Mango Nicky Rice

 Back in August, before I arrived here, a Burmese mother arrived at the hospital in labor. She had not wanted another pregnancy, so she took some medicines to try to abort the baby. The medicines didn't take, though, and she remained pregnant. She did not have any prenatal care, so did not know to take vitamins or alter her nutrition. It is also possible she just wasn't able to obtain any of those things.  When she was in the prenatal area, a cursory ultrasound showed that the fetus had an abnormally large head, so the mother was transferred to the bigger hospital for a c-section. The baby girl was born with severe congenital defects, including cleft lip and palate, microphthalmia of her right eye, one shortened arm that never developed a forearm and had a vestigial non-bony finger at the end, abnormal fingers of her other hand and toes of both feet, and of course hydrocephaly. I have not been able to procure the early imaging of the baby's head, but another volunteer here ...

On Christmas Eve, we received news that the land just across the Thai-Burma border from us would be bombed by the Burmese military government.  The military used RPG’s, air strikes, tanks and other heavy artillery to decimate the area, forcing thousands of the nation’s own people to flee into the forest or to the edge of Burma for safety. Reports said the military government had killed women and children, and many bodies were found burnt to crisps inside vehicles. Just cruelty and fear everywhere.  We have had an influx of the post-bombing casualty patients, from sniper bullets to the skull to paralysis to amputations to extensive wounds and broken bones, lost eye sight and more. We currently have 3 patients with tracheotomies and 3 amputees. After they stay on the unit awhile, they get moved to Patient Housing which is basically an roofed outdoor facility similar to a rest area you might stop at on a long road trip. They sleep on wooden benches in there and have no home you g...

​ Sometimes I get frustrated because we just don’t have basic equipment we need for patients.  For example, here is the baby incubator I saw when I first got here. Yikes. I was planning to scrub it down with bleach myself.  Then I saw we had a better one, but it still made me nervous: And then 2 weeks ago we got this amazing one: I was very excited we got a donation of state-of-the-art medical equipment.  There are a lot of other things I hope for here. The thing is, sometimes the hospital isn’t ready for new tech. I’ve been on a bit of a soapbox about us getting more lab test capability. We have CBC, POC Glucose and urine pregnancy, Total bili, malaria smear, and urinalysis without micro.  We have a TON of cirrhosis, alcohol withdrawal and altered mental status patients. I’m working on a sepsis protocol because we have so many deaths from sepsis. But we can’t check lactate, sodium, potassium, calculate anion gap, creatinine, LFTs or anything else for critical patien...

​ https://gofund.me/e099b23a Most of my Global Health Fellowship year is spent here on the Thailand-Burma border helping a 30-year old refugee clinic to develop emergency medicine and acute care focused care. The patients are escapees from one of the world's longest civil wars and have become stateless refugees. The mission of the clinic I am helping is to provide Healthcare as a Human Right. I have seen that many of the displaced people are very poor and often cannot afford even simple life-saving diagnostics and treatments such as chest X-rays, antibiotics, immunosuppressants for diseases that are ravaging their vital organs or transfer to the bigger hospital for severe hypoxia or sepsis. Others need simple things like walkers, crutches, physiotherapy equipment or nutrition (generally that consists most basically of formula for malnourished babies and rice and oil for adults). Healthcare providers in Burma have been targeted and forced out of the country, so many Burmese come acr...

Curriculum meeting nwe ni: no emergency care here (GIB, AUB, DKA) no IV potassium here. No IV insulin.  Concern should we bother teaching the treatment if we don’t have the resources? I think yes. When in doubt, train up and look to the future. Don’t train down because as we grow, medics will need to know the right way to treat patients. We don’t have to go into excruciating detail. But we can mention the ideal treatment and why it’s important 

About 6 weeks in my city here and I’ve learned: We can stop dosing so much Bisacodyl and Senna. Just feed every one curry. You will stay regular.  Nose hygiene is a daily thing. After cycling or walking around the city or to work, your nares are coated with a fine crust of booger cake. You must be a nose-picker in order to thrive. The Thai word for pumpkin sounds like a cuss word. I learned this from a Thai couple who were asking what was in a Burmese soup. The man kept bursting into giggles while trying to explain. “It’s called ‘Fuk’ in Thai hee hee hee, hee hee hee.” The woman rolled her eyes at him   Fuk If you can’t read Thai, it’s easy to find that you’ve bought a sack of fertilizer instead of a sack of rice.  Girls should have delicate nicknames - like “Bird” or “Fish” or “Flower.” I went out with a Thai friend and we decided I would pick an animal to nickname myself. Her nickname in Thai is Nok , which means bird. I chose “Elephant.” My friend’s eyes widened and sh...

Today I went into the COVID isolation unit with the head medic there. They ain’t playin’ around with PPE, man. It is literally head to toe, including dedicated slip on loafer shoes that get soaked in a sanitizer barrel before being reused, full-body suits a la Squid Game or   Outbreak , shoe covers, spraying every door handle as we go in or out before and after we touch it.  There’s no air conditioning here and it’s about 85-90 degrees minimum all the time during  the day.  Today’s COVID numbers weren’t terrible. 3 COVID patients, one unlucky patient with both COVID and Tuberculosis, and one lady in alcohol withdrawal whose husband is one of the COVID positive patients.  As we approached the building, I could hear a woman’s voice shouting in Burmese with the familiar timbre of alcohol withdrawal fervor.  We entered the unit after donning our COVID sauna suits. The first problem was that the TB guy was lounging in bed next to the alcoholic lady’s bed. No ma...