Leaving New York was quite exciting. The sight of the shrinking skyline in the distance, the thought of the centuries old skylines (both natural and man-made) of my destination, gave me little sleep on my 20-hour flight. When I was in Bangkok, Thailand, two years ago, I noticed a man selling Buddhist amulets on the sidewalk of a busy street. The man, yes, had had a stroke, actually an "Ammaphruk," in Thai. When? I wasn't sure. To what severity? I couldn't determine. Yet, he was one in a large population of the world, who had been faced with the result of life long disability. His choice? Absolutely not. His fate? Maybe so, but I didn't know at the time.
South East Asia, my first destination in this 8-month journey, and Bangkok my first stop. A bustling, congested, modern and highly polluted city, Bangkok, in my mind, is the furthest example of what I thought South East Asia was going to be like, but as for mainland South East Asia, Bangkok and Thai medical practices seem to be the closest to western practices as I could get.
For the last month and a half, I have spent my time in two countries, Thailand and Myanmar (Burma). One country, a blossoming society of east meets west, and one country, a stagnant society living in the past and present with what seems to be no concrete vision of the future, yet both overflow with centuries of traditional knowledge and culture. And like my descriptions of each country, my findings in one were of a mature and modern approach to strokes and disabilities in general, while my findings in the other were like reading a cherished and wrinkled family recipe handed down from one generation to the next.
In addition to the long intertwined histories that these two countries share together, Buddhism is one link that both share the most. In Thailand, more than 95% of the population is Buddhist, while Myanmar is 87% Buddhist, and for Buddhists, beliefs concerning disabilities and the reasons behind the presence of disabilities, impact and influence the lives of the disabled in a way I was never aware of.
Buddhism, unlike many of the other religions of the world, is not centered around a god or gods. It is based on a system and a set of principles in which a person should exist. And in these principles is the belief of rebirth from one life to another. Where the actions taken (either good or bad) in one life transfer to the next. The word nirvana or nibbana is the ending of these births and rebirths, in which one has reached a level where desire and suffering cease to exist(suffering being many things). To most Buddhists, nirvana is an unattainable goal, so many live their lives in hopes of attaining a better existence in their future rebirths. Therefore, this rebirth is a continuation of actions from one life to the next rather than a transfer of a spiritual entity. And it are these actions that are believed by Buddhists to result in a healthy rebirth and yes, an unhealthy rebirth.
So, in the teachings of Buddhism, disability is the outcome of the actions, bad actions rather, which a person made in his/her previous life, leaving stroke survivors and other disabled people immediately caste in a negative shadow, both externally by society and internally by oneself. The result: a person pitied by society, a person overly protected and sheltered by family and loved ones, a person easily ignored as an asset to society and a person left with an incredibly low level of self-esteem (this largely due to their belief of a wrong doing in the previous life). So yes, Buddhism has had a huge impact on stroke survivors and the disabled in South East Asia, a religious impact most westerners do not have to face.
Both Thailand and Myanmar are extremely large countries. Both with long coast lines in the south, sprawling agricultural plains in the central sections and lush mountainous regions in the north. And even though both countries, specifically Thailand, have bustling metropolitan cities (Bangkok, Chaing Mai, Yangoon, Mandaly) the majority of the populations of these countries, and SEA, live in rural areas (64% Thailand, 75% Myanmar, 90% SEA).
This enormous rural population, where standardized medical practices and a lack of resources limits not only stroke services but proper stroke detection, is where Thailand and the countries of SEA face the greatest challenge for the future. In a 1998 study, there were roughly 430,000 stroke survivors throughout Thailand, yet inaccuracies in not only census figures but the lack of neurological expertise in many of these rural areas show that this number could be much higher. And as for the death rate from stroke in Thailand, 6700 per year, which could be possible higher by 15%. In these areas syphilis, tuberculosis, snake bites, malaria and parasitic infestations appear to be the leading causes of both ischaemic strokes and cerebral hemorrhages. And with only one stroke unit in all of Thailand(located in Bangkok), 150 CT scanners and 20 MRI scanners, the rural population of stroke survivors practice home and traditional treatments more than modern practices.
