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Myanmar: IDP Buthiduang

Buthiduang, where the stateless Bengali Muslims & Rohingyas struggle to survive. It is a medium-sized town south of Maungdaw. It feels incredibly remote, surrounded by mountains, dense untouched rainforests and a sleepy winding river. I like it a lot. The house for the medical field staff (me, the other doctor and two nurses) is as basic as they come. I’m still trying to work out if we have any electricity. The downstairs outdoor squat loo has me praying I don’t get diarrhea. 

The clinic manager was on leave for a few days, so I took on the role. Working with staff from different communities means that differences of opinion easily become political, and mediating these discussions was both time-consuming and stressful. Even simple tasks, such as dividing duties among the medical team to organising lunch breaks, every decision required some convuluted discussion. It is understandable that many staff members use me as a neutral listening ear, something that has also become quite common in Buthidaung. 

Stress levels are high here, and most staff have incredibly difficult living conditions. Doubling up as a clinic manager meant I really had little time to see patients this week. It was an interesting role though, and I did enjoy the power of telling people when they could go for lunch.

My first patient of the morning was a 15 day old baby with newly acquired spasms and poor feeding. I almost missed the diagnosis of neonatal tetanus, and looking back it was fairly straight forward.

The mother had a home delivery, and had used a kitchen blade to cut the cord. Easy marks on the diploma of tropical medicine exam, but it was the first time I’d been faced with it in real life, so it took me some time. The rest of the morning was spent dealing with incredibly sick patients: an obstructed labour, a severely immunocompromised pregnant lady who did not stop vomiting and had probably miscarried, dog bites, and acute watery diarrhea galore.

It was pretty busy, especially with limited equipment and only a nurse and midwife to help while a few others left for Outreach (bringing medical help on foot to remote villages). Important to remind ourselves we are doing our best. 

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Myanmar: Hidden Genocide

“I hate being a Rohingya. We are being tortured in Myanmar. Now in Bangladesh, we have no rights. Nothing. We don’t have a roof. We are living under the sky. We have no future”
— 27 year-old Rohingya Refugee fled Bangladesh in February when her husband went missing.
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In Myanmar the preconditions for genocide are now firmly in place. Racism has been normalized among the ethnical Burman population and the Rohingyas have already been subject to communal violence, state oppression and have been forced into both internal and external exile. 

A powerless minority is the victim of effective ethnic cleansing, in an environment where they are hated by their neighbors and actively discriminated against by state authorities. Despite the grim situation there is much that can be done, both domestically and internationally, to help the Rohingyas and hopefully avoid a genocide- but a real will to take action is needed, rather than the continuation of "business as usual" in the hope that nothing actually happens in Rakhine to make us complicit through inaction in a repeat of the genocide in Rwanda. 

Rohingya IDP camps, rekindling fears of being displaced and losing loved ones all over again. 

No adjectives to describe sufferings of Rohingya refugees especially after the monsoon. No shelter and nowhere to go in the middle of the monsoon. These are the poor conditions the Rohingya live in. Small dirty shacks in the mud, rain comes in, chickens walking in and out. in constant fear they will be attacked again. 

My time here in Sittwe, the major town of Rakhine State. Sittwe is the first place I’d ever been to that has a curfew, imposed in response to the civil unrest and violence that rocked the state last year. The beautiful landscape and bustling asian market mask the deep tensions that divide this part of Myanmar. One needs to have knowledge of the recent history of the area to appreciate the constant threat of violence that hangs over the town. It's impossible not to feel something when walking past numerous piles of rubble marked with red signs to highlight where houses once stood.

Yesterday afternoon a patient came in after being in labor for 48 hours at home. She’d been pushing for over 12 hours. She was running a high fever and the baby was dead. It’s head was visible when she pushed but it was mostly “caput”, the swelling of the top of the baby’s head.

