Loi Tai Leng Clinic

Loi Tai Leng Clinic interview transcript with Head Medic Paw Shar Gay, February 2010

How many medics do you have here?

Here we have two medics, and the other people is me, Ba Tay is finished from Dr. Cynthia's clinic and then the other is finished the Siesta Blue training. Siesta Blue training Community Health Worker. Total staff at the clinic is 22 people.

How many patients do you get here per day?

One day is maybe 20, sometimes 30.

Are they mostly from Loi Tai Leng, or from inside Burma too?

Some people is from outside, some people is from here. But mostly IPD (In-Patient Department) is outside.

Loi Tai Leng's problem is ARI (acute respiratory infection), also skin infection is high. And rainy season is rain all the time, four months no sun. Sometimes is maybe one week or two week sun is come out. You know, our dress we make the fire wood and the fire make dry. The sun cannot make dry. And then UTI (urinary tract infection) is become high.

What do you do to help people prevent it?

Every year we plan to prevent it. Our clinic do like the home visit. One month we will going to section and home by home, give education. And then give information and vitamin A.

Do you see vitamin A deficiency here?

Sometimes we see like one year maybe one case or two case.

Do you always have enough medicine?

Enough medicine? Yeah is enough. Before the medicine did not enough and then we ask more money to buy the medicine. And the Partner did not came in here and also backpack, FBR (Free Burma Rangers) did not come in here. From outside, we take medicine here to outside and go and give the people who live outside Loi Tai Leng, like mobile team, and then our medicine did not enough.

The donor says 'Paw Shar Gay, you say every year medicine did not enough. How about this year, this is enough?' Last year he come back. And then I said, 'yes, before medicine did not enough, but this year enough.'

And then he laughing and said 'why medicine did enough this year?'

'Backpack is coming here, and then FBR is coming here and go outside outside, and same the Partner group is outside and then our medicine we use here not outside.' So here is enough for me.

Are there any backpack medics here?

Backpack medics is four, five people. Yes, sometimes if they come back from inside they coming here. If he going inside maybe two months or one month he will come back here.

Are people's gardens here big enough that their nutrition is good?

Yeah, we see now better than years before. And then we can get vegetables. Big garden (in reference to the sponsored one in the valley) but the vegetables is not enough. Some the shopping go down to Burma part and buy vegetable. Because you know here we can plant in the rainy season. This season no water. We can't plant, we have to buy outside. But in the rainy season is enough. We can buy here and sell here, in the garden. It's like, how do you say, save the money for us. But in the dry season is cannot save the money.

Do you have a computer?

Yeah. One computer is not so good. Internet if we going to the leader's house and check the Internet. But our computer is maybe five years. Is working very very slowly.

Do you see health here looks better now than when you began as a medic 14 years ago?

When I arrived here in 1999, no clinic. In 2000 one clinic. The people, the leader here is building the one clinic, like small like this, this room. We treat the villager, also the military. We treat both. And then clinic is very small, in Section 3.

At that time the people is not know about health. Not health education, they did not know about this so much. They did not know about the family planning. You know in the year 2000 we delivered 120 babies. At that time population is maybe 1,000. And now population is 2,600. More people here but the people know about the education and then they can provide and think. And this year is 42 babies delivered. Very different.

Then you know about the vaccine? Before two year, three year they don't want to receive the vaccine immunization, because the people said if they get the immunization her children is become sick and then is painful, cannot sleeping enough for the night time, because the baby is crying. Very painful, they don't want to come. The health worker is work hard, like go down and give education like this. Because immunization is very very important. But many people they also tell me, 'before we did not receive, we never receive vaccine. But we alive until now. We did not get other disease like you say.'

They ask me and then I answer, 'before is like the before. Before is the disease is not like this. So your baby, how do you say? Like, you is very old, and then you will dead. Your baby is growing and then in the future you will not see. Your baby, maybe your baby can get some anything you did not know about. If you receive the vaccine maybe the vaccine can help like the infection is coming less. Not 100 per cent. Maybe 50 per cent. Explain the parent about the vaccine. And then now, if we looking in the register book the vaccine is become improved. And many children is receive the full course of the vaccine, immunization. For me I think is improved.

And then the last one is education about diarrhoea. We need to boiling the water and then drinking. If you boiling the water, water will be safe for our life. Cannot get the disease easy like the diarrhoea, something like that. Washing the hands for you going to toilet, but if after you finish the toilet after you come back wash your hands before eating.

One man is very old, and then he ask me, because we give toilets, we have the budget for building the toilets. We ask to building the toilets and one man he ask me, 'Sa Mah,' they call me Sa Mah, 'I never believe about this because now my age is 70 and I never boiling the water and drinking the water because if you boiling the water, the water is not sweet. If you go to taking in the river and then drink, is sweet. And then sometimes we did not go in the toilet, we go in the forest. Sometimes we going pass stool in the river,' he said like this.

