The Cold War Comes to Burma

Given the present interchange between Russia's Vladimir Putin  and President Obama, the following true story from 1961 may be of interest.

2 p.m. February 15, 1961: Squadron-Leader Tin Maung Aye, accompanied by the commander of the 5th Kachin Rifles, Major Aye Win, were flying reconnaissance in a Burma Air Force Cessna southeast of Kengtung. Over the Mong Hpayak area, they spotted a field with strips of cloth laid out to spell “D Z” and realized that the Kuomintang forces were preparing a supply drop zone. They returned to Kengtung airstrip and sent up three BAF fighter planes with orders to force any KMT aircraft they encountered to land at Kengtung. The squadron patrolled the area for about a half-hour with no success. Then, just when they were about to return to base, they spotted a green four-engine plane enter Burmese airspace from the south and make two air drops. Squadron-leader Maung Thein radioed the intruder to identify itself but got no reply. The three Burmese Sea Fury fighters closed in and were fired upon but not hit. When they fired back, the intruder made a U-turn, heading for Thailand. In a second pass, both the intruder and one fighter were damaged and crashed just inside Thai airspace. The Burmese pilot, Noel Peters, died in the crash. One of the other fighters managed to reach Kengtung with part of its tail shot away, the third fighter was undamaged..

The Burmese army and the KMT often fought on the ground but this was their only air battle, at least during the years I lived in Kengtung. The KMTs, of course, were the remnants of General Chiang Kai Shek’s anti-Communist Chinese forces supported by Taiwan. They had had little effect on the Chinese Communist army since the 1949 Communist takeover, but often harassed the Shans and mountain people of Kengtung State.

Radio Voice of America that night announced that the Burma Air Force had shot down an unarmed plane bearing relief supplies to refugees in Northeast Burma. I could see the damaged fighter parked beside the local airstrip, and the Burmese newspapers were full of reports of the battle and the death of Pilot-Officer Peters. I knew VOA had it wrong, possibly misinformed by Taiwan, its ally in the so-called “Cold War” of communism vs. democracy in the mid-twentieth century.

By the time Burmese officials could inspect the wreckage across the border in Thailand, KMTs had stripped the four-engine plane of identifying markings and equipment. It appeared to be a modified World War B-24.

A Taiwanese group calling itself the Free China Relief Association acknowledged chartering the plane to supply “Chinese refugees.” Taipei news editorials compared the overflight of Burma to America’s use of U-2 spy planes over Russia, said the flights would continue and “if we are caught, we are caught.”

A week later the Burma Air Force flew military attaches of the United States, India, Indonesia and Thailand to Kengtung to inspect the damaged BAF fighter, and then on to Mong Paliao near the Laotian border, where they had recently captured a KMT base. There, reporters saw 75 mm guns, machine guns, mines, ammunition, radios and fuel drums, all bearing United States markings. The Nation, an English-language Rangoon newspaper, printed a photo of one label: “Commanding Officer, Erie Ordnance Depot, Port Clinton Ohio, TO: Officer in Charge, Air Freight Terminal, Travis AFB, California”. A Burmese reporter noted the American officials paid closest attention to equipment several years old, and said it could be bought by anyone at any surplus store. The reporter said they made no comment on items manufactured within the past year.

Burma had enough trouble fighting its own insurgent armies in those years without involving itself in conflicts between world powers. It wanted no part either of the United States and its allies, or of China and the Soviet Union. It declined foreign aid from either side whenever possible, and distanced itself from both. References to the “American Way of Life” made little impression in Burma. Burmese could read reports of American racial problems as well as anyone else, and were familiar with Russian maneuvers as well. No one could prove the United States knew what Taiwan was up to. But some thought that if it didn’t know, then of what use was the CIA?

In any case, there were protest demonstrations in front of the U.S. Embassy in Rangoon. A crowd of 3,000 demonstrators got out of hand. Before police controlled the riot, two demonstrators died and fifty three were hospitalized. Things quieted down until two months later, when U.S. Senator Fulbright publicly declared that he didn’t think it a good idea to send American boys to the jungles of Laos. The terrain was not suited to them, he said; better for them to fight in Vietnam, Thailand, or Burma.

Russia showed the world that it could make equally bad foreign relations blunders. In April 1959 TASS, the official Soviet news agency, implied that a prominent Burmese newspaper editor was in the pay of the U.S. Embassy. The TASS correspondent must have been dismayed when many Burma newspapers published front-page blasts against him personally and started two lawsuits for libel, pointing out that the source he quoted didn’t even exist.

About the same time, the Russian military attaché entered Rangoon General Hospital and, according to news reports, tried to pass along information (nature unknown) to Burmese Intelligence. He then jumped from a hospital window in an apparent escape attempt. His Russian comrades caught him and hustled him back to the Soviet Embassy, and from there to the airport at Mingaladon. Several reporters tried to question him there while he was being put aboard a plane, and his Russian escorts beat them up. Even pro-Communist Burmese newspapers then united with other Burmese to denounce the Soviet Union, and about forty reporters gathered at the Soviet Embassy to hurl tomatoes. The Russians emerged armed with broken chairs and joined battle. Police soon stopped the fight, but the Burma press gleefully pointed out that in Russia, May 5th is celebrated as “Freedom of the Press Day.”

It is not surprising that for many years Burma’s attitude toward the world powers was, in effect, “A pox on both your houses!”

A Shan Christmas Greeting

My Internet connection has been shut down for three days for something in the regional system, but is apparently fixed tonight. I have been working on a new book during the past two months, and have had few new posts. While working on the new MS, I shall bring a few stories from the past for your interest: the following is a Christmas letter home from Kengtung in Myanmar's Shan State, that I wrote fifty-five years ago - a different slant on the holiday.

Christmas in Kengtung December, 1960

Merry Christmas to all of you! There is no snow and few Christmas trees in Kengtung, but we are all looking forward to a pleasant time. Here, everyone visits everyone else and the Shan Christians are holding open house for the whole city, whether Buddhist, Animist, Christian or Muslim, and have bought more than one ton of noodles to feed the crowd. (Shans' favorite dish, called hkao sein, is a sort of spaghetti and meat sauce, though the spices and flavor are different from the Italian kind.) At the same time, they will have exhibits and movies in the church to tell non-Christians about the birth and life of Christ.

Susie, Patsy and Johnny are very impatient for Christmas to come. Already Susie is getting suspicious of the Santa Claus theory, though she is only six. The trouble is that all her playmates have been skeptical from the start, since they'd never heard of such an idea till Susie told them, and certainly had never ever experienced a visit from Saint Nick. Susie is also in the school pageant, and Patsy would very much like to be, just as she always wants to go to school, but she is too little for either. John, at the age of two, still takes things pretty much as they come.

Christmas Eve brings to mind the unsettling experience we had last year of being serenaded by a large number of drums and Scottish bagpipes at three in the morning. (At that hour, even one of each is a large number but there were more than that.) We awoke to the crashing strains of "For He’s a Jolly Good Fellow" outside our window, led by a bandmaster who kept time by loudly clapping his hands to the beat. Presumably, some of the Regimental Band members whose children had been treated at the hospital got together to celebrate with a few drinks and decided, "Let's go serenade the Doc." At three a.m., I'm afraid I could do nothing more cordial than pull the blankets over my head and pretend I was sleeping through it--quite an illogical pretense now that I think of it.

Everyone in Kengtung enthusiastically celebrates any holiday, including Christmas. No one refuses an extra chance to celebrate, especially one with all the pageantry the Burma Christians put into their celebration of Jesus' birth. Electricity is limited, but Christians decorate the outside of their houses by hanging dozens of lighted candles inside colored cellophane cylinders, to rival the Buddhists' October festival of lights.

