Mae La refugee camp

I am loving my time at Maela. It's still a novelty for me and I appreciate life is hard at the camp for the Burmese refugees but it's a beautiful place in heaps of ways. The setting is stunning, limestones cliffs and dense tropical vegetation, bamboo houses on stilts with leafed rooves amongst palm trees and vivid colourful flowers. A big thing for me is the strong sense of community, people pull together here, they look after each other, we had an emergency at the clinic this week, word got out and within minutes staff who were not on duty were there to help.
There's heaps of poverty, I saw a three year old with a really nasty infected wound, I asked how he injured himself, dad said he and his wife had to leave him at home alone as they both had to work in the fields to earn money to feed the family. Other people don't want to stay at the clinic/hospital despite being seriously unwell as they simply need to work and feeding the family is their priority, staff members offer food in order for them to get the health care they need and I have given money to staff to buy food for patients.
The children are very cute, they hang out around the clinic playing games with stones or a ball, some are shy, most want to talk and to have their photo taken, they laugh at my hairy arms and gesture at my height, I am a giant here ! They gather to wave us off every evening. They have grubby feet, some have shoes, some don't, some don't even have pants, they have big brown eyes, lots of cheeky laughter, the boys play with the boys and the girls with the girls, they look after their siblings and children of 5 and 6 years have a younger brother or sister in a sling on their back. The infants don't wear nappies and are breast fed till at least two, if they are upset they're straight on the breast and peace is restored.
The animals all live in harmony, dogs, cats, piglets, hens all together wondering around clinic with no fIghting.
One thing I can't get use to is all the hoicking and gobbing, everyone's at it ! It's totally acceptable to gob between the gaps in the bamboo flooring in clinic, and jets or red saliva come rocketing from the mouths of the betel nut chewers ! their mouths and teeth are stained orange. Tried betel nut, my mouth went numb, and haven't taken up gobbing !
Spent last weekend on call, Friday 8am till Monday 5pm, felt very lucky to have a bed frame rather than the floor, but the mattress was a plank of wood with a bamboo mat ! kept waking with numb bits, it's a lovely place to sleep, no street lights so it's pitch black with beautiful stars, i had open bedroom walls so could hear the cicadas and babies crying as they were born, then the call to prayer at 5 in the morning, then the Buddhist monk joins in on his microphone so it's early to rise. All meals cooked, the cook calls it a rice party ! rice three times a day, breaky, lunch and dinner ! bathroom is a bit scary, lovely open view over the camp but it's a bucket of cold water to wash (glad I brought my Molton Brown to bathe in !) and the squat toilet terrifies me with the beasties living around it !
The SMRU clinics have two main goals, to treat tropical infections and to provide care for pregnant women and their babies/children. It's also a big academic centre so heaps of research going on. The organisation train people from the camps to be health care workers, no formal qualifications but you work your way up from health care worker to nurse to medic. Clinical work is guideline driven and the staff know the guidelines inside out, some of the medics are amazing, they have great medical knowledge, great clinical skills and can think laterally.There are two new medics, one working in the antenatal clinic and the other in the out-patient clinic (where anyone with a fever is seen). I have been spending most of my time teaching these two, have had to learn about the tropical infections quickly, we see patients together and the medics translate for me, their English is good. I love antenatal care at home, where women tend to be well with not too many problems, problems are dealt with relatively easily and then a baby appears. In contrast women here have lots of problems in their pregnancy (malaria, TB, hepatitis B, thalassaemia, hypertension, malnutrition and poor foetal growth ....) and limited resources to deal with them, so a bit more challenging.
Also help out with the in-patient ward and the labour ward, am terrified of the premature babies in the special care baby unit, love going into the delivery room when I can to help out with births. No one seems to want to call their baby Michael or Michaela ! The woman are amazing, the only pain relief on offer is paracetamol, hardly anyone has it, there's no screaming, women just get on and push these babies out. Twice now women have been on the ward in labour and have been too polite to interrupt anyone to say they needed to push so ended giving birth right there on the ward. The birthing room is a bit stark; four metal bed, no privacy a bucket to catch the bits and bobs, the women don't seem to mind public birthing, there is lots of spectating amongst the birthing women but husbands aren't allowed in.
Been involved in some scary medical situations. A 17 year old girl had an eclamptic seizure in clinic, everyone came rushing to help, we were trying to control her seizures, she was unconscious and repeatedly fitted, we couldn't stabilise her, c sections are not allowed to be done at the clinic, I thought that was the only way she and the baby could be saved, really thought she and her baby were going to die, the obstetrician decided we had to transfer her to the hospital in Mae Sot, an hour away in the back of an open truck, the metal floor was covered with a bamboo mat, I maintained her airway for an hour, she continued fitting, we were monitoring baby's heart beat which was constantly below normal, her 17 year old husband was by her side, he wiped her tears, cleaned her vomit, stroked her hair, I cried, I just thought it was hopeless and that she was going to die, it seemed so unfair, how different things would be if this was happening in a developed country. And she was just a kid, 17 years old, tragic. Arrived at the Thai hospital in Mae Sot, she was strapped to a trolly there to help with the seizures ! she had a C section, amazingly baby was alive, mum spent a few days in ITU and a week later she was back at Maela. It was so great to see her, she gave baby to me for a cuddle and her husband showed me their bible ! they were together as a family, how good is that. It was miraculous.