And then I'm about this question thinking, because I cannot answer yet. I thinking, and then I remember my Sir tell me that if you go in the community you will get many many problems. The people will ask you many questions. And then I remember. I ask that man, 'OK, you say is true. The water you carry from the river is sweet. If you boiling then is not so sweet, right, true. But at that time,' I call him uncle, 'Uncle, at that time how many household at that village?'

And then he answer me 'not so much.'

'And then you see now, many people in this village. And then if the one people going to pass stool at the river, and another people is going to pass, it will put a lot of things in the water. It will be clouding. If only Uncle you going to pass in the river maybe the river will pass stool with the river, but many people not so good.

And the pig, they did not make the pen, they did not have a pen for a pig, they will free for the pig. And then maybe that pig will go pass stool at the river. And then maybe the rabbit, some rabbit is move down to the river. And then this water is sweet. So then uncle is drinking some stool from the river, so become sweet. So that uncle not believe me. Only uncle can pass in the river, but for the other people I think it's not so good if you go down to pass in the river or in the forest. You need to build the toilet. The toilet it will save the stool and then not so smell.

The Inefficiency of Aid

Inefficiency driven by ignorance is driving Dr. Lopita mad. She came up from dinner to the room this evening hopping to tell me something Deryl said that made Lopita blush. Lopita got an 8-year-old patient today who may have a congenital heart defect. She wanted to know how the organization could raise money for the girl should she need an operation. The girl had been told before she could only have the operation overseas, which Lopita said was wrong—complicated surgery can be performed in India. Actually, India is a hub for Westerners coming for affordable quality surgery. We can send the kid to Calcutta for this. Deryl had no idea this could be done in India.

There are many things people on this trip are doing that are a waste of time and money, and which seem born of a stubborn ignorance in our group. They treat this place as if it's the ass-end of the earth, which from our perspective it is but from the locals' it's the other way around. If you look at it one way it's primitive as hell and half the people live in bamboo-wall houses. But look at it from another angle and we would see everyone has a TV, a camera phone, a fridge, an email address. While we eat they take pictures of us on their phones. They're not the end of the earth, just the other side.

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.

Bay Da

We arrived in Loi Kaw Wan in the afternoon. Once we came through town to the medic compound, we stood and looked around at things. Suddenly a tall young man running at full tilt leapt onto Dr. Semkuley and hugged him with his arms and legs. That's the most emotional reunion I've ever seen between two men. The man was Bay Da, whom everyone knows has the biggest smile since Eddie Murphy, and much nicer than Murphy's. Especially since the corners of Bay Da's mouth curve up, even when he stops smiling, which he eventually did. He smiled so much those first few days anyone would think he was the happiest man in the borderlands. Of course, his smile fell into disrepair over the next two weeks. It began with slow fractures, changing from joy at having Myron back, to worry, nervous smiling. Beaten dog smiling. Shorter smiles, frowning in between, right in front of us. It took two weeks for Bay Da to stop being formally gracious, open up, and say enough for me. Two weeks to say something to me that could make me cry. When the woman watching her mother die of AIDS in the clinic down the road only made me angry. Bay Da climbed down from the frame he and the others spent all day building to hold these mega big solar panels, so the clinic will finally have night light. We sat on the grass together and he took off his Chinese army boots, inside which his feet had stewed all day without socks. Man what a stink! Like grade C ham left under the deck for a week. I moved to sit up wind and we joked about the smell. He said I should write about how people in Loi Kaw Wan are too poor for soap so donors would send some for his feet. Then we headed off to bring the tools someplace for safe keeping.


“Sometimes when we walked in the forest for four or five...or seven days, very difficult to get clean. No soap and got very dirty.” “You mean you were in the forest for that long?” “Yes” “What were you doing in the forest for seven days?” “Hiding, from Burmese soldiers.” “Oh. You were one of those people.” “Yes.” “What would happen if they caught you?” “They want to make us porters. Porters carry their weapons and food, and big bombs. A big bomb... They burned my father.” My skin crawled. “They took cigarettes, pressed on his face. You know when cigarettes burn, and the end is red? They burned on his face, here,” he traced his finger along his cheeks, “here.” “They tortured.” “Yes, tortured. I was seven...or six. I never forget that in all my life.” Earlier we had also joked about how he would like to be president. The things he would do, notably enact litter laws. Bay Da is an environmentalist, dislikes litter, and takes the decimation of the local teak forests by the SPDC personally. As he should, the SPDC are raping his people in order to rape his land. Anyway, his president talk ends with a smile and he says “in my next life.” “I want to have some coffee.” “I want my freedom.” “And what will you do with your freedom?” “I will travel, and present about Burma's politics and the environment.”


