What brought you to Myanmar?
It was while working in an HIV clinic in Chiang Mai in 2003 that I first became aware of Myanmar and subsequently joined theThaiborder clinics serving migrant workers. Over the next few years I helped to set up water and hygiene projects both in Kengtung and with refugees living in New Delhi. It seemed to be an organic progression to [be] eventually living in Myanmar.
After Cyclone Nargis in 2008, I participated in the recovery process and for the past several years have been working with the Myanmar Medical Association to improve post-graduate training of general practitioners.Since early 2013 I've also been caring for international and Myanmar patients at the LEO medicare clinic at Victoria Hospital in Yangon.
What were your perceptions of Myanmar when you first arrived?
From a primary care perspective, I've long been worried by the educational and financial realities that constrain Myanmar general practitioners in providing responsible care to the people of the country. These challenges remain as prominent today as when I first arrived.The difference is that now I meet doctors emboldened to take steps toward solutions.
As an expat who often treats other expats, what are yourperceptions of some of the challenges they face?
The primary environmental health challenges faced by expats living in Myanmar are generally the same as those faced by the local population: Water quality, food hygiene, viral infections, dog bites, traffic accidents, holes in the sidewalk. However, expats typically live here at a higher socio-economic status than the majority of the population and so are better able to protect themselves.
While acknowledging that international residents have a privileged position, it's fair to say that it can be scary getting ill in a country where you face communication challenges and a medical system that is difficult to trust. I find some of my patients acting hyper-vigilant in looking for diagnoses of tropical diseases, for symptoms they might not be that worried about in their home country. It's natural to fear the unknown and thereby overestimate risk. Unfortunately it might lead to laboratory testing, medication and travel decisions that aren't necessary.
I try to help patients decide what they are comfortable with so we can make personalized decisions for what should be done in-country and what might merit a trip to Bangkok, Singapore, or the home country.
Have these challenges changed over the years and if so, in what way?
In the last several months I've seen in increase in the number of patients with physical problems that seem to be linked to emotional stressors. Westerners tend to be very project-oriented and are often extremely motivated to make a quick and impacting contribution to Myanmar. This disposition can lead to frustrations in a country in which human resource capacity suffers from decades of systematic devaluation of the education system. A foreigner might then experience mind-body symptoms to which they're not accustomed.
I have no objective evidence to back this statement but perhaps the international arrivers of the last one or two years are culturally less prepared than previous residents, who really had to have a psychological commitment to Myanmar to be able to live here prior to the transition. More likely of course is that there are just more expats and therefore I'm seeing a broader range of conditions, but there does appear to be a changing nature of the foreigner living in Yangon.
What are the more common types of health ailments you see?
Many patients have the coughs, pains, cholesterol, and blood pressures that doctors evaluate in all countries regardless of stage of development. Fevers and rashes are sometimes distinct from what I see in California, primarily because moving to the tropics means exposure to a new set of viruses. Stomach pain and diarrhea are of course more common and can be challenging because of the fear of the unknown I mentioned previously.
What health care advice do you have for newlyarrived expats?
As a primary care doctor that thinks about preventing disease, I have to first recommend focusing on the things that we know keep humans healthy: Eat well, exercise regularly, watch your weight and don't smoke. Common sense behaviors for Yangon include selecting street food carefully, peeling your own fruit and wearing a seat belt if possible. Bed nets for children and eliminating sources of standing water are protective against dengue. Again, I have no evidence for this but I tell people not to eat shrimp since it seems to be a common denominator in the recent food history of friends with illness.
Wash your hands with soap and water but don't overdo it with the antibacterial gels, as those products have never been shown to prevent disease and smell funny. I've been trying hard to get people vaccinated against rabies, and the Japanese Encephalitis vaccine is [a] reasonable [precaution] if you live in Yangon. You definitely want a yearly flu shot and remember that the flu season here is the rainy season.
Something to remember while you're away from your home country is to keep up with the preventative health screening that we know saves lives. This means cholesterol labs, blood pressure checks, Pap smears, mammograms, and colon cancer screening. Expats can usually access these services but unfortunately, they remain out of reach for much of the rest of the country.
Giving generalized mental health recommendations is more difficult. Any leisure activity that provides psychological balance will likely be helpful. I find going for walks and paying attention to the rhythm of the city reminds me why it's special to live here.
What keeps you in Myanmar?
I'm here because I have hope for the medical system.I try to think about how to utilize our international clinic as a model for best practices in health care delivery. It's been a couple of years now that I've been looking at the training of general practitioners and I'm convinced that the will to improve is strong. The challenge will be upgrading primary care by introducing Family Medicine as a discipline within which doctors can begin to meet global standards for training. Working to establish a College of Family Physicians Myanmar is what will keep me in town.
What do you enjoy about Myanmar?
Geopolitically, socially, and economically this is one of the most interesting places in the world to live at the moment. Everyone seems to have a plan. It often feels like our conversations really matter and may impact the direction of the country. Also, when I look at a place like Mahabandoola Park and how its been reimagined and accepted as an urban gathering place, I get excited about what is possible in this city.
http://www.information.myanmaronlinecentre.com/expats-and-health-care-a-doctors-perspective/
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