The way to work

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I am relieved to be out of London. In the last months before leaving I was starting to lose it. The tipping point – on top of shift work, erratic sleep and general life upheaval ­­– was the commute.

443px-Brixton_Tube_2006-04-22I was living in the South and working as a locum doctor in a handful of A+E departments strewn over the city. Unfortunately the one with the most regular shifts was in the Northeast, bordering Essex, which meant a minimum of 90 minutes travel time each way. This was divided into 10-minute frenetic spurts on various buses, tube lines and underground tunnels, and one unreliable train.

Most of this was spent glued to my iPhone, engaged in a futile struggle to vanquish my ‘To Do’ list – sending emails, tapping out texts till my thumbs seized up, making calls to various unsympathetic office workers about things like tax codes – and checking the minutes as they ticked away.[1] At the end I would walk for 6 minutes beside a highway, past rows of concrete blocks and through a car park, before taking a deep breath in and passing through the automated hospital doors. After evening shifts I would run back up through the dark empty streets, sometimes still in my crumpled green scrub bottoms. If I missed the last train I would take the dreaded night bus and arrive home at 3am, disheveled and exhausted.

There has been research into the effect long commutes can have on mental well-being. The effect on mine wasn’t good. After six months my neurons were irritated. My already-elevated stress levels went up, and my irritability threshold went down ­– to a disturbing new low.

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I found myself holding back impulses to knock elderly people aside when they moved too slowly or push tourists down the escalators when they strayed haplessly into the wrong aisle. I threw small internal tantrums when something obstructed my way (like the Pret-a-Manger checkout person at Liverpool Street Station taking too long putting my avocado wrap into its paper bag). I forgot to think what I looked like, stalking up and down underground platforms like an agitated panther in aqua-coloured Nike sneakers, sucking down flat whites and staring at the departure board with dark-ringed, narrowed eyes. I felt alienated, isolated, surrounded by incoherent noises, concentrating only on dodging human traffic and other obstacles to my final destination – like a caffeine and cortisol-fueled lemming in a warped, urban-jungle-themed video game.

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In Mae Sot, at the eleventh hour, the transport arc of my everyday life has changed dramatically. For the past 3 weeks I’ve been bike riding to work – and everywhere else – and if I pedal firmly it only ever seems to take 10 minutes. And it’s not a coincidence that I no longer feel a homicidal antipathy towards my fellow man (or elderly woman).

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In the mornings I leave the guesthouse and whiz through the warm air fragrant with fish sauce, garlic and burnt sugar, listening to birds tweeting and loudspeaker announcements from the Buddhist temples (loud, but better than squealing tube brakes). Everything is covered in foliage, like a small, inhabited jungle. My mind feels like a dehydrated plant that’s been transplanted from an arid, hostile environment into a cool, watery, reed-filled one. Things go past in a blur, but it’s a slower, greener, softer blur. Not a sensory assault.

There’s still traffic – cars, trucks and motorbikes leaving smoky trails of exhaust fumes, other bikes with passengers sitting sleepily on the back with their feet dangling just above the road – but a lot less of it.

Like a stop-off at Brixton, I pick up a coffee from a shop on the side of the road past the main roundabout. After chatting with the guy in my limited Thai/apologetic English I ride away with an espresso shot in a cup overfilled with ice-cubes suspended in a plastic sling tied to one of the handlebars, with cold drops splashing on my ankles as I swerve to avoid centipedes inching along the road and bump over rock-filled mud puddles.

London commuters get stuck in the rain, but in South-East Asia it’s more of a big deal, and as September is the tail end of the wet season there’s at least a brief shower every day.

In the first week I was caught unprepared in a sudden downpour. The rain fell in loud, straight streamers, and I was drenched within seconds. After that I started traveling with an industrial-looking waterproof laptop sac, a small umbrella, and a rain-poncho fastened to the rear rack.

