Ed Wilkins in Myanmar: Week 17

As any nursery child will proudly inform you, six minus two equals four: and that’s my blog debt to date. And it’s also true that the perennially patient web-keepers who oversee the sites where these embarrassing missives are published are looking elsewhere for someone to take over my role. But, unfortunately for them and for you few readers, I have every intention of completing my two years in this lovely place and therefore you get a years-worth of blogs. So, given I now have a geriatric calibration for events with ‘busy’ equalling 2-3 events a month, November, which is only 9 days gone, has been literally non-stop activity and so there is plenty to tell since I last wrote.

First and of course foremost, my family has come to check that I’m really working and not just living the life of a delusional elderly alcoholic back-packer; and I think they found both are indeed true. Second, I have experienced the private health care system after a near death experience – slight embellishment but a tale worth recounting. Unfortunately, the result is that I have less hair on my head and less money in my pocket; both sorely missed as they are precious commodities at my age. I’ve also eaten something I’ve never come across in Myanmar that resembled and was indeed partly bacterial culture and to top it all, my football team lost. The latter you might believe is totally irrelevant and of course it is when you think of the mountain of problems that exist in this country, but around every corner, in every hairdresser’s hut, in every tea-house, and in every bar, there will be Premier League matches being streamed live almost continuously. No need for Sky, BT or Cable here, it’s all literally on tap! And although biased, the team that draws the biggest audiences is Manchester United. So, it’s with that in mind that the advertisement I saw inferring that ‘Man U cereal’ had a close association with a hole-in-the-ground toilet summed up their dismal last performance and will please all City, Arsenal, and Liverpool fans (right). Not that I can find anything about Man U cereal but obviously it’s something that maybe Mourinho could consider for his team’s breakfast to improve on their recent poor run of form.

So, with testosterone fuelled high profile names booking themselves into clinics for their predatory activities to purge themselves of their addictions, I thought I would Google around to find a few more addictions, all harmless by comparison. So, not surprisingly you can be addicted to anything (I expect even blog-writing): sun beds (tanorexia), mobile phones (nomophobia), internet gaming (IGD), box-sets (binge-watching), and coffee drinking (caffeineoholic). But on the nobler side, I’ve witnessed here benefactors who are addicted to giving for no reward to themselves, only to help (no descriptive term for this group). Additionally, you see volunteers in the field giving so much and not seeking any recognition. Believe me, this is much harder to do than you think and certainly than I ever thought it would be. 

I love being a volunteer doing what I do: it makes me feel a heck of a lot better as a person. But to give of your money and your time selflessly and with complete commitment is super hard. I think I’m getting there but it’s a slow process. As an example, today I visited a home for children most with HIV whose mums, dads, and other family members are no longer around which has, since inception to this day, been fully supported by two overseas sponsors (left). Nameless individuals give of their money, and they’re not all loaded with dosh, to keep MAM (Medical Action Myanmar) – this fabulous charitable organisation I work for – and all its activities not just functioning, but expanding in what it does.

But let’s move on to my near-death experience which was in fact just a 3-inch cut to the scalp. For those that don’t know, scalps bleed like billy-o so you always think you’re about to exsanguinate but since I’ve avoided inheriting haemophilia, it settled with pressure. A democratic decision over supper in the local Burmese restaurant between an Aussie statistician, a post-graduate medical student-to-be but currently doing a bit of work experience, and a pharmacist, was 2 to 1 in favour of getting it looked at. Given it was night-time, my only option was a private clinic and in a nutshell, it cost the equivalent of two months of a junior doctors’ salary to have 3 stitches. And that was without local anaesthetic as that added significantly to the bill. In retrospect, I realise the scalp is very well innervated and the anaesthetic might have been a worthwhile investment. So, the moral is make certain you have medical insurance (and go for the local anaesthetic).

Before I get to the bacteriological culture, let me update you on where I’ve got to in my endless pursuit of putting my skills to effective use. The second of the guidelines was presented yesterday together with a ‘clinical notes’ section on everything from history taking to treatment and is being rolled out in the other clinics today and I’ll do the third next week (before I come home for 6 weeks). The clinic and bedside teaching continues and there’s a push to get the senior NGO doctors to start writing articles and participating in research. It’s all basic stuff really; case history discussion, problem solving, recognising where improvements can be made, making a case for new investigations and drugs, and never ceasing to emphasise the importance of self-directed learning and CME teaching to be overseen by the senior local doctors. There’s nothing I do that many with less experience couldn’t do if they found the time. Do I miss the annual fire lecture, being assessed on my hand washing, and annual appraisals where you try and write down some new achievement you’ve made for the Trust that ideally has reduced patient waiting time somewhere, allowed beds to be closed, and 

most importantly helped targets to be reached and money to be saved? The answer is no, and golly how liberating an experience it has all been.

 

So, to the bacteriological culture (right). In my youth, I decided to do my MRCPath so that I had a career to come back to when I was around fifty if I followed my naïve dream of doing third-world medicine. Confronted with ‘Shwe Yin Aye’, I was immediately reminded of an overgrown blood agar plate. Interestingly, it is based on ‘agar-agar’ which is made from seaweed together with a combination of cendol, sago, glutinous rice and white bread served in coconut milk. Very sweet, very colourful, and very edible!

I’ll leave you with that image and write another epistle shortly, like maybe tomorrow!