Nursing the Shan

On a bamboo bed in a dark clinic at Loi Tailang, a woman sits with her three children. One has a severe foot burn, which is all infected and ugly looking. It is very common for children in the rural villages to be burned when cooking pots overturn on the fire at the center of their hut. At the Loi Tailang temple there is a young monk who was horribly disfigured by similar burns which cover his face and head. A health worker explained to me that in the villages burns are often treated with a poultice of cow dung or with oil, both of which worsen the effects of the injuries.

The children sit on a single bamboo bed, beside their mother all day. They have no toys, no TV, and no books, nothing to occupy them at all. They just sit, in sad quiet, waiting for the head nurse, Paw Surgay to bring them their next free meal. The mother had a tremendous tumor on her right arm which was all white and discolored. The tumor itself was visible through the skin. It was the size of a lemon.

Paw Surgay tells me that the woman is HIV positive and suffering from advanced stages of TB. They are planning to surgically remove the tumor, but have to wait till the woman’s other infections are under control.

Head nurse and chief of station since 1999, Paw Surgay from the Kerenni tribe, told me that when she first came to the Shan State Army headquarters at Loi Tailang there was no clinic. “There was a home with some medicine and no staff,” she explained. “There were a few untrained medics who tried to help people.” Since taking over the clinic, Paw Surgay has invested, each year, in training more and more medical staff. Most receive their training at Dr. Cynthia’s clinic in Mae Sot.

Paw Surgay is one more bright face that we find amidst the ruble of the war in Burma. She is a young, attractive woman, who has dedicated her intelligence and diligence to helping others live. In this racist conflict, perhaps the most remarkable fact about Paw Surgay is that she isn’t even Shan, she is Kerenni. She was able to let the question of race disappear and see the sick and needy simply as people.

“In the beginning we didn’t have any support for medicine or equipment. I relied on small organizations like Partners NGO. to help support what I was doing.” Paw Surgay went on to explain that she couldn’t pay the medics so Free Burma Rangers (FBR) and Partners helped her get started. The current clinic at Loi Tailang was built in 2003. The location was chosen because it was closer to water. In recent years, a foreign engineer put in a water line, which pumps water 300 meters up hill and operates on solar power. “It always works,” remarks Paw Surgay. “They said it couldn’t be done, but it works now.”

The story of the water system is yet another miracle in a land of darkness. The engineer who built the system is an absolute genius with engineering systems and particularly with anything related to water. Using hand held GPS devices and other scientific equipment he conducted a geological survey to find the best way to build his uphill water pump. I had a chance to meet him, while he was planning plumbing for Lt. Philip’s house. He was one of those geniuses who just exists on some other plane of reality. Things were obvious to him which whole teams of mediocre geniuses would miss. When I asked him how he wound up with the Shan, he told me that he chooses a worthy location and group of people. He then does private fund raising to get money or equipment, then he flies in and builds the water system. He had done similar projects with other ethnic groups throughout Burma and elsewhere.

“The hospital used to be down by the stream, but it was not good because pregnant women and injured people couldn’t walk down to it,” said Paw Surgay. Now, because of the brilliant irrigation system, the hospital is at the top of the hill. This position will protect the patients from monsoon flooding and from malaria. “The first two clinics were built completely of bamboo, but it wasn’t good because it became moldy in the rainy season. Everything, equipment and medicines would be destroyed.”

Eventually, the current structure was built entirely of wood.

Among its many functions, the clinic at Loi Tailang, under Paw Surgay, runs a vaccine clinic once per month. They get a small stipend from a small charity to do this. “It costs about $300 per month,” said Paw Surgay. “All maternal care providers are trained by Dr. Cynthia. Dr. Cynthia also does all of the lab work.” The clinic treats between 700 – 800 outpatient and 40 inpatient per month. This includes the nearly 1000 orphans, 350 refugee families, and several thousand soldiers living on the base, as well as villagers who come to the base because it is the only hospital within a month’s walk in the jungle. The most common health complaints are acute respiratory, urinary tract, and skin infections. In the rainy season there are a lot of fungal infections and skin infections. These are simple infections, but because they don’t get treated they get much worse. In dry season respiratory infections are high because of the dust and jungle pollen that people are forced to inhale.

