We arrived at the Hopone clinic on a very hot sunny day. The roads leading to the clinic were narrow and at a three point cross road where the driver had to park quite far from the entrance to the clinic. From far away, could see hundreds of villagers lining up near the entrance. There were a big group of women wearing their traditional outfits lining up to greet us. We have been so well received everywhere we went to in Myanmar . They are, as I told one of the physicians, the most appreciative and the sweetest patients I have met. "They are!" She replied happily"they are very simple people". Being simple people? There is nothing wrong with that; as it would be a compliment to me if someone considers me simple, as Dr. Robert Smith, a former headmaster at my son's Quaker school quoted:

"Without simplicity of spirit we are not prepared to receive the truth."

As in the first two days, I saw quite a few cases that truly "shook " me up, with one making me run to the pharmacy section to take a death breath, wipe my eyes and be composed. It's never a good sign for a physician to breakdown in front of her patients. Empathy has its limit! She was a 15 year old strikingly lovely girl , tall and too thin for her height. Her BMI probably was less than 17! Her age made me think immediately of my son, a 16 year old living the life of privileges!

She complained of not feeling well, as her menstrual cycle came only once in awhile . Her neck looked and felt as if there was a mass on the right side below the chin. I immediately listened to her heart and checked her pulse, which was in the upper 120s. Her eyes were wide opened and I thought they looked a bit exophthalmos . I asked her to follow me to the triage area where Dr. Dominique Legault was and asked him to take a look at her neck. Dominique reassured me that there was no mass; she was so skinny everything became more prominent. He agreed she needed a thyroid evaluation for her tachycardia and the look of her eyes. However , TSH is not a test available there and this patient will need to go to a lab more than hour away to have it done. Dominique and I wondered about anemia which could have causing her anemia, so I decided to give her some vitamins and urged the translator to find the doctor of the clinic to make arrangement for her to have her lab done, a blood count and thyroid stimulating test.

Towards the end of the clinic, Doanh ,the infectious disease specialist of the team, and I had to work at a team, seeing two patients at the same time. She would interview one while I examined the other. The patients didn't mind at all. They giggled at each other . There was no privacy , but at least they got to see the doctors before the clinic closed. All was well except for a woman in her forties with a 4cm abdominal mass and a palpable 3-4cm right pelvic soft mass. We advised her to have a sonogram to evaluate these masses, since neither Doanh nor I believed the abdominal mass was a lipoma, a benign tumor . It was a deeper and more solid mass. The clinic was closed and I couldn't send her to our GI specialist Dr. Frank.

I had a great day. The patients kept bowing and thanking me, not knowing how the privilege was actually on me. I walked away to our bus, thinking of all the patients I have met and hearing in my mind the Rolling Stones singing the famous lines:

"You can't always have what you want, but if you try, you have what you need."

Today, these patients haven't not all cured their illnesses but with our help, hopefully they will get the evaluations they need or be on their way to healing.

-Dr. Thu Tran, Obstetrician

On day two of the trip we visited the main hospital in Taunggyi. The day before we had set up a station where the local nurses and physicians would get vital signs and chief complaints as well as an area where we could do lab work, ECGs and basic treatments. By the second day at Taunggyi, the setup was refined to facilitate the rapid movement of patients throughout the system. There were many, many patients all of whom were kind and grateful, but above all, gracious. Their appreciation and sweetness was truly humbling. This caused me to consider the reasons we travel to do medical mission work. Personally, I hope that our presence here will provide real relief -- relief of pain and suffering, and by way of a warm smile and a soft touch, comfort in knowing that other people care. But the benefit goes both ways. I take with me a renewed perspective on the human experience which itself cannot be put into words. The people of Myanmar therefore help me, and indirectly my patients, more than they will ever know.

-Eliud Rosales, RN

The team promptly went to work deploying our pharmacy and laboratory sections. It was true collaboration and team work with the hospital staff as we all working side by side with our counter parts, to include hospital administrators, pharmacists, nurses, and physicians utilizing both hospital and our resources to take care patients. Having accessed to the hospital X-ray, lab, and sonogram departments had helped the team made difficult diagnoses and more advance treatment plans. The hospital, provincial government and MMCWA made a concerted efforts to provide limited resources so these patients could be seen and treated by our team.

Another part of my work day was made even more pleasant was because of the wonderful hospital staff who couldn't stop smiling. They took care of me on top of taking care of the patients. At the end of the day we received an appreciation gift from the provincial local MMCWA chapter.

As cardiology section go, there were no shortage of severe valvular disease, arrhythmia, ischemic heart disease , cardiomyopathy. and cardio pulmonary disease due to a wide variety of etiologies. As a matter of fact, the number of cases came, at time, like a torrential rain.

-Dr. Thien Do, Cardiologist

DAY 2

DAY 4