Everyone holds open house. No one could possibly attend everything. One Christmas we were fed at seven different homes, and regretfully turned down an equal number. And that's only in Kengtung. We try to spend Christmas eve or part of Christmas day with our colleagues Paul and Elaine Lewis, seventeen miles up the mountain at Pangwai, and there are more invitations from neighbors there.

Many groups come caroling; some know little more than "Merry Christmas To You," (same tune as the birthday song). Others try an American melody or two when they get to our house, maybe in tune, maybe not. One group offered, "I'm dreaming of a white Christmas, just like the ones you used to do," and then faded into confusion as they tried to recall what rhymed with that. The older students at the school which Susie attended stay up all night, warming themselves around a fire, serenading neighbors and gratefully accepting cups of hot tea or cocoa from those who were still up.

The gifts are sometimes embarrassing. We have so much more of material goods than most of our neighbors, and are given so much more. People bring us baskets of oranges, eggs, or a live chicken on a bed of rice. We reciprocated with baskets of cookies or banana bread, and held a dinner for the hostel students. The ruler, Sawbwagyi Sao Sai Long himself, stopped by with a basket of avocados one Christmas, and our next-door neighbors sent us a live fish all Christmas-wrapped. (There was no doubt of its freshness at least). We put it in a tub of water where Susie and Patsy watched it wave a fin at them as it swam lazily back and forth.)

The more cosmopolitan mission compound church holds Christmas morning services in simultaneous translations into Burmese, Shan, Lahu and Chinese, but its main event is the Christmas pageant. Susie was in the angel chorus one year, her blond head standing out among the little Shans and Lahus, and Lois and I of course had to attend all three performances that season. The first night, the pageant ended very impressively, with people of all the ethnic groups of Kengtung bringing their gifts to baby Jesus as the music built to a climax. The second night, when VIP arm chairs had been assembled and the first two rows were filled with invited city elders and assorted officials, the pageant director seemed to feel that more was needed.

The curtain drew to a close on the final scene. Moments later it opened to reveal four schoolteachers, each with one foot propped on a chair, guitars at the ready. I had a premonition of disaster, which was confirmed when the quartet broke into a spirited version of "Old MacDonald Had a Farm" complete with sound effects. I don't know what the visiting officials thought. I privately thought the director had lost his mind.

Christmas is also a time for reflecting how many people here have still not been reached by God. The thirty-year-old man dying of cancer, the boy half-crazed with fear after threats of torture by rebel soldiers, the woman who believes her disease is an evil spirit eating her insides--what do you tell them? The idea of a loving God who cares for them is so foreign to all they have been taught, and seemingly is refuted by the very situation in which they find themselves. It's not easy to try to explain, even in one's own native language. Still, it's not all discouraging. This week, a ten-year-old boy opened his eyes to see for the first time in three years, after getting the vitamin A he had so badly lacked. A middle-aged clerk, out of work for seven years because of his swollen draining tuberculous knee, now walks free of pain because of what, with God's guidance and help, you and I have done for him. The salvaged are rather few, but we must continue to do what we can. May God bless you all during the coming year.

John Tharp, Coincidentalist

After closing my Pinehurst, Idaho, office medical practice in 1993, I spent the next eleven years as a part-time locum tenens ("rent-a-doc"), traveling to fill temporary vacancies in doctors' offices or hospital emergency rooms. In 1999, I worked several weeks in St. Francis, Kansas, a small town far in the northwest corner of the state.

 

It's a pleasant little town in semi-desert; the hospital took good care of me, providing free lodging in a home whose owner was on vacation. But the house badly needed cleaning and I later moved to a motel out on highway 36. I was up early next morning, and searching for some place to eat. I could see a gas station a quarter-mile down the highway, and figured I could at least find coffee there, so I started walking toward it. 

 

Midway, I met a man of about 50 coming toward me with a cup of coffee. He stopped and said in amazement, "I know you! We were at board meetings together in Philadelphia!" He was staying at the motel, traveling by bicycle from Utah to Illinois. We had served together on the American Baptist Foreign Mission board several years before, but had not met since then.

I know that New Yorkers boast that if you stand at Times Square long enough, you will see someone from back home. But in a town of 1,300 on a two-lane road where Kansas, Nebraska and Colorado meet? What are the chances that one day two acquaintances, one from Idaho and one from Illinois, will walk into each other along the shoulder of the highway?

John Tharp and I had breakfast together, and later that morning he rode his bicycle into town to see the hospital where I was working, before continuing his journey eastward.

I have occasionally wondered, in the ensuing fifteen years, whether God had had a purpose in that meeting. I have not perceived any reason in my own life, and finally, I wrote John to see if he was aware of any in his.

In his reply, he said he, too, remembered the incident and also wondered about a reason. He had not detected any, but said that, after a number of such coincidences in his life, it has often entered his mind that "God loves to show off." [I myself prefer to think of it as God's sense of humor, but anyway . . .] he went on to say that this may be a way that God alerts us to what He can do, to keep us ready for the occasional time when He does indeed want action from us.

John's observation brought to mind an incident in Mae Sariang, Thailand in 1965, when the new hospital was ready to open except that we lacked nurses. The following report is from my journal of that year:

"We had a bit of drama in the three mission families’ weekly get-together two weeks ago. We were praying that the hospital would soon have some nurses, only to be interrupted by a man at the door asking where he should put some girls' luggage. One of the girls, our friend Orawan who spent some time with us last month, was only visiting, but the other, Yawalak, is now our first full-time graduate nurse-midwife. This afternoon (nearly two weeks after that prayer, for the scientifically minded) a motorcycle pulled up with another nurse riding on the back. Gaysala is just looking the place over today, but will be back permanently on Saturday. Later in the afternoon, two others appeared entirely unexpectedly. They said they were graduate nurses working in Mae Hongson [the provincial capital, about a hundred miles north] and were interested in transferring to MaeSariang where their homes are. The upshot is, one will probably come and work; perhaps the other will come later. With one or two others we expect in the next several months, we will soon have a full nursing staff (and an empty hospital bank account.) As for unskilled workers, two or three new ones apply every day and we can afford to be a little choosy for that group."

My dad sometimes would remark, "When people pray, coincidences happen more often." I'm inclined to agree.

The Medicine She Never Took

"My doctor gave me a new medicine for my stomach pain," a friend answered when I expressed hope that she was feeling well. "It works fine, but I can't take it." 

"I'm sorry to hear that," I said. "Too many side effects?" 

"No, the samples he gave me helped a lot. But when I took his prescription to the pharmacy, a month's supply was four hundred dollars. That's almost half my Social Security check! How am I going to pay my utility bills and buy my groceries? So I'll just keep on with the antacids."

"Did you tell your doctor you couldn't pay that kind of price?"

"I phoned him, and he said he had no idea it was that high."

"Did you ask him about any of the over-the-counter medicines? Some of them are about one-tenth that price, or less."

"No, I didn't know anything about that. He had his nurse make me an appointment for two weeks from now for follow-up. But I never had the prescription filled when I found out the cost."

If you think that's an isolated example, another patient had had at least six back surgeries over the years (laminectomy) and no surgeon would now touch his scarred back. His local doctor was trying to manage the pain with various pills and patches, some of which eased his steady pain, but not the "lightning spasms" that struck when he moved wrong. Additonally, over the years, he had developed unacceptable reactions to some of the medicines, and the doctor was trying a new one. His medical insurance refused to pay for it. The doctor's office clerk said she would try and straighten the matter out, and would call him back. She never did, nor even to let him know the problem. He finally called his pharmacist to see if he could afford to pay for it himself, and found to his horror that a month's supply was $525.00, half his entire monthy income. Presumably, the doctor's clerk could have found that out, but if she did, she never let him know. 
 

