to know where where they are and what they are doing
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um did how how is this cult cultural difference between when do you notice a
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lot of cultural uh I don't know how to
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say um maybe
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Gap is that where you're getting at yeah exactly yeah yeah so no well so think
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about this so the one family that I focus on most in the telling of the story um was a widow and her seven
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children um the youngest child being about four years old and the oldest uh
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child the oldest three children being daughters um the oldest is my age and
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then the her next sister is maybe a year younger than me and the next sister is maybe three years younger than me so
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while I'm just you know I'm I'm sort of an honorary adult because I have a job
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in the camp and I'm an American and that that's how it worked but but I was so I
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was dealing with her you know the mom and I was dealing with the other couple um the the the man who was my translator
32:31
when I first arrived there Lee because he was one of the only refugees who spoke English but the but the mom um Tia
32:40
and I would had the main relationship but I was constantly trying to figure out how to relate to these young women
32:47
that are my age and and the reason the word gap popped into my mind is there
32:52
was a huge cultural there's a language Gap but also a huge cultural Gap you
32:58
know Cambodian women in that era were very modest very socially reserved and
33:05
very um you know it wouldn't be appropriate for them to try to interact
33:11
with me or or if so very limited you know so and I was trying to to bridge
33:16
that Gap and you know if we jump to the you know years that follow and it took
33:22
decades you know now um those uh women are close to me as my own blood sisters
33:30
I mean we're very close um We are family and and we kind of look back and laugh
33:35
at say like when we first saw each other we didn't know how we would ever connect or if we ever would how we would connect
33:41
it took time is I think the the main answer I can share with you you know I I
33:47
did form an initial connection with them there and they me but um because they
33:53
were also young and didn't know how to negotiate cross-cultural experiences like that and of course it what
33:59
obviously helped is they did resettle to the United States and they learned more really about my culture as I was
34:04
continuing to learn more about theirs it helped narrow that Gap to a point now
34:10
where you know decades later the Gap is is pretty much gone but it it didn't happen
34:16
quickly can imagine how how did you I I assume that another
34:23
slow process was also learning languages and and being able to communicate
34:28
uh I assume that at the point of time people who speak English in the camps
34:33
were very few uh especially from The Ref for the refugee side um how were you
34:41
communicating and and you said also that you learned a little bit of of Cambodian languages and and you were able to to
34:47
catch a little bit up on that how how was the process for for learning there well I mean it was it was you know when
34:54
you think of a 17-year-old and what we teach young people about learning a second language go to for an immersion
35:01
experience you know I had to you know that if Lee wasn't available the only way I could
35:08
communicate was in K and so you know sure when you know over the first week
35:13
or so he rapidly you know teaches me my first 30 or 40 words and for a while I
35:19
have the conversation with people as far as I can get with those 35 you know and I and I continue to build on that now
35:25
there's a cautionary tale here and I I imagine some of your other guests have talked about this but people who um look
35:33
at people who who who go to another country and learn language there's a a bit of a plateau once you gain sort of
35:40
conversational level um in a new language and then it's really hard to
35:45
push through to True fluency and competency and I'll have to confess that
35:51
as I arrived at that conversational level of comfort you know with by the way people tell me fairly good pronun
35:57
iation because the first time I ever tried to learn the word I was being taught in C you know the Cambodian board
36:03
by cambodians um but but I never really mastered the language the way I should
36:08
largely because then you know by by three or four months I get the job with the embassy I'm doing work you have to
36:14
use interpreters because it's legal work and I'm now back to mostly speaking English and allowing an interpreter to
36:21
translate for me um and and then I'll take you know credit myself that that I
36:27
never quite put the effort uh in uh I I could have to to master the language I'm
36:33
still happy I have some conversal conversational camar but I admire my friends and have many of them who who
36:39
are truly bilingual in in many languages um not something of all my
36:44
accomplishments not something I've truly accomplished I speak a little of a number of languages but uh I'm fluent
36:50
I'm barely fluent in English as youve probably already determined well definitely better
36:57
English than mine that's for sure like that's that's where it comes my my second third language I don't know what
37:03
what it is actually I I improve also like uh as you said like best way is get
37:09
to get yourself where you need to speak the language and not that's right for because of because of whatever reason um
37:17
I have a question around like the fact that you are living inside of a country
37:23
but dealing mainly with another culture so you actually are in the refugee camps
37:29
of Cambodian people with Cambodian culture around you with Cambodian language but officially you are in
37:35
Thailand and at some point you are working with the US embassy it's the US Embassy work also in the camps or it's
37:43
some moment that you IM you need to immerse yourself also in the Tha in the Thailand culture and and the the world
37:49
