In Burmese folklore, it’s said that lunatics act up most on full moon nights, and that the sight of water drives a rabid dog even more insane. If those sayings are true, then every April—Tagu in the Burmese calendar—must be when I see water under a full moon. Does that analogy even make sense? Oh well, never mind. What I do know is that this is the time of year I go a little crazy from missing my motherland most—right about now.
Back then, the air at home would be thick with the fragrance of blooming yellow padauk (Pterocarpus indicus), mingling with the fresh, earthy scent of rain-soaked ground. Thingyan—the Water Festival, known as Songkran in other parts of Southeast Asia—would have everyone’s spirits lifted. Joyful Thingyan music, hilarious than-gyats (satirical ditties or barbs), and the enchanting dances of beautiful young women filled every town and village across Myanmar, the Golden Land.
The excitement was always real, whether you were a mischievous kid wielding a water gun and watching for the arrival of the Sugar King Tha Gya Min (King of the Devas), or a love-struck teenager hoping to offer a padauk blossom to your crush. And 2007 was no different. Just like every year for the past quarter century, I had been bitten by the Thingyan bug once more. But this year held a special sting. It marked the twentieth anniversary of my coming of age as a doctor—I had graduated from the Institute of Medicine (1), Rangoon, Burma, twenty padauk blooms ago in 1987.
Although I had returned to Burma every few years since leaving, I’d never again had the chance to enjoy Thingyan, or breathe in the scent of freshly bloomed padauk. I sorely miss those days of being a true Tagu reveler.
If someone had told me in 1987 that twenty years later, I’d be living in a small Midwestern town called Battle Creek, working as a nephrologist and holding citizenship in my adopted country, I would’ve laughed in their face. How could that be? I didn’t know a single person in the U.S. back then—unlike some of my Chinese classmates who had relatives abroad. And with the government policy at the time that banned expatriates from even visiting Burma, it seemed unimaginable. At most, I had vague dreams of visiting the U.S. or U.K. as a state scholar, but nothing more.
Yet here I am. And I’m not alone. The path I took was hardly extraordinary. My story mirrors the journey of many Myanmar doctors of my generation. The seismic changes that occurred right after we graduated reshaped the futures of so many of us. But to explain how we got here, we have to go back. So, may I take you on this nostalgic ride? Though I’m the one telling it, this is the story of an entire generation. I think you’ll enjoy the journey.
So here I am—emptying my heart.
April 1987
Whenever memories of the summer of ’87 flicker through my mind, I hear Bryan Adams’ Summer of ’69 playing in my head: Those days I was nothing, had little to prove and none to lose but eventually those turn out to be the “Those were the best days of my life.” How fitting.
In Burma, summer means March and April—not July and August like in the West. I had just passed my Final Part II MBBS exams, and internship was set to begin on May 1, 1987. You’d think I’d be breathing a sigh of relief after seven grueling years of college and medical school. But the truth was quite the opposite.
Despite being exam-free for the first Thingyan in years, I wasn’t looking forward to it. My future looked bleak. We had grown up believing that once you became a doctor, your life was set. That may have been true a decade earlier, but not for us. Everywhere I looked, I felt like I was hitting brick walls.
Personally, I hadn’t yet found a soulmate. The girl I had a crush on didn’t seem interested. Socially, an ordinary MBBS degree didn’t hold much allure anymore—not compared to a sailor on an overseas shipping line, a customs officer, or a second lieutenant in the military. Professionally, many newly minted doctors couldn’t find employment unless they started their own GP clinics from scratch.
I was the eldest of three children. My parents, both lifelong teachers, had no savings and no property. We lived in a government-subsidized rental apartment. Having spent most of our lives in Maymyo, we always felt like outsiders in Rangoon. My parents’ marriage was also unraveling. As the eldest son in Asian culture, I felt immense pressure to support the family. But how? The prospects for a fresh MBBS graduate were dim.
I began to lose faith in everything—family life, the system, even the profession I had worked so hard to enter. To pursue postgraduate medical training, you had to join the government civil service—there were no private hospitals or alternative routes abroad. Otherwise, you remained a GP, administering vitamin B12 and penicillin injections without proper diagnostics. Even as a GP, the competition in major cities made it hard to survive. You’d need to practice in a district or remote village.
