Saturday, 25 April 2015

A Weekend at Bagan Medical Clinic (Part 2)

In Part 1, I briefly described the Clinic and the activities on Friday 24th April 2015.

Saturday 25th April 2015

After a good night's sleep at the Bagan Thiripyitsaya Sanctuary Resort, I took breakfast before exploring more of the hotel grounds. Adjacent to the hotel access road, I'd seen a restored temple and I examined this more carefully. A sign informed me that the site was the Kaladha Koun monastic complex, dating from the 13th century. Some parts remained only as ruined brick walls but the one temple had been restored. A marble tablet commemorated the completion of this work, sponsored by the hotel on 2nd May, 1998.

The restored temple in the hotel grounds.

A little after 08:00, a car arrived to pick me up. We drove to Emily's hotel to collect her and we were then taken to the Bagan Clinic. When we arrived, about 150 patients had registered but when I enquired later in the day, that number had already risen to 250 and the 'List' had not been closed so the final total for the day may have been higher.

Patient registration.

The newly-qualified Burmese doctor we'd met the previous day was joined by a newly-qualified Chinese-American Doctor and they were allowed to practice their diagnostic skills. Of course, this meant that Dr. Hla Tun was frequently interrupted to confirm the correct diagnosis and treatment.

The two newly-qualified doctors (in blue 'scrubs') are briefed by Dr. Hla Tun.

On initial registration, each new patient is issued with a record book with basic information. This is handed to the doctor giving treatment and completed to show the details of treatment. This book is then retained by the patient and, should further treatment be required, the record book is brought back by the patient when registering.

Dr. Hla Tun's Treatment Room

Dr. Hla Tun is assisted by two dedicated members of staff whom he has trained and give him high-quality support.

Dr. Hla Tun's assistants.

The treatment room in which they work has three examination couches and various racks holding commonly-used items. A remarkable number of injections are required and the assistants will pre-prepare a small number of various injections to reduce the treatment time.

Pre-prepared injections.

When a patient is 'referred' to Doctor Hla Tun by one of the clinic doctors, the patient's record book is placed in order on a pile in the treatment room. As each patient's treatment is completed, Dr. Hla Tun writes up their record book which is returned to the patient. The next record book on the pile identifies the patient to be called in from the covered waiting area immediately outside the treatment room. This is done by one of the assistants who measures blood pressure and obtains details of the problem whilst Dr. Hla Tun is attending the patient on the third examination couch. There is thus no wasted time as one patient leaves and the next enters.

As necessary, Dr. Hla Hun will carry out checks with a stethescope, check the pulse and carry out simple diagnostic tests. He will ask the patient additional questions, and this occasionally brings problems. Because patients often travel long distances from other parts of Myanmar to reach the clinic, they may speak in an unfamiliar dialect with the possibilities for misunderstanding.

Additional Tests

Through the generosity of donors, it has been possible to add a well-equipped laboratory and various blood and urine tests are produced as required. An electro-cardiograph machine allows heart performance to be monitored and ultra-sound facilities are being added. A standard lab report form is completed by the Doctor indicating the required tests and the patient takes this to the laboratory, returning later with the results added to the same form by the technician.

A completed lab report form.

Additional Facilities

Many patients display impaired mobility and joint pain from a variety of causes. The availability of a well-equipped physiotherapy unit at the clinic offers the possibility of helping patients to improve their situation.

Treating knee problems.

Lunch and beyond

Once again, the Doctor broke-off at 11:30 to show his visitors the distribution of the free lunch. This time, the Head Monk and Emily shared the handing out of the plates of food whilst I, with help from the jolly Monk who calls patients for their initial assessment, handed out the pressed metal spoons.

Distribution of free lunch.

The Doctor had hoped to break for his own lunch at about one o'clock but some tricky cases (one requiring an infusion) meant it was after 14:20 before his morning surgery was finished. Once again, we were treated to lunch in the monastery.

Lunch in the monastery.

At the start of Dr. Hla Tun's afternoon surgery, three patients were brought in initially but, thereafter, as one patient left, another was admitted whilst the doctor was treating one of the other two patients. Each patient may require a number of injections but if the injections are straightforward, they may be carried out by one of the Doctor's assistants. The aim is to reduce lost time so that, as far as practical, the doctor and his two assistants are each working with a different patient.

Back treatment.