of Thailand itself and not so much Cambodian yeah so most of the work I did
37:55
on that first trip and really across the five years that I was there on and off um was in camps um I would eventually
38:03
work in my ocean camps Mong camps um Vietnamese camps most of my time on the Cambodian border though um but in in all
38:09
those cases um you know I'll talk about the book I without permission used to stay in the camp with the families I
38:15
mentioned um unauthorized um but but for most of the time I was in country you
38:21
know you'd go work in the camps during the day but you'd go back to the town in Thailand at night so when you're talking
38:28
about adapting to cultures I was simultaneously I also had to learn enough conversational tie to get around
38:35
because you're in rural Thailand you know in Bangkok it wasn't too hard to find Tai who spoke very good English but
38:42
you went up country and and very few people did so you know to get by you had
38:48
to get conversational at least in the basic you know of things of how to order a meal or where's the market or
38:53
negotiate or Hegel and all the things um that they have have to do to get by so while I'm trying to learn Chim I'm also
39:00
needing to learn enough Thai and again very different languages from different language families there's not a whole
39:06
lot of overlap um Tai for example is a tonal language and Chim is not um and
39:13
and so forth um culturally again some similarities but really quite distinct differences so yeah I was trying to
39:23
learn Thai culture and language while at the same time I was trying to learn uh Cambodian culture and language and just
39:30
to throw in the mix during that first trip I got assigned to a Vietnamese camp for about four or five months so you
39:36
know throw in it again totally different culture totally different language um you know maybe helps explain why I
39:42
didn't Master any one of these new languages uh but still yeah all all
39:48
different um and um you know I I guess I I mastered them as quickly
39:55
as I could as best I could but by any objective measure my Mastery was
40:01
rudimentary in all you know all all of those areas on the other hand you are able to
40:08
meet multiple cultures and not a single one which I assume it brings also a lot
40:13
of richness on on your way of seeing the world um absolutely I I I think
40:20
so I wanted to ask you a little bit going maybe into your personal view on
40:26
on the on the whole thing what are what are some of the most favorite memories
40:32
that you have from your time in Thailand well to this day um I love
40:40
Thailand and and the Thai people and I love Cambodia and the Cambodian people Vietnamese the Vietnamese people um and
40:48
and I I mentioned before why I don't live overseas but boy at least once a year I try to get back to the area for a
40:54
short trip just to be there um just to be among people and and and I I let me
40:59
also add you know uh if you visit any new
41:06
country um for any period of time but even if it's a just a matter of a couple
41:11
weeks if you can get out of the Cities go to the smaller areas off the
41:20
beaten path because that's where you really see the country nothing wrong with International cities we all love
41:26
them we usually good pay base when you land and you're getting oriented but my experiences with the people in Thailand
41:33
and Cambodia in the rural areas to me have been the richest and most
41:39
rewarding um so you know when I think of yeah you know when I think of Thailand
41:45
or Cambodia the food's great we haven't talked about all the wonderful tropical
41:50
fruits that that we don't quite have uh in the United States or if you get them they're imported and not fresh um
41:58
there's so many things uh to to like about the culture but but for me it all comes down to a really basic thing I
42:03
love the people I love the interactions I've had with them um they're they're a warm and welcoming uh and generous
42:11
people um so that's to me you know the best memories and still very active I I
42:17
go back you know seeking uh that that uh company on a regular
42:23
basis well it's very nice that you still have contact with it and you still go
42:28
back after more than 40 years later that's that says a lot of how much it
42:34
marked uh you you entered a little bit on the question that I wanted to ask you and it was like food drinks uh how how
42:44
different was it how but you you still miss some of these food some of these
42:49
drinks traditional from yeah well so we I I I did refer a little bit to fruit
42:55
but let's go back to that 7 18y old kid getting off the plane and the next day met up with another world traveler who
43:02
kindly was showing me the the ropes and we just went out I didn't have I had like 50 bucks in my pocket at this point
43:08
and no job and no prospects and um you know managed very carefully that would
43:15
sustain you for about a week if you bought just street food but off we go to buy street food and he had uh my travel
43:21
companion who I met uh at the airport uh another American he had been to Thailand
43:27
before and he was introducing me to the foods and one of the first things we get is is a plate of Curry now I grew up in
43:34
in Connecticut in a largely white community and you we had no hot sauce or
43:40
anything and if you know Ty Curry especially as served in Thailand I remember you know taking the first bite
43:46
and and and my head wanted to explode and I thought oh my goodness how am I going to survive here I can't you know I
43:52
can't eat this stuff um and it's funny I again the impact of travel anyone who
43:59
knows me now knows I'm addicted to to Curry I love curry and if I don't get
44:05
good curry you know I start you know seeking it out like a drug withdrawal so
44:11
um you know travel or living internationally pushes you beyond your comfort zone and and remember if at
44:17
first you don't like something don't give up on it right away um I you know to survive because it people kept
44:24
serving it to me had to keep eating Curry until literally on that first trip I I remember it's like something clicked
44:31
and I was eating I'm going like actually I like this there was no in between it
44:36
wasn't a slow transition something clicked where I don't know I I got it um I appreciated it and now now love it um
44:44
you know there so many other T I mean things like the fried noodles and the fried Rices those were easier um to
44:50
adjust to from my very you know U untraveled palette but you know there
