Clinic on the India-Burma Border

Our first day working the Zakawthar clinic. Why is that important? Because Zakawthar is separated from Burma by a narrow river. In fact the town is contiguous with the Burmese one on the other side, and the locals cross back and forth all day without getting hassled. We can't go though, whities restricted.


Half the patients crossed the border into India to get treatment from the foreign doctors. As we began there was already a 15-year-old girl lying on a bed suffering a major anxiety attack. A few minutes after Dr. Myron began treating her the entire clinic could hear her hyperventilating until she passed out and they carried upstairs to rest in the doctor's bedroom.

The people coming in from Burma truly are in much worse shape even than the Burmese Chin who have migrated to India and live here full-time. two women came in with great big goiters, there was a man with a bandage over his deformed face who had been mauled by a bear years ago and couldn't afford to have reconstructive surgery in Rangoon. So, his face healed askew and he's been walking around ever since with a bandage taped over the part that won't heal at all. Also a little girl pale with malaria,and all kinds of undernourishment and infections.

Everything they have is something they just can't afford to avoid or fix. Simple things that we all get, but that we never see bet out of control.

The worst thing by far was the birth. In the morning a young man and his pregnant wife came in. Dr. Lopita wasn't sure if anything was wrong and hoped it was just a bladder infection. Later, we were called to their house on the hill because the girl had gone into labour. She was lying on a blanket on the floor, well attended by midwives while the anxious father (who could easily be under 20) waited in the other room. Lopita thought the midwives were doing an excellent job so we left them to it.

About an hour later they called us back because the baby had been born. We came in congratulating the mother, but there was a bad air in the room. The mother was resting, wrapped up on the floor, and the midwife sat on the bed. We couldn't see or hear the baby, it was bundled up completely in the midwife's arms.

She called us over and unwrapped the child to show us. When I saw it I thought it was already dead. it was born at least two months premature, and it was the size of a skinny little guinea pig. It's skin was grey, it's eyes were shut and its mouth was dry and open. I thought I was looking at a dead body.

Outside the room Lopita said she couldn't tell if it was alive or dead, but the midwife assured her it was breathing, a little. Dr. William, the Burmese Chin physician we're working with at the clinic, brought a steroid injection to force the baby's lungs open. When he stuck the baby's thigh, it flinched, just a little, giving us hope it might survive the night. But Lopita said there was no hope it would last longer than that, and maybe William only gave the injection to make us feel better. It did indeed die in the night. 

Mizo Orphanage

Today was the eight-hour drive back to the capital of Mizoram. The road just went around and around...and around. The curves and bumps would never, we were exhausted and the drivers floored it. All drivers in Mizoram floor it, and that's not a generalization. They also like to pass, and since the entire road is a curve, on a cliff, that's dangerous driving.

At 3:00 we stopped at a roadside orphanage that takes in the abandoned from all over Mizoram, and even a few states nearby. The place was hopping by the time we arrived, with children running around outside and doctors running around inside. This is a terrible orphanage, the worst I've ever seen. But the staff try.

The entire place smelled of urine, the children were filthy, and disabled and retarded people abandoned by their families hobbled among the crowd of orphaned children. Inside one big room near the entrance was a child, maybe 12-years-old, laying on the floor and propped up on its elbows, with its crippled legs twisted uselessly behind. I couldn't tell if it's a boy or a girl, and didn't find out later that it is a little girl. The name is Rua, her hair is cropped short.

Rua was excited to see us and tried to pull herself closer when we walked in. Her arms seem strong enough but she doesn't have any means of getting around beyond the distance she can drag herself. She is just left to lay on the concrete floor in that room with splinters of wood to play with. She can't talk either, all she can say is "bee," and the meaning changes with how loudly and excitedly she can utter her word. It seems terribly lonely in there for her, in that dirty concrete room. I knelt down and began taking pictures of her face to turn the camera around and show her the photo, which she loved.

"Bee? Bee! Bee!" I couldn't take enough to satisfy her. Finally I had to leave to photograph the doctors and other orphans, but I felt terribly leaving her alone in that dog kennel, still wanting company and unable to follow. "Bee? Bee?" I went back in again and again.

There are others there as tragic as Rua, and others who are smart and healthy, eager to practice their English, and just as tragic for being thrown into the mix. The youngest is a preciously stunned four year old in a crinoline dress. The oldest is in her 80s. the old ones are the retarded ones. Too ill and embarrassing for their families to keep. One old woman, barely four feet tall, wanders around with a doll strapped to her back the way women strap babies on. A man with Downs Syndrome groans and points to a rotten black tooth at passers by.

Since there were too many volunteers to work the clinic, I got to photograph the entire time. It didn't take long for the abled children to get the nerve to ask for a picture, and of course to immediately go nuts to see how it turned out. Kids are always beautiful , but I felt sorrier than usual for these ones. They're so poor, and with only three staff members surely they really only have each other. They were dirty but obviously dressed in their best for our visit, with all the little girls' short hair pinned away from their faces.

