Medical workers take a swab sample from a patient with COVID-19-like symptoms at the Insein Fever Clinic on October. (Hkun Lat I Frontier)
Medical workers take a swab sample from a patient with COVID-19-like symptoms at the Insein Fever Clinic on October. (Hkun Lat I Frontier)

Fever dream: inside a Yangon fever clinic at the epicentre of the pandemic

In a Yangon fever clinic, a photographer witnesses the breadth of emotions the COVID-19 crisis has brought in the time it takes to return a single batch of rapid antigen tests. 

By HKUN LAT | FRONTIER

A medical worker, clad from head to toe in personal protective gear, sat behind a glass partition, ensconced in a hastily constructed box that sealed him off from the outside world. Outside of it, three more health workers – also covered in protective gear – ushered a man onto a seat in front of the partition and advised him to lean forward and tilt his head back. 

Through two holes in the box, the arms of the medical worker inside reached toward the man’s nose with a cotton swab, the medical worker’s plastic-sheathed arms moving stiffly from the box like some intergalactic robot. A few feet away, along the wall of the Insein Fever Clinic, about 100 people paced in line, waiting to be screened by doctors for what they believed were symptoms of COVID-19. In the back of the clinic, more than 40 people who doctors had already screened and recommended for testing waited their turn.  

It was the first week of October, and I had just finished a two-week hotel quarantine, followed by another week at home, after returning from Rakhine State shortly after Myanmar’s second wave of COVID-19 had broken there. I was tested upon my return in September and spent three agonising days waiting for the result to come back (negative, much to my relief).

Early in the first wave of the pandemic I followed a team of swab collectors from the government’s Department of Medical Research as they took samples at a quarantine hotel in Yangon. Back then, testing required several, labour-intensive steps, without strict adherence to which the samples could be rendered useless by the time they reached government labs. First, the swabs had to be put into a viral transport medium in a sterile tube, which then had to be wrapped in plastic and kept on ice. Samples taken from the field in Shan or Rakhine could take days to arrive. At the lab it took technicians an hour to unpack the samples, after donning full protective gear. They would combine the test tube contents with a chemical reagent and process that mix through a RT-PCR machine for at least four hours. Results weren’t available to patients for another 24 hours. 

But by that first week in October, the Ministry of Health and Sports had begun using rapid antigen tests purchased from South Korea, and I had come to the Insein Fever Clinic to see them in action. So many people had arrived wanting to be tested by 9am that social distancing became impossible. The clinic – a repurposed township hall – was packed, and there were more people queuing outside.  

With the South Korean kits, medical workers mix the swab sample with a chemical reagent and  apply it to a test strip. Within 15 minutes they have a result: a single line on a strip means the test is negative, while two lines means it is positive. By the time the man seated in front of the glass partition had finished, staff were already announcing the results of the first 10 tests they’d done, which included five positives. 

I was shocked. I hadn’t expected so many to be positive. I’d just been standing beside several of the five that had tested positive. It was proof of what we were already beginning to understand: this virus had been spreading around the city much more widely than any of us had realised. I immediately saw sorrow and fear move through the room, brows furrowing and faces going sullen. Most of them were working-class people, and I wondered how their families would cope with the temporary loss of a worker. One, a 45-year-old uncle, told me he needed to call home to let his family know he’d tested positive, but that his phone had no credit on it to make a call with. There were no mobile shops nearby either. I used my phone to transfer K3,000 to his account. 

Behind us, another person who had tested positive, a woman of about 50, stood at the clinic gate, telling her daughter – who was wiping tears from her face – not to worry about her. Her daughter turned toward her motorbike and headed home to pack some clothing for her mother, who was headed for treatment and isolation at a nearby hospital. 

Perhaps one reason the positivity rate was so high was because of who was deemed eligible for a test. People were split into groups of A, B and C, based on the severity of their symptoms, and only those in group C – the most severe – could be tested that day. Ambulances kept arriving to take confirmed patients one by one to government hospitals. All the while, the medical staff did their best to keep people’s spirits up. “We will fight this together,” they kept saying. Their optimism and unyielding hope was moving, despite the obvious fear and anxiety in the air. 

By the time I left, 23 of the 42 tests performed had come back positive. 

Elsewhere in the country that day, October 2, another 1,119 tested positive, leaving a total of 15,525 active cases, health ministry figures show.

I was thankful for my health, and hoped I hadn’t been exposed to the virus while doing my job. I remain optimistic that the new test kits will help to more rapidly identify, isolate and treat confirmed cases. Few things are more important than that right now. 

Watching events unfold at the fever clinic that day, I couldn’t help notice how the new rapid tests seemed to distill the whole pandemic experience – the uncertainty and anxiety but also the fellowship and solidarity – into a few brief moments. It was like a snapshot of the last seven months imprinted on a single day. I just hope it all ends sooner rather than later. 

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