44:57
were there were other Foods too that you even just seeing from my middle class U
45:03
white background in the northeast of the United States you know you'd get the noodle soups in the morning and they'd have tripe in them and and you know
45:10
other pieces of the the animal that I wasn't used to seeing including you know
45:16
chicken feet and so it's like that was all new but I I did have that good
45:23
youthful attitude that you know I put myself here and I should be open to what
45:29
people are doing here and I should try things and you know so I did and you know did I did I enjoy everything that
45:36
was put in front of me no but um I learned to appreciate almost all of
45:42
it I mean I'm really up to Cory also so I would be I think I would really like
45:47
to I've never been to Thailand before but I I take your word as soon as I land and I go there first thing that I would
45:55
do uh although I we tried we tried to replicate a little bit the taori here
46:01
it's I assume never so never close to the origional recipes of Don in in
46:07
Thailand so true uh probably where you are just like in the United States you know there's now there weren't when I
46:14
went over 44 years ago but now every small town seems to have a Thai restaurant but what those Thai
46:19
restaurants in America have done is over time is turned down the heat and the spice level to accommodate the American
46:25
tastes and and you if I'm lucky and get to talk to the Cook and just say you
46:31
know quickly in my limited tie hey I lived in Thailand I want it like you're making it for a tie person then then
46:38
it'll come out like that but so often I'll I'll order it and I'm disappointed how how bland it is here compared to
46:44
time yeah can't imagine so maybe two last questions before we jump to the to
46:51
the second part of the episode the first one would be music are are you a music
46:56
person General like do you remember if there was music involved in life because
47:01
it's one of the common things that a lot of places have and they have their traditional Styles and and
47:08
things so yes absolutely I got to tell you you ask am I interested in music I'm
47:13
an amateur musician I'm a singer songwriter I I live in Breathe music it it it to me is so therapeutic and always
47:20
has been um since my childhood injury was one of the ways I coped and when I Was preparing to go to work in a refugee
47:27
camp in a foreign country in in a war zone and I remember talking to my friends my friend said what are you
47:33
gonna you you know you're you're not gonna have music remember this is even prew Walkman era you know like you know
47:39
there was like not like I couldn't bring a Walkman to listen to my music that would come out a year or two later and
47:46
revolutionize my travel experience but at the time and then I played piano and guitar and like they said you know
47:52
you're not going to have those there either so I arrived in the camp and and and it you know I shouldn't have been
47:59
surprised but there are a couple beat up guitars there and I mentioned to someone I play guitar can I borrow your guitar
48:05
and play and one of the most you know when I didn't have a lot of language to connect to people once I started
48:12
struming that guitar and and singing say Beatles songs which they were familiar with um you know it was just such a
48:18
lovely way to sort of break the ice um now the the next thing is um I started
48:25
you know in those early camps to start to learn about um the the pop stars from
48:32
Cambodia that sadly uh the most prominent of them had been executed and
48:38
killed in the revolution um so you know there's a a male uh the most famous
48:44
Cambodian male uh vocalist of of the 1960s 1970s was ciny samut and probably
48:52
the woman Ross SAA um people had cassettes of their music um usually poor
48:59
quality because they were pirated multiple times um but they would play them in the camps and they they wanted
49:04
me to to know you know listen to our music um so that first exposure to
49:09
Cambodian pop music now there is also Cambodian traditional music which you
49:15
would also see the very small number of traditional Chim um musicians who had
49:21
survived were preserving both Thai kind of Galan music um that you you know
49:27
similar music you'll see in Thailand and all the way down through Indonesia and Malaysia um very you know very
49:33
percussive and like the xylophones and the the um the the th saw are are like
49:39
violin um instruments combined with traditional
49:45
Cambodian dance now most of the dance teachers and music teachers had been executed but the few people who had
49:50
learned and still retained the skill we trying to revive those Arts even in the camps so that was all
49:57
you know new to me um and and again you know uh it was easier to relate to the
50:02
Cambodian pop music which had a a close relationship to American pop music although a very distinct Cambodian style
50:08
but the traditional music was even further a field and it's sort of like you know I suppose when the West first
50:14
comes into contact say with Indian traditional music um you know on first listening you go like I I don't even
50:20
know where to grab onto this but if you invest some time into it over time Prof
50:26
ly moving and and so now I have appreciation for both the Cambodian pop
50:32
music and the um traditional music by the way there's a um documentary that
50:38
came out um a few years ago called don't think I've forgotten that you can find
50:44
streaming um that tells the story of of the um Cambodian pop scene prior to the
50:51
cimar Rouge and then the the very sad ending uh of so many of those those musicians but but it's a story that's
50:58
worth checking out nice actually the last question that
51:03
I wanted to to ask on this on on this uh part of the episode was any
51:09
recommendations that you would give book documentaries movies anything that I
51:14
mean of course besides your own book now probably that it also touch your experience in there but
51:20
um any any resource that somebody needs to read or to see uh watch before going
51:27
to Thailand or to Cambodia well it you know it depends if if you're in particular in Cambodia if
51:34
you want to have some appreciation for that period we're talking 40 years ago but it's such a enormously important
51:41
period I mean I think uh you know if you look at you know you you can say the Armenian Armenian Genocide was a long
51:47