Those who could speak English did, even if only to tell their name in a complete sentence. Those who couldn't strained to show how excited they were. They crowded in, led me around, sat me down and petted my hair and arms. Then they noticed my white skin against theirs and hurried off to find the darkest-skinned man there, and held our arms together in comparison. They unbraided and rebraided my yellow hair, thanked me, hugged me, lined up to give me five and get their picture taken all over again. It was terrible, because we had to leave them. 

When the doctors were finished checking everyone, the staff begged us to stay for supper. Dr. Myron refused repeatedly, and told us it was wrong to stay because we were in a hurry and the children needed the food that would be served to us. He was right on both counts, but once we saw the banquet they prepared we all knew it would have been another tragedy for that place if we turned our backs on them without eating.

They didn't eat. The children were sent away and the staff watched us. What a spread. They gave us food we hadn't seen since we left Canada, and much too much to feed the 11 of us. Apples, pineapples, pudding, fried chicken, sliced bread, cheese, nuts, chocolate bars—they had everything, for us. It was a terrible meal, knowing how much anticipation had gone into it, and how much they should eat it instead and how much it would hurt them if that happened.

Two ancient women had their beds behind the table. As we ate they petted our shoulders and motioned to their mouths for us to share with them. At the end we had cleaned our plates but the food left on the platters barely looked touched. We gave the orphanage some money, and the clothes we could spare. The pastor who runs the place told us about his ambitions to add a chapel, which is the last thing the orphans need. We drove away in the dark.

Dr. David

Dr. David has a soft business card with his entire Burmese name on it and his parents' address. He is 26 years old. He became a doctor about a year and a half ago. The rule in Burma, if you become a doctor, you work where the government tells you to work for three years. Then, I think, he can apply for a passport. Where the government tells you to work can easily be someplace horrible, for (I think) a horrible wage. Dr. David didn't want to work where they said, and began to look for a job with an NGO, of which he says there are many inside Burma and they pay well. Against the odds he decided to go to the fringes of his home state, working for a Canadian NGO on the India side of Burma's Chin state border. 


He's the only medical staff in the clinic on this growing border town. It grows because it's contiguous with Burma's town across the river. Burmese refugees are still relatively welcome in this part of India, so they cross the border to contribute to the population, and as traders, casually smuggling Burmese goods all day long (especially alcohol, since the Indian state of Mizoram is dry). 


Dr. David is very soft, shy. He is tall, and still young-looking even for a 26-year-old Asian. Asians on the whole look young for a long time. They just do and we all know it. He is tall, thin, his hair is cut flat on top and too short on the sides, and he doesn't gel and spike it the way a lot of the others do. He wears glasses. If you know what Frank Grimes looks like, he looks like Frank Grimes. He's a difficult man to joke around with because he is so shy. Teasing makes him nervous. Spies make him nervous. Sometimes he crosses the bridge to shop in Burma, sometimes goes a little further in to treat people in the countryside. He hasn't had trouble yet. If the Burmese stop him he lies and says he's a government doctor. But he's worried about the spies. They cross into India as easily as he crosses out. They visit his clinic, ask questions, watch him and tell on him. They suspect him and he doesn't know of what or what's going to happen. He wants to go to Canada, or Australia, or back home to his parents in Burma. Somewhere away from this place. 


“What will happen if you go back to Burma?” “I don't know. Maybe nothing. Maybe put in jail. Maybe a few years or 20 years. I don't know because there is no law. It depends on the government.” He has a loft above his clinic, but he's too lonely to sleep there. He sleeps on the couch at the next door neighbour's. His way of talking is to smile and squirm. He's self-conscious about his nasal English because he so rarely speaks it, but his English is really quite good despite his agonizing. He gets this story out with difficulty. Not language difficulty, but shyness. Dr. Lopita tells him if he can come to Canada she'll give him a job in her clinic. Eventually he's brave enough to say something to his Canadian bosses. In all he does say to them there is an air of grasping for excuses to leave this job without angering them. He wants more money. True, he deserves more. He only makes about $400 dollars a month. Good enough in this town but not good enough to send any home to his retired parents, and not as good as he could have made with an NGO on the inside. The organization can't afford to pay him like a Canadian, but he deserves at least $1,000 a month, even if that is twice what other professionals make in town. They give him a raise, $500 a month. Next, he says he doesn't feel qualified. He's such a new, young doctor. If only he could return to his home town for another two years of training. Then he will come back. He knows other doctors from his graduating class who might replace him. They tell him wait, bide your time, it took long enough to find him. What if you don't come back? Just stay a little longer. Maybe they were on to him.

Zokawthar, Day 1

Finally, a little action. Within 15 minutes of opening the clinic the building echoed with the sound of a young woman's obscenely laboured breathing. What made her do that was a mystery, but it didn't matter because it stopped, abruptly. Immediately after that the curtain around the doctor's office blew aside and the unconscious girl was carried upstairs. 

“Put her in Doctor David's bed upstairs so she's not in the way.”

“What was wrong with her?” we asked the Calgarian doctor who decided to conclude the check-up when his patient passed out. For the sake of accuracy, I have to admit we asked him that night.

“She's having panic attacks and hyperventilating. When I tried to get her to breathe in a paper bag she got scared and stopped breathing altogether. So I thought, 'uh oh.'”

