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Dear Friends of the Thomas Durant Fellowship in Refugee Medicine,
It's been a busy first six weeks!
Dr. Durant, in his Forward to the book, Humanitarian Crises, had emphasized the need for those with experience to teach those coming after. Despite the chaos of refugee situations, he felt patterns had emerged and, in learning from these, perhaps the repetition of past mistakes could be minimized. In keeping with this aim, I'm presently completing the Diploma at the London School of Hygiene and Tropical Medicine. In the Spring of 2001, Dr. Durant had recommended that I take this course and I believe it is meeting his expectations.
My instructors, and the physicians I'm studying with, have practiced medicine in virtually every corner of the globe. It's a great exchange (and has notably generated a lot of interest about the novel "Durant Fellowship"). In a typical week, I will round one day in the Hospital for Tropical Diseases seeing patients from the tropics with a range of illnesses. I also spend a day in lab learning how to diagnose diseases prevalent in impoverished populations. We even spent a day learning how to set up and maintain a basic lab "in the bush". (How accustomed I'd become to the luxury of an excellent, reliable diagnostic laboratory at the Massachusetts General Hospital!) The rest of my time is spent learning about issues or diseases affecting impoverished or displaced persons. Today, for example, we discussed how to assess and address a lethal epidemic in refugee camps located near a conflicted international border.
I'm also eagerly anticipating my move "into the field". In April, I'll move to the Thai-Burmese border to work with American Refugee Committee (ARC) and the Karen Refugees displaced by the Burmese Military Government. ARC's Director in Southeast Asia anticipates that I'll travel to other camps along the border for approximately one week per month as well, though this may be dependent on roads in the rainy season.
I'll trust this letter finds you all well and will continue to update you along the way.
Sincerely,
Kristian R. Olson
3 June 2003
Hello! It's difficult to know where to start. Let's just say that this is one of the most incredible clinical (and general) experiences I could imagine.
In a stroke of luck (for me), ARC International found themselves without a clinical coordinator for their southern-most refugee camp on the Thai-Burmese border when I arrived. As it turned out, the timing was perfect for me to fill this position during May and June.
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The camp, named Ban Don Yang, is comprised of 3800 Karen Refugees from Burma located 1 km from the Burma border in Kanchanaburi Province not far from the Thai town of Sangklaburi and the famous "Three Pagodas Pass" . Officially, there are about 110,000 refugees from Burma living just within Thailand's western border- in a conflict, arguably a genocide, that is completely underpublisized. Now that the rains have started, the Ban Don Yang camp is a 1 1/2 hour drive each way from Sangklaburi- where I stay. ( For security reasons, |
The camp "hospital" is a little easier to navigate than the MGH. It's on stilts, constructed of woven reeds and has 16 inpatient beds, a busy outpatient department, a basic lab and a maternity "suite". I'm the only camp doctor but my newfound heroes are nine refugees trained as medics who speak English fairly well- and treat patients very well. They're humbling in their
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them "everything from Boston" . I've been working on Thai but
none of the refugees speak it.
The cases - more so the people - are amazing! I expected Malaria, Leptospirosis, Diarrhea, Dengue and URI's. However, it's the other stuff I didn't see coming. One woman delivered and proceeded to repetitively seizure within an hour of my arrival. I find myself neck deep in an Obstetrics text frequently since. I've diagnosed some unfortunate cases such as fulminant liver cancer. There is a nasty brand |
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frequent in the Tropics. Not a day goes by without something new. We refer a few patients to a local mission hospital but one must weigh the downside of bouncing the patients about in the back of the truck on the trip. Those who are in the country illegally are reluctant to make the trip. There's a mini-dragon in a territorial battle for control of my bathroom - laying a line of dog sized droppings in front of the door nightly. The insects are deafeningly relentless. I swallowed more termites than beer during a recent evening hatching. And overall, there's no place I'd rather be. |
I'm incredibly grateful to the Durant Fellowship for this experience.
ARC International has been more than professional, helpful, and accommodating as well. After the arrival of a new full-time physician for Ban Don Yang Camp, I'll be moving northward to Umphang in late June to work in two larger camps near there.
I look forward to hearing from you.
Sincerely,
Kris
1 August 2003
Dear Dr. Ronan,
I hope this finds you well and enjoying a Boston summer. The "Bangkok Post" takes a couple of days to make it up this way but I did hear news about the switching hitting pair of Red Sox grand slams.
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Things continue to go well. I finished up almost two months of working in the southern camp of Ban Don Yang at the end of June. In a touching send off, I somehow managed to break a couple of ribs on my last day there in a soccer game against the Camp leaders on World Refugee Day. I've since moved further north and settled in a town called Umphang in Tak Province. It's a village about a five hour ride in the back of a truck from the nearest town (as defined by having at least one place serving any semblance of pizza). Things continue to go well. I finished up almost two months of working in the |
I've since moved further north and settled in a town called Umphang in Tak Province. It's a village about a five hour ride in the back of a truck from the nearest town (as defined by having at least one place serving any semblance of pizza). I now split time between two larger refugee camps of 12,000 and 17,000 people. The UNHCR and Thai Ministry of Interior has a policy of preventing ex-pats from staying in the camps- which results in a three hour round trip commute to each camp.
