Matt Spreadbury has been on a mission trip to Asia.He has explored different opportunities for the Tesfa Foundation to possibly be involved in relief work in Asia.
For the last two months I have been deep in the Burmese jungle serving at the Jungle School of Medicine Kawthoolei clinic. This trip has been a long time in the making. After I came back from South-Sudan in 2020 some friends and I watched a documentary on the plight of the ethnic people facing the brutal Burmese military dictatorship. I thought, ”Wow, there are people who live out their faith just as we did in South Sudan, They go to the sound of gunfire, they go to the sound of need and ask; Jesus, how can you use me?”
I got in touch with the documentary makers asking “Hey do you need a surgeon?” Their response was “Yes, please pray and if God leads you, come.”
Two years later life under the rainforest canopy is raw and simple. Food is made over an open fire. I wash myself and my clothes by swimming in the river. Houses are made out of wood & bamboo that are elevated on stilts. This is for the animals to live underneath and during the rainy season to be off the ground. Bamboo is a marvelous material that can be used for seemingly anything. Building houses, irrigation pipes for crops, you can eat the young shoots, weave baskets, the list continues. Each morning one is either woken up by cacophony of cockerels at an ungodly hour or discomfort from rolling around in a hammock. Breakfast is a solid staple of rice and what looks like leftovers from dinner. Dinner is again leftovers from breakfast and the cycle continues.
Our inpatient department is again elevated on stilts. Its made out of strong teak, open walls and a large roof. It could be mistaken for a large house, just we lack the animals underneath. Though occasionally a mule will crawl its way under trying its luck to find scraps of food. There are no permanent walls and all buildings are of the open kind with a large overhanging roof to prevent rain coming in.
The patients sleep on reed mats on the hard wooden floor or suspended in hammocks. The Karen is the ethnic tribe here and there are around 1.5 million of them. Very few health centers exist as they are under constant attack from the Burmese army. Until recently there were no doctors in the entire state. The next clinic with a surgeon is upto a 5 day hike away through mountainous steep jungle terrain. Distance here is measured by hiking in days, not hours. Walking it on foot in good health is one thing. When you are sick it is near impossible. The Karen have a solution for this, the “Bamboolance”. They unwrap a couple of their traditional cloth shawls (Longhis) and throw a patient and a bamboo pole inside. Bam and you have made yourself a bamboolance.
Our operating theater is made of thick mud and is verifiably bulletproof. On construction an M4 carbine was fired into the wall and it only penetrated about 3 inches. My favourite feature are the bamboo lights above.
War is ever present in everyone's mind here. The ethnic tribes suffer from the world's longest running civil war which started over 70 years ago. It shows no sign of letting up. Despite being deep in the jungle we occasionally hear the sound of distant shelling or jets flying over. The likelihood of a bomb falling directly on you out of the sky is incredibly small. However when the radio chatter starts calling for “lights out” many of the ethnics flee to the jungle for safety. Its the jungle they know best. The patients we see here are a true mix of tropical medicine. Pediatric malnutrition. Abdominal tuberculosis. Liver abscesses. Hernias. Typhoid fever. Jaundice. Then come the war wounded.
On a quiet day we visited a local village which had the promise of better snacks. Rice and leftover breakfast does get tiring sometimes. Our escort showed us the local school. As I turned up to this huge long building and adjacent football field I noticed one eiry thing. It was deserted. I walked along the edge of the playing field and found out why. In the middle of the school building a wall had been blown out and you could see through the rubble a hole in the roof. The school had been bombed last year. No one had even attempted to clean up the damage. The glass in the windows was still jagged and twisted metal stuck out of the concrete. A thick layer of dust covered the 11 grade class picture. Most of them were young girls. What are they doing now I wondered?
