Walking in Dignity Amid Despair
We are sharing a series of journal entries that the author, JH, contributed following an invitation from Insight Myanmar for publication on our website. She 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.
“They have taught me to walk in dignity as if supported by an invisible line from sternum to sky, entire being held high, feet rooted, head balanced upon the neck as if to carry the loads they do upon their crown.”
Burma Border Journals #9
I can hardly believe it’s been a month already. It is no longer surprising to me when the heavens open up with rain that I see people come to stand over the wide metal sewer gratings with hook, line, and threaded worm. They dangle the bait to attract precious catfish from a sulfur-scented soup of Styrofoam, pastel colored plastic packaging, old shoes replete with toe cheese. I no longer feel I should get on with whatever busy-ness previously occupied me when I see an acquaintance in the street, instead choosing to pursue to social connection. Song and dance incorporate to the ring of a cell phone. It has become normal to see a woman in a trim and pretty ankle-hugging sarong, called an “hta mein,” balancing sideways slightly recumbent on the back of a moving bicycle, an umbrella perched in one raised hand over the other rider peddling through the downpour. Don’t confuse the word for skirt with “hta min,” which means rice. The big spoon stays in my right hand, the curry ladled in increments via left hand from bowl onto plate of rice; the fork never touches this mouth. I enjoy the cooling sensation of “thanaka,” a cream-colored ground root bark and water facial preparation worn by women and children, on my cheeks. The diaper rash formed under any elasticized garment where sweat collects has resolved, as have the blisters on my feet from many kilometers in flip flop sandals. The footwear has softened, the skin grown callous. Gone too are the prickly heat bumps, little blisters of sweat in the sun-exposed areas on my hands and arms.
Neighbors become friends; we happily exchange pleasantries in Burmese, “Did you finish your meal?” Like the Thai, I offer drinks when people spontaneously stop by my room. At the clinic, we hug at the elbow and hold hands in Karen fashion. If ever the six o’clock chanting should fail to blare from the monastery loudspeaker I would mourn the loss of my unseen Pāli-speaking friend. I don’t lift my bag or my body unless the bus pulls up to the stop. The man in the white pick-up truck with billboards and bilateral rock concert style woofers and tweeters, still drives back and forth in town, but he turns off the loud, repeating, musical advertisements when he goes close by me. When a gecko falls from the restaurant wall to the table, from the bathroom ceiling onto a bare leg, from the clinic window moulding into the folds of my dress, I give thanks knowing this means good luck. I receive gifts more completely now than before and note this expanding urge to give, even to those persons in whose company there is a surge of annoyance.
So too, there is no shock when the young patient with rigors, who looked like death the day before, is given a plant medicine related to the Asteraceae genus Artemesia, then sits up playfully, and smiles. There is no alarm when after three negative smears for malaria trophozoites a pregnant woman is discharged from the clinic, though in developed nations we treat until absence of gametocytes. No one gets works up about eradication of latent hepatic hypnozoites; the mosquitoes just bite again. The pregnant woman will have a follow-up ultrasound in one month. I half expect giggling children and staff to slip my footwear onto their own feet when I turn the other way, and I wash my hands by dipping fingers into Borax and pouring a plastic pan of water over my hands onto a slanted portion of the floor. That the suds should meander across the room to some hole in the corner wall and out into the gutter is as unremarkable to me as non-physicians, actual refugees, performing skin grafts and excising biopsy specimens. They are brilliant, inside and out.
In this microcosm; however, there is very little recoil in me these days to hire-for-kill arrangements in town at three hundred Thai Baht per person, less that ten US Dollars. There is minimal terror when the SPDC, under the auspices of Thai authority, breaks into and ransacks homes of those who are friends of friends, evidently judged by someone to be the wrong friends. Plans change in hours, minutes; it is no longer safe to go here, there. Come here quickly, no don’t get up yet. Paddy wagons with faces, eyes, fingers wiggling out between bars, periodically round up people from the lands the British colonialists once decided to call Burma and drive them back to their fate. I don’t jump to the funeral fireworks knowing that shelling has reached in this far in the past. An investigative friend reports that one hour at the brothel is cheaper than the price of our room, that lighter skinned women cost twice as much as the usual going rate, that there is a discount for two at a time, and it’s almost funny. Cane balls and the Thai head-butting, kicking blend of soccer over a net is no more a spectacle to me with prostheses than if the team members had all of their original limbs.
