Monday, 2 May 2016

The Work of Bagan Medical Clinic


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.

Patient Notes

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.

Individual stories

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.

Related posts

All my posts on this trip can be found here.

My pictures

There are a few pictures of this trip here.

More pictures will be posted as soon as possible.

Bagan (Day 2)

Events of Saturday, 30th April 2016

I was booked into the Aye Yar River View Resort for our four days in Bagan. For me, this location has two particular attractions. Firstly, the 'River View Rooms' are literally that. They are built on the east bank of the Ayeyarwaddy River (but at a higher level) with only a narrow strip, a hedge and asandy track between the base of the hotel building and the river with a variety of moored boats visible. It can be noisy at times - most of the smaller 'longtail' boats are propelled by raucous Chinese-built single-cylinder diesel engines which kick up quite a racket and the powerful tug-boats which power the barge traffic have large, loud marine diesels. But if, like me, you're an incurable romantic, it gives a connection with "The beating Heart of Burma" and, I noticed this time, the hotel provides disposable ear plugs. The second attraction is that the hotel is within walking distance of the Bagan Medical Clinic via a network of dusty, unsealed roads quite busy with pedestrian and motor cycle traffic. The walk takes ten or twenty minutes, depending how fast you walk and how impervious to sun you are (I'm not very good on either count any longer). However, Doctor Hla Tun usually insists on my using the monastery car for the commute.

The car picked me up, as arranged, at 8.30 a.m. and by the time I arrived at the Clinic, Doctor Hla Tun had already started consulations. The Clinic was noticeably busier than the previous day and I think the total patient registrations for the day exceeded 200.

Doctor Hla Tun introduced me to the lady opthalmologist who now conducts eye tests at the Clinic on a every other Saturday and I was able to watch her at work. Later I discovered that in the week, she works in Chaulk Hospital.

The lady Opthalmologist at Bagan Medical Clinic.

I'll describe my morning observing Dr. Hla Tun's consultations in a separate post.

Doctor Hla Tun asked if I had visited the famous monastery at Salay (sometimes transliterated as 'Sale'). As I had not, he arranged what turned out to be a fascinating trip for the afternoon. We set off in the monastery car with the young monk in the front passenger seat and the lady opthamologist and I in the rear.

We left Bagan heading south, passing first through the village of Myinkaba and then through a rather modern area called 'New Bagan'. We kept going firstly through the familiar landscape of the Bagan Plain but then becoming very undulating and, to my surprise, I spotted a number of four-legged steel oil derricks dotted around.

Chaulk Oilfield

I knew that Burma was an early producer of mineral oils but I had no idea that the Chaulk Oilfield (the name is sometimes transliterated with an 'l', sometimes without)was on our route, still less that it still produced useful amounts of oil.

The first derricks we saw were exactly as you see in old pictures but later we encountered a much simpler design which appeared to comprise a tripod of three wooden poles with simple wooden horizontal bracing. Where derricks were close to the road, I saw traditional 'nodding donkey' oil well pumps lazily extracting 'black gold' from the bore hole and delivering the oil through a flexible pipe to some unseen collection point. A network of overhead electric distribution systems, some appearing quite elderly, criss-crossed the skyline, carrying power to the numerous electric well pumps. I saw a reference to Well number 1118! Myanmar Oil and Gas Enterprise (MOGE) lists the Chauk Oilfield as having been discovered in 1902 and still producing. There's an MOGE slideshow here and a Wikipedia article here

Near Chaulk town I saw a large farm of oil storage tanks and, further south, a single pipeline apparently lying on the ground ran parallel to the road. After a few miles, we came to an industrial complex which I assumed (principally from a series of 'flare stacks') was an elderly and relatively small-scale oil refinery.


The town of Salay is famous for its 'Yoke-Sone-Kyaung' monastery with its spectacular woodcarvings now in the care of the Department of Archaeology & National Museum. Built entirely of wood, and crammed with various artefacts, I found it a fascinating place. As I explored the gloomy rooms, thunder and lightning was followed by torrential tropical rain, sending the attendants scurrying to close the top-hinged 'doors' which formed the sides of the building. The storm was short-lived and it was dry as I returned to the monastery car.

Jan at Salay Monastery.

Sarkjouhla Pagoda

We then drove a few miles to the venerated temple of Sarkjouhla, dating back to 1191 A.D. Having explored the various elements of the complex, we headed back north.

Back to Bagan

We dropped the Opthalmolgist at her home in Chaulk before completing the journey back to Bagan Medical Clinic. Tired by the journey, it wasn't long before I accepted the offer of a car to my hotel. Doctor Hla Tun and his staff were working until midnight to finish treating the patients that day.

Related posts

Next post in this series.

All my posts on this trip can be found here.

My pictures

There are a few pictures of this trip here.

More pictures will be posted as soon as possible.