Watch your step….BETEL NUT!!!!


Here is a shot of a man preparing Betel Nut Quids.  Quids is the technical name for these betel nut filled parcels he is so carefully  assembling. It is a tad bit ironic that he is preparing the betel nut in such a methodically manner with latex gloves, almost appearing to imply a level of  sanitation…. take 5 steps back and you are standing in a makeshift stall assembled from  obvious pieces of  remanent wood at the opening of a narrow trash strewn street which we would call an alley in the states. This HIGHLY ADDICTIVE Myanmar past time is very much like a form of chewing tobacco. It is derived  from the areca palm which produces a soft, it is refered to as  Betel Nut. The nut of this palm is chopped up and slathered with a slimy  lime solution ( that cannot be good), then wrapped in the betel nut palm leaf ( a quid) occasional additional  tobacco and or other spices are added to enhance flavor and effect. Betel Nut pod is then placed in the mouth  between the cheek and the gum like chewing tobacco in the USA.  People who I have met have tried it says it kind of taste like eating soap… mmm appetizing!!

Then the most charming part of this national phenomenon is  the wretched red spit which is EVEYWHERE  and people spit it out randomly, walking down the street (right in front of you),  taxi drivers just open their doors and spit, men… women… young.. old  it doesn’t much matter. When the urge strikes I guess you have to  just spit. Just watch your step its EVERYWHERE!yuk! Germ-a-phobs beware!!  You will find the spit stains everywhere and anywhere,  sidewalks, stairs, trash cans, walls, dripping down car doors. These are the days you are praising the Gods for monsoon season that brings the daily down pours and near floods that washes away the crimson remnants.  Here is where you are not of the local custom and you strap on your rain boots that you had your wonderful mother send 9,000 miles because along with the tilde wave of people’s spit God only know what lurks in the constant sewage filled rain water. In this instance I do not make like the locals, I throw on my wellies and fly my ” she is a foreigner flag” high and proud!! lol!!

It really can be quite  distracting and nerve-racking, people will be talking to you while gargling this mouth full of  red muck, it’s not as if I  can actually understand them without the mouth full of chew but it definitely  add insult to injury.

I understand it is a cultural norm but if you ask me ( to which no one has) it is quite disgusting  habit. And let me tell you, it is hard not to be preoccupied with people’s oral health,  when some have these blood red stained, rotten teeth. Just maintain eye contact .. Pretend like you don’t notice and hide the horror from your face … Nothing to see here just keep it moving!











Theravada Buddhism in Myanmar. This is the religion or way of life for Monks and Nuns here in Myanmar.































I think the one thing which I will definately miss when I leave here is seeing the Monks and Nuns everyday… everywhere!


Early morning in Yangon young Buddhist Nuns  dressed in traditional pink robes humbly wander the streets carrying thier silver alms bowls collecting donations and food for the day.




saffron draped washing clothes, protect thier shaved heads from the scortching hot burmese sun.

Nuns of Myanmar

Nuns of Myanmar






Nuns walking the Streets of Yangon

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Facts I have learned about Buddhist Monks:


  • A MONK is the highest
  • Monks do not handle money
  • Monks renounce all worldly goods except 8 items ( 3 robes, a razor for shaving, a needle for sewing, a strainer to make sure they do not swallow ANY living thing, a belt and an alms bowl)
  • You should never touch a Monks robe
  • Monks  are the Buddhist equivalent of Priests
  • Monks only eat 2 small meals per day, one  in the early morning , which is usually a rice based porridge and  a second meal which is eaten at 12 noon.  After the noon meal they fast until the next morning
  • Every morning Monks walk around townships and city’  in single file lines collecting alms of food for the day. From  this collection of offerings from lay-people in their alms bowls during the morning  hours. After  several hours they return to the monastery. This food is shared among all at the monastery.  The lay-people earn merit by feeding the monks
  • Monks cannot handle the alms they are given, it must be placed directly into the alms bowl by the lay-person
  • Nuns only collect alms twice a month on Sunday
  • When collecting the alms in the early morning hours the Monks walk barefoot
  • Monks alms bowls are black lacquer and Nuns usually have silver or tin alms bowls
  • There can never be any contact between a monk and a woman
  • The only real difference between the nuns and monk is the color of their respective robes
  • There is no distinction between monks, all robes are the same saffron color despite seniority.
  • There is no such things as a life long vow, Monks are able to leave the monastery  whenever they like
  • young men in Myanmar are expected to spend some time in monastery during their adolescence as a way to accrue merit.
  • it is reported that more than a half a million monks live in Myanmar