Getting a government job was a feat in itself. Of the 550 annual graduates from the country’s three medical schools, only about 50 to 60 were recruited. You needed connections, bribes, brilliance, or to be someone’s favorite. I fit none of those categories.
Even if you joined the civil service, there was no guarantee of further training. Nepotism plagued the postgraduate selection process. Talented young demonstrators from our medical schools were often passed over in favor of the well-connected. Most likely I would end up as a SMO (Station Medical Officer) and perhaps a TMO (Township Medical Officer) just before my retirement. Also, overseas post-grad exams seemed extremely tough. Even our Sayas with MSc under their belts often failed at those exams. My chances of ever earning an MRCP felt like wishful thinking. Many of my friends felt just as disillusioned.
That summer, the country’s political situation also seemed unstable. After twenty-six years of failed socialism, the public’s patience was wearing thin. Our seven years as university students (1979–1987) had been relatively calm, but that was just the eye of the storm. Six months earlier, the government had demonetized the K75 and K100 notes overnight, wiping out people’s savings. Inflation soared. Discontent was brewing everywhere. Socialism was quickly losing its appeal. Its defects which were exaggerated by the corruption and the mismanagement of the Burmese Socialist Program Party (BSPP) government were rapidly being exposed.
The more I thought about the future, the more hopeless I felt. After all that hard work, was this it? Why hadn’t I just become a seaman with a tenth-grade education?
I suppose I was having my “Benjamin moment,” like Dustin Hoffman’s character in The Graduate—a Burmese version of a confused young man with no Elaine, and no Mrs. Robinson.
Eventually, I gave up worrying. I decided to enjoy Thingyan and begin housemanship on May 1, refreshed and ready. At least I had one more year as a house surgeon before facing the real world.
My friends and I pooled money to rent an open-top Thingyan jeep for one day. The festival lasted three days, but we could only afford a single day of revelry. Still, it was worth it. Army Rum kept us warm, despite being drenched all day. And the danpauk (biryani) lunch at Kyat Hlar Soon was unforgettable.
“Achit yay, nay lo ma kaung yel lar?” (“Dear love, are you okay?”) was the catchphrase we used to greet girls on the street, borrowed from a J. Maung Maung hit song. If we spotted a cuddling couple, we’d shout: “Nyi Ma Lay, don’t trust that guy—he’s married with three kids!” If we saw a jeep of older folks, we’d yell, “Uncle Gyi! Why aren’t you at the monastery? The abbot’s looking for you with a cane!” The jokes were never crude—just playful banter. Most people laughed along.
For the rest of the festival, we hung out at the Burmese Medical Association’s pandal on Thein Phyu Road. It was always packed with the most popular and stylish folks in Rangoon’s medical community. A live band would often play. A few tipsy sayas would dance in ways no textbook could explain. We weren’t part of the in-crowd—just wide-eyed onlookers.
One sad memory lingers. A year later, one of our Thingyan gang, Thet Khine Lin (aka Arafat), would pass away from cerebral malaria while practicing in Kalaw. May our dear, jolly friend rest in peace. His laughter lives on in our memories. Death, after all, doesn’t discriminate by age. That was one of the first hard lessons we learned.
Housemanship aka Internship (May 1987 – April 1988)
For the first time in our lives, we were addressed as “U” or “Daw,” and even referred to as “Saya.” That alone felt like a rite of passage. Otherwise, my internship year was mostly uneventful.
We did enjoy the graduation ceremony and dinner, which happened halfway through the internship. The medical school concert and the Ah Nyeint (our version of a play) were memorable. Many of us, intoxicated and rowdy, ended up waving our sandals at poor Soe Thu while he was performing on stage. I think he was still in second MB back then. At the time, Soe Thu, Kyaw Thu, and Yè Aung were heartthrobs among teenage girls. Among musicians, Soe Lwin Lwin, Htoo Aein Thin, and Hay Mar Nay Win were at the height of their popularity. But those of us in our early twenties fancied ourselves more mature and leaned towards Sai Htee Saing and Khaing Htoo—looking back, it feels a bit pompous. I’ve come to appreciate Soe Lwin Lwin and Htoo Aein Thin’s music much more with time. Back then, Bo Bo Han was already considered an “oldie.”
