vinaysansborders

2006-10-28T07:47:00.000-07:00

NUMB3RS...

I was warned.

When I signed up for my mission with Doctors Without Borders friends advised me that the administrative and management responsibilities would consume me. Time with direct patient contact would be limited.

Then, the first ART (Anti-Retroviral Therapy) Report needed to be prepared for Bhamo. Each patient’s clinical course on ART, since the start of our program, needed to be documented and analyzed. I debated whether to pass the task onto the unsuspecting Expat coming to replace me in a month or so, or to bear the inevitable frustration of trying to make sense of files from years ago.

As I dug deep into the patient charts, gaps in filing and record keeping were uncovered. Slowly, painstakingly, I corrected and updated our database. At the end of my mission, this unexpected and time-consuming report occupied most of my time and sidetracked my scheduled final activities here.

Week after week I poured over compliance, record keeping, clinic procedures and protocol, trying to put together a coherent report.

While in the clinic, between hunting and gathering ancient charts, a shopkeeper with AIDS was consulted. Polite and appreciative, he initially responded well to treatment and he took his medication regularly, though he did not follow his doctor’s advice to rest.

Our patient was frequently seen selling his wares at a local market festival into the early morning hours. The doctors insisted he slow his pace but mere words could not keep him from enjoying every minute of the festival, given his return to relative health.

His progress faltered.

We adjusted, then maximized his medication. Though he seemed to be getting by in his own way, we prepared him for skin scrapings, blood tests and a lumbar puncture.

Then his family requested a home visit.

Unexpectedly, his condition had deteriorated to the point that he was unrecognizable as the person I had seen days before. In a backroom behind his store, surrounded by relatives, we struggled to examine him in his delirium.

Following transfer to the MSF clinic, we had no more success and could not secure an intravenous line. He slipped into a coma. A careful discussion with his family followed, reviewing his limited options while respecting our patient’s privacy regarding his diagnosis.

A transfer to the relatively well-equipped Bhamo Hospital could offer this patient nothing more and would only drain the family of whatever financial resources they had. Focusing on comfort measures, the patient returned home to his family, with a promise we would support them with homecare as the days progressed.

The next day we received word that he passed away, at home, a few hours after leaving the clinic.

As I returned to the ART report, the tedium of sorting through old charts and tracking down missing information seemed more relevant. Between the lines of symptoms and diagnoses, the charts of patients I’d never seen developed personalities, families and tragic stories not to be forgotten.

2006-10-10T20:25:00.000-07:00

Family Ties…

Communication with family is always a concern when leaving for an extended period of time but I felt comfortable that I could always be reached, if necessary, through MSF.

A few days after my arrival in Myanmar, as I recovered from an illness that made me wonder if I would be able to continue my mission, I received an e-mail from Canada. It reminded me to contact my family, as they hadn’t heard from me. It also explained MSF was to be called by my family in emergencies only and my parents would be informed if anything were to happen at any point. The e-mail also explained that parents often contact MSF about volunteers, especially parents “of Indian decent”. A general e-mail reminder had classified me as “of Indian decent” with all the unknown behaviours associated with this new label.

I could not access my email in Myanmar and by the time I saw the printout it had passed through the hands of most of my fellow Expats. The international volunteers here are dedicated to working with various populations regardless of classifications used to divide people. While I felt isolated from Canada and scrambled to arrange alternate methods for urgent communications, I found myself having to defend MSF-Canada and explain the e-mail comments to my new colleagues in Myanmar.

Recently a close relative was severely ill in Canada and I wondered if signing up for my mission precluded me from being present to support my family. Following my instincts, I made the decision that if any possibility existed for me return to Canada, I would go.

I spoke with my supervisor and within 24 hours I purchased a ticket and was on a plane headed for Toronto. No explanation was required, it was a matter of fact that I must go home, and the only question asked was how much time I needed, the other details could wait for my return.

In the field, people are placed together like pieces in a puzzle, forced to fit as a matter of function. Random connections which develop into a familial network. We all have families back home- sometimes we can be there for them, sometimes we can’t. We understand that, and that is a common bond we share.

2006-09-16T20:25:00.000-07:00

The Bhamo Zoo…

When I go out, I carry about 10 000 Kyats (approximately 8 dollars) and a little piece of paper, in Burmese, listing what I can eat. In a place where rice is the staple and meat is a close second, finding vegetarian food can pose a problem. However, most people understand the concept of vegetarianism and are accommodating.

As far as towns go, Bhamo may as well be a farm- animals are everywhere, though a lot more chickens wandered around when I first arrived.

