Our Outpatient Department began as a small space in an old house, but as the Clinic grew, the department did too, and it now has six separate exam rooms and a waiting area. But as our patient load continues to increase, we keep needing more space for the Outpatient Department, which, unfortunately, is not available.
In the beginning, all of the medical services available at MTC were provided under one roof. Patients came for treatment of a wide variety of ailments, ranging from treatment for malaria, to having wounds dressed to the delivery of babies. Although many of these patients stayed overnight, this is still considered the origin of the Medical Outpatient Department (OPD). Equipment and medical supplies at this time were scarce and food was limited and very simple. Despite the limited resources of the clinic, no one was ever turned away.
Although the space was small, an effort was made to keep trauma and maternal health patients separate. The original space was an old house, with various improvements added as time and supplies allowed. Originally, the clinic was only open from 9:00 a.m. until noon, but increased patient loads necessitated an expansion of operating hours to a timetable of 8:30 am until 4:00 p.m., Monday through Saturday. Of course, emergency patients were also admitted on Sundays.
As time went on, the number of patients and scope of services continued to increase, with the number of patients requiring specialised services such as minor surgeries, obstetric and delivery services, and child services beginning to overwhelm a single Medical OPD. In 1999, MTC expanded to allow the establishment of separate departments, ultimately leading to better standardised treatment of patients and the adoption of established protocols. After the expansion, the Medical OPD had a larger space with four separate exams rooms, three for seeing patients and one for administering medication. A mere six medics completed all of the renovation work.
In 2000, the Medical OPD moved into a new building with six exam rooms, four for general care, one for chronic disease patients and one for malaria cases.
The Current Department
A separate space to treat malaria patients has always been necessary at MTC, but a separate exam room to treat patients with chronic disease is a newer development. The patient demographic is changing considerably, with more and more patients crossing the border for health services as the state of health care continues to decline in Burma. Moreover, as word of mouth continues to spread regarding the wide variety of free services at MTC, more people are willing to risk the journey in order to receive the potentially lifesaving services.
The department handles all acute and chronic medical problems, ranging from minor conditions to malaria, tuberculosis, HIV, malnutrition, pneumonia, acute diarrhoeal diseases and chronic conditions such as diabetes, epilepsy, thyroid disease and cancer.
At this point, MTC cannot fully treat most of the chronic disease cases that are presented, such as diabetes, heart disease, and hypertension. Both the lack of resources and infrastructure to support the health care needs of long-term patients are issues yet to be overcome. Moreover, medics are not yet fully trained to cope with these illnesses, although they continually strive for that knowledge and work to gain it through weekly case studies, and upgrade training programmes. It is a frustration and a challenge for the medics when they cannot provide the proper treatment for a patient, but it is also a challenge when they can.
The staff of the Medical OPD continually work to ensure that patients take their prescribed medicines properly. Unlike the other clinic departments where patients receive their medication directly from the medic caring for them, in the Medical OPD, the pharmacy is a separate unit. Therefore, the medics and the pharmacy staff have to maintain high levels of communication and ensure that communication with patients is also strong. When patients speak a variety of different languages, and often cannot read or write, this presents considerable obstacles. In 2005, new medicine distribution bags were created in order to eliminate the need for a patient to be able to read. Since the implementation of these bags, the dosages and schedule for taking the medicines are depicted through pictures, making it much easier for the patient.
Language barriers and illiteracy have also been a challenge when it comes to educating patients about their illnesses. With Medical OPD continually getting busier, the medics can only spend a small amount of time with each patient, so the hope is to produce more printed education materials to give to patients. However, these printed materials need to be produced in more languages and need to take into account patients who cannot read.
The staff of Medical OPD recognises that until there are radical changes in the political situation in Burma, MTC will continue to see an increase in patients. The staff hopes for the necessary developments to be able to serve these patients. They need a larger waiting area, more exam rooms, more medics, further training and greater resources to be able to recognise and treat the greater variety of illnesses coming through the door.
Two medics work together in each exam room, normally seeing only one patient at a time, but sometimes seeing two at a time if the department is overwhelmed with patients.