Torn Between Stories and Suffering
We are sharing a series of journal entries that were sent to us as an essay submission for our website. The author, JH, includes the following message: The following entries from my journal along the Burma-Thai border were first shared more than 18 years ago. On the advice of a respected teacher, they were distributed only on paper, so as to protect involved parties while raising awareness. Later, when the Internet became available, many of us still hoped in our hearts that these descriptions would soon become obsolete. Finally, I offer these words here in realizing that certain details remain far too accurate. May they bring benefit. Please forgive my youthful ignorance and arrogance. Errors are my own.
“Torn. Torn between having agreed to write, enjoying too the process of putting as of yet non- verbalized notions to the page on the one hand, and on the other a real reluctance to make a story.”
Burma Border Journal #1
Torn, torn as these pages become when rubbed to erase the incorrect date. How easily one loses track of markers like the month of May, in climates, microcultures such as this along the tropical Thai-Burmese border. Enjoyable, perhaps, the sparsity of those collectively agreed upon punctuations in time. Relative human constructs serving to lubricate communication and productivity on the one hand, and on the other, building identity into such fixtures as time, space, and the ensuing separation. It seems that, in fact, there is a certain adherence here to norms familiar to our Judeo-Christian capitalistic tendencies; only it is not all-consuming. Rather it is finely balanced with mannerisms and celebrations resonant with some larger heart or psyche, soothing and expressing the non-linguistic, non-rational aspects of the human being. One result of honoring such real needs, however unpopular or altogether dismissed in the West, is that people here are happy. Poor, sick, tribal villages brutally decimated, hunted by military, and happy. Maybe one can downplay interest in the etiology of happiness but as a symptom it is strikingly difficult to ignore.
Yes, torn, I was feeling torn about an obligation in this medical role to describe and to document the individual cases encountered, cases such as one twenty-year-old female who appears to me fourteen. She has pulmonary hypertension secondary to a long-standing septal defect and congenital aortic abnormality. Her family spent its life savings, equivalent to about sixteen US Dollars, for a diagnosis but could not find skilled consultation regarding repair in Burma’s capital Rangoon, or Yangon as it’s been renamed by the junta. Surgical consult in Chiang Mai, practically speaking the Northern capital of Thailand, is the next step, the family having illegally crossed the border and the patient now examined and referred. This plan is complicated by the need for four thousand Thai Baht, some of which goes to pay the specialist but much of which is budgeted for safe hiding, food, transportation, and for escorts skilled at bribing appropriate officials at checkpoints along the way. These challenges, and then the sheer amount of time that
has passed, the obviation of pulmonary changes; is surgery even a viable option at this point in progression of the disease? A visiting British medical student has taken it upon herself to launch a fund drive.
And what about the sixteen-year-old boy who looks eight or nine and comports himself like a full-fledged grown-up, with compassionate eyes, the quietude of one who has suffered much? Arthralgias and febrile. We performed a tourniquet test, which thirty percent of the time brings out a rash of faint reddish papules in the antecubital area of patients with Dengue Fever, although not entirely specific to this condition. The technique is painless but involves inflating a blood pressure cuff around the upper arm for five minutes. Discomfort. Silence. No squirming. No Rash. Still the pain, the fever. Some die; we don’t know why.
The volunteer surgeon introduces me to another young man, with a history of undisclosed trauma to the right lower extremity. He has a femur fracture as well as comminuted tibular and fibular fractures. Non-union and no treatment for three months. He arrived here and somehow a decent orthopedist from another Thai province was able to offer external fixation. This is a suspected landmine injury, eighty percent of the accidents here are sequelae of just that. Yes, if worse comes to worse, he can visit the bustling prosthetics department, proud of its new capabilities to cast and fit the product in the less accessible jungles of the Karen State. But the point seems a bit bigger than just getting him walking again doesn’t it? Where is his family? What will he do for a living when he grows up; how will he eat? How is it growing up knowing you could step on a piece of ground and blow up a body part or an entire body, knowing experientially that there are people who devote a considerable amount of energy toward designing, building, and placing these contraptions really purely intended to maim fellow beings? How will he love, in direct knowledge of such realities?