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The CBO[2] I’m working at, is located in a Burmese residential area on the edge of a vast field of rice paddies. At the turn-off from the tarred road the traffic disappears and lone battered rickshaws coated in faded red paint rattle past goats and stray chickens and children on their way to school. I ride past small corner shops, washing lines and a series of stained and dilapidated concrete fences, through some more puddles, to the entrance of the office.

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On my second day there, the one doctor on staff, who runs a mobile medical clinic and various other programs, took me to buy the bike from an outdoor warehouse beside the Moei river, on the border. It’s not very wide and on the other side you can see where Burma/Myanmar begins. The experience was very different to buying a bike from Argos.[3]

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There was an endless expanse of bikes and bike parts heaped up in different sized-piles, in various stages of assemblage and decay. A group of young men and their small, sprightly assistants – boys that looked about 7-10 years old – pulled out a tall-sized frame from the end of a long row and asked me to pick the various bits that I liked from other bikes – a seat, handlebars, front basket – for them to swap. Then they changed the tyres and fastened on a rusty but effective lock and a generator-powered light. They worked quickly, with a fervent collective concentration (and seemed a lot more engaged with the process than the Argos employees).

As I marveled at how much better it was to go shopping here, I had to remind myself of the situation they were in – displaced and undocumented, living in poverty, most likely without much chance of getting out. Six weeks ago there had been severe floods in Mae Sot and hundreds of bodies were rumored to have washed up on the riverbanks, but no one knew how many because there had been no official count.

IMG_2863I left with my new (recycled) hipster-looking bike, 3000 miles away from the immensity of London, feeling lighter. And a bit uncomfortable. Even though it’s a lot to do with being in a small town, there’s a dark lining to this expat/‘voluntourist’ contentment – the immense relative wealth, the heightened sense of one’s own freedom, the sometimes-morbid fascination.

Other observations in the streets on the way to work – a man with no legs pushing himself beside the gutters on a skateboard (also stuck in the rain); a young child with wasted limbs, contorted with spasticity, being steered through traffic in a rusted makeshift wheelchair by a teenage girl – make it difficult to get too carried away with the ‘Life is better here!!’ feeling. Maybe, in a process of apathetic evolution, the effect will wear off, like it has with the mentally ill and homeless people outside London’s stations.

But I’m not spending 3 hours a day/night stuck on a hurtling tube, on my iPhone, or in my own head. And this can only be a good thing.


[1] I tried listening to music and podcasts, as per Google’s advice on how to improve your commute, but it was harder to concentrate on the tube/tube/train transfers, so I stopped

[2] Community-based organization

[3] In retrospect a very ill thought-out and regrettable decision. It was also not as cost-effective as I’d hoped, mainly because after the bike was assembled (by me and a helpful customer at the store), it squeaked and wobbled and felt too unsafe to ride, or to sell or give away (M. called it a “death-trap”).

Day 1 at the Mae Tao Clinic

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In the midst of all the leaving-London mess, I hadn’t really thought about what I would be doing for my once-a-week placement at the Mae Tao Clinic.[1] And so my first day there was a daunting one.

The clinic is a sprawling, plant-filled complex of one-story buildings located just off the Asia highway, outside the center of Mae Sot. I was dropped at the entrance by a tuk tuk and jumped off the back in my grey hospital skirt outside a row of dark, shed-like food stalls with roofs made out of corrugated iron and dried leaves.

I instantly felt inappropriately dressed – although the skirt was knee-length (as per advice from the ‘Volunteer Orientation Manual’) almost everyone else was wearing a longyi. Tugging self-consciously at my waistline, I wandered in and around and tried to figure out how to find the ‘RH OPD’ (Reproductive Health Outpatient Department). This was only piece of information on ‘where to go’ I had discovered on trawling through my inbox the night before.

I followed some dusty signs with uterus drawings on them, passed an open-air delivery ward where a baby’s slick black head was crowning, tentatively stepped into a large room filled with pregnant-looking women, and introduced myself to someone sitting in a small office who seemed to vaguely register who I was. She sent me into another room where I was adopted by one of the health workers and sat down with a jolt for row after row of consults in the antenatal clinic.

