Congratulations on a job well done!
The same day he recorded an interview with WUSF-FM’s Carson Cooper on disaster preparedness for the upcoming hurricane season, Steve Morris, MD, received a phone call from a long-time friend who was planning to travel to Myanmar to provide medical assistance in the aftermath of the deadly cyclone and its storm surge. Dr. Morris, codirector of Bioterrorism and Disaster Training at USF College of Nursing, spent a month volunteering in southern Mississippi in the wake of Hurricane Katrina and has extensive experience working in a variety of disasters and disaster scenarios. After some initial reservations, he agreed to accompany his friend to Myanmar. He made the trip May 11-16. So that he would not call attention to himself and possibly put his Thai friends at risk, Dr. Morris left his camera behind. His only photo, the group shot above, was taken at an airfield in Thailand. The story of his Myanmar experience, in his own words, follows:
Fateful call from an old friend
“Call it fate; call it a coincidence; but I guess some things were meant to happen. Ironically during my interview with Carson Cooper, he asked my opinion about the situation in Myanmar. We reflected upon the devastation and the disappointment in the Myanmar government for not allowing disaster relief and assistance from the international community.
Later that day, a long-time friend of mine, Awing Saawat of Thailand, called me. Awing is a nurse midwife. She has provided services in the northern regions of Thailand for more than 25 years. She has a special interest in caring for the immigrant mothers who travel the sometimes dangerous routes from Myanmar (formerly called Burma) to cross the border illegally into Thailand. Most of these immigrants risk the travel to Thailand to find work and escape the desperate conditions in Myanmar.
Awing and I are friends from my time in the country in 2002 and 2003, when I volunteered with her non-profit organization. She often calls to say hello and to get an occasional internal medicine consultation on one of her many patients. This call was no different; she and I discussed a young refugee patient who had recently crossed the border. Unfortunately, according to Awning, this patient would be quickly returned back to Myanmar. Awing told me that she was planning a trip of her own to the impacted cyclone area of Myanmar in the next week. Since she had provided service to the area for many years, she had many well established contacts and had made the journey on multiple occasions.
I casually mentioned to Awing that I would love to share the experience, and surprisingly she responded, ‘Come on!’ My mom always said, be careful what you ask for.
I couldn’t believe it. I had heard on the news about the problems foreign aid workers were having getting into the region, so, of course, I started speaking of passports and visas, which I knew would take time. Awing informed me that there were ways to expedite the process. When I expressed safety concerns, she reassured me that her contacts were solid and that I would have no problems. Just keep your mouth shut, she told me — an inside joke we often shared when she was allowing me to observe the birthing process years ago with her. Like then, she would do all the talking. She again reassured me that I would be fine.
The long journey to Myanmar
With that, I packed my bags for what would turn out to be one of the most remarkable experiences of my professional career. The flight to Bangkok, Thailand, was 26 hours with stops in Detroit and Japan. I then traveled two hours by bus from Bangkok to Nakhon province, where I met up with Awing. The rain delayed our departure to northern Thailand for a day; but soon we were off on another bus ride to an area just south of the town of Chang Mai, Thailand. The next leg of our trip to Myanmar began early in the morning hours. Since there is literally a 12-hour time difference between Florida and Thailand, I was wide awake. Add the time difference to my anxiety, and I was literally on pins and needles.
Travel into Myanmar was quite unofficial. My U.S. passport was left in Thailand with Awing’s associate.
We departed from a small airfield in two light aircraft for a 500-plus mile flight from Thailand into Myanmar. We were accompanied by 10 other people. I did not know their names or what their roles on this trip would be, and following Awing’s lead, I did not ask.
One of the pilots was a relative of Awing’s. They had long conversation prior to our departure. Their cordial manner eased my mind and I was again reassured that I would have no problems.
Though the smell of insect replant permeated my clothing, Awing beared it and stayed close by my side the entire journey. It was important that I look somewhat disheveled as not to stand out. She added to my blending-in process by sharing a local skin powder/insect repellant to put on my face, arms and legs. My wrist watch was left behind and replaced with a simpler watch that I kept in my pocket. It had no wrist band and a scratched dirty face. Because I am African-American, we both felt, that as long as I did not open my mouth, few if any, would know my nationality. (Don’t misunderstand, I am a proud American, but in this instance, waving the U.S. flag was not an option.)
