Post-Myanmar Visit Musings - 2016

 AMAPura, © 2016, R. Ono

In January 2016, my wife and I traveled on AMA Waterways' 14-day river itinerary on the AMAPura, from Yangon to Mandalay. This was an enjoyable trip and I wanted to share my general observations about the cruise and, later, post details and photos from our many river stops.

This riverboat cruise focused on travel along the Ayeyarwaddy River (aka Irrawaddy River). Post-cruise, we included an AMA transfer from Mandalay to Yangon and then continued on a private tour to Viet Nam. We arrived three days in advance of our AMAPura cruise start date. In Yangon, we engaged “Tour Mandalay” for two days of private guide and driver services in Yangon. This was well worth the effort as we spent much more time visiting the sites AMA included on its half-day tour of Yangon and additional sites of interest. During the AMA excursion in Yangon, we opted to remain on board and relax.

This northbound cruise itinerary starts with one excursion per day and shifts to two excursions per day or all-day excursions as you move towards Mandalay. Some guests indicated the schedule was too slow at the beginning. An alternative is to start from Mandalay and cruise to Yangon. This would have resulted in enjoying the less active days at the end of the river cruise. Though I understand that due to moving with the river current, the southern cruise from Mandalay to Yangon includes one additional excursion.

Another cruise alternative is to select the 10-day itinerary. The disadvantage of this cruise itinerary is that it requires a six-hour bus trip between Yangon and Pyay. We were fine with the 14-day program.

Time for an Ice Cream Social on the AMAPura!
 © 2016, R. Ono

Travelers should recognize that Myanmar river touring has only recently opened up. Accordingly, some excursion stops on the AMAPura cruise, between Yangon and Bagan, were more focused on seeing local life rather than spectacular cultural or historical locations.  The walking pace of all the excursions was generally slow. There was no distinction between groups for more active versus slower walkers. In addition, there is little accessibility accommodation in Myanmar for those visitors with significant walking limitations or difficulty dealing with stairs. Often times, there were no stair handrails at many excursion stops. In temple and pagoda visits, shoes must be removed. In many cases, visitors must also remove their socks. Generally, we found the temple and pagoda tiles and floors to be very dusty and it was better to simply avoid wearing socks. Feet wipes were provided by AMA staff after each stop that shoes were removed.

The AMAPura staff – hotel, dining, housekeeping, ship crew - were all very friendly and extremely service oriented. It was nice to be welcomed back by the captain and crew members after each excursion.

The food was what I would characterize as hotel quality food – tasty local fruits and vegetables, some regional Asian dishes and Western selections. Breakfasts and lunches were buffet oriented but also offered some personalized offerings. Complimentary wine and beer were provided during lunch and dinner.

The cruise manager and assistant cruise manager were very good at providing information before each excursion and during the excursions. At some meals, the assistant cruise manager joined a guest table for dining. We particularly enjoyed the personal stories and experiences shared by cruise managers with the passengers.

Our cabin (third level) was nicely furnished. The balcony was convenient, but we rarely used it. We could occasionally hear some noises from the fourth level public areas, such as furniture movement or heavy footed walkers. Generally, this noise wasn’t much of an issue for us. One cabin discovery was that there were no air filters integrated into the individual cabin HVAC system. Some guests with CPAP machines mentioned that their CPAP filters were heavily soiled within 2-3 days.

I'm a light sleeper and an early-riser on most days. It was often difficult for me to sleep past 6am due to noise from the loud engines on small river boats plying the Ayeyarwaddy or early morning music played by temples on the river bank. Use of noise cancelling insert earphones was helpful but I tended to just get up, grab a cup of coffee from the lounge and chat with other early-risers.

On-board laundry was available, but our travel clothes wash/dry easily and we tended to do more hand-wash. We strung our portable clothes line with suction cups in our bathroom.

On the AMAPura, there aren't many opportunities for aerobic exercise. Just a few passengers, including myself, used the single exercise bicycle on the upper deck. While circular walks could be taken around the upper deck, the laps were somewhat short in distance.

In regards to January insect life, we did experience a few mosquitos in Yangon. We took anti-malarial pills but some guests decided to forego the pills. The weather was often very cool in the early mornings and moderately warm during the day. We didn’t experience high humidity or any rain during the day.

During January, the daily air quality along the Ayeyarwaddy was generally smoke and dust laden. Including eye drops and cough drops on your packing list is recommended as well as antihistamine drops for itchy eyes. A dust mask may be helpful. Some guests developed respiratory issues during the cruise. A friend traveling with my wife and I developed pneumonia about half way through the cruise. Experiencing difficulty breathing and fever, she was transferred by ambulance from the AMAPura and admitted into a Mandalay Hospital.