Initially, “bird flu” caused concern and people refused to eat chicken and restaurants refused to serve it. A chicken family living in front of the AZG clinic clucked greetings to people as they entered. Despite viral concerns, no one seemed to mind they couldn’t walk 20 feet before mingling with some birds. As worries subsided, the observable chicken population dwindled and the chicken family vanished.

I also realized roosters don’t wait until sunrise to crow, as the next-door neighbour’s rooster starts up at 3:30 a.m. and continues until dawn, daily. Like an alarm clock with a broken snooze button, if he manages to stop for more than 9 minutes, his counterpart down the road fills the gap.

Snorts and oinks from a neighbouring pigpen erupt into non-stop squealing at disturbingly loud levels. Lasting over 30 minutes, scattered into the mayhem would be a slap, a whip, a shuffle and a cry. As the noise continues, annoyance becomes irritation and then disturbance at what could possibly be happening on the other side of that fence.

Oxen pull carts, right behind air-conditioned buses, while cows walk single file along the side of the road, without a farmer in site. Seeing animals wander here and there, causing their little bit of chaos, is part of Bhamo’s charm and closes the gap between animals and the dinner plate; nothing here is hidden away in factory farms.

I looked forward to going to Goa for vacation, for a dose of animal rights, environmental well-being and healthy diets at the International Vegetarian Union meeting.

The conference, however, took an unexpected turn on its second day. In addition to animal welfare, a look inward challenged me to adopt a “vegetarian-attitude”.

Non-violent in thought and behaviour, a “vegetarian-attitude” encompasses the environmental and humane impact of our actions. Only examining the food we eat seemed passé, a “vegetarian-attitude” involved every aspect of our lives and our interactions with others.

One of many interesting concepts emerging from the conference, I carefully packed my budding “vegetarian-attitude” as I headed back to my Bhamo Zoo.

2006-09-03T20:25:00.000-07:00

No, But I Saw the Movie…

As I biked to work one morning, a semi-retired hospital physician pulled up beside me on his motorcycle and “requested” a meeting with me. I wasn’t sure what the meeting was about, but I was sure I couldn’t decline.

I made myself available.

His pretext of being interested in foreigners and my life story was revealed when he willing accepted a 30-second summary of my life and directed the conversation towards medicine. Putting patient care first, he wanted to ensure continued co-operation and understanding between the local physicians and AZG.

I knew there was another purpose to the meeting, but this was an unexpected development.

The doctor, who spent his early years practicing medicine from the back of his motorcycle, described the personal war he took up against HIV. He passionately spoke of his years of commitment and dedication towards solving the HIV crisis and somehow equated that to my 9-month mission here.

He pressed a book into my hand.

"You will understand this," he said.

It was “City of Joy” by Dominique LaPierre, a story about humanity and hope in the slums of Calcutta.

“Have you read it before?”

“No, but I saw the movie,” I said, unintentionally revealing he may have over-estimated me.

“Oh, yes, there was a movie. I can not remember that actor.”

“I can’t either,” I said. “Patrick Swayze,” I thought.

“You must read the book, anything is possible,” he continued. “You can return it in 1 week?”

Explaining I was going on vacation, I gained an extension.

The book was interesting, slightly melodramatic at times, but fascinating in its perception of Calcutta's slums. The lifetime of dedication the lead character put into his work was remarkable, and certainly the book revealed an entirely different tale from what I can recall of the movie.

What really struck me, however, was the hospital physician chose to share this particular book with me as a bridge to mutual understanding.

As I progressed through the novel, the story developed an additional layer- the inspired determination of a Burmese doctor in Northern Myanmar, taking on a problem so much bigger than himself.

2006-08-27T20:25:00.000-07:00

Right Behind the Rain…

Late May to early October is “Rainy Season” in Myanmar. Until recently, the rain was largely limited to sun-showers and early morning downpours, hardly interrupting my daily routine.

Then the rains came.

At 3 a.m. I awoke to a violent pounding on the roof. Louder than sirens or jackhammers, the heavy rain penetrated my dreams and pulled me into reality. There was no sleep. Each flash of light lit up the night sky, followed by a thunderous explosion that rattled my body, my bed and the entire house. This is the power that flattens homes and topples trees.

Hour after hour, the rain poured down. Awake and exhausted in the morning, I waited for a break in the storm to make my way to work, but the rain continued without hesitation. Finally, I decided to make my way, Burmese-style, to AZG. I rode my bicycle in the pouring rain, balancing an umbrella against the wind with my left hand while my right hand clutched the brake, not really certain the brake would work if needed.