As many of you might know, our class was the last to enjoy an official graduation dinner and performance hosted by the medical school. After the 8888 uprising, student gatherings were banned for many years, and with that, a cherished coming-of-age tradition was lost.
I chose to do most of my rotations at peripheral hospitals rather than the crowded RGH, hoping for more hands-on experience. I did Medicine at WRGH under Sayagyi U Sein Oo, Surgery at ERGH under Sayagyi U Tun San Maung, OB-GYN at Dufferin, and Pediatrics under Sayagyi U Myo Min Aung—if I recall correctly, it was Ward M-2.
During this time, I began hearing about the PLAB (Professional and Linguistic Assessments Board) exam in the UK. Supposedly, if you could pass it, the GMC (General Medical Council) would register you, and you’d land a job as a Senior House Officer (SHO), earning about £1,000 a month. That was an enormous sum by Burmese standards—and you’d receive training too.
In 1987, the black-market rate for US dollars was around K50, while the pound sterling fetched about K75. Officially, the exchange rate printed on the front page of Time magazine’s Asia edition claimed the dollar was worth just K5.25. At that time, a Toyota Corolla or Mitsubishi Lancer cost around K100,000. A Publica pick-up truck went for about K90,000. These were the cars of the wealthy. Most new vehicles were brought in by sailors, except for locally assembled Mazda Jeeps and B600s. Government ministers and BSPP Politburo members drove imported Mazda 929s and 323s—luxury cars by local standards.
Yet, despite the appeal of PLAB, the hurdles were immense. The average pass rate for Burmese graduates back then was only 15–20%. Many failed to clear the exam within the two-year visa window and had to return home. Unlike the U.S., part-time or under-the-table work wasn’t an option on a PLAB (student) visa. You needed substantial savings in a foreign currency, as the BSPP government did not allow Burmese kyat to be converted into hard currency.
The exam tested both medical knowledge and English proficiency. The English portion was rigorous—essay writing, listening comprehension, and a viva, in addition to multiple-choice questions. If you failed, you had to retake all sections of the exam, and none were offered outside the UK.
On top of that, getting an official transcript required an educational clearance from the Burmese government. Without it, you couldn’t even apply for overseas exams. But to get the clearance, you had to serve at least two years in the government—without any guarantee they’d allow you to resign afterward. A true chicken-and-egg situation.
Still, compared to a year earlier, I felt a glimmer of hope. I enrolled in English classes and started hunting for PLAB prep materials. The first book I found was A Manual of English for Overseas Doctors by Joy Parkinson. I was so unfamiliar with Western names that I initially assumed the author was a man. Later in the UK, I found out she actually taught English at Southwark College.
Study materials were scarce—few were taking the PLAB then, and of course, there was no internet. Everything came via snail mail. Eventually, I decided to build a solid foundation by studying standard texts like Davidson, Ten Teachers, and Bailey & Love. I figured that once I understood the core concepts, I could polish things up later—and that turned out to be true.
That year, the political atmosphere became increasingly volatile. Tension was palpable. In March 1988, a gathering of RIT students was violently crushed by riot police, resulting in the death of a student named Phone Maw. On March 16, RASU students protesting his death were also attacked—several were killed at the “Tatar Phyu” (“White Bridge”) bus stop on Prome Road, beside Inya Lake. The site became known as the “Red Bridge,” and the crackdown was remembered as the “White Bridge Affair.”
All universities and colleges were shut down. Rumors of student leaders organizing underground movements circulated, while Military Intelligence intensified their surveillance. Many believed something bigger was brewing.
As house surgeons, we were paid about K300 per month—a decent allowance at the time, especially since we were still living with our parents. On payday, we’d usually treat ourselves to dinner at a restaurant. Occasionally, the Assistant Surgeon might ask you to cover for them at his or her private clinic, which paid K50 for the night—a welcome bonus. We began to pick up the tricks of General Practice (GP). One key lesson: never send a patient away saying, “There’s nothing wrong with you.” To keep them coming back, you’d offer treatments like B12 injections—even without clinical necessity—just because they wanted a “tonic.”
