“All the truly Living, at least once, are born again” (The Beautiful Struggle, Ta-Nehisi Coates, 2008, p74 Loc784).

It is interesting (disappointing), to look back at how I saw the world and Thailand before and just after I arrived. My learning and growth feels so profound right now, but I expect it will feel quite limited tomorrow. I am gladdened by the sense that I am starting to gain a more accurate understanding of the world around me, though it does come with frustration and sadness at times.

I am proud that I came with a willingness to be taught and the desire to avoid casting judgment - I could do better or much worse. I remember the overwhelming difference when comparing the look of a hospital wards. Comparing was the only way I could make sense of what I was seeing, but it was quickly clear that there are things that are done much better here, and much worse. Recognizing what I see as part of the larger system is sometimes beneficial, such as the merits that offering universal access to preventative medicine and acute care carries.

And sometimes I read a book that opens my eyes even more. I talked about how common it is for married adults of child-bearing age to live with their parents here. I reflected on how great it is that grandparents can share their wisdom with the young and impressionable. I read Atul Gawande’s wonderful book Being Mortal, and he discusses how the advancing life spans of adults has made this a challenge. He also discussed how the usual trajectory of a nation’s economic development and medicine looks like: people die at home, people die in the hospital, and then people die at home again. I look at it as a progression from lack of medical ability to medical sophistication, but I don’t like the negative connotation this description gives countries in early stages of prosperity.

So here I am living with people, who are people, as people in community. We work together in a common mission - to keep this place in operation. There are many different roles, and there is some hierarchy, but at the end of the day we all work together to create or sell products, or we foster or develop improved health.

Susan and I still have a lot of privilege. We cook on a propane stove, while the other families cook outside with charcoal, but none of us have a microwave. We wash our clothes in a washing machine - the families do their wash by hand, but we all line dry them. The interesting thing to me is that their methods are more ecologically sustainable. They use less water for laundry and the wood they burn is renewable.

The community is also more accustomed to seeing the disparities in life. Whether watching television, riding down the street, hanging out on social media, or talking to a family member who migrated away to help support the family - prosperity, abundance, luxury, and waste are all around them. But I see the consumption choices. I know many people who have their values more in order than I ever have. Sacrificing clothing and eating off the land in order to purchase and build their first house. Young people who are saving, modeling kindness and generosity despite having lived in a world with significant pain and tragedy. Again I compare, but I try to do so without judgment - even self-effacing judgment.

The world I see today is one where people are mostly happy. Some of that happiness is an appreciation for the life they have because of what they have been through. Most of that happiness is because they are wonderful and kind people who have a passion for joy, a community to engage in, little desire to feel sorry for themselves, and personal goals they are working toward.

But to me, the look of life on the margins feels different too. Recently, I have witnessed the fragility of a few people who previously seemed rock solid. It is nothing out of the ordinary, just a reminder that just because you escaped hell doesn’t mean you don’t have the memories of it, or can weather anything at any time. I see this in part because of my role as a health care provider: people are more willing to be trusting and honest with a nurse.

I see people who were marginalized at a young age through abuse, exploitation, or death. People who are smart, but never had the good fortune of education. Individuals who were raised and continue to be raised by people who are not their parents. People who are regularly reminded of their own mortality as friends and loved ones die with seemingly greater frequency due to their complex medical conditions. Children who are bravely encountering some of the most confusing times of life with questions that cannot be answered to satisfaction. Questions that were unimaginable for me at that age, and that are still unimaginable to me now.

I see them and I stand with them. I live with them and love them. I learn from them, and am so thankful for their acceptance of me, because landing 12,000 miles from home in a culture I rarely understand - I need them and would not have made it this far without them.

What I think I have learned is that this community is not asking for pity, which is an easy trap to fall into. However, they are amazingly appreciative of the people who help create, maintain, and fund this project. They are not sitting back waiting for things to be given to them. They work. And they work. And they get paid for a lot of their work. They also choose to help out wherever needed (work for free) because they love and believe in this community. They choose to live simply because they are closely connected to so many of the things that really matter.

Life is a struggle. Enduring to find joy amid the inevitable loss, pain, and sadness. On the margins it seems that falls are swifter, landings are less secure and less assured, and it takes a whole lot more people to help you up. But I still know very little, because I have only really been paying attention for 10 months.

"One has to decide whether one’s fears or one’s hopes are what should matter most" (Being Mortal, Atul Gawande, 2014, p232 Loc3290).

"Our ultimate goal, after all, is not a good death but a good life to the very end" (Being Mortal, Atul Gawande, 2014, p245 Loc3474).