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Trekking to Myanmar's Clinics: Diary of a Medical Missionary -- First Day in Naypyidaw Clinic 04/06/14

written by Thu Tran, MD,FACOG
on Monday, 28th April ,2014

After a wonderful breakfast in the Amara hotel, where I thought I had the sweetest papaya since I had come to Myanmar, the bus took us to the Naypyidaw Hospital.  We were told it was the best hospital in Myanmar.  After all, Naypyidaw is Myanmar's new capital since 2005. According to an article in the NYT,Naypyidaw or "Royal Capital" in Burmese, was secretly built by the ruling generals and announced to the public once the project was done.  The total cost of building Naypyidaw remained a secret, although the consensus estimated it to be between $4-$5 Billion, in a country where per capita annual income was, at the time, $280, or less than 80 cents a day, and where one in three children is malnourished.  The new capital boasts a large zoo with an air-conditioned house for the peinguins donated by Thailand and China, and a huge pagoda, which some members in our mission team visited one evening, on top of a hill.  The pagoda was a replica of Shwedagon in Yangon, the former capital of Myanmar, which is a nine-hour drive away. Mandelay was also another former capital of Myanmar.  The grandiose buildings and boulevards of Naypyidaw, I agreed with the NYT, showed a stark contrast to the surrounding impoverished areas.  Many opposition groups have complained that the ruling generals have clearly been out of touch with the impoverished people of Myanmar.

The waiting room was packed with patients, with many having to sit on the floor.  I was taken by a senior attending in OG to the area where I would be seeing patients.  Noel wanted to come with me today and I welcomed her as I needed some company and she was an intelligent nurse with common sense and a big heart.  We were assigned a very sweet medical officer as our translator.  The room had wide windows looking out to an empty courtyard.  Later on, I saw many street vendors selling different foods to the passersby along the courtyard.  It must have been an open hospital cafeteria, I jokingly told myself, as I watched family members sitting down for a variety of fried foods.  I didn’t think it was such a good idea eating dry fried fish or vegetables in such hot sun while there was no refrigeration.  Obviously, one’s stomach gets used to the local foods and the locals might not get sick as I would if I was to eat there.

Even with the two fans in the room, the clinic was so hot.  The windows were wide open and, on and off, I had to apply mosquito repellent.  My baby wipes were again my saving grace, as I had to stop in between patients to wipe my face.  Noel and I drank one bottle of water after another.  I felt dehydrated as usual.  How did I survive my childhood in Vietnam with such hot weather?  Our house in Saigon had air conditioning, but outside it was also burning hot like Myanmar.  Years later when I grew up in the U.S. and became a “silent activist,” I still felt guilty when I thought about our chauffeur waiting for hours for me and my sisters outside our middle school in the hot car.  Why didn’t my parents tell him to go back to our cool house and wait for us there?  What did he do during all those hours?  If it had not been for the fact that we became very poor after our arrival to the U.S., I might not have felt sorry for him thinking back on those days.  Until we walk in someone’s shoes, we might not be able to feel their pain.

We ended up seeing so many patients that Sophie had to come to our rescue.  I was told we saw more than seventy-five patients that day.  There was a mixture of pregnant women, who Sophie would see, and gynecology patients who Noel and I saw together.  Noel filled out the forms for the patients to bring with them with my recommendations for their medical problems, while I wrote similar notes on the forms we needed to keep for the team as records.  We complimented each other as I performed the counseling parts, and Noel asked smart questions whenever she didn’t understand the problem completely.  I did the pelvic exams with Noel and the nurse acting as my assistants.  

By the end of the day, I felt as if Noel could have been the physician of the clinic minus the pelvic exams.  She heard me counsel many patients who had similar problems, either no menstrual cycles or infertility.  Unlike family practice, gynecology has only a few medical conditions.  Fortunately, we didn’t see any cancer cases.  I was burned out from the three cervical and the recurrent ovarian cancer cases from the other clinics.

The patients in this hospital clinic, as expected by the team, were mostly well to do women.  Many of them probably were in the upper 1% of their society.  They were well dressed,  some wore fancy jewelries, and many had advanced college degrees or “white collar” jobs.  Many of them had the problem of the upper 1% of society, namely infertility.  Some had already had a full workup while others were at the beginning of their workup.  I didn't think I was very helpful to them at all except for a few cases when I told them frankly how, in America, the fertility specialist would have advised them to use a younger woman's eggs or "egg donor."  In other words, it was time for them to think of alternatives like adoption.  I didn’t know if this procedure was available in Myanmar, or if the conservative nature of their culture would allow these patients to use this treatment option.