time ago but but isn't it relevant to anyone who's visiting Armenia now and the Holocaust in Europe was a long time
51:53
ago so so the karage period is really a profan period in Cambodian history
51:58
modern Cambodian history I I still think probably the quickest and easiest way to get a handle on that is the film The
52:04
Killing Fields um that that came out in the early 1980s it still really hasn't I
52:10
don't think been surpassed a lot of it was filmed on location and literally the star uh the Cambodian star of that movie
52:16
was not only Cambodian Refugee he worked with us at the embassy he was a physician so there's a lot real authenticity to that that that story
52:24
more recently um the the book and movie first they killed my father is a another
52:30
Cambodian uh perspective um by un um on on that period um but you know if you're
52:38
if you talking about just uh being practical the book that I'm sure it's on the bookshelf behind me the because I
52:45
still have it in many subsequent editions but the Lonely Planet series which was in its infancy when I first
52:51
went to Thailand saved my butt so if you're just looking for practical advice that type of series not NE I'm not
52:57
necessarily endorsing that above others but um you know a general sort of guide that gives you brief orientation to the
53:03
history maybe a little bit of cultural orientation um a little bit of tips on language and and suggest sort of
53:10
strategies on on how you uh negotiate your way around the country those those kind of resources are worth their weight
53:17
and goal I think still a very valid uh even
53:24
with I also have Lar Planet like guys even if the the the way of getting
53:30
information about traveling has changed so much and everyone is like still referring quite much to to the internet
53:36
and everything I I we still value these ones especially for for specific
53:42
countries that maybe the information that it's online it's not always the most accurate on the reality but more
53:48
like a touristic approach on what what it's out there know like uh and and and I would be remiss if I didn't say you
53:54
know people do ask uh younger people uh who hear the essence of my story and they go how how did you find your way
54:01
around you know without your iPhone you know without your maps without your
54:06
ability to look things up without Google translate how' you do it and I said you know for those people my age and older
54:13
we have an a simple answer we used to walk up to strangers and ask yes for advice or ask for help some something
54:19
that's a little bit been lost in the age of the internet um so don't forget that that still works especially in where
54:26
people you know I I suppose in the United States being one of them you try to walk up to a stranger on the street
54:32
and ask him a question in the United States compared to when I was growing up there's now suspicion of like why do you need directions why don't you look on
54:38
your phone like what are you trying to pull here but I but I still find again you talk about rural Thailand rural
54:44
Cambodia you can walk up to a stranger and strike up a conversation and you won't be viewed with suspicion and maybe
54:49
that's a disappearing thing but while it's still here take advantage of it absolutely
54:57
well with this uh last recommendations I would say that we we jump uh to the second part of uh of today's
55:04
episode hey there everyone if you're loving this episode so far and you want to stay tuned with other expert
55:10
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the description and book your session today with that said let's go back to the
55:46
episode the expert Healthcare in US prisons and immigration detention centers it's also a jump on time what we
55:55
are doing now um so you've been
56:00
working very close right now since some years addressing the challenges that the
56:07
Health Care System it's providing in prisons and immigration detention centers in the US and of course the best
56:15
the first question and the the obligated question is when did you start with this
56:20
work and why did you start with this work so um as we we touched on a little
56:26
briefly before I um worked on and off through through my college Years I worked in Thailand in the refugee
56:33
program so from 19 80 to 885 and then I came back and to pursue my medical
56:38
education but even while doing that I set up um uh with a community health center in Providence Rhode Island where
56:44
I went to medical school I set up one of the uh first uh Cambodian focused
56:49
clinics in their Community Health Center Network um and you know and continued and did make some trips back to Thailand
56:56
uh to do uh some research and support work there and was in a track uh being groomed and trained to do International
57:03
Health when um uh I married a medical school classmate and as we were
57:09
finishing our residencies our first child was born as I mentioned before um he had really uh compelling and profound
57:16
health challenges suddenly you know a decade of preparing for international work seems
57:23
like it's out the window and irrelevant and I initially did some work in community health centers which which
57:29
satisfied some of the same needs of wanting to do that kind of work but um
57:35
then a former colleague from training called up and said you know gee I know you liked working overseas and you can't
57:41
now but you know you might find working at the prison as a medical doctor might
57:47
uh give you the same sort of satisfaction rewards of addressing um compelling unmet needs and and and in a
57:54
challenging environment uh so off I went and I worked um in in the state of Rhode
58:00
Island um as a primary care physician eventually the medical director of the
58:05
the state prison and jail system um and and indeed there were a lot of overlaps
58:11
uh that I you know just described compelling you know sort of higher rates of disease um poor resources um often
58:20
not only ignored uh by the public but ignored by the profession of Medicine um
58:26
and a lot of systemic problems in delivering care so um I I was able to take some of the insights and lessons
58:33
from working in in resource challenged areas and working with populations that people were not seeing or being aware of
58:39
um and bring some of those uh experiences from overseas to my work in
58:45
um and working in jailon buis I see so a lot of it it's like okay
58:50
transition into needing to go overseas or to other countries where your work