Our planes were old but appeared to be in good shape. They were designed to haul cargo, but other than us, a few personal items, drinking water and the meager provisions prepared by Awing there was no other cargo. Our diet for the next three days consisted of cooked pork and rice. The cargo area of the plane was stripped and had an intense moldy smell. There were no interior lights and no formal seats, just some tarp-like material that we fashioned into seats. I expected to see large quantities of supplies.
My memories of Hurricane Katrina led me to expect a tremendous outpouring of relief supplies. To my dismay, there were no medical supplies, no fresh water, no meals-ready-to-eat or food of any kind, no clothing …
absolutely nothing to indicate that we were on a relief mission.
Trying to bring in supplies was not an option according to Awing, whatever we would use would be provided to us by our host when we got there.
Greeted by armed guards
We landed after a little more than two hours on an even more remote airfield in the mid-south region of Myanmar. Nothing was there other than a small abandoned tin-covered structure. We sat at this location for another hour and a half, before I heard the sounds of vehicles approaching. Three large short-bed trucks (the kind you would typically see livestock in) pulled up. Two or three heavily armed men exited each truck. The pilots of our planes and the people in the trucks obviously knew each other. They greeted and talked for a period of time. There was an occasional look in my direction, but I never had any indications that caused me to worry. Awing was completely at ease, so I was able to remain calm.
When the time came, the men directed us to climb into the back of their trucks. Though our view was somewhat obscured by wooden boards lining the sides of the truck bed, we could easily see between them. As the early morning hours faded the heat of the day could be felt. The truck was not covered. The heat and the humidity reminded me of Florida. The terrain was extremely rough. I know I am spoiled by paved roads, but this was a difficult journey. I can see the need for the big trucks. Any organized relief mission into this area would be difficult by ground.
I suppose, I thought my relief work with Hurricane Katrina on the Mississippi Gulf Coast would have somewhat prepared me for what I about to witness in Myanmar, but I could not have imagined the incredible destruction I would see.
Through the side boards of our truck, I could see vast areas laid waste by the storm. What must have once been towns looked like garbage dumps. People appeared to be sifting through these heaps of debris. Many sat hopelessly by the roadside or under improvised structures made from the debris. I saw no begging, no outstretched arms; the people just simply looked beaten.
Many wore rags; some had no clothing at all. I saw all ages from the very young to the very old; however, there seemed to be many more children.
Most remarkable was the horrible smell. So foul, so pungent, that at times it would cause me to gag. I have experience with death in my profession; but death, hopelessness and despair at this magnitude was just unbelievable. The pictures on television and in the newspapers could not possibly capture this suffering.
Waiting patients, sparse supplies, long days
The truck ride was about 90 minutes from the air field. We arrived at a stone-and-wood structure that would be our home for the next 60-plus hours. This was a clinic. It had been built by a mission group many years ago, and withstood the test of time. Awing had worked from this location before. Surprisingly, there were a few medical supplies — a few old stethoscopes, antiseptic and basic bandages; but no medications. Awing told me that we would be receiving a few additional supplies later. There was a generator with fuel and a few working lights, but nothing on the scale of the Disaster Mobile Assistant Team that I had worked with in Katrina.
The patients were already waiting. Awing told me that our host had selected the people that we would see. How that process worked, I guess I will never really know. The people we cared for clearly had a relationship with the people who had arranged this trip. Going into the village to offer services clearly was not an option.
Many wore rags; some had no clothing at all. I saw all ages from the very young to the very old; however, there seemed to be many more children.
Most remarkable was the horrible smell. So foul, so pungent, that at times it would cause me to gag. I have experience with death in my profession; but death, hopelessness and despair at this magnitude was just unbelievable. The pictures on television and in the newspapers could not possibly capture this suffering.
Waiting patients, sparse supplies, long days
The truck ride was about 90 minutes from the air field. We arrived at a stone-and-wood structure that would be our home for the next 60-plus hours. This was a clinic. It had been built by a mission group many years ago, and withstood the test of time. Awing had worked from this location before. Surprisingly, there were a few medical supplies — a few old stethoscopes, antiseptic and basic bandages; but no medications. Awing told me that we would be receiving a few additional supplies later. There was a generator with fuel and a few working lights, but nothing on the scale of the Disaster Mobile Assistant Team that I had worked with in Katrina.
