Sodden

11 August 2019

[Above photo: Ginger blossoms and a pagoda in the National Botanical Gardens in Pyin Oo Lwin.]

In an average year, Yangon receives 28 inches of rain in August alone and 2019 is no exception.  It rains 37.5 inches in Seattle in a year, and Seasonal Affective Disorder fells many there. Maybe it’s the number of grey days. During my internship at Harborview Hospital one intern’s spouse counted 90 consecutive days when no patch of blue was seen. I knew then that I couldn’t settle there.  As a kid, until we moved to Denver at 12yo, I loved it in the Northwest and never thought much about the rain, even when regularly soaked on our Scout overnights. You always dig a ditch around the circumference of your tent when camping in the Cascades. I vividly recall a great camping trip with Harold in the Sierras where we met rain, it was so unusual.  Both Nate and Christopher were good sports about it. Returning from catching trout at Lake Constance (?; 11,000+feet) we paused in the drizzle under a dry tree to lunch and read aloud from Bruce Chatwin’s In Patagonia. Returning to our campsite, we discovered we’d pitched our tents in a granite bowl thinly covered with pine needles. The tents were literally floating but dry inside, a testament to their waterproof floors. Some poor guy was crouching in his tent with his two young kids, wet and miserable. They were pulling up stakes, having just arrived, and gave us lots of food they didn’t want to carry out. Canned tomatoes, I recall. A first trip, I’d guess. Maybe a last.

The electricity was out this morning. Is out. It came on briefly and then is off again as I write. This happens very rarely here and usually briefly, although often enough that I have used my portable PP projector several times for a lecture. I fired up the little propane burner I asked the landlord to supply when I moved in and made some tea. It recalled camping in Namibia, Zambia, and Botswana at this time last year and the fun of brewing tea each morning. That was a very special trip. I probably wouldn’t have done it, except for Linda and her long-time desire to camp in Namibia. I say “probably” because when I found out our friends, Peter and Caroline, were doing the same trip I might have signed on.  But prior to that, I confess to have known nothing of the beauties of those countries.  It was a fabulous time, with no mishaps except missing the once-in-a-lifetime total eclipse of the moon because I was choking and gasping, focused on trying to start some green wood for a cooking fire. Otherwise, minimal discomfort, maximal excitement, no real danger, and so much beauty.  Truly a once-in-a-lifetime road trip.

I dropped by the Drug Elimination Museum yesterday. I’ve meant to go since I first read about it in January. It is a monstrous, 3 story, concrete structure set on spacious, overgrown grounds with many stray dogs. It really is just a monument to General Than Shwe, who was the Senior General, head of the Tatmadaw (Military), and Head of State from 1992-2011. His earlier career included directing a war on drugs in Shan State, especially, as he was rising through the ranks of the military. He also attended a KGB intelligence training course in Moscow and another senior officer training course there. As Head of State, he was reclusive, made some very poor economic decisions in the name of state socialism, refused to let the majority party, the National League for Democracy, and its head, Aung San Suu Kyi, participate in the 14 year drafting of the Constitution, and listened to soothsayers for advice. (His predecessor, General Ne Win, once shot a mirror in his house to avoid bad luck.) He was seen as a humorless, sullen hardliner. He refused to allow foreign aid into the country to assist after Cyclone Nargis, fearing an invasion and contributing to the deaths of an estimated 130,000 people. And refused on two occasions to meet with a high-level UN envoy.

The museum has three floors with many photos and portraits of Himself, numerous immense dioramas of poppy fields and battle scenes (The cubic meters of earth in that building!), and endless illuminated battle plans and detailed inventories of drugs and chemicals seized. It wasn’t just opium or heroin. There were bales of cannabis, hundreds of thousands of methamphetamine tablets, endless barrels of volatile hydrocarbons (toluene, ether, etc) used in the manufacturing processes, and sophisticated pill machines. On the first floor was an intact airplane, one of a fleet used to spray 2,4 D on the poppy fields. And the rear fuselage of a government fighter plane shot down by the drug lords. There were plenty of photos of “drug kingpins” being hauled away. There was a full-sized steam (diesel) roller crushing bottles of methamphetamine pills. One blurry photo caught my eye—a man being “operated on” to remove 22 packets of heroin—“.99kg”— from his stomach. Lots of burning drug labs. Even pictures of the British during the Opium Wars in China, shooting Chinese citizens. And an allusion to the oft-told-tale of the CIA profiting from the opium/heroin trade here.

