healthcare and history in the land that the world forgot-Myanmar

 

MINGALABA!!

This is the common greeting for friends and strangers in Myanmar. The direct translation is, ” it is a blessing” which has dual meaning for hello and goodbye. It also has a wonderful subtext as an offering of ‘ auspicious blessings”. What nicer way could there be to greet and part with someone, than by offering them a blessing.

Traveling to the other side of the world is no euphemism here… I  spent more than 25+ hours in air ravel, approximately 9,856 miles from my home in Atlanta, Georgia to Officially arrive in the Republic of the Union of Myanmar (formally the Republic of Burma). Logistically, it  has been quite the  undertaking to prepare for months gone from your home and outside of the country. Thankfully, I have a village preparing me for my time away, all who have conspired to help me be successful and given me the peace of mind that everything both professionally and personally is under-control while I am serving as a Global Health Fellow. To each and everyone of them… I am grateful!

It is both and honor and a privilege to have the opportunity to represent Pfizer as a Global Fellow and partner with PSI, all while being a first hand eye witness of a country introducing itself to the world and on the precipice of evolution and expansion. Myanmar is a country where access to the outside world had been all but criminalized for more than 4 decades. Trade, communication, innovation and medical advances had been halted for more than 50 years. The world marched on while the population of Myanmar was all but frozen in time. Imagine a country where Coca-Cola was considered contraband until just a few years ago, a place where they skipped right over the concept of black and white TV and were instantly catapulted into color tv, cable television, facebook and cell phones. A good majority of the population in the rural provinces still has little idea of the advancements the world has been making.

The military lead government (junta) was officially dissolved following a 2010 general election and a sparse civilian government was installed. Although the military retains enormous authority it has taken steps toward relinquishing control of the government back to the people. Myanmar is a country that is unquestionably on the verge of growth and modernization, the change in government constraints has allowed forward progress in the country’s foreign relations and has led the way for improvement in trade with Europe and the United States. The upcoming general election in 2015 will definitely be telling for the future of democracy in this country.

At this moment, Myanmar is one of Asia’s poorest countries. When the World Health Organization (WHO) ranked Myanmar against its global counterparts, the country was ranked last out of 190 countries with respect to what the WHO calls “overall health system performance.” %. Myanmar’s government spends the least percentage of its GDP on health care of any country in the world, it spend roughly 2% on healthcare; whereas impoverished Laos spends 4.5%, and Cambodia 5.6% of its GDP on healthcare.

The general state of health care in Myanmar (Burma) is poor. I recently read that Myanmar has barely 61 oncologists in the entire country and a meager 3 radiation machines in all of Yangon. Cardiovascular diagnostic capabilities barely exist anywhere in the country.

A bit of perspective on health care costs in Myanmar, currently it is mostly a private pay system. The average estimated patient’s out of pocket contribution accounts about 92 % of total health care expenses. Today, person in Myanmar needs medical attention, the vast majority will go to a private-pay clinic or monastery where for a small fee, they can receive very basic primary care services. If medicine is prescribed, the individual knows they will have to pay 100% of the costs out of pocket. The net of this is that today’s healthcare consumers in Myanmar are accustomed to taking nearly full responsibility for their individual healthcare costs.

Luckily for Myanmar, the demand for healthcare services, pharmaceutical products and medical innovations will go hand in hand with the economic development and increasing income of the Myanmar people. As Myanmar continues its economic growth, the demand for quality healthcare will undoubtedly increase, as will the demand for access to better more advanced procedures and treatment options.

I will be excited to learn more about this country , its customs, cultures and most importantly its people. As for now, I say to you…

MINGALABA!!

The land of the golden pagodas

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I started the week with a little sight seeing… First up Shewdagon Pagoda! The story goes like this, it is the largest pagoda in Myanmar and the oldest pagoda in the world, more than 2600 years old. It hold remains of all 4 Buddhas and even 8 strands of hair from the Lord Gautama Buddha dating back to 558 BC. These hairs were presented to the then king by 2 merchant brothers fIndia, upon their return to their home land Burma, who had received them from the Buddha himself .,It is said that when the King opened the coffin like case where the hair was stored and….

“There was a tumult among men and spirits … rays emitted by the Hairs penetrated up to the heavens above and down to hell … the blind beheld objects … the deaf heard sounds … the dumb spoke distinctly … the earth quaked … the winds of the ocean blew … Mount Meru shook … lightning flashed … gems rained down until they were knee deep … all trees of the Himalayas, though not in season, bore blossoms and fruit.”