I didn't expect him to have an answer so ready. After we put the tools away, and after he told me about his father's torture and I tried to keep my head tilted up so tears wouldn't fall out of my eyes and perhaps he was doing the same thing, he told me more. “I will tell you my real dream. This is real, what I wish. I want to go to a small village and teach English. Have maybe 50? students. I teach English and improve my English. At my home town we have waterfall,” he showed with his hands, “a beautiful waterfall. And land is flat and soil is very...good.” “It's no good here?” “No. Very hilly, and difficult to bring water.” The Shan aren't a mountain people. They are traditional farmers who are used to rich plains where they can grow just about anything. This place is Akha land. The Akha like the rugged land, but they had to move aside here to make room for the Shan refugees. 


“I want to have a house, and around the house, trees, because I like the environment. I would have trees. That is my real dream.” “Do you want this in Shan, or Thailand?” “Shan. If I can, I don't like in Thailand.” 


The whole time, his nervous smile would flicker by. It's surprising how a face constructed to fall so naturally into a wide grin can drop into such exhausted despair. He'd mentioned even on the first day that he doesn't think about worrying things because it would just make him depressed. But I knew when he said that, even though I didn't know him, that he must think about those things all the time.

Shan AIDS

Bay Da said in 2007 he saw about 10 HIV positive patients. That he generally sees “a lot,” and they are typically male, under 40, and soldiers. I don't know why he said “2007” instead of “2008,” unless he hasn't counted up the 2008 cases yet. The first AIDS patient I saw was on February 11. She was, well she still is at the moment, a 52-year-old woman who had been in the week before (although this one looks so shrunken that I find it hard to believe it's the patient they're referring to) with an infected tooth socket. This patient is very wasted, certainly under 100 lbs and probably around 75 lbs, black lips surrounded by sores. Her daughter is with her, a healthy-looking, distressed woman, also a young man and a bunch of same-aged kids who may just be in for the show. The daughter is so upset that she won't let me take pictures, Khang Seng is busy putting her IV in and he looks up to tell me to stop. So I'll wait until the family leaves the In-Patient ward for awhile, if they do at all. The photo is necessary Why is the photo necessary? Because she's part of her people's genocide। Burma has enough money to have kept her safe and well if it wanted to. Her death is a victory for them. Word is, the woman will die within days without medicine, which can only serve to hold her on a little longer, slow the deterioration. That much is probably obvious to anyone. Amy says that her daughter said that this woman's husband died a few years ago. 

“Of the same thing Mom has now.” The next day she's still alive. She has tuberculosis and pneumonia, and what all the medics call “CD4,” which is code for HIV. I ask Homm Noon if people here understand the phrase “HIV.” She says they do. I ask her if they've told the woman's daughter she has HIV. She says no. I ask her if it will embarrass the woman's daughter if they say “HIV.” She says like she always does when I wish she'd be precise. “Yeah sure.” “But they must guess that she has AIDS.” “No I don't think they guess it.” “Why did they bring her in?” “Some abdominal pain."

The air around her bed smells dangerously rotten। A terrible smell around her, but it's not that she's soiled herself. I don't know what can take the nasty smell of death off her body. It's not the same as feces or vomit. It's unnatural decomposition. Like something breathing of a dead body. Anyway. The next morning I come in to take her picture if I can. She's awake. She nods when I show her my camera, and she pushes down the comforter and lifts up her blouse so I can see her emaciation.

Kang Hseng

Within three days of arriving in Loi Kaw Wan, we all had a Kang Hseng crush, and he knew it. Kang is hot to begin with, but being one of the few city boys in Loi Kaw Wan, he possesses unusual charisma. This is what he said: Kang was born and raised in the capital city of Shan state: Taunggyi (Dong-chi). He has two older sisters, both of whom have been to college and now have relatively good jobs in retail. His father was an opium addict for 25 years. He paid for his habit by dealing. It's a little fuzzy, but he may have been a bootlegger too. The work put Kang's family squarely in Taunggyi's middle class. When it was evident Kang was on the verge of growing up, he had to decide what to do with his life. He's Shan, but because they lived in the city and his father had a mind for business they never felt threatened by the Burmese. 


At first Kang wanted to be an engineer, but he fell 5 per cent short on the entrance exam. His uncle in Singapore offered him a job. “Come work for me in Singapore. I'll set you up with a position and you can make a good living here,” his uncle told him. No. Another uncle is a monk in San Francisco, but Kang didn't want to be there either. A third uncle told him about the rebel Shan State Army, which he knew nothing of before, and the medics who bring aid to the Shan huddled along the border. 