These illustrate a basic flaw in the American way of marketing medicines. The manufacturers have well-paid "detail persons" who make regular calls at each and every doctor's office to inform him/her about their company's latest and most advanced product. They sometimes used to appear around noon, with enough pizza for the whole office staff. Friendly people, well trained and informed in their field, they are a principle source of information for busy doctors who don't spend as much time as they might with medical journals and Internet search. The pharmaceutical rep has free samples to leave with the doctor, along with note pads or pens bearing the product's name.

Sometimes they really do have valuable updates for the doctor, but they rarely mention the price of their product, or that the older remedies still work as well as they always did. And the doctor will try the samples on his patients because (a) he doesn't want them to buy a whole month's supply of any medicine unless he knows it works for them, and/or (b) he may want to help a patient he knows is having difficulty affording care. 
 

Most doctors don't keep up with the present-day price of what they prescribe. But they could. Every doctor gets an annual free update of Physician's Desk Reference listing all prescription medicines with their uses, side effects, and precautions (about 4,000+ pages—old copies make good doorstops), and a supplement with all the non-prescription medicines is available as well. Plus an annual update of Redbook (not the women's fashions one, but current drug retail prices) with the option of subscribing to monthly updates.

So - here's what a patient can do. Don't be afraid to ask what a new prescription will cost, and if necessary, ask if there is a less expensive generic that will be adequate. Sometimes there will be, sometimes not. 

And Doctors, here's what you can do. Be aware that the latest drug is pushed by the drug rep because that's what he/she is hired to do. It's good to keep that product in mind, but ask yourself, "Is this what this patient sitting here in front of me really needs, or will an older, less expensive drug be effective?" And stay away from reps who want to buy you meals or pay for a vacation trip. Your patients have to pay for that in the cost of their medicine.

And all you readers in the general public, pressure your reps in Congress to reasonably regulate the charges for medicines. Why should a drug that has been on the market eleven years now cost fifteen dollars per pill when the company was raking in high profits at the original price of ten dollars per pill? Why should an injection aimed at mass use be selling for thirty-five dollars, when it originally wholesaled forty years ago at one dollar? Or why should a drug, manufactured in USA, sell for less in Canada or Europe than it does here where it was made?

Even in a free market economy, the customer should get as much consideration as the company's stock holders get.

Understanding an Unchanging God

One concept shared by many of the world's major religions - Christian, Muslim, Jew, at least - is that of God, eternal, unchanging, creator of the universe (in the Bible, for example, in Psalm 90, v 2; or Isaiah ch 40 v 28). Instinctively, we accept the basic forces of the universe - gravity, motion, heat, light, etc. - as dependably stable and unchanging. Such things, as best we can learn, always behave the same, day after day, year after year.

There are some sincere Christians who believe that the Bible is word-for-word [in the original language] direct dictation from God, not subject to interpretation: "The Bible says it, I believe it, that settles it!"

This raises some questions: Have they ever read the whole Bible themselves? And for those who have, do they ever think about what they have read? And do they take into consideration how much the meaning of words change from generation to generation, let alone century to century?

A Pharisee asked Jesus what is the greatest commandment in the law; Jesus readily replied (in Mt 22: 37 - 40 NRSV): "Love the Lord your God with all your heart, with all your soul, and with all your mind." It is okay to use your mind, to think about what you read, and ask questions about interpretation.

Consider the story of Creation in Genesis Chapter 1: "the earth was a formless void and darkness covered the face of the deep, while the spirit of God swept over the face of the waters. Then God said, 'Let there be light'; and there was light." Modern scientists would agree with the beginning of the creation story; they would envision a plasma of subatomic particles, but in ancient times "waters" would be the closest word in human vocabulary, and the "big bang" certainly produced an instantaneous, massive burst of light.

The Bible itself modifies the concept of all creation taking place in six days: (Psalm 90 v 4: For a thousand years in your [God's] sight are like yesterday when it is past, or like a watch in the night.

Some of Moses' laws in the Old Testament have changes even by the time of the New Testament:

Exodus 21, the next chapter after the Ten Commandments: the laws about slave ownership. The history of slavery goes from "anything is permitted" to "owner and slave both have the same master . . ." And nowadays, slavery is not permitted at all in most nations.

In Leviticus ch 11: the laws about food declare many animals unclean and not to be eaten. Has God changed his mind about these? In Mark 7:19, Jesus declared all foods clean.

Deuteronomy 21 v 18 - 21: The law for a disobedient son: Stone him to death. Not legal nowadays in any country that I know of.

Deuteronomy 22 v 28 - 29 - The law about rape victims. The rapist shall pay the girl's father a fine; The rapist shall then marry her, and cannot ever divorce her. But where is justice for her?

Slavery was justified for centuries by quoting Genesis 9, where one of Noah's sons, Ham, somehow offended his father, and his descendents were cursed to forever be the slaves of the descendents of Noah's other two sons. Did Noah's curse justify slavery, thousands of years later? Southern Baptists, many of whom are descendents of slave owners, finally issued an official apology 120 years after slavery was abolished in America.

The history of vengeance, from maximum force, through eye-for-an-eye, to forgiveness and loving your enemy: Is the world ready yet for peace? Can we handle it? There are many such questions that could be discussed.

But the central question is, Does God change?

Is not the Bible a history, rather, of the changing human understanding of the eternal unchanging God, down through the ages? (and also, perhaps, the history of God eternally reaching out to humans, waiting for them to trust and obey?)

And on into the future? There is a hymn sung by some Christians; not a quotation from the Bible, but a thought worth pondering, nevertheless. Written by poet James Russell Lowell, one verse goes:

By the light of burning martyrs, Christ, Thy bleeding feet we track,

Toiling up new Calvaries ever with the cross that turns not back;

New occasions teach new duties, time makes ancient good uncouth;

They must upward still, and onward, who would keep abreast of truth.

When you can't get a doctor's appointment soon

Although I am retired from medical practice now, friends often complain to me that their doctor's office can't work them in until six weeks from now.

"But I'm sick now! The pain just started Friday, and it's getting worse! His office clerk told me to go to the hospital emergency room, but the doctor there just gave me a prescription for hydrocodone and told me if it didn't work, to see my doctor Monday. When I told the ER doc that I'd already tried get an appointment and the first opening wasn't till six weeks from now, he acted like that wasn't his problem. And the ER visit cost me $160."

It's true, most doctors keep busy. There may be several reasons for difficulty getting an appointment. Office appointment secretaries often book the schedule full for days in advance, instead of leaving room for walk-ins. Sometime in the year, the doctor will take vacation time, or maybe update his knowledge at a medical conference, or maybe need some sick-time himself. And there may be times when he has a big emergency at the hospital or office that wipes out several appointments and delays everyone.

That being said, the doctor can remedy long waits by using a different appointment policy, and here it is. I used it for fifteen years of solo office practice, and I know it works. It should work even easier when several doctors share an office (if they don't all demand the same day off.)

Doctors: Leave space open for the walk-ins, and make life easier for yourself, your staff, and your patients.

Walk-ins happen. Half the patients you see only got sick or injured a day or two ago. So leave time for them. Here's how it works:

Figure out how long it takes you to see the average return visit, or minor new complaint. In my case, it averaged around 15 minutes - 4 patient appointments each hour, If my secretary knew it would be a new OB or a diagnostic workup, she scheduled it for 2 or more time slots. I was dependably in my office from 10 to 5 Mon-Tues-Thurs-Fri, + Wed and Sat from 10 till noon. An hour off for lunch. I did hospital rounds and/or minor surgery from 8-10. Work out your own schedule as you choose, then stick to it and let your patients know it.

