The Pioneers of Medicine in Burma #6
Prof U Tin U (Child Health)
(by dr thane oke kyaw-myint)
"If I have seen further [than other men) it is by standing upon the shoulders of giants."
Sir Isaac Newton: Letter to Robert Hooke, February 5, 1675.
I thought that the pediatricians of our generation and of our times would agree with me if I use the quotation of Sir Isaac Newton: "I am able to see further because I am standing on the shoulders of giants." A lot of us would not have achieved what we did if we had not been "standing on the shoulders of the giant of child health" Saya U Tin U. It was his vision, mission and ambition for the children of Burma, which paved the roads that we had walked and lighted the paths that we had taken.
Prof. U Tin U, MBBS, MRCP (Pediatrics), FRCP (Edin), DCH (Eng), retired Director General of Health left behind a legacy of philosophies (Ko Mya Thein would call them ideologies), policies and programs for improving the health and well being of the children of Burma. From the very start, on coming back from England, Saya never called our discipline as paediatrics. It was always Child Health, the emphasis always on keeping the child normal and healthy and not children being our concern only when they became ill.
I left for England in 1971 together with Ma Ma Thein and Daisy and was surprised to find that at that time, there were no exams in pediatrics. Pediatrics was considered as a subject under general medicine in medical schools. Even the question on child health included in the medicine papers in the finals was not compulsory. But, Saya after much argument and with the support of far seeing senior physicians (which included Ah Ba U Hla Myint) had managed to convince the Academic Board, and later the University Senate, that Child Health must be a major discipline similar to medicine, surgery and OB-GYN. It became a major discipline in 1965 and those who took the exams in 1966 were the first batch to have child health as a separate paper (Ko Tin Maung Tun’s batch)
There were many "firsts" about Saya. He was the first Burmese to successfully get through MRCP (Pediatrics) from the Royal College of Physicians of Edinburgh. Saya was appointed the first Medical Superintendent when the Rangoon Children Hospital was opened in 1964. He was the first Professor and Head of the Department of Child Health (initially for Institute of Medicine I, and later also of Institute of Medicine II). He was still in his thirties then, yet after attending a few international meetings on child health, Saya impressed people so much that he was made a Member of the WHO Technical Expert Committee on Maternal and Child Health, by Dr. Angelo Petros-Barvasian, one of the earlier Directors of MCH, WHO Geneva.
Saya was the only pediatrician among us who was chosen to be the WHO Professor of Pediatrics (at the University of Dhaka, Dhaka Medical College in Bangladesh, and also, in University of Calicut, South India). I read Saya’s report at the end of the assignment, which was so different from other assignment reports by many international experts. I went to him and asked, "Saya, all the experts who came to our country on leaving would recommend what needs to be done including the need for them to come back again to evaluate but in your report the last recommendation by you was that there would be no need for you to come back and evaluate the porgramme, as there would be enough expertise in Bangladesh/Calicut to evaluate the recommendation made by you being implemented." Saya replied, " Like you, Johnny, I also read this recommendation in almost all international experts’ report at the time of leaving Burma i.e. they must be the ones to evaluate Burma’s programmes in one year or more. If they had been able to build up our capacity as their assignments were meant to, there should not be any need for such recommendation which I felt was meant only for them to get another assignment in a year’s time. I showed my draft and discussed with the pediatricians in Bangladesh. They appreciated the fact that I did not put in a recommendation for creating an opportunity for myself. If by any chance you get a chance to do a similar assignment, please follow my example." I could still hear Saya telling me his principle of working, even for an international agency like WHO. Saya was also responsible for recommending that a senior lady consultant be made the first professor of paediatrics in Bangladesh, again another "first" for a male dominated field of medical sciences in Bangladesh.
Now, we take for granted that all children with diarrhea would be given ORS. But, as soon as Hirschorn and his team in International Centre for Diarrhoeal Diseases Research, Bangladesh published their findings, Saya told us that the "simple solution to save many lives" was available now and must be introduced to Burma. In the outpatients’ department in RCH, he would ask the staff to make literally hundreds of litres of ORS, put them in large containers with taps. These had large signs saying that any mother or any one could take as much ORS as they wanted without needing to see any medical or nursing staff in the hospital. Only if they were unsure of how to give, nursing staff and HS were available to teach. Saya started the OPD Rehydration centers in RCH, the second center to offer this after ICDDR,B and this was long before the Control of Diarrhoeal Diseases Programme and ORT were initiated globally.
