Chin
State Odyssey
Dr James Muecke AM
I left my ŌLonely PlanetÕ at home as I set off for the
remote Chin State in the northwestern reaches of Myanmar (formerly Burma). The
capital city of Hakha doesnÕt even rate a mention in this trusty guidebook for
travellers – you know you are heading somewhere exotic and untouched. I
was really excited!
I have been visiting Myanmar for over a decade with my
blindness prevention organization Sight For All. Our eye surgeons have been
working with local colleagues to find sustainable solutions to the enormous
burden of vision loss that afflicts this poorest of countries. I had with me a
team of three from Royal Adelaide Hospital, including a trainee eye surgeon (Dr
Paul Athanasiov), an ophthalmic nurse (Sister Siew Kim Teo) and a public health
scientist (Steve Nygaard). Escorting us were Drs Hlaing Win and Tin Mg Thant, young
colleagues from Mandalay Eye Hospital, the second largest ophthalmic training
centre in Myanmar. We were bound for two regional eye centres in the Chin State,
each manned by an eye surgeon posted for a year or more, far from their homes,
far from their families, and in the midst of minority people with whom they can
barely communicate.
I knew that Sight For All Ambassador and acclaimed
filmmaker Scott Hicks had a close connection with Myanmar, and was eager to
experience Sight For AllÕs work first hand as well as explore his family roots.
ScottÕs grandfather, George Augustus Hicks, had been the chief engineer on a
major rail bridge near Mandalay and GeorgeÕs father-in-law, Henry Felix Hertz,
was a District Superintendent of Police in northern Burma. Scott was to become
our unofficial but devoted photographer, relishing the opportunity to capture
our teamÕs work as never before. HeÕs an accomplished photographer, having cut
his teeth capturing international rock bands during the 70s.
The first leg of our journey began in Mandalay in central
Myanmar, the cultural and spiritual heartland of a country that is just opening
up to the world after decades of military rule. Our flight to Kalaymyo had been
cancelled and so we were faced with a grueling 10-hour road journey to the
upper reaches of the Sagaing Division.
Fortunately the first break came after only an hour into the excursion,
when we stopped for sunrise at Ava Bridge, the eighty year-old iron structure
that scales the mighty Ayeyarwaddy River to the Buddhist pilgrimage site of
Sagaing. More importantly, for the British Colony of the 1940s, it allowed a
vital supply channel into to the west of a country on the brink of invasion.
The British destroyed a short segment of the bridge as they
retreated from the fierce onslaught of the Japanese, in the hope of slowing
their advance from bases in occupied China. The bridge survives, proud and
intact, like a giant reptilean skeleton lying silently beside its utilitarian
and less evocative Chinese-built successor. We crossed the half-mile long
bridge on foot, enjoying the energy of another Myanmar day bursting to life and
the play of light on the iron girders. For Scott, this was a special moment,
one he had been looking forward to for years. In 1934 ScottÕs
father, at the age of seventeen, had opened the bridge in place of his own
father who had been taken ill. Peter Henry Hicks could never have contemplated
that his son would be following in his footsteps nearly eighty years
later.
From Ava we skittled along the highway to Monywa, another
important landmark in the ancient Buddhist heritage of Myanmar. There are a
number of important religious sites scattered in the rice paddies that surround
this dusty town, but we only had time to visit Thambuddhe Paya, a riot of
colorful temples and monastic buildings that feel more like a seaside carnival
than a holy monument. A thirty-story high concrete Buddha bid us farewell as we
continued on our way to Kalaymyo, an interminable seven-hour rollercoaster ride
away.
Just to keep us on our toes, or at least on the edges of
our seats, cars in Myanmar drive on the right hand side of the road, but the
drivers are also seated on the right hand side, shielded from a clear view of
the oncoming traffic. Overtaking large slow vehicles becomes quite an art on
the narrow choked arterials – first the driver veers to the right edge of
the road to see if he can catch a glimpse of what lays ahead, before gingerly
moving toward the centre until he can truly determine whether it is safe to
pass. Of course this then exposes the left half of the car whilst the driver
blindly attempts the maneuver. Being in the front passenger seat and
disconcertingly in the line of fire, Scott used his keen directing skills to
rapidly relay the relative safety (or otherwise) of the road ahead, as menacing
trucks suddenly appeared beside the exhaust-spewing gargantuans we were caught
behind. One wonders how many lives have been lost since the former regime
changed the regulation on a whim and a desire to shed their country of its
colonial past.
The journey was one of endless fascination as the
palm-fringed road snaked its way through rice paddies busily under harvest and
fields of bright yellow sunflowers, following our passage to the west. Bullock
carts plied the dusty verges as they have done for centuries, a scene that will
soon become extinct as Myanmar progresses along its newfound path of economic
development. Small gatherings of the devout chanted and rattled silver bowls
outside each village monastery in the hope of attracting a few Kyat (the local
currency) for the monksÕ coffers. Ramshackle roadside cafes and stalls selling
fruit, palm toddy, and soft drink bottles of gasoline came and went with
monotonous regularity.
