Joko MacKenna

Trust your local doctors!

Believe me when I say that great medical staff can be found anywhere.

One of the most sublime forms of pleasure is the cessation of pain. I'm not talking about people who derive pleasure from pain itself. No, what I mean is the incredible feeling one gets when a chronic ongoing physical problem or annoyance subsides. For example, we've all felt that 'ahhh' feeling after taking a big and long-coming dump. Right now, I feel so good, and there's nothing fecal about it.

Terrible pain

For the last ten days or so, I've been in excrutiating pain, first from bursitis in my knee and later from a bulging disk in my back aggravated by the funny way I had to walk with a bum knee. Tonight, thanks to my local Southeast Asian health care professionals, my horrific debilitating anguish has been numbed to a dull ache. Feels damn good, and how I got this way is an edifying anecdote.

I live in Yangon, Myanmar. After a year in Thailand and then assessing the situation here, I was a bit skeptical about the quality of the health care I might receive when needed in the Golden Land. Mind you, I'm in the (cultural) capital. There are dozens of hospitals here of varying quality., I've got friends who work with aid organizations and their duties often take them into some of the more questionable medical institutions. The stories I've heard have sometimes made me cringe.

In many different ways, Yangon makes Bangkok look like Singapore. That said, there's still a significant educated class here, and whereas structurally, resource-wise and institutionally, Myanmar is challenged even within the spectrum of ASEAN nations, some of the people here are as good as it gets.

Anticipating the levels of care

Through my role as an English teacher, I've had the chance to teach several Burmese medical doctors, and I can't say I've taught anyone brighter or more sophisticated. In a nutshell, while I was trying to decide which clinic or hospital to visit for my recent orthopedic pain, I concluded that the level of care here in Yangon would be about the same as I might get in a mid-sized Thai city. A Roi Et, a Chaing Rai, a Nakhon.. Nakhon... a Nakhon Whatever.

Well, considering I get paid the medium bucks to teach here in this corner of Asia, I decided not to skimp on my health care needs. My knee hurt like the devil; the resources I was willing to commit to fixing it were commensurate. I took an eighth's of a month's pay up to the International SOS Clinic on the site of a posh, lakeside hotel in Yangon's fashionable north side. This is where the expats go to get the highest level of care. There, I was seen by a British doctor. He poked me and asked if it hurt. Sent me for an on-site X-ray. Given that I was in a lot of pain, it was at least comforting to express that to another native English speaker.

Doctor diagnosis

Ultimately, he diagnosed me with Patellafemoral Pain Syndrome (PPS; a really impressive name for bursitis). When I asked about the treatment, he said, gently (he was somewhat portly himself), that first and foremost, I needed to lose weight. Well, that's great, true and all that, but it didn't help me on that day. He also gave me the phone number of a local physical therapist (apparently, how I walk may have something to do with the condition's cause) whom they recommended and sent me off with a 3-day script for Tramadol and instructions to rest. Hmm... I wasn't sure that this was worth the $175 I then paid for this wisdom.

Two days later, I was hobbling home from the market (I still had to do my shopping), and something twisted funny due to my awkward gait. My back screamed in pain. I'd aggravated a bulging disk. Now, I had to endure really bad knee pain AND really bad back pain. One infuriated the other, and for the first time in 5 months teaching here, I had to call in sick to rest my body.

Three days later, not much improvement. My opiate Tramadol had run out and again I had to cancel a class. This morning, I woke up in so much pain, I couldn't walk. Had to use a chair like a walker to get to my bathroom. Gritting my teeth, I thought about going back to the International SOS Clinic, but in this instance with my back which eclipsed my knee pain by far, I already knew my diagnosis. I just needed treatment. Off to the local Burmese Hospital I went... errr... stumbled... shambled... what have you. I walked slowly down my gossip-strewn local street like an octogenerian.

Ten minutes after walking in the door (and apparently ahead of dozens of locals sitting in the waiting room), I was sitting in front of their orthopedic specialist. I explained the PPS and the bulging disk. His English was good (at least his medical English), but even the least fluent speaker wouldn't have been able to read how my description of the pain made my eyes tear up. I hurt! Pain is a universal language. Please, doctor, help me!

Doctor Aung Zin gave me a cortizon shot. He gave me a script for three different meds, plus 3 days more worth of cortizon shots (to be injected by neighborhood nurses that I'll find myself). He told me to rest my back by lying in bed as much as possible (writing this blog is kinda defying doctor's orders). I implied that I'd like a letter that would maximize my resting opportunities by excusing me from work, but as a testament to his ethics, he said no. He told me I could work. Teaching ain't like digging ditches. Work, then rest. You'll be fine, he told me.

Feeling human again!

He was right. After the treatment, I felt great! Going back to my point about pleasure caused by the cessation of pain, I taught class that night with a big smile on my face and a lot of energy. Between the Cortizon shot and whatever meds he gave me, they killed the pain, yet still left me coherent enough to deliver an awesome TEFL lesson. Damn it was good to be able to walk like a normal human being and not stumble along trying to minimize the horrible agony any movement caused.

Oh, and the cost of my treatment at the Burmese hospital? $5 for treatment. My meds cost me $3. There was a $30 foreigner surcharge, making my total cost $38. That's a long way from my medical insurance's $1500 deductible, but 1/4th the cost of the mediocre, going-through-the-motions care I got at the International SOS clinic.

So, even if you're in Yangon, or it's Thai mid-sized towns like Mae Sot, Ayutthaya or Rayong, my anecdote's point is trust your local healthcare providers. The marginal advantage one gets from paying premium dollars for premium healthcare isn't worth it here in Southeast Asia. The most important factor in quality healthcare is quality doctors. As Dr Aung taught me, a quality doctor can be found anywhere.

I've enjoyed my cessation of pain, that most subtle form of pleasure, and am off to relax and rest. What about you? My conclusions are based on a single anecdote. What value have you got, or not gotten, from paying extra for premium Western-standard healthcare?


Teaching here with universal health coverage which can include western and Chinese medicine and I use both including acupuncture and herbal medicine. Also got several teeth pulled from former gone bad root canals from USA. Nothing has cost more than about ten bucks US- visits and meds. Usually in the $3-$6 range. Premiums maybe $35 a month US. Great for chronic problems like sore back.

By dave hall, Taiwan (15th October 2014)

So glad you got some relief from your pain. I've seen my hubby in terrible back pain (he ended up having surgery a couple of years ago) and I know how he suffered. But his treatment cost a whole lot more than $38.

By Sandie, United States (18th August 2014)

Had similar experiences with local versus "premium foreign" doctors. I had a nasty flu in upcountry Thailand. Had an hour-long check-up in rudimentary English and hand-waving, came out with a bag of 5 medicines, all for 30 baht. OTOH had a fatigue-related illness and went to a premium foreign doctor in China, ended up setting me back $50, didn't get any medicines, and doc told me to come back in a few days for blood checks. What a rip-off.

By Scott, United States (15th August 2014)

I feel for you Joko, I really do. There are so many horrible pains we have to put up with, but having been a sufferer myself in the past, I think agonising back pain has no equals. You just can't function in any aspect of your normal daily life. Back pain is horrible. Glad you got it sorted out.

By philip, Samut Prakarn (15th August 2014)

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