And these traditional practices were what I learned about during my three weeks in Burma. While in the capital city of Yangoon, a city mixed of Buddhism, Hinduism and Islam, decorated with the orange and aqua blue and yellow architecture of colonial Britain, I had a conversation with the owner of the guesthouse I was staying in. He was aware of stroke in Myanmar, which is called "Lei Hpja" in Burmese, and told me of the master monk of a monastery north of Mandalay that might have some interesting information for me regarding the medicine he gave to help the mobility of people affected by strokes. So, he wrote me a letter in Burmese to present to the master monk of the Mahabawditahtuan Monastery in the town of Monywa, Myanmar. The master monk's name was U Narada and he served not only as the Buddhist leader of the region, but also as an expert in traditional Burmese medicines.
After a 4 hour bus ride from Mandalay and a one hour horse carriage ride to the monastery, I presented my letter of introduction to two younger monks, U Kumuda and U Tejinda (U Kumuda acting as my English translator). They forwarded my letter to the senior monks, who were quite excited about the purpose of my visit. They told me that U Narada was in his daily meditation session, but that they would arrange an audience for me when he was finished at 1:00.
At 1:00, I knelt down in front of U Narada to ask about his traditional prescriptions. He said that when someone who has suffered paralysis of any part of their body (stroke included), he gives them pills made from the crushed bark of the Lat Pankha tree. This bark powder is mixed with pure honey and formed into small marble-sized pills that are to be taken one in the evening and one at night for one entire month. The pills are to be ingested with water that has a Da Loun stone or philosopher's stone dropped in the bottom of the glass. According to not only U Narada, but the senior monks and the man in Yangoon, the result is an increased control of the movement of the affected part of the body and that people from all over the country make the journey to the monastery for these pills.
After my audience with U Narada, I sat talking with U Kumuda and U Tejinda. They were very curious about strokes and after talking for an hour, U Tejinda said he knew of a man in a nearby village who was known throughout the region for giving nerve specific Hnei or massages to help with paralysis as well. Next, I found myself in the back seat of a 1952 English-built black Ford as U Tejinda drove and U Kumuda navigated. We wound through the sandy country roads until we reached a small village and were greeted by the man we were seeking. The man said that he uses a massage method that focuses specifically on nerves and that just last month he had worked on a Lei Hpja survivor from Yangoon. He said that the technique had been passed to him through "too many generations to count" of practice and that 75% of the people he has worked on, leave with an increase in mobility. Due to language barriers, U Kumuda couldn't translate the specifics of the massage technique. Both the monks were extremely humble during our conversations with both U Narada and this man, and I will always remember the size of their hearts and the kindness of their souls.
After my time in Monywa, I decided to travel east, to hike for three days in the mountains of the Shan State. In pre-Buddhist days, many Burmese practiced 'Nat' worship. 'Nat' being a spirit that holds dominion or acts as a guardian over a person or place or thing(specifically an experience). Nat worship is much more widespread in the rural areas of Myanmar than in the urban areas, and with Buddhism being so strongly accepted through the country, many Burmese abandoned Nat worship altogether. But some worship both (Buddhism and Nat) and it is practiced by many Burmese, by separating their worship according to future and present lives. Buddhist worship focusing on the future life, Nat worship focusing on problems in the present. And in dealing with strokes and disabilities, I was told by a man in one of the hill tribes that if a stroke happens, Nat worship is the first order of business in treatment.
The Butterfly Nat holds dominion over health, and if a stroke has happened, it is believed that the Butterfly Nat has flow away, out of the person's body, leaving him vulnerable to illness and disease. And in order for successful treatment to take place, the Butterfly Nat must re-enter the body. So, the stroke survivor is taken to the local medicine man, where the figure of a man is cut out of paper made from the pulp of local trees. The figure is placed on top of the man's head and the medicine man then begins to call for the Nat to return. If the Nat returns the man will become healthier, if not, the man will remain disabled and possibly die.