And then there is the woman who looks fifty but is actually only thirty-five. Her husband had pulmonary tuberculosis (TB) for six years and recently died. She spent those years loving him, caring for him. Now she presents complaining of..., well they don’t really complain these people, but that is the medical way of reporting. Her chief symptoms include ten days of chest pain, non-productive cough, and weight loss. She escaped Burma temporarily to seek treatment, but when told of impending referral to Médecins Sans Frontières (MSF) for Acid Fast Bacillus (AFB) testing of her sputum, her face wrinkles into contortions of stress. No, she just needs the medicine. Can’t she just have the medicine and go back? She cannot stay here illegally. It is too dangerous; she has no papers. And of course, everyone knows there are spies. Every bit is true. All this and then there is the prevalence of undiagnosed HIV seropositivity in TB patients. On a less individual scale looms the debate about whether releasing Burma’s HIV data amongst international agencies would lead to banishment of non-governmental organizations (NGOs) suspected of collecting the numbers, those who have not yet fled the region.
Another common finding in Burma is esophageal carcinoma, and the Karen and Burmese- speaking medic, trained at the refugee clinic, astutely noticed that I spell the term differently than my predecessor from the United Kingdom. I begin the anatomical word with the letter “E,” but in England they write “Oe.” My friend was confused as to why I was looking in the wrong alphabetical section of the oncological index. If she can note this dialectical difference amongst all else, in the company of the dog with half its head cancerous and maggot infested behind the
food stall, the pregnant women of her own people shaking in the throes of Malaria; when her peers are deciding whether to raise their children here illegally on the border with possibility of deportation, experiencing or witnessing violence, or to abandon kids at the clinic altogether and flee; if she can recognize a spelling anomaly in at least her third language amidst all that, even a traumatized human is capable of so much more than we know.
So, the seventy-seven-year-old man with two months of hoarse voice, dysphagia to solid foods, and weight loss has been referred for a barium swallow study. For what? So he can know what is killing him? We are all being killed; should we spend our lives learning how exactly our body will decay? Is that good? Is that useful? On which level do we approach the issue? So here is the tearing in me: I don’t want to describe the medical cases. I want to talk about the root of this morass. What drives the formation of such conditions amongst beings when there actually exist adequate resources for all on this planet?
I want to talk about the clouds. They held the answer, or they exemplified the quest and its fruits, long before my sense of me got involved. There they were out the airplane window, reminding me before arrival on this scene, this particularly horrid and vivid midden of suffering, how the senses deceive us. How easy it is to believe in the solidity of things that cannot be grasped, to equate the form of a thing with its explanation. How naturally we forget about the immeasurable periphery, composed of microscopically and endlessly changing boundaries. Most importantly, the mind leaps to create, almost instantaneously, strategies to come closer to that which strikes us as desirable. My first urge was to touch the puffy whiteness. The engines, red- tipped and mostly pontoons of grey, resembled buoys, and thus I felt as if floating upon some soft sea. Supported, the drive to connect followed suit. The second story touched on insubstantiality, in an absolute sense, nothingness and the idea of falling through some abyss. I tensed my body at the thought, held my breath, hardened the eyes and belly, as if to prevent any incoming sensation, as if to fight. All this in two instants.
Yet, in actuality, even the atmosphere is made of not too minute substance. Every drop of water condenses around something seeding the saturation, like a particle of dust for example. What is Burma’s dust; around what might such beautiful and tempestuous storms of humanity arise? Knowing in this way, you cannot say, “This one thing is good; this other thing is bad.” You cannot say this is all the fault of the Malaria, or even of the mosquito for that matter. You can’t say this is the cause of Ne Win, first general for the State Law and Order Restoration Council (SLORC, now retitled State Peace and Development Council, SPDC, with less of a ring to it) who launched a coup in 1962. You can’t even say that this NGO or that NGO is doing the right thing. This arising and passing away of suffering is not so simple and not so complicated either. So many factors and everyone trying so hard, all exerting real effort to alleviate or avoid pain in whatever way they imagine best, based upon their own particular sets of conditioning. It’s like a playground here, for people whose actions are based upon their own happy or unhappy associations with the form in which they happen to believe. And where is that not the case?
