1st vs 3rd World Expectations

After a bumpy start in Reproductive Health (ehehe), Ive been spending Wednesdays in the Surgical Department – a concrete block towards the back of the Clinic, to the left of the sea-blue plastic water tank.

Surgical Department

Thongs (flip-flops) of all sizes are heaped up outside the doorways in accordance with Buddhist shoe-removal etiquette. There is a 40-bed ward, two procedure bays, an outpatient clinic, a small, air-conditioned operating theatre and a staffroom (like all public hospital staffrooms) filled with stray chairs, unstable piles of notes, watermarked textbooks, empty bottles of Coke and Red Bull and a PC that looks like a grey rock stuck to a desk. This one also has a litter of indifferent kittens huddled in the base of the bookshelf with an entourage of fleas – less familiar, although no more disturbing than some of the things I’ve stumbled across on top of NHS staff lockers.

Entering a surgical inpatient ward barefoot is a disorienting sensation. After two or three times you start to get used to it, and to the curry bowls and green banana bunches everywhere, the cats (graduated from the bookshelf) and the patients lying in rows on wooden beds, all in the one room, with relatives mingling in the aisles. It’s a large, airy space, like how I imagine makeshift war hospitals might look like, with missing ceiling tiles and noise from a lone TV buzzing in the background.

Most of the admissions are for treatment of conditions like infected ulcers and burns and chronic cellulitis, or for post-operative care following on-site hernia and hydrocele repair. There are also occasional swathes of young men presenting with severe penile infections caused by unsterile injections of coconut oil into the shaft. How word hasn’t got out yet that this is a bad idea, I don’t know.

In the outpatient clinic I’m paired up with one of the medics, a Karen man who’s been studying or working at the Mae Tao Clinic for the past thirteen years. Together we assess patients with an array of wounds, work injuries, dog bites, abscesses, sprains, lacerations and lumps, mostly in the neck, breast and groin. They tend to stream through the door, one by one, in either a light trickle or a patient tsunami.

One young man walked in the morning after accidentally mangling his index finger with a machete while cutting down stems in a field (or something). He was joking around with his friend and seemed to have no trouble accepting the fact that there was a bloody stump where half a finger used to be – not something stitches could fix.

I thought back to the last severed finger I had come across, in a London A+E a few months before. A middle-aged woman had stuck her hand through her neighbour’s letterbox and had one of the tips bitten off by an overly zealous housedog. What happened next was difficult to follow. She called for help and somehow 3 friends appeared and managed to sidestep the dog, retrieve the fingertip and put it into the neighbour’s freezer, directly on ice (this is the wrong thing to do btw – readers take note!). Then when they arrived at the triage desk, bewildered and flushed, they realized the finger was still in the freezer and the ambulance had to turn around and go back for it, sirens blazing.

More drama ensued. To cut a long story short, my whole day was taken up with this finger, not least because while I was on the phone arranging an urgent referral to the plastic surgeons at a specialist hospital in the unlikely event they could somehow reattach it, the wide-eyed patient and her not-so-helpful but well-meaning posse jumped the gun, presumably in a fit of collective anxiety, and raced out the door without telling anyone, without clear instructions or a trackable mobile phone. And they forgot to take the finger. Again.

I remember wrapping the poor, frostbitten thing in a shroud of sterile gauze and noticing it looked very dainty and well tended-to. A perfect nail painted an inviting shade of coral, with a glitter sheen.

It would make sense that First World fingertips get more attention than the ones on the Thai-Burma border (except when they’re in the freezer or on a hospital desk). The loose phenomenon is one of Adaptation  – of priorities, expectations and distress levels falling in line with the resources at hand (ba-doom).

This is something that’s been on my mind a lot since moving to the edge of one of the least developed parts of Asia, where I happen to find myself spending a lot of spare time reading articles and blog posts related to current debates on the connection between happiness, expectations, and reality. Like this one: Why Generation Y Yuppies are Unhappy. And this one: Fuck You. I’m Gen Y, and I Don’t Feel Special or Entitled, Just Poor.

Some incipient thoughts on the psychology of 3rd world expectations:

There is a undoubtedly a positive side. Deprivation can bring out remarkable levels of human resilience (from experience, the converse is also true). And even observing it can instill a sense of perspective that is difficult to maintain in conditions of saturated affluence. Almost every morning at the clinic, often while fumbling with a cold thermos filled with mixed fruit frappe, I walk past another young man with both arms missing, likely an old landmine injury. Things like that make you remember – or realise – what matters. Fingertips and spilt fruit frappe don’t make the list.

