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Lights of Diversity September 5, 2012

Posted by Nazneen Uddin in Luce, Malaysia.
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As I sit on the monorail train heading to work, I gaze at the landscape around me: a multitude of glistening skyscrapers embedded against lush greenery and village homes.  In a span of two minutes, I spot a set of minarets hiding behind a turquoise dome, a red rooftop with gold ornamentation from a Buddhist temple, a pyramid-shaped tower of gods arising from a Hindu temple, and a white cross hanging atop a Gothic style church.

Eid prayer at National Mosque

I am distracted by the young woman in front of me wearing a beautiful red sari, speaking to her friend in Tamil.  I turn to my left, and see a mother speaking to her son in Mandarin, while on my right, I hear a woman in a pink headscarf speaking Malay on the phone.  When I reach my stop, I pass by a hawker stand and smell the aroma of fresh Naan, fried Chinese noodles, and an array of colorful Malay sweets.

As I try to grasp the richness of the diverse cultures of Malaysia, I head to a women’s crisis shelter to give a talk on prenatal care. I am humbled by the stories the victims of domestic violence share. One woman narrated that she was alone at home with her five-year-old son when she started having  contractions. She delivered the baby with the help of her son.  The umbilical cord was not cut until three hours later when the ambulance finally arrived. Luckily, she and her baby survived with no impact to their health.

As I walk home, I pass by an endless line of green lights in honor of the month of Ramadan, when Muslims fast from sunrise to sunset refraining from any food or drink. Stalls stud the streets, selling everything from fresh coconut water to chicken soup for the daily Pasar Raya, or Ramadan market.  People are flocking towards the market carrying bags of food home for their families as sunset nears.

Food market during Ramadan

Chinese New Year lights

Six months prior, I remember the same street had red lanterns in honor of Chinese New Year.  In Malaysia, every religion has its holiday honored, and open house invitations are sent; regardless of your faith, you are invited to homes to eat, exchange gifts, and celebrate  together.  Various shaped lights in an array of colors illuminate the streets for each festival – be it Diwali, Christmas, or Eid.  I reflect on the enormous diversity in America, and how much more enriching it would be if we adopted a similar culture of honoring each other. There is always another celebration and set of lights to look forward to, and has made living in Kuala Lumpur an exciting experience of exponential growth.

Mall decor at Christmas

Mall decor at Diwali

On the Run June 5, 2012

Posted by Nazneen Uddin in Luce, Malaysia.
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Nazneen Uddin

Nazneen Uddin

Never judge a book by a cover. And never judge a country by its looks.

The several, newly built skyscrapers that glitter amidst lush greenery and the well-paved roads, high speed public train lines, and clean streets makes Kuala Lumpur seem too pristine to be true.

Malaysia prides itself on being a middle-class country, and upon seeing the skyline at first glance, I thought it would be difficult to find a medically related placement that would satisfy my intended goal of serving the undeserved population.

  

However, I quickly came to learn that amidst all this glitter, there were gaps that needed to be filled.

One such gap is the rising population of  refugees, with estimates from the United Nations High Commissioner for Refugees nearing 100,000, primarily from Myanmar, but also Sri Lanka, Somalia, and Afghanistan.  What makes the situation especially delicate is that Malaysia is not a signatory to the 1951 UN convention for refugees, and as such, their presence in the country is a delicate one.  Many of them are assaulted and robbed by locals,  face harassment from cab drivers, or are put in detention centers by police authorities, even if they hold a UNHCR card.

I joined one of the NGOs that runs a clinic for the refugees and every day, I am astounded by the cases that come through the clinic.  Designed to be a family medicine primary care clinic focusing on preventive health, it is more or less like an emergency room or urgent care center.  Because of the language barrier, the high cost of medical care, or fear of being caught by authorities, the patients are often scared to seek medical attention in the local hospitals. So by the time they come to the clinic, their clinical presentation is often very advanced.  I’ll never forget one Burmese man in his mid 20s who  presented to the clinic with fatigue.  On further questioning, he had diarrhea and chills and on physical exam, he was in acute distress with a high pulse rate and respiratory rate. He also had a rash distributed throughout both arms and oral thrush.  Suspecting HIV, we did a rapid test which was positive, and immediately sent him to the hospital for further work-up.

Occupational injuries are also very common.  Many of the refugees work in very challenging, high-stress environments such as plantations, factories, or restaurants.  They work long shifts, have extremely low wages, and little, if any benefits.  I never would have thought to do this at first, but now I examine every patient’s hands, as many of them have missing digits from being cut in a machine, or have rashes from washing dishes or cleaning with bleach without the use of gloves as it will “slow down” their work.

Moreover, many of them have a past medical history, such as a congenital heart condition, TB, or a fracture that was neglected in their country of origin because of the lack of adequate healthcare or loss of follow-up given the unpredictability of their life.  I remember seeing one man in a mobile clinic we ran in a rural farm who was walking crookedly because of a childhood accident–it had resulted in a tibia fracture that never healed properly.  Despite all the pain, he continued to work in the plantations.

Given that many of the refugees live in pocketed areas, cannot open bank accounts, and cannot speak the local language, they are especially vulnerable to assault.  I’ve seen everything from deep head lacerations, black eyes, lost teeth, and knife wounds for what amounts to a mere 15 USD or a cell phone.  One young man lost his sight, voice, and has both hands disfigured from a severe burn because an official, at a detention center he was held at for not having a UNHCR card, asked him to change a light bulb but did not turn off the fuse first.

Mental illness is also quite common. We were astounded to find one of our long-term patients experiencing uncontrollable convulsions from ingesting insecticide as a suicide attempt. A Sri Lankan native, the suffering this man faced in his country and the continuous stream of struggles he faces in Malaysia were more than what he could bear.

Interestingly, the word for refugee in Malay is perlarian, which literally means “a person on the run.” I will be forever indebted to each of the patients.  Not only did they teach me more about their medical condition, but they taught me how brave and resilient the human spirit can be when running away from oppression and injustice.