Suggested soundtrack: Cut Copy - Where I’m Going
I stumbled home in the dark, covered in the faeces of the family I had just eaten dinner with.
Back in Bhutidaung, the torrential rain has made it quite difficult to remain dry, and everything I own now smells. The rainy season refuses to die quietly. The conditions do little to slow the flow of patients, who continue to crowd the waiting area in the clinic. Reza has joined me again for the week, and his past experience with Action Against Hunger (ACF), a French NGO working in Maungdaw, comes in very useful when managing the many kids with severe malnutrition.
I spent most of Monday morning trying to work out what to do with a snakebite case. He had been bitten several hours previously and developed worrying signs from the poisonous venom that was circulating in his veins. Unfortunately anti-venom medication is not available anywhere in Rakhine state, so in the end I could only provide first aid and advice, then sent him home. Definitely have an uneasy feeling about that one, but the referral hospital would’ve done nothing more for him.
This week also saw representatives from the UN, the Global Fund and Ministry of Health come to visit the clinic, led by the MSF Head of Mission in Myanmar. I spent the morning running around making the clinic look presentable, installing a makeshift hand-washing unit in the waiting room, and putting boxes of condoms and signs everywhere. HIV doctors love condoms. Unfortunately the large group of officials arrived just as I was stood in the middle of the waiting room shouting to my assistant “I don’t care how you do it, just get these women out of here,” referring to the large collection of well mothers who were sat in the clinic socialising. Anyway, their visit remains a blur. They asked me a lot of questions. I learnt that anyone is impressed if you keep quoting random statistics and figures, regardless of whether or not their accurate or relevant. Well, they’re either impressed or bored.
The clinic is specifically designed for stable HIV patients and has limited resources, so the usual practice is for any emergencies to be referred straight to the local hospital. My experiences in the last week have hopefully shown the staff that despite our lack of equipment, something can often be done to help stabilise patients while they are in the clinic. I finally found the emergency medical box, which comprised of a vial of an expired antibiotic, three unopened syringes and a collection of dead beetles, all inside a small dusty leather suitcase. An hour later, and we had ourselves a kit capable of providing initial treatments for most medical emergencies, as well as basic equipment for delivering babies safely. No doubt I’ll find out too late that I’ve missed some essential bits and pieces, but at least it’s something to start with.
As fate would have it, the emergency bag got an immediate test run. As I walked to a local restaurant for lunch, I noticed an unconcious teenage boy being pedalled on a trishaw down the road. I watched for a second to see which way it turned at the junction, secretly hoping that it would turn left to go to the hospital. Predictably, it made a right turn and headed towards our clinic, so lunch would have to wait. The 17 year old boy had a high fever for four days before going into a coma that morning. Despite most of the staff being out for lunch, we managed to stabilise him and did a few tests to rule out malaria and some easily reversible causes, before giving him some antibiotics and sending him to hospital in our car. He did well, and is now back home having fully recovered from a severe bacterial meningitis.
When it finally stopped raining, I carried on exploring the town. The segregation of ethnic communities is much more difficult to see here than in other parts of Rakhine state, but it does exist. Most restaurants and tea shops have a homogenous clientele, with food and drink catering for that particular ethnic community. A few places have a mixed crowd, although the different ethnicities don’t usually sit together. One of my favourite spots is aptly named The Peace Cafe, which is always packed full of men smoking and chewing betel nut on the corner of the main street. Be careful where you sit, otherwise you’ll be flobbed on. It also sells samosas that have noodles inside, a typical snack in the area- could possibly be the perfect future emblem for unity in Rakhine state.
I spent an evening with one of the clinic assistants, who insisted on giving me a backy on his pushbike as we hurtled down a track along the river as the sun was setting. I had to duck my head several times, dodging labourers loading bamboo onto massive lorries. After a few beers, a curry and some rancid betel nut, which I tried for the first time, we headed home. However, without much warning (most likely lost in translation), he swung by his family home where his 11 siblings and parents were waiting to greet me.
As I sat down in their living room, his mother placed a table in front of me, and several of the children brought out massive plates of food. I was already stuffed, and fairly tipsy, but did the polite Asian thing of eating the rice mountain that was in front of me until I was pretty uncomfortable. Bit intimidating having 14 sets of eyes on me while trying to bat away any further offerings of food. Was great food though.
As we left the house, it was pitch black outside. I tried to find my phone in my pocket to get some light, but tripped over and fell headfirst into the open roadside sewer just outside their house. It was an epic fall, and as I tried to get up, I slipped over again. Twice. Just like some Sunday night BBC sitcom. I could hear the canned laughter in the background. When I finally got out, I realised I’d lost a flip flop, so had to fish around to find it. I stumbled home, covered from head to toe in brown effluent and absolutely stinking. It was incredibly foul.
A few showers later, and I was back in Maungdaw for the weekend, just in time to prepare for our Hallowe’en party. Explaining to the national staff what Hallowe’en was provided some entertainment. There were some excellent costumes, mostly from the inpats who were seemingly inspired by Japanese horror films. There was also a good showing by the ACF team down the road. Good time had by all. Needless to say Sunday was a complete write off.