Blog: Myanmar Day 6: Mandalay, Part III
Our Burmese Doctor
When we got off the plane, Susanna planned to take us to visit a monastery where we could tour the monastery and then see approximately 1,500 monks when they lined up to receive their daily lunch. However, there was a slight glitch in this plan.
Somewhere between Yangon and Bagan, Clarissa began complaining of a sore throat. Remember, we were in a country where we were not expecting access to western medical care. There is a Global Doctor clinic in Yangon, but by the time I suspected we might need such a clinic, we were far away from Yangon. Fortunately, I had carried antibiotics in case they were needed, albeit just plain penicillin for adults and one pediatric round of Augmentin.
When we arrived in Bagan, I gave Clarissa the penicillin and told her to start taking it. Twenty four hours later, however, she had gotten slightly worse. I told her to start the pediatric Augmentin and that we would try to find a western doctor in Mandalay. To my alarm, when I looked in her throat I saw that her tonsils were beet red, swollen, and covered in large white patches. Clarissa insisted she felt fine except her throat hurt too badly to eat.
When we got off the plane I asked Susanna to arrange to take us to a doctor. Susanna puzzled over where to take us. I already had read that the only medical option in Mandalay was the hospital, and I had no idea what that would be like. I told Susanna that a local doctor would do, as long as he had western training.
Another issue running through my mind was money. I had done something stupid: I had estimated what I thought the trip would cost and had brought just that much money. Our meals had already cost more than I had estimated, so there was nothing extra. We already felt we were running low on cash. Additionally, it is impossible to access an international bank account while in Myanmar. One must carry in all the cash one expects to need. If we had an emergency for cash, we would have had to do something extreme such as ask our travel agent to help us out. This was a factor in my telling Susanna that a local doctor would do; but my mind was perplexed by the question, “Is this a big mistake?”
I certainly didn’t want to make any mistakes that would harm my child’s health. I had purchased medical evacuation insurance at the time I purchased our air fare. As a family, we decided to try the local doctor as the first step. If she didn’t get better quickly, we’d pursue other options if needed, including a medical evacuation.
As we drove toward Mandalay, the road ran parallel to a canal which was on the right side, the same side as the traffic flow. Beside the roadway, there was a row of shade trees and an occasional small shop, then the canal, and then rice paddies.
On the left (opposite) side of the road, there were various kinds of shops and businesses in small, unpainted, wooden buildings that didn’t seem to have electricity. It looked like shops selling things like soft drinks, vegetables, pots and pans. Outside one of these buildings, there was a sign with a red cross: a medical clinic.
Susanna had the driver pull the car over onto the right shoulder. She told us to wait in the car while she went inside to inquire about the doctor’s credentials and whether he’d be willing to see a foreigner. It turns out, he spoke very good English, had a university diploma in medicine, and even had an Australian credential. And he was willing to see Clarissa.
I once read a N.Y. Times newspaper article which pointed out that one of the taboo subjects in discussions about the high cost of medical care in the United States is the issue of doctor compensation. If I remember correctly, this article said that an average physician in the USA makes more than double ($150,000) the relative salary of an average doctor in Europe ($60,000). In Europe, the average doctor lives about like an average, middle class person. In the USA, the average doctor lives about like an average upper middle class person.
The office of the local doctor in Mandalay was a striking example of a person who was earning a living roughly equivalent to the community which surrounded him. He was not making $60,000 per year. His office was a wooden building with a dirt floor and no screens on the windows. His examining room consisted of a small room with a table and a desk. There was no receptionist, no nurse. He was dressed in ordinary clothes. The doors and windows were all open and I didn’t see any electrical appliances or light bulbs. He had been reading a book before we arrived, sitting in the back room. I didn’t look closely in the back room, but it appeared to have a bed in it.
The doctor quizzed Clarissa about her medical history and then he asked her to lie on his table so he could listen to her chest and heartbeat and take her blood pressure. Then he looked in her ears and throat. He said she had severe tonsillitis and needed a tonsillectomy. We told him that we wanted to wait until we got back to China to do such a procedure. He gave Clarissa more of the same antibiotic she was already taking, but he also added another antibiotic (cephalexin I think)) to the mix. (If I’m not mistaken, this may be the same formulation which comprises augmentin?) He tried to use a medical tool to remove some of the detritus but it was stubborn and wouldn’t budge. Then, after he did the western medical thing, he said he’d also like to apply some traditional Ayurvedic medicine to her treatment, in which he had also been trained. What could we say? And, I thought, what harm could it do?
He stood beside her as she sat on the table and lightly massaged her throat with his fingers. He faced the wall, looking away from the rest of us, and closed his eyes to concentrate. Then, still feeling her throat, he began to belch. He interrupted himself to explain to us that he was not belching because he had indigestion, but rather to unblock whatever it was that was stopping up the energy channel (Chakra) in Clarissa’s throat. He did this for several minutes, it seemed. So I stood, in a wooden hut with a dirt floor, with a medicine man belching over my daughter, thinking to myself, “Have I made a terrible mistake?” At that moment I was thinking in terms of medical evacuation and really glad I had purchased the insurance; but we did have the antibiotic, and Clarissa insisted that evacuation wasn’t necessary, at least not yet. In fact, she insisted on continuing our tour rather than resting at the hotel as we offered to do.
I decided at that moment that this story would not go into my blog until the ending were known! There was a possibility that it could have been a dramatic ending to our vacation, routed to first world medical care in Bangkok. Fortunately, there was instead a nondescript and happy ending.
While I couldn’t judge about the Eastern portion of the medical care, the western portion was reasonable and appropriate. When we asked the doctor what his fee was, he refused to state one. He said we should only pay what we felt was fair. Looking at our cash, and trying to figure this out, I pulled 20,000 Kyet out of my wallet (roughly $18). Susanna saw the amount, I silently asked what she thought and she said it seemed about right (I knew that was about the amount Susanna was making for a full day’s work), and so that’s what I gave him. Looking back on it, I think I probably should have added in more for the cost of the antibiotics. The infection took several days to clear, but clear up it did. By the time we returned to China there was no trace of the tonsillitis, and we didn’t even feel a need for a follow up visit to the doctor here. And we have quite a memory to show for it!