That was the job 19-year-old Kang took. When Kang first told me this I thought “well you're a good guy Kang, but you're the only one here who can go home anytime you want. It doesn't have to be a serious thing for you.” Then I realized how much it meant. He could have chosen so many other lives. He was one of the rare ones; safe, comfortable, educated. He chose to go in when the others ran out. Almost three years later. He likes Loi Kaw Wan. He's a good medic and when the supplies hold he's the town dentist. He'll only leave if he wins a spot in the Mae Sot training clinic. And after that he would come back. Plus, he's staying because he's fallen in love with a 20-year-old student down the hill. He's a clothes horse with a choker of black beads like the surfers wear, and a black motorcycle jacket. His motorbike lust is strong, but with the honorarium salary he gets it will take him years to save up for one. He has an elfish face, likes to smile and show-off. His anime haircut makes him look like Bruce Lee and he loves it when people tell him that. 


He has no desire to be a soldier, but he calls the SSA “our organization.” Many Shan change their names when they escape or become rebels. Kang didn't change his, because he wants people to know it's him doing these things. Dangerous. He has his own private house; a bamboo and thatch hut the size of a backyard tool shed, with a dirt floor. There's a bare light bulb in the thatch that works for the two hours a night the generator's running. Between the bamboo cot and the rest of the house is a rack of clothes that acts as a wall. The door hangs onto the upper corner of its frame literally by a thread. He loves his house, because it's his only private place. In a few months he and the other two single male medics will be moved into a dorm, and he's not looking forward to it. 


Early every morning he took Cody and Sanjeev down to the clinic yard to teach them kung fu. Now and then he'd find one of the medics' guitars and play, which he was good at, and sing, which he needs to brush up on. Every night when all the others went to bed, Kang and I stayed up together to talk. We would play cards and tease and flirt. He told me all his secret gripes about how the Commander runs the town when there are no strangers to see it. Talked about politics and the genocide in Shan and how it's all going to end. And what happens after the end. He reminds me so much of another friend.

Uncle Sam

“Don't take my picture. Don't say where I take you. Don't call me my name, call me 'Uncle Sam,' I have enough problems before with foreigners.” Uncle Sam began his life when he was born in Rangoon in 1951. That was before the junta. His mother was a midwife and his father was a health assistant for the government. Even though they were Shan, they had little to fear from the government because of their jobs, and because things weren't so bad then. 


When he finished high school and had to choose a career, Uncle Sam chose jade trading. Moving gem stones out of Burma was a popular business. His dad gave him some start-up funds, which Sam quickly ran through. The trade wasn't as easy as he thought, so rather than face his father with the bad news, Sam went to work construction in Bangkok for three years. His father wasn't an idiot. He entreated Sam repeatedly to come home and try something else.


“You don't have a head for business Sam. My friend will set you up with a job in the hospital mixing drugs.” Sam took the job. Although he wasn't impressed with the pay he found he liked being in Health. Eventually he became a health administrator for the government as his father had been. As such he was assigned to government convoys sent to the Shan countryside, forcing development projects along the way. Much of what employees like himself told the Shan about the projects and the benefits was just propaganda. They never got much. Shan nationalism was growing then. The people weren't happy, not with the government, not with the union, not with the starvation. Kun Se's rebel Maung Tai army was getting stronger, really at its peak back then. They had real weaponry, real training, tens of thousands of volunteers. And of course, such a charismatic leader. Uncle Sam began to help them secretly. As a government employee, the son of a government employee, from Rangoon, he was above suspicion. He wasn't counted among the Shan, even while he stole medicine from the government and gave it away. 


Things were going fine and he wasn't particularly worried about being found out, until Kun Se surrendered to the Burmese in 1996 and went into house arrest in Rangoon. The Maung Tai army broke into pieces, and in the crumbling Uncle Sam was ratted out. “Betrayed me!” he says. He fled to Thailand. 


When he arrived there he found a reunion of rebels. A little disoriented, he served briefly in what was left of the rebel army. By 1997 he knew soldiering wasn't for him any more than gem trading. He learned of the medic training centre in Thailand, further south along the border. The Shan sent him there, where he trained for two years to become something of a rough and ready doctor. He was good at that. And ambitious with it. Before too long he brought his skills to camps of displaced Shan scattered along the northern Thai-Burma border, where the Shan were pushed by a furious Burmese army. Those refugees are still there. Uncle Sam still sends them medicine. 


Today he lives permanently in Thailand, fat and loquacious. Canadians bought him a migrant worker ID, and as long as he has that he can stay. He is happy in his young career. He takes Shan teenagers and makes field medics of them. He butts heads with rebel commanders who stew along the border in new villages of displaced ethnic minorities. Butts heads with well-meaning foreign doctors who come to help him train. Can't ever go back. He betrayed the Burmese government, and then was betrayed himself, so he cannot go back and keep his life.

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.