Breakfast at the Lucky Tea Garden

They start up the bread oven at 5am at the Lucky Tea Garden in Mae Sot. By 9am, the party is over, all the stock has been sold and eaten. It specialises in Muslim food from Myanmar. Dough balls, which have been prepped earlier and allowed to rest, are arranged like miniature cannonballs, ready for action.

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Festive tinsel still adorns the ceiling fan, which has not turned since winter began in November. There’s only one menu and it’s hung on the wall.

One chef slaps them into disks the size of a side plate, and places them on hot coals in the bread oven. They cook in a minute or so, crispy underneath, bubbly brown on top and soft inside. They are called “nam piyar”. You can eat them with cold onion and bean salad, chick pea curry or just as they come, fresh from the oven.

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Another chef stretches them out and folds them up, like puff pastry, cooking them in a large shallow frying dish. Or flipping them over and over, like an Italian pizza chef, until they are wafer-thin, and frying them quickly with an egg smeared on top. Once cooked, the chef adds condensed milk and sugar, and chops the sweet roti into bite-sized chunks.

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A customer wearing an Angry Bird helmet waits impatiently for her rotis.

If you fancy something savoury, they have samosas stuffed with onions and chopped vegetables, with just a hint of spice and chilli. Cheap at three for 20 pence. Lassi (yoghurt drink) is also available, but most customers go for the strong sweet tea. It is laced with condensed milk, which sits sullenly at the bottom of your cup if you don’t keep it stirred.

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Another house speciality is bone marrow soup, which is delicious. Here are the bones that made the stock.

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These samosas are even better than the fresh ones from the Indian sweet shop, Milan, on East Park Road in Leicester.

There is no garden attached to the Lucky Tea Garden. It is situated on a busy road, just 200m from the main town market. A full Muslim Burmese Breakfast cost me less than a quid. I was lucky to have discovered this traditional café.

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Weekly Photo Challenge: Juxtaposition

This is a roti – a simple dough mixture of flour, oil and water, fried on a huge hotplate, cooked to order, eaten wrapped in paper at the roadside. The dough has been kneaded, stretched and folded in on itself before frying, to make it resemble puff pastry when ready. The traditional accompaniments are a dusting of sugar and a drizzling of Carnation condensed milk. Alternatively, one may choose to have jam spread over the roti (nothing wrong with this; my father enjoys strawberry preserve on leftover Yorkshire puddings). But what jam to choose? The juxtaposition of a dollop of chocolate spread next to an electric blue splodge of goodness-knows-what was the solution to this problem.

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Bogeyman

I am the only “gollowah” (white-skinned foreigner, in the Karen language) working at Mawkerthai Clinic. I attract a lot of attention from the clinic attenders, especially the children. Some are unsure, some are fascinated, others are terrified and a few are delighted when they see me.

Of course, I might have done something unpleasant to the children, during the course of their treatment. If I have to operate on a child, I use ketamine as an anaesthetic, which is supposed to cause amnesia. The child might not remember what happened, but I’m still the chief suspect in their eyes. One child, who is an inpatient at present, covers his face when he sees me, with the flawed logic of: “If I can’t see him, he can’t see me.”

Here are a few pictures of children who are not scared stiff of me.

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A more recent development has been the way some staff members find it hilarious when the child of one of the senior nurses sees me and screams if I get too close. The child has a serious, thoughtful nature, and frowns as she scrutinises me from afar. Perhaps they have encouraged this behaviour, by telling her that I’m the “bogeyman”, coming to get her.

And I thought I was thick skinned

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This is a pomelo, citrus maxima. It was on sale in Mawkerthai market this morning for 40 pence. this one was a magnificent specimen, about 25cm across, weighing 2kg. Most of it is skin and pith. The vendor sliced it apart with a chopper and removed the rind. As an accompaniment, he gave me a few sachets of sugar-salt-chilli mixture, which brings out the flavour. It doesn’t taste as sour and acidic as grapefruit. The internal partitions separating the segments are very tough and fibrous. It can be fiddly opening up each compartment and extracting the fruit, but it is worth it. This pomelo provided most of the clinic staff and several patients with one portion of their “five a day”.