Now, I told the front office to fill two of those four slots each hour ahead of the day. If those fill up six weeks in advance, so be it; they are only routine return checkups. That leaves two slots for each hour when each day begins. The secretary knows she can fill one of those for each hour for anybody who phones in that morning - Mrs. Jones' kid, who developed a fever in the night; or Mr. Smith with a cold that now has cough and chest pain, whatever. That leaves one opening each hour for emergency walk-ins, and they do happen. But done this way, it doesn't mean making your other patients wait past their appointment time. Sometimes there will still be waits. But your patients will be more likely to accept that because they know they can usually get in on the same day they phone in. If you're in surgery or the delivery room, or going to be away next week, the secretary makes sure the patients know that right away, and she offers to reschedule those who wish.

Sometimes a slot never filled. No problem; I used that time to catch up on my medical journals or correspondence. And I usually was able to accept new patients at their first call. It requires a doctor to stick to his office hours and start on time - read the newspaper later. It requires a knowledgeable person on the front desk, and you need to pay her wages accordingly, and instruct her how to handle calls. A good helper rarely has to call you out of an examining room, but be sure to answer your phone messages or e-mails promptly.

Readers: You can help make the visit easier, too, by doing some preparation before seeing the doctor: (1) If there is any question of fever, take your temperature (preferably in the evening, when it's likely to be highest) before you see the doc. It doesn't help him for you to say, "well I felt my forehead and it didn't feel hot."

(2) Write down a brief list of whatever problems you need to talk to your doc about. The reason you are coming, of course, with the major symptoms; and perhaps some ongoing problems you want to be sure to remind him of. Don't hit your doc with an "Oh, and by the way . . ." as he or you are going out the door. Take time to communicate - no essays or orations are necessary - just so long as he is aware of your major problem(s) of the day. Let him get to the next sick person on time, if you can.

(3) have a list of your allergies and medications written down, in case the doc or the nurse asks."I take a white pill and a green one," is not adequate. Spell the medicine's name and dose.

(4) It helps to let the doctor know you appreciate the pleasant surprise of getting an appointment the same day you called.

Who Can Afford American Drug Prices

Who Can Afford American Drug Prices?

Last night I watched 60 Minutes with my daughter, who manages the Critical Care Unit of a large hospital. The topic was prices pharmaceutical companies are charging for their products. Some cancer drugs now cost more than eight thousand dollars a month (and must be taken for months or years.)

How did this ever get started? Somehow, Congress enacted a law that forbade the VA, Medicare, etc. from negotiating prices, leaving the drug companies free to charge as much as they liked. In other nations the drugs cost about one tenth the price, even though they come from USA. And it doesn't affect only cancer drugs. I get the same story many times from with former patients (I am retired.)

A chapter from my 2008 book Access to Medical Care seems worth repeating here:

Chapter Four: The Medicine She Never Took

"My doctor gave me a new medicine for my stomach pain," a friend answered when I expressed hope that she was feeling well. "It works fine, but I can't take it."
"I'm sorry to hear that," I said. "Too many side effects?"
"No, the free samples he gave me helped a lot. But when I took his prescription to the pharmacy, a month's supply was four hundred dollars. That's almost half my Social Security check! How am I going to pay my utility bills and buy my groceries? So I'll just keep on with the antacids."
"Did you tell your doctor you couldn't pay that kind of price?"
"I phoned him, and he said he had no idea it was that high."
"Did you ask him about any of the over-the-counter medicines? Some of them are about one-tenth that price, or less."
"No, I didn't know anything about that. He had his nurse make me an appointment for two weeks from now for follow-up. But I never had the prescription filled when I found out the cost."
If you think that's an isolated example, another patient had had at least six back surgeries over the years (laminectomy) and no surgeon would now touch his scarred back. His local doctor was trying to manage the pain with various pills and patches, some of which eased his steady pain, but not the "lightning spasms" that struck when he moved wrong. Additonally, over the years, he had developed unacceptable reactions to some of the medicines, and the doctor was trying a new one. His medical insurance refused to pay for it. The doctor's office clerk said she would try and straighten the matter out, and would call him back. She never did, nor even to let him know the problem. He finally called his pharmacist to see if he could afford to pay for it himself, and found to his horror that a month's supply was $525.00, half his entire monthy income. Presumably, the doctor's clerk could have found that out, but if she did, she never let him know.

These illustrate a basic flaw in the American way of marketing medicines. The manufacturers have well-paid "detail persons" who make regular calls at each and every doctor's office to inform him/her about their company's latest and most advanced product. They sometimes used to appear around noon, with enough pizza for the whole office staff. Friendly people, well trained and informed in their field, they are a principle source of information for busy doctors who don't spend as much time as they might with medical journals and Internet search. The pharmaceutical rep has free samples to leave with the doctor, along with note pads or pens bearing the product's name.
Sometimes the reps really do have valuable updates for the doctor, but they rarely mention the price of their product, or that the older remedies still work as well as they always did. And the doctor will try the samples on his patients because (a) he doesn't want them to buy a whole month's supply of any medicine unless he knows it works for them, and/or (b) he may want to help a patient he knows is having difficulty affording care.

Most doctors don't keep up with the present-day price of what they prescribe. But they could. Every doctor gets an annual free update of Physician's Desk Reference listing all prescription medicines with their uses, side effects, and precautions (about 4,000+ pages—old copies make good doorstops), and a supplement with all the non-prescription medicines is available as well. Plus an annual update of Redbook (not the women's fashions one, but current drug retail prices) with the option of subscribing to monthly updates.
So - here's what a patient can do. Don't be afraid to ask what a new prescription will cost, and if necessary, ask if there is a less expensive generic that will be adequate. Sometimes there will be, sometimes not.
And Doctors, here's what you can do. Be aware that the latest drug is pushed by the drug rep because that's what he/she is hired to do. It's good to keep that product in mind, but ask yourself, "Is this what this patient sitting here in front of me really needs, or will an older, less expensive drug be effective?" And stay away from reps who want to buy you meals or pay for a vacation trip. Your patients have to pay for that in the cost of their medicine.
And all you readers in the general public, pressure your reps in Congress to reasonably regulate the charges for medicines. Why should a drug that has been on the market fifteen years now cost thirty dollars per pill when the company was raking in high profits at the original price of ten dollars per pill? Why should an injection aimed at mass use be selling for thirty-five dollars, when it originally wholesaled forty years ago at one dollar? Or why should a drug, manufactured in USA, sell for less in Canada or Europe than it does here where it was made?
Even in a free market economy, the customer should get as much consideration as the company's stock holders get.

Returning to the Sixty Minutes report, I asked my daughter how her hospital handles these exorbitant costs. "Often we talk with the doctor, especially in cases where the drug is likely to prolong life only a month or two. More and more, hospitals are buying out the doctor's practice [that is, it's the same doctor, but now employed by the hospital.] Medicare can't negotiate the price, but we can, and we can buy in bulk, getting a much lower price."

Granted, new medicines sometimes do cost a lot to develop, but that ill-advised law forbidding federal agencies to negotiate the price should be repealed. Or perhaps USA should go to a single payer system like most other countries have. As things stand now, even insured patients are going bankrupt.

"But How Many Souls Did You Save, Doctor?"

Sometimes, I hear that question aggressively asked when I speak about medical missions to American audiences.

The answer is, “How many did I save? None. Jesus saves souls. But I hope I sometimes helped him.”

American Christians who have never been outside their homeland often assume that the missionary is the star performer on the foreign field. For the pioneer in an area never before touched by the Christian message, that may have been true. There are few more heroic tales than those of William Carey in India. Or of Adoniram and Ann Judson in Burma, who labored for seven years before even one person believed their message, but who lived to see thousands accept Christ.