Physical Records

Doctor Hla Tun has always insisted on comprehensive records. In addition to the patient's record book, written records are maintained at the clinic about treatments given. There is not a computer in sight but the Doctor can extract statistics in various ways. A surprising statistic is that, although the original concept was to provide health services to the Bagan area, now 90% of patients are from outside the Bagan area. Neither the Head Monk nor Dr. Hla Tun have any reservations about the involuntary expansion of services. They continue to aim to offer the best service possible.

I feel privileged to be able to report on this inspirational project but note that all errors are my own.

An Interlude

During the afternoon, I decided to explore the local area a little more. The monastery compound which houses the clinic is on a sandy cliff overlooking the Ayeyarwaddy River. Steep concrete-faced steps led down to the river, with a tablet acknowledging the donor:-
"The renovation of the stair case, its steps and railings is meant for the welfare and wholesomeness of the children at Taungbi Le Yar village and for the safety of staff who sail with the "Road to Mandalay" Supported by MICHAEL PERRY The Chef Road to Mandalay 1999 - 2003."

Steep steps leading to the river.

In a couple of places, electric pumps connected to long pipes were provided to lift water directly from the river to storage arrangements in the monastery compound.

One of the electric pumps on the river bank.

But my eye was drawn to a moored ship, probably little more than a hulk but with paddle boxes either side, conjuring visions of the 'Irrawaddy Flotilla' and Kipling's words "Can't you 'ear their paddles clunkin' from Rangoon to Mandalay?". There's more about Kipling's Burma and his famous poem here.

"Can't you 'ear their paddles clunkin' from Rangoon to Mandalay?".

Part of the fascination of the Bagan area is the sheer number of surviving pagodas - some large, some small, some in deteriorating condition, some carefully restored and built in differing architectural styles, according to their age. Within a few hundred yards of the Medical Clinic, I was able to explore a number of pagodas.

Pagodas protected by a pair of mythical Burmese lions (Chinthe).

A pagoda in a different style.

Yet another style of pagoda.

Exhausted by my explorations, I returned to the Bagan Medical Clinic but, after observing treatments for a while, Emily and I were taken by car to our respective hotels for a relaxing evening. The next morning, we would have a chance to observe the final day of clinic opening for that week.

Go to next post on this trip.
All my posts on the Bagan Medical Clinic can be found here.
All my posts on this trip to Myanmar can be found here.

My pictures

The following albums (on Flickr) hold pictures relevant to this post:-

Bagan Clinic, Saturday 25th April 2015.
Bagan Thiripyitsaya Sanctuary Resort.
Around Bagan, 2015.

All my albums for this trip (except purely 'technical' ones) can be found here.

[Text revised, pictures added 10th and 22nd June 2015]

A Weekend at Bagan Medical Clinic (Part 1)

In my last post Visit to Mon State, (Part 6), I described our return to Yangon. After an all-to-brief night's sleep at Dr. Hla Tun's house, we were to fly to Bagan where Dr. Hla Tun would spend the weekend seeing patients at the Bagan Medical Clinic.

Outline of the facilities at Bagan Medical Clinic

The Abbott at Bagan Monastery and Dr. Hla Tun have been the driving force behind this remarkable medical centre which provides virtually free medical care. Since August 2011, when the clinic first opened, it has seen rapid growth in facilities due to its popularity, thanks to the support of local and international donors including Belmond.

The first Clinic Building (opened in 2011 - see post here) remains in use as Patient Reception, Dispensary and Consulting Rooms. This has been supplemented by a larger building used for consultations, E.C.G., Laboratory and physiotherapy. That building had been open on my last visit, but it has since acquired an impressive array of second-hand gym equipment and specialist machines for heat treatment and remedial therapy and been divided to provide a consulting room, E.C.G. and Laboratory. A third building, slightly larger than the original building, was under construction on my last visit and is now fully commissioned. A central entrance area is flanked by a general consulting room one side and the consulting room used by Dr. Hla Tun on the other.

The original aim had been to provide care for the people of Bagan but the lack of affordable care in Myanmar has meant that patients are willing to travel long distances to receive treatment. Patients arrive from all parts of Myanmar using bus, train, boat and road vehicles (most commonly the passenger-carrying pick-up trucks but sometimes ancient heavy goods vehicles) and motorcycles. It's not uncommon for patients to have been travelling for two days to reach the clinic and the journey may aggravate the underlying problem. Patients from the new capital Naypyidaw, Yangon, Chin State and as far away as Magwe Division are common. To keep travel costs down, a group of patients from the same area will often club-together to hire transport and they must be prepared for a round trip lasting up to five days.