58:57
was required you were also PHR so the Physicians with human
59:03
humanitary um background let's say like this um so you went to a lot of trips
59:09
outside of the US after uh after the being living in Thailand for first ATT
59:16
amount of time you you work in other countries not as as extended uh time but
59:22
you you've done work in in other City situations of Crisis and other uh moment
59:29
difficult moments in other in other uh uh overseas uh
59:37
regions well yes so as you said now you I shifted from the long-term type of
59:42
work to uh more consulta but also um also learned over time you know in
59:49
medicine we might say you can have a Band-Aid approach you get a a cut and I come along and they put on the Band-Aid
59:56
but if everyone keeps coming with cuts I might go where who who's cutting these people and like can I move upstream and
1:00:02
try to prevent the injuries you know advocacy uh and public health sort of perspective um these are things that are
1:00:08
both re Rel uh relevant to working with Refugee populations but are also relevant to working with jails and
1:00:15
prisons you know you can just respond every unmet Health need in the moment or you can start to look at them more
1:00:21
systemically and say do we have opportunities to be more effective and advocacy for the resources and needs of
1:00:27
the population these are these are the overlaps that really help me makes a lot of sense D I suppose the
1:00:35
systemic uh approach it is a little bit better than just taking care of the lower level if
1:00:41
you can cut the The Source no the root of the problem um can you describe a little bit what some I assume there is
1:00:49
there is multiple and maybe we don't have the time to go over all of them but um some of the of the systematic issues
1:00:55
that you have been tackling in in in prisons and detention centers in the US
1:01:00
right now well broadly speaking I think the two big areas um when you talk about
1:01:06
the intersection of Health and Justice internationally but certainly in the United States is that so many people um
1:01:13
and I think many your listeners probably are aware the United States incarcerates at a higher rate than most countries in
1:01:18
the world or in history and a uh majority of the people incarcerated have
1:01:24
unmet need needs when they're in the community in two broad areas um one is
1:01:30
UN mental health needs and the other is unmet needs around addiction and as you
1:01:36
can imagine there's overlap between those two areas so there's a good example of you know you can you can deal
1:01:43
with someone while they're in crisis or you can maybe revive someone from an overdose in the moment but if you're not
1:01:49
more effectively addressing and treating the underlying diseases in the community
1:01:54
boy I think you can expect there to be bad outcome um from from the natural um
1:02:00
you know history of of both of those conditions um so and and and then in a
1:02:06
related note a lot of the work I did over the years related to infectious diseases which also go hand inand to
1:02:11
some extent with addiction the the epidemics of HIV and and viral hepatitis
1:02:16
B and C were at least in decades prior largely tied um to Shared needle use um
1:02:23
and injection drug use um so you know again these were all areas that again
1:02:30
you could treat one individual patient or you could take a step back and say how to we more from public health perspective how do we better protect you
1:02:37
know I do want to make one more um uh health issue that's related to the mental health but when I'm pivoting you
1:02:44
know you mentioned I also do work Consulting and visiting and auditing
1:02:49
care and immigration detention which is really you know slightly different than
1:02:55
um the corre ctional system for people convicted of crimes or charged with crimes um and there um you see it in
1:03:03
both jails and prisons but more pronounced in Immigration centers which
1:03:08
are a little bit more like refugee camps you see more um impact of trauma on the
1:03:14
population so what they call trauma informed care which is care where not
1:03:19
just the mental health person is sensitive to the fact that you've been traumatized but you teach every everyone
1:03:26
who works in that facility um how to be more sensitive to people who have suffered trauma um that's an example of
1:03:33
adapting a systematic approach to working with population in addition to working with them oneon-one
1:03:40
I see so you no this differences between the detention centers and the prisons I
1:03:46
suppose the the problems facing in in these two situations are not always the
1:03:53
same they reside in a lot into mental health probably not being tackled which is also
1:03:59
a problem of society in general I would say no like uh yes right you you we deal with mental health
1:04:07
as it was something less than uh other kind of practitioning uh no we take more
1:04:14
care of our bones broken but our mental health is it's the last thing that we take care of uh so um absolutely how how
1:04:22
do you deal with with mental health in environments where you're you are
1:04:27
privated of Freedom or or or movement or or well you you really hit it around on
1:04:34
the head so first of all there's usual resource constraints generally um all medical services but particularly Mental
1:04:40
Health Services are not is properly resourced in proportion to the need but
1:04:46
you've touched on another important issue the environments themselves are harmful to mental health and there's
1:04:53
really a rich literature on that particularly an immigration detention where um the detention can be indefinite
1:05:00
you know one advantage if you're convicted of a crime in the United States and you're sentenced to prison
1:05:06
you have a fair idea of how long you might be there although there are adjustments for good behavior and you
1:05:12
know maybe appeals for early parole but you have a fixed idea of what you're facing you get picked up in Immigration
1:05:17
detention you're often in an indefinite detention situation you don't know if you're going to be there for a week a month a year two years five years and
1:05:25
that uh creates an enormous um stress on people caught up in those systems and
1:05:31
that's an international phenomenon not unique to the United [Music] States how much of your work then it's
1:05:38
actually working inside of these centers like inside of of prison or the institutions itself or trying to avoid