But even then, the goal was to teach people of the country to tell the Gospel story in their own language and cultural view. That is even truer now, when in Burma, for example, there are over one million Christians—Baptist, Roman Catholic, and others.

There are still foreigners who become expert communicators. Among my close colleagues, Paul Clasper and Emily Ballard stand out, each completely fluent in conversational Burmese; Paul and Elaine Lewis in the Lahu and Akha languages, and Don and Janet Schlatter in Lawa. But they are far outnumbered by citizens of the land who have given their whole life and effort to telling their neighbors about Christ.

Sala Ai Pun, headmaster of the Lahu high school at Pangwai, felt called to resign his post and devote the rest of his life to the leprosy villages. (I had nothing to do with this decision; I was as dubious about the idea as anyone else.) The Lahus were aghast, protesting that he was needed at the school and, moreover, he was in his sixties, diabetic and almost blind. He replied that this was what God wanted him to do. He and Yakop (the young man who had visited the villages for years) made an unlikely pair, walking the mountain trails. The younger man limped with a deformed hip and had a defective heart; the elder was too blind to see the single-log bridges clearly that spanned rushing mountain streams. He had to crawl across them on his hands and knees, guided by his wife.

For the next several years Ai Pun visited leprosy villages, giving them the personal attention and spiritual guidance that no one had offered them in twenty years. At first I was concerned about his diabetes, because he never had any refrigeration for his insulin. But for him, the insulin always seemed to work. He and his wife are long gone now, but today most of their eight children are college-educated leaders in the Lahu community.

Sala Yawtha Chang was my next-door neighbor in Kengtung, and a leader of another group of Lahu Christians. I differed with several of his theological and medical beliefs, but I’ll never forget that, even though he believed blood once lost is gone forever, he still gave a pint of his own blood three times to help a man I was treating for recurrent internal bleeding.

The pastor of the Shan church at Kangna once came to me with a sore eye. I diagnosed dendritic keratitis, a viral infection that never responds to bacterial antibiotics, and that can destroy the eye. I painted his corneal ulcers with a special iodine compound repeatedly, with eventual success. The Kangna congregation, fifty or a hundred people in the l960s, now is reported to number around a thousand. The pastor must have continued to do good work. And the pastor in 2001 is a former hospital night watchman, on whom I performed an emergency appendectomy forty years ago. So even though I am not a prolific preacher, God has enabled me to be instrumental in other ways, as he can with each of us.

Some of God's servants are cultivators, some are harvesters. I perceived my work as preparing the ground. Or, if you prefer, I am the salesman with a foot in the door, offering a product (medical care) to which the householder could relate, until he saw that God had something even greater to offer.

Lois and I were sometimes parental surrogates to some of the nurses whose own families lived hundreds of miles away. Inevitably, these young ladies attracted suitors, and marriages took place. Fascinated by Western wedding customs, and seeking an exotic touch to the ceremony, they would ask me to give the bride away, or Lois to make a wedding cake, or blonde Susie to be one of the flower girls.

Lois was also able to assist others in bringing God’s word to those who had never heard it. For about a year, she went weekly with a Shan friend to Wan Mai, a village of new Christians, to teach reading and Bible. When a group of armed insurgents demanded a ride to a village farther on, her Shan friend told them, “We are women, we can’t do that.” This was apparently an acceptable answer. For a couple more weeks, I went with them, once passing a truckload of young men with rifles sticking out of the vehicle at all angles. Soon after, the Burma army shut down local travel outside the city. Lois often drove the hospital jeep truck to pick up market supplies or to drive a patient home. Even with no overt evangelism, small-town girls saw a woman actually driving a truck, and perhaps caught a vision of what might be possible for them some day.

Clinics Beyond the End of the Road

Dr. Gunter Kittel's account (PNG Attitude's blog, 'Bush Clinic at Nankina', 07/Sept/2014) is an excellent account of difficulties in bringing medical care to remote areas . His team went by air to the village of Nankina, Papua New Guinea, where the clinic had been closed for years, depriving 6,000 people of any medical care. The plane landed them all right, but when it came time to leave, heavy rain prevented air transport and the team had a three-day walk through deep mud to reach the coast. Frequent return visits are thus impossible.

This same problem was addressed for hill tribes along the Burma/Thai border in medical work with American Baptist Foreign Ministries in 1965:

The road had barely reached Maesariang district of Thailand's Maehongson province that year. Private air service and two-way radio were not permitted back then. Walking, or in a few cases riding an elephant, was the only way to contact most villages. Because hill villagers trusted their traditional medicine men, the Karen tribe members of our 10-bed hospital's board proposed reaching the villagers by offering to train their medicine men.

The board sent invitations to villages one or two days walk from Maesariang, suggesting that each choose two people to attend a three-day course. Each village would get a free box of medicines, with refills at cost. I chose the contents, mostly simple remedies for fever, diarrhea, pain, malaria, anemia, etc., including one or two simple type antibiotics.

Eleven villages responded. Each night after clinic hours, I taught how to use the medicines; other staff during the daytime taught sanitation, nutrition, maternal and child care.

Most students had only two three years schooling and knew nothing about bacteria. I introduced the topic by briefly mentioning familiar forest dangers like tigers and snakes. Then I scaled it down to mosquitoes, lice and other small critters they recognized as nuisances. Finally, I taught about still smaller "germs" that could enter the body and cause some of the diseases in their villages. I had our lab tech set up a microscope slide with a drop of swamp water, teeming with live organisms, for them to see.

The talks also covered a few simple rules for treating fevers, cough, etc., and when to send a patient to the hospital despite the distance. Some of them asked intelligent questions and taught me a lot about their traditional ways of treatment, especially childbirth. Others just sat there, and we had to hope that they would at least do little harm."
I learned to listen as well as speak. Not to tell them, "No, not that way", but 'Yes, and . . ," building on what they were already doing correctly. Karens traditionally encourage bleeding after the baby is delivered, placing a warmed stone on the mother's belly to get the "bad blood" out. I agreed that the womb should be emptied of clots, and showed them the way to massage the womb through the relaxed abdominal wall, to get it to contract. That way blood stays in the blood vessels, where it is "good blood".

We encouraged them to let diarrhea patients drink water, rather than to limit it. We explained the danger of applying cow dung to a burn. One Karen leader pointed out to the students that several green plants they regard as weeds are actually a good source of vitamin A, that would prevent one common type of childhood blindness. We encouraged proper prevention of measles, which killed so many children, despite the traditional Karen treatment of giving them pig urine.

By far the most popular session was two nurses teaching about family planning. The students stayed a full hour overtime to ask questions about ovulation, anatomy, and safe methods of preventing conception, all new topics to the Karens.

Altogether, everyone thought the conference a success. In following years, the hospital repeated it once or twice a year, with special conferences for village midwives, or for seminary students going out into hill villages.

In the 1990's the government in next-door Myanmar closed its civilian universities (for political reasons) and then realized that they had no new medical students to graduate. They invited my wife and me back to Myanmar as consultants to a medical group in the Kachin State. At the time we last went into Myitkyina and Putao in 1998, the group had trained 500 village health workers. each caring for about 30 households in their home village.

Villagers with a week's training are certainly not as good as university-trained nurses and doctors. But they are better than nothing, in the rainy season or beyond mountain airstrips.

Balloons

Balloons fail to excite me. They are irritating, boring, trite. They are very politically correct nowadays, a popular way to urge joy and sensitivity on people, who may or may not be receptive at the moment.

Purveyors of new cars, party supplies, or political candidates are among those who dispense large numbers of balloons, and whole shops have sprung up in most cities, offering balloons as a substitute for saying it with flowers. Balloons rival T-shirts and coffee mugs as a way of expressing sentiment. Many of us may not fully agree with these sentiments, but we don't like to create a public scene by refusing the dam’ thing, so we allow ourselves to be bullied into accepting a balloon from some sad-eyed woman in a garish clown costume, or from an aggressive public relations agent blocking the aisle in an exhibit hall.

