What did I do for two months in Mae Sot?

My days in this Thai-Burmese border town started with waking up to tinny brassy music blaring from a loudspeaker in the distance followed by some Thai mumbling. I roused myself from slumber quite easily; my room was really bright even at 0630. I slept under a mosquito net with a fan blowing every night, but it usually became quite cool in the early morning hours. I started taking warm showers again while in Mae Sot. There was a small water heater in my bathroom which did an okay job at warming things up. My bathroom had a western toilet, but it was set on top of a squatter; so sitting on it was like being a kid in an adult's chair, legs hanging free. I didn't like this set up so I bought a step stool for my feet during my first week there. My bathroom was shared with some cockroaches and ants. That was nice.
I spent my mornings typing in my journal, listening to the birds in the trees around my house. It was really relaxing -- a good way to start the morning.
I had breakfast most of the days. I kept a box of granola cereal and yoghurt drink in the fridge down in the common area. Sometimes there were new guests having breakfast, and it was fun to discover what other people were doing in town. A lot of vistors were volunteers on brief missions, stopping for a couple days before moving on, while some were there for a few weeks. When June hit, a lot people came to stay all summer. We had some guests who were working for the UN High Commission on Refugees (UNHCR) -- real high brow stuff. A lot of the guests were volunteering at the Mae Tao Clinic or teaching English to Burmese groups. There were a few who were working towards their Masters Degrees in Public Health or International Development or other humanitarian stuff that I never heard of back in college.
Mae Sot had an interesting mix of NGO's (non-governmental organizations) including Medecins sans Frontiers (Doctors Without Borders), Aide Medical Internationale, the International Committee for the Red Cross, and the International Organization for Migrant Workers to name a few. These NGO's were referred to by their acronyms not unlike the acronym soup we used on deployment in Baghdad. When I first arrived, people slung those acronyms around me with an air of indifference, as if their meaning was common knowledge, certainly for any experienced NGO volunteer.
I usually made it to the clinic by 0930 via my motorbike. My first impression of the clinic: I walked passed it and had to ask for directions. It was located at an inobvious gated dirt road off the main road that looked like a bus stop; there were covered benches for the motorcycle taxi drivers and for sawngthaews. Walking into the clinic grounds, I thought I had stepped into a refugee camp. There were lots of Burmese in traditional clothes (longyi's), but many of them were somewhat dishevelled. There were stands selling food (an assortment of deep-fried foods on a stick, e.g. a whole fish on a stick and a mass of unshelled shrimp fried into a large frisbee-sized disc) and the line for the registration was packed, as was the waiting room. There were mangy dogs everywhere. People were sleeping on benches. Add to this image all the mud, dirt, and flies. There were random kids running around barefoot screaming with laughter. There were sick people lying the shade. I had the distinct feeling of "what did I commit myself to?!"
The inpatient wards were hardly any better. Imagine a large open ward (no doors, cement wall that don't go to the ceiling for ventilation) with three rows of wooden tables as beds. Some patients were on the floor. The TB patients are separated from the rest of the patients by a four-foot low wall. There were a few iv's hanging, but everyone is wasting away. The other wards were pediatrics in/outpatient, adult in/outpatient, reproductive health in/outpatient, and trauma (surgery). In trauma, the medics ran a couple cases everyday using some spinal anesthesia and Valium. And they didn't gown up -- just gloves. They could not take care of anything above the belly button.
I spent six days a week in the adult OPD clinic from 0930 to 1600. I parked myself in a different every week, getting to know the medics and nurses in that room, and trying to teach them a little. It took about a month to get to the point where I had figured out their approach to their patients. Back home, we would admit many of the patients they see at the clinic, and at the very least run some blood work, but their management of patients is very different from back home. In spite of the differences, they do a fantastic job. Their approach works for their patient and their diseases. Even with the mud, dirt, and flies, and the whole refugee camp look, they stamp out disease. These medics have about 18 months of training, then the rest of it is OJT. The senior medics move, talk, and joke around like medics and physicians back home. It was fascinating to see these similar mannerisms replicated in a different culture. Is it universal?
I saw some crazy walking pathology there. There were a lot of late stage abdominal masses, goiters, nephrotic syndrome, cirrhosis, TB, and, of course, malaria. A lot worm infestation, gastritis, and mental stress. It wasn't until after a few weeks of being there, I realized their diagnosis of "generalized weakness" was mental stress in a patient. The typical patient would be a young woman in her mid-20's complaining of intermittent palpitations, fatigue, dyspnea, back pain, insomnia, and loss of appetite. The treatment? Vitamin B complex, which was their panacea or their placebo. It was fun being grabbed to see a patients in other rooms. I got to see a lot of wierd cases that way, but most of the time it would be a late-stage presentation of a terminal illness.
At lunch time, I bought snacks for everyone. All the snacks were 5 BHT, which is about 12.5 cents. I brought my crappy dietary habits from back home to the workplace at MTC. We snacked on potato chips, rice crackers, and other junk food. "Don't you eat lunch back home?" Nope.
The afternoons were usually quiet in the clinic (except for Mondays when we would get crushed, just like in Biloxi). Twice a week (Wednesdays and Fridays), we had didactics and chart review. My first lecture was on reading EKGs (they have an EKG machine, but they can't use it because it has a three-pronged plug from Canada). I thought it would be a review for them, but I think it was their first lecture on reading EKGs. My first day, I bombed. First of all, there is a language barrier as most medics have only a basic grasp of English. They do their charting in English, but beyond that basic level of "5 days vomiting. no fever or chills" they have a tough time. Then, there is the concept of positive and negative values on an x and y graph, essentiallyalgebra, which I think were new concepts to them. Well, we got through it after two more days; it was really challenging.