It must be 1976 or 1977 when Saya made the first diagnosis of Dengue Haemorhagic Fever, when a series of children were admitted for fever with coffee ground vomiting. Initially, we all thought that parents had given aspirin containing Burmese medicine but he insisted on having salicylate level done. Having found no salicylate in the blood, Saya asked around especially Saya U Ko Ko and his pediatric friends in Bangkok, and thus, the first cases were diagnosed. Saya went on to developing simple treatment regimen for DHF and Dengue Shock. I owed Saya a lot because when my eldest daughter was having severe Dengue Shock Syndrome, with anuria for three days, bilateral pleural effusion and myocarditis, Saya would see Myo at least six to eight times daily, adjust her treatment and saved her life. Saya would also take time to talk to Marie and me to give us encouragement. Saya asked for WHO Research grant to prove that large doses of steroids being given were expensive and not needed. Saya tried, asked for and maintained microhaematocrits and plasma packs first in RCH and later in almost all paediatric units all over Burma, which must have saved hundreds if not thousands of lives.
Whether Saya is with us physically or in spirit and in his philosophy of caring for children, his students including myself will go on remembering and admiring him for all that he did for Burma’s children. Whether setting up Dehydration centers, OPD monitoring of DHF, or pioneering Nutrition Rehab Centres and standard therapy, saya will always be remembered for his clinical acumen and diagnostic excellence.
Since my house surgeon days and later as Saya’s AS, then Saya’s assistant lecturer, Saya’s lecturer in RCH, Saya amazed us with his clinical acumen and diagnostic skills. Almost every day, Saya would remind me of Arthur Conan Doyle’s professor of medicine in Guy’s Hospital who was so good in getting diagnosis of the most obscure cases; Doyle modeled Sherlock Holmes on his professor with the same logical and analytical skills. Saya would just be passing by through OPD and would shout, "Will somebody give Burplex to the child crying with Beriberi?" or "make sure that Xray of the hand of the child (who looked normal to us not to saya). The baby is crying like a cretin." Or "Johnny, why did you miss the case of diphtheria in this child with stridor? "Saya, I did have a good look down the throat and I cannot see any patches. " Johnny, did you smell the child’s breath, it’s typical of diphtheria. Must be laryngeal diphtheria. Keep a tracheostomy tray ready." Or " Is the child with typhoid OK? I smelled typhoid when I was passing by your ward?" Saya’s senses were so acute, which he used to diagnose disease in children from a far, not even touching them. Saya never said "the patient" it was always "kha Lay", Char taik", "ka chuut", "child" because Saya never saw these thousands of patients coming to the hospital as patients but as children. I emulated Saya when I became a pediatrician, a habit that humanizes every child coming to see me.
Saya founded the School of Child Health, first conferring Diploma only, training doctors who could man health centers and small hospitals, as there were not many pediatricians. Saya changed to the Master’s programme only when he felt that there were enough of his students all over the country doing "child health". Saya was considered by many internationally renowned pediatricians as one of the pioneers of social pediatrics like Dr. David Morley (who was one of saya’s very close friends).
Saya was appointed the Director of Medical Education, then, Director General of Health from which position he retired. He immediately took over as President of the Myanmar Red Cross Society until his health prevented him from making the much-needed visits to al parts of Burma.
I cannot stop here without describing the other side of saya, his strong sense of fairness, his joy being out in the field especially with his former students, his joy in asking dozens of us at the same time to his house to have meals and drinks with him, his firm conviction that only in a socialist state that the disparity could be addressed.
I can still see Saya in my mind’s eyes, rushing out of the MS quarters at 5.30 a.m. pushing the shirt into his trousers, an already tied but loose neck tie in the other hand, which he would loop around his neck and pull it up as he walked to his office. How any parent could wait outside his office and be seen by him between 6.00 a.m. to 8.00 a.m. every day. How every child who had never seen Saya before would slide down from their parents' laps to clamber over to where he was sitting.
Saya’s belief in ensuring enough protein and affordable one. I can still see him going out at 4.00 a.m. in the morning in the VW microbus with the hospital bursar and a few other staff to go to the jetty to get sea fish not just for the hospital but to encourage his staff to eat sea fish also (I was never convinced and still prefer fresh water fish!); his firm belief that there was no mother that he could persuade and help to breast feed, which he demonstrated time and again in the hospital.
His firm belief that health and nutrition education is the key to dealing with most problems in childhood in Burma. Saya with the help of U Chit San Win, wrote, published and distributed books in Burmese on breast feeding, nutrition, Dengue, child development and others many of which went into sixth, seven printings, very rare for books in Burma. For all these efforts, Saya was awarded the Ah Myo Thar Sarpay Su. The proceeds from these books never went to saya but to charities (and of course, the Children’s Hospital being Saya’s favorite charity, we benefited a lot out of Saya’s writings apart from being educated more). I wondered how many knew that Saya donated his earning from the Ahlone Thama Clinic also.