For AZG, this can also be called “Malaria Season”, as the mosquitoes are not far behind the rain. Our malaria clinics are overwhelmed with feverish patients coming in for diagnostic blood slides and free treatment. For many, a short, simple course (of Artesunate and Mefloquine) is effective in reducing the high rate of illness and the many deaths from malaria. The rewards of curing a case of malaria in a matter of days compliments the rewards of the intensive, long-term management for people living with HIV and AIDS.

When the rain comes, within minutes temperatures drop by 10 degrees. Without air conditioning (or sometimes, electricity), the hot, humid weather often exceeds 40 degrees Celsius. The rain brings relief, though short-lived, as within an hour after the rain the sun returns in full force, evaporating any evidence that the rain was here.

As the sun and the rain take turns with each other, Myanmar comes alive. A hundred shades of green colour the landscape, brilliant and beautiful, and the crops shoot up, ensuring a bountiful harvest to reward the farmers.

With the destruction and illness that follows the rain, the only thing more devastating would be if the rains did not come.

A comforting thought, as I put on my damp and moldy clothes, for another day in Myanmar.

2006-08-18T20:57:00.000-07:00

Lost in Translation...

One day, a telephone stand appeared in front of the staff house. Once established, it could serve as an observation point for one of the town’s sources of curiosity- the AZG staff. Though the attendant mostly sat in the shade, reading a book, a potential problem existed and, as the “Expat”, I looked into it.

The telephone stand was connected to the staff house's phone line. Previously, a storm damaged our phone line and the house owner refused to pay for repairs. The AZG staff managed without a house phone, only to have the owner reconnect the line, for public hire.

Initially, the owner agreed to move the telephone stand away from our house, but 2 months later the attendant sat below a tree reading yet another novel. Local rumour described the owner, a well-known engineer, as indulging his daughter’s efforts to start a business with this telephone stand.

In our search for the owner, we arrived at his house and met his daughter who stated she was authorized to discuss this matter, on her father’s behalf. About 22 years old, petite and soft-spoken, she found chairs for all of us while she remained standing.

Through the translator, I explained my need to consider the safety of AZG staff, the security of our supplies and respect for the lease, which does not mention a business at our doorstep.

Head slightly bent forward and hands folded in front of her, she explained the telephone booth will be moved in one month, and some of our rent money will be returned. A quick and pleasant end to the negotiations, I thought, and an offer to return some rent to compensate AZG for our troubles!

I did not understand that our unused rent money was to be returned in one month, when we are thrown out of the house!

In my mind the issues were settled, but a sudden rainstorm trapped us in her house, making small talk. I asked her if she was managing our house, as well as the telephone stand. Her voice rose slightly, tone a little firmer. The interpreter conveyed that her father had given her the house to manage, as she feels fit. I congratulated her, stating it is pleasant speaking with her and I looked forward to our future dealings. As my words were translated, the confusion on her face puzzled me; perhaps it was inappropriate for her to accept the complements.

My Burmese housemates accompanying me looked equally confused, but later applauded my strategy; as her attitude became more “rude” and her veiled threats became more obvious, I became more polite and complementing. Her words intended to anger were deflected by courtesy, causing frustration and confusion. A brilliant tactic on my part, if only I had known what was going on!

Still unaware we were to be homeless in one month, I praised her father’s sculptures and constructions around the town and encouraged her own business endeavors as a young female entrepreneur. Through the interpreter, she explained she is opening a home décor store, the telephone would move into that shop.

A lofty idea, Bhamo’s small middle-to-upper class community could hardly support such an endeavor, but it was not my place to discuss demographics. Her dream and her father’s money have little to do with me.

As the rain continued its heavy downpour, I asked her when she planned on opening her store. The translation, “in one month”, seemed a little unrealistic. Continuing the conversation, I asked her where the store would be located.

The interpreter flatly replied, “In our house.”

I looked at the interpreter, confused. There really wasn’t enough room in the house with five of us living there.

Then it dawned on me.

Suddenly, the small talk became nonexistent, and the pounding rain consumed the silence.

With my final words, I confirmed the telephone booth would be moved at the end of the month and we graciously accepted some umbrellas and left, all of us looking a little baffled by what had just occurred.

2006-07-26T20:57:00.000-07:00

This Child…

Orphaned, when HIV claimed both her parents, a small child of 5 years is raised by her grandmother. Battling HIV herself, this child survives with life-saving ART (anti-retroviral therapy) to treat AIDS. The impact of MSF on this little girl’s life is not lost on her, as she is determined to become an AZG doctor when she grows up, just like the role-model she found in the female physician managing her treatment.

Our patient finds joy among her difficulties. Privileged to attend school for the first time in her life, she studies hard, takes extra tuition classes and reviews her books at bedtime, charting a path to achieve her medical aspirations.

