Ed Wilkins in Myanmar: Week 5

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You soon learn there are hidden dangers for us western folk in super-hot Yangon. First, you never text while moving. If on the pavement, you’re likely to disappear 4 feet down into the mosquito larva encrusted sewerage system because there is the occasional missing paving stone; veering slightly off course onto the road means a drop of at least a foot from the curb into the path of a taxi; and if you’re brave enough to send your loved one a message while crossing the road, well it’ll be the last one.

Added to this, is the fact that a hand-me-down Nokia has become my new means of communication and that requires nimble thumbs and a young brain, neither of which I have. Second on the list of the ‘be wary of’ is check what you’re eating. Be brave but there are some unusual items on the menu. Chicken ‘butt’ was the delicacy we tried last night but I’ve previously baulked at pork colon and placenta. The Burmese are obsessed with deep-frying foods in oil: buthi kyaw was my latest experiment, battered and deep-fried chunks of gourd, never again! Also, if you’re over 60, you’ll never manage a 30-minute meal in the Lotus position which is the level where lunch takes place, and if you’re thinking of going to the Western supermarket and getting some comfort food from home, you’ll be faced with the option of 6 x 750ml bottles of the excellent Myanmar beer for the same price as a small muesli bag which will last a few days: for some it’s a no-brainer.

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So, what’s been blog-worthy in the clinic this week. Maybe the trump card was the multidisciplinary meeting of all clinic staff (at ground zero – picture, top). Energised and thorough, counsellors and social workers levelled with doctors and all problem patients were discussed. Here it seems, rightly, every health care worker carries equal status. Now that’s one thing we all do, but there are 1500 consultations for HIV and/or TB a month and for all illness around 11,000 – the 5 doctors work their longyi’s off. There are outreach clinics for sex-workers and all defaulters are chased and dragged to clinic. There is a purposeful and caring drive to the LTFU patients which is a lesson to us all. Another eye-opener is that every morning, all the locals gather for a 20-minute lecture on ‘health messages’, which can be from contraception to hand-washing: not a seat on the bench to be had (picture, bottom). The NHS could learn from this: prioritising, staffing, but most importantly, funding: Medical Action Myanmar manage it, yet this is one of the least health-care resourced nations in the world.

What have I not seen! A 4-hour waiting time graph for A&E, e-mails about bed pressures, C. diff and MRSA numbers; phone-calls from the bed manager who despite your demands still uses you ring-fenced bed for a demented elderly patient requiring long-term placement; EDD, SQUID, VTE, alcohol and smoking assessments forms; stickers, protocols, demands for GMC numbers and legible signatures; reminders of my incomplete mandatory training, portfolios and so much more. Nevertheless, I’m free to wear a watch and have my sleeves rolled down (to protect against mosquito bites): there is no evidence folks anyway for this mantra of infection control.

So, free not only your mind but you’re your impending hypertension by a 6-month placement in this beautiful place; it can be arranged (sounds like I’m selling time-shares for the Costa Brava). And maybe I’ve spent too much time on myself and the medical side. We have a wonderful nurse placed here as a volunteer now by Green Shoots Foundation. Like you all, dedicated and motivated, she has achieved more than probably I will do: introduced NEWS assessment charts; improved documentation; supported and trained nurses to become practitioners; educated on STI’s, taking sexual histories, and drugs to name but a few. The unchallenged queen of selfies, she is leaving a legacy. So, everyone has a role to play whatever their training and stage of career.

The capacity of the locals to accept their lot and only be grateful for the care that this charity gives always amazes me. The whole family selflessly sacrificing their time to nurse their loved one; the wife feeding the patient with food they’ve prepared, the sons literally picking the patient up at 5pm and returning them at 9am for their amphotericin etc. when they’re too weak to stand, and the youngest being there to distract and show love. Now daily, these staff witness suffering, hardship, and death in the clinics at an unprecedented level for the West, so with the news of the Westminster carnage, the concern for my family and lives they hardly know in a culture foreign to theirs was truly touching and demonstrates their kindness and willingness to help whenever and wherever. Another weekend on the famous Jet2.com bus taking 10 hours to another chocolate-box picturesque place awaits me. It’s not all hard work. Speak next week.

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