It was Thursday afternoon, and I was having my first relaxing day of the week. In fact, I nearly finished digging a rain-water ditch that morning, since I didn’t have any patients that day (which was unusual). So just as I was getting ready to work on some letter-writing, I saw a truck drive up to the door, and a villager carried a young woman piggy-back up to the chair on the porch of the principal’s house. The patient didn’t immediately appear critical, and I dialed my cell phone to summon the only person that I thought was on campus and could translate the Karen language for me (my language skills are improving, but still need a translator). The phone failing, I jumped on my motorbike and went over to his house and woke him up. When we got back to the patient, my usual translator, Anna, was somehow already waiting at the porch clinic (I thought she was gone to Mae Sot)! The truck and its driver, however, were gone.
Equipped with a translator, I could start to ask the villagers detailed questions about what was going on. Looking closer at the girl, it seemed that although she was sitting up, sometimes she was drifting and having a hard time keeping her eyes open. Checking her vital signs revealed that something was majorly wrong, and her arms were cold and clammy, and her mother told us that she had been having severe stomach pain and constipation for 10 days. (They had just now come here from Burma.) Sure enough, her abdomen was hard. I remembered the page in my medical manual that talked about the emergency called “Acute Abdomen.” There are three types listed—acute abdomen with shock, acute abdomen with infection, and acute abdomen with obstruction. (I found out later that this girl had all three of those at once!)
Being that our porch “clinic” at the school is really only meant for minor school emergencies (including sutures) and non-critical care for villagers that come, this was obviously a case that had to go to the nearest hospital. There is no “911” service here. Our only “school vehicles" (the personal vehicles that are used for the school by necessity) were gone that day, and the truck that dropped the patient and her relatives off at our porch was gone, and nobody knew him or had his phone number. I asked Thara Ehginyah try to call someone else to hire a local truck, but he wasn’t able to get a hold of anybody at that time. Another possible option was to take the local public transportation on the rural highway--a “songtaew” pickup truck with small bench seats. But we didn’t know when the next songtaew would go past or whether it would be too full, and the driver might not even let us take a critical patient on board due to liability, etc. So finally it came down to…using my motorbike. The girl seemed to be able to sit up and walk a bit and the mother agreed to come on the bike and ride with us to the hospital.
So here I had two women riding behind me on my 125cc bike that you would probably call a scooter. The 21-year old patient, Mu Seh Paw, easily weighed more than me (I’ve gained a bit of weight this year, but only in muscle), and it didn’t take very far down the road to realize I was going to have a very difficult ride, as she could not sit up straight most of the time. She put her head on my shoulder and was leaning against my back as I gripped the handlebars and tried to hold both of our weight up, especially against the G-forces as we went down hills. After the first couple of kilometers, my arms were burning with pain as I gritted my teeth and used my full strength to hang onto the handlebars and try to control the bike with that weight pushing down on my arms (I was glad that my arms had been recently toned by all the jungle-climbing and push-ups I’d been doing). I was having to ride hunched down with my head low, I could barely reach the handle-brake due to my position, and the bike was making strange noises occasionally. I wondered if we were going to survive this trip. My back was starting to ache too, and just when I didn’t think I could hang on any longer, the mother (sitting in the back) pulled Mu Seh Paw off of my back for a few seconds so I could shake out my sore arms and stretch my hunched back a little. It was a short reprieve, and soon I was gritting my teeth and trying to hold back the weight again.
This went on repeatedly for kilometer after kilometer, as I prayed continuously for God to help us survive this trip. I knew that Mu Seh Paw could die any minute from respiratory failure or other complications with shock, but her mother was talking (shouting) to her and I could tell she was staying mostly awake by her occasional mumbled responses. After about 45 minutes of tortuous riding, I saw a milepost that said we had 5 kilometers left to get to the local hospital, and I knew we would make it. And we did, praise God!
I was practically panting with all the effort as we pulled up at the hospital. The girl was able to get off the bike, although kind of in a daze as they brought a wheelchair for her. At first the hospital staff weren’t treating her very seriously, but it didn’t take long for them to start checking vital signs and then immediately took her into the trauma room. (I really want to learn more Thai language so I can talk to the main hospital staff…) After getting an IV started, taking X-rays and ultrasound, etc, starting an NG tube, a doctor came and told me in broken English that she was going to send Mu Seh Paw to the Mae Sot hospital (bigger city) for surgery. She said the patient had a complete bowel obstruction and sepsis (dangerous infection in the bloodstream). There was some confusion about how long the bowels had been obstructed, but it was obvious from the shock symptoms that things were serious. The mother stayed with her daughter to go on the ambulance to Mae Sot, and I rode my motorbike back home with much less effort. (In similar cases to this, usually I don’t have much more contact with the patient/family due to difficulties of communication, and don’t always get to find out what happens to them after the hospital visit.)
The next day, the principal’s family had arrived back at the school from America, so I was taking advantage of my fewer responsibilities to spend some time at my room for once, trying to clean and organize things. Then I got a phone call saying that some villagers were at the porch clinic asking if we could go down to Mae Sot to help retrieve a body for them. At first I was like, “what? I don’t remember anyone dying in Mae Sot during the past couple of…” But when I found out they were talking about a girl in her 20s, it started to dawn on me…After all that…and now she’s dead? It took a bit of time for the sad shock of that to sink in. (She had died in the ICU in Mae Sot, before being able to have surgery.)
Mu Seh Paw’s brothers wanted to bring her body from Mae Sot back to here where they could take her in a small boat back into Burma to her village. I agreed to drive the principal’s car with Anna to take the brothers to meet their mother in Mae Sot at the hospital. Due to more communication difficulties, it took us a little while to track down where the body was. At the mortuary, the sight of the mother there sobbing was enough to make me fight my own tears. And when the staff member working in the mortuary asked the mother (along with the brothers) to look at her dead daughter’s face for identification before releasing the body…I can still hear her frustrated anguished cry, “gwah wee lee!!!” (I’m finished looking!)
After the brothers loaded Mu Seh Paw’s wrapped body into the back of the station wagon, we drove silently the two hours back to Mae Salit. I was trying to think about what more I could do to help this poor Buddhist/animist family, in their hopeless state of loss. (I wished we had some tracts in the Karen language that we could share with them, but we don’t, and I don’t even know if they can read. In America we are so blessed to have so many resources that aren’t available here.)
Upon arriving at the river, the brothers carried Mu Seh Paw to a small boat. The mother went with them, but then hurried back to the car and wanted us to open the hatch again. She had to make sure the shadow didn’t get left behind, or something like that. She called (in Karen) “spirit, come with me…” and then went back down to the boat. And I went back home and went to our Friday night worship service in the school chapel, heart as pained as ever. Please pray for these people and for all of us and for wisdom to know how to reach people in these kind of circumstances. Sometimes our focus is on the busy school and our students, but we have other opportunities for witnessing that we can take advantage of sometimes too.
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