Suggested music: Space - Neighbourhood
The rest of the week was fairly uneventful in comparison to that first day. Buthidaung is a nice town. It feels quite remote, with limited communications and little outside influence. The roads bustle in the morning with trishaws (bicycles with a two-seater sidecar) and vintage trucks piled with bamboo, rice and sugar cane from the surrounding countryside.
The river provides an idyllic spot for breakfast and a coffee. By the late afternoon, the market stalls and tea shops are crammed with locals, who sit for hours discussing life while watching the latest offerings from Asian cinema on flickering 30 year old TV screens. The setting sun concentrates the masses to the few tea shops and bars that have electricity, which remain open right up until the strict 10pm state-wide curfew.
Though a majority Muslim population, there is still a sizeable Rakhine and Burmese community, and all seem to live harmoniously. There is a general sense of pride in the town that Buthidaung has avoided the significant violence that has rocked the rest of the state in the last year. This is clearly evident in the clinic, where the staff comprises of a real mix of ethnicities and shows how things could be elsewhere.
I spent my first week in Bhutidaung socialising with the various communities here. My assistant is a very intelligent young Aladdin-type character, who was born and raised in Bhutidaung and seems to know everyone in town. His fluency in five languages (mostly self-taught) and excellent knowledge of politics, health and culture has gained him the respect of both staff and locals here, regardless of ethnicity. He has introduced me to “Muslim Junction,” as it’s unofficially titled, which is a road filled with tea stalls and small eateries serving spicy meat curry.
The sun sets by 6pm here, and after that the street is lit by candles and small dim halogen bulbs. It’s mildly unnerving drinking tea and discussing local issues in the dark, surrounded by strangers and sitting in the middle of a busy road. The bicycles and trishaws do well to avoid any collisions, though I am surprised I haven’t accidentally been spat on by the many betel nut chewers here. I expect that will happen soon.
I’ve also had a few meals with the inpat staff eating typical Myanmar cuisine, which is delicious in all its porky goodness. There are three inpats- a doctor, a nurse and a midwife. Wing Ko Ko (I’m still not sure if I’m supposed to call him Ko Ko or Wing) is a mild-mannered young doctor from Yangon, who joined MSF a few months ago. After a few weeks of HIV training he was assigned the role of clinic manager in Bhutidaung. The nurse and midwife are both newly qualified. For all three of them, this job is the first time they have been away from their family homes.
I find the inpat situation quite interesting – although they find MSF’s work admirable, most inpats join for the salary and training opportunities. A lot of them see their post in Rakhine as a temporary hard graft before hopefully being posted elsewhere in the country. I liken it to doctors in the UK who often have to work in areas like Hull because they’re forced to rather than because of their desire to help out in the chronic humanitarian crisis that is the North of England.
I also met the head of the local hospital, who I soon realised was a pretty big deal in town. I went to his house after work, and as we chatted by his front door two rather Burmese guys set up a candlelit table in his front garden, and proceeded to serve us chilled beer the entire night. He’s a Rakhine doctor who has been all over Myanmar, and previously worked with the World Health Organisation’s polio vaccination programme. Apparently Rakhine State had its last case of polio in 2008, although coincidentally that was also the year they stopped checking for it. Nice beer though- been desperate for a drink all week.
Most of the cases I saw were not particularly interesting clinically. Malnutrition, diarrhoea, parasitic infections- diseases of poverty tend to be easy to diagnose and treat. Dealing with the social context in which these cases occur is not so easy. Displacement and separation of family members is a common theme, and one which understandably causes much anguish for the patients I encounter.
I returned to Maungdaw for the weekend, which unfortunately did not bring much relaxation. On arrival I was asked to attend to patient in one of the MSF clinics there who presented with severe abdominal pain and vomiting. Her rigid belly made me concerned that she needed a surgical intervention. Unfortunately the doctor at the local hospital I referred her to disagreed, and refused to accept her. Thus I spent much of the weekend managing her in a small run down guesthouse in town that MSF paid for her to stay at. I felt like a massive tool being pedalled on a trishaw lugging a large medical emergency box. Putting in a cannula* at 8pm holding a torch in my mouth was not what I had planned for my Sunday evening.
*A cannula is a long needle inserted into the body to drain fluid.