Healthcare in Yangon

March 1st, 2013

Yangon, Myanmar

Song of the Day: I Can't Help Myself (Sugar Pie Honey Bunch) by The Four Tops

Mood: Excited to start the next leg, sad to leave my family

Healthcare in Yangon

In the fall, I am starting at Wharton to earn an MBA with a special focus on healthcare management. I want to expand my knowledge base about healthcare delivery while I travel and a new friend, the Motherly Anesthesiologist (M.A.), generously connected me with hospitals and doctors in Yangon.

A hospital created to serve foreigners and well-off locals

The church clinic

Churches here deeply care about the needs of the community around them. The leaders of one of Yangon's churches determined the most pressing need for their community was access to affordable healthcare. As a result, M.A. and the Physiology Professor co-founded this clinic 10 years. Now, it treats 9,000 patients per year for an equivalent of ~$12,000.

Meeting the Physiology Professor and the Motherly Anesthesiologist 

These two amazing women started the clinic. At age 75+ they remain active in teaching and helping others. I hope to continue serving others with the same vigor when I am their age.

Even though the clinic is Christian, anyone in need is treated. Many people from different religious and ethnic backgrounds come from far away because they know that they will be treated with dignity, respect, and love.

When M.A. (in pink) found out I didn't have a cell phone,
she insisted I use hers until I left Myanmar

The clinic even treated one of the boys from the Professor's street kid ministry for free. They gave him a check-up, drove him to another doctor, took his x-rays, drove him back, gave him medicine, and scheduled a follow-up visit out of the goodness of their hearts.

At lunch after church

Compliance

In the US, patients not complying with medication prescriptions cost the healthcare system between $100 and $300 billion each year. (Source: Atlantic) Failing to comply can lead to a myriad of negative consequences such as increased drug resistance, hospitalizations, and risk of death.

We were able to see non-compliance firsthand. The boy said his medicine was stolen when he slept on the street instead of going back to the place we had rented for him and some of the other kids in the at-risk youth ministry. Even if he still had his medicine, not following the treatment protocol was a risk. Doctors say that many, many patients don't understand that they shouldn't take their entire course of treatment at once and the most important part of every appointment is explaining how to take pills.

The doctors were very clear that the boy's pain was a result of a lifestyle choice
and pain would continue unless he changed

Tuberculosis is relatively more prevalent here, especially among poor populations.
Luckily the doctors ruled TB out

The very night that we came back from the doctor, the boy made the same bad decision that caused his condition. The Professor asked the boy why he continued to do what brought him pain. He replied, "I don't know." When the Professor asked why it was bad, he responded, "Because it hurts my lungs and it makes my head funny." At least intellectually he understands the consequences of his actions. We can only hope that it will eventually lead him to change.

Pointing out the areas of lung damage 

It's impossible to help people that don't want to help themselves. It's also so hard to admit your own powerlessness when working with kids who might not have enough perspective to make good long-term decisions and especially those who are addicted to a substance. I agree with expert advice that if you're caring about others, your level of effort should match their effort, but it is still hard to wait patiently for people to want to change when you see the negative consequences.

The Anesthesiologist

The Anesthesiologist took me around to many different care sites. In addition to starting the clinic, she has had quite a remarkable life. The government used to pay for anesthesiologists to have fellowships abroad, and the Anesthesiologist was sponsored to study in the UK fifty years ago. Because her Western classmates were better prepared, she spent many, many hours studying to catch up and averaged only three hours of sleep per night. However, she succeeded and also studied at Stanford in the early '90s.

The government found that very few anesthesiologists would succeed like M.A. and stopped sponsoring anesthesiologists to study abroad. As a result, M.A. was one of less than a handful of foreign-trained anesthesiologists in the country for decades. 

In America, there are many more male doctors than female doctors and I wondered if it was hard for M.A. to be a doctor and get a scholarship as a woman in a patriarchal society. She said that it wasn't a problem in Myanmar and there is an even split between male and female doctors.

M.A. had trained nearly all the top doctors in Yangon. Everywhere we
went, she checked up on her former students and updated contact info

The woman in the middle is the head of the OR of one of the hospitals
we visited. M.A. has known her since she was a girl 

Searing loss

One of our stops was to visit M.A.'s friend after surgery. She is in early thirties and had her uterus removed two days before we saw her. She and her husband were childless and when I asked the husband how he was doing, he confessed how hard it was because now they would never be able to have children. In this culture, not having children is very stigmatized. It would be so hard to not be able to have kids if you really wanted them. The woman is a teacher and I think it would be doubly hard to work with children every day and not be able to have your own. I prayed for them at the end of the visit, and I hope that God can continue to comfort and encourage them in the days ahead.

Identity disguised to protect privacy

Making the rounds

M.A. connected me with one of the best neurologists in Yangon. He is so well known that when I was going through my pictures with a stranger at the Chinese embassy, he immediately recognized the doctor by name and I earned mad props for knowing him.

We were able to visit his clinic and see him in action:

Everyone has a unique sense of humor. This doctor loved his snow globe 

We were able to go on the rounds together:

For those who are wondering, he was wearing scrubs too,
but took them off before the picture.