This Shwedgagon Pagoda is pretty awe inspiring and for Buddhist of Myanmar, it is considered the holiest of sites. The Shwegadon Pagoda stands about 300 feet high and is gilded in more than 800 bars of solid gold. The tip of the stupa, far too high for the human eye to discern in any detail, is set with 5448 diamonds, 2317 rubies, sapphires, and other gems, 1065 golden bells and, at the very top, a single 76-carat diamond. It can be said that the Myanmar like a little bling. Surrounding the pagoda are a plentitude of smaller shrines housing pre-Buddhist spirits called Nats, miracle working images, and even a wish granting stone. The worshipers were everywhere… young … old… common people and oh so many monks. This pagoda is said to be the most sacred place for Buddist in all of Myanmar.  It is said, that all Myanmar have an  asspiration to make a religious pilgramige to the Shwedagon Pagoda at least once in thier lifetime.

It was all so glistening, golden and beautiful I didnt even mind that white marble , which had been absorbing the Myanmar penetrating sunrays all day  was searing the bottoms of my feet. I  rather ungracefully hopped from the very few shady spots I could find. It was like those Tom and Jerry cartoons where Tom is walking over the hot coals.  Now  for full disclosure, you are required to remove your shoes and socks before you enter the Pagoda, so even before you enter, on  ground floor at the elevator to the courtyard, up the two stories … NO SHOES OR SOCKS FOR ANYONE!!!  So maybe I am a self professed germ-a-phob, which probably stems from my  recent run in with toxic agents that stripped my immunity and my eyelashes. But somehow this was seemingly very unhygienic and against all things I am comfortable with.  I get it,  the SHWEDAGON PAGODA maybe  the most sacred of  ALL place for Buddhist but I was not loving the dirty-ness( so not a word) or the wretched stentch of B.O in my 42 second elevator ride.  I was sure I would contract west nile or MERS  or even possible catch another case of cancer!! Germ-a-phobs need not enter… your silly hand sanitizer is useless against the bacteria that looms here ( insert evil cackle here!)IMG_1348

SHWEDAGON PAGODA!!

SHWEDAGON PAGODA!!

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no metal scafolding needed we have bamboo and string??

no metal scafolding needed we have bamboo and string??

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I am a friday born person.so my animal is a guinea pig/hamster

I am a friday born person.so my animal is a guinea pig/hamster

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Myanmar Adventure

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April 30,2014 Wednesday

Day one of Global Health Fellowship Assignment. I have been in the air for just close to 22 hours and have covered at this moment around nine thousand and some odd miles clipping along at 478mph hovering at an altitude of 34000 feet or 10363m. As I type this KoreaAir flight 47 has just passed over Hanoi and only 600 miles to my new temporary home! I have passed the international date line , so now it’s May1,2014 . The first ieg of the trip we are headed out from Atlanta straight north , giving a wink and a wave during my fly over of the Windy City, Soaring across our Canadian neighbors , then West over the pacific only to arrive on the Asian continent and touch down in Seoul Korea. Which by all accounts is the “Far East ” for most of us. Seems contradictory heading west to arrive in SE Asia.

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Observations of travels thus far:
Korean Air, like most international carriers I have flown has been great. I know this will not surprise you and for your future reference as you make plans to fly Korean Air to Myanmar . I humbly did not spend the extra 6 thousand to upgrade to business class . Yes that is correct an extra $6k on top of the fare that Pfizer has so generously already covered. That being said I have found no issue slumming it here in “economy class”. Economy class internationally in my experience has never been bad… Consider if you will..

what economy domestic airline do you know that gives you:
Thick pashmina life ( emphasis on “like””) extra large blankets
Individual packaged headsets
Slippers
Warm towels for you hands and face before the continuous barage of meals, snacks,treats and free adult libations
“Real ” silverware no plastic here. Oh and no plastic cups so much classier to be drinking my nameless white wine from a glass and not a paper cup. So classy!!
Toothbrushes, toothpaste, mouthwash

All the latest movies you can handle so far I have watched The Ride Along, the secret life of Walter Mitty, saving Mr. Banks, That akward moment, HER, the book thief , catching fire and a handful of TED talks I downloaded prior to leaving

Where the pristinely dressed flight attendants in their aqua silk blouses with large French cuffs, creamy off white pencil skirt all toped with a dollop of the cutest and most ridiculously starched neck scarf I have ever seen, take care of all your inflight needs with a smile!! One side note there are only female flight attendants ( the only fellas on this crew are flying this metal tube). My inner feminist longs to protest but I completely understand the cultural differences. Sorry as I digressed ! Attention to detail must be this corporate motto because I am awe struck as the attendants bring your drinks on a tray, along with treats and snacks in baskets and in my Quiet observation no soft drinks. I mean there were cans of Korean CocaCola but I don’t believe I noticed anyone drinking soda on the plane. Hmm us Americans!