1:05:45
these things because for example you touch the the fact of shared needles no and the addiction uh infections for
1:05:53
example but that's something that it comes not only in Insight of of of the system of Prisons or the or or these uh
1:05:59
closed systems it happens in so Society in general so how how do you try to
1:06:06
prevent that from from a previous step to to arriving to the penitentiary centers it's a great question because
1:06:13
another thing my colleagues in the profession have been trying to work on
1:06:18
for years as we interface with people in government government officials and public health officials is to remind
1:06:25
them that jails and prisons and immigration detention are not as you might think
1:06:31
walled off isolated you know if you're walking around in the Free World you just don't need you know if you're
1:06:36
humanitarian good you can care about what's going on in there but the rest of us don't need to worry about it doesn't concern us then you don't know anything
1:06:44
about jails prisons or immigration detention because they happen to be areas of high turnover especially jails
1:06:50
where you're maybe held for matter of days before you're released in court um
1:06:55
and as such actually they're a very important part particularly in infectious disease we uh and my
1:07:02
colleagues anticipated as covid was developing that that the government and
1:07:08
the public health authorities had not factored in jails prisons and immigration and detention they were
1:07:14
Tinder boxes of how you could spread effectively spread infectious diseases
1:07:20
like Co and indeed in spite of our warnings um you know some some facilities did listen some didn't we
1:07:26
basically said you got it you know you were emptying colleges you were you were breaking up all sorts of congregate
1:07:32
living settings as much as you could you're getting people off cruise ships but you were leaving everyone in jails and prisons and and as you as you know
1:07:39
and internationally as well as in the United States there are a number of of huge outbreaks that spilled over into
1:07:44
the surrounding Community because people didn't realize that uh you know this the
1:07:50
jails and prisons are part of our community and when you're looking at Public Health they're
1:07:56
um ideal places to deliver resources to because not only are you dealing with a
1:08:01
high burden of disease and mental health and addiction in jails and prisons but
1:08:06
in addressing them you're positively impacting the community with Downstream effects that are often in the case of
1:08:12
infectious disease fairly immediate you said a couple of times the
1:08:20
term public health and it's something that maybe it's it's from a European persp perspective and maybe it's a
1:08:26
little bit biased no but but how how does it work like because
1:08:33
normally or what it arrives informationally wise to us it's that American System of Health it's it's
1:08:39
rather private so it's it's difficult to access even for uh normal people outside
1:08:47
it's expensive um how does it works when you are in a Detention Center when you
1:08:53
are on a on a prison who who pays for that who who is taking care of course
1:08:59
you are there no I suppose that's basically your role but is is it part of
1:09:05
like I don't know a bundle of the government saying okay this goes to prisons and that includes the health of
1:09:11
of the prisoners or is a separate uh institution it it it depends on where
1:09:18
you are there are some um health programs in jails and prisons that are run through the health Departments of the state and then but more commonly
1:09:24
they're usually run by by the jail and prison bureaucracy itself but um you
1:09:29
know you did use the term healthcare system or American Healthcare System I have a colleague an advocate who likes
1:09:36
to remind uh us whenever we use that term he says no actually the problem in the US is we don't have a system at all
1:09:43
we have you know just a lot of private uh you know parties all in the space but
1:09:50
there's no really organized system but the interesting thing in the United States not immediately relevant to
1:09:56
immigration detention because the rights of non-citizens are different but for jails and prisons that house US citizens
1:10:04
um there have been uh two major Supreme Court cases one in 1976 and the other in
1:10:09
2011 that have reaffirmed the government's obligation to provide
1:10:15
medical care for people they incarcerate um under the eth amendment ban on cruel
1:10:21
and unusual punishments so ironically the one population in the United States
1:10:27
that has a constitutional guarantee and access to care are people who are in jail and prison so think about the bit
1:10:34
of irony there now does it mean they get the best of best care does it mean they often even get adequate care no but it
1:10:40
does give um lawyers and legal profession some Foundation to Advocate
1:10:46
effectively um when there are gaps in healthare and right now in my own home county in Southern California and
1:10:53
Riverside uh I have been appointed by a federal court to monitor improvements in
1:11:00
the healthcare program in my county jail so often the mech you know using the legal mechanism um is how the standards
1:11:07
and Care are maintained but it's a constant battle can imagine that it's it's not
1:11:15
something that comes out of the blue no it's years of of of working on it um one
1:11:21
of the questions that I also wanted to ask you it's how has your worked where is the little
1:11:28
victories or the victories that you had in these years of like trying to improve the the the healthc care system in
1:11:34
prisons and detention centers in the US for you like where is the the moments that you say now we are doing something
1:11:40
now I'm changing this so it took years uh and often I got
1:11:47
to be honest I would get discouraged and pessimistic I have a colleague I should uh give a shout out to his name is Jody
1:11:52
rich and together we founded the center for for Health and Justice transformation at Brown University but
1:11:58
Jody of the partnership is always the eternally optimistic one um and he's uh
1:12:04
always encouraged me when I'm getting discouraged to just keep going but you know one quick example I think would be
1:12:11
um hepatitis C when I first started uh treating uh patients in prison um even
1:12:17
the National Institutes of Health said don't treat people in prison with