Novice Monks at Shwegadon Pagoda





rainy season in Yangon


Funny story….met this monk on a tour and after he asked me where I was from and I told him that I was from America… his next question was ” Do you know Edward Snowdan” ( really I cannot make this stuff up) Nope, your holiness I have not made the aquaintance of the American traitor!! lol


novice monks worship at Shwedagon Pagoda


Temples, Synagogues, and Catholic churches in the land of the buddhist


St Johns Catholic Church – Yangon

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Catholic Cathedral-Yangon Myanmar


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Myanmar is said to be 95% Buddhist with sprinkling of other denominations scattered throughout the country.  A smidgen of Hindu, a speck of Christians, a spattering of Jews and the largely opposed

hindu temple-yangonminority of Muslims. Before arriving I knew of the religious uprising that was occurring in the Rhogina region in the northern states of Myanmar between the buddhist and the Muslims however I was not aware of the extreme separatism that exists here. In fact, I feel it my responsibility to share some of what I have learned about Buddhist during my time traveling through SE ASIA,  I think there lives a misconception that Buddhist are very “Zen”  and a peaceful brood. However, as I travel throughout some of these asian countries where the majority of people are buddhist I have become keenly aware of the rather unapologetic and in flexible views of buddhist. It appears to me that there is a widely unspoken understanding of Equal but Separate. I have been quite surprised with the amount of religious unrest that exist between the Muslim and the Buddhist particularly.  I have recently been made aware of  the 969 Movement which is a anti-islamic movement created by none other than BUDDHIST MONKS. The 969 movement is growing rampantly and a stark contrast to the preconceived ideals of buddhism, which according to most of us is a religion and lifestyle that is built on peace and pacifism.  Not so much here, Myanmar, where it is said that 90% of the world monks come from, it seems like an odd contradiction. Actually Ashin Wirathu- a buddhist monk  is the creator of this anti-muslim movement, he has been  nicknamed the “Burmese Bin Laden” .

The 969 number stands for three things: the 9 stands for the special attributes of Buddha, the founder of the religion; the 6 stands for attributes of his teachings of dharma; and finally, the last 9 stands for special characteristics or attributes of the clergy. Stickers and posters are everywhere . These openly racists icons warn Muslims away from  buddhist shop owner, taxis , and  restaurants but rest assured the muslims have a similar icon which warns buddhist from their establishments.

My Myanmar friend does a good job of explaining the intolerance as a way of preserving the history and culture of the Myanmar people from the immigrants from Bangladesh  and other Muslim nations. For her it comes not as form of racism but more from a sense of wanting to preserve her history and religion. She also goes on to explain that the Muslims here have long ago separated themselves from the rest of the people here in Myanmar and only now that the Buddhist are staging their own demonstration does it become a conflict. I think it is all very interesting, especially considering that most of us would believe that buddhist are mostly accepting but unfortunately I have witness more intolerance than acceptance.  ( so much for being ZEN)

The long and short of that sad little diatribe is that there is good and bad in all groups, religions and races. And just because a group would seem to be impervious to judgment, alienation and terroristic acts does not mean that there are some among them who harbor hate and intolerance!

Myanmar’s legislation will vote in the next coming weeks regarding a bill that strictly prohibits and  makes it illegal for individuals to marry outside of their region. There have been some speculation that this piece of legislation will be removed however that is largely unlikely  given the overall strong hold that the restrictive government still has on the citizens of Myanmar. This country may have just become open to the rest of the world in the last 3 years and the government may  appear to be “reorganized” to make opportunity and civil liberties  more accessible to its all of its citizens, I fear that there is still quite a bit of oppression and military-like control.  Please keep in mind this is just my view from where I sit;)

I know in America we feel like we haven’t gotten very far where race relations or religious freedoms  are concerned but each day that I spend witnessing the oppression and the extreme separatism that exist first hand,  I am grateful to live in the wonderful US of A,  with more religious , cultural, and civil liberties than most other countries in the world. To that I say ( everyone sing along with me) …… ” and I am proud to be an American where at least I know I’m free…”




Gardenia/lime garland offerings for the HINDU Gods at the Temple. Made of gardenia /lime/leavesofferings for the Hindu Gods


Shri Kali Temple- Yangon

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Goddess Lakshmi means Good Luck to Hindus. The word ‘Lakshmi’ is derived from the Sanskrit word “Laksya”, meaning ‘aim’ or ‘goal’, and she is the goddess of wealth and prosperity, both material and spiritual. Lakshmi is the household goddess of most Hindu families, and a favorite of women. I wonder if this is the HINDU GODDESS who will bring me a fantastic fellow?? Either way I shall pray to her…. it  couldnt hurt. Lakshmi did I mention that I need him to be  attractive, kind,smart, funny and wealthy!! lol. Just thought if we are sending out prayers I ought to be as specific as possible right?? Anywy, here I gave a prayer to all the beautiful, amazing, funny, fearless and brave women I know!!

