The population of this village is 4,159 and currently stable with no major changes in the intervening year. It is a primary education center for the Karen; and has one primary and two advanced schools. Godot, a prized student from previous year, ran out ahead of the others to greet us first. A woman named Koso put out her hand with the customary alternate hand under the right elbow. She was gently holding a baby and another woman was at her side with a similar aged baby. Each smiled broadly revealing the betel quid (the fruit of the Areca catechu palm tree) in their cheek along with the lime, leaf, and unrolled cigarette tobacco accompanying discolored and decayed teeth.

We spent the first evening visiting the clinic and reviewing a handful of patients with the assistance of Godot. It seems one of them had cold flashes and was possibly menopausal, but could alternatively have been malaria as their other problems were treated normally with multiple antibiotics. One child had bloody stool possibly caused by shigellosis, an acute bacterial infection of the lining of the intestines, and warranted antibiotic treatment as well as IV fluids. Another child had pneumonia. So with our first three patients we diagnosed three of the top 10 causes of death on our planet earth.

Zach, Doc G, and Jason review a patient file.

Same, same but different.

We went up to our dormitory-type accommodations and broke open the mosquito netting on top of a split bamboo platform. This was as comfortable as we needed to fall asleep after our fried‐egg topped noodle dinner; which for our team had been prepared with excess quantities of Tabasco and Choro sauces to give a variety to the “Same -­‐ Same But Different” menus we will experience over the coming weeks.

The next morning we were up at 4am in anticipation of another move further up the river to a more remote refugee camp that would be the setting for 4 days of training. As we departed, a team of volunteer porters grabbed most of our bags. Each wore flip‐flops and seemed to leap up the hill packing 50+ lbs; a stark contrast to our Goretex boots and awkward missteps. We climbed the steep muddy sides of the protruding ridge that separates the hidden village from the Salween River. We waited for 20 minutes until distant echoes of the V8-powered long boat became almost deafening.

Our short river ride ended at a little flooded cove where we disembarked. Now a new hazard was added to the rocking small boat. Our vision was obscured by the morning light and our hoods flopped down over our eyes so that we had to be lead off the boat onto the slippery mud bank by hand like handicapped elders. We walked along an idyllic little stream; hop-scotching over the rocks in a rivulet that would shortly become a raging torrent once the afternoon tropical downpour struck in the middle of our afternoon sessions.

We hit the ground running and put in a full day first with student introductions then straight into our first lesson.

Jason instructing with students with a little help from our macbook and a lot of help from our translator Echo-Two

Jason acted as point for most of the lectures. His background fit perfectly with the curriculum since he has spent many months abroad teaching US and foreign military students in field medicine. With the help of PowerPoint presentations and our translator, Echo Tu, Jason got in-depth with subjects including: Airway; Mortality; Circulation; Prolonged Field Care; Head Injury; and Massive Bleeding. The hands-on tourniquet class allowed the students to work with a variety of systems (from primitive to modern) and practice on one another.

On the right is a Free Burma Ranger member and a victim of the ever-present landmines. He was also one of our top students.

Doc G focused on patient care principles and reviewed hand signals with surgical tools. There’s a universal language to passing instruments, a firm place in the hand for scissors and delicate reverse hand‐off of the scalpel. A good surgical assistant will anticipate their surgeon’s next tool selection and should be able to perform in complete silence; avoiding a possible translation barrier.

Each day around 2:00pm the rains would commence and the creek would swell into a torrent; diverting our trek back to the sleeping quarters. We found that our breakfast, lunch, and dinner menu remained a constant mix of rice/noodles/egg in various combinations. Our water supply remained a freshly boiled warm and smoky blend of creek water. Life moved slowly as we got to know and bond with our Karen friends. Some of our students had traveled from great distances to join us. One in particular hiked through the dense jungle on footpaths risking mine injury for a solid 5 days in order to participate in our program. He will take his new knowledge back to his home village and continue to train his trainees. A powerful force multiplier in effect. Though bashful at first, many of the students began to initiate conversations in English with us during dinners. The iPad was a unique medium to break down conversation barriers. Many were quickly enthralled with the Eyewitness App that showcases current event imagery from around the world.

Tablu engaging the iPad, studying and inquiring about each photo. An amazing sociology engagement.

For three days we worked with the students. Andrew has spent most of his life in Alaska and is currently working as the state planner for critical infrastructure for the Alaska Division of Homeland Security and Emergency Management. Having the ever-present threat of monsoons, flash floods, and typhoons, he took the students through proper building construction methods and reviewed disaster preparedness.

On day 4 we began surgical training, allowing the students to practice their newly-learned skill set in a much more realistic model. Under the guidance of Jason and Zach, each student completed a tourniquet application and simulated packing wounds. Exercising personal caution while analyzing the severity of the condition was stressed. The students’ patients often have gunshot wounds and land mine injuries from being caught in the mist of a conflict zone. They were taught how to assess the situation and quickly prevent rapid blood loss. This swift implementation will aid each one of the students in saving lives when time becomes the difference between life and death.

Jason leading the surgical training.

The students were attentive and eager, each taking their turn patiently then supporting their fellow classmates. Doc G led a suture lab allowing each to practice the previous day’s lesson. It was a fun to see all of these people lined up and wordlessly using the hand signals taught to conduct a soundless series of operations.

After the long day of training, our village leader Tablu guided us on a trek up-river to see a little more of the region. The dense jungle doesn’t allow for vast scenic views. Just a 15 feet periphery is usually visible with intermittent sun rays poking through the overhanging canopy.

When we returned to the village, the students had already begun the preparation of a pig for our celebratory dinner. As is commonplace in most of the world, the Karen people utilize every component of an animal, leaving nothing to waste.

Tablu's sense of humor transcended the language barrier.

Roasting dinner.

 

 

After breakfast everyone convened in the bamboo longhouse for the commencement ceremony. This was a particularly important highlight of our mission. These students were being recognized and acknowledged not simply as practitioners, but also as instructors who will in turn spread the principles and practices they have learned with us over the past two years to others. By promoting this form of indigenous medicine, we are decreasing reliance on outside support; a key strategy of strengthening their medical program.

2011 Karen Medic Graduates

There was a definite sense of pride from each individual as we brought them up in front of the class, shook their hand, and presented them with a signed Certificate of Achievement and a customized tourniquet. Some amazing things happened here this week. Knowing that the education we provided will carry foward and assist in teaching new students is very satisfying. But this is only half of our journey. We are to depart tomorrow and move north to the Shan State where we will be working with an entirely new group of students under the guidance of the Free Burma Rangers.