“The base doesn’t have big problem with malaria because it is high and cool. The people who live in the villages, however, come here with malaria. People who live here don’t usually contract it,” explained Paw Surgay. “Last year, we treated 11 HIV/AIDs patients. Three of them died.”

HIV is a growing concern in Shan State and much of Burma. At Loi Tailang, th medics first do a rapid test. If it comes up positive, they do two more. If all three are positive, then the patient is sent to Dr. Cynthia for blood work.

“No patients pay anything. Even in-patients don’t pay anything, not even for their food.”

One more reason to respect Paw Surgay is how responsible she is with the hospital’s finances. She keeps careful track of all of the donation and expenditures.

Opening her meticulous financial books, Paw Surgay showed us that it only cost 3000 Baht ($100 US) per month to feed ALL the patients. It was amazing what they could do for very little money. The total annual budget was only 600,000 Baht For 10,000 patients.

The small hospital does everything from baby birthing to surgery. There is, however no real dentistry. They do extractions for the children if their teeth are badly rotted.

Referring to the woman with the tumor, Paw Surgay said, “We want to operate on it, but it is too hard now. So, we will wait till it gets soft and then cut it out.” She had already started the patient on a regimen of medicine that would soften the tumor.

A male patient, a long term residence of the ward, also has AIDS. “They have no home to go back to. We will try and find financial support for them. Maybe we could build a house for them behind the hospital.”

The two HIV patients were being treated with antibiotics only, no retrovirals or HIV medicines.

“They are treating the symptoms but not that actual illness.” Said a visiting foreign medical aid worker. “They can’t afford to buy antivirals so they use an antibiotic.”

The foreign nurse explained that if the immune system is low, the patients get infections. “So, you treat the infections. But once the white blood cell count gets very low, then you can’t really treat the them anymore. The immune system goes down over time, the longer they have the disease.”

She told me that she believed the tumor was caused by an extremely advanced case of TB, which would suggest that the body had completely lost the ability to fight off infection. This woman was close to death. Operating on her in such primitive conditions seemed a very risky prospect for all those concerned. The risk of cross contaminations seemed very high.

I was at the Loi Tailang clinic as a guest of Partners NGO, which was founded in 1994 by Steve Gumaer and his wife. They had made a back pack trip to a refugee camp and started. “In 1994, we made a thirty dollar commitment to save a child for a whole year,” explained Steve who was appalled at how little it cost to save a life and how much money is wasted annually in the west.

“There are millions of refugees,” said Steve, meaning there was still a huge need for help. In Thailand, one camp alone was home to 140,000 refugees. The people in the first camp Steven visited were Karen, a group who have been fighting against the Burmese junta for almost 60 years.

“There are a few million in camps and a few million scattered around. The SPDC forces people out of villages and makes life impossible. So, they run to camps in Thailand or inside of Burma or elsewhere. I found out that thirty dollars would pay for school, food, and housing for one child needed to survive. A woman who had been raped and tortured for several months by the Burmese army asked us to tell our friends in the west and ask them to help. So, in 1995 we started a newsletter called Partners and used that to start helping people.”

Today, Partners has four programs: relief for displaced people, a child welfare programs, which is helping 1500 children, and education and child welfare inside of Burma, and also training in IDP communities. The new areas they are working in include post traumatic stress and trauma therapy. “We also added capacity building, animal husbandry and irrigation.”

Steve and the Partners are saints for the help they have given the ethnic minorities of Burma. Paw Surgay is a national treasure and deserves some type of major award. Dr. Cynthia is a gem, her hospital and health care programs have helped countless thousands over the years. FBR, the water engineers, and the Shan, Karen, and Karenni people are all worthy of praise for their tireless resistance to the junta and for constantly putting the needs of others ahead of their own.

Together, all these people, and more, are nursing the Shan. Please remember them in your prayers.

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