April, 2006  Dr. Cynthia and the Malaria Story
By David Downham

Margaret Mead has talked of the anthropologist's predicament; saying, one cannot understand a culture until you are absorbed by it, and once you have been absorbed, it is no longer possible to describe it. Nevertheless she did continue to do just that! Toynbee believed that cultures, coming into conflict, resulted in enrichment and eventual advance. They spoke for the first part of the 20th Century and believed in progress. It would be hard to predict what they would say in today's convulsed and troubled world.

Although I have tried, I have not understood too well how things work at Dr. Cynthia's Mae Tao Clinic – who really calls the shots, or if anyone really does. There is a huge disadvantage in not being able to speak the language. The respect for Cynthia is universal amongst the Karen as far as I can see. This is largely so too for the foreigner's and NGO's, though there is a vocal minority that would like to see things run differently, or even in some quarters, would like to have a major say in the running of the Clinic themselves. This is understandable. The NGOs manage other's money and have an obligation to see it well spent and therefore may disagree with her priorities. I have never been sure if she is always the decision-maker. But I think it is certain that she enables the right decisions to be made. In the College that has been established just across the border, the students are exposed to a high malaria risk. It is endemic in the nearby villages. It is brought from one place to another by the soldiers, and IDPs and in both these populations there is a substantial resistance that results in mild cases, continued mobility and transfer. Last year in one month, between the College and the Hostel, then between 140 and 150 students, there were more than 20 cases in one month. In the close proximity of their situation, contagious diseases have a field day, and Malaria always with a plentiful supply of its Anopheles vector does just as well.

If one of the students in the College gets a fever, they have to take a journey several miles to get their blood tested. Transport may not be immediately available. In a nearby military post there is a Medic and a Health Centre, I visited on Revolution Day. They told me there were no funds for anti-malarials. Then they dug up a rusted but once perfectly good microscope, but explained that they were not trained for malarial smear examination, and anyway there were no slides, cover slips or stains. Clearly something badly needed to be done about all this.

The Lab in the Clinic is very limited in what it can do – something I have always felt I should be doing more about – but there has not been too much enthusiasm for this from Cynthia. I guessed she had her reasons and left it alone for the then. However, they are brilliant at malarial recognition and in the season do hundreds of examinations a day.

I asked Cynthia whether she might accept our trainees. She was polite, and said they would need to apply in June when all the new students started. I took this really as a ‘No', and we decided we would need another way.

We went back and talked to her again much later on, keeping a whole Australian Photo Crew waiting. This time she seemed to have a different view and the advice she gave was very sensible; did we understand that in all likelihood within a very short time we would find ourselves diagnosing and treating everyone in three days march of the College, in all likelihood including the SPDC soldiers up the river and the local DKBA, the breakaway Buddhist soldiers; a good warning and something we will have to work on. But we felt our kids could die if we did not do something and we had to push ahead.

The person nominally in charge of the Lab is Dr. Cynthia's husband. In a bit of an underhand approach, Kshakalu went to see him, and over beer, he agreed to the kids coming and being taught, provided Kshakalu brought him a goat, as a tribute. We have a lot of goats at the College, and this may have been an idea of Kshakalu's, a chip in the bargaining, at which he is something of a master. Later the goat was delivered, apparently a very fine Billy, and Lynn Toye was there as a witness, to the front door of Cynthia's house, while a meeting of KNU members was going on, producing some disruption; one world colliding with another. My head medic, Law Kwa, in Trauma, with whom I had discussed all this, decided then it was time for us to bring our kids, of whom we are very proud, to see the Head Tech in the Lab. and before that I had met him and he had said that he was delighted to help. And he seemed just as pleased with the kids as we are. When we were there, all four, and Cathy and I, she eventually asked when he would like them to start. He said 8 o'clock tomorrow morning. We were dancing.

That first night or two they stayed with us. Then Kshakalu took them and left them with Cynthia. This bothered us a lot but when we went and tried to get them back she said they were fine and leave them with her. Now they are 3-4 weeks into their 6-8 week course. They are still there staying with her and now I am back from England, will check in on them and see how they are doing.

I am sure that Margaret Mead and Professor Toynbee know far more about all this than we ever could or ever will. But here this is the way things usually happen. It takes a good deal longer than we are used to. But it seems to work, and there was never a frown or a cross word spoken, and it seems to me a far better way.