By Minzayar

“There are about thirty patients in our hospice and the number’s always about the same. New patients arrive regularly and as old patients die. About ten die every month here.”

When the nurse showing me around the hospice said that, I was kind of shocked. If ten patients die a month, that means one every three days. To be honest, I have very rarely seen someone die near me. When I do, it is very sad and scary. I cannot imagine how the people here live with it.

U Hla Tun’s cancer hospice is a well-known place in Myanmar where cancer patients have been looked after for many years. It was founded in 1998 by U Hla Tun, who despite his wealth couldn’t save his young daughter from deadly cancer. His hospice only accepts cancer patients in the terminal stage, those who have already been given up on by the government hospitals’ cancer wards. “We accept only the hopeless and the helpless,” says Naw Lar Htoo Aye, the head nurse.

Naw Lar Htoo Aye has seen countless deaths since starting at the hospice in 1998. At first she felt strange when a patient expired in front of her. Now she’s used to it. “I just want to help them die as comfortably as possible,” she says.

The aim of the hospice is to provide relief from distressing symptoms, so the patient and their family can preserve the quality of life during their last moments together. But only the very few who still have a family get this. Many don’t.

Everything is provided free of charge, from medicines and meals to burials and last rites. Everything except one very important thing: companionship. Sadly but truly, most of them die very lonely.

“Some don’t even have a visitor at the funeral. There’s only me in such cases,” said Ko Oo who takes care of the dead bodies inside the hospice’s morgue.

“Families try to save their loved ones, try to spend as much money as they can, or even more,” said U Ohn Myint, the assistant administrator of the hospice. “So when it gets to a time they realize it’s impossible, they send the patient here. Some don’t have family, like the grandma who’s been here for ten years. She says she wants to die here. She has nowhere else to go,” he said. “Some still have family, but because of their poverty or because they have to continue working after spending so much trying to save their loved ones, they cannot personally accompany the patient.”

He also pointed out that 90 percent of the patients who come to the hospice die.

U Kyaw Shwe from Mon state is 51 years old, a father of six, with mouth cancer. “When this small mass started to appear inside the left side of my mouth, I thought it was just a small mass and I used a traditional way to cure it. It just got worse and now I have to remove the whole of my left gum,” he said. “I have many children. But how could they leave their jobs and waste their time near me? The cost for them to travel to Yangon is very expensive. We are just farmers, we can’t afford that much.”

“It’s okay here. I can happily die here if I have to. I wait for my daughter’s call and tell them I’m okay here. Here, I feel disconnected from the outside world. I don’t want to do anything else, just pass the time, pray and meditate. Now I realize, when a person dies, they’re not even as valuable as a dead animal. You can eat the meat when an animal dies, right?”

People here seem beyond being afraid of death. One old man, U Soe Thein, 67, has cancer in a gland in his neck. He has been in the hospice for seven months. Every day he just meditates or prays. “Since the first time I saw a cancer patient die beside me, I decided I wouldn’t care anymore,” he explains. “I would just do my prayers and meditations. I got this order from above,” he said, speaking of the gods and spirits. “They tell me it’s not my job to care about dying.” He sounded a bit strange when he mentioned this “order from above,” but I guess at least this is what he’s holding onto.

He also told me that the doctors from the Yangon hospital took three months before they were even able to diagnose a mass on his shoulder as cancer. He had wasted about 6,000,000 kyat already. “At first, I had a swelling in my prostate gland, so I had to undergo surgery and my testicles were removed in the Yangon government hospital,” he said. “After that, this swelling appears in my neck. I told them to cut it out as well but the doctor didn’t agree. Then they did tests after tests. I spent so much money. When they told me I have to pay for a CT scan, I told them I couldn’t afford it. But still I had to do it. Only then could they diagnose this as a “cancer”. It is already too late. Nearly three months wasted.”

In Myanmar’s government hospitals, especially in the Yangon General Hospital, the cancer wards seem overcrowded most of the time. Many of the professors and top doctors visit the patients only a few times a week. Most of the time it’s managed and taken care of by the ordinary doctors, house interns (medical students who have not yet graduated) and the nurses. So for cancer patients it mustn’t be enough care. The cost is high for government hospitals to treat serious diseases, and overcrowding means patients are discharged when their treatment is finished, according to Naw Lar Htoo Aye, the head nurse.

It’s rare in the hospice, but a few patients still seem to have hope. Like one nice lady, Daw Hla Hla Thein, who is 58 years old. She told me her son is a policeman and she also used to work at the police station. “I have to go back soon and work at the police station again. I’m not very old yet,” she said. But Ko Oo and a few others who work at the hospice thinks that she may be mentally ill.

I spent about a week in the hospice, searching for the strongest photos to tell the story. Unlike with other stories, I think at some point I became involved. I spent more of my time talking to the patients than taking pictures. I met a patient named U Than Hlaing, also suffering from mouth cancer. He was sitting alone and looked very lost. I went to speak to him, but of course he couldn’t speak.

Even still, with gestures he told me he has two little daughters and their mother passed away already. Maybe he didn’t know how to gesture to me to say “I’m very worried about my little girls”. I kind of felt it from inside.