No longer am I tempted to take home the wide-eyed little girl in the handmade, princess-waist, green dress whose two siblings are sick, whose father died, whose mother committed suicide, who were towed along here by a woman who just happened to step in somewhere along the way. Though the surrogate’s teenage daughter is jealous and angry, though the child really has nowhere to go, there are too many. When the mothers give birth we hold them up from their shoulders and neck; they grasp us on the opposite arm firmly. We whisper “Breathe, just breathe,” in Karen or Burmese. Unspoken prayers stream silently from both parties. They do not scream. They do not scream at all. They have taught me to walk in dignity as if supported by an invisible line from sternum to sky, entire being held high, feet rooted, head balanced upon the neck as if to carry the loads they do upon their crown. Their sarongs are one and a half yards of woven or floral fabric sewn into a big tube. The women fold theirs to the side of the waist; the men wear the burly knot in front, right at the midline. This cylinder serves as clothing, functions as a curtain when changing, becomes privacy when sponge bathing from basin or while standing calf-deep in the river. This single sheet represents portable personal space. They maneuver the material by second nature with skill and ease. I have tried. I look forward to that moment at the end of each day when I go to my own room at the guesthouse, close the door, and shower undisturbed.
There is a lump in my right armpit, a bit too tender to be TB, but firm not fluctuant, not inflammatory either? I sense some chest constriction, a slight non-productive cough over two to three weeks, mild indigestion. My contact with patients of all ages who suffer from similar symptoms, who went on to cough blood-tinged sputum, to gastrointestinal obstruction, multiple coin-sized ulcerating skin sores, spinal lesions, and signature cachexia, could only be described as too numerous to count. One would have to find an N-95 mask daily and wear it form-fitting from sun-up until sun-down in every department for adequate protection. It would be difficult to eat and drink, and besides a single mask doesn’t last that long. So I’m thinking how inconvenient it will be when I arrive home to find someone to place a Purified Protein Derivative (PPD) test that I can afford. Plus I’d have to take the time to get the thing read three days later.
The medications are super expensive and one of them will turn my secretions embarrassingly burnt orange. This will be such an inconvenience.
In my case, the symptoms are probably attributable to an ingrown axillary hair, changing molds of the rainy season, and a healthy imagination. The brief mental fantasy goes beyond TB to include tropical pulmonary eosinophilia caused by microfilariae. I don’t want elephantiasis either. This will be such a hassle I think to myself. The people hiding out in the jungle, most likely they’re not thinking temporary annoyance. Most likely they’re not thinking about it much at all, just knowing from seeing it happen to friends, knowing directly one more avenue to death.
So, really, it’s not unusual to read in the obstetrical chart of a female in her late thirties or early forties: gravida eight, para three, spontaneous abortions one, induced abortions four. There are so many sticks of various shapes, sizes, and materials responsible for maternal sepsis that we’ve hung them on the wall in see-through baggies as demonstrations of danger. A child emerges from the womb with a knotted rubber band stuck in the vernix on his back. He was not wanted. Not that he wasn’t loved, not that the woman doesn’t love herself, but there’s just so much suffering.
A fourteen-year-old girl pleasantly and politely tells us she walked here from Rangoon to Thailand because she has type I diabetes mellitus and has never been on insulin. She looks so young. One might think she is nine years old, no signs of puberty. It’s hard to believe until we test her sugar. We admit her immediately to the IPD, in fact, we escort her across the dirt parking lot, and call the hospital to try to get some STAT insulin. For her the Thai hospital is mysteriously closed today, but it is open for someone else. I go outside with what I thought was poise and equanimity; suddenly tears wet my cheeks.
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.