Our driver chewed steadily on betel nut, a mild stimulant
that kept him alert but also stained his eroded teeth a deep reddish-brown, a
curse that afflicts even the most educated of developing Asia. We were soon
greeted by a wave of diesel sloshing about beneath our feet. The plastic jerry
can in the boot of our Pajero had been filled in situ, the driver unaware that
there was a large hole in its base until the flood had declared itself. He did
his best to soak up the fuel that by now had permeated the layers of carpet and
insulating material in the floor of the four-wheel drive. A vigorous spray of
air freshener only enhanced the sickly aroma, so we continued on our route, the
windows wound down, our noses soaking up the fresh air streaming in to the
diesel-suffused interior. I kept one hand on the door handle, ready to leap
free if the vehicle were to suddenly burst into flame, charged by a fear of
combustion from the heat of the tarmac streaming beneath. We were rather
unconvincingly reassured that diesel at least is less flammable than petrol.
Needless to say we were relieved to reach our destination, a little shaken, very
stiff, our nostrils twitching with dust and sinuses laden with diesel fumes.
Kalaymyo is not the most inspiring of MyanmarÕs towns, but
in soft light the following morning, itÕs street market was captivating –
the curbs were packed with cross-legged vendors selling an extraordinary array
of exotic fruit and vegetables, pulses and beans, and red chilies of every
shape and size, fresh or dried, whole or crushed, powdered or pasted. Open-air
butchers buzzed with flies and fish stalls buzzed with scales catapulted by
axe-wielding fishmongers. Chemists dispensed skin-lightening potions and
toyshops dispensed plastic pellet guns that sabotaged the efforts of our
colleagues to fight childhood blindness. Fluorescent fluffy nylon clothes
imported from China, the latest fashion accessory in highland Myanmar, dangled
merrily from doorways and eaves. Flags of the now legitimate National League
for Democracy fluttered beneath multi-coloured umbrellas and t-shirts proudly
bearing images of Aung San Suu Kyi defied the former guard. Dimly lit teashops
and noodle vendors served sleepy diners perched on miniature plastic stools.
Buddhist monks in crimson robes filed past businesses collecting their daily
alms, the donors claiming a few Karma points for a better lot in the next life.
Mongrel dogs weaved in and out, dodging sticks and collecting scraps that never
seem to fill the cavities between their ribs. All of this bathed in a serene
light filtered by an atmosphere saturated with mist, dust and diesel smoke.
We left this scene behind as we passed through the tired
boom gate declaring our arrival in Chin State, and headed up and west into the
low lying mountains that fill its interior. The stifling heat and humidity of
the plains was replaced by the refreshing cool breeze of the crisp mountain
clime. Thanaka, the ubiquitous makeup that adorns the faces of MyanmarÕs
children, was traded for grime, bullock cart was traded for packhorse and
Buddhist instruction was traded for sermon, attempting to save the souls of the
Christian majority.
The drive to Falam took nearly six hours, our vehicle
bridled to an average of 20 miles an hour as we ascended mountain passes and
skirted steep valley walls on a sinuous track never more than one lane in
width. Our driver chose not to wear a seat belt, preferring the option of
leaping free of the vehicle if the opportunity were to arise. For the most part
we hugged the mountainside, aware that on the return journey the car would be
clinging to the edge of a precipice that was utterly devoid of any useful
protective barrier. Fortunately MyanmarÕs vehicles seemed to have developed a
language of their own, communicating with each other by a complex series of
beeps, one asking if it is safe to pass, the next relaying its response.
The road cut a shallow swathe across the green mountain
face, the fine brown line so created gently inclining on its upward path. We
entered villages lined by wooden houses never more than one row deep and
brimming with delightfully friendly children, who perhaps should have been
receiving an education elsewhere. The abodes that lined the lower side of the
road were stilted out over a steep drop that becomes an impenetrable cascade
during the monsoon. From a distance, the uniform row of village houses was like
a series of betel nut-stained teeth in the face of a grinning madman.
Teams of construction workers, often entire families,
labored on sporadic stretches of dilapidated road, short expanses that seem to
have no more urgent need than any other on the perilous path. Great rocks from
rivers far below were broken down to rubble by wiry hands wielding hefty
sledgehammers, a relentless and unforgiving job that must rank among the
worldÕs worst. The rubble was in turn scattered by women, often only children,
and ultimately doused in a layer of tar and gravel and pressed flat beneath the
monolithic steel wheels of an antiquated roller, the gang constantly immersed
in a choking cloud of dust and tar smoke. No eye protection and not a mask in
sight – there are no occupational safety regulations in this far-flung
destination.
Falam greeted us with an unexpected charm, layers of
two-storied colourful houses spilling down the mountainside and a multitude of
churches of every denomination connected by a ribbon of road weaving up between
them. We spent the night in a guesthouse of sorts, hastily furbished to
accommodate our group, in a town devoid of amenities, in a state that has not
opened to tourism, in a country unprepared for what is to come. Diesel
continued to haunt us through the night, seeping up from rusty barrels stored
beneath our dormitory room.