It's been interesting. The arrest of Aung San Suu Kyi and other NLD members in May continues to be a source of tension. With universities closed in Burma in the aftermath, there was an influx of students in one of the camps.
A thriving premy in Umpiem Mai Refugee Camp. |
Days in camps are spent on seeing patients and going on house visits to examine newborns with the midwives. The rains have brought more malaria and a barrage of scrub typhus and leptospirosis. And there's a host of unexpected things. A couple of weeks ago, I found myself diagnosing leukemia on a 10 year old's malaria smear- and aplastic anemia on another. We've had a few premature babies as well. They seem to be thriving- with the help of bubble wrap and incubators of wicker baskets with hot water bottles to keep them warm. |
In addition, I've been asked to help with a number of other projects in the camps. There's currently no individual HIV testing or care- it officially doesn't exist in camp. However, we see it clinically, and pick up some on anonymous screens of donated blood- so we're setting out to work on a control program. We'll also do some pediatric and neonatal resuscitation workshops over the next couple of months.
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The ribs have since healed up well. In fact I was out working in a rice field for a few hours today without any pain- or that in my back made it unnoticeable. With that I'll wrap up. I'm being deafened by the rain hitting the tin roof, in case it wasn't apparent that the monsoons are in full swing. Please pass along my regards to the friends of the Thomas Durant Fellowship. I"m continually grateful.
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15 October 2003
Dear Dr. Ronan,
It's amazing how fast time has passed. I've had a period where there just haven't been enough hours in the day. With a mix of clinical medicine, prevention, and the political, I've found there's more and more to do as I have less and less time left. Since I last wrote, I've continued to work in Tak Province in the refugee camps of Umpiem Mai and NuPo. Each is about six miles from the Thai-Burmese border.
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The clinical experience has been incredible, and I've been seeing patients in field hospitals of both camps. It's been a mix there as well, young and old, with anything from exotic tropical infections to strokes from unrecognized hypertension. Undoubtedly, this is the part I like best. In terms of prevention, it's even clearer with such limited resources that these efforts give the highest health yields. I mentioned in my last letter that HIV was long denied in many of the camps by different leaders of the refugee community. There are a number of reasons for this, and some of them good. Still, |
we know it's there, and, as you know, so much easier to prevent than treat. After a series of sleepless nights finishing an HIV assessment and recommendation report for the camps, I was in Bangkok presenting it this last week in hopes that a control program will soon be started.
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As for the political aspects, it would take too long to give my impressions and even then it'd be only my biased view. Leave it to say, there seems to be so many toes to stand on that there is hardly room to place your feet. It's unavoidable to step on a few toes from time to time. Mike Barnacle asked me a question last Fall that I think I only now have a part answer for. He wisely asked whether it would be frustrating feeling like "only one person" helping in the face of such overwhelming need. Sometimes it does feel like that. It's as if it's only you, your training, a few |
Presenting at the Burma Medical Association (in exhile)
HIV Seminar. |
medicines, and this other person who has suffered too much already, hoping you know what to do. In fact, that is self-indulgent and it's not that way at all. Coming into such a situation, you're far from alone. There are a host of organizations, ARC one of them, and people, such as Tom Durant, that have continually contributed over the years. It's into this legacy that one comes to help. Even more importantly are the people of the refugee communities themselves. They are the most important resource and have a humbling will for self-help. There are refugee medics who I have told I'd have as my own doctor in Boston- and I meant it. If we can offer
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something, it's building capacity within these communities any way we can. And before efforts are misdirected, asking the refugees themselves is useful for identifying need. If I've helped at all this year, I'm certain it's me that has gained the most from the exchange. It's an important principal to stay politically neutral as a humanitarian worker, and it's equally impossible as a human. The Karen people are infectious, and admirably still hanging on in the face of a military dictatorship in Burma that annulled democratic elections. |
It's not long before I'll be traveling back to the US. I'm already trying to figure out how I can keep a foot in each place. I think Tom Durant foresaw this when, on a cell phone call from Bosnia, he told me, "Asia will bite you in the ass and never let you go." Still, I'm really looking forward to coming back, and have been telling myself that it's time to go. Maybe you've spent too long in a place when you've moved from gulping down caterpillar larvae while trying to avoid offending
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someone to seeking it out- even knowing "good" from "bad" larvae. It was definitely time when I said, "Please pass the MSG" without a hint of irony. It's wouldn't be easy to plan, and less so, to control an experience in "Refugee Medicine". I've been incredibly fortunate with an excellent breadth of experiences this year. I'm very grateful to The Thomas S Durant Fellowship in Refugee Medicine, the MGH, and ARC International for making it happen. |
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If there are a couple of Team Durant marathon numbers unspoken for, please set two aside- for Erica and I. Our "heartbreak hill" training runs have been along rice paddies and a banana plantation but perhaps we could adjust to the one in Boston.
See you Stateside.
Sincerely, Kris
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Site design by yellowcat and Tyler Johnston. |
Kris- enjoying the mud and newly cracked rib during
the Refugee Day Soccer Match in Ban Don Yang (Kris Olson)
Kris performing paracentesis on a patient with liver
cancer
Nine Medics and Kris in front of the ARC Ban Don
Yang Hospital 