There is also a disturbing side – the apparent resignation, or passive acceptance of a miserable status quo. Unlike a distal phalynx, the penis is a near-universally revered and undeniably useful appendage. Yet some of the young men who wander over to the procedure bay for their daily dressing changes seem almost resigned to the fact that theirs looks like it’s about to drop off. Maybe it’s just because I can’t read their anxiety, or maybe they don’t understand the potential long-term consequences. Maybe on discharge they’re planning to go out and start an awareness-raising/prevention campaign, with flyers and street theater, to alert other men in the community to the dangers involved.

It’s hard to tell.


Photo Essay – Saturday morning in the market


I have to confess I haven’t cooked anything – not one thing – since moving to Mae Sot six weeks ago.

Once I went to Tesco Lotus and bought some items with the view to cooking them, but when I got home hungry I unwittingly bit into a raw mackerel, then spat it out on the floor, then spent the remainder of the evening cleaning up mackerel juice and scrubbing my hands instead of cooking (or eating). And that was that.

For budget reasons though (and to avoid diabetes/high blood pressure/obesity), I will need to start. To get the ball rolling I decided to take a Saturday morning class at Borderline – a store and gallery that sells handwoven crafts and art and makes very good Burmese vegetarian food – and learn how to shop in the local market.

My guide, Bo Bo, was a man in his early thirties from Shan State who (like many here) is planning to go back to Burma sometime in the next few months. He was calm, friendly and very fit, with both arms covered in tattoos.

Bo Bo explained that the market is divided into three parts – first Thai, which blends into Burmese, which blends into the Burmese-Muslim covered market.

We mainly shopped in the open-air Burmese stalls.

market umbrellas

   As someone with pale skin, I was struck by the high levels of sun sense amongst the locals. The methods depend on which part you’re in: baseball caps, loosened headscarves, warm glowing umbrellas, thanaka cream, those conical Asian hats designed to protect from sun and rain while toiling in rice paddies, etc. I think the Burmese ones are made of bamboo. They’ve also (like many things here) been known to double as a political symbol.

eam made from ground bark, and one of the main ways I tell whether to say 'mingalaba' (Burmese hello) instead of 'sawade ka' (Thai).

This woman has Thanaka on her face. It’s a distinctive yellowish-white cosmetic suncream made from ground bark, and one of the only ways I decide whether it’s better to say ‘mingalaba’ (Burmese hello) instead of ‘sawadee ka’ (Thai).

Thai man in a cap

Betel leaves, pressed into intricate whorls, can be found everywhere. They’re used to wrap up the wood-like areca nut (‘betel nut’) along with tobacco, spices and lime, a calcium-containing substance that’s meant to aid digestion. This little bundle (a ‘betel quid’) acts as a mild stimulant, like drinking a cup of coffee.

New leaf – betel leaf

New leaf – betel leaf

Chewing betel quid is a widespread habit in Asia. It’s believed to have medicinal properties but has unfortunately been linked to a number of diseases including gastritis, kidney stones, birth defects and oral cancer.

Most ironically, it’s rumored to be good for dental hygiene – this has not been my impression. The dentition here is not good. The leaves deliver tannins which stain a deep dark red, and some of the patients I’ve seen give the impression that they have a mouthful of blood and rust and are chewing on shards of their own rotten teeth.

Betel nut – deceptively pretty

Betel nut – deceptively pretty


Bags of lime. Hmn.

But betel was not on our shopping list (although, despite the carcinogens, I am curious to get a betel buzz and watch my spit turn red).

Some essential ingredients, whether you’re Thai or Burmese, Buddhist or Muslim (or even farang [1]): rice, dried chilies, limes, eggs and a wide variety of fresh vegetables.

rice fresh vegetables and mangoes

dried chilies

limes Eggs and dried fish

Another new fruit…

Custard applies on a cart – like a pile of sweet grenades

Dragon fruit – more exciting on the outside

Dragon fruit – more exciting on the outside

And some more familiar ones.


Pineapple patterns


Incandescent banana bunches




They somehow seem more vivid scattered around in the morning market heat, as opposed to ordered and spaced out in an air-conditioned supermarket.






I was so drawn to these watermelons that I asked to buy one so I could take a bunch of photos without feeling too awkward.



N.B. not the lightest fruit




Somehow I ended up with four, that ended up in Bo Bo’s backpack. I don’t think he was too thrilled. Watermelon is not the lightest fruit.



Fermented fish paste, or ngapi, is a staple of rural Burma/Myanmar, especially the Irrawaddy Delta. I noticed it was a recurring thread in the autobiography ‘Little Daughter’ by Zoya Phan, a young Karen woman who was forced to flee her village at the age of 14 when it was attacked by the Tatmadaw (the Burmese Armed Forces). She is now a prominent activist living in the UK, where she has political asylum, and remains a vocal critic of the current Burmese government.

