Jesus College, Oxford
23 April 2012
I'm a third year studying medicine at Jesus College. During the Easter vacation, I travelled to Burma for experience at the Jivitadana Sangha Hospital in the former capital, Yangon (formerly Rangoon), in order to learn about healthcare in a developing country.
The humanitarian crisis in Burma has been described by the Human Rights Watch as one of the worst in the world. Over a third of Burmese people live on less than $1 a day, and this is reflected in the major causes of death: tuberculosis, HIV/AIDS, malaria, diarrhoea and malnutrition; most of these are diseases of poverty, and preventable. Unfortunately healthcare provision in Burma is poor, with a lack of equipment and medicine which is directly attributable to the shockingly low government expenditure on health in Burma.
The Burmese government spends approximately $23 per person on health each year, a measly sum in comparison to $345 per person in neighbouring Thailand, and $3399 per person in the United Kingdom (WHO, 2009). The quality of healthcare in Burma is so poor that Burmese government officials are known to travel to Thailand and Singapore to receive better care. Sadly, this is simply not an option for most ordinary Burmese people, who cannot afford the expense.
For most of my time at the hospital, I was shadowing Dr Khin Maung Aye, the Deputy Medical Superintendent. To my disappointment, I soon realised that without clinical skills, there was very little that I could do. However Dr Aye took me under his wing and showed me a wide variety of interesting cases on his ward rounds. In addition to being a dedicated, highly skilled and amiable physician, he had a great love of teaching, and at the end of each day he would explain each case in further detail in his office.
The case that I remember most vividly is a young monk who had come to the hospital to receive treatment for his rheumatoid arthritis. His story was tragic; he was one of only two at his monastery who had survived Cyclone Nargis in 2008. Although he was born with disability in his lower limbs, he survived the cyclone by clinging to a palm tree with his arms, until he was rescued by locals and volunteers when the flood-waters receded. Now, at the hospital, the doctors were frustrated that they could not obtain the latest, most effective drugs for the monk’s rheumatoid arthritis, as they were too expensive.
I saw many cases of tuberculosis, a disease closely linked to overcrowded living conditions and malnutrition. Other risk factors for tuberculosis include HIV/AIDS, alcoholism and smoking. In Burma there is a problem, particularly amongst men, with smoking and excessive alcohol consumption, which are engrained into Burmese culture as symbols of affluence; my parents recall that they received gifts of cigarettes and cigars at their wedding in Burma 25 years ago.
The health risks of smoking are not publicised in Burma as they are in the UK. At the hospital, I saw many cases of lung cancer and oral cancer. Sadly, many people are reluctant to consult a doctor about any symptoms as they cannot afford it, and so by the time patients are diagnosed with cancer, it is often too late.
The doctors faced numerous obstacles, including old, outdated equipment, lack of access to drugs, and unsanitary conditions. In a country where even the tap water is unsafe to drink, since there is no public water treatment, maintaining sterile conditions is hugely difficult. There were opportunities for contamination; alarmingly, instead of disposable needles, needles had to be washed and reused.
However, throughout my time at the hospital, I was impressed by how the healthcare staff had adapted their practice in the face of poverty. Ingenious methods, developed through necessity, replaced some procedures which are standard in developed countries. For example, in the UK, wounds are most frequently closed using sutures or staples. This is difficult in Burma due to expense and increased risk of infection. An elderly woman had collapsed and struck her head on a tiled floor, creating a large wound in her scalp. I observed as Dr Aye adeptly held sections of hair from either side of the wound and knotted them together, pulling the wound closed. This way, the wound could heal more quickly, and was less likely to become infected than if stitches had been used.
I am very grateful to the staff and patients at the Jivitadana Sangha Hospital, in particular Dr Aye, for this invaluable experience which has made me so excited to begin learning about clinical practice in September. However, it has opened my eyes to the poverty afflicting many millions of people, and the lack of access to healthcare - a basic human right which should be available to everyone.