[Above photo: Early evening boat traffic on the Yangon River from my deck.]
26 January 2020
It is 9:30AM and we’ve already been treated to an episode of drum banging and cymbal clanging. The decorations at the intersection of Sint Oh Tan and Maha Bandula for the Chinese Lunar New Year celebrations are over the top. A 75’ long dragon. A long row of elevated (up to 10 feet) pedestals for acrobatics and dancing. There are pop-up shops and displays all over Maha Bandula, lanterns hung for blocks, loud loudspeakers, stalls with delicious-but-deadly looking brown and white gelatinous cakes, and on and on. I leave for Mandalay this afternoon to teach the nursing faculty for 3 days so I’ll have some respite from the noise and crowds. What a time for a corona virus to emerge! Would drinking Corona have any prophylactic value? I like to think so.
I am excited about the 3 day course, an Introduction to Child and Adolescent Mental Health, I’ll teach at the University of Mandalay. I have no idea how much of any of it will stick but at least they get a taste of it and I can do a follow-up course for them in the Fall after my major teaching responsibilities have concluded. My graduated students there can, as well. I was pushing to get the grand monthly salary of $200 that the government gives to each doctor but realize that then it may make it harder for me to come and go as I wish. I want 3 months a year in the US, mostly on Beach Island.
Three of us—two physicians from Metanoia Mental Health and I—met with two UNICEF workers to review the grant and teaching project we’re starting. The entire focus is to teach 8 of them psychotherapy. Am I excited! And they are smart, highly motivated people. Of course, the head, at 38yo, looks about 25, making me realize that I am old enough so everyone under 60 looks fresh out of college. Where have the years gone?
They certainly have gone to my belly which isn’t huge but also isn’t toned. I dislike that old man protuberant belly look and, yes, I’ll continue my sit-ups although they are the most hateful part of my little exercise routine. Harold started us with the Canadian Air Force exercises when we were in medical school; we’d do them each morning to the Beatles “A Hard Day’s Night”, which was lively enough to get the juices flowing even without any pushups. I must now use weights to tone my muscles and cannot do pushups. I can do them fairly easily, but I’ve injured my shoulders with them in the past so it’s no pushups for me. I recall thinking at the time how silly Jack Palance looked at the Oscars when he dropped to the floor at 72yo and did one-armed pushups. Now I sort of understand his desire to showcase his personal attempts to defy aging.
I went to Yangon Mental Health Hospital on Wednesday for their CME. It was very good—high quality, especially presentations by the three senior residents summarizing the current literature on Dual Relationships, the Adverse Childhood Events studies, and the use of ECT for treatment-refractory PTSD, respectively. There was a nice lunch provided by—you guessed it—-United Pharma, “Serving Your Healthcare Needs”. Their presentation was almost an hour long. I especially liked Cholinerv, “A CNS Stimulant/Neuroprotective Agent” helping “Memory, Focus, and Brain Health”. Also, “LiverCare” a “Liver Health Supplement with Siliphos” having “The Power of Two” (containing both Silybin and Phosphatidylcholine plus Multivitamins and Zinc) whose motto is “Love Your Liver, Live Longer”. I wonder if their science is as good as their graphics. No, I don’t. At home I am very critical of paid presentations, knowing that the gift of a Risperdal-imprinted pen alone can make you prescribe it more often than other 2nd gen antipsychotics. But here, with salaries at $200/month they get a free lunch and several hours of quality CME. I cannot be that critical of the psychiatrists. I just always include undue influence by the drug companies in my presentations.
The highlight of the week was a tour of the Military Services Medical Academy by Professor Nyan Win Kyaw, the Chief of Psychiatry. Two younger faculty picked me up and took me out for a breakfast of mohinga on our way. The facility is massive, much larger than the University of Medicine 1, with very up-to-date classrooms, library, skills labs, etc. They have an entire building dedicated to gross anatomy dissection, 4 students per body. The massive sign in front announces “To Be A Good Soldier And An Efficient Doctor” in gilt letters. I don’t think efficiency is the first quality I’d seek in my personal physician. Across the street is the parade grounds and hostels where the “Cadets” live. Knowing how the Tatmadaw (army) has been used in the past, I went with apprehension but I think that, generally, you can best effect change close up. After all, the soldiers are humans, most have families with children, and all are under a lot of stress, which impairs parenting. Soldiers, even more than physicians, are moved about the country like chess pieces which causes considerable developmental disruption here, as it does in the US. “Military brats”. I offered to do some lectures for the medical students during their psychiatry rotations. Part of the attraction was that Dr. Nyan Win Kyaw is such a smart, kind, energetic guy that I was drawn to helping him, however I might.
An exception to the above approach to effecting change would be with a sociopathic narcissist. If they aren’t my patient, ignoring them and protecting myself from them is likely the best approach, since change is not going to happen and why reward their bad behavior with attention. The recent ad attacking Susan Collins is smart, I think. I heard it described as “vicious, which I don’t think at all. Honest and direct, I think. Watching her sell out the people of Maine, pandering to Trump Republicans while saying she is “concerned” is gag-worthy. She voted against Equal Pay for women, for god’s sake! And for Brett Kavanaugh, after an endless amount of hand-wringing. Hand-wringing is supposed to signal deep moral deliberation, I guess, but she employs it often enough that it is clearly a combination of political calculation and window-dressing. She’ll lose the next election and will lose it with shame for having supported this liar 90% of the time. There will be a lot of GOP bloodletting; we used to think it was a treatment for ailments but it only makes a mess and weakens a person.
I now will go out and buy some hand sanitizer. I generally avoid it, as it isn’t good for the water supply but since I’ll be travelling on a plane in 6 hours and since there is a big Chinese presence in Mandalay, I’ll be careful. I worry about Aillen, working in a hotel in Macau. Nearby Hong Kong is now reporting cases.
A Psychiatrist in Myanmar 