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hindu temple in yangon- located in the little part of yangon which is called little INDIA .

hindu temple in yangon- located in the little part of yangon which is called little INDIA .

Shri Kali Temple, Yangon Hindu TempleIt was built by Tamil migrants whilst Burma Province was part of British India. The temple is noted for its colorful architecture, especially its roof, which contains images and stone carvings of many Hindu gods.

Shri Kali Temple, Yangon
Hindu Temple. It was built by Tamil migrants while Burma Province was part of British India. The temple is noted for its colorful architecture, especially its roof, which contains images and stone carvings of many Hindu gods.



pigeons outside the temple.

pigeons outside the temple.

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Jewish Synagogue - yangon

Jewish Synagogue – yangon



A Sterling Silver Torah Case.



vessels that hold the tora

The handwritten scrolls of the torah are stored in the holiest spot within a synagogue, the Aron Kodesh (“Holy Ark”), which is usually an ornate curtained-off cabinet or section of the synagogue built along the wall that most closely faces Jerusalem, the direction Jews face when praying.


silver protective vessels for the torah scrolls

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lit a candle and said a prayer for a special friend (AG)

lit a candle and said a prayer for a special friend (AG)

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This temple is maintained by one man via donations and his life savings. There used to be more than 2000 Jewish people in the country of Myanmar currently there are 20 reported with 8 living in Yangon.

This temple is maintained by one man via donations and his life savings. There used to be more than 2000 Jewish people in the country of Myanmar currently there are 20 reported with 8 living in Yangon.

Dating from 1896, this is the only Jewish temple remaining in the city.

Dating from 1896, this is the only Jewish temple remaining in the city.


This is the only Synagogue in  Yangon

This is the only Synagogue in Yangon. Only 8 Jews remain in the city, 20 in the entire country.







      Shabat Shalom!!!






healthcare and history in the land that the world forgot-Myanmar



This is the common greeting for friends and strangers in Myanmar. The direct translation is, ” it is a blessing” which has dual meaning for hello and goodbye. It also has a wonderful subtext as an offering of ‘ auspicious blessings”. What nicer way could there be to greet and part with someone, than by offering them a blessing.

Traveling to the other side of the world is no euphemism here… I  spent more than 25+ hours in air ravel, approximately 9,856 miles from my home in Atlanta, Georgia to Officially arrive in the Republic of the Union of Myanmar (formally the Republic of Burma). Logistically, it  has been quite the  undertaking to prepare for months gone from your home and outside of the country. Thankfully, I have a village preparing me for my time away, all who have conspired to help me be successful and given me the peace of mind that everything both professionally and personally is under-control while I am serving as a Global Health Fellow. To each and everyone of them… I am grateful!

It is both and honor and a privilege to have the opportunity to represent Pfizer as a Global Fellow and partner with PSI, all while being a first hand eye witness of a country introducing itself to the world and on the precipice of evolution and expansion. Myanmar is a country where access to the outside world had been all but criminalized for more than 4 decades. Trade, communication, innovation and medical advances had been halted for more than 50 years. The world marched on while the population of Myanmar was all but frozen in time. Imagine a country where Coca-Cola was considered contraband until just a few years ago, a place where they skipped right over the concept of black and white TV and were instantly catapulted into color tv, cable television, facebook and cell phones. A good majority of the population in the rural provinces still has little idea of the advancements the world has been making.

The military lead government (junta) was officially dissolved following a 2010 general election and a sparse civilian government was installed. Although the military retains enormous authority it has taken steps toward relinquishing control of the government back to the people. Myanmar is a country that is unquestionably on the verge of growth and modernization, the change in government constraints has allowed forward progress in the country’s foreign relations and has led the way for improvement in trade with Europe and the United States. The upcoming general election in 2015 will definitely be telling for the future of democracy in this country.

At this moment, Myanmar is one of Asia’s poorest countries. When the World Health Organization (WHO) ranked Myanmar against its global counterparts, the country was ranked last out of 190 countries with respect to what the WHO calls “overall health system performance.” %. Myanmar’s government spends the least percentage of its GDP on health care of any country in the world, it spend roughly 2% on healthcare; whereas impoverished Laos spends 4.5%, and Cambodia 5.6% of its GDP on healthcare.

