Events of Saturday, September 22nd 2012
Saturday was my last full day in Myanmar. The ship had arranged quite an intensive and varied series of options for the Guests but Doctor Hla Tun had invited me to accompany him for part of the day so I did none of the set options. I met the Doctor at 7.45 a.m. and we were transferred ashore by one of the local boats. They are powered by a Chinese diesel engine, so starting them up requires the boatmen to crank a starting handle furiously before the engine splutters into life. There were steep steps to reach the top of the bank and I'm sure they were steeper than last year. We walked the short distance to the medical clinic.
A number of buildings seem to have appeared since last year. There's a substantial covered, open sided, raised area which waiting patients use to sleep if they need to wait until the next day for an appointment or if they cannot return home on the day they receive treatment. There's a simple shelter with some seats which patients can use whilst waiting in the day.
Some patients have been travelling up to 150 km for an appointment, often by fairly primitive and slow methods. Although the Clinic provides a free meal for waiting patients (paid for by the local Monastery), private enterprise seems to have given rise to one or two food establishments as well.
The project has been carried out by the 'Road to Mandalay' Social Contribution in conjunction with the Head Monk of the monastery at every stage. One young monk who I'd met the year before seemed to be permanently based at the clinic and another monk seemed to be in charge of making announcements on a public address system which has appeared. The Head Monk himself is a familiar figure in the Clinic. He arrived at the Clinic a few minutes after Doctor Hla Tun and I and he made another visit in the afternoon on that day. The Clinic itself has spawned a much larger awning at the front of the building and an additional lean-to awning at the side.
On Clinic days, there are normally three Doctors at work but one was away on the day I visited. Whenever possible, Doctor Hla Tun also carries out consultations working (as do all the staff) punishing hours. Of the seven support staff (not counting monks) I think there are two trained nurses. The other assistants have been trained by Doctor Hla Tun to provide professional assistance in registration, injections and dispensing.
Early each day, the Clinic starts making bookings for the day through a window marked 'Registration'. Existing patients will have a record book with details written by the doctor which the patient looks after and brings back for any further treatment. New patients are issued with a record book as necessary. As the pile of record books for waiting patients grows during registration, brief patient details are entered in a 'Daybook'.
Normally, patients are dealt with in the order in which they register but serious conditions or other factors are used to assign a medical priority as well. On the day I visited, the pressure of patient numbers was not so high, probably because many of the country people would have been involved in bringing their harvest in. With only two doctors present to start the consulations (Doctor Hla Tun would not be able to carry out consultations until the afternoon) the day's 'List' was stopped at 270. Unsuccessful patients would either have to overnight or make a second journey on a later date.
Before the Clinic started, Linda and Ruth (two Guests on the ship and also Donors) arrived to be involved in the distribution of spectacles. The elderly in Myanmar suffer the same age-related defects of vision as we do. In the absence of an eyesight test chart, a number of out-of-date newspapers were provided, so the queue of elderly which had formed as if by magic, were issued with a pair of spectacles and a section of newsprint to check the improvement. Alternative spectacles were then tried until the best effect was achieved. A number of photographs were taken to record the event.
As the spectacle selection process continued outside the Clinic, the Doctors started their consultations and the function of the 'Announcement monk' became clear. To make sure that the right patient appears, a small public address system has been fitted and the monk with the microphone declaims the next patient. Certain monks are used to broadcasting readings from the Buddhist Scriptures using a similar Public Address system in the Monastery on special days and these monks develop a very effective speaking voice.
When I was there, two doctors shared one small consulting room and the second room, with two unpadded examination couches was allocated to the third doctor and the assistant giving injections. In addition, two chairs had been set up on the front verandah so that two of the assistants could measure and record blood pressure before the patient saw a doctor, making better use of the doctors' time.
Doctor Hla Tun had arranged for us to visit two schools during the day, Htee Pu and Nga Minn May and so, at around 9.30 a.m., he had to leave the consultations to the other two Doctors and we walked to the nearby monastery to load the stationery to be distributed at the schools into the monastery car which had been hired for our transport. The visit to Htee Pu is described here and to Nga Minn May here.
It was late afternoon before we were back at the Bagan Medical Clinic and there were still lots of waiting patients. Doctor Hla Tun immediately returned to giving consultations and I was invited to observe.
After an hour or two, I'm afraid I was so exhausted that I decided to return to the ship, leaving the Doctor and his colleagues (who are clearly made of 'sterner stuff') to complete the day's work.
Photographs:
Life at Bagan Medical Clinic.
[Revised 19-Oct-2012, 17-Nov-2012]
