Prologue – In July 2018, Uncle came to the University of Nursing, Yangon a few days before leaving for the United States for treatment. He looked sad, and although he would normally not disclose such things, he did so now. He had been diagnosed with nodules in the liver and appeared depressed. He was due to deliver an address at the Htun Foundation Literary Award Ceremony for his book, “A Concise History of Medical Education” and asked me to be at the ceremony to support him. I was a bit apprehensive about how he would perform, but it was just perfect; wisdom laced with humour. a typical ATBT performance. I approached him later and told him, “Uncle, it is a great speech”. He squeezed my hand and whispered “Swan Song”. He was thinking then that he might not survive liver cancer at 87 plus. But he did, and lived a full life for another 2 + years, serving the profession and country till his last breath on 7th October, 2020 (Myat Thandar).
Who was ATBT?
“Mummygyi” Daw Myint Myint Khin once remarked,” people view Aung Than as cold and clinical because of his analytical mind, not allowing intimacy with students and being straight-faced, and wonder whether he can appreciate the Arts, music and literature. Only his very close students will know.1 “Dr. Aung Gyi has elaborated on his observations that demonstrate ATBT as a warm, down-to-earth human indeed. Above all, he preferred simplicity over complexity. Longfellow’s quote. “In character, in manner, in style, in all things, the supreme excellence is simplicity” fits him exactly. He lived simply and did things with sincerity.
This article complements Dr. Aung Gyi’s article and collates reminiscences from various sources, adding our personal encounters.
The Early Years and Education
“ATBT “as he was affectionately known, was born in Promeb (now Pyay) on 21st June, 1930 to U Ba Tu and Daw Than Myint. His generation reached teenage during World War II, experienced disruptions in education, and were the pioneer collegians when the universities reopened in 1946. The hardships they faced and lifelong friendships forged, moulded these youngsters into adults with strength of character, resilience and holistic approach so characteristic of their generation.
Stories of growing up on a boat plying back and forth on the Irrawaddy on which his father-who had a pweyone (outlet storing & selling goods) in Henzada – traded goods give an insight into how he preferred simple, practical solutions over complicated rocket science. His love of literature began around 13, when an uncle introduced him to stories of adventures, astronomy, Greek culture. He also developed a liking for modern Burmese literature.
He matriculated from the Myoma National School, Yangon in 1947; MBBS from the Faculty of Medicine, University of Rangoon in 1955; MRCP from the Royal College of Physicians, Edinburgh in 1960 and FRCP from the Royal College of Physicians, Edinburgh, in 19702.
The Brilliant Clinician-Scientist
Junior doctors and students remember the dynamic young doctor in dark blue trousers, white shirt and red or blue tie who they would consult when in a tight corner with diagnoses, as Saya Thein Myint Tun recounts. “ATBT stat” was their mantra. When a brilliant student from the IM-1 was asked which clinician he admired most, he promptly replied, “ ATBT”, the reason being that he was a clinician-scientist; “not merely a clinician”1.Many shared this admiration. His clinical acumen and thorough analysis of patients’ history were legendary. He was flabbergasted to hear about the common practice today of spending just two minutes per patient.
His enthusiasm for research is reflected in an oft-told story of how, looking through a microscope late at night, he discovered something that excited him so much, he called his colleague (Cherry Tin Gyi @ Khin Kyi Nyunt) to come over, adding that he would send a car. She soon returned his call, saying her mother-in-law said “No!”(This discovery is mentioned in Haemoglobinopathies in Burma. HbE, HbH. Aung Than Batu. 1971 March.Trop Geogr Med. In series, 1,2,3,4). Even after retiring from active research, he helped aspiring young scientists get their research done. He advised me (MTD) to start setting up the model to measure red cell deformability, and helped to contact Nick White, the authority in that field. As a result, several postgraduate students (Physiology and Medicine), received their degrees on research related to red cell deformability in various pathophysiological conditions+.
