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