In her grandmother’s struggle to care for her grandchildren, she attempts to make enough money to keep them clothed and fed while grieving the loss of her daughter. In her retirement, she did not expect to be caring for small children alone, particularly not a child with chronic illness. Tearful and distant, the grandmother quietly recounted the unexpected turns in their lives.

As the grandmother relayed their situation, the child sat still on a little stool beside the doctor. No cries or tantrums, I felt my heart break as I noticed her silently weeping, making efforts to hide the tears she could not stop, before her doctor would notice.

Love and duty, expectation and burden. This child understands too much of these things for her age.

Realizing the world is not fair, she makes the most of the limited opportunities in her life, rising above the labels she is given. Perhaps naïve, her dreams keep her motivated. What lies beyond her grasp will be obtained through determination, and her determination gives her strength.

20 years from now, it would be truly remarkable if this child beats the odds and begins working as an AZG doctor. Keeping dreams alive.

2006-07-03T20:57:00.000-07:00

Rose-Coloured Glasses...

I lost the pair of cool grey clip-ons that came with my glasses a few weeks before I left Canada. I hastily replaced them with a dusty-rose pair of shades I obtained for free, saving me $79.95 (plus tax). A freakishly odd look in Canada, the red tinted sunglasses on steel blue frames assume an oddly fashionable look in Burma.

The dusty roads of Northern Burma prevent me from wearing my contact lenses, so my glasses with clip-ons remain fixed to my face as I travel to our field sites. My shades add a welcome touch of red to the brilliant blue sky, the magnificent green fields and the bright yellow sun. A passion is apparent in the people as they work the roadside, building curbs and planting castor plants.

Another beautiful day in Myanmar approaches perfection as my sunglasses draw the colours of the landscape together in unity.

The beauty is in sharp contrast to the harsh reality on removing my shades. The sky, land and water seem at odds with each other as the blazing sun in the cloudless sky leaves the trees struggling to remain hydrated. Villagers battle the elements while balancing water, wood and babies on their shoulders, the weathered faces revealing tales of hardship.

In Myanmar, first impressions are of perfection. Welcoming and smiling, hard-working people who take little for granted in life’s journey. A slow, comfortable existence that hypnotizes as it draws you in.

Illusion gives way to reality. Burmese people struggle forward daily, coping, as they must with life’s challenges. Largely protected from the eyes of the West, my time in Myanmar provides the opportunity to see and understand this land of stark contrasts, and the greatness of its people.

An undiscovered paradise.

2006-06-25T01:16:00.000-07:00

Full Circle...

An e-mail originating in Africa took me back over 10 years, to Zambia, when I worked on an HIV & TB research project. The e-mail described the devastating impact of HIV/ AIDS on a community.

In Zambia, I worked in the relatively rich, well-equipped hospital of a copper mining company. However, the equipment to diagnose HIV and medication to treat AIDS was still too expensive to consider. Illness and death was surrounded in secrecy, suspicion and fear. As debates raged between preventive health education and community morals, HIV left families of children without parents.

Strangely, I find myself in the context of an HIV & TB project once again, with differences as striking as the similarities.

The crisis I witnessed in Zambia has not developed in Burma, perhaps due to foresight and early intervention. Heath education focuses on decreasing the spread of disease and early diagnosis, with educational, government and religious institutions receptive to the long-term benefits knowledge can provide communities.

Treatment of AIDS and HIV related illnesses is available in simple fixed-dose combination drugs, provided by MSF to qualifying patients. Dramatic changes are evident with the addition of anti-retroviral therapy (ART), returning some AIDS patients to remarkably high levels of functioning. Seemingly insurmountable challenges of costs, supplies and continuity of care continue to be addressed with vigor.

My experience in Myanmar is, in some ways, the unanticipated sequel to a story that started in Zambia. It brings resolution to experiences that could not occur through reading statistical reports on survival, death and numbers of patients treated.

Across time and space, questions find answers, need finds hope.

2006-06-08T04:40:00.000-07:00

Talk Talk...

This entry could not be posted.

2006-05-23T04:40:00.000-07:00

Ants Marching...

A battle rages in the kitchen, over the ownership of food.

Initially harmless, ants crawled along the edges of cupboards and shelves, steering clear of my stores, apparently driven by a higher purpose. My food, packaged or wrapped in plastic bags, was protected. We lived in harmony for weeks, if not months.

Then they struck.

In one day my entire cupboard came under attack. First, some salty snacks carelessly wrapped in a plastic bag. Then biscuits, in a supposedly airtight container. Later, as I prepared my dinner, I saw the tiny red ants popping in and out of small pores in the noodle packaging.