"Sanitized" communal ICU slippers

Delivering care at the clinic

This girl could not be comforted

A busy day at the clinic's pharmacy

Cleaning up after oral surgery

  

Detroit and Yangon

February 15th, 2015

Yangon, Myanmar

Song of the Day: Call on Me by Eric Prydz

Mood: Grooving

Detroit and Yangon

(Source: http://detroitontap.blogspot.com/)

For all their differences, Yangon and Detroit have a lot in common:

Some of the streets have the same name:

 

Source (wikipedia)

People like similar things

On my block in Detroit, people used to huddle behind a car and shoot craps. I feel right at home here:

Yangon even has a waffle house

The best rapper is named 'Ye and he likes shoes:

 

(Source: MTV, kanyetothe.com)

Perception that light = beautiful:

One time in Detroit, I was playing Frisbee with kids from the community. One African-American kid asked me for sunscreen, and when I said I didn't have any, he wanted to stay in the shade. He said that he didn't want to get darker and that he was going to bleach his skin when he was old enough so he could look more light-skinned.

In Yangon, nearly all of the billboards and music videos show people with skin much whiter than any citizen I've met here. Many of the other places I've visited in Asia associate beauty and health with paler skin.

Many people here have told me I'm handsome. Some even go so far as to say I look like a particular celebrity. The week before I left Detroit, strangers at Panera said the same thing. You decide:

(source: teaser-trailer.com)

We ate at a restaurant in the shape of a giant duck.
I borrowed part of one worker's traditional outfit

Perception that white = rich:

In America, the average black household has a net worth of $4,995 (CNN June '12), which is probably higher than black households in our neighborhood. The 8% of my zip code that isn't African American usually lives in the nicest area of the zip code and owns the most expensive houses. Some of the few white people in the poorer areas are from my church and are resourced (e.g., doctors). They live there as a choice and not out of necessity. There are exceptions, including some of my friends, but the general rule that white people in the neighborhood are relatively "rich" covers the majority of cases.

In Yangon, the situation is similar. If you are white, you are probably a foreigner. If you are a foreigner, you could afford a plane ticket to get here. This makes you "rich" because any international travel is beyond the means of the vast majority of locals.

Street merchants informally charge a "white premium" when negotiating with foreigners. Oftentimes, especially tourist sites, the price discrimination for foreigners is formal and the fees have to be paid in US dollars. Even at tennis courts, we have had to pay five times the amount of locals.

Local currency. About 855 kyet = $1 USD.
(Note how bills for the same denomination can be different sizes)

Children struggling to thrive

In Detroit, family sizes are often large, and mothers often raise children without the support of the fathers. If the parent(s) can find a job, the pay is often low so they need to work long hours to care for the basic needs of their family. For many reasons, many children are often neglected and unsupervised.

In one extreme example, I knew a mother who drove to a party 800 miles away and left her 8, 11, and 16 year old sons home alone. During the trip, she ran into trouble with the police and will be jailed for the next couple years due to outstanding arrest warrants for past felonies. When her boys heard she was in jail, the oldest son took the family's welfare card and fended for himself. People from our church cared for the younger boys until a more permanent solution was found. Although concerned people can make a difference, there is nothing like having two loving, involved parents. When that doesn't happen, children suffer.

Our work here deals with kids in similar situations. One boy is an orphan. Another boy's family has been in jail for a couple years for suspected human trafficking and he has been living on the street. A third boy's father ran off with a woman and abandoned his family. At 14, the boy is the breadwinner for his mother and sisters. Although the Professor  buys food, secures housing, gets the boys into school, and helps them find jobs, progress seems difficult to sustain. A kid can learn the multiplication table one day and sniff glue the next. A boy can shows us he has learned to read one day, and play poker and telling us he is adamant about quitting school the next.

Looking at pictures from previous visits

He is the hardest worker and the best student

Talking about long-term thinking and job opportunities with the help of a translator

Why do we work with kids that lie, omit information, steal, and consistently make bad decisions? It's a question we often ask ourselves.

One reason is mercy. God loves humans unconditionally, and that includes the most righteous saint to the children we work with or the crackhead that peed on my house in Detroit. Even though people can be poor and make bad decisions, they still deserve dignity and respect.

Another reason is justice. Not everyone has the same opportunity, and what we are trying to stand in the gap to give these at-risk kids a chance. It may be the best chance they have.

Yet, even though we have resources, we're fully aware we can never be these kids' saviors. Unless the kids have a vision for their future and want to have a better life, there is only so much that can be done. In the same way, God needs to work in the kids' hearts for them to become Christians and experience the full and abundant lives we want for them.

The odds are against us and our success rate will be below 100%. In each case, we don't know if they will capitalize on their opportunities or become just another victim of the streets, but we are trying to do what we can to develop character and boost the odds as much as possible. 

Good people trying to make a difference

In both places, there are a lot of good people helping improve the lives of those around them. In my previous post,  I talked about the Liberator's work with World Vision. We've also met people from UNOPS and the Burnet Institute who are working to improve public health. In Detroit, our church runs a literary clinic and a sports program among many outreaches.