Another scary moment, I was the only dr at the camp, we had a 7 day old baby with a fever, did all our routine investigation including a lumbar puncture which showed meningitis, I assumed we transferred to the hospital in Mae Sot but oh no he was staying at the bamboo hut clinic. When we told mum her baby had meningitis she was calm, took it all in her stride, it was only me who was panicking, people here seem so accepting of what life throws at you. Baby did really well, recovered and is now at home.
It's not all good, there have been a few deaths. Last weekend a premature baby born at 31 weeks died after 24 hours, very sad. He probably would have survived if he was born in the west. There is no option to send these baby to hospital, they have to be cared for at the camp. Most 31 week old premature babies do survive here though. Also a 20 year old woman died, she had her baby at home with a traditional birth attendant, they apply pressure to the top of the womb with bamboo poles to help push the baby out ! and this caused the women's uterus to evert and she bled to death. Her baby survived, either the wider family will look after the baby or the baby will be adopted by a family at the camp, adoption is common. SMRU has home visitors who aim to educate the traditional birth attendants and also to advice women to have their babies at the clinic. Another home birth, the traditional attendant cut the cord with bamboo, mum had never had a tetanus vaccination, baby arrived rigid and having seizures with tetanus. There is a dilemma in these situations, baby needs ITU in the Thai hospital for at least 2 weeks, the prognosis for recovery is poor and SMRU organisation has to pay the Thai hospital fees. So it's a choice between paying a relatively significant amount of money for one baby or putting that money to help 100s of others. NHS offers free health care to everyone who needs it, argh, no free health care for all here. Anyway our boss decided this baby could be transferred to hospital, he was transferred to Mae Sot but his parents could not go, they needed to work to support the rest of the family, very sad but that's the reality. Baby is still in ITU, fingers crossed he will do well.
The organisation is highly regarded for providing high quality health care compared to other charities working on the Thai-Burmese border who are providing healthcare on a very tight budget. We treated a pregnant lady with malaria at the weekend, she had travelled 24 hours from Burma. I asked her why she had travelled so far, she had heard of SMRUs reputation and that that the treatment would be better here than in Burma. Other people who live at the camp come to SMRU seeking help for problems we are unable to deal with owing to its reputation in the hope we will treat them but often they have to be directed to the other clinics. A lady arrived this week she had taken an overdose, we had to put her in a truck and get her down to the appropriate clinic. There were three suicides in the camp last month, I have been to,d it's the people who have been living at the refugee camp for ten years or more who commit suicide, too long living in limbo.
The refugees who work at the clinic are amazing, have been listening to their stories about fleeing from the military, many have had relatives who have been killed, imprisoned or used to locate landmines. There is talk about programmes to resettle people back in Burma but the staff say there is nothing to go back for. Some countries are taking refugees - Norway, Australia, America, it's the brighter people who have good jobs at the camp who tend to take this opportunity, they tend to get unskilled work in factories but go for their children, who will get better education and a better future. The staff all seem to have very strong faith, they go to church for hours and so many time they say I will do what God has chosen for me.
The staff work six days a week, get two weeks holiday a year, pregnant women work till their due date then can have two months maternity leave. No running water in their homes and some have electricity, the medic I am teaching brings her torch, which lights her house, to work each day to charge. The staff look immaculate in their traditional gear. Have been invited to their homes which is fab, really simple bamboo homes with a couple of rooms, a living area and a sleeping area with hammocks or bamboo mats. One of the nurses was celebrating her 4th wedding anniversary so it was open house and she cooked noodle soup for everyone. They have very little but are incredibly generous.
A group of teenagers were at the clinic being interviewed for a new cohort of staff, they were really bright, had great English, were curious about what I was doing and they all had skinny jeans with the waist band below their bums, how has that caught on !
The staff have been asking me about their health problems, we find a quiet corner to try to have a consultation and then everyone else appears, they all gather around to listen in, nothing is confidential ! you can't have a secret.
the staff bring their kids to work, am very confused who's is who's as they are collectively looked after by the grown ups. But after a ward round the babies go on mum's breast which helps me identify families.
I wonder what the staff think of the westerners who work here, I think there're pleased to have us, they're incredibly respectful, and there's heaps of banter and laughing and I feel very lucky to be able to spend time with and get to know them. I am trying to learn a bit of Burmese and Karen but its a tricky language.
Have been taking heaps of pictures as you can see, loving the photography, always creates laughter, people like to see their photo and also see people taking photos of me on their mobiles !
It's just luck as to where you're born, being here has made me appreciate things more, my freedom, the NHS, the opportunities free education gave me, freedom of speech.... Don't know know if I would swap my life for a life here, but I am enjoying jumping off the consumerism world and am enjoying simple things and watching people help and care for each other.