The general state of health care in Myanmar (Burma) is poor. I recently read that Myanmar has barely 61 oncologists in the entire country and a meager 3 radiation machines in all of Yangon. Cardiovascular diagnostic capabilities barely exist anywhere in the country.

A bit of perspective on health care costs in Myanmar, currently it is mostly a private pay system. The average estimated patient’s out of pocket contribution accounts about 92 % of total health care expenses. Today, person in Myanmar needs medical attention, the vast majority will go to a private-pay clinic or monastery where for a small fee, they can receive very basic primary care services. If medicine is prescribed, the individual knows they will have to pay 100% of the costs out of pocket. The net of this is that today’s healthcare consumers in Myanmar are accustomed to taking nearly full responsibility for their individual healthcare costs.

Luckily for Myanmar, the demand for healthcare services, pharmaceutical products and medical innovations will go hand in hand with the economic development and increasing income of the Myanmar people. As Myanmar continues its economic growth, the demand for quality healthcare will undoubtedly increase, as will the demand for access to better more advanced procedures and treatment options.

I will be excited to learn more about this country , its customs, cultures and most importantly its people. As for now, I say to you…


The land of the golden pagodas

IMG_1309 IMG_1313 IMG_1314 IMG_1316 IMG_1319 IMG_1321 IMG_1323 IMG_1325 IMG_1335 IMG_1337 IMG_1339 IMG_1340 IMG_1341 IMG_1346Week 1 in Yangon
I started the week with a little sight seeing… First up Shewdagon Pagoda! The story goes like this, it is the largest pagoda in Myanmar and the oldest pagoda in the world, more than 2600 years old. It hold remains of all 4 Buddhas and even 8 strands of hair from the Lord Gautama Buddha dating back to 558 BC. These hairs were presented to the then king by 2 merchant brothers fIndia, upon their return to their home land Burma, who had received them from the Buddha himself .,It is said that when the King opened the coffin like case where the hair was stored and….

“There was a tumult among men and spirits … rays emitted by the Hairs penetrated up to the heavens above and down to hell … the blind beheld objects … the deaf heard sounds … the dumb spoke distinctly … the earth quaked … the winds of the ocean blew … Mount Meru shook … lightning flashed … gems rained down until they were knee deep … all trees of the Himalayas, though not in season, bore blossoms and fruit.”

This Shwedgagon Pagoda is pretty awe inspiring and for Buddhist of Myanmar, it is considered the holiest of sites. The Shwegadon Pagoda stands about 300 feet high and is gilded in more than 800 bars of solid gold. The tip of the stupa, far too high for the human eye to discern in any detail, is set with 5448 diamonds, 2317 rubies, sapphires, and other gems, 1065 golden bells and, at the very top, a single 76-carat diamond. It can be said that the Myanmar like a little bling. Surrounding the pagoda are a plentitude of smaller shrines housing pre-Buddhist spirits called Nats, miracle working images, and even a wish granting stone. The worshipers were everywhere… young … old… common people and oh so many monks. This pagoda is said to be the most sacred place for Buddist in all of Myanmar.  It is said, that all Myanmar have an  asspiration to make a religious pilgramige to the Shwedagon Pagoda at least once in thier lifetime.

It was all so glistening, golden and beautiful I didnt even mind that white marble , which had been absorbing the Myanmar penetrating sunrays all day  was searing the bottoms of my feet. I  rather ungracefully hopped from the very few shady spots I could find. It was like those Tom and Jerry cartoons where Tom is walking over the hot coals.  Now  for full disclosure, you are required to remove your shoes and socks before you enter the Pagoda, so even before you enter, on  ground floor at the elevator to the courtyard, up the two stories … NO SHOES OR SOCKS FOR ANYONE!!!  So maybe I am a self professed germ-a-phob, which probably stems from my  recent run in with toxic agents that stripped my immunity and my eyelashes. But somehow this was seemingly very unhygienic and against all things I am comfortable with.  I get it,  the SHWEDAGON PAGODA maybe  the most sacred of  ALL place for Buddhist but I was not loving the dirty-ness( so not a word) or the wretched stentch of B.O in my 42 second elevator ride.  I was sure I would contract west nile or MERS  or even possible catch another case of cancer!! Germ-a-phobs need not enter… your silly hand sanitizer is useless against the bacteria that looms here ( insert evil cackle here!)IMG_1348



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no metal scafolding needed we have bamboo and string??

no metal scafolding needed we have bamboo and string??