“Why is she having panic attacks?”

“I don't know. She lives in Burma, so, stress.”

This was the first day in the Zakawthar clinic; the closest you can get to Burma without leaving India. Most of the patients had walked for hours from inside Burma to be seen by visiting Western doctors on the India side of the river. This group of Canadian doctors ran health checks in half a dozen villages in the area over the past week, but most of those villagers had left Burma years ago and live permanently in India now, so they're sick, but not Burmese sick. Zakawthar is the Indian side of a town centred precisely on the border, where Burmese (Chin, to be accurate) cross back and forth all day to sell cheap Burmese goods on the other side.

The two halves of the town are connected by a dirty iron bridge painted red in the middle to mark the borderline. On the Indian side is a thatch hut with two guards paralysed with boredom, since Burma wouldn't dare. Across the bridge is a more elaborate check-point manned by Burmese guards, identifiable by their buzz cuts and leather US Air Force jackets.

The ground around the clinic was splattered red with betelnut spit. Betelnut is a stimulant, chewing wads of it is so popular in this part of the world that enclosed spaces generally reek of it and even teenager's teeth are stained red.

It was a good day in the clinic for voyeurs of medical curio. After Panic Attack came Bear Guy, a man who had been mauled by a bear years ago but who couldn't afford reconstructive face surgery in Rangoon. Since then much of that side of his face has healed into a purple misshapen lump. Once a week he changes the gauze that protects the skin that refuses to heal. 

There were a few goitre ladies, a little girl pale with malaria, starvation-soft hair and pierced ears, 80-lb old ladies and productive coughs. Unfortunately, for the voyeurs anyway, we missed the guy whose butt cheeks were melded together by untreated syphilis scars. He was in last week. Gross.

Very gross. But the majority of patients were just tired and hungry. They needed vitamins and aspirin and TUMS. In the morning volunteers and interpreters fought off fatigue by exchanging courtesy questions about family, in the afternoon by genuinely cracking jokes.

Around two o'clock, three of us, Dr. Lopita from Toronto, Zoey the Geisha-faced interpreter, and I, were called to the house on the hill to see a woman in labour. Woman, or teenaged girl, not important. She was well, the midwives were skilled, and we were only taking up space in the little plywood house. “Call us again when the baby comes.”

Around five o'clock the crowd was thinning and the sky was dimming. I slipped around the curtain and into Lopita's office. Her and Zoey were chatting softly, really just waiting for it to become too dark to work. Zoey's tiny Betty Boop lips were stretched over a piece of chaw lodged in front of her bottom teeth.

“Zoey, what are you eating?” She giggled and threw a pack of powdered betelnut on the table. “You should know better!” She giggled again and crossed her legs.

“You want to try?” Of course. Of course I want to try. She split the pack between Lopita, whose Indian heritage accustomed her to betelnut long ago, and the one who doesn't even like to drink. That's me.

One new to betelnut, especially in its potent powdered form, will suffer from an urgent desire to hork it as far and fast as possible out of their mouth. Then to go drink from a hose. Bitter, nasty dry stuff that sticks all over the mouth. My face blushes and contorts wildly even with mild discomfort, so my reaction now sent Lopita and Zoey into hysterics.

“Spit out! Spit out!” laughed Zoey. No, never. I'm tough, I can't take it. I squeezed my face to keep

myself from gagging and shook my head. When I stood up to go back to the waiting room I was introduced to the true power of betelnut.

“Oh god I'm dizzy. Zoey, I think I'm high!” They were laughing so hard by the time my knees gave out that the doctor in the office banged on the wall for us to shut up or share. I staggered back to the waiting room and collapsed into the chair. While I tried to scrape all traces of betelnut out of my mouth into the garbage can at my feet, Chester, who is from the '60s, counselled me. “Chester I'm high.” He agreed. “It's a stimulant Suzy, like mild cocaine.”

“I don't think this counts if I did it by accident...Oh jeez Chester, these Chins are all high.”

“Yeah,” he grinned. “Didn't you know?” Until that day I was proud to have never experienced a chemical high. Now I have to find something else to feel superior about.

The midwife raced back in, the baby was born.

“Wait for me, I need you two to help me to walk.” Every time either of them looked at my situation they began to laugh again, which made our hike to the house on the hill a giggling stumble. We stomped through the door, laughing and wiping away tears and holding me up until the world stopped spinning.

But there was a bad air in the room. The mother was resting, wrapped up on the floor. The midwife sat on the bed. a silent bundle of blankets in her arms. She unwrapped the blankets to show us. I thought it was already dead. It was least two months premature, like a skinny little guinea pig. It's skin was grey, its eyes were sealed shut and it's mouth dry and open. The midwife leaned this tiny body toward my lens so it would be easier for me to take a picture, which made me feel guilt-sick.


Outside the room Dr. Lopita said she couldn't tell if it was alive or dead, but the midwife said it was still breathing a little.Dr. David agreed to bring an injection of steroids to force the lungs open. When they stuck the needle in the little baby's thigh, it flinched, and gave us hope that it might survive until tomorrow. But Lopita said there was no hope it would last longer than that. It did indeed die overnight.