I sorted through my supplies for noodles that had been spared and noticed a thin scarlet line marching towards my peanut butter! All the way from Canada, peanut butter is a treasure not available in Bhamo. If the ants wanted to break me, this was the path.

The lid of the peanut butter was only slightly ajar, and the fiery line climbing up the bottle and disappeared under the lid. For a fraction of a second I wondered how the ants had managed to move the lid, but I quickly pulled myself back to reality.

I unscrewed the lid, hoping the ants hadn't yet penetrated the contents of the jar. Following the spiral grooves to the top, my sticky, delicious taste of home was littered with clumps of glowing crimson organisms slowly trudging their way through my muddy, foreign treat. The bottle went into the garbage, with a quick check to ensure my sealed jar of peanut butter remained uncompromised.

Something had to change.

Peanut butter and jam, biscuits and bread in the tightly sealed cool box. Dry rations in airtight, empty pill bottles. My canned food is safe, I smiled to myself, as I moved the can opener from the cupboard to a drawer on the other side of the kitchen. They will not be underestimated this time! I was relieved, but slightly insulted, the ants showed no interest in my vegetables sitting untouched in a basket on the counter.

The cupboard was wiped down, the ants cleared out.

While at work the next day, the ants had been busy again. A commercially double-sealed bag of oats had been attacked. Again, the cupboard was emptied, wiped down and then…insecticide.

Each time I open my cupboard, my food is untouched but I am reminded of the battle raging by the thick, toxic odor of insecticide that greets me. I frequently feel ants crawling over my legs, arms or neck. I reassure myself it is just my imagination, but at least fifty percent of the time I catch a stray soldier on my skin, marching on.

I am certain the ants are regrouping, waiting for me to let my guard down, but for now, I eat peanut butter.

2006-05-06T04:40:00.000-07:00

Break the Chain...

The Prevention of Maternal to Child Transfer of HIV infection, known as the PMTCT program, is a MSF program being introduced in Bhamo. The goal is to screen pregnant women in the general population for HIV, and offer those who test positive medical intervention to prevent their babies from getting the HIV virus.

In Canada, routine HIV screening for pregnant women is offered, in Bhamo I truly appreciate the value of this program.

PMTCT can change the course of a child's life; reducing the chance that he or she will have HIV/AIDS. The MSF program in Bhamo can also offer HIV/AIDS treatment to the parents, promoting their health and ability to care for their child. Helping prevent the transfer of HIV to a newborn, and enabling the parents to effectively raise their child will have a huge impact on individual lives, families and the community.

The entire team is mobilizing with renovations, community outreach and health education to prepare for a community PMTCT program. As well, it is an opportunity to outreach to religious and cultural groups within the Bhamo community, as PMTCT puts HIV prevention into the perspective of the unborn child.

MSF in Bhamo has a reputation for helping the severely ill; our HIV/AIDS, TB and malaria programs return many people to quality, functional lives. However, stigma surrounds the clinic as being a centre for HIV, preventing many people in the community from using our services. The opportunity to prevent mother to child transmission of HIV infection can help mobilize a community into awareness and action.

Unfortunately, my time here will be over before any of the babies born into the program are definitively determined to be HIV negative (a test performed when the baby is 18 months old). However, the hope of this program is something I can carry back home with me.

2006-04-11T19:30:00.000-07:00

The Ladies in the Backseat...

A 5-hour drive to Myitkyina, the state capital, was a true Myanmar experience.

My shared taxi arrived at 7:30 am with 2 Myanmar women already comfortably seated in the back; the entire front seat reserved for me. After driving a few minutes, the driver walked out of the car, abruptly halting our early morning departure. As the cab warmed in the rising sun, the women left the taxi and vanished behind a row of buses. I eventually ventured away from the taxi in search of the driver. I found him sipping tea at the bus stand. I tried to coax him back to the car but he shuffled towards an arriving bus and indicated he needed 2 more passengers to fill the backseat. In Bhamo, taxis try to seat 2 passengers in the front and 4 in the backseat, charging individual fares for each person.

The original 2 women reappeared in the back seat as the driver emerged from the bus with 3 well-dressed women bound for Myitkyina. Suddenly, the driver and all 5 women were eyeing the place beside me. I looked at the spot beside me, no wider than an armrest, and declined their offer to buy back the “extra seat” reserved for me. Commotion erupted in the back seat; the 2 women were ejected from the car & quickly replaced by the 3 women from the bus and their packages.