ATBT urged, “Don’t think that lack of research funds and instrument exist only today. It was worse before. When I was given a position in DMR, I was shown a room; almost an empty room, a desk. no assistant. no funding. Every morning at 7, I went to the mortuary at the Yangon Children’s Hospital, did autopsy on bodies of children under five, counted worms, and related the number with their nutritional status. I published the findings and funds followed. That research gradually led to research addressing their absorption capacity. Do something with what you have!
A Family Man
Some would think that these “mad scientists” would make awful husbands and fathers, but that is not the case with this family of four: ATBT, Aunty Htwe (Dr. Khin Khin Htwe), Drs. Htin Aung and Thidar Aung. He would personally arrange that everything went smoothly. Once, he arranged for my spouse to lead Thidar, Nwe Theingi (Thidar’s classmate and Dr. Chan Taik’s granddaughter; also Aunty Htwe’s grand niece) and friends to Mahn ShweSettaw . He even arranged with the Myanmar Embassy staff in India to accompany me and Ma Ma Khin Seinn Win to Buddha Gaya because it was at a time they were burning train carriages to Buddha Gaya (1990). With the children working in the USA, he “adopted” Nwe Theingi and Myat Thandar (also another of Thidar’s classmates) as his daughters. ATBT called Myat Thandar one Sunday morning to tell her they had met with an accident and were at the YGH Emergency. Worried that these two old people would feel helpless, she hurried over, only to find ATBT giving a lecture to nurses who stood around him, with arms folded. Two elderly people living alone with only some domestic help downstairs needed some innovation. He made sure he would wake up if Aunty woke up to visit the toilet, by tying his big toe to hers with a string. This did not always work, with his foot being dragged off the bed. .Family life continued by proxy, with the parents travelling to the US not less than 25 times to visit the children and grandchildren Thidar installed CCTVs throughout the house, so she could monitor from overseas.
His idea of relaxing was reading books and listening to classical music, Burmese and Western. U Ant Gyi was his favourite. Myat Thandar and he would exchange books, and he would recommend which books to read. I remember the occasion very well, when he decided to go to the Book Fair in the hot sun. But the Administrator in him took the lead. He went straight to the manager, asked for the catalogue, chose books to his liking, and sent errand boys to find and fetch them. He also advised the manager to daily update the registry.
He kept his mind alert, keeping up with world events and advances in Science, subscribing to The Economist, Scientific American, Time till the very end.
Venturing into Research
ATBT was widely admired as a brilliant young Physician who had just returned with an MRCP and two years’ training in the UK and was trusted and valued by all three leaders in Medicine in those days (Major Shwe Zan, Dr.U E, Dr. Mohan), but his interest in research remained. In the “Reflections of a Director-General (Medical Research) “ATBT recounts how the Burma Medical Research Society and the Taron Scientific Expedition launched his career into the field of medical research. In his speech at the ceremony honouring U Mya Tu. He talked about how he wandered to the Department of Physiology to find intense activity going on, preparing for a research expedition to Puta-O. to study the Taron Tribe ( now almost extinct in Myanmar) .(This research expedition found over 50 pure-blood pygmies3, and although cases of cretinism, mental retardation, goiter and other physical and mental ailments were noted, they felt as though the community would sustain itself4). He immediately volunteered to join. That was the beginning of a lifetime commitment to research.
He carried on with research work while serving in the Institutes of Medicine, to ultimately devote full time at the DMR as Head, Haematolgy & Clinical Research Division , Assistant Director (Research ) and finally as Director-General. His research interests were mainly in the field of haematology (clinical haematology, pathophysiology of anaemias, anthropology of blood groups) nutrition and malaria. Later work (as DG DMR and Director, SEARO-WHO) focused on Health Systems Research.
He was an avid reader till the very end, devouring books of all kinds; and always the first to read new journals that arrived, ticking the articles he wanted us younger scientists to read. That made it all very easy for us. He also made sure we got our feet planted firmly on the path of research and publication. My first international publication (Reliability of the Xylose Tolerance Test as an Index of Intestinal Absorption., published 1973 in the Am. J. Clin.Nutr.) was written largely by him; a kind of pushing me into the water ! His message: “Now that you have your first publication, don’t stop!”
