Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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414 Surgery and Healing in the Developing World
time can you buy before a real emergency arrives? These questions were compounded
by even greater complications when we were at mobile clinics seeing migrant workers,
since these people had no legal status in Thailand, making it almost impossible for
them to be transferred to other medical facilities. Even in my limited experience, I
have seen much waste of life due to delayed management caused by the lack of
logistical support for nonmalaria care.
I came back to the US after 2 months of an incredible amount of learning,
excitement, frustration, and sadness on the border. That first trip motivated me to
read and research more about malaria and other tropical diseases, and to be curious
about how NGOs work with the population on the border.
Five months later, I was invited by the International Rescue Committee (IRC) to
help with medic training in another group of refugee camps near Mae Hong Son, a
small border town located on the northern border of Thailand with Burma. The
IRC is a US organization, based in New York, that provides considerable support in
humanitarian crisis situations all over the world including Burma.
Working with the IRC was a slightly different experience. I worked exclusively
with medics doing bedside teaching and training on basic wound care and trauma
management. The common problems we saw were similar: mostly infectious diseases
ranging from HIV to malaria and dengue; from typhoid, to diarrheal diseases
to septic abortion, from pneumonia to skin and eye infections. We also saw a significant
number of patients with untreated or unrecognized hypertension, heart failure,
and renal failure.
When I was with the International Rescue Committee, I worked closely with a
Burmese-Canadian doctor named Win Myint Than. She has been trying to develop
a training system that adopts the health system setup in rural Burma where you have
one doctor per township of a large population. This is an umbrella system in which
many multipurpose health workers including health officers, nurses, midwives,
medics, lady health visitors work in the community under the supervision of the
doctor they do health education, diagnosis and treatment, referral, transport. By
emulating this system on the border, we not only make it easier to reach every little
corner of the community there, but we set ourselves up to go back into Burma one
day and to fit right in to the effective preexisting system, but with newer and more
up-to-date skills and information.
I have gone back and forth between the US and the border area a few times now.
Aside from my experiences with the SMRU and the IRC, I have also worked at a
medical clinic, Mae Tao, led by Dr. Cynthia Maung, that deals exclusively with
illegal migrant workers from Burma.
Throughout the Thai-Burma border area, there are also, in my humble opinion,
three huge hidden silent problems. One is chronic malnutrition. I don’t remember
how many patients with B1 deficiency I saw; many are either pregnant women or
new mothers. In America, we see B1, a very basic vitamin, deficiency only in patients
with chronic alcoholism. A second hidden problem is psychological trauma—
mostly the trauma of fleeing and fighting and witnessing atrocity and bloodshed,
and in a significant number of cases, the trauma of domestic violence. That is strongly
related to my third problem: addiction to alcohol and drugs.
These problems are made worse by the almost complete absence of basic health
education. I met many people who still believe that malaria comes from eating bad
bananas. I met many mothers who strongly believe that they should not give any
fluid or food to kids with bad diarrhea and who sadly watch their kids slowly fade