Beriberi

If you had asked me about beriberi twelve months ago, when I was on holiday in Burma, I would have been reminded of Sir Alec Guinness, in the film, “Bridge over the River Kwai”. Most of the allied prisoners of war, who were used as slave labour to build the notorious Death Railway, suffered from malnutrition, especially thiamine (vitamin B1) deficiency. So did this three year old girl.

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NOTE: I have deliberately cropped the photograph to protect her confidentiality.

Beriberi is a bit like sandpaper; it comes in wet and dry forms. Thiamine deficiency can cause heart failure, with shortness of breath, rapid pulse and swollen ankles – wet beriberi. However, this little lass had dry beriberi, when the nervous system is affected.

Her mother said that the problem began two weeks ago, when her daughter felt weak and tired. Within a few days, she couldn’t walk and was finding it difficult to stand up. Now her hands and arms were weak. She also had problems talking and she looked exhausted.

I examined her with one of the nurses. She was slumped on her mother’s lap, chin on her chest as though it was an effort to hold her head up. She had a convergent squint (cross-eyed) but her mum said she’d always had this. She was able to keep her eyes open, there was no ptosis, and although she looked washed out, she was not anaemic.

Her pulse was rapid, just over 100 beats per minute, with occasional dropped beats. The lungs sounded clear although she was not able to breathe deeply. I could feel and enlarged liver in her abdomen, but no other signs. Her arms and legs were very floppy. Lying on the examination couch, she could not bring herself to a sitting position without help.

Examining the neurological system of a small child is difficult. The nurse claimed he could elicit a patellar reflex (knee jerk), but this was just the leg bouncing back after he had hit it. There was no twitch in the quadriceps. I couldn’t elicit any peripheral reflexes.

She claimed to be able to feel the touch of a whisp of cotton wool on her legs, even when I hadn’t touched her. I used the cold metal of the tuning fork to test her sensation of temperature, but again, she was unreliable with her response. She did claim to feel the buzzing of the tuning fork, suggesting that vibration sense was preserved.

The treatment is simple – vitamin B1 by intramuscular injection. Our protocol is to give 50mg thrice daily. Even though she couldn’t cry loudly, it was obvious that she could still perceive pain!

The prisoners of war had beriberi because of their appalling diet, deficient in many vitamins, not just thiamine and niacin. The outer covering of rice grains contains thiamine, but this is lost when the rice is milled and polished. Other popular local foods such as raw and smoked fish, contain enzymes which destroy thiamine. Cassava contains a tiny amount of thiamine, but digesting it consumes more than it provides. Although this girl didn’t chew betel nut, her mother did, and this can reduce thiamine levels in breast milk.

Within 24 hours, the transformation was amazing; she was completely better. She could walk, talk, eat and play. Result! Discharged with six weeks B vitamin oral supplements and dietary advice for mum. It’s not often that a treatment has such immediate and dramatic results. But it’s great when it happens.

Karen lunch

Great spread of food for lunch last Thursday. It was cooked for us by the wife of the senior nurse.

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A culinary first for me – eating frog. The dish was very spicy, but I can confirm it tasted like muddy chicken. I didn’t eat the bones, even the tiny ones in the flippers, but most people just crunch away.

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The Karen like their vegetables, too. Here are some florets of cauliflower cooked with herbs and spices, and a side dish of mint, cucumber and podded beans.

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Rice forms the mainstay of every meal. To make it tasty, you add chillies, dry or in a paste with oil and garlic, and fish paste.
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Just when we thought we’d finished, the cook brought out a tray of fried eggs, sunnyside up. It was simple food, using local ingredients, tasty and nourishing. Delicious, even chillied Kermit.

Weekly Photo Challenge: Family

This mother and her two children are going home. They are wading across the Moei River between Myanmar and Thailand. The elder child became frightened half way across, but her mum couldn’t pick her up as she had to balance the shopping in the basket on her head. She plucked up courage after holding onto mum’s lunghi and kept going. They had traversed the river earlier in the morning to visit the clinic where I work.

Mother had struggled to get loaded up with baby and shopping as she left the clinic, so I carried her shopping bag to the border crossing for her. I’m not allowed to cross the river at this point, so I watched from the bank. And took this picture.

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Reminds me of the classic Jimmy Cliff song, “Too Many Rivers To Cross” (“Harder They Come”). The final line of the song is “Yes, I’ve got many rivers to cross And I merely survive because of my will…”