Marginalized Medicine: when you have to carry them out

Imagine carrying a struggling pregnant woman through the bowels of the jungle, pushing your body and straining your spirit just to get her somewhere where she might have a shot at surviving. This kind of thing happens every day.

The jungles of Burma (Myanmar) have suffered through a devastating civil war for over 70 years. While most pictures and media show you the most traumatic and gruesome aspects of fighting, there is a whole field that often gets overlooked.  Because of all these tensions and conflicts, it becomes incredibly difficult to build permanent, effective infrastructure.  That means little development on things like roads, public transportation, school, and healthcare.

Dr. Jack Chamberlain, one of the leading foreign doctors in the area, was an ER doctor in the United States, though he has rarely uses those skills now. Instead, he finds himself a sort of jack of all trades in the marginalized medicine realm.  It’s unlikely that he will treat a traumatic injury on the spot; it’s more likely that he will treat festering wounds, or things like diarrhea, malaria, or complications in birth. These problems are much more serious when you have no infrastructure to combat them.

The travel aspect of healthcare is something that is easily taken for granted in the United States. If you get sick or injured, you can find someone to drive you to the hospital, and you can even call ahead. If that’s not possible, we have ambulances on standby, ready to get you to professional care in no time.

In marginalized areas, this is not possible. When I was in Burma in 2015, we had to carry a woman hours through the jungle as she was having life-threatening complications in the early hours of the morning. There was simply no easy to way to get her to good care.

Dr. Chamberlain is not the only foreign medical professional that has dedicated their life to the healthcare of the Burmese people.  Midwife Maria Parks has spent years helping the Karen in the jungle–teaching and providing the best healthcare possible in a place with little to no resources. I worked with her briefly in Burma, and she was a constant source of experience and knowledge, for which the Karen have been incredibly grateful.

Recently she came across two cases of complications during birth, both including a retained placenta.  As the term indicates, this is where the placenta stays in the uterus after the baby has been born–it’s a life threatening problem if the placenta is retained longer than 30 minutes, as the risk of heavy bleeding drastically begins to increase.

Parks had woken up to hear that a patient of theirs was being carried by stretcher from a remote village to their clinic. She had delivered twins, and while the little girl was alive, her brother didn’t make it. They were also unable to deliver the placenta, and the mother was bleeding heavily. The clock was ticking.

They had two others meet them halfway on the road–by “road” I mean a footpath cutting through the middle of a vast jungle. They carried her to the nearest vehicle access, and started driving in a personally owned vehicle. They were only an hour away from professional care when she died.

“Another unnecessary death. Strong and brave men in the absence of transportation had carried her 12 hours in the hope of reaching medical care, only to lose her one hour shy of trained personnel and two hours shy of the clinic,” Parks said.

It was only weeks later that they would encounter the same problem.  At 4:30 a.m. she received a call from a clinic with slightly better access. After a successful birth, the mother’s placenta had failed to deliver. “Management was simple: a friend with a truck from a local Karen organisation was able to take our staff out to meet her, due to a bridge being down, the woman was transported to the bridge and over by motorbike and a rickety bamboo bridge.”

Let’s put aside the fact that Parks considers this simple. The mother was now on a road that was accessible by pickup truck. From there she was transported, and “four hours from the time we received the call, she had safely delivered her placenta and her blood loss was being managed adequately.”

She survived because of one thing: access.

As aid workers and local healthcare professionals continue to practice medicine in marginalized areas, Parks reminds us that, “transportation is an underrated factor in all of this.”

All images taken by the author.