1:12:23
hepatitis C it's too hard to do and you know just don't do it that was actually
1:12:29
you know the health authority in the United States the academic recommendation and someone who was
1:12:34
treating patients who needed to be treated I I had a problem with that um and with Jody's help we started treating
1:12:41
patients in our state prison we turned out to be among the first to do that and then published our results and shared
1:12:48
with the world and then uh supported or helped out in strategic litigation over
1:12:53
the next few years long and short is now if you're incarcerated um you have access to hepatitis C care um and you
1:13:01
know when we started it was quite the opposite you were told you can't get it even though it was when I first began my
1:13:07
career it was the leading cause of death in my state prison so you know that's
1:13:12
that's one um example I I think we can and there are just as an example because
1:13:18
there are other areas particularly my colleague Jody Rich's work he's made great strides in um in addiction related
1:13:25
treatments um and harm reduction where even if you're still using um addictive
1:13:30
substances you're doing it in a way that reduces risk of transmission of HIV and viral hepatitis and other diseases so
1:13:38
you know there are areas I think where we've made a great success um and then finally um you know if you read on my
1:13:45
background probably what I achieved most maybe the word is notoriety in the United States is pushing back on the
1:13:52
Detention of children and immigration detention and um without as much fanfare or
1:13:59
Attention our push back with many other Advocates uh uh working with us um at
1:14:04
least right now we do not detain um children with their families we still detain unaccompanied miners um but we
1:14:12
did make progress in basically shutting the family detention centers that were so much the focus of attention um under
1:14:19
the previous administration those do not exist at least for the moment they could always come back but you take these even
1:14:26
limited and temporary victories and run with them well that's for my perspective it's
1:14:35
a big victory no even even if it's temporary these things are are like are
1:14:40
important and it's a you you should be proud of them no it's uh and when I mean
1:14:47
you it's also the the next question was going to be related you always talk in plural um a little bit when when you
1:14:54
talk about this I assume it's it's not a oneman job uh it's a work of a of of a
1:15:00
multiple people are you Associated inside of some kind of organization or
1:15:05
or uh how does this work comes together yeah that's a great question earlier in
1:15:11
my career I had more formal roles with uh organizations and I still you know I so you mentioned PHR which is Physicians
1:15:18
for human rights a really great organization that I've been working with now for decades um and earlier on I had
1:15:25
very formal roles with them including times part-time employment with them um my relationship with them now is as one
1:15:31
of their medical advisers um and so you know in a more intimate way I do work
1:15:36
with them um I I still work as a expert consultant with both federal courts and
1:15:43
the um uh Department of Homeland Security on the immigration detention issues but that's sort of end of career
1:15:50
you know I'm sort of well established in the field now so people now reach out to me for consultations and advice but
1:15:56
earlier on yes the point you started with I I really want to emphasize uh you
1:16:01
know to the extent that I think I've had a somewhat successful career I never achieved anything acting Alone um it really was
1:16:10
Finding Partnerships but that's true in life and in general so he say you know one of the things where you know the
1:16:16
heart of your program why um go overseas is to make connections to broaden your
1:16:22
perspective to learn how to collaborate with people are very different than you now you bring that you know you learn to
1:16:27
do that in another country and you come back to your home country that what seemed like cultural gaps in your
1:16:33
domestic setting really start to seem small and you go like boy if I could learn how to you know connect at least
1:16:40
have a conversation with with a rural cimar Rouge rice farmer you know this this guy who lives
1:16:47
next door whose politics are a little different than mine and you know he he dresses differently and culturally he's differently yeah I can probably find a
1:16:53
way to connect to him so yeah the importance of working
1:17:00
with with other people working with communities finding like-minded people
1:17:05
to do the work you want to do is the key to success completely
1:17:13
agree it's better when you have multiple hands working on something no and pushing in
1:17:18
a and multip and multiple perspectives right and accepting perspectives from
1:17:26
from other perspectives it's also part of absolutely on on that sense maybe like
1:17:32
one little bit more personal question um when it comes to accepting and
1:17:37
and leaving no or or dealing with with moments that maybe that doesn't really
1:17:44
work how how did you cope with the ethical moments working with prisoners
1:17:50
and especially with I I assume in in in prisons and and certain environments you
1:17:56
find people that you by your ethicality and your morality would not align with
1:18:02
you would not like actually like to be involved but at the end how you separate your work from from your ideal of what
1:18:10
it's correct or not boy you know too bad this is coming
1:18:15
at the very end of our conversation it's such an important question and ethics in particular has guided I think you could
1:18:22
probably have you know figured this out has guided my whole career and there are tremendous ethical conflicts in the type
1:18:30
of work I do I I think you were referring to actually one of the easiest to address and that is um how did I feel
1:18:36
about caring for people you know Rhode Island was a small state I knew you know even though we say in in in Correctional
1:18:43
medicine you generally don't ask what you're in for it's not relevant but you can't avoid reading the papers so some of the are notorious and horrific people
1:18:50
um who had killed multiple people who had raped and killed children you know these from patients but I got to tell
1:18:56
you that that that part was actually easy because I did truly believe that my
1:19:01