Having no real O+G experience aside from medical school, I had to concentrate hard to remember/pretend to remember how to take an antenatal history, measure a fundal height, feel a cervical os, and determine estimated date of delivery (EDD) with that cardboard wheel-calendar thing. The health worker – a very patient, slender, seemingly sweat-proof woman in a clean, light-coloured shirt – seemed to figure out quickly that I was essentially useless, and relieved the awkwardness of the situation by both acting as a translator and telling me what to write in the notes. She was very good-natured about it, smiling and twittering quietly in clear but broken English in response to my frequent questions. The patients seemed bemused whenever I spoke directly to them – this was a bit disconcerting. 

MTC fanThe room was sticky with heat and I tried to position my plastic chair directly under the fan. Embarrassing moments included not being to find the fetal heartbeat 3 times in a row, then being asked to interpret a bedside ultrasound (I could barely make out the gestational sac in that swamp of inscrutable grey lines). And as the day went on I felt more and more uncomfortable, partly because I was dehydrated from all the sweating, and partly because of the pressing question: what is the point of me being here when I don’t speak Karen or Burmese, don’t know anything about O+G, and am only going to float in, ill-equipped, saddled with a mild but ridiculous white-saviour complex, for one random day per week?

I was relieved to be sent out for a break. I bought a longyi – a sarong-like tube of material that goes down to the ankles – from a makeshift hospital store that was dark, dank and covered in dust. For lunch I had a fluorescent orange chunk of fried chicken thigh, a small plastic bag full of noodles and some water from a flimsy bottle that tasted like chemicals. I swallowed it all in front of two expectant dogs, then stood under the shade of a large tree in the middle of the main passageway holding a green apple, feeling faint and staring blankly into the heavy air. Lost in a blur of human activity.

The Mae Tao Clinic was started by Dr Cynthia Maung when she was a young doctor fleeing the brutal repression by the Burmese military in the wake of the 1988 student uprising. From its beginnings in a small, run-down shack, it now provides an extensive range of free health and social services to an estimated 150,000 refugees, migrant workers and other displaced groups living on the border. Around half travel to the clinic from the Burmese side, where healthcare is essentially non-existent. Many belong to ethnic minorities (mostly Karen).

As I stood there eating the apple, I thought about how it was less sterile here compared to other hospitals I’ve been in – both literally and metaphorically.

MTC sinkThe toilets have splintered wooden doors with rusted locks and a plastic bucket floating in a dark pool of water for a flush. There are dregs of rice blocking the sinks, and cracked eggshells in the gutters. The soap is diluted. Gloves are scarce. But people seem more connected – less alienated and scared – with healthcare being this intertwined with everyday life. As per the website, the MTC is “not just a workplace…it is also a home” – there is an on-site orphanage, and 95% of the staff have themselves been displaced from Burma.

I went back to the RH OPD after lunch less naïve and more reluctant. The afternoon session was much the same, except the health worker wasn’t there anymore and none of the others paid me much attention. I spent some time taking blood pressure and walking in and out of different rooms, and attempted to communicate with staff and patients but didn’t get very far without intensive help. And when my longyi fell down while listening in vain for another fetal heartbeat, I decided to give up.

I left early, back on a tuk tuk through the searing afternoon heat. At the guesthouse I collapsed under my anti-mosquito tent and fell asleep in the dark with the air-con on.

I’m strongly attracted to the MTC, the buzzing humanity of the place – but one day a week won’t be enough to get the hang of things, let alone contribute anything. And I should probably ask to be moved somewhere other than the RH OPD (or anywhere else RH-related).

I remember now reading something about the problem with short-term overseas volunteering, but I didn’t pay much attention at the time. It suddenly seems very clear: I am here asking the MTC for help, rather than the other way round.


[1] The rest of the week will be spent working at a community-based women’s organization