Minal Ahson (DAWN)
November 15, 2017
I have visited many poverty-stricken, under-served areas
of the world on medical missions. However, my most recent trip to the Rohingya
refugee camp in Ukhiya, Cox’s Bazar in Bangladesh, marked the first time that I
have ever cried during fieldwork.
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| A mother holds her sick child at the clinic |
This time, however, things were different and the
emotional toll my work at the Rohingya camp took on me was greater than ever
before.
I had come to Bangladesh as part of the MedGlobal
assessment team — a group of doctors, nurses and public health professionals
tasked by the NGO with the huge responsibility of determining the needs of the
population and initiating a primary health care clinic in the middle of the
camp.
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| Children play by the water pump at the base of the refugee camp |
One day in the camp, after listening to an elderly lady's
breathing to diagnose pneumonia, I went to find water so that she could take
her first dose of antibiotics. Upon my return, I found tears in the eyes of my
Bengali/Urdu-speaking male interpreter.
After many childhood summers in Karachi, I knew well
enough that for a man to show his vulnerability like this in a public place,
especially around relative strangers, is not typical in this part of the world.
So something must have been very disturbing.
When I asked him what happened, he just shook his head
and told me that our patient was describing how she and her frail husband had
witnessed their three adult sons being killed by the Myanmar army. They also
saw one of their young grandchildren being thrown into a fire.
Despite the unimaginable horrors they had experienced,
somehow, the couple managed to travel for days to reach Bangladesh with their
granddaughter. The young girl had accompanied her grandmother to the clinic and
could not have been older than eight or nine.
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| One of the pathways leading to the crowded tents of the camp. |
The child would get daily rations of food and water for
her elderly grandparents. Seeing how this little one was bravely shouldering
the responsibility for the care of her aging grandparents not only brought
tears to my eyes, but also made me worry about her future. What would happen to
her after they are gone?
Maybe she would become like the three children we met as
we explored the makeshift refugee camps in the Kutupalong and Balukhali areas
of Ukhiya. The site consisted of about 800,000 people and was comprised of
tents made from flimsy tarps and bamboo poles pitched on dirt ground, which
turned into slippery mud during the monsoon rains.
These children were brought across the border because
their parents were killed in Myanmar. They are being raised by distant
relatives.
Their story was told to us by a man who spoke both
Rohingya and Bengali. He was standing outside of his small tent, in which he
lived with his four children, wife and two other family members.
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| Refugees carrying bags of food and supplies in the monsoon floods. |
As he stood outside his makeshift home, he told us
another story of the lady in the neighbouring tent, who walked nine days over
mountains, at eight months pregnant, with her three other children, to reach
safety. Her husband was back in Myanmar, and she was unsure of his fate.
Editorial: Rape in Myanmar https://www.dawn.com/news/1370401/rape-in-myanmar
So many women had made this difficult journey by foot or
boat while pregnant. These women brought their tiny babies to the clinic to be
checked by a doctor; tiny likely due to premature births and lack of
hydration/nutrition of the mother, which leads to decreased breast milk
production.
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| MedGlobal Needs Assessment Team exploring the camp. |
One baby sticks out in my memory. She was extremely small
and had a sickly appearance. I took her temperature and found out she was flush
with fever.
Normally, a baby in her condition would be rushed to the
emergency room for blood work, a lumbar puncture, and IV antibiotics. As I
tried to keep calm and decide what to do, I asked the interpreter to ask the
mother how old the baby was. He replied, “Twenty something days.”
I asked again, saying that I needed a more precise
answer. The mother replied and again my interpreter shook his head in sadness:
“She says that the baby was born on her journey here, which she had made on
foot. She walked for so long that the days and nights blended together, so she
does not know how old the baby is.”
In the doctor’s room next door, my colleague was dealing
with a similar situation – a malnourished, tiny baby with a fever.
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| Children stand outside what is now their home. |
After writing our assessments and findings on a referral
form, we spoke to the local staff and arranged a tom tom (rickshaw) to take
both babies to the nearest hospital. We returned to the queues of patients
waiting for us, busy again with physical exams and dispersing medications.
A few hours later, I asked the clinic manager if the
babies reached the hospital safely. He stated, “One of them did. The other one
went home with the mother. She said she needed to ask her husband permission to
take the baby to the hospital.”
My heart stopped. Did the mother not realise how sick the
baby was? That the baby could die? Why did the staff let that happen?
I had a long discussion with the clinic manager about the
seriousness of the situation. I asked him to inform us the next time this
happens so that we can educate not only the mother, but also the father. This
particular scenario really opened my eyes to navigating cultural boundaries and
norms.
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| The campsite overlooking the roofs of the tents. |
Many of these patients had never seen a doctor before due
to their socioeconomic status in Myanmar. Most of them had acute complaints –
respiratory infections, gastroenteritis, dehydration.
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| These children just crossed the Naf River to Bangladesh a few hours prior to this picture being taken. Myanmar can be seen in the background. |
There were descriptions by many women of post-traumatic
stress disorder, with symptoms of insomnia due to anxiety and flashbacks. But
occasionally, I found a case that made me wonder if we were even equipped to
provide appropriate treatment in such a resource-limited setting:
The eight-year-old with huge lymph nodes sticking out of
his neck, pointing to systemic tuberculosis or cancer; the man with one-sided
weakness likely due to a stroke; or the child with a neuromuscular disorder who
stopped walking.
In a proper medical facility, these conditions would
easily be worked up with biopsies and MRIs. However due to our lack of
resources, all I could do was offer a smile, encouragement, and offer a prayer.
These are just a few of the many horrific stories I heard
during my time at the refugee camp. Each of the hundreds of thousands who have
fled Myanmar, now and over the years, have a tale equally heart-wrenching.
Since returning home, I have had multiple people tell me
that the first time they had heard of the conflict was through me. This has
reinforced my motivation to stand up and speak out for this neglected group of
people.
The writer is an American of Pakistani
descent who has made many medical mission trips around the world. She is an
Assistant Professor of Internal Medicine and Pediatrics at the University of
South Florida. She currently serves on MedGlobal’s Rohingya Committee. She can
be contacted at minal.ahson@gmail.com
