Ed Wilkins in Myanmar: Week 10

Now normally Saturday morning is blog-time in my Western paradise, the Myanmar plaza. However, instead I was scaling what was rather exaggeratedly called Hpa Pu mountain (it took about 45 minutes to climb): views of course stunning. But weather changes with the blink of an eyelid here and I was soon in the thick of a tropical storm: luckily the police in a little hut took pity and allowed me to take refuge in their cosy shelter together with two goats with the same idea. Today, sitting in the clinic, the ward is completely empty and you can hardly blame the patients because venturing outside for a second necessitates an immediate change to a dry set of clothes; and I must type with the computer screen at an angle as water is intermittently coming through the roof. As you will be aware from any previous blog that you might have read (and I think I still only have my family as subscribers), to and from these weekend destinations is always by dirt cheap overnight coach. My major gripe is that they are designed, quite reasonably, for the average Burmese build and, although the years have shrunk me somewhat, I am still a foot taller (right). Also, the air conditioning is full on with no way of altering it so, unless you are brewing Dengue fever or have undiagnosed thyrotoxicosis, you need to take warm clothes or you’ll die from hypothermia. However, the eight-hour journey costs just three pounds which the NHS pension scheme just about covers.

Having mentioned Dengue it’s worth dropping in to this cathartic epistle that I have just been to one of the government hospitals for a ward round where it seems the Dengue season has not unexpectedly with the rains, started to escalate. Hence for those interested, there were several cases in hospital including classical haemorrhagic and shock presentations. Tack on snake bites (where anti-venom is give dependent on the whole blood clotting time in a glass tube as more sophisticated clotting tests are not available in the rural health centres), Chikungunya, scrub typhus, fungal endocarditis, and of course, tons of super bad TB, this is an ID clinician’s Utopia although, obviously, for the patient this is a tough place to be ill especially if there is no family money (and I mentioned that last blog as well). For example, there is Meropenem but the patient must pay for half of it. And by golly the doctors work their proverbial socks off: every day 150 new admissions for the on-call physician so all available space must be utilised (left).

For many, patients get a better deal with MAM (the charity I effectively work for) as they don’t dip into their pockets. Nevertheless, it does mean that expensive tests are only done where imperative because they cost the charity precious money from their finite resources. With that in mind, and this will continue to bore the non-medics, we’ve made a diagnosis of HIV-related PML on an MR scan in a man presenting with cortical blindness (which surprised us as the charity only paid for a CT – which is tons cheaper) and almost certainly a patient with Hodgkin’s lymphoma. Diagnosing anything other than TB is a massive challenge so these two cases are particularly important as educational lessons. Sadly, it’s unlikely that anything much can be done with either because the first is a beastly disease where those that do recover with ART are left with significant morbidity, and chemotherapy is effectively unobtainable for the second. Nevertheless, it shows that it is possible to practice a level of medicine which is equal to the West if only we can get the necessary investigations done (and of course treatment).

Now this week witnessed an important first for the MAM clinic. Colors Rainbow is an LGBT rights umbrella organization working in Yangon who are working wonders in educating, training, lobbying, advocacy, and the production of a range of multimedia resources in Burmese (colorsrainbow.com). To a packed house (right), they presented their mission and work. We can all learn from such events and hopefully this is a first of many such times where the messages will be reinforced, namely the need for all of us working in the clinics to offer a non-judgemental and safe place for this community to go and access healthcare. Another super-stigmatised group was a topic of last week, those with leprosy. So, I took the opportunity this weekend to visit the Christian leprosy hospital in Mawlamyine which I doubt has changed much since Rudyard’s opening line ‘By the old Moulmein pagoda looking lazy at the sea’ (below). Although there was an almighty monsoon downpour, it was obvious that many patients were long-term residents and I came away feeling that there are still significant hurdles with community reintegration and stigma: interestingly the number of new cases started on therapy is increasing steadily since 2011.

Having just purchased my third umbrella (with ‘one at every port’), the incessant tropical rain is starting to weigh heavily on my clothing allowance. With just two pairs of trousers, even the crème de la crème of umbrellas is impotent at protecting your lower limbs and at my height there’s just more of that. Hence, one is forever trying to dry your clothes: this last weekend saw me trouser-less, with the aforementioned item drying in the street with accompanying socks and sandals before the bus came. The Burmese have the answer as they so often do. They draw up their longyi and tuck it in back and front (so functional): nevertheless, I have so far baulked at the prospect of facing up to my Burmese colleagues let alone my children wearing such a fine item.

Now, everyone loves bank holidays and if you plan well in the health service and especially if you coordinate the on-call rota, you can usually sneakily switch weekends so you get both May and August bank holidays thereby allowing you some bleep-free relaxing family breaks. Most of us have forgotten why they’re there but everyone agrees it’s nice to have them (I do remember happily prancing around a village maypole many moons ago)! Out here they carry such significance: outside of the usual religious breaks (including Christmas day): there is Martyr’s Day, Peasants Day, Union Day, Armed Forces Day, and National day – somehow more symbolic and celebratory. On this theme, I’m going to try and tour Aung San Suu Yung’s house this week which I’ve heard has been turned into a museum, but there are varying reports as to how easy it is to do this and you definitely cannot book it through booking.com!

So, you’ll be glad to hear that this late blog is drawing to its conclusion. However, I do worry that there are some back home who, remembering I was not the hardest worker in the Unit, think that me being a volunteer in Myanmar equates to retirement on holiday. Hence, here are a few pictures. And I think it’s probably time to stop and nip to the local supermarket (as I’m now back in the Plaza) to treat myself to some gorgonzola.

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