Than Soe (now a consultant pediatrician in the UK) and I even took up smoking for a while, trying to look cool. Thankfully, that phase only lasted a year.
During my OB-GYN rotation, I skipped duty for a few days and took a bus to Magway to court my future wife, who was doing her housemanship at Magway General Hospital. My buddy Aung Naing (now a pulmonologist in Florida) covered for me, reporting to duty in my place. The poor AS never caught on.
Once we started housemanship, we rarely saw each other the way we had in med school. We were scattered across different hospitals, on different shifts. My close friend Than Htut Aung (now the owner of Eleven Media Group) did his internship at Mandalay General Hospital, where his family lived. About twenty of us from IM-1 were posted at DSGH in Mingaladon. Several met their future spouses there—many from IM-2. I remember Than Win Nyunt and Khin Maung Lwin (now professors of Neurology and Neurosurgery in Mandalay, respectively) among them. Some fell in love with nursing cadets at DSGH or nursing students from RGH. Kyaw Htin Maung (now an ENT surgeon in the UK) is one example.
The last time the whole class gathered was for the graduation ceremony. Our final hurrah was the community medicine field trip to Hmawbi Township. And just like that, the party was over.
Everyone had to start walking their own path.
Life as a GP (May 1988 – November 1989)
Once I completed my internship, I found myself in an unfamiliar position—free time. For the first time in my life, I had no work and no need to study. Fortunately, that lull didn’t last long. Even then, I had already set a goal for myself, though I had no idea how I’d reach it. My father’s advice played a pivotal role during that period. I resolved to open a GP clinic in Rangoon, not in the districts. I also decided to take the PLAB exam at the earliest opportunity, and I needed to stay in Rangoon to prepare. I wanted to be as well-prepared as possible before leaving Burma so I wouldn’t have to spend excessive time or money abroad before passing the exam. The timeline for going to the UK was uncertain, given financial and logistical challenges, but I had made up my mind.
Surprisingly, that wasn’t how my plan originally started. Initially, I told my parents that we needed money and that I would set up a GP clinic in a district. My father disagreed. He gave his own life as a cautionary tale—a case of being the wrong person, in the wrong place, at the wrong time, with the wrong qualification. He was a brilliant student—an old Paulian selected as a state scholar during the U Nu era to study Nuclear Engineering in the U.S. The plan was to build nuclear reactors in Burma. But by the time he returned six years later, the political landscape had changed. The new government had scrapped the nuclear program, and he found himself unemployable. Needing to support his widowed mother, he took a job as a Physics demonstrator at the DSA, where he remained stuck for the next eighteen years. Since he wasn’t formally trained as a physicist, his career never truly advanced.
He often said he wished he had never returned to Burma—or left again as soon as he saw the writing on the wall. He didn’t want me to make the same mistake. He wanted me to aim higher—to become a specialist, not remain a GP. I remember countering him: “Dad, you’re daydreaming. We don’t have the money for that. We’ve been living paycheck to paycheck for 25 years. And with the way we were trained during the BSPP era, I doubt I can even pass those exams. That’s what everyone—especially the old missionary school-trained doctors—keeps saying.”
He replied, “Son, if there’s a will, there’s a way. But you must have a will and a dream first. Work hard and trust in the Buddha. Bear no ill will toward others. When the time is right, things will fall into place. I believe in you—and more importantly, in karma. A son who wishes to support and repay his parents will always be blessed in the end.”
Little did I know how prophetic his words would be.
I opened my GP clinic in Hlaing Township. As expected, the income wasn’t great. Around the same time, I began volunteering at the Malaria Research Unit at No. 2 Base Military Hospital on U Wisara Road, under the late Colonel (Dr) Kyaw Win. After a few months, I was offered a Research Medical Officer position. The real benefit wasn’t the salary—it was the hospital attachment. I was allowed to join consultant rounds with Lt. Colonel (Dr) Ye Thwe and Lt. Colonel (Dr) Aung Kyaw Zaw, in addition to Uncle Kyaw Win. Their mentorship was invaluable in preparing for the PLAB.