As I understand it, this was the first actual medical evacuation in two years of AMAPura operation. The AMAPura cruise manager and hotel staff were extremely attentive and supportive during this incident. The cruise manager and my wife were at the hospital until 1am on the day of patient admission. As my wife and I worked on preparing medical evacuation insurance documentation and visiting the hospital, AMAPura staff were very helpful at arranging transportation (understandably, at our expense) and ensuring we had translation support. We were also extremely lucky that an AMA-related consultant was on-board during the cruise. He provided us Internet access from his laptop (using non-ship Internet connectivity) to reschedule our travel from Mandalay so that we had more time to ensure there was movement on evacuating our friend back to the US.

Third-world hospital conditions can be very dissimilar to what one might expect in a US hospital. The bed in the initial admitting room had a very primitive appearance. Once admitted to a private room, we were informed that you needed to pay (Kyat) in advance, bring your own food and water and hire a private nurse assistant. The bathing equipment was essentially a plastic tub with a ladle. After entering the private room bathroom, I saw what looked like a cockroach scuttling across the floor. Our fellow passengers shared their concerns and a physician passenger was very helpful in providing guidance and sharing personal supplies he had brought on board (e.g., food snacks, fly swatter, etc.). Many passengers offered to loan dollars or Kyat to cover unanticipated hospital expenses (very much appreciated but not needed). AMAPura also shared ship supplies such as water bottles, toilet paper and tissues.

When attempting to press the hospital physicians to complete the insurance paperwork, we were asked to email the forms to a hospital physician. I did this at 9am after the evening admission and was told to return at 4pm to pick-up the updated forms. My plan was work with AMAPura staff to digitally scan the documents and email them to the US insurance carrier. When we returned to the hospital at 4pm, we were told the forms were not received as the hospital did not have Internet access. The request for me to email the insurance forms to the hospital doctor seemed curious, at best. The on-call physician offered to transmit a heath summary to the insurance company using a hospital document, but this seemed likely to lack all the details required by the insurance company. Luckily, the English speaking taxi driver (arranged by AMAPura and who accompanied us to the hospital room) brought me to a Mandalay copy shop where I could print out the forms and return to the hospital. This fiasco set us back one day in respect to updating insurance forms. Once the forms were updated, AMAPura hotel staff assisted me in electronically transmitting the documents via personal cell phone hot spot Internet connectivity.

There are a number of lessons that we learned from this event that I will offer as suggestions that are more related to third-world travel rather than purely an AMAPura review. These include:

• Bring a printed copy of ALL your insurance forms and instructions with you on your cruise.
• Start contact with your travel insurance as soon as emergency medical assistance is requested. We waited until the following day and, in the best case, would have placed us several hours behind on paperwork submittal. Read the paperwork submittal instructions carefully – it may be that just the assignment of benefits authorization will start the insurance process
• Confirm that you have medical evacuation insurance to your residence area and not just to a local hospital.
• Bring an unlocked GSM phone with you and purchase a local SIM for its use. A Myanmar SIM is very inexpensive (1,500 Kyat) and, given poor ship Internet connectivity, it may be critical to arranging medical assistance. I suggest purchasing additional SIM top-up cards (10,000 Kyat) to ensure enough cellular phone, messaging and Internet time is available. Possession of even a network locked GSM cellular phone in Myanmar may be very useful - though possibly costly - in an emergency medical situation. 
• Despite the marketing material of travel evacuation insurers, there may NOT be any local/regional emergency personal to accompany a solo traveler back to the US. In this incident, it took several days for the insurer to arrange a nurse to travel from Bangkok to Mandalay to accompany our friend back to the US. Be prepared to deal with this type of delay.
• A local physician may be unwilling to discharge a patient to fly home. This may not necessarily rule out discharging the patient to a local western-oriented hotel while an anti-biotic regimen completes and/or evacuation assistance arrives.  
• When contacting the medical evacuation call center emergency number, it may be beneficial to request a case manager. This avoids the repeated updating of case details to each new call center representative that contacts you. 
• Bring two different ATM cards for withdrawing local currency - or travel with a companion that has an ATM card. I suggest two cards as our friend’s ATM card was not accepted by multiple machines despite assurances from the card issuer. We needed to use our ATM card to withdraw sufficient Kyat for the hospital. A short Myanmar hospital stay could easily run about 500,000 to 1,000,000 Kyat ($400-$800USD does seem like a bargain, but it really isn't). 

Overall, we enjoyed our AMAPura cruise and would recommend it to others. The cruise also reminded us that a little advance planning for emergency situations can go a long way.