Oh, the pain is real. It’s just that the patterns underlying this effect are not linear. Not seeing the causes clearly due to our individual issues, we butt heads as to symptomatic treatments of choice. Many folks are wise enough to trust their bearing to service; not all however do so with the insight and patience necessary to effect optimal and sometimes subtle shifts. Part of the reason is
that often outcomes occur over lifetimes, requiring patience and little glimpse of payoff. The conversation around the table where we foreigners congregate in the evening centered today around one man’s triplicate deportation from Burma, or Myanmar as the generals inform the world. He told of how his molars had been broken off at the gums from the butts of rifles thrust against his cheeks, how they did give him cigarettes but only so that the burning butts of those could be held against his skin.
I met one child who was found to have cerebral palsy. His mother had passed away; the father had run away, leaving the young one to a coma of malnutrition. He lay smaller than most dolls, toothpick arms at his side like a little soldier, skinny feet splayed laterally, but breathing. During morning shift when ants were found to be streaming all over him and his mat, the decision was made to stop nasogastric feeds and to let him die. Then the second shift took over, and either through lack of communication or confusion therein, feedings were resumed. This was noted by a student who explained the initial decision: if the child did receive appropriate calories, hydration, and vitamins, since family members do the nursing, who would keep the insects away? Given that the patient was unable to move himself even prior to the current predicament, who would care for him if he one day emerged from the comatose state? Tube feeds were again discontinued until a woman on the third shift just couldn’t bear it and began to thread the tube back down through the child’s nose.
The patients and chaperones unanimously love the kid, and when some provider lifts the pink framed mosquito netting from over his spot on the floor, all ages gather around wide-eyed and pouring out love. The adults who are there in the Child Inpatient Department (IPD) with their children practice the most beautiful sort of communal support, acting as temporary surrogates for one another should some adult need to leave. I found myself remarking aloud at the absurdity that I should need to travel all the way to the deforested jungles of Southeast Asia to see how love is really shared. We teach the refugees a few basic medical skills; they become better doctors than we in some cases. They incorporate such skills while pouring bleach upon tile floors, spontaneous septic abortions and women who don’t know what hot flashes mean, having lost the elders they might ask, gone to torture, slavery, forced internal displacement, fanning each other over ancient metal operating tables, bare foot with mats for beds, painting scenes of home on pressboard partitions, playing soccer in the dirt. If we pay attention it is clear that in every moment they are truly alive they model what is important for those who survive.
At six each night in this town Theravadin chanting is broadcast over loudspeakers from the Wat, Thai for temple; the Muslim routine occupies early morning. The Christians say their prayers at dinner and bedtime. Children call from games in the street before it gets too dark, and cicadas or some relation of theirs commence to cha cha cha. Compared to the chirping crickets of my home, these have a slowness, a drawl, like a pause between breaths to let the heat of the day settle.
Sometimes when the radio is on and I’m winding down the street, the pedestrians tune their walk accordingly and the trees seem to sway in time. It’s like weaving through the crowd at a concert. We adjust the pendulum swing of our hips, shoulders, and limbs in synchrony with the larger dance. So it is with these cicadas; I compose my individual melody in harmony with the accompaniment. Moving with the music, it points to where the real power lies.
Torn. Torn between having agreed to write, enjoying too the process of putting as of yet non- verbalized notions to the page on the one hand, and on the other a real reluctance to make a story. This human condition, this stringing together of experiences deemed pertinent, it builds a scaffold in the mind upon which we hang subsequent perceptions, in order that we might more easily attribute meaning to interaction. In doing so we fortify some sense of certainty in an inherently uncertain world. Like drawing a straight line tangential to the spiral that is the truth, the circular reconnects with the self and the line removes itself infinitely.
Having gotten to the point of seeing this addiction to mental constructs, I am wary of enabling the habit, of making it too easy for the experience here to live out the story. I write hypnotized by imagined assignments of value and meaning.
May this writing heighten awareness about the plight and great beauty of the people from all parts once called Burma. May it bring benefit to all who are described herein and to all who read it. May you be truly happy.