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A DAY IN A XISHUANGBANNA HOSPITAL
Dai people.Xishuangbanna.
Dai ladies fishing in a
river.
Just before our morning teaching round, one of the students broke out with chills and rigors. His temperature was 39 degrees Celsius and he said that he had been having these febrile attacks twice or thrice a week for the past month. Instead of going with the ward round, I invited two students to take a history and do a physical examination. After a while, Ai Jian, an herbal doctor from the same district as febrile student, said that the spleen was enlarged and that he would treat for malaria.
“I have taken two courses of chloroquine and it didn’t help at all.”
Yang, who comes from the north of the Mekong River, suggested a course of intravenous Qinghausu.
“Too expensive!” The students from Ai Jian’s district said in unison. Ai Jian looked at me and said, “We live on Bulang Shan (Bulang Mountain). We do not have as much padi fields and flat farms land as them. Intravenous Qinghausu is much too expensive. In fact, even the oral form is expensive for us.”
A course of oral Qinghausu costs about S$2, the intravenous equivalent costs about ten times more.
“Many of the new medicines are too expensive for us to use,” Ai Jian continued. “For example, we do not use Zentel to de-worm our children. In my village, we still give the children a mixture of crushed pumpkinseeds. It works most of the time. You can see the worms the next time the kid goes to the bathroom!”
Many families in the remote districts of Xishuangbanna use the anti-helmithic concoction of crushed pumpkinseeds and with good results too. Ai Jian’s remarks caused me to ask the class, “Qianghausu plants grow almost everywhere in Xishuangbanna. It is such a common plant in and around your villages. Can’t you make use of that? It will be cheaper right?”
Silence for a few moments.
Ai Jian lowered his head and said softly, “We do not know how to use the plant to treat malaria.”
I asked if anyone in the class knew about herbal cures of malaria. In each village doctor- training course, there are usually 5 to 10 students who have been practising herbal medicine in their villages. They were selected by the Xishuangbanna Health Department to attend the 10-week doctor-training course as they were already the primary healthcare- providers in the villages. One of them said that he had used fresh Qinghausu leaves to treat malaria. He cupped his hands together and said, “Take this much Qinghausu leaves with … (and he rattled off the names of 3 other herbs) and double boil for one hour. Let the patient drink one bowl a day for seven days.”
“How sure was he about this cure?” Some students asked. “Sure! My grandfather taught me,” he said with such conviction. I had no other references to fall back on and it seemed that the class was convinced too. Nevertheless, I took some time to go through the other medications that they could use for malaria, and pointing out the danger signs, which would warrant a transfer to the district hospital. Chloroquine-resistant malaria is still not rampant in this area and therefore many still use this cheaper medicine.
We could hear the townclock striking 12 noon. Lunch Time. One of the ladies reminded the other female students to have their height taken and to make a note of how high 1.45 m is in relation to their own anatomy. Lady village doctors often provide primary antenatal care. One of the tricks of the trade (to cut down the number of things they have to buy or carry around) is to let them stand beside the pregnant women, check the height and refer anyone less than 1.45 m to the district hospital. They therefore have to know their own height, and also where 1.45 m is in relation to their eyes, mouth, shoulders etc.
Compared to Singapore, life goes on at a very relaxed pace here in Xishuangbanna (we have a 2-hour lunch break). The roads are lined with coconut trees and luxuriant oil-palms. Dai women in colourful sarong-kebaya outfits congregate at street corners selling fruits, BBQ meat (much like our satay sticks but spicier) and a local delicacy: deep fried buffalo skin (subcutaneous fat excluded). Like the mouth-watering smells outside an old-fashioned bakery, the smells of the BBQ meat entice many a hungry customer. Xishuangbanna is a place where several ethic groups live together. The Dai people (closely related to Thais) form the main ethic group. The others are the Ahka, Lahu, Bulang, Yao and the Han Chinese. The diversity is richly expressed in the different costumes, food, festivals and languages.
I pushed my bicycle out of the hospital compound and joined the many cyclists on the route home for lunch. The village doctors had just completed the training module on preventive medicine and were now moving smoothly into learning how to treat common diseases such as typhoid, malaria, dysentery, chest infections and other respiratory tract problems. Thankful that most work-related tasks are dealt with appropriately, my mind shifted to my next immediate problem: What to do with the 2 small chickens that one of the students brought last night? Let my daughter keep them as pets? Slaughter them or pass them on to the other doctors in the hospital who are surgically inclined?
Dr Tan Lai Yong
(Dr Tan has participated in the Village Doctor Training Program in Xishuangbanna
The Xishuangbanna Dai Autonomous Prefecture is about 25,000 km2 and lies at the southern tip of Yunna, bodering Laos and Myanmar.)