“The hospital is a 2-hour boat ride and 3-hour van ride away…”
The team and I were into our second day of clinic in Dae Bu Noh village and villagers were slowly streaming in. We weren’t particularly busy and by mid-afternoon, the blazing heat had deterred many villagers from coming. Some even gave up halfway into their journey.
After seeing our last patient, we started to pack up and were ready to conclude yet another uneventful day. Just before leaving, the medic in-charge of the acute clinic referred a critically ill villager to our doctor. This lady had oliguria, a condition whereby abnormally small amounts of urine are produced. He was also uncertain if the placement of her urine catheter was accurate.
We stepped into the acute clinic and were greeted with crying babies, as well as worried-looking family members. The acute clinic had a simple facade. It had a corrugated zinc rooftop, and the surrounding wooden fence allowed just sufficient sunlight to peek through. A cabinet sits on the wooden floor, storing only basic medical supplies. There were no beds, privacy curtains, or drip stands. The villagers sat and slept on the floor.
As we scanned the room to look for this lady, we were alerted to a frail figure. We quickly realised that the ill villager was the lady who had shared a boat ride with us two days ago. She looked ill, weak and breathless, a stark contrast from when we first saw her. She could still walked on her own then. But now, she couldn’t lie flat and had to sit up right, supported by many blankets which were used as pillows due to breathing difficulties. After a more detailed history-taking, we realised that her condition was more critical than what the medic had thought. She was in severe hypotension. Her blood pressure was very low and she was in great discomfort. It was a medical emergency.
Stabilising this lady’s blood pressure was our priority. In an unfamiliar environment, we had to work within our means and resources to attend to her. We ramaged around to find the necessary items to set an intravenous (IV) cannula, ran fluids and sourced for medications to resuscitate this lady. Adding to the confusion was communication barriers. The situation was just chaotic.
After much effort from our team and also our partner who was helping to translate, we finally managed to stabilise the lady’s blood pressure. Due to limited resources at the clinic and her critical condition, our team doctor made a medical decision to send this lady to the nearest local hospital for urgent treatment. Our doctor explained her critical condition to her family and emphasized the need for prompt treatment in order to survive. The journey to the hospital however, was not in her favour.
The nearest hospital was five hours away; two hours by boat, and three hours by van on rugged terrains. The lady also ran the risk of being turned down at the hospital due to political tensions. Her village is located in Karen state, a region that has been in conflict with Burma’s central government. Cost of treatment was, unfortunately, another setback for the family. Despite the multitude of potential problems, the family decided to hold on to even the slightest gleam of hope and sent her to the hospital.
Our coordinator immediately made transportation arrangements. The lady was carried out of the clinic on a canvas sheet suspended on a thick wooden pole - an improvised stretcher. We prepared whatever standby emergency medications that we had at hand and escorted her on a 20-minute journey by foot to the river, where a boat was waiting for us. When we reached the river, the lady looked pale, with cyanotic lips. Her oxygen saturation was low .Our hearts sank as we knew that there was nothing more we could do within our means to improve the situation. All we could do was hope for a miracle, that she could endure the treacherous journey to the hospital.
As our chapter with this lady closed, we walked back to the clinic with a heavy heart under the setting sun, hoping for the best ending - that she would receive treatment.
Dinner was sombre that night. Everyone was deep in thought and experiencing a whirlpool of emotions - sadness, despair and powerlessness.
There were also many “what ifs”.
Did we make the right decision? What else can we offer in our capacity? Will she make it to the hospital?
Just as we thought that the night was over, the medic-in charge again alerted us to a baby having persistently high fever. He was suspected to have meningitis, a medical emergency especially in babies. The child was acutely ill and required prompt treatment but the clinic did not have the required medicine to treat. Similarly, the baby would have to be sent to the nearest hospital for appropriate treatment. However, it had turned dark and the baby could only be sent for treatment the next morning.
And now, all we could do was wait. A wait that was excruciatingly painful.
In Singapore, we are blessed to have an organised and effective healthcare system. Though not perfect, we cannot deny that prompt treatment, investigation and medication are readily available for our people. Ambulances arrive within 10-15 minutes upon activation and patients are sent to the nearest hospitals within 15 minutes.
As a medical professional, it is always heart-wrenching to see people suffer. We always want to do our best to save and cure everyone that comes to us. Just like the ill villager and the baby with suspected meningitis, it is sad when reversible medical conditions are left untreated or when people receive delayed treatment because of the lack of resources.
In retrospect, I started to ponder about the various difficulties we faced during medical mission trips. Besides facing limited resources, there are also constraints arising from the socio-political environment where the villagers are living in. Are we sometimes too blinded to treat when the delivery of medical treatments are often limited by circumstances? What else can we offer to the people if medicine cannot cure?
Putting the situation into perspective, I probably would not have only focused on treating the villager medically. I would have put more thought into considering the situation more holistically. Maybe at that point of time, attending to her spiritual and physical needs, such as alleviating her pain and giving her more quality time to spend her last moments with her family, would have made a greater impact. Through this experience, I have learnt that treating those in need does not always mean finding a medicinal cure.
The family had decided to turn back 10 minutes into the boat ride and the villager passed away surrounded by her family at home. The baby with suspected meningitis passed away the next morning.
Madeleine is a community nurse in Singapore. She is the founder of Project Light. Inspired by the medical mission trips she undertook while studying to be a nurse as an undergrad, she decided to continue her passion even when she started work.