I have always been puzzled by ecology groups that celebrate the pristine purity of nature by getting the people at rallies to release a thousand balloons bearing, for example, the inscription Save the Ducks. The cloud of color soaring upward is very impressive. Up, up they go, carried eastward on the wind to disappear high over the horizon, invisible when they finally burst and send a thousand pieces of rubber-litter down on some forest glade or lake. Perhaps the ducks will think they are something to eat, and choke on them.

But returning closer to home, bouquets of balloons and other happiness icons are not so bad when delivered to the privacy of the home. Usually a van with some logo such as Giggles and Smiles, or Daisy's Bloomers and Balloons (one hopes that this is a florist shop) will stop at my door, and a bouncy delivery person will ring the doorbell and thrust a large artistic creation into my hands. The delivery person's smile is only semi-spontaneous; she does this all day long, and probably knows that I am thinking now what am I going to do with this? But she is just doing her job, so I thank her, close the door, put the creation on the table and search for a card of explanation. At least I can be grateful she didn't deliver a singing telegram along with it.

Here's the card: "Happy seventeenth anniversary from Bill and Barb!" or "Congratulations on whatever!" will mean sending a thank-you note (that's assuming that Bill and Barb have at some time past given me their last name and address). But at least I am in the privacy of my own home, and don't have to walk six blocks to where I parked the car, towing a balloon on a string.

In the latter instance, if I am lucky, I have a kid with me, and can pass the string to him/her, tying it to a wrist so it won't go sailing upwards accompanied by anguished wails. Or maybe you have already experienced the anguished wails when some grimacing clown has bent down with a latex bag of gas twisted into some ill-defined animal shape, to offer it directly in the little tot's face. Never mind; hide the creation in the crook of your arm. The kid can get used to it later. Try not to let it explode in his face. Unless, of course, he keeps rubbing his hand on it, making a sound like fingernails on a school blackboard.

Once the balloon is home, there are several things you can do with it. The first is, let it float up to the ceiling, safely out of the way. It can stay there for several days, requiring no further comment, and showing everyone that you are not such an old curmudgeon after all. In about a week, enough helium will have slowly leaked out to make it lose buoyancy and sink to lie restlessly on the floor. Now is the time to carefully clip off short sections of the string, or maybe trim the edges on those shiny metallic balloons, to where it is exactly light enough to float in mid-air. There will be enough imperceptible air currents in the house to waft it almost anywhere. Tonight it may silently drift up to hover over your mother-in-law's left shoulder, causing her to sense a presence there, turn, and shriek. (Maybe it's a balloon with a smiley face. So much the better in the semi-darkness).

When all the string and other non-essentials have been clipped, and the balloon has finally lost enough of its gas to sink to the floor, never to rise again, there is yet one more function it can serve. A lungful of helium does odd things to your voice; ordinary conversation sounds like a comment by Donald Duck. Choosing your moment carefully, you can inhale the remainder of the helium and make a conversational remark two octaves higher than your usual voice to some unsuspecting person. Perhaps the phone has just rung, or a solicitor for Save the Ducks is at the door.

Or, with suitable warnings about the dangers of more than one low-oxygen breath of helium, maybe you can amaze and amuse a medium-size grandson or niece with your new voice. The possibilities are endless.

How I Write

I am a reluctant public speaker, but I enjoy telling stories through the printed page; and have published three novels, plus non-fiction biography and memoirs. I write for enjoyment, both mine and the reader's (I hope.) If there is such a genre as "faith-based fiction founded on fact", that describes what I try to do. My target audience is not "religious" people, but the reader who has minimal or no interest in religion because he/she has never thought about it much. Some people term the genre "inspirational".

My writing falls into a gap between "Christian" publishers (for not being evangelistic enough) and many mainstream publishers (for even suggesting that God might be relevant to ethics or human behavior.)

Another Idaho author, Carrie Stuart Parks ("A Cry from the Dust") reports that publishers have strict boundaries on Christian writing: "No profanity, no sex, but you may kill as many people as you like." I hadn't crystallized it so concisely myself, but realized that's exactly the kind of block I have met in my own writing. Secular publishers reject my work for not being lurid enough to hold the reader; Christian publishers red-pencil some of my best lines. I respect God's name; I even omit the thoughtless abbreviation of surprise, OMG. But when ordinary people are insulted, assaulted, or otherwise given cause to express anger or distress, they often employ language that might not be appropriate in Sunday school, and it is unrealistic to portray them otherwise.

When searching for like-minded writers, there is, of course C. S. Lewis, whose "Out of the Silent Planet" trilogy, his "Screwtape Letters", and "The Great Divorce", among others, are classics far beyond my amateur talents. There is also Kimberla Lawson Roby, whose well-written novels about an immoral clergyman, she describes as faith based, but which I found overly explicit (in the one I read.)

I have tried to solve this conundrum by writing the way I hear the English language being used. If the result has social or ethical merit I will still offer my work to Christian bookstores, successfully in some cases. But I may loan a review copy for them to read first. ("But if you spill coffee on it, you've bought it.") I respect the manager who doesn't think it will be accepted by her clients, but some will see the story as a worthwhile contribution to understanding the world's conflicts.
There are other values besides financial.

Medicine and Faith

Every now and then, the newspapers report a child with some dire disease―leukemia or diabetes perhaps―whose parents refuse medical treatment, saying they will depend on God alone to heal the child.

If these same parents were caught with their child in the middle of a raging flood, or some other natural disaster, I think that in most cases they would not hesitate to accept rescue by boat or helicopter, acknowledging that God sometimes sends help by way of such things in this world. It puzzles me why they might think that medicine is less a part of God's created world than a helicopter is. Maybe it's the way they perceive the offer, perhaps with a requirement for cash in advance, or offered with arrogance; or because someone they heard of died anyway. Be that as it may, there is a need for both faith and medicine in medical crises.

To take diabetes as an example, one feature of this disease is a lack of insulin, a natural body product, which the body needs to regulate the way it uses food for energy. Damage to the insulin-producing cells in the body results in diabetes, and if not treated can cause death. Giving daily doses of insulin allows the person to continue to live. It’s not wise to treat a child’s diabetes with prayer alone, when she urgently needs insulin to survive.

Many cases of diabetes in adults, however, are caused by an unhealthy life style which “wears out” the insulin-producing cells. In early cases, simply modifying one's food intake and life style can restore health. But the person may find it very difficult to change life-long habits. Even though he understands what he must do, he finds he hasn’t enough willpower to maintain the change. I have seen prayer and faith make that change possible in some cases.

Faith in what or whom? Some advise self-reliance— “I am the master of my fate; I am the captain of my soul.” Others depend upon another person, a spouse perhaps, or a work partner, or a doctor or counselor. Some trust in following the rules set down by their particular religious group. Some others hope to be lucky.

This is a touchy subject. In matters of faith, those who claim to have all the answers often feel threatened and insecure if anyone argues against their particular interpretation. Many other people, more secure in their own faith, may suspect the person with “all the answers” has not yet addressed all the questions.

As Benjamin Franklin put it: “[Most suppose themselves] in possession of all truth, and those who differ are so far in the wrong. Like a man traveling in foggy weather, those at some distance before him on the road he sees wrapped up in the fog, as well as those behind him, and the people in the fields on each side. But near him all appears clear, tho’ in truth he is as much in the fog as any of them.”

I freely admit being a follower of Jesus, even though an imperfect one. I believe in a Creator God who takes benevolent interest in each of us and who has a plan for our lives if we, in our freedom of choice, choose to trust God. That’s my basic life view.

