4 August 2019
[Above photo: All cigarette packages have either this photo or one of a very nasty cancer of the tongue on the front. What you can do in a government without lobbyists and privately-funded elections! Why do we in the US allow vaping companies, basically drug dealers, to flourish? Reynolds Tobacco and Liggett and Meyers are thrilled to have a new generation addicted to nicotine. ]
One of my students and her husband took me to supper the other night. We went to a Wa (ethnic) restaurant, hip by Western standards, with superb food. I prefer the different tribal foods—Kachin, Shan and Wa—to regular Burmese food, perhaps because they are more novel. We laughed a lot and I found out about his work. He’s a seaman, a Chief Officer, on a 600 ft car carrier and similar-sized container ships which ply the waters between China, Japan, Australia, Singapore, and the US East Coast (through the Panama Canal). When a cyclone looms ahead, they simply stop the ship until it passes. He’s gone 8 months at a time and then home 3-4. They fly him out to the ship and back from it when it’s his leave/work time. The salary is much more than he could make here and he likes the work. He doesn’t like the absences, nor does his wife. They are incredibly cute together, chatting away and obviously very in love and enjoying each moment. He’ll take a captain’s examination in a year. Is it more work being a captain? Less work, more responsibility. Many Burmese men work on freighters; for their sacrifice they gain financial security.
It reminds me of Malawi, where so many men go to S. Africa, even just for menial work, and so many skilled men and women have job postings in cities apart from their family. The physicians in government service here all are forced to rotate around the country every 3-5 years, as are the military. Partly it is to share the burden of undesirable postings—generally rural and often in conflict areas—but it also is to diminish the possibility of their developing a power base which could challenge the government or, for the military, to discourage corruption. It’s why after the 1988 student uprisings and massacres they destroyed student union buildings and dispersed university campuses to small, rural towns.
Along those lines, there is a remarkably good-for-genre film based on a true story, “Beyond Rangoon” with Patricia Arquette. It is about an American tourist who gets caught up in the 1988 student uprising. I bought a bootleg copy of it at a shop here; I find it amazing that it is available, since it shows the Tatmadaw (Myanmar army) at its most capriciously, viciously murderous, executing students and villagers, shooting fleeing civilians in the back, etc. The scenery was wonderful, as well.
My gut continues to trouble me, despite taking a course of metronidazole and another of azithromycin. CBC and stool samples are negative, so I may need an ultrasound or CT to see what’s up. That my mother and her brother both died of pancreatic cancer at this age isn’t reassuring to me. If I need much fancy diagnostic work, I’ll go to Bangkok. If I need treatment, I’ll head to Boston or New York. Rats. It does make me realize how much I love life. Of course, it also brings my life into focus that an old friend is currently being treated for a gi cancer. I am of that age, I suppose.
I’m looking on Zillow for coastal property in Maine, either land on which to plunk a house or land complete with a house. The latter is less expensive at the outset but, depending on the condition of the place, it may be false economy. I’m excited about it, my next chapter.
Linda will come to visit in December and we’ll travel together in Myanmar and India, unless it coincides with the opening of her midwifery ward at Queen Elizabeth Central Hospital in Blantyre. Then we’ll adjust to Plan B.
I also want to stay involved here, shepherding child psychiatry training and child mental health. I can do video supervision and teaching and I can return for a couple of months a year, probably in the Maine winter when the weather is best here. So I have lots of fun and challenge and excitement on my plate and I want to pursue it all.
The US Embassy has a program—YSEALI, the Young Southeast Asia Leadership Initiative—in which they have local and regional workshops in different aspects of leadership to foster and encourage young bright minds. One of the participants, a general practitioner who attended a regional symposium in Indonesia recently, put on a morning program at the American Center in Yangon re. Non-communicable Diseases, including Mental Illness. I spoke to an audience of about 40 young people, some physicians, about mental health awareness and stigma in Myanmar. Others spoke, as well.
