February 15, 2008 Cathy saves a Life - College Student's Cousin with TB
By Cathy Downham

Two weeks ago Monday I spent a long, frightening morning in the Surgical/Medical Ward, at Mae Sot General Hospital.

The Friday evening before, on my way back to Mae Sot from our College, I had a phone call from Mu Ku Ku, one of last year's graduates. My road home to Mae Sot passes the 23 year old refugee camp where she has lives. She needed a ride from me (she has no papers) to Mae Tao Clinic where David works, because her cousin and his sister were there. She had a scrap of paper on which she had written ‘ankle – broke bent and the tibia and various other, to me incomprehensible definitions and descriptions of parts of the lower body – all neatly printed. She speaks quite a bit of English but with jumbles of words in no particular order. She was excited and anxious as she told me about her new job in the camp working with Handicap International, how she visited and took pulse rates talked to people from 3 to 75.

I dropped her at The Clinic and she rushed off -nervous smiles in all directions heading toward her cousins in the IPD (In-Patient Dept.).

When I next heard from her that Sunday night I expected she was calling for a ride back to the refugee camp and I was confused when she said she was now –not at the clinic- but in Mae Sot General Hospital. Then she burst into tears. It was after eight in the evening and I knew I wouldn't understand what she was saying until I saw her so I promised to come early in the morning. She calmed her hiccupping and said ‘thank you please Cathy'

Sitting with Mu Ku Ku on the edge of a small stool close to her cousin who, attached to an IV, lay limp in his bed in the too crowded ward I began to understand that Mu Ku Ku's cousin, Saw Kaw Lee Htoo , 25 years old, was paralyzed from the chest down. Less than two weeks before on the other side of the border, he had been tending the small plot of land he and his sister share in a tiny village in Karen State about 5 hours west and north of Mae Sot, doing the odd jobs he could find for a little money to provide for himself and his sister. He weakened quickly and his sister somehow managed with the help of neighbours to get him across the border to Dr. Cynthia's Clinic.

Mu Ku Ku's, parents, dead now, were from the same village. Both sets of parents are dead despite the fact that they would be near fifty years of age. Though she now lives with an auntie in the refugee camp, the cousins remain very close.

From the hospital I had called David on the phone trying to describe everything while getting information from the sister and Mu Ku Ku. The Thai nurses could not speak English, nor I Thai and the chart was confusing – certainly to me! D. on the phone, speculated - Lou Garrick's, maybe a parasite, maybe a tumour, likely TB. We waited for the doctor to do his rounds (usually at 10:00). But it was Monday and many were waiting. Luckily, young Jack, a Karen who speaks Thai fluently, has been a Backpacker and trained as a medic and who now works as a liaison between the Clinic and the Thai general Hospital came by. He talked to the nurses who explained the Thai doctor was over loaded and late. He also told me that this small public hospital – about the size of Orillia's Soldiers' Memorial sees 1300 out-patients daily.

We waited and wondered. Why had the clinic sent him here? Did he have any money? None- all used getting to the clinic. How had he been moved from the clinic to this hospital? – by the clinic truck. Was the clinic remaining responsible for him? The sister had bills of over 5000 Baht already. The only thing any of them had was me – connected by Mu Ku Ku.

One of the toughest parts of being here is making decisions about where PUB's donated money should go. The education of the young, possibly saving a life doing nothing so death when that can be the life or death of a family unit or one person or only time. Fathers get killed portering or by landmines or disease so Mothers die because they have no support and give what they have to their children.

I continued to phone David and one time catching him when the background noise in Trauma at the clinic was not so loud; I asked how did he get himself to the clinic each day knowing that each day there would be a patient that we didn't have the resources, skills or legality to help? As well by the time some get to the clinic, it is too late. Was this my present situation?

Finally the doctor arrived still looking quite fresh after his horrendous day that must have begun before seven. David had found out earlier that a spinal tap had been done on Sat. at the clinic and they, and so I, had the results and but the doctor did not. He accepted my hand written notes as if this was normal, thought myelogram then said Mae Sot Hospital's CAT Scan was no good and raising his significant eyebrows at me said the CAT Scanner at the private hospital was expensive but good??? I kept nodding. He nodded as well and hurried off. Jack said the Doctor suspected TB of the spine.

Later David and Jack would come and talk to the doctor and when I returned from the college the following Friday, the diagnosis had been confirmed. Saw Kaw Lee Htoo had TB of the spine and now been isolated to a place in the hall outside the ward Toilets and was wearing a mask. Pulling it aside, he had a small smile to give.

We were hoping to transfer him back to the Clinic as the hospital bills were mounting but they wouldn't take him. The French ‘Doctors Without Borders' (MSF) have suddenly stopped supplying TB drugs to Burmese/Karen people who cannot prove they are legal migrant workers or registered with the UNHCR. The In Patient Department at the Clinic couldn't take him because of the MSF ruling.

The Karen medic in charge of Trauma said he would take him there (because of our interest I suspect) so Kaw Lee Htoo with his sister sleeping under his bed are now in Trauma, PUB is paying the very small amount for the TB medicine and care.

David says he is improving and indeed today he independently raised both his legs and gave me a huge smile. David says we don't know if he will get complete recovery. I hopefully disagree.

A touching anecdote to this story is that their village had somehow borrowed enough from someone in Bangkok to begin helping him. This put the village almost into bankruptcy I would expect. PUB has taken care of that debt. The village elder travelled all the way here to the clinic and talked with their accountant to whom we had given the money.

David connected with John Toye about this and he connected with a former OSMH colleague, Tony Reid, who is now working in Belgium at the headquarters of Doctors Without Borders and they are still trying to understand why treatment of TB has been stopped here.

We were lucky. If by chance we hadn't been there David has no doubt Saw Kaw Lay Htoo would be back in his village dying of ‘a tumour'.

Cathy Downham