Growing up comfortably in the suburbs of Houston, I have been isolated from the turbulence my parents faced in Myanmar (formerly Burma) along their paths in medicine. But on occasion, the heavy curtains parted to reveal glimmers of their past. These instances occurred in passing—at the dinner table, in long car rides, and through phone calls. In those moments, I passively listened, absorbing what I could through my second-hand perspective. However, I dug deeper by interviewing my parents, taking a more active role in trying to fill their shoes and redefining my understanding of my relationship with them. The following series of poems—highlighting conversations on medicine in Myanmar, immigration to the United States, and implicit parental expectations—is an attempt to become immersed in this void.

Before starting, I wanted to share some—and not necessarily comprehensive—context about Myanmar. Myanmar has developed a notorious reputation in international media, heightened by the recent Rohingya Crisis and the 2021 Coup d'état amidst the COVID-19 pandemic. This isn’t a new development, as frequent conflict, often ethnic-based, has marred Myanmar’s existence following independence from British rule in 1948. Immediately after independence, internal strife took place as different parties fought for power. Though a parliamentary government was established, in 1962, a coup d'état resulted in a military dictatorship led by U Ne Win and the Burmese Socialist Programme Party (BSPP). In 1988, the 8888 Uprising occurred due to dissatisfaction with this rule, which prompted another military coup d'état that overthrew the BSPP and brought about Aung San Suu Kyi’s popularity for her role in the pro-democracy movement for the National League for Democracy (NLD). In 2011, reforms took place that promoted a nominal civilian government, though ethnic conflicts persisted. In 2021, another military coup d'état resulted in the civilian government being overthrown and restored military rule. Altogether, military rule has been steadfast in Myanmar since its independence.

Healthcare in Myanmar is commonly considered inadequate; though there is limited information about Myanmar’s healthcare system, its inadequate self-documentation is evidence that it is abysmal.[1] Under the first decade of U Ne Win and the BSPP, one of the few bright spots was healthcare, as government expenditures on health surged, leading to improvements in health indicators like life expectancy and an increase in the number of hospitals, hospital beds, and doctors.[2] These positives did not transfer into the present and were balanced by seemingly poorer living standards as consumer items were in short supply, leading to a reliance on the black market.[3] More recently, in 2000, the World Health Organization ranked the performance of Myanmar’s health system to be 190th out of the 191 countries in the World Health Organization.[4] Myanmar still has poor health outcomes in many health indicators,[5] which can be attributed to years of underinvestment as current health expenditure (% of GDP) hovered around 2% under military rule[6] and around 5% under the civilian government.[7] Additionally, out-of-pocket expenditure is one of the highest in the world at 76% of total health expenditure in 2018.[8] In practice, these issues have translated to shortages in specialists, drugs rendered unusable because of energy blackouts, and spread of epidemics like tuberculosis.[9] Similarly, researchers from the Humans Rights Center and Johns Hopkins reported the rise of drug-resistant malaria, the circulation of counterfeit antimalarial drugs, and the crippling outbreak of tuberculosis.[10]

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The conditions described above are reflective of the development of my parents in impoverished conditions and strife. Many of the aforementioned issues were stated verbatim in the interviews. While facing these challenges, both were able to obtain the necessary medical training to practice in Myanmar, but they had varying degrees of success in the transition to practicing in the United States. Nonetheless, their experiences in Myanmar continue to impact their outlook and their children’s outlook on medicine, profession, and life. They appear frequently in my relationship with them through snide comments, bitter disagreements, and differing expectations. Unsubsiding confusions abound in me. Why can we never get along about career choice and professional development? Why is praise rarely expressed but criticism frequently handed? Why does their leash seem to tighten as I become more independent? I aim to address and meditate on these conundrums in the following poems by detailing prominent moments in their childhood, medical training, and immigrant experiences to provide potential rationalizations and increased sensitivity to their respective backgrounds. Even more essential to the heart of my work, I hope to fill in the vacant jagged edges, the unspoken aspects of our relationship, and grow closer to them by understanding them not as parents but humans—perfectly imperfect—in the double vision of our generationally fissured immigrant realities. Maybe one day, when I gain the strength, I’ll personally express to them the sympathy and acceptance of their outlook I gained from the creation of these poems. Perhaps I’ll even share these poems with them.

Bibliography

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• Anwar, Yasmin. “Burma Junta Faulted for Rampant Diseases.” UCBerkeleyNews. Accessed August 12, 2021. https://www.berkeley.edu/news/media/releases/2007/06/28_Burma.shtml.

• Butwell, Richard. “Ne Win’s Burma: At the End of the First Decade.” Asian Survey 12, no. 10 (1972): 901–12. https://doi.org/10.2307/2643067.

• Francis Khoo Thwe. “Myanmar Faces Medical Emergency with Unusable Drugs and Shortage of Doctors.” AsiaNews, August 23, 2013. http://www.asianews.it/index.php?art=28811&l=en.

• Risso-Gill, Isabelle, Martin McKee, Richard Coker, Peter Piot, and Helena Legido-Quigley. “Health System Strengthening in Myanmar during Political Reforms: Perspectives from International Agencies.” Health Policy and Planning 29, no. 4 (July 1, 2014): 466–74. https://doi.org/10.1093/heapol/czt037.

• Tandon, Ajay, Christopher JL Murray, Jeremy A Lauer, and David B Evans. “Measuring Overall Health System Performance for 191 Countries.” Geneva: World Health Organization, 2000.

• World Bank, “World Development Indicators Myanmar Country Statistics,” 2021, https://data.worldbank.org/country/myanmar.

• World Health Organization, World Health Statistics. Geneva: World Health Organization, 2021.

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Footnotes

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[1] Isabelle Risso-Gill et al., “Health System Strengthening in Myanmar during Political Reforms: Perspectives from International Agencies,” Health Policy and Planning 29, no. 4 (July 1, 2014): 466–74, https://doi.org/10.1093/heapol/czt037.

[2] Richard Butwell, “Ne Win’s Burma: At the End of the First Decade,” Asian Survey 12, no. 10 (1972): 901–12, https://doi.org/10.2307/2643067.

[3] Ibid, 909.

[4] Ajay Tandon et al., “Measuring Overall Health System Performance for 191 Countries,” Geneva: World Health Organization, 2000.

[5] World Health Organization, World Health Statistics, Geneva: World Health Organization, 2021

[6] The World Bank only has data starting from 2000. The transition to a civilian government occurred in 2011.

[7] World Bank, “World Development Indicators Myanmar Country Statistics,” 2021, https://data.worldbank.org/country/myanmar.

[8] Ibid.

[9] Francis Khoo Thwe, “Myanmar Faces Medical Emergency with Unusable Drugs and Shortage of Doctors,” AsiaNews, August 23, 2013, http://www.asianews.it/index.php?art=28811&l=en.

[10] Yasmin Anwar, “Burma Junta Faulted for Rampant Diseases,” UCBerkeleyNews, accessed August 12, 2021, https://www.berkeley.edu/news/media/releases/2007/06/28_Burma.shtml.