Wasting no time, we parted the bus stand at 9:30, only to pause at a teashop. Clutching their purses, the ladies filed out of the backseat, heads high, each proudly exclaiming “Breakfast”, in English. Half an hour later, we departed Bhamo and I adjusted my arrival time by several hours.

The ladies in the backseat enjoyed the drive, with Burmese singing, enthusiastic chatter and high-pitched laughter. In an effort to include me in their hilarity, they leaned forward and raised their voices to shrieking levels as I pushed my earphones deeper & deeper into my ear canals. A quick glance at the driver revealed their humour was not universal, as he drove stone-faced & silent amid the laughter.

A detour and a driving miscalculation lodged our taxi in a patch of mud. The driver accelerated, the balding tires spun and our car sunk deeper into the earth, blocking my door. The ladies climbed out of the backseat, sought shelter from the sun, and nibbled on edibles that emerged from their purses. As the driver attempted to convince onlookers to push the car, I decided against crawling out of my window, to avoid creating further spectacle for the villagers.

After 30 minutes our journey resumed and the ladies interviewed me with their limited English. Their efforts revealed that I am a doctor based in Bhamo with AZG (Artsen Zonder Grenzen, the name for MSF-Holland in Myanmar). They returned to their Burmese chatter, now clearly peppered with “AZG” every other sentence. Their conversation continued for another hour and they seemed to have enough to say about AZG without questioning me further.

A security checkpoint served as an opportunity to pass around the driver’s cell phone for an unbearably long time. As we started to leave, the ladies jumped from the backseat, surrounded 2 arriving truck drivers and pulled surprisingly large pieces of rocks from their purses! The group retreated to the rest area and the ladies motioned me to follow. The rocks, apparently, were zinc and sold to make construction nails. My inquiries, however, why 3 Myanmar women dressed in skirts and suits had purses filled with large rocks for sale went unanswered.

Unnecessarily delayed by over 1 hour, I was very irritated with the ladies in the backseat for hijacking the taxi for their own business purposes. Back on course, one lady leaned forward and said “thank you”, and offered me dried fruit she pulled from her bottomless purse. I was impressed with her attempt to communicate in English, her understanding of my discomfort and her purse’s ability to rise to any occasion.

Silence followed, occasionally broken when one of the ladies belted out a line from a Burmese song, however, each attempt failed to invoke a chorus. 8 miles from Myitkyina, a flurry of activity consumed the back seat and commanded the driver to pull over. The ladies scurried across the street to the open-air market, for dinner. With only 8 miles to Myitkyina, I approached the driver who didn’t understand my words but knew what I was saying. I negotiated for him to drop me off in Myitkyina and return for the ladies. Though I sensed temptation in his eyes, he just looked down and shook his head.

I arrived in Myitkyina more than 5 hours later than expected. I jumped out of the taxi, grabbed my bags and waved a quick farewell, as I fled the ladies in the backseat.

2006-03-30T20:05:00.000-08:00

I Am Here...

A cool breeze greeted me in northern Myanmar’s rural township of Bhamo, offering me respite from Yangon’s sweltering heat. This section of the Ayeyarwady River holds 35 000 people, as it courses over 1000 km south to the capital.

Bhamo is busy with teashops & roadside vendors, with bicycles & scooters weaving around horse-carts and roaming farm animals. I felt relieved to unpack my bags in the house I share with MSF’s national staff, settling into the place I will call home for the rest of the year. Within days, intermittent electricity, absent phone lines and cycling to work have become my norm.

Practically, the MSF activities in Bhamo continue with or without my presence. As the only expat on-site, I am involved in the project’s functioning across the medical, administrative and logistical areas. Each day brings more knowledge about medical supplies & ordering, human resource issues, monthly & quarterly reporting and computer databases. With the expanding awareness of my role in Bhamo, I realize the learning curve will continue on its incline.

My first day in the clinic, a national doctor and I sorted through a patient’s complex case of acute and chronic illnesses. We balanced history & physical examination with diagnoses & treatment options and developed a management plan, as in any other clinical encounter. With this patient, however, I moved from being an observer to a participant in this foreign land, and it signaled my arrival in Bhamo.

2006-03-16T02:35:00.000-08:00

Discovery, that intention cannot find...

Myanmar welcomed me with beautiful, warm weather, which quickly turned scorching hot. The dusty roads are a little too narrow as they try to accommodate cars, bicycles, trishaws and pedestrians. I am still quite disoriented in Yangon, but the friendly and helpful people have helped ease the transition, with a smile.

