By The original uploader was Kurosawa at Italian Wikipedia. – Transferred from it.wikipedia to Commons by Marcok using CommonsHelper., CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=7783809

When meritocracy is abandoned, clowns inevitably rise to the top—and nowhere is this more dangerous than in the field of medicine.

Let’s examine a tragicomic case from the Myanmar medical system, which increasingly resembles a circus due to incompetence cultivated by nepotism, not merit.

A Case of Hypothyroidism Gone Haywire

A female patient presented to a hospital with classic signs of hypothyroidism (myxoedema)—a condition caused by reduced thyroid function leading to a decreased basal metabolic rate. Among her complaints were constipation and abdominal discomfort, both common in hypothyroid patients.

Instead of performing a proper clinical evaluation, the physician rushed through the examination and immediately ordered an expensive CT scan of the abdomen—perhaps motivated by laziness, the allure of kickbacks, or simply a desire to go home and catch the latest Korean drama.

CT Misread as Cancer

The radiologist reviewed the CT scan and reported a mass suspicious for rectal cancer, located near the terminal end of the large intestine. With this alarming finding, the patient was referred to a colonoscopist for further evaluation.

A Colonoscopy Gone Wrong

The colonoscopist, equipped with the latest technology—including a robotic arm and remote-controlled scope—performed the procedure while viewing the monitor. His detailed notes stated:

“After inserting the scope through the anus and advancing two to three inches, I encountered a circular, constricting mass obstructing the lumen. I saw a small slit-like opening and managed to pass through it, only to reach a blind pouch. I attempted further but was forced to retreat and take biopsies.”

The “mass,” it would later be revealed, was not a tumor at all.

Pathology Compounds the Error

The pathologist, after reviewing the clinical history and biopsy specimens, reported adenocarcinoma—a malignant tumor originating from glandular tissue.

Emergency Surgery Unveils the Truth

That night, the patient developed an acute abdomen—sudden, severe abdominal pain. An erect abdominal X-ray revealed gas under the diaphragm (GUD), suggesting a perforated viscus. An emergency laparotomy was performed.

To the surgeon’s surprise, there was no perforation or pathology in the abdomen. The operation ended with no therapeutic intervention.

Postmortem of a Medical Farce

Fortunately, the patient survived. But what followed was a painful retrospective realization of systemic failure:

1. The initial cause—hypothyroidism—was completely overlooked.
   Constipation was a red flag symptom that any competent first-year medical student could have traced back to thyroid dysfunction.
2. The radiologist misdiagnosed a normal CT scan as rectal cancer.
3. The colonoscopist mistook the vagina for the rectum, inserted the scope through the vaginal canal, identified the cervix as a tumor, and even navigated into the uterine cavity.
4. During the procedure, air insufflation—a standard part of colonoscopy—caused air to pass through the fallopian tubes into the abdominal cavity, resulting in the radiologic finding of free gas, which misled the surgeon.
5. The pathologist then misdiagnosed normal cervical tissue as adenocarcinoma.

All this occurred because not one clinician conducted a simple digital rectal examination (P.R.), a basic skill taught in every medical school. As noted in the surgical textbook Bailey & Love:

“The abdomen is a magic box—if you don’t put your finger in, you may end up putting your foot in.”

More than 90% of rectal cancers are within reach of a gloved examining finger. Yet the exam was skipped entirely.

A Broader Diagnosis: Systemic Incompetence

This is not just a story of individual failure—it is a warning about what happens when merit is discarded in favor of favoritism. In Myanmar today, many so-called specialists are appointed not for skill or knowledge, but due to connections with the military regime.

Despite having access to modern technology, these “doctors” operate with stone-age mindsets, perpetuated by a racist, xenophobic, and fanatical junta. Under the military dictatorship of the SPDC, Myanmar’s medical institutions have become a dangerous circus—with patients as unwilling performers.

Let us not forget: medicine is a sacred trust. Without competence, integrity, and accountability, it becomes malpractice dressed in a white coat.

Postscript: A True Story from a Student Who Never Forgot

This account is not hypothetical. It was a real case, shared with me by a former medical student during a Skype conversation years later. Back in the early 1980s, I was serving as a Demonstrator and Assistant Surgeon in Anatomy and Surgery at the Institute of Medicine Mandalay (IMM), now MMU. He was one of the brightest and most dedicated students I had—often coming to me for extra teaching in between regular classes.

Years later, while undergoing surgical training in Thailand, he contacted me again—this time, deeply frustrated. He had just learned that I had been denied the chance to enter the local Master’s program in Surgery, despite my qualifications and dedication. He was visibly upset by what he saw as a betrayal of meritocracy, especially given how hard I had worked to teach and guide students like him.

He went on to train across Europe and ASEAN countries, eventually becoming a Professor of Surgery and Head of Department in his subspecialty field.

It was he who shared this case with me—real, shocking, and utterly preventable. His story is a sobering reminder of how far a system can fall when those in power prioritize connections over competence.