I am a friday born my animal is a guinea pig/hamster

I am a friday born my animal is a guinea pig/hamster

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In the beginning…

Sunday May 4,2014

As of this moment I have been awake for more than 36 hours, with faint intermittant bouts of sleep.
Whoooooa Jet lagged … Nope I think I was teetering dangerously on the verge of full on psychosis. In my wild imagination it is my perception of what a crack-head must feel like .. ( picture Halle berry’ circa Jungle Fever character) The roller coaster of emotion…. I’m tired … I can’t sleep, I’m exhausted , yet wired, I’m hungry, I can’t eat, I …. wait …am I tired?.. I am bleary eyed and physically exhausted. I can sleep for only a few hrs then, despite the onslaught of pharmaceuticals I have enlisted. I am startled wide awake at 1 am. You know…. that crazy paranoia that we all get when we’ve traveled and awake in the middle of the night, not recognizing your surroundings,  with no earthly idea where or who we are and panic because we fear weve been abducted or worse yet roofied (sp). Nope,unless you consider self medicating with a cocktail of bendedryl, lunesta and some classy mini-boxed wine roofied then all I am is jet lagged in SE ASIA.
So back to my self diagnosed psychotic escapades….
What’s on tv at 2 am? Oh yes the infinite loop of fast and furious movies , in Korean, in japaneses, in English with Burmese subtitles.what the hell people? Ok now I’m fully engaged in al jeezera tv  news network, this can’t be good. One of my moms concern was that I would turn into a buddist, no worries here Luz , with all the AlJeezera TV I’m watching the worst that could happen would be me buying into the radical Islamic movement … Only kidding!! It’s just the jet lag!
Wait am I NOW watching obie ( my affectionate code name for Obama ) deliver the White House corespondent speech… If I am watching this then I must be delirious!!

After a room change I am unpacked rather half heartedly as I have 2 rather small closets with exactly 5 hangers and 3 small drawers to divide up the 3 suitcase I have so methodically packed with the close supervision of my mother. Where am I going to put all this… I will decide later now I must sleep.. is it only 12noon? who cares, ahhhh sweet slumber awaits.
My first few days I am grateful I packed… Miniature boxed libations of Pinot griot( you laugh but at these moments it’s sweet salvation), scented candles, microwave popcorn, and a few hangers.

Sunrise From INYA LAKE

sunrise on inya lake

sunrise on inya lake

Myanmar Adventure




April 30,2014 Wednesday

Day one of Global Health Fellowship Assignment. I have been in the air for just close to 22 hours and have covered at this moment around nine thousand and some odd miles clipping along at 478mph hovering at an altitude of 34000 feet or 10363m. As I type this KoreaAir flight 47 has just passed over Hanoi and only 600 miles to my new temporary home! I have passed the international date line , so now it’s May1,2014 . The first ieg of the trip we are headed out from Atlanta straight north , giving a wink and a wave during my fly over of the Windy City, Soaring across our Canadian neighbors , then West over the pacific only to arrive on the Asian continent and touch down in Seoul Korea. Which by all accounts is the “Far East ” for most of us. Seems contradictory heading west to arrive in SE Asia.


Observations of travels thus far:
Korean Air, like most international carriers I have flown has been great. I know this will not surprise you and for your future reference as you make plans to fly Korean Air to Myanmar . I humbly did not spend the extra 6 thousand to upgrade to business class . Yes that is correct an extra $6k on top of the fare that Pfizer has so generously already covered. That being said I have found no issue slumming it here in “economy class”. Economy class internationally in my experience has never been bad… Consider if you will..

what economy domestic airline do you know that gives you:
Thick pashmina life ( emphasis on “like””) extra large blankets
Individual packaged headsets
Warm towels for you hands and face before the continuous barage of meals, snacks,treats and free adult libations
“Real ” silverware no plastic here. Oh and no plastic cups so much classier to be drinking my nameless white wine from a glass and not a paper cup. So classy!!
Toothbrushes, toothpaste, mouthwash

All the latest movies you can handle so far I have watched The Ride Along, the secret life of Walter Mitty, saving Mr. Banks, That akward moment, HER, the book thief , catching fire and a handful of TED talks I downloaded prior to leaving

Where the pristinely dressed flight attendants in their aqua silk blouses with large French cuffs, creamy off white pencil skirt all toped with a dollop of the cutest and most ridiculously starched neck scarf I have ever seen, take care of all your inflight needs with a smile!! One side note there are only female flight attendants ( the only fellas on this crew are flying this metal tube). My inner feminist longs to protest but I completely understand the cultural differences. Sorry as I digressed ! Attention to detail must be this corporate motto because I am awe struck as the attendants bring your drinks on a tray, along with treats and snacks in baskets and in my Quiet observation no soft drinks. I mean there were cans of Korean CocaCola but I don’t believe I noticed anyone drinking soda on the plane. Hmm us Americans!

