People have at least one turning point in life. For me, this turning point was developing a disability. This changed me from a naive person to a thoughtful person who can relate to the meaning of and quality of life.

Looking back on my life, I was an average doctor who performed usual activity with no special thought. I was born in Myanmar, raised in a middle class family. I was a bright kid, and I achieved success academically. During university years, I experienced back pain, but I did not realize that this back pain would later upside-down my life. I was more focused on medical school and discovering my future career: I enjoyed working in pediatrics — treating and playing with children, but I hated the shouting and smells of labor ward. Overall, things were going smoothly, and I graduated into my first job as a general practitioner.

Then, my back pain worsened — and suddenly, everything was falling apart. As I was brought up by middle-class parents, I needed to work after graduating from medical school. However, the pain and stiffness limited me from working full-time. In Myanmar, there are not many part-time jobs. General practitioners also get by on very little money. I felt depressed and stuck.

Scoliosis was a very strange word for a person who had just graduated. Even though I had been told it would not be a problem, the back pain became progressive over the past three years. My mom and I flew to Singapore to seek specialist care. On first and subsequent visits, we took numerous spine X-rays and MRIs, getting pictures of my whole spine. Imaging revealed moderate degree of S-shaped Thoracolumbar scoliosis along with spinal stenosis. The doctor said that it could increase one degree per year. Despite my young age, my disease was advanced, and the doctor wanted to do a spinal fusion surgery — placing metal rods from T2 to L5 on each side of spine fixed with screws on each level to reduce degree of the curve.

On subsequent visits, left sacroiliitis was noted and at this point, I experienced intense back pain radiating to left leg with a difficulty in walking. I was referred to a rheumatologist, who recommended injection of anti-TNF medication. It was there where I was first told that I likely had ankylosing spondylitis. After discussing with my family, we decided to take time to think before acting — yet my body was impatient. A few weeks later, I became febrile. The fever lasted for more than two weeks. My physician thought it was due to discitis. We went to Singapore, and after a CT-guided sacroiliac joint fluid aspiration, I received a surprising diagnosis: Tuberculosis of left sacroiliac joint. I was lucky that we had decided to wait and I had not been injected with anti-TNF medication, as this likely would have severely worsened my disease. Although it felt like a conclusion of sorts, this was only the beginning of a long journey. I took anti-TB medications for one and half years. My magical journey to diagnosis lasted two years because of vague and overlapping symptoms.

Two diseases had made quite an impact on my life. After years of TB medication, there was one disease, scoliosis, left. Regarding its operation, there are many risks including fusion failure, adjacent segment disease and infection which places at higher risk for non-fusion (pseudoarthrosis). Besides, it is more likely to have 40% chance of complications after doing one operation. There might have repeated operations. Therefore, my orthopedic (spine) surgeons did not let me know that I had lumbar spine stenosis because they did not want me to undergo the procedure. It might have been good sense not to tell me — I cannot know their reasoning.

My diagnosis, scoliosis was caught late and we decided not to undergo the operation. Now, I take pregabalin every day. Things are better than they once were. With the medication, I can sit for three consecutive hours. If I walk for more than one hour continuously, I will suffer moderate pain and my back cannot be in upright position. I am not ordinary person who can work full-time. As a doctor, this journey and its realities have been difficult to manage emotionally. I have felt hopeless, frustrated and overwhelmed with negative thoughts and did not see any point in life. “Which career can I have?” “Can I earn enough money without anyone’s support?” Moreover, I did not know which passion I should pursue. I have struggled to find meaning and direction in life in the context of my limitations. I asked myself where my place was — hoping it could be in medicine, and in a place where I can support myself and my family. I have repeatedly questioned my value. My disability challenges were mostly hidden from sight — locked inside my mind and spirits.

Although I had moments of doubts and fears, I tried to pull the stars from the sky. I applied for, but was denied from a dream of a wheel-chair accessible job as a doctor working in UK. I reminded myself that my struggles and falls did not define who I am.

Hellen Keller overcame deafness and blindness to become an inspiration to people around the world. She said, “Character cannot be developed in ease and quiet. Only through experience of trial and suffering can the soul be strengthened and success achieved.” My disability has benefited me in some ways. It has made me more compassionate towards others. Too much of our world — and our profession — is about seeking comfort instead of providing it. I came to realize that I had grown talents which might ease burden of others. I believe even small kindness can have a powerful impact.

My disability has also made me reflect on disclosure of diagnosis and its importance. We can all recognize the importance of disclosure to a supportive family and community for many chronic illnesses - such as cancer or schizophrenia. Families and communities need to be knowledgeable, supportive and able to make informed decisions on their loved ones’ behalf if need be. In professional settings, disclosure can be more complicated. People with physical or mental illness who have been treated adequately should be hired, and accommodations should be provided for qualified candidates. People should not judge abilities solely upon the presence of illness. Everyone has their own value and should not be excluded. We must make our voices louder and increase awareness. Workplaces should be safe places for disclosure without judgment or fear of loss of work. In my experience, I had to interview multiple times, and was re-interviewed to ask about my health condition. My interviewers were clear that given my condition, they may not want to hire me. I reassured them, explaining the details of the condition and my general condition. Yet this self-advocacy and sometimes over-explaining your health to your employers is a hill that people with disabilities must climb that sometimes cannot be overcome.

According to survey, nearly six million people in my country are persons with disabilities. There is stigma around understanding and awareness of disability in Myanmar. Therefore, members of our community face discrimination and unequal access to health care, education, opportunities and employment. It is essential to build an inclusive society on a strong foundation of qualified people and knowledge of supporting and accommodating disability.

In Myanmar and across the world, we need more awareness-raising programs and skills development programs for people with disabilities. Strategies and cooperation to create disability-friendly environments should be planned and implemented. Moreover, it is necessary to improve quality of primary health care, help people understand its role and thus can reduce burden of disease and hospitalizations. Additionally, implementation of mobile clinic system with full facilities in order to promote health care in remote areas should be done. Promoting availability of resources including manpower, facilities and essential supplies is necessary to both prevent and treat disability.

I have heard it said that if there is no struggle, there is no progress. My invisible disability actually heightens my ability to serve as a more empathetic doctor. My courage grows when I face my fears. I am making a huge leap of faith and putting the faith into action by defining my own purpose.

Dr. Tin Zar Lin, MBBS is a Medical Officer at Jivitadana Sangha Hospital in Yangon, Myanmar.