With MSF, nothing is ever set in stone. Adjustments are made as situations are constantly evolving. After 2 weeks of uncertainty as to when I would leave for Rakhine State to join my team, my work was reassigned to Kachin State in the town of Bhamo. I will be the only Expat in this region working with the National staff on an HIV/AIDS and tuberculosis program.

While I wait in Yangon, I am attending several of the clinics, trying to learn as much as possible about the treatment and protocols for the various illnesses seen in Myanmar. There is some overlap between medicine in Canada and Myanmar, but the treatment options are not always so clear. Social problems and the stigma associated with HIV have a powerful impact on the management of illness, and an essential multi-disciplinary team helps address these issues for each patient.

Eager to enter the field, I value this experience for what it is. Navigating with fate and flexibility, I follow a path of discovery that intention cannot find.

2006-02-28T04:49:00.000-08:00

Beginnings...

The call for Myanmar (Burma) arrived. I will be in the west, Rakhine State, working on an ongoing malaria project. Though I knew the day would come, I still found myself rushing to complete last minute details, as usual.

As I attempt to prepare for a life I have never known, in Myanmar, I will miss the life I have always known in Canada. Communication will be infrequent as access to telephone and internet is limited in Myanmar. It will be strangely quiet and liberating to be out of the earshot of cell phones and pagers for close to a year.

The cancellation of my initial mission last November allowed me to welcome a beautiful new niece into our family. In the few weeks at the start of her new life, I watched my niece grow & develop, and saw her wonderful personality begin to take shape. Whatever I can accomplish while on my mission with MSF, my hope is it will carry forward in some small way to improve our common future.

Briefing in Amsterdam was quick, with a lot of information. Fortunately, the PPD in November had previously introduced much of the information. In Myanmar, updating this blog will be difficult, due to limited internet access, and I will have to ensure "blogging" is not counterproductive to the safe continuation and goals of the project.

2006-01-19T21:00:00.000-08:00

Sitting, Waiting, Wishing...

Returning to Toronto, I had a quick re-entry into life in Canada. Work, Christmas, ice storms and election fever. A shoot-out on Yonge Street during peak Boxing Day shopping claimed the life of a young woman. It shocked the city into remembrance & into protests of the escalating gun violence gripping the city. Another young life lost as she innocently followed in the carefree footsteps of so many others that day.

Ugandan Betty Bigombe was recently interviewed by George Stroumboulopoulos on CBC's "The Hour". Noted for her efforts to mediate peace in Uganda in 1994, Betty moved on to work for the World Bank in the USA. In the wake of a massacre of over 200 Ugandan villagers in February 2004, Betty put herself back in the line of fire and returned to Northern Uganda. Betty is a uniquely accepted mediator between the Lord's Resistance Army leader Joseph Kony and Uganda's President Museveni. Maintaining dialogue between the two sides & protecting fragile cease-fires, Betty's skills in diplomacy are impressive, she even managed to slow George's passionately rapid opinions. An inspiring story in the context of unimaginable and horrific crimes against humanity, I welcomed the coverage of this forgotten war on "The Hour".

My work in Uganda was cancelled, due to increasing security issues in the area. Initially disappointed that my Ugandan plans did not materialize and eager to start my volunteer experience, I found myself once again waiting for news of a project.

I am to go to Myanmar (Burma) in a project focused on the treatment of infectious diseases (HIV/AIDS, tuberculosis, malaria etc...). I am waiting for a Letter of Invitation & Visa from the Myanmar government. No one is quite sure when the documentation will arrive, but once it is obtained I will be leaving Canada within a matter of days.

Patience.

2005-12-04T19:09:00.000-08:00

Detour via Prague...

Ready and waiting for news regarding Uganda, I decided to stay in Europe rather than return to Toronto. My eyes settled on Prague, a beautiful and historic city in Central Europe, a sharp detour from my intended course of travel.

Arriving in Prague, it was difficult at first due to my lack of knowledge of the Czech language. Not knowing how to buy a bus ticket, exactly where I was going or how to get there. It was frustrating trying to interpret well-meaning people's hand signals to form instructions. Eventually, after a day or two, and many wrong turns, I managed to get an idea of how to make it around the magical city of Prague.

A view from the Charles Bridge, with St. Vitus's Cathedral in the distance.

The Gothic architecture is stunning and intricate. The beautiful open air markets, narrow cobblestone roads and warm cafes made Prague a unique place to discover. I gradually learned how to make it around the city without too much difficulty and with a few helpful strangers, and there were a great number of tourists exploring the city, despite the bitter cold.

American franchises were abound in Prague- initially comforting in their familiarity, they began to disturb me as I attempted to appreciate the true Czech culture and atmosphere.