Now the cuisine was a bit questionable… Most likely only to me as I felt like I was one of 10 Americans on this flight? First my meal came with a gaggle of condiments, most of which I had no idea what to do with however I committed to trying everything even if it was called a beef Bibimbap.There was a small language barrier but I’m pretty sure that’s what she called this complexity of a steamed rice packet, bowl of sprouts, ground beef , w 3 types of mushrooms and spinach .A tube of red pepper paste, which I bravely taste tested ( holy smokes…. It was super spicy, definately not for the faint of heart , sesame oil, peppered pickles? I did not know whether to mix everything up in the large bowl, add all the secret sauces and enjoy or to try everything individually. I scoped around to cheat off of my neighbors for assembly instructions and they had all mixed it together… But I couldn’t fully commit so I did a little of both. I tried each portion separately, each we’re interesting individually and quite honestly except for my longtime aversion to what I refer to as shrooms but lets get real people we all know its fungus. I pushed past it took a bite…. Nope still have a fungus aversion! The Korean Bibimbap sp?? Was decent and it could have been because I was ravenous. Either way, my first experience with Korea food, not bad! Ooooo! Except for the seaweed soup, now I appreciate a tastey warm broth of belly warming goodness but this was not that!!! It was more of a clear broth with a pungent fishy aroma and seaweed bits floating around limply. It was a bit too much! I kept hearing my father joke with me about eating fish head soup and Only hours into my adventure he was right! Although holding true to my word, I peeled back the bowl submerged my metal spoon and yup it was fishy salty broth and that’s all I have to say about that!

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Thank you sweet Baby Jesus !!! Landed in Yangon 11:50 pmWait what day is it? Only a few minutes short of Friday May 2nd and let me first digress just to say a thing or 2 about plane etiquette … I thought the Everyman for himself … Boarding zones .. Yeah right… sheer malay that ensued while preparing to board another international flight Bound for the US in Abu Dhabi was sheer insanity however I stand correct. the pushing, shoving and cutting -in line ( yes I have revered to my 3rd grade dialect,) to board and deplane I experienced on these flights is no joke. Grab your goods, shoulder up and gird your loins… Because that’s the only way to survive and not be lost in the wave of south East Asian stampede… Am I giving of my land of the free home of the brave American pheromones again! It like they can smell the overly courteseous American platitudes and whoosh they pounce! Chicagoans and New Yorkers got nothing on these characters. Americans are seemingly gentle and soft mannered compared to the 70 year old tiny Asian spitfire of a grandmother who body checked me to get her luggage down first or the not so sweet middle aged man who clearly noticed me waiting for the bathroom on the plane and breeze passed me only looking over his shoulder smirking ever so slightly as he entered the lavoratory. Please God or Buddha hit us with a large jolt of turbulence right now so he pees all over himself. Or my favorite young Korean mom and baby whom just waltz right in front of me as I was next in line to hand my ticket to the agent for boarding board… excuse me lady the line starts back there … Oh suddenly you no speak English!! Right lady!!!( of course that dialogue was all in my head, pause while I channel my inner Ralph Kramden with a my pretend fist in the air and a “why I Ought to”)

Safely on the ground in Yangon to be welcome with stifling blast of humid dense air. Wait no air conditioning in the airport? Even at at midnight the heat was sweltering, it hung in the air like a damp rag and as I walked I could feel the little beads of sweat racing down my back, with each step I tried to remove unnecessary clothing. Suddenly a hoody, a tank top and a tshirt all seemed like excessive clothing. My scarf while useful on the plane felt like it was strangling me I couldn’t break free from its octopus like strong hold quick enough. Amblimg down the long terminal corridor to the non functioning escalator arriving at immigration which took just under 40 minutes to clear.

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The airport is quiet and there are more workers than travelers, a kind of eerie apocalypse desolation. All that keeps racing through my mind is , ” Please let there be an angel holding a PSI sign when I get out of here” please GOD Please … Hallelujah! there she is, in her printed longy( I will explain later) and bright lime green PSI polo holding a sign with my 3 favorite words… PSI Kimberly Cotto! Let’s be real it could have said “yo homie -over here” and I would have been no less thrilled. My worst fear was American girl abduction in Yangon … I can just see Anderson Cooper on CNN, reporting my abduction in his severely concerned and dramatic fashion describing the intimate details of my life and what took me to Yangon…. Again, I digress, must be ” the lagg” lol!!! How fantastic not to have to use my ” Pfizer how to survive a kidnaping tutorial ” on the first day oversees, I much prefer to wait and use those skills if need be when I am not bleary eyed, starving and delirious with jet lagged. Kidnapping averted onward to my new home away from home here in Yangon on Friday May 2, 2014!!!