Life suddenly became intense: daytime hospital work, evening GP clinic, and late-night study sessions. Weekends were reserved for English tuition. Despite my efforts, I often questioned whether I was on the right path—or simply wasting time. I still had no clear idea how I’d make it to the UK. I didn’t have the means, nor did I know anyone there.
Meanwhile, many of my friends had become successful GPs, mostly in district towns. Myo Myat Lwin (now a consultant pediatrician in the UK) was in Nat-Ta-Lin Township. Ko Ko Naing (now a UK GP) was in Mu-Se, following his fiancée who hailed from there. Thaung Win had become the “GP king” of Tha-Kay-Ta, where he remains to this day. Some joined the army medical corps; others hoped to get into government service through the PSC exams. My friend Wint Maw (now a psychiatrist in the UK) later joined me at the Malaria Research Unit. A few left medicine entirely to run family businesses or sought hard-currency jobs abroad—even if not in a medical role. Some got scammed by bogus “ship doctor” job agencies in Singapore. A handful of experienced senior doctors secured UNV posts in Africa or other developing countries—unavailable to fresh graduates like us. Though the stipend was just $600/month, it was still a coveted job. Others who spoke Chinese aimed for Taiwan.
Classmates with relatives in the U.S. prepared for ECFMG and TOEFL. For me, that path seemed even more unattainable. The FMGEM exams were held only twice a year, and U.S. residencies only accepted new doctors annually. Miss the July intake, and you’d wait a full year. PLAB, by contrast, was held monthly, and training jobs followed quickly after passing. The U.S. route required funds to survive for two years before earning a penny—ten times more expensive than PLAB—and U.S. visas were notoriously hard to get.
Then, everything changed—almost overnight.
The 1988 uprising in August and September—the 8888 event—was a seismic, life-altering experience, akin to a personal Pearl Harbor or 9/11. I won’t rehash the details, as they’ve been well-documented—even dramatized in the film Beyond Rangoon starring Patricia Arquette. Like many, I joined the demonstrations. I wasn’t a leader, but I walked with the crowd. My close friend Tha Tha Oo (Thomas U) became deeply involved and had to flee to the Thai-Burma border after the military coup. Luckily, he made it out and is now a successful neurologist in the U.S.
For me, the aftermath of the uprising—though chaotic and scary at times—proved to be a blessing in disguise. Lawlessness crept in; mob rule began to rear its ugly head. Still, those turbulent days created unexpected opportunities.
For one, my GP practice became busier, thanks to the 8 p.m. curfew. Most doctors closed by 7 p.m. to make it home safely. I chose to sleep at my clinic, keeping it open until just before curfew. With no nearby competition, my clinic flourished. I slept on the exam table with new bedsheets. By the end of 18 months, I had saved around $700—enough for a flight to the UK.
In the initial years after 1988, the SLORC government experimented with openness—promising elections and an eventual military withdrawal. They likely underestimated the NLD’s strength. But for a brief window, things got easier: passports were issued more freely, expatriates were welcomed home, and educational clearance for professionals became routine. The mandatory two-year government service was abolished, and resigning from government jobs became possible. Public Service Commission (PSC) applications were accepted widely. Foreign companies were invited, and joint ventures blossomed.
Suddenly—and sooner than I ever expected—I had both a passport and an educational clearance.
Then, more miracles occurred. One of my dad’s old classmates from St. Paul’s, Mr. Alan Khoo (Than Win), who was working at the Asian Development Bank in Manila, came home for a visit. Upon learning of my father’s struggles to support my education, he offered to help. My dad asked for a $1,000 loan—and without hesitation, he agreed. I’ve never met him to this day, but I repaid him as soon as I received my first UK paycheck. I still hope to thank him in person someday. His kindness changed my life.
Shortly afterward, my maternal grandmother passed away, leaving a small inheritance to my mother. My parents considered using it to buy a house, but instead, they gave it all to me. It was a huge sacrifice and a gamble, especially given the high PLAB failure rate. But it showed their unwavering faith in me—a gesture I now fully understand, being a parent myself. It motivated me to work ten times harder.
