|EAST meets WEST|
After The AIDS-Related Death Of His Partner,
Psychotherapy and Zoloft!" declares Tikapon "Tom" Baholyodhin about how he coped with pain over the AIDS death of ihs lover, Rawley. "Those two things savied my life. I have a lot of respect for good therapy. It really helped me." Tom and Rawley were together for eight years and had only resided in America for four years before Rawley took ill.
Dr. Baholyodhin is a Board Certified Internist with the American Board of Internal Medicine and holds a Certificate of Full Registration as a Medical Practioner, General Medical Council, in the United Kingdom. He has an HIV/AIDS medical practice in Los Angeles. Tom is discussing the issue of grief from his cliffside Hollywood Hills home. "It's one of those situations where I never expected to live without him. I was very angry at this disease for taking someone so special in my life away from me. And that's been my driving force." After Rawley's death, Tom changed his medical focus from pulmonary critical care to HIV treatment. "We think we are in control of our destiny, but sometimes it's our life events that really shape and focus our lives in different directions."
Baholyodhin, thirty-four, was born in Thailand, leaving at age ten to attend boarding school in England. He studied medicine at the University of London, graduating in 1990 at age twenty-five. Upon the completion of his internship, Baholyodhin decided to spend three months in a Buddhist monastery. An intergral part of the Thai culture is for men to enter the monastery for a specified time. "You lead a minimalist life. You give away everything you have. You then have two sets of robes, a begging bowl, and a little pillow. You sleep on the floor in a little wooden hut." A typical monk's day begins at three a.m. for the morning chant. Then he goes out on the street for "giving alms" (begging) in order to collect food for the local folk. At five, he returns to the monastery, cleans up, and eats together with the other monks—only one meal a day. Some afternoons are spent studying and some evenings there are lectures and meditation sessions.
What motivated him to enter the monastic life? Tom felt it was his duty to pay homage to his father, who died when Tom was fourteen. "We believe by doing good things like being in a monastery [we] will make a good marriage for our parents." He was involved with Rawley, but needed to "rethink his life," especially since Rawley was back in his homeland of Hong Kong fulfilling a family obligation. And besides, Tom wanted to avoid a prearranged marriage, still common in Thailand—even though his parents knew he was gay. "You must preserve the face, the exterior. It's like [the movei] The Wedding Banquet." He says his future wife was a friend of his, but they were more like sisters, not busband and wife!
Originally, Baholyodhin was only going to the monastery for three months. "After three months I realized that I felt more at peace than I've ever been at any point in my life. When you strip your life down to the bare minimum you get a feel of what's important to you and of who you are." However, after a year he truly missed practicing medicine. What insights did he gain living as a monk? "Learning that less is often more," he says in a quiet voice with his British accent.
After Tom's sequestered life, he and Rawley moved to Los Angeles. Rawley was a lawyer and wanted to work in the entertainment industry. Tom took the state boards for licensure. In 1995, Rawley died, and Tom completed his internship at UCLA.
"I'm strongly for Western traditional medicine but I think an important Eastern value that I bring into my practice is the principle of surrender." He encourages his patients to accept their disease—to embrace it—and to move forward on the treatment with gratitude. He emphasizes compassion on the part of the caregiver and the need for the patient to be calm and centered. Dr. Baholyodhin will recommend alternative medicine to his patients if he feels they will benefit, especially herbs to counteract the harsh side effects of the protease inhibitors.
"The protease cocktail is the best treatment yet for the AIDS virus. They're wonderful. I think we've made a significant leap, particularly in the past two years. The regimen is getting so much more manageable. The once-a-day regimen will soon be a reality." He says the life expectancy for HIV/AIDS is above thirty-six years now from the date of diagnosis with the correct treatment. Tom received a call from a sobbing patient last night, "I'm doing so well with my life right now, Doc. Am I going to live...?" "Yes!" exclaims Tom. "And you're going to live to come to my funeral, and you better bring some nice flowers!"
