1st vs 3rd World Expectations

After a bumpy start in Reproductive Health (ehehe), Ive been spending Wednesdays in the Surgical Department – a concrete block towards the back of the Clinic, to the left of the sea-blue plastic water tank.

Surgical Department

Thongs (flip-flops) of all sizes are heaped up outside the doorways in accordance with Buddhist shoe-removal etiquette. There is a 40-bed ward, two procedure bays, an outpatient clinic, a small, air-conditioned operating theatre and a staffroom (like all public hospital staffrooms) filled with stray chairs, unstable piles of notes, watermarked textbooks, empty bottles of Coke and Red Bull and a PC that looks like a grey rock stuck to a desk. This one also has a litter of indifferent kittens huddled in the base of the bookshelf with an entourage of fleas – less familiar, although no more disturbing than some of the things I’ve stumbled across on top of NHS staff lockers.

Entering a surgical inpatient ward barefoot is a disorienting sensation. After two or three times you start to get used to it, and to the curry bowls and green banana bunches everywhere, the cats (graduated from the bookshelf) and the patients lying in rows on wooden beds, all in the one room, with relatives mingling in the aisles. It’s a large, airy space, like how I imagine makeshift war hospitals might look like, with missing ceiling tiles and noise from a lone TV buzzing in the background.

Most of the admissions are for treatment of conditions like infected ulcers and burns and chronic cellulitis, or for post-operative care following on-site hernia and hydrocele repair. There are also occasional swathes of young men presenting with severe penile infections caused by unsterile injections of coconut oil into the shaft. How word hasn’t got out yet that this is a bad idea, I don’t know.

In the outpatient clinic I’m paired up with one of the medics, a Karen man who’s been studying or working at the Mae Tao Clinic for the past thirteen years. Together we assess patients with an array of wounds, work injuries, dog bites, abscesses, sprains, lacerations and lumps, mostly in the neck, breast and groin. They tend to stream through the door, one by one, in either a light trickle or a patient tsunami.

One young man walked in the morning after accidentally mangling his index finger with a machete while cutting down stems in a field (or something). He was joking around with his friend and seemed to have no trouble accepting the fact that there was a bloody stump where half a finger used to be – not something stitches could fix.

I thought back to the last severed finger I had come across, in a London A+E a few months before. A middle-aged woman had stuck her hand through her neighbour’s letterbox and had one of the tips bitten off by an overly zealous housedog. What happened next was difficult to follow. She called for help and somehow 3 friends appeared and managed to sidestep the dog, retrieve the fingertip and put it into the neighbour’s freezer, directly on ice (this is the wrong thing to do btw – readers take note!). Then when they arrived at the triage desk, bewildered and flushed, they realized the finger was still in the freezer and the ambulance had to turn around and go back for it, sirens blazing.

More drama ensued. To cut a long story short, my whole day was taken up with this finger, not least because while I was on the phone arranging an urgent referral to the plastic surgeons at a specialist hospital in the unlikely event they could somehow reattach it, the wide-eyed patient and her not-so-helpful but well-meaning posse jumped the gun, presumably in a fit of collective anxiety, and raced out the door without telling anyone, without clear instructions or a trackable mobile phone. And they forgot to take the finger. Again.

I remember wrapping the poor, frostbitten thing in a shroud of sterile gauze and noticing it looked very dainty and well tended-to. A perfect nail painted an inviting shade of coral, with a glitter sheen.

It would make sense that First World fingertips get more attention than the ones on the Thai-Burma border (except when they’re in the freezer or on a hospital desk). The loose phenomenon is one of Adaptation  – of priorities, expectations and distress levels falling in line with the resources at hand (ba-doom).

This is something that’s been on my mind a lot since moving to the edge of one of the least developed parts of Asia, where I happen to find myself spending a lot of spare time reading articles and blog posts related to current debates on the connection between happiness, expectations, and reality. Like this one: Why Generation Y Yuppies are Unhappy. And this one: Fuck You. I’m Gen Y, and I Don’t Feel Special or Entitled, Just Poor.

Some incipient thoughts on the psychology of 3rd world expectations:

There is a undoubtedly a positive side. Deprivation can bring out remarkable levels of human resilience (from experience, the converse is also true). And even observing it can instill a sense of perspective that is difficult to maintain in conditions of saturated affluence. Almost every morning at the clinic, often while fumbling with a cold thermos filled with mixed fruit frappe, I walk past another young man with both arms missing, likely an old landmine injury. Things like that make you remember – or realise – what matters. Fingertips and spilt fruit frappe don’t make the list.

There is also a disturbing side – the apparent resignation, or passive acceptance of a miserable status quo. Unlike a distal phalynx, the penis is a near-universally revered and undeniably useful appendage. Yet some of the young men who wander over to the procedure bay for their daily dressing changes seem almost resigned to the fact that theirs looks like it’s about to drop off. Maybe it’s just because I can’t read their anxiety, or maybe they don’t understand the potential long-term consequences. Maybe on discharge they’re planning to go out and start an awareness-raising/prevention campaign, with flyers and street theater, to alert other men in the community to the dangers involved.

It’s hard to tell.