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.