Glorious red poinsettia announced the imminent arrival of
Christmas as ŅSilent NightÓ boomed forth from megaphones to wake us at 5.30 the
next morning. We strolled about town through the pre-dawn light in the surreal
embrace of Christian heavy metal as a mad woman preached from the balcony of
the townÕs domineering Baptist church. We savored steaming breakfast noodles to
the intrusive cackle of a TV evangelist, in the unsettling gaze of a mutant dog
with human eyebrows and an adopted psychotic claiming beer money.
After a four-day journey to reach this remote outpost, we
were finally able to get down to work. The next couple of days were spent at
the regional eye centres of Falam and Hakha, the latter a four-hour drive
deeper into the Chin. Sight For AllÕs quest was to deliver and install new
equipment, and to provide training and eye health promotion workshops to the
two centres, to enhance both the quality and quantity of eye surgery being
performed. Sadly, Myanmar has the highest reported level of blindness in the
world, the vast majority due to a clouding of the lens of the eye known as
cataract. Once removed, a cataractous lens needs to be replaced by a clear
acrylic lens so that the patient can maintain focus. Prior to Sight For AllÕs
involvement, the local surgeons simply made a Ōbest guessÕ as to the focusing
power of the replacement lens, and frequently the patient was left with vision
worse than before. The donation of highly specialized devices to calculate the
appropriate lens power, and training in the use of this state-of-the-art
technology, has resulted in a huge visual benefit to patients having cataract
surgery, the results filtering through to isolated villages, a call out to
those destined to a life of blindness.
Any patient embarking on surgery is fearful of the encounter,
none more so than illiterate farmers in isolated villages of destitute countries
where life has barely progressed in centuries and waning eyesight is an
accepted companion to greying hair, creaking joints and a stooping back. Not
only must a potential patient cobble together the fee for an operation
(cataract surgery is not free in Myanmar and in most instances amounts to
several months wage for a subsistence farmer), many social and cultural
barriers must also be overcome. The task of convincing the patient and their
family of the need for surgery falls on the health care workers and a team of
midwives who spend their days travelling to distant settlements. As you can
imagine, midwives are schooled in the art of childbirth but have scant
knowledge of the intricacies of microsurgical extraction of cataractous lenses.
And so a vital component to our injection of technology into rural Myanmar becomes
the education of midwives in the fine art of eye surgery and solutions to
overcome the hurdles preventing patients from seeking it.
Why take such a long and hazardous journey? Why me? Of
course the adventure is second to none, but the humanitarian spirit lies much
deeper, an inexplicable desire to help those in need that is perhaps the core
of many who seek medicine as their lifeÕs work. I have always enjoyed teaching
my developing country colleagues, who in Myanmar had for years been starved of advances
in our specialty. ŅGive a man a rod so he can fish for lifeÓ is Sight For AllÕs
catch cry. A wonderful example of our work was the training of MyanmarÕs first
childrenÕs eye surgeon, a young doctor named Than Htun Aung who spent a year
studying at the WomenÕs and ChildrenÕs Hospital in Adelaide. He returned to a specialized
clinic established by Sight For All in 2010, the first Paediatric Eye Unit in
the country, the first for a population of perhaps 20 million children. A
15-fold increase in childrenÕs eye surgeries in the two years since heÕs been
back is testament to the extraordinary knowledge and skills that were imparted
by my colleagues in Adelaide and the sustainable impact of the Sight For All
legacy.
The real clincher for me however, came earlier than this
when in 2005 I was part of a team conducting a survey in central Myanmar. The
Meiktila Blindness Study was a population-based study seeking the magnitude and
causes of blindness in the Dry Zone of Myanmar, the first of its kind in the
country. Each day we were faced with dozens of people who were blind or
severely visually impaired, many of whom were my age or younger, most of whom
had conditions that were preventable or treatable yet with no hope of ever
seeing again. The scant few whoÕd received surgery were in most instances no
better off. Every member of our team was deeply moved by the experience and the
scale of the problem. It motivated us to campaign Alexander Downer, the then
Foreign Minister, who subsequently granted Sight For All funding for a
nationwide project to reduce the consuming affliction caused by cataracts, a
readily treatable condition keeping many Myanmar communities entwined in
poverty.
As part of the five-year AusAID-funded blindness prevention
program, Sight For All has been upgrading the facilities, providing training and
raising awareness at over thirty eye centres throughout Myanmar. The centres at
Hakha and Falam in Chin State were the last two requiring our attentionÉfor the
time being. There is no doubt we are making an impact, not just for the rare
individual, but for families, for communities, perhaps even the entire country.
There is still much to be done however, with diabetes and its blinding
complications looming as the next major public health issue. Our work complete
for now, we retraced our path, descending down through the clouds, content in
the knowledge that we had made a difference to the moral of our displaced
colleagues and the lives of the Chin people in this distant pocket of the world.