job was to provide um Healthcare without judgment to everyone and I was comfortable with that principle it was
1:19:07
for everyone else you know I didn't I don't object to the fact that there's a judicial system and that there's punishment meded out um and that if
1:19:14
you're spiritual that maybe there's a larger frame of where Justice uh Beyond
1:19:20
this life is is meded out but that had nothing to do with my profession responsibilities in fact you can get
1:19:26
into trouble real fast if you start making judgments about your patients so that was the easiest part the bigger
1:19:32
challenges come when there's conflicts between what Physicians and other health professionals are asked to do in
1:19:38
detention settings that come into conflict with the conflicting mission of what the detention Authority has so I'm
1:19:45
thinking um ethical conflicts that are well known to us in the field um the medical profession says you never force
1:19:51
feed a hunger Striker but most you prisons say legally absolutely you have
1:19:57
to force feed a hunger Striker so these ethical conflicts come up um that
1:20:02
Physicians have to negotiate and I've spent a lot of my career helping other Physicians navigate those ethical
1:20:10
dilemmas um so the ethics really yes enormously ethically challenging you really have to have a a a firm ethical
1:20:17
compass and remember as a professional you don't always do what you're told you
1:20:23
do what the ethics of your profession dictate even if it means uh standing and objecting to the institution you work
1:20:30
for even when it's the state or federal
1:20:37
government that's a strong statement I agree completely like I think it it
1:20:42
world would be better if a lot of people stay by their ethicals instead of following orders no maybe um
1:20:49
yes um maybe the last question also a little bit related to this that has been
1:20:55
already a recommendation for everyone who wants to enter this field but maybe the last question before we close the
1:21:01
interview would be what would you be your advice for anyone who is in the
1:21:07
health care professional who is interested in entering the field that you work the last
1:21:12
years well that one's actually uh finally the E easiest question you've asked all day you know um most most
1:21:19
jails and prisons in the United States have trouble recruiting Good healthc Care Professionals so I think you know
1:21:24
if you have any interest it's probably not that hard to look at Job vacancies in uh in Health Care Systems and jails
1:21:31
prisons um and so forth um and you will probably find uh that you know wherever
1:21:36
you live relatively close to you that there might be vacancies available and I encourage people to do it um if you went
1:21:43
into medicine because you wanted to address unmet Health Care needs um there it is um as a little bonus the United
1:21:51
States because it's all a privatized system uh a lot lot of people get burnt out doing uh medicine in the community
1:21:57
because of all the hassles of billing and so forth they work for a prison as we talked about before it is funded
1:22:03
through the government you know it's the only place we have socialized medicine you're only spending time uh focusing on
1:22:11
the care and yes with limited resources and trying to get what you need for your patients but you're not doing as much
1:22:17
documentation and paperwork that drives people crazy in the private sector and lastly um if you're up for challenge you
1:22:25
know the the cultural challenges you know there's another culture that we didn't talk about going in and working
1:22:30
among people in uniform whose job it is to detain people that's a different
1:22:36
that's a different world and how you interface with them where you're in contrast to the hospital or the clinic
1:22:42
you're not the authority you walk into a jail in prison the security people run the place you're there almost as a guest
1:22:48
a required guest but a guest nonetheless you don't call the shots Hospital clinic the the doctors call the shots so
1:22:55
um it's enormously challenging but enormously rewarding um and you know
1:23:00
most people who try it I think uh find it very
1:23:08
rewarding thank you so much Scott has been a an enormous pleasure to have you
1:23:13
and to be able to talk about all these topics that a lot of people doesn't have the perspective that you have and the
1:23:19
experience that you have so I'm 100% sure that our listeners will be
1:23:25
uh will extract fantastic uh ideas and experiences out of this conversation it
1:23:32
has been a an enormous pleasure really to to be able to talk to you about your
1:23:37
time in Thailand but also your your work in life uh and thanks for your work uh
1:23:43
also I think it's it's it's incredible and it it has been a pleasure to to be
1:23:48
able to interview you well thank you for the invitation and the opportunity the pleasure was all
1:23:54
mine and and lastly thank you for everything you're doing with your podcast I think to the extent that
1:24:00
you're opening people's eyes to the rewards of cross-cultural experiences I
1:24:08
salute you and I support you thank you so much um maybe a last
1:24:13
thing uh before we close the episode it would be if there is any way besides of
1:24:19
course reading uh the book that you that you uh
1:24:26
published where where can listeners find your story a little bit more of course reading first the book and then find you
1:24:32
uh out there uh so people who is interested in knowing a little bit more about you the book again is called
1:24:40
across a bridge of fire it's available on Amazon and through a variety of
1:24:45
places where it can be ordered um the best place one stop to go is to drscott
1:24:52
allen.com that's the e r s c o TT a l l
1:24:58
n.com for more information and you can also reach out or message me through that
1:25:04
platform perfect with uh that point of contact uh to to Scott uh we close the
1:25:11
episode today uh thanks again all the links to to the book to to the websites
1:25:18
and the multiple recommendation that Scot has uh provided us today will be in the description of the video and the
1:25:23
episode epod uh so again thanks a lot and I hope we can talk again soon I
1:25:29
certainly hope so as well thank you so much you've been listening to expat
1:25:35
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1:25:40
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1:25:47
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