I asked them about their education back in Burma. I had ignorantly assumed that basic algebra was taught in public schools, but it was explained to me that education was limited to the wealthy and privileged, even the most basic of education. Most of the medics live at the clinic or nearby. They live five to a room and have little or no privacy. And they live in what looks like a refugee camp. Why would anyone want to leave their family, friends, and home for a interminal life at the in Mae Sot? The incredulity of such a decision to me is probably the best condemnation I can imagine on the oppressive government and lack of opportunity for the pursuit of happiness in Burma.
I usually got out of the clinic by 1600, sometimes buying a snack of pork & noodle salad from a food vendor close to the clinic for 10 BHT (about 25 cents). Most of the time, I would hangout at Ban Thai, my guesthouse, just shooting the bull with some friends as the sun set behind the driving range next door (while being serenaded by the droning chanting of the temple close by). Othertimes, I would run errands (buy stuff for clinic, get photos developed for the medics, or surf the net) or I would go on short rides in the countryside right before sunset, my favorite time of the day. The light would be perfect streaming through the clouds before diving behind the 6,000-foot peaks in Burma. A magical hour. Riding a motorcycle was something I fell in love with in Mae Sot. Who would have thought?
Dinner time (around 1900 to 2000), was usually shared in the company of other guests at Ban Thai. Considering how long I was in Mae Sot, I did not explore too many places; I pretty much ate at the same places over and over again. I am a creature of habit. There was the night market (loads of food stalls under corrugated tin roofs, and cheap plastic stools, but I only tried four of them), Round Table (actually named something else, but it was called Round Table by the Ban Thai guests because of the round tables there), 69 (the all-u-can-eat hot plate/pot place called 69 because the only thing you could read on the sign was "69"; it cost 69 BHT a person to eat there), Aiya's (slow service, and a few customers would get sick for a few days after eating there), SP's & Casa Mia's (SP's delivered Thai, Burmese, and Western food, but then the Burmese employees seceded and started their own place at Casa Mia's where five people can order different dishes, all of which happen to be the same thing -- quaint at first, but mildly annoying as well), Canadian Dave's (a big Canadian who has been there for seven years. Everything there is deep-fried, which explains his largesse.), the roti stand across from the mosque (great samosas in the morning, murturbaks in the afternoons, and lecherous looks from the other customers are free for the farang women), the Burmese curry noodle place (the closest thing to Malaysian Laksa noodle soup I could find), and Bai Fern (the best pizza in town). Food at the night market 20 BHT (50 cents). You could get chicken and basil on rice, chicken and chili on rice, pork noodle and wonton soup, fried rice, or fried noodles; it was all really good and really spicy. I got to the point where I didn't taste the spiciness, but I would be sweating up a storm. There were a couple great Burmese dishes I had. One was lipetho, a salad made of fermented Chinese tea leaves (fermented for three years they say), crunchy peanuts, peas, beans, and sesame seeds, with garlic, oil, and cabbage and eaten with tiny chilis on the side. Awesome. The heartburn is awesome too. Great stuff.
Sometimes I had Western food which was served at a few places (Canadian Dave's, Bai Fern, or SP's). These were the joints that a lot of NGO's frequented. I definitely knew the places I liked to go to in Mae Sot.
Some evenings, I would go drinking at the local watering hole called Koon's. A lot of NGO's went there too. I discovered another nice beverage called Sang Som. It's a Thai Rum, but it's pretty tasteless, so one tends to mix it with Coke. (Ahh, that's much better. Some ice, please. There you go.) Instant party. A small hip flask of this stuff is about 80 BHT ($2). Many a nights were blurred by this stuff, but no (knock-on-wood) hangovers.
I learned I could only carry on like that for so long, and my limit was about a month, after which, I practiced some maturity for a change, and plodded on for the next month, which became more and more boring and tiresome.
Despite the great cheap food, not riding a bicycle (unlike the rest of the volunteers), and not holding back on partying, I lost quite a bit of weight in my two months at Mae Sot. I weighed myself in Chiang Mai, and I am at a strapping 123 lbs. That's 9 lbs less than when I left New Zealand, and 20 lbs less than when I left Biloxi almost a year ago. I am at the same weight I was at during college. I've been trying to eat more in the past three weeks. Maybe I can convince my parents that I'm not doing drugs here. Haha.
Sundays were supposed to be special in Mae Sot, because it was my one day off. I should have done more with my time, but I ended up doing a lot of nothing on Sunday. On the first weekend, I went out to visit some waterfalls and a gibbon sanctuary (read: freakshow. They were looked worse than the patients at the Mae Tao Clinic.) After that, I did nada. I am sure I did something, but it was pretty immemorable.During the second month, the temperature cooled down quite a bit; the rainy season had arrived. It struck me as odd to think of these "summer months" as cooler months because of the rain. It rained almost everyday, turning the clinic into a muddy mess, but the rice paddy fields were flooded, reflecting the shrouded mountains in the morning. It was a change from the sunny days and parched earth that had greeted me when I arrived in Mae Sot two months ago. It was a good time to leave.