Judged by Western standards, my reporting at the Clinic may seem intrusive, with access to the Doctor's Consulting Room during diagnosis and procedures and with photographs made freely available. But ideas of personal privacy have not developed in the same way in Burma and Dr. Hla Tun believes that those interested in the work should understand the problems of medical care in Myanmar, in general so different from the Western world.
In my observations, I try to better understand the working of Myanmar Society, developed over centuries, and give others a small insight into the lives of these admirable people who moved me to try to make some small attempt at offering support. Misinterpretations of what I see may occur and are, of course, my responsibility.
Myanmar is a large country with, by Western standards, relatively poor internal communications (although the growth of internal air transport over the last few years has been impressive). Although the Bagan Clinic was conceived as a local clinic, the reputation it has earned means that it now attracts patients from a wide area, despite the problems of travelling long distances.This also introduces problems of language, because people from Myanmar are highly diverse, as discussed in 'Ethnic groups in Myanmar' below.
The Clinic now charges a flat fee of 10,000 Kyat (around 10 U.S. Dollars) for a consulation but this is frequently waived because of the widespread poverty of patients. The fee includes all medication supplied and, where required, blood tests and E.C.G. carried out by the Clinic's laboratory.
As is customary in Myanmar, patient notes are entered in a specially-produced notebook with the clinic details printed on the cover and the patient's name and address written in spaces provided for the purpose. These notebooks become the patient's property and are taken away by the patient, with any relevant test results or E.C.G. printouts tucked inside. It's fairly common for patients to bring similar patient notes issued by other clinics consulted previously. Orthopaedic patients often bring X-rays taken at other clinics. All of this patient history will be carefully studied by the Doctor during the consultation.
Details of medicines prescribed are entered in the patient notes. Some drugs are taken from a stock in Doctor Hla Tun's consulting room but, more generally, the patient will take their notes to the Dispensary which forms part of the original clinic building where the prescribed medication will be issued.
Doctor Hla Tun's consulting room
There is little privacy in the Doctor's consulting room - it is more like a general ward. Three examination couches are permanently occupied and the Doctor moves between them. If he prescribes various injections, these are generally administered by his two female assistants and, in the meantime, the Doctor will move to the next patient or update patient notes. In addition, mothers with young children are frequently seated adjacent to the Doctor's desk, making a fourth patient, and patients with just-completed tests will also wait at the Doctor's desk for him to review the results. Many patients also have a friend or relative with them in the consulting room so, together with Clinic staff frequently entering with information or questions for the Doctor, it can be quite crowded at times. Somehow, Doctor Hla Tun keeps track of all this activity, radiating quiet confidence.
On Saturday, there was a party of 9 patients from Shan State. They spoke a different dialect so the Doctor needed to use somebody with knowledge of standard Myanmar language and Shan dialect as an interpreter. The group had set-off by road in a hired pick-up at 6.00 p.m. Friday and arrived at the Clinic compound at 3.00 a.m. Saturday morning. The Driver of the pick-up charged each of them the equivalent of 35 U.S. Dollars.
One of these Shan patients was a large man from the Shan Hills with poor mobility following a stroke. It required two strong young men to help him to the examination couch whereas before he would regularly walk 14 miles to the nearest town. The Doctor aspirated fluid from the knee joints and gave a number of injections for pain relief. He also suggested a number of exercises to help strengthen weakened muscles.
I'll outline some other cases later.
Ethnic groups in Myanmar
The Myanmar Government recognises 135 distinct ethnic groups of which the major groupings are:-
For more information, refer to the Wikipedia Article.
All my posts on this trip can be found here.
There are a few pictures of this trip here.
More pictures will be posted as soon as possible.