Maybe I am being too sensitive, but it would be nice if the story weren’t so dramatic. It’s just like the nurse said: I hope they spend the last moments of their lives as peacefully and comfortably as possible.

By Minzayar

It was a fine winter evening and the first frame I took was a silhouette of a farmer and his wife wearing ta-na-ka, riding on their cow carts, so at once, I thought this is a very nice village. But in fact, its people have been living in fear for several years.

Kyar Chaung village is 64 miles north of Yangon, Myanmar. Most villagers have two houses. One on the ground to stay during the daytime and one in a tree to protect themselves from a wild elephant’s attack.

As I went to see the head of the village, people were already gathering in front of his house and chattering about a man who had to run for his life as he was chased by an elephant just a day ago.

“One night, while we were sleeping, we heard a loud crashing sound. I knew it was a ‘Bo-Taw’ (meaning elephant as if it is a powerful spirit). I was shocked when I found its trunk already lifting our rice bag. I just ran and ran and ran!”, the wife of the village’s head recalled her most terrifying memory with an elephant searching for meal. Luckily none of her family was hurt that night. “They can get a smell from within 5 miles and they can run more than 10 times faster than us!”

Five other neighboring villages within a 7 miles radius have been terrorized for 16 years. Villagers plant paddies, corns, sugar-canes, bananas and other crops for a living. Their houses are scattered, a few in the paddy fields, a few near the banana fields, some at the edge of the corn fields but all these fields are what an elephant loves to eat. It was not a problem when there was one or two elephants here. But villagers say there are about 30 to 40 elephants who eat in these fields that the villagers have been planting all their life. I knew there must be a reason for the increase over the last few years. Later, I found out why.

A notice board with a sign, “Beware Of The Elephants” states that every year, at least 5-10 people die in this township because of wild elephants. This notice board (which is now torn in half) is one of the very few things that the government forestry department has offered the villagers over the 16 years. The other thing the government offered, not to the villagers but to businessmen, was calling out tenders for the permit to arrest the elephants in 1997. Those who paid the highest price were allowed to arrest 17 elephants to be used as labor in the timber business. “When someone dies from an elephant’s stomp, instead of getting compensation, the remaining family members lose money as they pay to carry the body to and from the hospital,” Aik Too, the head of the village, said.

Villagers find their own ways to protect themselves. They use fire to prevent the elephants from coming near. They sleep in their tree-houses every night, but they have to forget about their belongings left in their house on the ground. In nearly every tree-house, there is a CD that’s reflection is used to scare the elephants. They have bow-guns to shoot at the elephants. This does not kill it but at least it is better than nothing.

As a last resort, a nearby military training camp gave the villagers a few ‘flash bombs’ to use when things get really out of control. There is also one 67-year-old retired hunter, Than Maung, who is an expert with the elephants. According to the experienced hunter, the reason many elephants come to this area is because there is no more food for them in the forests and mountains due to serious deforestation. “The elephants do not attack you if you don’t try to disturb them having their meals. But if they do, you run. You don’t run straight but you run in curves, heading along with the direction of the wind because they chase after your smell. That’s why you always need a lighter to know the direction of the wind.” Than Maung has once killed an elephant a long time ago on a government request. He is a hunter who hates to keep ‘souvenirs’ from the animals that he kills. “I hunt for my living but not for a pride or pleasure.”

Everyday, these wild elephants start searching for meals around 4pm and they go all night from one field to another until around 8 the next morning. Most of the elephants sleep during the day. When they don’t sleep, they often surprise the villagers working in the fields. There are some elephants who chase a person as soon as they see one, but there are also some who avoid humans. “We still have to work though. We must be on alert every hour. We cannot live without farming. What do we eat without our farms,” Su Mar Win, who works in the farms with her husband and has a 2-year-old daughter, said. Their family plants banana fields. Because of the elephants eating their banana leaves, their monthly income has decreased from about 45000 kyats ($50) to nearly no income at all. She still sadly thanks the elephants for letting her family live and eats what’s left by the elephants. “I don’t hate these elephants. I know they have fewer places to survive. I just hope my husband can go to work safely. I hope the government would move the wild animals to a suitable place”. But Su Mar Win will never forget that her cousin’s whole family was trampled to death by an elephant.

To me, the bravest is Dhamma Nanda, a 58-year-old Buddhist monk who says “I don’t care anymore. I just pray and share my love for them”. He believes the elephants only kill people who speak or do wrongful things. He has seen parts of a body of someone he knows being put in a bag and carried away. Dhamma Nanda lives alone in a monastery made with bamboo. There’s no tree-house in his compound. This might be the reason I saw only a few bananas and some scattered rice grains on his dining table. This is already his third monastery since the previous two were destroyed by the elephants.

Dhamma Nanda recalled his worst memory of an elephant chasing him. “I ran for my life until I got stuck in a bush. I couldn’t move anymore because this bush had many thorns. I kept praying. I spoke to them that I’m not someone who did wrongful things. I haven’t had enough time yet doing Buddhism. So please let me live!”

I spent some time in Kyar Chaung and nearby villages searching for the frames that might tell the story best. I spent a very cold night In a tree-house. But I never wished for a frame in which someone was chased or injured by a wild elephant. Maybe, I was sharing the same fear together with these villagers.