Some people reject this, blaming God for making the world the way it is and causing so much suffering. But before we cast blame, it makes sense to do everything possible to correct the wrongs we ourselves (or others) have caused or could have prevented. Among these causes that might be remedied I see infection, injury, ignorance, greed, demand for vengeance, and misguided desires or life-styles, to name a few.

There are some events, such as volcanic eruption, or earthquakes, over which we have little control. Perhaps God allows such misfortunes as a test of our faith, or to teach us how to help each other, or to teach nations how to get their priorities straight. That’s only a perhaps. I don't claim to know the answer.

Whether dealing with disease or disaster, it makes sense to use the facts of science as far as they can be applied. But there is a point beyond which intellect alone is not enough to fight mass murder or indifference, once we cease to acknowledge God.

If God exists and created the world, as Christians suppose, God is not a genie in a bottle. We do not bargain with God, or order God around. If this world is God’s creation, we can choose to accept it and seek to learn how best to live in it, or we can choose to be angry about it and raise our blood pressure to unhealthy levels. Rather than complain or panic when confronted with crisis, I often find it useful to ask for God’s help.

Some quite intelligent people believe that what I call answers to prayer are no more than coincidence. Perhaps so. My father used to remark that when people pray, coincidences happen more often. I tend to agree with him. I have seen many separate instances where something was accomplished by several people happening to be in “the right place at the right time.” To always ascribe such results to blind chance appears unlikely, considering the odds. There is a lot we don’t comprehend about God and the universe. But to state that the world depends on random chance is merely another way of saying that we don’t yet completely understand how order comes out of chaos.

How then is faith relevant? To me, it's the infrastructure of life. It is the fiber, the substance of what we call integrity, dependability, honesty, character. Without it, life and direction begin to wobble, become indecisive, or even collapse.

It is not faith’s function to abolish all trouble, but to deal with it effectively, whether by prayer or the scientific methods God provides through his servants.

“There is no narrowing so deadly as the narrowing of a man’s hunger for spiritual things. No worse evil could befall him in his course on earth than to lose sight of Heaven. And it is not civilization that can prevent this; it is not civilization that can compensate for it. No widening of science, no possession of abstract truths can indemnify for an enfeebled hold on the highest and central truths of humanity.

“What shall a man give in exchange for his soul?”

(Inscribed at Stanford University Chapel, Palo Alto, California)

Pacifism and War

I was a registered conscientious objector during the Korean war, just finishing my medical residency. I sincerely believed that all war is wrong. Since then, I have spent a lot of my life dealing with the human wreckage the insurgents and armies have left behind.

I worked as a doctor during the Shan rebellion in 1961-62, when the Burma army controlled the countryside in the daytime, and the insurgents did at night. I learned that the insurgents had confiscated all the villagers' guns, and even their dogs, until people were defenseless. Insurgents came for a neighbor in the night time, and told him that if he came quietly, they would not kill his family, and then they slit his throat.

My wife and I were medical first responders in Thailand in 1979, when half a million Cambodian refugees poured across the border to escape the advancing Vietnamese army. In Sa Kaew camp alone, we were part of a 1,000-bed hospital for some thirty thousand people, and that was only one of several such camps. Many died before reaching the camps. All because one communist government was fighting another communist government over doctrinal disputes.

In the early 2000s we saw Burmese refugees fleeing into Thailand, to escape persecution by their own army.

There are wars in Libya, in Nigeria, Congo,Iraq, Afghanistan, Syria, Ukraine, Gaza, and now a Muslim radical sect intent on killing all who won't convert to their viewpoint. Hard to understand. Harder, even, than understanding greed for oil profits, or for cocaine, or for increasing weapons exports. But how do you stop indiscriminate violence, without becoming violent too? Sometimes it appears that war is the lesser of two evils. But what ever became of common sense?

Ten-Year flashback in Flame Tree

They had been visiting on the Burma border, a half-day's trek from their hospital. A birthday party for the village headman's daughter, the invitation had said. Actually, it was a dedication ceremony for a new refugee village, but the Thai Border Police could not have looked the other way for that. George had been out walking with a village guide in the early morning when the top general of the whole Karen Insurgent army, Bo Mya, had appeared on the path ahead.

The supreme commander was a man about his own age of fifty-seven, heavily built, mustache curving down around his mouth. He wore a brown leather jacket and appeared out for a stroll except for the hunting rifle under his arm. His only companion wore forest camouflage, carried an automatic weapon and a backpack sprouting a radio antenna. When George glanced back at the village, he saw armed men poised silently at several points where no one had been moments before.

He had thought at first that the war in Burma was spilling over into Thailand, but as it turned out, the general had received an invitation to the village ceremony too.

At the feast in the village hall later that day, the general's adjutant had sat down at George and Vienna's table. "The general regrets that he does not speak English or Thai," the officer explained. "He wishes me to tell you that his rear guard will arrive soon, escorting a group of Burmese refugee students seeking asylum in Thailand." He looked out at the door where two soldiers stood at ease, rifles slung over right shoulder. "Some need medical attention, and he asks if you would have a look at them. The village clinic will be at your disposal, of course."

George poured more strong tea from the battered pot on the table. He looked up again. "Students. From Rangoon?"

"Exactly. The Burmese arrested them in the student uprisings and have been using them to carry army supplies." The officer cleared his throat modestly. "We, ah, distracted the Burmese unit in a skirmish last week, long enough for them to escape. Our intelligence staff has debriefed them and they appear to be genuine refugees."

"Of course I'll give them any medical treatment I can, Major, for as long as I'm here." George thought it good to raise a point of diplomacy. "To be frank. I'm not really certain what my relationship to the Karen army should be. I used to work in Burma a long time ago. But as a guest in Thailand, I should stay neutral if possible."

"I'm sure we have no problem with that, Doctor," the major said, "although I think you may discover the Burmese government different from what you remember, even hostile to outsiders now. Our people have been happy to have you nearby this few months. Colonel Bridgestone's wife was especially pleased with her gall bladder surgery"

George had only removed one gall bladder during his time in Thailand, and the patient had appeared to be a hill farmer's wife. Apparently nothing could be taken at face value out here. But it might explain the invitation to the birthday party.

As the major rose to return to his own table, George saw a stir at the door where two small grubby boys were shouting something to friends inside. An eager exodus of children and a few adults went to watch more soldiers passing by. The village headman leaned over from the next table. "This is the rear guard arriving," he said. I will show you to the dispensary." George and Vienna retrieved their sandals from the clutter of footwear outside the meeting hall and followed the headman to the dirt road that served as village main street.

The small boys from the meeting hall were strutting alongside a military drum corps passing down the street, bamboo fifes piping, drummers beating a tattoo on homemade drums of horse-hide.

Lagging behind the marching troops, a small procession had turned aside to limp up the path to the village clinic. Their gaunt exhaustion and ragged clothing contrasted with the clnic's small garden. Eight refugees in all, two of them carried piggyback by soldiers, another on crutches. Two soldiers carried yet another in a hammock litter slung on a stout bamboo pole. George surveyed the four sickest, laid on the treatment room floor.

One of the refugees identified herself as a senior medical student from Mandalay University, Ma Pyone Hla. She was a small slender Burman woman of twenty something. A scar creased her right cheek; Her English came out of a textbook, but the village midwife helped translate.

"What about the unconscious one?"

"He became sick two days ago with fever and headache, Doctor. I think, perhaps, malaria?"

"Any cough or diarrhea?" George knelt and checked the man's neck for stiffness.

"None."