There were two patients who simply wanted to have a regular gynecology visit.  At first I was annoyed, but then I realized It would be good to show my medical officer how to perform a gynecology exam including a breast exam, as the team had seen quite a few young women with serious breast cancer.

It turned out that the medical officer didn't seem to know how to perform a breast exam.  She watched me intensively and was totally interested in the process.  I instructed the patients to do the exam themselves.  In this kind of setting, you have to fight for your own survival.  Teaching breast exams to women in areas where there is inadequate healthcare can save lives by detecting breast cancer earlier.  Over the years, despite some reports that breast exams have not been helpful in reducing the mortality rate of breast cancer, I still urge patients to do their monthly breast exam.  There have been so many patients who have found their cancer by doing their monthly breast exam.  I have heard reports of as high as 70% of all breast cancers in the US are discovered by the patients!

We worked until the late afternoon when suddenly the sky got dark and rain came pouring down.  The electricity went out, and we still had a few patients to see.  I pulled out the headlight from my “Mary Poppins” backpack and wore it around my head.  I saw the last few patients with ease.  We had such a productive day.  The medical team was overwhelmed with patients also and finished with their clinic even later than us.  

As we reached the Amara hotel, I let my roommate take her shower first.  In the middle of her shower, the electricity went out and so did the running water.  It was so hot that I wandered out to the foyer.  Our team had been put up in the back section of the Amara hotel where there was a foyer near a bus stop.

I had a sudden urge to run in the rain.  I badly needed some water on my face and body and, without anybody in the foyer, I was so tempted to stick my hands into the two big cisterns full of flower petals.  Every morning, the hotel staff meticulously arranged beautiful, colorful tropical flower petals in circular patterns in the cisterns for decoration.  I would have disrupted these flower patterns had I stuck my hands in for some water.

I thought of the last scene in the movie “The English Patient” where the title character Count Almásy was dying in the monastery.  To fulfill his last wish, nurse Hana and her boyfriend put him on a stretcher and, in the pouring rain, carried him outside the monastery.  Like the women who were sitting around me in the theater, I was sobbing as I watched the nurse carrying the Count in the rain around the monastery.  Do men sob in the theater like us women?  This whole complicated love story has, since that moment, been reduced in my mind into that last scene where the English patient just wanted to feel a sense of freedom, of living a real life before he died, living life as raw as it could be.  Wouldn’t all of us have wanted to live that way?

As I was pondering if people would think I was crazy for running in the rain to cool myself down, or if I would be late for dinner, the rain stopped, and the electricity returned shortly thereafter.  

After dinner at a local restaurant, we walked toward a night market which closed shortly before we could get there.  It was after 9 p.m. and, at the corner of a street, I saw a boy about seven years old sitting alone, staring into space.  His face was muddy and he had no shirt on.  The dim street light was shining on top of his shaven head.  Where were his parents at that hour, I wondered?  What was he thinking about, this little boy, sitting alone in the street at that hour?  He didn’t seem to notice that we were passing by.

I slowed down and reached into my backpack for a trail mix bar, but realized I had left them at the hotel.  With this heat, I hadn’t wanted them to soften.  I had nothing to give him.  Should I have asked him for permission to take a photo to show my teenage son how lucky he is to have a comfortable home?  I could hear Sandy grumbling:

“Oh, Ma, you should expect to see many kids like that in a poor country.  If you can’t face them, you shouldn’t go on missions anymore.”  

Sandy has always been a practical kid.  I remember how, when he was only about three years old, I often ordered him to finish all the food on his plate.

“The children in China wish they had your food, so finish it up and do not waste any food.”  I nagged at him.

One evening, as he left some food on his plate, I started my lecture again:

“No wasting food Sandy, the children...” 

Immediately, I could hear him mumbling to himself:

“Oh no, not those children in China again...”

From that day on, I replaced the word China with Africa, Vietnam or India.  You can be creative and change the location, but do not stop your moral lessons.  Somehow I believe our children will retain at least some of these lessons.  That was how my mother used to treat us children, telling us all the sad tales about the poor and hungry children in some countries we had never been to.  She used to tell me how a grain of rice was called “a gem.”  I ended up eating everything in my bowl.  I imagined, somewhere, a child was yearning for a grain of rice.

 

 

  

 

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