To die in peace

February 27, 2013

Yangon, Myanmar

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.

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