At the same time, I was also remembering other episodes: when I was a house surgeon, saya usually asked me to help out with his outpatients as I usually arrived quite early (but not as early as saya). One morning, at the end of the clinic, U Nyunt Maung, the Admin. Officer came in bringing with him one of the drivers, Mauna Aye, a Karen young man. His crime for being brought before Saya was that he took laundry to the Rose Bank Laundry, parked the car up Rose Bank Road, which was a hill but did not put on the hand brakes. The car rolled done across the Lower Kemmedine Road, and fell into the ditch on the other side denting the back of the microbus. Saya was very careful about equipment and supplies and about accountability (please see another anecdote below), so Saya said, "Maung Aye, Min Yaw Ya Mae." Meaning Maung Aye would have to pay for repairing the damage. Maung Aye replied, "Sayagyi, kyun daw ma yaw naing bar bu." That he could not pay for the repair. Saya’s voice was raised and he repeated, "Maung Aye, Min Yaw Ya Mae." Again the same reply. Saya then said to Maung Aye, "Maung Aye, min yaw ma lar, ma yaw bu lar. Dar naught sone mae nae dar."" will you or will you not pay for the damage, I am asking you for the last time. Maung Aye replied, "Sayagyi, kyun daw hmar paik san ma shi bar bu, ma yaw naing bar bu." I have no money and therefore cannot pay. Saya’s final remarks were so unexpected that I nearly busted out laughing. Saya said, "Ko Nyunt Maung, you heard what Maung Aye said. As Maung cannot afford to pay for the repair, repair the car with hospital budget." Only after Ko Nyunt Maung and Maung Aye Left, I asked saya why he said what he said last. Saya answered, " I did check three times whether he could afford to pay, so it will be recorded that I checked and finding that Maung Aye cannot pay, ordered the repair to be made by the hospital." Just showed how Saya was fair to this young driver, whom he could have sacked, or put some penalty or stop his increment.
When we moved to the new Children’s Hospital, Dixie (Khin Khin Win), Ko Mya Thein and myself – we collected donations, donated some ourselves to equip the ward especially Medical Unit 1 (Saya’s ward). Part of this was all of us collecting money among ourselves to buy nice materials for curtains for saya office. Even though we could not fix the curtain on the entrance door of his office from inside, Dixie advised us that we should put one outside so that even if the door be open, saya would have privacy and that this must match with all the curtains inside. Saya came, looked at the curtains and never even commented on them. A few days later, the three of us came on duty and immediately Sister informed us that the curtain to his door had been stolen. So, the three of us waited for saya to come, asked permission to see him to report the loss. Saya’s immediate response, " You three, as my assistants, are accountable for the loss!!! Sister, make sure that Mya Thein and Johnny replace the curtain with their own pocket money!" The three of us we did not know whether to laugh or cry on hearing saya’s remarks but came out. Dixie insisted that Ko Mya Thein and I pay her to buy new curtains with our pocket money. When we reached the AS Room, we were amazed and laughing as we bought the curtains and put them up ourselves and here was saya insisting we pay out of our own pocket money. A few moments later, saya came out, mollified and told us not to bother putting up another again but still insisting that Ko Mya Thein and I would be held accountable. The term "pocket money’ was used by Saya as his expression of accountability because he wanted to make sure that if money be needed it must be from the money that we would have spent on ourselves.
Saya was very disciplined, he taught us discipline and would also insist that we be disciplined. Saya came along with me on a field trip in Hlegu, and Ko Mya Thein and Nettie (Myint Myint Yi) insisted on coming along. We had to travel by boat for over an hour to get to a village. The village headman had arranged for us to eat soon after arrival. Saya started his discussion on how he felt that the three of us (like most of his former students) needed to be more disciplined, an example saya gave was how he disciplined himself to eat very moderately. At that time, saya had finished what was on his plate and asked Ko Mya Thein for a bit more. Ko Mya Thein’s reply," Saya, you talk of moderation and you have already been served twice so I do not think I should give you more." Saya’s answer." Ko Mya Thein, sar kaung doun, ta khar ta lar sar da bya,htae saya shi dar, dae kwar !!!" – occasionally when I find the appetite, I allow myself to eat, just put more as you are being asked. Ko Mya Thein, The headman and myself started laughing at saya’s remarks which saya himself joined. This was one of the many occasions where I saw saya very relaxed and enjoying himself just by being with his former students. His laughter, his smile, his hitting Ko Mya Thein on the back, jokingly saying, "Ko Mya Thein ga lae, Ruby kya nae dar pae, choke char gyin laik tar." We all laughed again because we always knew that Ma Ma would not or could not restrict saya from doing what he wanted to do at any time.
Such memories of a great man, a great teacher, a mentor, a man of principle, a man of vision. It is not just we, his former students, who have lost a great teacher but Burma has lost a great man.
Saya U Tin U passed away on January 24, 2006.