The patients were already waiting. Awing told me that our host had selected the people that we would see. How that process worked, I guess I will never really know. The people we cared for clearly had a relationship with the people who had arranged this trip. Going into the village to offer services clearly was not an option.
The complexities of the problems were many. Without any necessary equipment and supplies, the task was extremely difficult. Awing translated for me promptly along with doing a million other things. No one ever seemed to complain; there was no crowd; few people even spoke unless addressed by our guards or by us.
We worked continuously until the night. Awing and I took our first break after about six hours. Following her lead, I would pause for a break only when she did. We were with armed guards the entire time, though they seemed quite relaxed. There were several groups of people all around the clinic area, but we never had contact with them. I am still not sure if the guards were there to protect us or to keep us from exploring on our own, but I suppose, probably both. It’s not like exploring would have been an option for me anyway. I didn’t speak the language, I had no idea where I was, and I certainly did not want to get lost. We slept on the floor inside the clinic. Throughout the night, there was conversation and activity outside.
Three small boys
The next morning we awakened to see three small boys, probably ages- 8 to 10. They were asleep at the door of the clinic. Two sat up immediately when we opened the door. One child was lying on a piece of tin, which had been fashioned as a sled. I could surmise that the two other children had pulled him there on the sled.
I don’t know how far the children traveled, but I don’t think they would have been allowed at our clinic door if the guards had seen them. I am not even sure how they slipped past our guards. Awing began to talk with the boys as one of the guards approached to chase them away. I had already starting assessing the child on the sled. Awing argued with the guard for a bit. He backed away and left us to our work.
According to Awing, the child on the sled was injured during the storm. None of the three had known one another before the storm. Two boys met immediately after the storm, and they found the injured child a few days later in a field of debris. Since he was unable to walk, they made a sled from the piece of tin to pull him around. The three had been together for many days, but they were not sure how long. They could only assume that their families were dead. There was nothing left of the village where they stayed. They lived off scraps that they found or whatever they could get by begging.
The child on the sled appeared extremely ill and near death. It did not take an X-ray for me to determine that the injured boy had a compound fracture of his right tibia and fibula. Distal to the fracture his leg was cold and to a point of decay. His eyes were sunken, jaundiced and his body was wasted. He was dying from sepsis, dehydration and malnutrition. His fate had been written when the storm struck.
His needs were far beyond our capabilities and resources. Even with hospitalization, an amputation, massive doses of IV antibiotics, nutrition and hydration, I doubt he would have survived. It was simply too late; and we obviously had no way to provide any of those needed services.
A small degree of peace and overwhelming sadness
Awing and I could find only a small degree of peace in the fact that at least the young child was in no pain. He could not feel the injured leg. Awing fed the boys from our provisions. The injured boy was too weak to eat very much at all. Unfortunately, we had to move on to our already waiting patients, and we did not want to upset the guards anymore than they were already.
Awing reluctantly motioned for the guards and with that the boys were scurried off; pulling their injured friend behind them. We never saw them again.
The next day and a half brought more of the same. The sad and sometimes horrifying stories were endless.
I left feeling like a drop of water on a searing desert. Our promised supplies never came. I had to ask myself, did our little mission make a difference? I knew it would not be for me to judge.
Awing and I spoke few words on the truck and plane ride back to Thailand. I know we were tired and hungry, but I know she and I both felt depressed that we could not do or provide more. The Thai people refer to Myanmar as “paan má-noh” or “bad heart” — a term that certainly reflects a government that refused to allow aid to reach its people in dire need."
Since Dr. Morris returned from Myanmar, he has spoken several times to his friend Awing, who plans to return to on another humanitarian trip. The situation in Myanmar is still precarious, as the country’s military junta continues to refuse offers of outside support including the use of military helicopters to ferry aid to remote regions. Unfortunately, Dr. Morris says, many donated supplies never reach the people who need it – much of it taken by the military or black market agents who will sell it for a profit. With the monsoon season beginning, hundreds of thousands of cyclone survivors remain without shelter. “I had tremendous support from the College of Nursing and Dean Burns in supporting my decision to make this trip on short notice,” Dr. Morris says. “and I owe special thanks to my colleagues Sandra Cadena, PhD, RN, and Fred Slone, MD, who covered for me while I was away.”
- Story edited by Anne DeLotto Baier/USF Health Communications
