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A week in the life of… an F2 working in a refugee camp

Working in a Burmese refugee camp opens your eyes to what really matters in medicine, says Dr June Tay. Here she gives her personal view on what she saw and what she experienced

week-in-the-life-ofIn the remote mountains of the Karen state of Myanmar, Tuk and his family were on the run after an attack by Burmese military officers. Tuk’s mother lay injured on a bamboo stretcher, severely burned from a landmine blast. It was a six-day journey to the nearest hospital, and even then he was unsure if they could afford the care his mother required. Angry and frustrated, Tuk initially resolved to join the rebels and fight the officials that hurt them. Instead, at the urging of his mother, he joined 30 other young people at a training course provided by ‘HOPE 4 the World’ (HOPE) – a UK-based charity that supports education and health in the Karen state of Burma. There, he would learn to equip himself with the basic medical skills that are much needed in his community.

The ongoing civil war in Myanmar has decimated most of East Burma. Civilians have seen their villages burned and pillaged, their women and children raped, tortured and become forced labour. Landmines planted by the Burmese military continually hinder their daily lives. The Four Cuts policy has also deprived ethnic minorities of basic healthcare infrastructure and driven them into the jungles. As a result, malnutrition, malaria, tuberculosis and lymphatic filariasis is rife. One in 12 women die from pregnancy-related complications and 25% of children do not live to see their fifth birthday.

One in 12 women die from pregnancy-related complications and 25% of children do not live to see their fifth birthday
The Karen Department of Health and Welfare (KDHW) was established in response to the health crisis faced by the 100,000 internally displaced people in the Karen state. KDHW run mobile health clinics (MHC) that provide primary healthcare, dental care, as well as community education. HOPE has worked closely with KDHW for the past ten years, training young people like Tuk who go on to work at the MHC and serve their community.

Last year, I had the privilege of joining a team, led by Dr Steff Nash that trained these young medics through a two-level programme. Level one consisted of classroom tutorials and hands-on basic clinical skills while Level two focused on tropical and infectious disease. Both these levels run for 13 weeks a year. Our team was based at Mae Sot, a small town near the Thai/ Burma border, close to several refugee camps.

We travelled three hours a day through the winding mountain roads to Umpian Camp, where the trainees had their clinical attachment. Security was tight and we had to show both identification and official camp passes to move through numerous checkpoints. It was akin to a prison – if any of the 10,000 refugees at the camp thought about leaving, they would most certainly think twice. The village itself was in a squalid condition, the stilt houses made with bamboo and Nipah leaves. There was neither electricity nor water supply in most homes. We were happy to learn that there were NGO-run schools in the area and a village hospital set up by ‘Aide Medicale International’ (AMI), where we held the training program.

Tuk and his colleagues travelled several days to reach the camp and receive their training. It was an intense week for everyone as we taught them to perform physical examinations, venepuncture, cannulation, administering intravenous fluids, suturing and dressing wounds, splinting, bandaging and administering local anaesthetics. Although most of the participants understood basic English, some creativity was required to improve communication. We used pictures and live demonstrations to teach some of the clinical skills. A translator was also at hand when needed.

The lack of medical resources could not be more evident than when I taught a session on the assessment of a patient with an acute asthmatic attack. I was impressed by the participants’ knowledge of the drugs needed to treat the condition. However, I was greeted with silence when I emphasised the importance of administering oxygen. At the end of the class, one of the trainees meekly asked: “What should we do if we don’t have any oxygen?” I was taken aback. I had assumed that oxygen was readily available at all community health clinics; it wasn’t.

At the end of the week, the trainees sat a formative test, which they all passed. It was a joy to teach such an enthusiastic, passionate and intelligent group. I was humbled by their genuine desire to help their community in spite of being plagued by poverty, forced labour, infectious disease and landmines. Although some reside in refugee camps, many live in the jungle, in perpetual fear of persecution from the Burmese military.

My short time as a volunteer in Umpian Camp has opened my eyes; the thirst for freedom, peace and a place to call home is as distressing as lacking material resources. I have a renewed appreciation for the NHS and for everything I have taken for granted. We are often accustomed to advances in technology that aid our diagnosis and management.

However, the art of practising medicine is the ability to rely on our clinical acumen and adjust our management based on the availability of (or lack of) resources. My role as a doctor goes beyond prescribing medication, diagnosing a clinical problem or treating an ailment. To quote one of the trainees, “Sometimes the only treatment you can give a patient is to hold their hand and comfort them in their time of darkness and pain, as they slowly die in your arms.” I have never found it truer than I do now.

HOPE 4 the World exists through the generosity of those in the UK who give or go. If you are interested in training others, please email: admin@hope4theworld.org or call 020 8299 9895.

My role as a doctor goes beyond prescribing medication, diagnosing a clinical problem or treating an ailment