   

One of the good organizations here is Helping Hands. It is organized by the wife of an Australian diplomat and helps teenage boys get a basic education and develop practical skills by repairing furniture and selling to westerners. The daily operations are run by the Foreman and he also helps us help the boys. You can read more about him on the Professor's blog.

Talking with the Foreman about how to best help the kids

Creating a game plan on how to help the kids when we're away

Detroit and Yangon are very different in many ways. But, there is also a surprising amount of cultural similarities as well as a basic humanity (both the good and the bad) that unites us.

Sacrifice and Commitment

February 12th, 2013
Yangon, Myanmar
Song of the Day: A Different Moonlight by Young Mozart
Mood: Determined

Sacrifice

Education is highly valued in this culture and students make tremendous sacrifices in order to learn.

Myanmar Institute of Theology (M.I.T.) is Myanmar's top seminary and where we work

Two of the Professor's M. Div students

The Peacemaking Photographer (not pictured) is in his last year of the M.Div program. He is passionate about photography, but sold his only camera so he could raise money to pay for tuition. Once at M.I.T, he earned a scholarship and the donors also bought him a camera. He was able to use that camera at his father's memorial service. Without it, no one would have been able to record the event. Most students have no margin and give everything for the chance to learn.

Like many of his classmates, the Peacemaking Photographer couldn't afford to bring his family with him to live in Yangon. He has had to be separated from his wife and children for three years, except for major holidays. Another of my father's students is studying in Yangon while her husband is pursuing his Ph.D. in Hong Kong. Since they are both studying, she has to leave her three year old son with the boy's grandmother, who lives six hours away. As a result, the mother can only see her son a couple times per year and her husband even more infrequently. Like her Th.M. classmates, she will most likely go into teaching and coming to M.I.T is how she can best develop her ability and serve her people.

The Labyrinth Lady laughing with an Old Testament lecturer

One lecturer gained admission to a good U.S. doctoral program in '09, but couldn't go because the U.S. school had to rescind its scholarship offer due to the recession. The school invited him to reapply this year and he will go if he is admitted with a full scholarship. However, since he doesn't any extra money, his wife (and soon to be born child) can't join him in America and they will be separated for five years. The lecturer will seize the chance to get a Ph.D. from an American school because his department needs professors with more training and this is his act of service to the school and people of Myanmar. For his family, the opportunity is worth the sacrifice and separation they will have to endure.

The Professor is following up one-on-one with a student 

Commitment

Reppin' my MN Club "Minnesota nice" shirt (Venice, 2010)

In the U.S., some people are very proud of their home state (e.g., those from TX, CA, the best state - MN). Even if people identify with a particular geography, they maintain a deep sense of individuality. When my classmates and I graduated, we typically moved to wherever had the best grad program, most prestigious job, or best opportunity to serve. Little regard was given to where immediate family lived and people rarely feel a compulsion to return to "their people".

Not so in Myanmar. As a top seminary, M.I.T. attracts top students from all over Myanmar. When I ask students if they plan to return to their home state, they almost always respond without missing a beat, "Of course!" 

One reason is interdependence. Most students cannot afford the tuition payments and their home church or region sponsors them with the expectation that they will serve their home congregations after they graduate. They don't receive a pension as pastors and so they will need to rely on their children and community to support them in their retirement. It is much less secure than their American way, but it fosters a deep sense of mutual reliance, and accountability.

A second reason is ethnic pride. There are eight main ethnic groups in Myanmar and they are mostly self-segregated into different regions in the country.

My new shirt shows the 8 main ethnic groups and their respective states

The students organized a special choir with students from different ethnic groups.
Each student wore his or her people's traditional attire.

The student in the middle is Karen. He helps the Professor with
 his ministry to at-risk youth (Click for pictures of the at-risk youth)

Some of my Kachin friends invited me over for fellowship and generously treated me to a tour of their dorm (6 people per room!) and a trip to tea shop:

 

Many students come from an area currently embroiled in armed conflict. They will willingly return to dangerous places to serve their people and work for a just and sustainable peace. In classes, these students ask pointed questions about how to practically minister because Jesus' command to "love your enemy" takes on new meaning after attending many funerals. Their congregations will not be satisfied with pat answers and will look to the pastors as leaders and guides on how to act amid the conflict. I have tremendous respect for these students and they ask for our continued prayers for peace.

I am inspired by them because they understand the reality of the situations they are preparing to enter and it causes them to invest everything they can in order to be equipped to serve others. 

Practical application

Coming from the American culture, my natural tendency is to think about what I want to get out of business school. Yet, the sacrifice and commitment of the students and professors here challenge me to view business school as the privilege and opportunity that it is. I don't want to view my two years as time for myself, or even worse, as a vacation, but as a time where I can minister to others and prepare to serve my society. Our world is full of tremendous need and I want to be a leader that uses my knowledge, relationships, and opportunities to advance the kingdom of God however the Holy Spirit leads.

I officially chose Wharton and will start school in early August