Dr. Baholyodhin says new drugs are on the horizon. One is being developed by a Japanese company that uses a fungal derivative to prevent T-cell infection by the virus. Then there are fusion inhibitors which appear promising. In a few years, four new protease inhibitors will be on the market that are less toxic and will beat the current resistant virus by the virtue of its smaller molecular size. Interleukin-2 (IL-2) shows promise in stimulating T-cell production and the cytotoxic killing of the virus. "There is so much good data on IL-2, I don't want to get too political about it, but I'm kind of anxious to know why it has taken so long for the FDA to approve this for certain patients," he scoffs. "We are seeing really good data on it. Although people say we need more. Well, if I had to wait five more years for the triple combo, maybe thirty percent of them would be dead by now. But thank God we never waited that long."
Dr. Baholyodhin is committed to the aggressive application of the latest advancements in the treatment of HIV-related conditions. Fifteen of his patients are multidrug resistant. His goal is to stabilize these men and women for the next few years so they can reap the benefits of the next technology. "A vaccine is at least five years away. The problem is that HIV is one of those really smart viruses that can escape our immune system. That's how it's able to cause so much damage. It does escape our ability to detect it. Finding a way that our body can detect it is going to be the key, but it's a problem within a problem.
Dr. Baholyodhin says the highest rate of infectoin presently is women, teens, blacks and Hispanics. "We, the gay sector, have done very well with our education policy, and we've gone a long way. Now, the message needs to get across that it's a heterosexual disease."
He is an avid fund-raiser, and serves on the board of L.A. Shanti, a nonprofit AIDS support and educational service organization. Recently, the board discussed funding. "What L.A. Shanti provides is emotional support. It is an important component that is a neglected field. It's so difficult for us to convince people that these are needed services. How do you quantify this? It's not food, not shelter, not medicine. Look at it this way. If you put food in front of somebody who has no motivation to live, food is useless. But if you provide that person with emotional support he or she needs, that can be far more enriching than food can." He sips his Pellegrino. "I would rather spend one very happy day than a hundred miserable years."
What has been the response of the Asian community to the AIDS crisis? "I think it's improving. The gay Asian is a minority of a minority, so it's hard getting funding. Less than a year ago they were being ignored, but it is better now. The message is starting to get out there, and hopefully it's getting there in time. We don't know how much damage has been done through neglect in the past five years, but certainly that's reversing. It will take a year or two to see the statistics," he says. "Dealing with minority's access to healthcare, access to screening is a barrier. That number may not be a true reflection." Baholyodhin has worked with Dean Goishi, the administrator at Asian Pacific AIDS Intervention Team (APAIT), and highly praises his work. ["The Secret of Their Success," A&U, October 1999].
"For an Asian, if you have AIDS you are an outcast from your family. It's still a stigma because people aren't really up to snuff about the disease," Tom says indicating that he had first hand experience of this with his in-laws. When Rawley became ill, his family whisked Rawley off to New York. "I was allowed to visit him, sadly, only once during his last year. I was allowed two, sometimes three phone calls a week during that year, in which most of the conversations were listened to by his mom. He was very uncomfortable talking to me about private things. It was very frustrating," says Tom looking around his sparsely furnished Zen modern living room. His last visit with Rawley, three months before he died, was devastating. Rawley had lost twenty percent of his weight, and he had no hair. "It was shocking to see him. I kind of wish I hadn't that memory of him—but there it is."
The Asian culture is a barrier and represents a rugged hurdle according to Baholyodhin. Attitudinal changes occur at a glacial pace. "People just get sick, drop, and die unnecessarily. They prefer their sons or daughters to get sick and die than to let them fight the disease, out and proudly. This belief is deeply ingrained and a tough one to approach. I have a number of Asian patients who receive very little support from their family. The best way for this group to find peace is to find a surrogate family who will be there to help and support them emotionally. And that's what I strive for."
Thailand was recently recognized by the World Health Organization for having the most effecive prevention program. The rate of infectoin has declined and is being controlled now. "It's a model system right now. I think it's probably because Thailand and all the Asian countries view sex differently, [especially] the sex industry. That was the main target, where the risk groups were, so they targeted that sector and it became a very successful program. They accepted where the problem was and they directed their energies there," Dr. Baholyodhin foresees that China and India will look more like Africa in the coming years. "Without treatment, they will have the highest death rates," he says.