A Time For Hope

19 July 2020

[Above photo: Twilight on the Yangon River.]

Last Sunday I needed some groceries so I set out with my umbrella and day pack under a light-appearing sky. Within one short block and one long block (equal to 4 short blocks), the sky emptied on downtown Yangon in the fiercest downpour of the season. It continued while I trudged to the market, 9 short and another long block away. I shopped for ¾ of an hour and it continued. I had a cappuccino and a brownie at Gloria Jean’s and it continued. Resigned,  I trudged home, getting soaked. Preferring to head south into oncoming traffic, I turned down 19^th Street instead of Sint Oh Tan. Soon I was sloshing through water 8-10 inches deep for a long time. I arrived home damp in body but I hadn’t melted or gotten hypothermic and my groceries were all ok so nothing lost. I could have taxi’d but I actually enjoy the wildness of getting soaked, as I did when I was a kid in Seattle.

On Monday the 9yo boy from the Defense Services Academy Pediatric Hospital who had severe recurrent vomiting returned to our clinic.  His EEG showed temporal lobe epileptiform discharges! A stretch of a diagnosis but it may well be. He’s on carbamazepine and vomiting/seizure-free for 10 days. His older sister has a history of severe headaches; migraine is common in families of children with Cyclic Vomiting Syndrome and anti-migraine medication is effective 60% of the time with those cases. We’ll see if the carbamazepine stops the vomiting; if not, he may have temporal lobe seizures and CVS. I’m sure the pediatricians think we are geniuses (just kidding).

A 15yo girl, the younger twin and the third of 4 sisters, was brought to us today. 3 months ago, on the occasion of her baby sister’s birth, she became mute, was episodically aggressive, slapping her twin sister, and destructive, and acted like a baby. She wanted to suckle her mother, who let her when her breasts were engorged and the newborn was full and sleeping. She also suckled a pregnant cat in the home. She developed an “imaginary playmate” who looks “just like” her. Because of her aggression and the confusing picture, she was admitted overnight to the Yangon Mental Health Hospital but Professor Tin Oo saw her in the morning and diagnosed her as having a Conversion Disorder. I think she has an Adjustment Disorder with striking regression in reaction to the birth of her baby sister. Of note is that her mother left her with her grandmother at 7 months of age and has been working in Bangkok since, not returning home.  She returned to Yangon 6 months ago with a new husband and bread in the oven. For about 3 months our patient was able to be the baby of the family (by 3 minutes) and to have her mother’s attention but, suddenly, it has been jerked away. Meeting with her she is mute, bright, infantile, engaging, and clearly not psychotic. When I ask her how old she is, she holds up 1 finger. “I am a baby”, she silently protests.

We saw a 10yo boy who has been talking a lot about sex for 2 months.  He touched his teacher’s breast once. He lives in a 7 story dwelling with 24 other adopted orphans and 10 single adults, two generations of one family. Each adult has adopted 2 or 3 of the children. There clearly is too much sex too early in his life. Perhaps a lack of adult supervision, perhaps a lack of incest taboo since none of the kids are blood relatives, perhaps he is engaging in “scientific researches” as Freud called the sexual explorations of younger children, or maybe there is a pedophile in the mix. We don’t have Child Protection Services here so we’ll form a positive relationship with him and try to tease out what is happening. If his “uncle” doesn’t bring him back to see us next week, I guess we may have to call the police after contacting him. I talked with the students about the dangers of overreacting or underreacting, the fact of our having to live with uncertainty and lack of definitive knowledge, the disorienting nature of the living arrangements, even for here, and the importance of fostering a supportive relationship with the adult(s) and child involved.

During one of my nighttime awakenings, of which there are usually two, I was pondering the future of our country. In areas where there is massive inequality—I’m thinking of parts of South America, Asia, and Africa, as well as our own country—-we often see social instability, as well as the inevitable suffering. The rulers also tend to become more and more totalitarian to ensure that they can hold on to what they have. The obvious struck me; money/material wealth is like a battery. It is stored energy which can be used to buy work or work’s products, if desired.  Some people have massive lakes with dams including electricity-generating turbines built into the dams.  Other people may have only a single triple A or even one of those tiny batteries that power a wristwatche. It is dangerous to freedom “of the people” that some have so much more power.

It also seems cruel, ridiculous, and stupid for some to have so much more than they’ll ever need while some never have enough to adequately feed their children to avoid stunting. It puts too much power in the hands of too few. In the US, together with Citizens United, the rich can direct the flow of work/energy to maintain the status quo or even widen the gap, as has been happening there for 3 or 4 decades. I don’t need a massive palace or an immense yacht and if someone wants one, I do begrudge them their greed and their contribution to Earth’s destruction. It seems crazy when a medium-size yacht will do and the poor could then feed and educate their children. A smaller house has less surfaces to dust, as well.

There will always be wealth inequality. The only way a democracy can survive is if there is a governor on the system—-anathema to Americans and their Dream— and if those who are more wealthy understand, or at least are forced to respond helpfully to, the plight of the poor. I suddenly don’t get a warm feeling from the word “democracy”, knowing that, like electricity, it can be manipulated to light our way or to torture and kill others. As we’ve learned with Mafia Don, a rich sociopath in the White House can get away with murder—-even multiple murders—while a poor man can be, and often is, killed for stealing a loaf a bread to feed his starving family.  We must address the tears in our federal fabric that allow a crook to repeatedly degrade it to save and enrich himself. And we must help to educate and support his benighted base, many of whom have been kicked to the curb. Also, we should eliminate the Electoral College, get private money out of political campaigns, and lessen the inequality by progressive taxation. It is strange to me that tax attorneys don’t think they are chiselers when they cleverly manipulate the tax code to save their employers from having to pay their fair share. So frail are we, such short memories, such limited compassion.

Kelly and I had supper last night with a couple he knows from the American Club; Kelly is a fiercely competitive and skilled tennis player and often wins the tournaments there. The wife runs one of the major art galleries here. Her husband is an entrepreneur who got his start after college when he played club lacrosse in Australia. They live a colonial life style in a gorgeous mansion on Inya Lake, in a  lush setting and facing the peninsula at the top of the lake where the late dictator, Ne Win, had his palace. They have a large staff to keep the enterprise running and the grounds manicured.  The air was soft on the candle-lit terrace. I felt strange being cared for by “staff”.  It was not an unpleasant evening and there was good conversation but I left feeling how behind the times it all was.  At least for me.

Mafia Don’s magic seems to be fading for most. Instead of a rabbit, his top hat is filled with a grey, slimy substance. I hope Tony Fauci will break character and bite their hand if they attempt to muzzle him. Such a wild debacle! Our death toll is heading toward the numbers of Iraqi civilians killed as a result of our invasion. The US acts like a rabid dog at times, snapping at others, then snapping at its own paws and tail. Just as the depth of the market’s plunge is the time to buy, now is the time for hope.  “Diseases desperate grown are by desperate appliance relieved, or not at all.”