Fish paste seemed to be one of the few points of continuity for her and her family when they were living for many years in refugee camps in Thailand.

fish paste

Karen comfort food – kind of like my cold Milo or macaroni cheese (except they don’t smell like putrefying flesh)

Other hallmarks of the daily Burmese diet.

Ingredients for the national dish, pickled tea leaf salad (otherwise known as လက်ဖက်သုတ်). In Burma, they don't just drink tea!

Ingredients for the national dish, pickled tea leaf salad (otherwise known as လက်ဖက်သုတ်). In Burma, they don’t just drink tea!

Banana stems (note the scale – they’re huge!). One ingredient in mohinga, a popular breakfast that consists of fish soup with rice noodles and fresh herbs (and other things). It’s up there with tea leaf salad as far as iconic Burmese dishes go.










As a child of divorce, I have 3 little half-siblings aged 7, 5 and 2 years old. For some forgotten reason I call the middle one “Froggie” and when I first saw frogs in the market it sparked the idea of compiling a photo scrapbook of the creatures in Mae Sot to send to them.

fish 2 atzsnail

aturtle 3 aturtle eel

But then I realised it would be like sending them a documentary on Guantanamo Bay.

Or a DVD of The Shawshank Redemption.

Or a storybook version of ‘Tales from the Crypt’.

Maybe it’s time to come up with a new nickname.

It’s a well known fact that Asians aren’t squeamish when it comes to their dead animals. Surrounded by buckets of slime-covered gizzards, beaks and feet and lone pulpy eyeballs, and bloody white entrails slopping out all over the place, I thought back to the neat little plastic-covered bundles of light pink chicken breast at the Herne Hill weekend farmers’ market.

In the Western world, where everything tends to be highly sanitized and over-packaged, there a lot of distance between us and the things we eat. I, for one, have never so much as seen a live headless chicken let alone slaughtered my own cow. And Anglo-Saxons like our meat very dead, in pieces (not all the pieces) and preferably a bit cute-looking.

Chicken ballerina

A chicken foot stretches out daintily into the warm air, like that of a tired ballerina.

Asians also like to eat insects. But it seems Westerners are the odd ones out again – in fact we’re behind the food 8-ball.

Entomophagy – the human consumption of insects as food – is common in most parts of the world, in almost every culture, on every continent. It’s even currently being explored as a potential way to solve global food insecurity. And (like sushi in the 90s) it looks like it might just be starting to become ‘trendy’.

High protein, low-GI, crunchy and salty, a solution to malnutrition and global warming….what more could you want from a snack?

Mae Sot is a major Thailand-Burma trade hub. According to Bo Bo the fish here comes from either the freshwater Moei river, tracing the border, or the Andaman Sea in lower Burma, south-west of the Bay of Bengal. The source affects the level of saltiness so it’s important to ask about it before you commit (N.B. this is not going on my expanding list of phrases-to-learn anytime soon).


Decision time

row of fish

“Salt- or fresh-water?”

Dried shrimp

Heaped trays of sun-dried shrimp, shrunk down to thumbnail size. A handful is often thrown on the top of Southeast Asian dishes.

Another random reminder of being in a border town.

Army men with flowers. These guys seem pretty chillax at least.

Thai army man with flowers

Mae Sot is adjacent to Karen State, Burma. Armed conflict between the Karen National Union (KNU) and the Burmese government is the world’s longest running civil war. Over the years it has spilled over into Thailand in fits and starts, mainly in the form of masses of displaced villagers. From what I understand, the fighting has been at a relative standstill since 2012. As it’s not an international conflict, I wonder what sort of role the Thai security forces have had (in Mae Sot at least).



After collecting enough fruits, vegetables, herbs, grains and fermented things we ended up in a Burmese tea shop located down one of the side alleyways.

Bo Bo and I had a very interesting Q+A about the history of tea and coffee in Burma and how it mirrors the political and economic upheaval of the past century.


I think the same must be true of the food. From what I can tell it’s infused with the complex myriad identities of this fractured country and its 60 million inhabitants – roughly two-thirds Burman and one-third ethnic minorities – living at the edge of Southeast Asia, squished in between two rising global powers India and China, and still struggling with the reverberating effects of their colonial and military-coup-dominated past. Although luckily it would seem the British had more of an influence on drinking habits than on the food.

cup of Burmese tea

All this makes a Saturday morning shop in the market more thought-provoking than a trip to Coles or Sainsbury’s.

[1] Foreigner in Thailand – generally a white person