Memories of Monsoons Past

a tribute to Saya U Nyun Tin 

 

Memories of Monsoons Past
by Dr Nyun Tin (who passed away  on April 8th 2006) 

 

It was at the height of the monsoon season when I arrived in Tigyaing, a small town on the Irrawaddy River, 150 miles north of the fabled city of Mandalay. My task was to provide a hospital service and primary health care to the people in the township which covered nearly 2,000 square miles.

Communication was primitive; there were no motorcar roads at all. Transportation was mainly by riverine traffic and the use of ox-drawn carts. The main street was a quagmire and I found it easier to walk barefoot. The nearest district hospital was two days’ travel upstream. It meant, therefore, that I had to handle all the emergencies on my own as I was the only doctor in town.

The sixteen-bedded hospital was in a parlous state. The wooden building had fallen into disrepair with the torrential rains leaking through the ceiling of the operating theatre. The ground was not fenced and cattle and goats were grazing happily in the compound. There was no supply of running water. It had to be carried daily from a well by the hospital water carrier, a sturdy teenager named Zaw Mun.

The rest of the hospital staff included a midwife, a male auxiliary nurse and a compounder (pharmacist).

 

Government funds for building repairs were limited. Soon I became acquainted with the local elders and officials. A meeting was convened where I pleaded for donations of timber, bamboo, bricks and cement. The response was more than I had dared to hope for, and at one weekend, there were about two hundred volunteers, including carpenters, masons, plumbers and builders, helping to repair the buildings, erect a wooden fence and construct a large outdoor concrete water tank.

 The work was done in a festive mood with the village orchestra in fine fettle with its drums, cymbals and clarinets. The womenfolk served mounds of steaming glutinous rice sprinkled with powdered dried prawns and fish, shredded coconut and peanuts, accompanied by cups of hot plain roasted tea. There was a sense of accomplishment and participation.

 

 
 

My next project was to obtain a constant water supply. A proper plumbing system was beyond our means. We hollowed out the large bamboo poles, joined them together and placed them on wooden stands, all the way up a gentle hill where the police station had an electric pump drawing water from the river. The police force waived the fee for the fuel. The first test run was a disaster as the water pressure became too great as it cascaded downhill and all the bamboo tubes flew apart.

 After the initial excitement, I settled down to routine clinical work (so I thought!). There were exotic diseases which I had never seen before, such as yaws and scrub typhus.

Poisonous snake bites, especially that of vipers, were common among the cultivators. Mortality was high from complications like acute renal failure and disseminated intravascular coagulation. Cerebral malaria was rife. I learnt to use intravenous quinine. Chloroquine resistance was already being encountered.

 

Obstetrical emergencies were always daunting and late one night while I was struggling with a breech delivery, the midwife suddenly arrived on the scene and after gently elbowing me out of the way, promptly and skilfully delivered the baby. I was never more relieved in my life.

 
   As I was tending my vegetable garden on a Sunday evening, a young man arrived in a distressed state saying that he had just left his wife who was in difficult labour at the hospital, ‘Could you tell the doctor to come urgently?’ Seeing me in my longyi (sarong) and shirt sleeves, he thought I was the doctor’s gardener. Imagine his surprise when I arrived later on my bicycle.

 

 

 

The expectant mother was a tiny woman, barely measuring five feet in height. It was her first pregnancy. I decided that a normal delivery was not possible. There were signs of foetal distress and I would have to do a Caesarean section. The male nurse who would be my surgical assistant, had already sterilised the surgical instruments by boiling them in a large tub over a kerosene stove. As the electricity supply was erratic, lighting was provided by several high-pressure Storm-king spirit lamps placed above a fine muslin net to prevent insects falling onto the operative site! Anaesthesia was given by the pharmacist using an open ether mask, whilst it was the job of the water carrier to monitor the pulse, blood pressure and the intravenous lines.

 
Fortunately, the operation proceeded smoothly and soon a healthy baby boy weighing nearly seven pounds was delivered. Mother and child progressed well, but on the sixth day as I was doing my ward round, she suddenly said ‘I have to go back home to help with the harvest’. She had already made her mind up and I could not dissuade her.

 
I had forgotten about this family but after about three months, a bullock cart stopped at my front door and the young couple resplendent in their best festive silk dresses together with the rapidly thriving child, had dropped in for a visit. They brought gifts of home grown rice, bananas and dozens of eggs. They wanted me to choose a name for their son. I felt very honoured.

 

 

 

The chief Buddhist monk, U Nandathuriya, became my best friend and mentor after I had treated him for pneumonia. I always looked forward to the regular visits to the temple on Sundays, when he would provide me with lunch. It was really a feast as the faithful would have cooked all kinds of savouries and mouth watering curries to offer to the Abbot.

 
I learnt my Buddhist scriptures, methods of meditation and facets of indigenous medicine from him. He, in turn, was intrigued by the different types of surgical knots and the rationale of Western Medicine.

 
His monastery was built on the most prominent hill in town. The golden Shwezigon Pagoda was visible for several miles from all directions of the township.

 
He remembered the days during the Second World War when the Chindits, the guerrilla forces under the command of Orde Wingate, set up machine-gun and mortar positions to interdict any Japanese troops attempting to land at the riverside.

A few home visits had to be done every week. In the dry season, I went round on my old bicycle with the Gladstone bag on the rack. As I was unable to afford the price of a new bicycle, the Chinese pawnshop loaned me a ten-year-old Raleigh.

 
With the start of the monsoon season, the level of the Irrawaddy river rose and half the town was flooded. All the houses were built on high stilts. I would then do my community rounds by boat. It was a small one and was moored to a post at the corner tea shop.

 
The most unlikely home visit that I had to do was by travelling on an elephant. An old man was desperately ill in Nyaungbintha village, just ten miles away but there were no proper roads to speak of. The family offered the use of horses, but it meant riding nearly bareback; there were no leather saddles, a blanket tied with a rope seemed an unstable perch and I had to decline the arrangement. The grandsons decided that they would bring an elephant which was normally used to haul teak logs from the forest to the river.

 

 

 

It must have been quite a spectacle as Zaw Mun and I sat gingerly on the howdah (seat) with the mahout (driver) in front and two attendants walking behind the elephant prodding it on with sticks. The town urchins followed us up to the town gates, yelling and clapping. The elephant was tired, having worked since dawn. She would stop at the various streams we had to cross and refresh herself by playing with the water. We were thoroughly soaked by the time we got to Nyaungbintha.

 
An examination showed that the old man had metastatic colonic cancer. I had a discussion with the district nurse about pain management and palliative care and left her the necessary medications and equipment.

 
The family would not let me go back without having a meal. It was already dark when I was able to leave. I was a little uneasy as we would be travelling through an area controlled by anti-government insurgents. However, I felt reassured by the fact that I had refused to bring along any police or military escort which would have invited an ambush. I was sure that the jungle drums would have sped the message along that I was on my own.

After eighteen months, a Health Department directive arrived, transferring me back to Rangoon (Yangon) to prepare for postgraduate studies in the United Kingdom.

I was very sad to leave these kind and gentle people who had placed their trust in me. I hoped that one day I would revisit Tigyaing but I have not been back for thirty years.

 

Dr. Nyun Tin

Consultant Physician

                              Department of Medicine for the Elderly

Leeds General Infirmary

  

Home