ATBT and U Mya Tu both believed that the “student must be smarter than the teacher”. U Mya Tu recommended ATBT as the only worthy person to take his place as DG-DMR when he left to join the WHO. ATBT groomed the staff in his Division and beyond. In fact, when I lost the Assistant Lecturer post in IM 1 to Daw Thin Thin Hlaing (because Saya U Myint Thein came back from Ethiopia and she had to step down from the Lecturer post she had assumed when he left, to the AL post ) he requested the- then DG U Kyaw Maung to post me at DMR. With a twinkle in his eye, he told me he wanted to train me to become DG some day. . But Daw Kyi Kyi May was not willing .I was posted to IM 2 Physiology and then to IM 1 Pharmacology but only to draw the salary, and not physically .This upset Daw May May Yi and Daw Khin Kyi Kyi.. U Kyaw Maung called me to his office and asked what I wanted, saying I was a “pyodaingkyike tai hninsikhine”. Then U Myint Thein passed away, and it was status quo again. He and U Mya Tu were conferred the title of “Emeritus Medical Researcher” in conjunction with the 50th Anniversary of the founding of the DMR.
ATBT’s account of how he was vacillating between accepting the DG-ship and not (it would mean having to stop practice, and therefore, extra income) and how Aunty Htwe had told him, “Take it. I will earn for both of us!” is endearing. How true it is that “Behind a great man is a great woman!”.
An illustrious Writer
ATBT ventured into a career in writing largely due to “Mummygyi” MMK who had a great deal of respect for him and “was afraid” of him5 although she was a very brave woman who would not hesitate to call a spade a spade and held the distinction of being the only lady doctor who dared contradict the all-powerful General Ne Win4. Around 2007, she recruited ATBT and Dr. U Ko Ko to write the “History of Medical Education in Myanmar (1886-2010)”. They were the last remaining members of a breed of doctors who lived under British rule, Independent Burma under Parliamentary Democracy, the lean years of the socialist era ruled by the Burma Socialist Programme Party (BSPP), and the State Law & Order Restoration Council (SLORC). They wanted to tell the story of the evolution of medical education in their own words. They recruited thirty two educators from the medical universities to contribute sections. It was eventually published in 2015. Unfortunately, Mummygyi did not live to see its publication. ATBT single- handedly wrote its sequel “A Concise History of Medical Education in Myanmar (1886-2015)” which was published in 2018. Other books that followed were “Further Development of Medical Research in Myanmar (1987-2011)” and “Reflections of a Director –General (Medical Research)” which was published together with a Myanmar translation by Dr. Aung Gyi. The “Reflections” was awarded a gold medal and prize from the Tun Foundation in 2019.
ATBT and Mummygyi worked very well together, and she would rely on him for his opinion and advice. He was requested to chair the “Dr San Baw Research Prize Committee “and did so, from about 1985 to 19944 (.I am honoured to have also served on that Committee). Together, they published the “Myanmar Handbook of Health Research Methods” in 2007. A practical manual for beginners, to promote research culture amongst doctors1.
The Final Years
The final years were still full of intellectual pursuits including publication of two books both of which won literary awards ; broadcasting a TEDx programme (“Innovations at the Intersection of Medical Science with Other Sciences”) and introducing TED to the community of medical educators after his granddaughter Eimon got him hooked on it ; spear- heading the resumption of publication of the Myanmar Journal of Current Medical Practice which he had co-founded in 1996 and publication of which had stopped in 2015; actively contributing to discussions at seminars and workshops. And even taking part in Teleconferencing at the MMA Conference in Naypyitaw in 20196 He, like his predecessor “Mummygyi” Daw Myint Myint Khin who would tell us, “I know I will live only X years, with my diabetes and nephropathy”, must have also felt like living on borrowed time , with so much to do and so little time to do it in. I personally felt he was burning the candle at both ends.