I'm sure that many of these types of treatments are still used in the rural areas of Thailand but according to Dr. Pattariya Jarutat, Director of the Sirindhorn National Medical Rehabilitation Center, the majority of the doctors in Thailand are either US board certified or Thai board certified and in general, the use of traditional medicine is decreasing as a result of spreading modernized medical facilities and doctors into rural Thailand.
Regardless, I've found that the acceptance and inclusion of stroke survivors and the disabled into SEA society appears to be the greatest hurdle. I wasn't able to obtain much information regarding the formal rehabilitation practices of Myanmar, but Thailand, which is projected to be 20 years behind US/Britain in stroke rehabilitation according to Dr. Pattariya, has already made the first steps into integrating stroke survivors and the disabled out of their sheltered and hidden lives and back into Thai society. From 1981-1991 King Adulyadej announced to be the "Decade for the Disabled". And in 1991 Thailand passed the country's first governmental Act focusing on the rights of the disabled.
The Rehabilitation of Disabled Person Act set the guidelines for the financial, medical and rehabilitation aid to the disabled in Thailand. It set guidelines for the construction of tools to help with the mobility of the disabled using public transportation and employment objectives for companies, encouraging the employment of the disabled. Unfortunately, as of Jan. 2000, less than 20% of Thailand's 1 million disabled have registered for such aid, the busses are far from being handicapped accessible and less than 8% of the companies which are supposed to employ those with disabilities actually have disabled employees following the fixed governmental ratios.
Awareness and Education of this act are of the greatest importance, and organizations like the Association for the Physically Handicapped and the Office of the Committee for Rehabilitation of Disabled Persons are helping to spread the word of the Act. And a comment Dr. Pattariya made clearly states Thailand's increased commitment to this, "We want to include the disabled. They are precious resources to Thai society."
I'll end most of my installments with this same phrase: so where does that leave me with my experiences in...South East Asia related to this project? It leaves me sitting in a home with a man and his family in Myanmar's capital of Yangoon.
Born in 1940, U Aung Nyein, moved to Yangoon and started his family with his wife Da Khin Khin lay. For years he worked as a chemical salesman. In 1986, for reasons not communicated with me, his profession changed to that of a man working in one of Yangoon's lively and flavorful tea shops. After having three children (Winthaw, That Naing and Thi Ha) and now at the age of 56, Aung Nyein returned home after a long day of work to lay down before dinner, escaping to the back of the home for a short nap. When he awoke, he found it incredibly hard to move the left side of his body. His oldest son, Winthaw, helped him to the dinner table, where the family watched him labor to move the food to his mouth. It was then that his speech turned into mumbles and it was then that the family knew something terrible was going wrong. What it was? They didn't know. After 3 weeks in the hospital, his speech had returned, yet movement in his left side hadn't improved, this after modern medicine had been use. he was now a victim and also a survivor of a stroke.
"My father is a different man," Winthaw said to me as I sat on a short wooden stool at a table that looked out the open front wall into the streets. 'Depressed' and 'Angry' were the words Winthaw used most to describe his father. "He feels that his stroke is a failure of life and living," Winthaw translated from his father's words. And in watching Aung Nyein say these words, I could sense and understand every word he said, even though it was all in Burmese.
After his weeks in the hospital, Aung Nyein started to take more traditional medicines, and it was then that he started to see improvements in his mobility. Nerve Tonic consisting of fennel compounds, honey and menthol roots, taken twice daily and a rejuvenating powder called Lu Pyan Daw, which increases the resistance of muscular decay have been given to him by his wife for the last 4 years, resulting in a considerable improvement of the strength and mobility of his left leg. But still his left side is weak and refuses to cooperate, leaving him afraid to leave his home and walk the street vendor laced sidewalks.
Family provides the strength to continue on, with "duty" being their only response when asked how they maintain this family strength. And in SEA, it appears that the strength of a family and the support of friends are the two most important factors that contribute to the overall quality of life and rehabilitation of stroke survivors and the disabled in this less medically advanced area of the world.
I hope that my findings in Myanmar and Thailand bring interest to you. And now my journey continues.
©Greg Constantine, available at www.strokesafe.org with the author's permission. For inquiries or reprint permission, contact gregc@strokesafe.org.