He looked in the man's eyes and throat, listened to his chest. He probed the abdomen. Skin hot, spleen enlarged; probably the student's diagnosis was right. The little clinic had no lab equipment to confirm it, but malaria was common in these hills. "Let's get an intravenous line in, with a quinine drip." He looked up from the comatose man's side. "If it's cerebral malaria, he'll need I.V. glucose too. Vienna, see what's in the supply room, please."

Now what about these other three?" He indicated the next one in the row. "What's wrong?"

"He says his legs have no strength," the medical student answered.

"What did the Burmese feed you people?" He checked the man's emaciated legs.

"Rice, doctor. Sometimes with a few pieces of gourd sliced into it. They didn't have much food themselves, especially when their platoon was on the move." She lowered her head. "There were twelve of us at the beginning," she said in a small voice. "Two were beaten and left by the side of the trail to die when they couldn't carry their loads. Another died from an infected foot. And one was killed when he stepped on a land mine. My friend with crutches was hurt in the explosion."

"Doesn't the Burma army have minesweepers?" George's voice was soft.

"They used us as minesweepers. They made us walk in front of them."

"Well, let's look at them." He squatted by the young man with the crutches, whose pain was obvious. "Behma natheleh?" (Where do you hurt?) Obligingly, the student bared his right hip. A large swollen red area surrounded a small wound. George felt it carefully, noting the signs of an abscess under the skin. "Has he had any antibiotics?"

"The Karens gave him two sulfa tablets three days ago."

Not nearly enough, George thought, but maybe that's all they had. "Explain to him, please, that I must let the pus out so that the wound can heal." The young man took this information stoically, watching George do the minor surgery with local anesthesia and a scalpel blade, releasing greenish pus to flow into a small basin. He winced only once as George packed the wound open to drain and applied a bandage.

The major looked in at the door. "I think these other two have beriberi," George told him. "Starving people haven't enough vitamin B, and their muscles get weaker when they are fed." He stood up. "The clinic has medicine they can use."


"I think they probably did set us up that day," George said now, as he poured more coffee, but I'm glad we were there. I remember that young medical student from Mandalay, Pyone Hla. She looked completely worn out when she entered the village, but somewhere she had found a flower to put in her hair."

"She said there were twelve of them," Vienna said, "Four had died, and Pyone Hla didn't even want to remember how many times she had been raped. I wonder what's become of them."

"So, what do you think/" George asked. "If we go teach village health in Burma, we can leave all this hassle behind for a month or two. But will that just strengthen the dictatorship in Burma - Myanmar as they call it now - or will we be helping the hill tribes reach peace?'

"It used to be such a beautiful, prosperous country. If we can help it bloom again, let's go."

"Or I could go, and leave you with the grandchildren in Seattle, George said, "Burma may be opening to tourists but I don't like to take you where things could turn dangerous."

"I'll see the grandchildren and Burma, thank you. And before we come home we can stop off and work at the mission hospital in Mae Hong Son again. That way, we can give Jerry and Wilma Judson a month off, and I'll get to shop in Thailand."

"Got it all figured out, have you" George tipped his chair backward, balancing.

"I always have it figured out," Vienna purred.

Humans Are Never Just "Collateral Damage".

Trudy Rubin's July 29th editorial in the Spokesman-Review highlights what Americans and many others often fail to do - to see imperiled people as humanity. They are not "others". Not "news items". Not "collateral damage".

All of us sometimes try to escape responsibility by putting the blame elsewhere, on someone "different" from us. Nowhere is this more obvious than in the present Gazan/Israeli conflict.

It's been sixteen years since I visited Israel, but I can identify with Ms. Rubin's observation that Gazans [and Palestinians living in Israel] are rarely seen as individuals. Rather, they are seen as opponents. Never mind that Israelis build new housing developments in West Bank territory, or blockade Gaza, or bomb Gazan neighborhoods. Hamas, in turn, fires rockets indiscriminately at Israel, and vows to eliminate Israel's existence.

Too many of us support the right to "get even". We idealize freedom, and justly so. But there is a difference between "freedom from" and "freedom to". Both have their place in civilization, but only when our own rights do not exclude the rights of others.

Military force alone is producing no result but mayhem.

CLICKETY-CLACK

There are times when I want to get totally away from every-day life and work, to think, or maybe dream, or learn something new. I suppose I could do this on the hillside above my house on a summer Saturday afternoon. But one of my favorite places to be alone is the railroad track outside Sandpoint, Idaho, on a hot summer day.

This isn't just any railroad track. This is THE main line of the Burlington-Northern Santa Fe transcontinental route, the place where the tracks divide. The left-hand track carries trains across northern Montana to St. Paul and Chicago. The right hand track leads them instead to Missoula, Helena, and the cities of the southern half of Montana. And in between the two main tracks is an old rusty siding, no longer used, ending abruptly at a pile of old railroad ties. I can sit there on the ties and smell the hot tar in the sunshine, listen to the whirring grasshoppers, see a hawk wheel slowly overhead. And watch the trains go by. I could sit there all day, if I hadn't promised my wife I'd take her to lunch.

One summer day, I wandered a little farther up the track, idly picking up pieces of scrap iron, rusty railroad spikes and the like and depositing them in neat little piles. When I returned, two men had taken my place at the dividing of the tracks. Seen from a distance, they wore hats that glittered, and they were doing something with fire. After watching them from afar, I reasoned that they were probably not sabotaging the rails at ten in the morning, and I strolled up closer.

The gleaming hats proved to be welder's shields pushed up on their foreheads, and they were merely a couple of bearded railroad repairmen surrounded by tools from a pickup truck parked on the road beside the track. We exchanged howdys. They spotted my notepad tucked in my belt, and asked if I was writing a book. I dismissed that idea with a small laugh, leaving me free to ask what they were doing.

"We take the clickety-clack out of the track," the older of the two told me. The mainline rails are an unending ribbon, free of the joints that used to give background noise to every train trip. I asked why the hot sun didn't cause such a long piece of steel to expand in the heat and bend out of shape. Even quarter-mile-long bridges need room to expand in the heat. I didn't understand his whole answer, but he said it is only an occasional problem. Like now, at this point. The inspection truck—a pickup that rides the rails on iron wheels—had recently been by, and had found a bump at this place as it passed, plus a couple more farther toward Bonners Ferry that they would presently go fix. He showed me a half-inch thick cross section of rail which he and his partner had surgically removed from the track with a large circular emery saw. They had then jury-rigged a small brick crucible around the gap, melted some of the track-side scrap metal with a welder's rig and re-welded the track together, polishing their weld smooth with all the care a dentist might spend on a front tooth filling. These two men were responsible for such repairs from Sandpoint all the way to Libby, Montana, an 85-mile long stretch.

These new methods of railroading fascinate me. After they left, I compared their work with the old unused spur, with rails bolted together every twenty or thirty feet. A date stamped into the rusty side of the rail on the spur said 1920. I moved back to where the main switch determines which route each train will take for the next thousand miles. There is no switchman there anymore. A computer in some city far way, activates the heavy-duty electric motor that moves the rails, and changes the overhead signal lights from red to green. In winter, an automatic propane-fired blower melts any ice that might clog the switch-points. I am told that the bits of scrap-iron I idly put in little piles next to the track might just as well have been left alone—a work train with a large magnet periodically comes along and recovers most of them.

But the job I have always dreamed about—the locomotive engineer—is still filled by a human being. A train is coming now; it had stopped down at Sandpoint station until the signal turned green. Its four diesel engine units throb mightily as it slowly accelerates its l06-car, mile-long load, the triangular pattern of the three headlights visible a mile away, The brilliantly painted orange-and-yellow engines with their Santa Fe logo are moving at thirty miles an hour by the time they reach me.

As he passes, the engineer, high in the cab, waves to me.

And the little boy inside me waves back.