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.