Now the cuisine was a bit questionable… Most likely only to me as I felt like I was one of 10 Americans on this flight? First my meal came with a gaggle of condiments, most of which I had no idea what to do with however I committed to trying everything even if it was called a beef Bibimbap.There was a small language barrier but I’m pretty sure that’s what she called this complexity of a steamed rice packet, bowl of sprouts, ground beef , w 3 types of mushrooms and spinach .A tube of red pepper paste, which I bravely taste tested ( holy smokes…. It was super spicy, definately not for the faint of heart , sesame oil, peppered pickles? I did not know whether to mix everything up in the large bowl, add all the secret sauces and enjoy or to try everything individually. I scoped around to cheat off of my neighbors for assembly instructions and they had all mixed it together… But I couldn’t fully commit so I did a little of both. I tried each portion separately, each we’re interesting individually and quite honestly except for my longtime aversion to what I refer to as shrooms but lets get real people we all know its fungus. I pushed past it took a bite…. Nope still have a fungus aversion! The Korean Bibimbap sp?? Was decent and it could have been because I was ravenous. Either way, my first experience with Korea food, not bad! Ooooo! Except for the seaweed soup, now I appreciate a tastey warm broth of belly warming goodness but this was not that!!! It was more of a clear broth with a pungent fishy aroma and seaweed bits floating around limply. It was a bit too much! I kept hearing my father joke with me about eating fish head soup and Only hours into my adventure he was right! Although holding true to my word, I peeled back the bowl submerged my metal spoon and yup it was fishy salty broth and that’s all I have to say about that!



Thank you sweet Baby Jesus !!! Landed in Yangon 11:50 pmWait what day is it? Only a few minutes short of Friday May 2nd and let me first digress just to say a thing or 2 about plane etiquette … I thought the Everyman for himself … Boarding zones .. Yeah right… sheer malay that ensued while preparing to board another international flight Bound for the US in Abu Dhabi was sheer insanity however I stand correct. the pushing, shoving and cutting -in line ( yes I have revered to my 3rd grade dialect,) to board and deplane I experienced on these flights is no joke. Grab your goods, shoulder up and gird your loins… Because that’s the only way to survive and not be lost in the wave of south East Asian stampede… Am I giving of my land of the free home of the brave American pheromones again! It like they can smell the overly courteseous American platitudes and whoosh they pounce! Chicagoans and New Yorkers got nothing on these characters. Americans are seemingly gentle and soft mannered compared to the 70 year old tiny Asian spitfire of a grandmother who body checked me to get her luggage down first or the not so sweet middle aged man who clearly noticed me waiting for the bathroom on the plane and breeze passed me only looking over his shoulder smirking ever so slightly as he entered the lavoratory. Please God or Buddha hit us with a large jolt of turbulence right now so he pees all over himself. Or my favorite young Korean mom and baby whom just waltz right in front of me as I was next in line to hand my ticket to the agent for boarding board… excuse me lady the line starts back there … Oh suddenly you no speak English!! Right lady!!!( of course that dialogue was all in my head, pause while I channel my inner Ralph Kramden with a my pretend fist in the air and a “why I Ought to”)

Safely on the ground in Yangon to be welcome with stifling blast of humid dense air. Wait no air conditioning in the airport? Even at at midnight the heat was sweltering, it hung in the air like a damp rag and as I walked I could feel the little beads of sweat racing down my back, with each step I tried to remove unnecessary clothing. Suddenly a hoody, a tank top and a tshirt all seemed like excessive clothing. My scarf while useful on the plane felt like it was strangling me I couldn’t break free from its octopus like strong hold quick enough. Amblimg down the long terminal corridor to the non functioning escalator arriving at immigration which took just under 40 minutes to clear.


The airport is quiet and there are more workers than travelers, a kind of eerie apocalypse desolation. All that keeps racing through my mind is , ” Please let there be an angel holding a PSI sign when I get out of here” please GOD Please … Hallelujah! there she is, in her printed longy( I will explain later) and bright lime green PSI polo holding a sign with my 3 favorite words… PSI Kimberly Cotto! Let’s be real it could have said “yo homie -over here” and I would have been no less thrilled. My worst fear was American girl abduction in Yangon … I can just see Anderson Cooper on CNN, reporting my abduction in his severely concerned and dramatic fashion describing the intimate details of my life and what took me to Yangon…. Again, I digress, must be ” the lagg” lol!!! How fantastic not to have to use my ” Pfizer how to survive a kidnaping tutorial ” on the first day oversees, I much prefer to wait and use those skills if need be when I am not bleary eyed, starving and delirious with jet lagged. Kidnapping averted onward to my new home away from home here in Yangon on Friday May 2, 2014!!!