Call me cynical, but I cannot believe that, as corrupt as they were, the generals didn’t find a way to make a fortune from all the drugs that they confiscated. BTW, Myanmar is currently the #2 supplier of opium/heroin in the world, trailing—you guessed it—-Afghanistan. So much for “Drug Elimination”. Colombia, Mexico, Pakistan, Thailand, Laos and others all make their contribution. Much of US heroin comes from Mexico and, decreasingly, Colombia but the players are agile and things shift quickly.  Fentanyl, the current killer, comes c/o China. 70,000 drug OD deaths in the US last year.

There was, of course, nothing about the addicts, the life conditions leading to their addiction, or efforts at rehabilitation.I can hear the military saying, “Weakness” and “Not heroic or dramatic enough.” as they planned the exhibits.

Interdiction is part of the fix but the thorny main issue is demand. How do we give enough people in the US enough hope for their lives and futures so they don’t turn to drugs to feel better? A simple formula, I think, of good education and vocational training, reasonable salaries and job security, and accessible health care.  This can only come, in part, from decreasing the wealth gap, which can only come from revising the tax structure progressively. This will only happen when legislators aren’t forced, and able, to rely on rich donors to get elected. So, we need election reform desperately. Publicly-funded elections seem far off, I fear.

My students will each have completed formal intakes with 10 children/families and will have observed and discussed several dozen more. We are gradually developing new clinical quarters at Yangon Children’s Hospital. In the outpatient department there is a section labelled “Isolation” for—-what? Ebola?  “Wash your hands well after clinic.”  It isn’t currently being used and there are 3 or 4 decrepit rooms with doors where we can see patients, at least on Thursdays. There is another section of a separate building that has 3-4 rooms, as well, that is completely unused which we’ll try to claim and possibly renovate. Little by little this subspecialty takes shape. It is strange to me that Child and Adolescent Psychiatry, whose target population is the foundation of the future, should be the subspecialty, not Adult Psychiatry, far downstream. By 14yo 50% of adult mental illness has raised its head; by 21yo, 75% has. In Malawi, with a birth rate of 4.8 children per family, half of the population is 16yo or younger. Here, with a birth rate of 2.1, about a third are under 18yo. Sigmund Freud, Charcot, Benjamin Rush, and historical precedent, I guess, although Anna Freud got it right.  Plus, adults are noisier to civilization than are children. But I digress.

We saw the 17yo girl who’d been regularly raped, 3x/week, vaginally and anally, by her uncle since 8yo. She lives at the Girls Training School where she is a star in her sewing class, has made several friends, and is allegedly eating well, although she remains very slender. Thankfully she didn’t have to face him in court at his trial. She now smiles faintly with us on occasion. I can only assume that her early years on the Myanmar-Thai border with her mother, who was a sex worker, must have included a close, positive attachment. The tale is that her mother tried to protect her from her livelihood. She certainly has had multiple traumata since then, with her uncle’s abuse and her step-grandmother beating her and telling her she was stupid, as well as the deaths of her mother and grandfather. But she doesn’t exhibit the multiple-domain dysfunction expected from such circumstances, as is well-described in the literature. She doesn’t have behavioral problems or difficulty with affect regulation. She is able to form close, positive attachments, and seems capable of learning. She’ll be attending school soon, to learn to read and do simple math, since she hasn’t had those opportunities before. Resilience, we call it.

It is noon and starting to warm. I hope the electricity resumes soon, as I’ll need aircon if I want to work. I plan to read The Theory of Poker by David Slansky. There’s a game tonight and I don’t want to keep losing.  Self-respect.