As my time in Prague came to a close, I interacted with some Czech people who showed me a few of their favourite places in Prague. They were friendly, attempting to communicate in English, and I was embarrassed that I could not reply to them in Czech. They allowed me to see a bit of their lives for a short period of time, and experience a side of Prague which I could not appreciate on my own.

I was in Prague for a total of 4 days, hardly enough time to truly appreciate all the city has to offer. However, I enjoyed my visit there immensely, and look forward to a return trip to discover more of Prague and explore the rest of the Czech Republic.

2005-11-19T02:51:00.000-08:00

UGANDA: Stand-by...

An orienteering game last night placed 10 of us in the middle of a cold, dark and muddy forest. The goal was to gather fictional medical and logistical information for an MSF intervention, the test was group dynamics.

We are in Hassocks, U.K., on the outskirts of London. 38 participants, medical and non-medical, from across Europe and North America. It is an incredible opportunity to meet like-minded individuals with a broad range of opinions and experiences.

The enthusiasm is high. There is excitement to get out into the field, with an undertone of not really knowing what we will be confronted with, or how we will function.

We have created this wonderfully inclusive community, quickly forming bonds which may last a lifetime.

I am on "Stand-by" for Uganda. There has been instability in Northern Uganda and MSF is proceeding cautiously with going to the IDP camps, and sending first mission volunteers into the field. My excitement remains, though I may be sent back to Toronto, I feel remorse for all those civilians who died secondary to the increased violence.

2005-11-02T20:31:00.000-08:00

Kicking up the Dust...

After my second year of medical school I had the amazing opportunity to live in Zambia for 2 months doing research on HIV & tuberculosis. It was an incredible experience, sponsored by the Canadian Society for International Health.

I witnessed children living in poverty, on the streets, though their lives remained a mystery to me. I was very much an observer and relied on my reasoning and imagination to piece together an image of their lives. I wrote this poem, appropriately, as a naive witness to the life of street kids, as I could not bring myself to imagine the truly unspeakable suffering and struggles they endure.

My heart goes out to the children who struggle for their existence around the globe. Claiming a home wherever the wind allows them to settle, until they must take flight again...

DUST

Kicking up the dust
that coats the dry land
She speaks of a life
I can't comprehend
Running through the streets
just playing her games
She's living her life
like freedom in chains

She's seen more of the world
than a child should know
And she can steal your heart
if you let it show
Stroking troubles away
like a wisp of her hair
Her past is a mystery
she dare never share

Her roof is the sky
her home is the land
Her future is tomorrow
in the palm of her hand
Living for the moment
and the children she guides
With a watchful eye to ensure
cursed or blessed they survive

But as the sun goes down
and the shadows grow long
Darkness weaves through the places
she feels she belongs
Cast out and outcast
there's one treasure she seeks
To feel a new day's light touch
her place on the streets

But today silence penetrates
bustling city street sounds
The laughter that's missing
will never be found
"Moved on or moved up"
"Did she suffer much pain?"
No one knows for certain
but they all say the same
"She will come, she will go"
"she left room here to claim"
a space filled too soon
left by freedom in chains

Vinay

2005-10-26T21:00:00.000-07:00

Vinay Sans Borders...

There is a force pulling within me, stronger and stronger, compelling me to embark on the voyage of a lifetime.

On November 16, 2005, I leave the comforts of Toronto and head out on a mission with Doctors Without Borders/ Medecins Sans Frontieres. It is a project that I have been working towards since December 2004, though the concept has been with me for years.

As a Family Doctor in Canada, I participated in the health and lives of my patients over the past eight years. Closing my practice was not an easy decision, and at times I felt I was abandoning a trust that I created with my patients. The time had come for me to contribute my share to the global health crisis, and I was grateful to find that many of my patients understood.

It is an exciting time. Submerging myself in an environment and culture foreign to me, and learning from them. Moreover, contributing my skills to bring healthcare to those who have none, improving their lives in the most basic ways and showing them that there is a world that has not forgotten them will be an incredibly fulfilling experience. As a witness to their plight, I expect to feel overwhelmed and under-prepared, but I hope that an open mind, flexibility and hard work will get me through my difficulties and allow me to be effective in my role.

I am to work in Northern Uganda, in camps for Internally Displaced Persons (IDP). These people have been forced from their homes by conflict led by the Lord's Resistance Army (LRA) against government forces and civilians. Along with a nurse, I will support and train local staff in basic health care centres within these camps. As an MSF volunteer, I am to monitor and bear witness to the humanitarian crisis faced in this region.

November 16th I leave Toronto for Europe where I will have 1 week of Primary Pre-departure (PPD) training prior to departing for Uganda.

Vinay