So I made it!! one year of chemo in the books!! Another chapter of this hilarious journey closed. No more beeping infusion pump alarms, port access, poking, prodding , and a little less anxiety. I had become a solider in this war on cancer… every Tuesday I marched into the infusion center with my posse in tow ready for the next batch of toxic agents that would kill this cancer.  I would miss all these beautiful and supportive faces that had been woven into my existence and into the fibers of my new life. Each one of them had touched and changed my me personally during my most vulnerable time and while they were mere strangers in the beginning they grew to be part of my family.

Now, the side effects I would come to learn would worsen and linger. The  exhaustion, the waves of nausea, and OH the neuropathy in my legs and hands would be the most torturous,  almost debilitating. I had a hard time walking short distances or holding a pen,  the pain was maddening. I could  not get to it, I was unable to rub it away it, it literally was nerve-racking. As time progressed… eh almost 2 years later it was all getting better. Despite being done with the infusions I was still dealing with the lasting effects both physically and emotionally.  I would be excited for my hair and eyelashes and taste buds to grow back. Oh how I longed to be able to savor flavors again. Big and Small victories!


the last drops of chemo

the last drops of chemo



last message on the bag!

last message on the bag!

Dr. Hahm and her chemo graduate

Dr. Hahm and her chemo graduate

these two!! always worried!

these two!! always worried!




MARY ANNE!!! love her!!!

MARY ANNE!!! love her!!! Chemo mix-ologist!!!


I came out of my self described “chemo suite” to share my final drops of chemo to what I had termed the “general population”.

my sweet shay!!! the bestest oncology nurse on earth!!!

my sweet shay!!! the bestest oncology nurse on earth!!!

chemo graduation celebration steak dinner!!

chemo graduation celebration steak dinner!!



no you dont

Up until this moment I already had had 2 surgeries: One for my port placement and one for my lumpectomy. I unconventionally had a lumpectomy prior to my mastectomy to see if my tumor was responding to chemotherapy. Good news was that I wasnt going to have a third type of chemo Adriamycin® (doxorubicin). I would continue on with my remaining infusions of  Taxol for a few more weeks and then Herceptin until next year.

Dec 2, 2011 The morning of my mastectomy is hard to remember. I do not recall being overly nervous. I knew the moment I was diagnosed I was going to have a bilateral mastectomy.  It was One of the few things I could  control with this diagnosis and I was confident that it would be the right choice for me.  I wanted the cancer gone. Some of my physicians thought lumpectomy with radiation would be a better option for me given how young I was  and for esthetic reasons but I couldn’t stand NOT  doing as much as I possible could do to get this cancer gone. The even better news I would later get was when the pathology came back from the mastectomy that a second cancer in a different location had been identified and removed thanks in part to my decision to have my breast amputated. I know that sounds harsh but its what happened, mastectomy just makes it sound less barbaric but  truly it’s not.

I had a  Nipple Sparing Latissimus Dorsi Mastectomy with reconstruction. Latissimus dorsi (LD) flap is a type of breast reconstruction surgery. It uses muscle and skin from the upper back that is pulled under the skin to the chest area.  Your latissimus dorsi muscle is located in your back, just below your shoulder and behind your armpit. An oval flap of skin, fat, muscle, and blood vessels from your upper back are used to reconstruct the breast in a latissimus dorsi flap procedure. This flap is moved under your skin around to your chest to rebuild your breast.  The blood vessels (artery and vein) of the flap are left attached to their original blood supply in your back.  This procedure would offer me a better support for the implant that would take the place of my breast tissue.

The nipple sparing component of this surgery would be the only real unknown at the time of my surgery. Both my surgeons warned me that it was a real possibility that I would not be a candidate for this. They would have to see the proximity of the tumor to my areola and subcutaneous nipple tissue.  During surgery , with the assistance of a new technology my breast surgeon would do on-site pathology of the nipple tissue to see if there was any infiltration of cancer or atypical cells. Thankfully there was not and I retained my girl bits! I would have tissue expanders in place  during  surgery in place of  where my breast had once been.  The technique for breast reconstruction uses a flat expandable prosthesis called a Tissue Expander,  which was placed beneath my pectoralis major muscle during the mastectomy, this procedure would be part of the “reconstruction process”.  These Tissue Expander’s would be slowly  and painfully inflated over  the next  few months, and then I would go back into surgery where my permanent implants would be placed. These tissue expanders would stretch the pectoralis muscle and skin in preparation for the new implants. That part would be yet another surgery!!!


