Land of Enchantment, Land of War

Reprinted from Sonoma Medicine magazine.
Dr. Brown, a family physician, is medical director of the Southwest Community Health Center in Santa Rosa and founder of the Burmese Refugee Care Project/Planet Care.

BURMA, LAND OF ENCHANTMENT, the rice bowl of Asia, covered with the footsteps of the Buddha, filled with exotic animals and with terrain rich with geographic and cultural diversity. I walk through the Burmese jungle on my way to a hill-tribe village, across beautiful hills with birds that seem to have streamers coming off their tails. The people have silver spools in their ears and wear exotic handwoven colorful dresses.

I am not here as a tourist; I am quite far from the areas the Burmese authorities allow tourists to see. I am here for another reason, to help establish even a small thread of a health care system in this beautiful yet war-torn area.

As I look through the beauty, I notice that the hills are patterned with bomb trenches, like the veins on the back of a swarthy hand. I am dangerously close to the war, so close I can hear the gunfire. When a plane flies over, it is time to run for one of those trenches. This area is the proverbial front line in a civil war that has ravaged Burma for more than four decades.

Why has this country been so ravaged? Formerly British ruled, Burma had a brief stint of independence after World War II. A chain of killings led to an unstable situation and what in 1963 looked like a small world event. The headline "Burma has bloodless coup and closes its doors to foreigners" has turned into the next killing fields. Two decades of relatively quiet extermination and two decades of more open extermination have left more than 10% of Burma's 45 million people either internally displaced, on the run, displaced into neighboring countries, under house arrest, or dead.

The current government, which changed its name from SLORC (State Law and Order Restoration Council) to SPDC (State Peace and Development Council), rules by totalitarian dictatorship. They have occasional well-publicized events to appease the international press. They held an election in the late 1980s, and then put the victor (Aung San Suu Kyi, winner of the Nobel Peace Prize) and her party under house arrest. They changed the name of the country from Burma to Myanmar.

These events look to the world like change, but little really changes. Same people, same policies, and - unfortunately for the country's population - same war.

What kind of war is this? You might call it a political war of dictatorship vs. democracy. You might call it a race war of central Burmans against the ethnic minorities. But most of the experts would say that, at its core, this is a war of greed. A few people in power, in a country rich with resources, have transformed their fertile jungle into one of the poorest countries in the world.

So far, Burma has managed to fly under the world's radar screen. As long as the Burmese continue to sell their natural resources at bargain prices, their fellow countries simply look the other way.

I walk into the villages expecting the worst: soldiers with infected wounds, missing limbs, and twisted lives. What I see is disturbingly different. I see forlorn women and children, with malarial fevers, measles, dysentery, and bellies swollen with worms.

Many of war's true victims are not the ones out fighting; they are the accidental ones, accidentally hit or accidentally left. The ones who were just in the way or the ones who were, out of necessity, left behind to fend for themselves in a world of wolves.

I have been returning to the Thai-Burma border area for 15 years. I have led many mobile medical trips. I have taught medics and have spent countless hours alongside them as they care for the people. I wish the stories I am about to write were made up, like some Stephen King nightmare, but they are not. These are cases I have witnessed, patients I have doctored, victims I have watched buried.

Pregnant woman hit by a mortar. Seven months pregnant, she was fishing from a stream when a bomb fell near her. She woke up in a military hospital days later with an 18-inch scar from her pelvis to her ribs. Her baby was not hit, though the same could not be said for her intestines. Despite a horrific scar and a long recovery, this one has a happy ending. Both the mom and the baby survived.

Forced porter raped each night. In the early days of the war, government soldiers would kidnap the men and force them to carry guns and supplies. Now they also kidnap women. One woman escaped to tell us her tale. She was forced to carry 40-pound loads up steep hills barefoot. She was fed only once a day, usually a meal of rotten rice. Then she was gang-raped by the soldiers. She is "lucky" … she escaped.

Forced to leave her family to work in factories in Thailand, a 15-year-old girl arrives at the clinic infected and septic. She is beautiful, though as she lies in bed shaking with chills and rigors, her beauty is hard to see. I ask the medic if she has malaria. She says, "No, she has a belly problem from an infected illegal abortion. She came here without her parents, and a man offered her a place to stay. He said he would take care of her forever, and then he left. She found out later she was pregnant. A co-worker said there was a woman in the factory who could help her. So she went to the woman and that was that."

Unfortunately, that was not that. The woman forced a small piece of wood through the girl's cervix and left it in place. Not surprisingly, the wood caused a serious pelvic infection. (More surprisingly, the procedure works most of the time). The girl was too sick. All the medicines and fluids we gave were not enough. She died.

Stepped on a land mine. A sweet 9-year-old girl was walking back from her grandmother's home with flowers in her hair when she stepped on a land mine. She was close to the border and made it to the clinic and then to the hospital. She lost her leg.

Pregnant with twins, weighed 98 pounds at term. No money and no food, she came to us in early labor and delivered two babies. The big one weighed two and a half pounds, a bit more than his sister. It is summer and warm; they might survive.

If these were stories of the way animals were treated, I would cry thinking about the cruelty. When I think that this has happened to beautiful, simple people, I feel my humanity trampled.

Is my role here accidental? I came, I saw, I cared, and I came back to help. I initially went back because I fell in love with the people, then because I knew they needed me, and now because I am their friend. We started a small nonprofit organization, Planet Care (http://planetcare.org), originally the Burmese Refugee Care Project), and we have done some good.

In Thailand, just across the Burmese border, what was once a converted barn is now a medical village with departments for medicine, surgery, reproductive health, child health, lab and blood bank, eye care, prosthetics, malaria and tuberculosis management, and migrant and cross-border outreach. We also train most of the health-care workers along the border. The clinics we built inside Burma were burned down, so we created backpack heath worker teams. They have grown from the initial seven teams to 70 teams.

Last year, the clinic treated 49,000 people (99,000 visits and 8,000 admissions), and the backpack teams saw an estimated 150,000 patients. About half were women and children. We fitted prosthetic limbs for 250 people, delivered 1,439 babies (30% to teenaged moms), trained 212 health workers, and provided ongoing training and internships for about 200 more. Although all the patients come to the clinic because of the war, only a handful are direct war casualties. The clinic serves not only people's physical health, but also their spirits, by offering a bastion of hope. It is a place where people can grow and learn and serve.

What have I learned from my 15 years in Burma? They have taught me how to hold a country and a people in my heart. I feel at times like a witness, at times like a student, at times like a helpless nothing, at times like a hero, and at times like a priest, just praying for a way for this to stop; a way for the bullies on the playground to wake up and see that what we do to another we do to ourselves.

When the bullies wake up or get told they can't keep doing this, I will see myself as a celebrator, and deeply celebrate our victory. Then we can begin our long road of repair. Until that time, I will continue to be a servant and a friend, doing whatever I can to help.