One young YSEALI-participant physician who has a lot of energy re. mental illness awareness did a bit on emotional first aid. His difficulty is that he craves public attention but has no mental health training. He really hasn’t a clue as to what he is doing, other than perhaps from reading Wikipedia “Emotional First Aid”. I have told him several times that if he wants to be a National Expert, he needs at least to be informed and do a psychiatry residency or some similar training. There are no short-cuts.
Like many of his persuasion, and I think of our Narcissist-in-Chief, he assumes he’ll just know what’s important and doesn’t have to bother with the work of learning it. Why listen to experts? Why read intelligence briefings? Mr. T. already is smarter than those fools who waste their time reading. I can recall, with a little embarrassment, times as a child, and even occasionally as an adult, when I felt similarly. I think that’s part of why this experience is so satisfying to me; I’ve really put my shoulder to the wheel and it shows in my output and in the students’ knowledge. I felt the same satisfaction in my work for many years in Berkeley.
I finally cruised through Yangon General Hospital with one of my students. I wanted to see it and compare it with Queen Elizabeth in Malawi. YGH has a capacity of 1500 inpatients. The main building is an immense, 100 year old, beautiful two story British colonial-style stretching for blocks along Aung San Bogyoke Street. Grand in concept with vast arches, marble floors, sweeping stairways, lovely ironwork, and beautiful windows, it has much in common with QE—-immense wards crowded with families, sheets and food courtesy of each patient, noise and commotion, and people from far away sleeping overnight on mats on the floor of outpatient clinics in order to be seen. All clinics are drop-in, which cultural habit will require a shift in order to participate in psychotherapy. There were rows of aluminum chairs bolted together in the waiting areas, a step up from our backless wooden benches at QE. In the psychiatry outpatient department, two or three senior psychiatrists, often with students observing, work in a single room; in Malawi we each worked in separate rooms. “In our culture, privacy and confidentiality are not so important.” Perhaps, but if they were provided, I think patients would appreciate it and would go deeper into their tales. There is a new building of surgical suites and a building devoted to interventional cardiology. How the immense enterprise works, and it seemed to be working, is an unfathomable mystery. I even saw the Dog Bite Center, since dog bites and rabies are common. Venomous snake bites and poisoning cases go to New Yangon General Hospital, which is across the street and down the block. But like county hospitals everywhere in the US, for serious acute illness and trauma, the ED at YGH is the place in the country to go.
Chikungunya is rampant right now, bestowing a high fever, rash, and incredibly painful joints on the unfortunate recipient. Two of my students have had it and another had 4 cases in her general medical clinic the other evening. My friend, Martha, contracted it in Ghana and to see her agony was chastening. I see the very occasional small mosquito in my apartment—-I mean one every two or three weeks—but otherwise haven’t seen any. Maybe it’s my vision. Mosquitoes never have liked me much and I don’t swell from their bites, unlike my poor kids who balloon up. I do get bitten by the frenzied swarms on Beach Island in Maine at times but they are as large as small ducks and easily dispatched. Dengue will come next month.
We were referred a couple and their 13yo autistic boy; they traveled for several hours to attend the consultation. They were so good with him. The father is a seaman who took off work for 4 years after the boy was diagnosed so as to be with him. The mother is a dentist but is so skilled at reading and responding to the boy she could be the Dean of a Special Education graduate program. The boy was sweet, if very socially awkward and linguistically limited. He is obviously intelligent and we supported their efforts to help him discover his interests and talents. He doesn’t care about the piano but he likes to draw and can move around a computer with enviable facility. We had few suggestions, other than that they keep doing what they are currently and find some children’s books in which he’d have an interest, reading to him every day. He is in a good special school and even has some “friends” he misses on weekends and holidays. He is a lucky child to have such bright, tenacious, imaginative, and caring parents. I knew a couple in Berkeley who constantly inspired me with the same qualities in caring for their two children, but it is rare to see.
Now I must prepare presentations on “Substance Abuse” and “Eating Disorders” for this week. Hammer it out, Dems, and thin the field. We want to see who is left standing. This election is more crucial, and just as thrilling, as 2008!
A Psychiatrist in Myanmar 