He personally chose/approved the members of the Editorial Board, using his charisma and innate authority. He recruited me with “Shwe Shwe, do this for me for a year. You can leave after that”. Of course you don’t say “No” to ATBT; nor do you leave until he tells you to! Many of the Board members had not known him before, but all were quickly impressed with his drive, sharp mind and the way he got things done. Our meetings were at the new Parami Office, then shifted to Parami Hospital because it was difficult going up the stairs of the office in a wheel chair. The meetings would be scheduled for 2 pm but he would be there by 1:15, then start talking about his experiences and things that interested him, ranging from getting a distinction in Public Health without attending lectures, to umami, to cooking rice in an earthen jar in the olden days, to using an umbrella to bring up carbon monoxide into unused wells before descending into them to value of TED over Facebook, to CRISPR. These preambles were interesting, entertaining and stimulating, and built up a bond between the members; a modern-day “Tuesdays With Morrie” He would stop these promptly at 2, to start the meeting. That reminded me of how he would say “I will start the car at 7” rather than “We will leave at 7” That is the kind of precision he would aim for. No half- measures are allowed with ATBT; even his drinks had to be icy cold or piping hot, as the girls from Parami quickly learnt.
By mid-2019, he was being hospitalized off and on, for oedema due to hypoproteinaemia, making him worried over delays in publication of his book. He would go directly to the Press on discharge. When Covid became serious, we stopped face-to-face meetings and went on Zoom, always informing him of the progress and constraints.
Mission accomplished
It is interesting that ATBT and U Mya Tu – two men of distinction- both had fathers named U Ba Tu, were interested in research as students, were founding members of the Burma Medical Research Council, were DGs of DMR, and Directors at WHO- SEARO. Their destinies were closely intertwined, notwithstanding the fact that one was a Physiologist and the other, a Physician. It is probably because of these close ties that ATBT was known to value the basic sciences in a way clinicians usually do not. They met and worked together in the research arena and had great respect and fondness for each other. On being conferred the FRCP, he was expecting a congratulatory message from U Mya Tu and was puzzled because it was not forthcoming. He was pleasantly surprised when it came at last, accompanied by a statue of The Thinker which had been ordered for the occasion. He felt he owed a great deal to U Mya Tu who was three years his senior and yearned to “repay him” by resurrecting the Burma Medical Research Council as the Myanmar Medical Research Council. This was not accomplished because the National policy is to have a centralized Myanmar Research Council.
A mission he did accomplish before he became incapacitated was to erect a plaque commemorating the founding of the Sir Harcourt Butler Institute and honouring Dr. Mya Tu, the Founding Director of the Burma Medical Research Institute and first Director-General when it was upgraded to the Department of Medical Research (His predecessor both at DMR and the WHO-SEARO). ATBT felt that he did not have much time, and pushed for it, although we Physiologists wanted to wait until a bronze bust could be installed. In a way, he was right because he would not have witnessed the unveiling of the bust, which had been delayed due to red tape.
Epilogue
The Swan Song has ended, the lights are dimmed, the curtains are down and the hall is silent….but is it silent? I still hear faint echoes rippling along the hallways of Learning. I see the Light of Knowledge relayed down the line.
What though the radiance which was once so bright
Be now forever taken from my sight,
Though nothing can bring back the hour
Of splendour in the grass, of glory in the flower,
We will grieve not, rather find
Strength in what remains behind
William Wordsworth
References
- Dr. Aung Gyi . ATBT. Pyi Thu Ayay Journal. 11th October 2020
- Who’s Who in Health and Medicine inMyanmar. (2003), compiled by KhinThet Htar&MyaTu , A Ministry of Health publication
- MMyaTu, U KoKo, UAung Than Batu, U KyweThein, CJR Francis & U Than TunAungHlaing. . The Tarons in Burma. Special Report Series No.1, Burma Medical Research Council, 1966
- “The Moth Presents Alan Rabinowitz: The Last Taron”. YouTube. November 17, 2011
- MyintZan .Sayagyi (Uncle) Dr. Aung Than Batu .Global New Light of Myanmar. 13 th October, 2020
- Saw Win. ThayThiiTaingAungPyiKyoSaung ( Service Till The Last Breath) .Facebook post, 9th October 2020
1. MBBS(Rgn);PhD(Lond); FRCP(Edin)(hon); Cert in Leadership for Physician Educators (Harvard Business School)