Pre-Op for Bilateral mastectomy

preop panic

preop panic







amandamy sister-in-law Amanda

I remember walking up from my surgery: The hospital room was dark, hadn’t it been morning when I went in? Yes but that was 9 hours ago. Yes 9 hours of surgery. Imagine if you will being in surgery for that long…. ???? That requires no further comment.

View from my hospital room at Kennestone Women Center. I was told there was a full moon on the night of my surgery.  Night 1 post mastectomy

View from my hospital room at Kennestone Women Center. I was told there was a full moon on the night of my surgery. Night 1 post mastectomy

So my first moments of consciousness where confusing, hopeless and painful. So painful I have a distinct memory of asking God why he was making me suffer so much. I asked… no I prayed that he would just take me at that moment… I told him I was ready to go. The pain in my chest, down my back was excruciating I felt like I had been ripped apart. Please God, I am ready,  take me away, make this pain stop…. please I surrender,  that is what I prayed.  I looked around my hazy fog, I  had tubes everywhere, I had no strength, very little will, and sadly could not even  sit up by myself. I was sliding down and I prayed again please take me away and make it stop. The pain was indescribable.

Later I would be made better through the power of pharmaceuticals… Yes my new best friend was my morphine pump! Crank her up and let it ride!!

I think the reason survivors of breast cancer and surgeons don’t  really talk about the post op part of the mastectomy is because it’s so incredibly painful to relive and gruesome to describe. There is nothing pretty or pink about this part of breast cancer… remember that!!


Check out my busted lip: That is thanks to my anesthesiologist it happened when they flipped me on  my stomach in surgery to do the surgery on  my back.





I was so drugged up I kept getting angry with my surgeons wondering why they hadn’t stopped by to check on me… Oh really what do you say, they have been by twice…. hmm that I did not recall. I will quit my b*tch’n now. Dont mess with me I’m medicated!

Nothing says you look like you could use a prayer more than a morning visit from the hospital clergy. My friends Maureen and Travis had a little holy communion and prayer. uh oh the big G-O-D must have gotten word and sent his troops. Faith restored

FIrst walk Day2





photo copyI was discharged from the hospital 5 days later. I went home busted and bandaged. I spent the next  several weeks in terrible pain, horrible back spasm, no upper body strength  and the inability to do anything by myself.  Thank God for my brother, dad and especially my angel… My MOM!!!

So when I left the hospital I carried around what I affectionately termed ‘my grenades’. Which were really the drain tubes for my mastectomy which were vessel for the accumulated fluid and blood monkeys in my incisions. I lost one 3 weeks after surgery but my other 3 pets stayed around for a few months. They became like pets, they are literally stitched into your skin and the tubes traveled to my back incisions and to my breast incisions. The tubes are long but time afer time I would catch these dam things getting dressed or moving about. The funny thing was that you had to “strip the tubes” . It  is a process that required you pinch the accumulated gunk in the long tubes and pushed it into the little grenades.  This became a favorite pastime with my sister-in-law, brother and mom.

These little suckers where hard to conceal, so big hoodies and jackets with inside pockets that held my post surgery paraphernalia was essential.  I already had a bald head there was no sense in attracting anymore attention to myself with these tubes coming out of everywhere.

my hand grenades aka my drain tubes

my hand grenades aka my drain tubes

Reconstruction part 2: March 2012: Happy Birthday to ME!



During this surgery I would have the painful and nuisance expanders  removed and my new silicon breast would be implanted by my amazing plastic surgeon  Dr. Fabian. I could not wait I was one step closer to all the kings horses and all the kings men putting Kimberly back together again!

scar poem

December 22, 2012: How do you start the new year 2013… Oh yeah recovering from yet another surgery

I had issues with the implant and skin thinning. Dr. Fabian went back in to place Alloderm to support the breast implant where the skin was thinning.  He also had to loosen up the latissimus muscles which because of muscle memory were trying to migrate  their way back to their  comfy home in my back. Seems weird but the body is an amazing thing.

Alloderm is a collagen matrix that is acellular in nature. That is to say, it is cadaver skin that has had all the cells taken out of it, and just leaves the collagen behind. It is like having a shell of a building there, without all the walls, furniture, and people living inside. This makes it easy for your own body to incorporate your own blood vessels and tissue into the Alloderm.

Reconstruction Part #3

can we talk about how much I love this equipment called Bear Claw. It was a hospital gown and  had a hose attached that pumped warm air into you gown. Oh happy day! Can I get one of these for home!!          Reconstruction Part #3


My lucky socks! These socks  illegally accompanied me into  every OR!!! Good luck Contraband!!