Doing Ethnographic Research during Covid-19 at Myanmar’s Main Public Hospital by Nora Wuttke
by Nora Wuttke
1st of July 2020
“Don’t take buses or taxis; it is better to walk” – and all of a sudden, my physical world became very small. At the same time, an infinite digital realm overlaid everything with its expansiveness. The tensions and discrepancies between experiences in “my” world and the digital discourses (mainly spun from Europe and the US where death rates where rising and mental health discourses flourished) paired with what was happening in the city (nothing really) versus frantic preparations at the country’s main public hospital for an influx of infectious patients (which might or might not come at this stage, late into the Covid-19 era) has since been a constant source of wonderment.
I have been in Yangon from January, since I returned for a brief break over Christmas to my field site – Yangon General Hospital, Myanmar’s biggest public hospital. Witnessing a global pandemic through the lens of a public hospital in one of the worlds most underfunded healthcare systems is a tremendous opportunity as well as a constant assessing and re-assessing of risks and associated ethics in doing research in a hospital at this time.
Since the first cases have been publicly confirmed the campus became a different place. The hospital reduced all non-essential services and made services available only by appointment. The crowds that usually populate the spaces between the clinical buildings vanished (patients only now are trickling back-in, two months after first cases have been announced in the country), functions have been re-organised and processes seemingly streamlined. It is astonishing what a pandemic can “do” where years of advocacy failed. Handwash basins have been installed all over the hospital campus and the city. An entire country with at best poor hand hygiene practices (due to a lack of fresh water sources), is washing its hands – and is flushing toxic soaps and other chemicals into the (if existent) poorly maintained surface water drains which inevitably lead to the groundwater. The cleanliness of our hands turns to toxic waste downstream.
I live on Yangon’s chemical street. All kinds of chemicals, food replacements, tastes and smells are sold here, alongside the containers to hold these items. Since February activity on the street was heightened. Plastic bottles, alcohol, and other ingredients necessary to make hand sanitiser were carried off in astonishing quantities, quarrels broke out. The USDP Party office next door (the opposition party to Daw Aung San Su Kyi’s NLD) went into production of hand sanitiser; little bottles popped up throughout the township – it is election year. Walking down the road one Sunday afternoon just before the lockdown my friend and I strategize over making hand sanitiser ourselves and who of our friends would like some. She points out that heaving litres of raw alcohol in a downtown apartment in Yangon, a city with a just about functional fire brigade and apartments with non-existent fire exits, might not be the smartest thing. I realise I live on combustion street.
The atmosphere in the first weeks of the WHO declaring a global pandemic was tense. Embassies asked their citizens to return home; the fragile Myanmar healthcare system would get overwhelmed in case of an outbreak. I decided to stay and kissed my partner goodbye when he boarded the last flight out of Yangon back to London via Dubai. I embarked on a nightmare marathon of bureaucracy to extend my visa and get a From “C” which permits me to reside in my apartment.
At this time between one to four cases were confirmed per day. I received my papers mere hours before the ten day lockdown started on the 10th of April over the Thingyan holidays; ten days of strangely engaged isolation – busy with loudspeaker announcements on my street overlaid with Facebook posts, analogue announcements confirming the digital alongside a nervous WhatApp group of expats who decided to stay. This year Thingyan had been “cancelled”. Celebrations of throwing water at any moving target and big crowds around loud stages with pop music were forbidden and Myanmar moved quietly into its new year. People seemed routinised with the restrictions on movement and gathering – a hangover from the past decades maybe.
My daily walk to the hospital takes me out the door, down 5 flights of stairs, past Mr A who may or may not guard my apartment building, up the typical downtown-Yangon street planned on the infamous colonial grid, onto the main road. At the corner of the main road vendors switch with the sun – in the morning ladies sell breakfast snacks, then shoes move in before DVD’s take over in the afternoon. Along the main road I pass two market streets and one of Yangon’s biggest markets in downtown, I walk diagonally across a big junction via an overpass, constructed after the 1988 uprising, past public toilets, before turning left into the campus of Yangon General Hospital at the mortuary-gate where bodies leave YGH for the last time.
Except for the ten-day country-wide lockdown that coincided with the annual Thingyan celebrations, I continued this daily journey. With the lockdown from the 10th of April the shoes and DVDs disappeared first, the market closed, a few days later the breakfast ladies, safe for one, stop turning up. The open-air street markets never seem less busy than usual.
After the city-wide lockdown is lifted and only selected townships which had more than 6 cases, including mine, were placed onto an extended stay at home order, my street was blocked off. Cars could not enter. The first few days after Thingyan I must sign in and out when I leave my street for shopping and work, later a mere wave and “I am going to work” is sufficient. A couple of times I am questioned if I live here as I am leaving the street. Neighbours jump to my side and confirm the legitimacy of my residency. When the lockdown is lifted from my township it is almost two months later and the relief of everybody on my street is palpable.
By the beginning of June, Myanmar had officially announced 228 Covid-19 cases including 6 deaths. First cases were announced on the 23rd of March in the evening and since then testing has remained low. By the end of May only 0.04% of the total population has been tested (based on official Ministry of Health numbers and the 2014 census). According to the Ministry of Health 62% of tested cases (22791 as of 29.05.2020) are asymptomatic.
Since mid-May no in-country infections have been announced by the Ministry of Health and Sports; all cases since case number 182 have been returnees from Malaysia, Italy, UAE and India (as of 2nd of June). The message from MoHS seems loud and clear – Covid-19 is a disease from outside Myanmar brought upon the country.