This is what the Burma army does. It bombs schools and a classroom filled with 11 grade girls. Fear is contagious and when fear takes over, it inhibits. As Dave Eubank says, ”I wish I hate lust and pride as much as i hate fear”. As I would find out later, there is a special feeling reserved for going back to an area that has been bombed. Your instincts tell you “LEAVE” even if logic says the chance of a second bomb falling in exactly the same space is actually close to zero. But we humans are not purely rational, we are emotional and spiritual.
“Want to see the clinic as well?” Shouted our guide. The town clinic was larger than the JSMK one. I was impressed. But again it was deserted and eerily quiet. “Where are the patients?” “Scared, they are in the jungle” someone motions, flicking their hand in the air. “You take me?” I got led on past more bomb craters in the ground following a small stream into the jungle. We passed groves of betelnut trees (oral cancer beware) and at the end of the path came to a bamboo shack covered in UN relief tarpaulins. I entered the shack which was very dark. To my left on stilts were three patients. To my right the staff’s quarters. I was met by a proud commander in flip flops, running shorts, pistol on his hip, a camouflage shirt and a military cap. I took in the situation as a grown man’s screams filled the tarpaulin makeshift walls. I pulled on my headlight and saw a man covered in dirt, sweat and dried blood mixed with the dark orange of iodine solution. He had been in the vicinity of a landmine when it exploded. Four men died instantly and he was wounded with another friend. The metal fragments and dirt tore into his skin and muscle leaving many gaping holes from his ankles upto to his chest. His testicle was hit by shrapnel and I was told, removed, without anesthesia. Poor man. A medic continued to stick iodine soaked gauze into this man's open wounds in his thigh. The screaming made me feel sick. I turned to the next patient, a young woman 22 years old with a gunshot wound through her left upper arm. Blood was coming through the bandage and she couldn't extend her elbow. She was holding her baby, also shot through its tiny right arm with a bamboo splint holding it straight.
My heart broke for the suffering under these tarpaulins, erected out of fear in the jungle.
The xray of the baby’s fracture. You can see the bullet fragment.
The mum and baby were bamboolanced to our clinic and then evacuated. Thank God for the Free Burma Rangers & the International Committee of The Red Cross who care for victims of war.
Bush surgery is not like elective surgery in a modern hospital. It's imprecise and done under sub-optimal circumstances and occasionally under fire. I can already imagine the critique from people who haven't been in a similar situation. Please reserve it for when you have been alone, with lack of resources, no back up and you have a desperate patient in front of you seeking help. With that pretext..
Na dai ku (NDK) is a feisty 23 year old woman. I’m hesitant to use that word, feisty. As if a bombing victim could still be feisty after all she has endured. She is stubborn, complains a lot and gives the staff a hard time. She is reluctant to accept help from others and wants to do things herself. I’m starting to admire her quite a bit.
As the indescriminate bombs fell from the jets on her village I imagine her and her husband clinging to their two adorable playful daughters as their bamboo house errupts in flames. The next few moments must have been a blur, the house is collapsing, metal and debris flies through the air. Shock, confusion and pain are felt as the bombing continues. The burmese army bombs civillians. Na dai ku’s parents were murdered as a bomb fell on their house next door and metal shrapnel fragments tore through her body.
Three days later she is being carried on a bamboolance to my clinic. She has a fever and an infection is raging through her body. The shrapnel (metal parts of a bomb) has entered her lower back by her spine and right buttock.
She needs to go to the operating room to dress her wounds and I can potentially remove the shrapnel pieces. Her left foot is numb and she can't walk. The shrapnel piece near her spine could have severed one of the nerve roots.
NDK is screaming hysterically out of fear, pain and the unknown. Despite telling her what we are about to do she is very scared. I give her a general anesthetic and we get about two minutes of respite from her hysterical shouting. This dose would make you or me unconscious for quite some time. She hasn’t reached -post traumatic stress disorder- yet. She is still in acute stress after the horrific trauma of the past days. Thus she requires much more anaesthesia than usual.