This means that looking after the welfare of waiting patients becomes a significant task. A number of shelters have been provided for waiting patients together with male and female toilet blocks. The Monastery provide a free hot lunch at around 11:30 on each clinic day and sometimes a meal is offered later in the day as well. A team of people prepare the nourishing meals which are distributed in just a few minutes to hundreds of waiting patients and their families. In addition, a number of privately-operated businesses have sprung up providing snacks and general goods.

Some of the monks are closely involved in the running of the clinic and the Abbot himself is a frequent sight around the clinic.

The Clinic is open on Friday, Saturday and Sunday each week but patients start to arrive from Wednesday. There are usually three doctors on duty, including Dr. Hla Tun. They are supported by physiotherapists and laboratory technicians. There is then a staff to assist the doctors, dispense the medication and manage the patients. Much of this work is carried out by volunteers.

Events of Friday 24th April

On Friday, 24th April 2015, I flew with Dr. Hla Tun, his son and Emily (a medical student from Ohio in the U.S.A.) on the 07:20 Air Bagan flight from Yangon Domestic Terminal to Nyaung Oo.

Nyaung Oo Airport, now polluted by huge western-style hoardings.

We were collected by the Bagan Station Manager for the luxury tour company Belmond (formerly Orient Express) who provide support for the Medical Clinic which is situated in the Monastery Compound at Old Bagan. The nearby Belmond Station at Bagan serves as the landing point for the Belmond river cruises by both 'Road to Mandalay' (which I've described in numerous earlier posts) and the new ship 'Orceila' (which I've yet to try).

When we arrived at the Monastery, we were immediately greeted by the elderly Head Monk who had arranged breakfast for us in the monastery.

We had breakfast in the monastery.

After our breakfast, Dr. Hla Tun took us on a conducted tour of the centre.

Dr. Hla Tun and Emily outside the first clinic building.

The most recent of the patient shelter buildings is of durable construction.

Patient numbers are unpredictable and tend to vary with the seasons. Friday was a "quiet" day. When we arrived, 180 patients had registered and a further twenty arrived later in the morning. Auxiliaries take the blood pressure of each case before they are seen by one of two doctors.

The two doctors who work with Dr. Hla Tun at the clinic.

More complex cases are referred to Dr. Hla Tun and these tend to take longer so his caseload was around 45 out of the 200 but, of course, he remains 'on call' to all the staff so there are frequent interruptions.

At 11:30, Dr. Hla Tun broke off briefly to show his visitors the offering of the free lunch. The kitchen team furiously made up the individual meals on a series of metal plates as the patients lined up to receive them.

The kitchen team serving lunches.

At first, the Head Monk offered meals to each member of the queue, next Emily was invited to make the offerings and then the writer took over. Dr. Hla Tun, together with a newly-qualified lady doctor from Myanmar who trained in the U.S.A., Emily and the writer were then invited to the Monastery for our lunch where the Head Monk kept a watchful eye to ensure we all ate enough.

Lunch in the monastery.

After taking lunch, consultations then continued in the afternoon.

Dr. Hla Tun's consulting room has three examination couches.

Emily and I left the Clinic and were taken to our respective hotels at about 17:30. This time, I was booked into the Bagan Thiripyitsaya Sanctuary Resort.

My comfortable accommodation at the Bagan Thiripyitsaya Sanctuary Resort.

After a shower, I took a light meal at the hotel's open-air restaurant, offering views across the Ayeyarwaddy River. As it grew dusk, a young lady played traditional music on a Burmese Harp called a Saung.

View from my hotel's open-air restaurant.

I'm afraid Dr. Hla Tun did not expect to finish his consultations until around midnight. He admitted the following morning that, in fact, he didn't finish until a quarter to one in the morning. Stamina is needed to work at the Bagan Medical Clinic!

Go to next post on this trip.
All my posts on the Bagan Medical Clinic can be found here.
All my posts describing this trip to Myanmar can be found here.

My pictures

The following albums (on Flickr) hold pictures relevant to this post:-

Bagan Clinic, Friday 24th April 2015
Bagan Thiripyitsaya Sanctuary Resort.

All my albums for this trip (except purely 'technical' ones) can be found here.

[Text revised, pictures added 10th June 2015. Text revision 20-June-2015]