The midwife I’m working with, Sally (originally from Australia but now living in Atlanta) tried delivering it with the vacuum extractor but the baby’s head was too large. I tried to place the forceps but the head was too large so, for exactly the second time in my career (the first was in Sierra Leone), I had to do a destructive delivery, making a stab incision with a scalpel through the soft spot in the baby’s skull in order to drain some of the brain matter and decompress the baby’s head making it small enough to pull out.

It’s a gruesome procedure and it was made worse by the awful smell of this mother’s infection. There’s a part of you that just disengages from the reality of what’s happening, thank goodness. We were able to get the baby out though, saving the mother an operation through an infected abdomen and pelvis. The baby had obviously been dead for several days which I guess made it easier to come to terms with.

I don’t think five years ago I could’ve imagined doing things like this. The most horrifying thing is not that I’m relatively comfortable doing it now, but the fact that there are places in the world where it’s necessary.

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Myanmar: Why are we here?

MYANMAR/MSF-USA

(WHY ARE WE THERE?)

 - Endemic/Epidemic disease

- Health care exclusion

- Natural disaster

Staff at work in the dispensary of one of the MSF clinics providing care and treatment for patients with HIV/AIDS, TB, or sexually transmitted disease in Yangon

There is an ongoing medical humanitarian crisis in Rakhine state, and there are concerns about the increasing challenges faced by those assisting people in need of healthcare

Violence and segregation continue in Rakhine state, more than 100,000 people remain displaced, living in appalling conditions in camps, and almost entirely cut off from healthcare and other basic services including clean water.

Minority Rohingya remain extremely vulnerable, MSF is striving to overcome significant challenges and obstacles and provide free, high quality medical assistance.

Not to mention offering basic health care, obstetric services, mental healthcare, treatment for HIV/AIDS and TB, and emergency referrals

So far:

TREATED: 10,816 patients, 84% of the national wide total

Staff worked in 10 townships across the state in fixed and mobile clinics in 24 camps for displaced people and a number of isolated villages.

Throughout 2013, MSF continue to urge the government and the communities of Rakhine to work together with international organizations to ensure that all patients in need of Emergency medical services could access the care regardless of their background ethnicity.

I have been preparing for this trip for months, and yet somehow, my brain wasn’t ready. It is only now, as I close the car door, that it clicks and the sight of my parents driving off – I am leaving. I am excited for the adventure, nervous to be leaving my home, apprehensive about the unknown waiting for me in Yangon.

Months ago, a secured hospital setting in Los Angeles to free myself up to do MSF field assignments full time. The staff at my clinic have been approaching me to chat, smiling and curious, supportive of my plan to work with MSF, yet maybe a little wondering if I am crazy. Some of them ask me if I will be safe. I reassure them that I will be fine, Everyone - the clinic staff, my friends, my Facebook friends, the residents I work with, my family – commend me for doing this. They are proud and happy that I am doing something good for the world.  I am too, and I appreciate their support, but I also feel a little funny when they congratulate me. I think it’s because I’m not doing MSF to be altruistic. In fact, my motives are a lot more selfish than it would seem.Sure, I’m volunteering to make sacrifices to work and live in difficult conditions. And it’s true that not everyone would want to do it. And MSF is a truly good organization, one that I have been consistently been dreaming to work with.But why am I doing this? I am doing it because I feel as if before this point, I had been living my life in black and white, and suddenly everything is in color. The work will be difficult and challenging, but so much more exciting.When I do a c-section, I really do save a life. Even a patient with a simple urinary tract infection was immensely grateful for my care, because they have so few options. The patients are so much sicker than they are at home, and I revelled in the challenge of using my wits to fix the problem without all the tools I normally have.As I look around in the plane, I take a deep breath and sit back. This is really real.  To operate, to work on very sick patients, to bring them back from the brink of death. To be scared, to be challenged, even to be frustrated. For me, this isn’t a sacrifice; it’s a pleasure. I know that all patient cases won't be successful and end happily and I'll struggle with reminding myself of all that has been accomplished versus the failures.

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