Once under anesthesia she can rest from the trauma.
I remove the necrotic skin where the shrapnel has torn into her skin. Debride the infected muscle. Her first wound is located on her lumbar spine. It’s oozing pus and I push my finger down the tract leading to her spine. I feel splinters of bone fragments. Once removed all i can feel is a hole going through the bony vertebral body. I decided to leave the fragment. I don't want to cause more harm than the shrapnel did.
Locating the metal piece in her hip
The second fragment entered on the medial side of her buttock and on x-ray is near her outermost hip. The canal is over 20cm long. I make an incision near her hip and take out a 2x2cm sharp piece of metal. It is remarkably heavy for its size. The canal can now drain through both holes.
The operation is over but the process of recovery is just beginning. The medics tended to her wounds and we would debride them every few days. In this time a ranger team went to survey her village. The Free Burma Rangers offer acute relief to victims of war all over Burma. They give food, build shelter and run school programmes. They are the light in the darkness, standing with the oppressed even if it means risking their own lives.
Over the gradual weeks Na dai ku gained strength and her wounds slowly started to heal. I had to keep reminding myself that here is a patient who has been mortally wounded, sick with grief over the death of her parents, is still in acute stress and is now on the path of slowly healing her body. The psychological trauma far outweighed her physical trauma. I do not know how the Karen process grief or sadness and I felt at a loss how to help in this area of treating holistically.
Naw dai ku’s home is reduced to ash, as are her parents
I set up a training program to get her to mobilise. It started with sitting, standing and then one day she looked aghast when i turned up with crutches and she dramatically shouted out “but they are not my style!” She was fiercely independent and wouldn't accept help from the medics to assist her to her feet. She struggled climbing up a chair pulling with her arms and pushing off the wooden wall for support. She shouted at her husband during this phase but wouldn't accept his supporting hand. Then once standing she shook herself off and gained composure before trying the crutches.
She can walk!
“Arise, shine - Naw Dai Ku- for your light has come, and the glory of the LORD rises upon you.” Isaiah 60.1
We clapped and shouted out praise at her progress. She managed a few steps at first and after a week she was walking around the clinic, still with a limp but better than ever thought. But there is always more in the Kingdom. After her morning dose of antibiotics NDK had started vomiting. I didn't think too much of it but an astute nurse from Sweden said plainly “guys come on, she is obviously pregnant”. No chance i thought. A fetus couldn't survive that bombing attack. I humbled myself and on the patchy ultrasound screen I saw with my own eyes a small heartbeat in her womb. WOW.
Her vulnerable baby HAD survived the bombing attack from the Burmese army, the three day journey to us, overwhelming infection and repeated operations. What a miracle!
“For you created my inner being; you knit me together in my mother’s womb.” Psalm 139:13. All glory be to Christ.
NDK’s daughters will soon have another sibling
These stories are just a few out of many which give me so much hope. It is not the dramatic operations which I think of most. It is the day to day of being with the medics and caring for whoever is carried to our clinic. One starry night I was walking around the creaky wooden floorboards seeing the patients sleeping to my left and right. All were doing well. My heart was full of the Fathers joy. Where my calling and His love for His people met. How beautiful life is to withstand so much oppression. The Karen are an example of humanity in chaos. To thrive in the midst of war. How God is our refuge and our strength, our very present help in a time of trouble. How a light shining in the darkness cannot be overcome by fear. Please pray for the Free Burma Rangers, they bring love, peace & hope wherever they are. They help to free the oppressed.
Late one evening I received a call “They are pummeling us up here and there are many casualties, can you come? Are you willing?” I prayed and thought of Isaiah 6. With God's peace, I was going to war.
Stay tuned for Part II of the Burma newsletter.
Please continue to pray for TESFA * VIPPS #508019
*Names and locations may have been changed for security reasons.
**Photo credit Thomas Hurst (Award winning war photographer, pastor, father and man of God)
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