This has been the line since the first cases were officially announced in the last week of March; case one and two were returnees from UK and US – us foreigners who stayed were relieved that they were Myanmar citizens returning from abroad, not foreigners.
With these two first cases, the atmosphere at YGH changed. I could see that patients and their family members were weary of me, they stepped out of my way and started whispering when I walked past. A level of xenophobia became palpable. Even acquaintances asked meekly when I had last been to Europe. I made sure to greet anybody I know when wandering the hospital campus, exchanging a few Burmese words, loudly, to signal my “belonging”; I could almost feel people relaxing around me when they realised staff knew me and I spoke their language.
Together with the hospital administration I discussed what I could still be doing for my research during the pandemic; we settled on research in non-patient areas and with staff that is less busy at this time.
My research with patients was (and continues to be) thwarted, I cannot go onwards and building relationships with people through masks is challenging when people are weary already. However, many of the staff know me and knew I had been there before the pandemic. Staying and continuing my research seemed to promote trust. I spend weeks with one group of workers, the stillness I found remaining in one spot, proofed to be an unexpected benefit to my research. Till today, entering new departments, which essentially are new fields in themselves, is draining and still requires a lot of effort through the inevitable literal filter over my mouth, which is mandatory now. All departments are working hard on infection control measures. In the city and around the hospital campus the atmosphere relaxed and rather turned into curiosity.
It is unlikely that Covid-19 found its way into Myanmar only in March (when testing in-country started); the ties between China and Myanmar are close, borders are porous.
What changed from before the 23rd of March? What changed since the lockdown over Thingyan? What changed after the countrywide lockdown since Thingyan when my township was still under lockdown, but we were allowed to go to work?
Despite the agreement I reached with the hospital administration to continue my research at YGH in a limited capacity and no official lockdown until April 10th, ethical concerns kept creeping up, alongside safety concerns; Myanmar is not a country with a hesitant military when it comes to controlling its people.
The first weeks, until the official lockdown was announced from the 10th of April for 10 days, were tense and filled with anxiety to stay on top of rapidly unfolding events, on Facebook, in Burmese language and messengers, and a constant assessment of risks – risk to myself as a researcher but more importantly risk to my interlocutors and to patients. I was ridden with concerns over possibly infecting the people around me. YGH workers all live in one area in Yangon. The infection of one could have a tremendous ripple effect and cause serious trouble for the hospital – if suddenly their general workforce (cleaners, runners, maintenance staff etc) would be sick. Admittedly this is a worst case scenario and that I am the cause of it is unlikely; but since the last few months worst case scenarios have played-out all over the world (alongside best case scenarios and everything in between) – it is a consideration.
I got a reprieve from constant worries for 10 days during the Thingyan holidays. Yangon emptied out. People were ordered to stay at home, isolate and distance. I bought food and water, ordered vegetables and did just that – isolate and distance in the most literal sense. I did not leave my apartment for nearly 10 days; on day eight I caved in and walked several buildings down the street to the banana shop with a turquoise door to re-stock. I recorded all loudspeaker announcements diligently and was happy when my Burmese teacher told me that she also had issues understanding all of them.
Since the country wide restrictions were lifted on the 20th of April, I did not see any friends for 6 weeks. Following the country wide “stay at home order” my township has been put on a “soft” lockdown together with first seven, then ten townships; gatherings of more than 5 people are forbidden, only one person per household is allowed to leave the house for shopping food and only two can go together when someone is sick (from my work at the hospital I am aware that people like to attend with their entire family). We are allowed to go to work. I spent a long time thinking about the implications and keep re-evaluating my earlier decision on a daily basis.
Even though I am technically allowed to keep doing my research, it is clear that the government wants to restrict movement and reduce the chances of infections but also need to allow people to work to keep the economy running. Obviously, I am not a cog in this particular machine, I won’t starve if I don’t continue my research.
However, I decided to continue my work. I am exercising even more care than previously on campus. I reduced my hours doing fieldwork at the hospital to not have to sit or eat on campus, use bathrooms or other facilities. During my daily hours at YGH I keep sanitising and washing my hands; I bring soap for the department I work closely with. One reason for me to continue my research through the crisis is that I gain valuable insights into the day to day of a major hospital during a global pandemic. I am probably one of very few anthropologists at a hospital right now. And so I continue to follow YGH’s infrastructure, its pathways, pipes, wires, walls, public spaces, buildings and gasses, to write an ethnography of its daily life, a compilation of the campus’ many rhythms. The aim is to answer the slightly naïve question what a good hospital is today and will have to be tomorrow; a pertinent question as Covid-19 showed so painfully over the past months. I ask how healthcare infrastructures are conceived of and used; all the while being thrown back onto the question of what a hospital is in the first place?
Till the beginning of June, Yangon General Hospital has yet to see the high influx of Covid-19 patients it is preparing for. Lockdowns are lifted, plastic partitions go up between diners in newly re-opened tea shops and people are fined when not wearing face masks. The breakfast ladies on my street returned, DVDs are sold. Only the shoes have not yet shown up again.
Nora Wuttke is a PhD student in the Department of Anthropology and Sociology, SOAS University of London. Her main interest is the reciprocal effect of the built environment, individuals, society, and the state. She has experience leading international teams on urban planning, architectural design and government advisory projects.