Lastly, through sheer serendipity, I found a sponsor. I met Dr. Daw Nyunt Nyunt Sein (Helen Sein), a family friend and former assistant to Sayagyi U Sein Oo at WRGH. When I told her of my plans and lack of a sponsor, she offered to ask her sister and brother-in-law in the UK— (Ma)Dr. Tint Htar Sein and (Ko)Dr. Zaw Lin—for help. I couldn’t believe it when, weeks later, they agreed. Though I had to cover all my expenses, just securing a sponsor letter was a major milestone. Dr. Zaw Lin, now a consultant cardiothoracic surgeon in New Zealand, had also once struggled—and his compassion reflected that.
For the first time in a long while, I believed in fate again. In people. In kindness. My father’s words echoed louder than ever. I saw how a small act of help could have a monumental impact. I vowed that one day, when I was in a position to help others, I would. I remain forever grateful to those who helped me—whether they knew it or not—through those difficult days.
Dr. Howard Kelly’s story, “Paid in Full with One Glass of Milk”, became my personal source of spiritual inspiration.
My Last Few Weeks in Burma as a Permanent Resident
I left Burma on November 15, 1989, aboard a London-bound Russian Aeroflot airliner—the cheapest ticket I could find. I didn’t know it then, but I was leaving the country for good. The weeks leading up to that departure passed in a blur. Suddenly, there was so much to take care of. Collecting various T-forms, D-forms, and permission letters from multiple government offices was an exhausting chore.
I had to arrange for someone to take over my GP clinic. My friend and classmate Tin Aung Hla (now an internist in Texas) kindly stepped in. I also had to resign from my position as Medical Officer at the Malaria Research Unit, a post later filled by my classmate and friend Wint Maw (now a psychiatrist in the UK).
There were emotional goodbyes, too. I went around paying respects to family elders and visiting relatives. I made a few last-minute trips to the tailor to have some suits made. Despite their assurances that the suits followed Western styles, I quickly realized—once in the UK—that they were completely out of place, both in cut and craftsmanship.
Everyone advised me to buy an attaché case, which I later discovered was practically useless in England. The “Cat Globe” brand of shoes was considered stylish, but I couldn’t afford them. Instead, I bought a pair from the government-run “Inn Daing” shoe factory. I also purchased secondhand luggage from departing diplomats—new ones were far too expensive. Ever thrifty, I bought two polyester ties from Scott’s Market. At the time, foreign goods were still rare and costly due to import restrictions.
There were also rumors that the government was about to reform the postgraduate medical training system. Government jobs were becoming easier to obtain, and there was talk that the Royal Colleges might come to Burma to conduct Part 1 MRCP and FRCS exams. Even GPs might be allowed to sit for them. The future seemed a little brighter than just a few years earlier.
Still, my resolve didn’t waver. I had already embarked on the river of no return. All I could do was press forward.
At that time, I had no plans to immigrate permanently. My intention was to complete my postgraduate training in the UK and return home. That’s exactly what I told Aye, my girlfriend, who would later become my wife. By then, she had said yes—she had agreed to date me. She didn’t wait to see how I’d fare in my exams or whether I would return home empty-handed. She had faith in me and made it clear that she wasn’t a fair-weather companion.
Still, I broke a promise to her. I had told her I would return to Burma after earning my MRCP, marry her, and begin our life together there. I did earn the MRCP, and I did return to marry her—but by then, I had made up my mind that my return wasn’t permanent. I wanted to live abroad, and she would have to come with me. It took her a while to forgive me for that.
On the day of my departure, my parents and sisters came to see me off at Mingaladon Airport. Fortunately, my classmate and friend Gyi Phone Mo (now an internist in Philadelphia) was on the same flight. As the plane ascended, the world below shrank until I could no longer see anything. Only then did I turn away from the window. I couldn’t shake the image of my family waving goodbye.
That was the first time in my life I felt truly alone. Tears welled in my eyes. Little did I know that this was only the beginning—of countless struggles in a foreign land, and many more tears to come in the months ahead.
Pyee Par Bi (The End)
