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.