lunes, 10 de mayo de 2010

Clinica en Crisis por Philip Thorton

Dr Cynthia Maung has won 14 international awards for her humanitarian work at the Mae Tao Clinic on the Thai-Burma border. In 1989, its founding year, her clinic treated 2,000 patients - by 2010, that figure surged to a massive 140,000

Most of the Burmese people coming to Dr Cynthia Maung's clinic are in dire need of medical care not available to them in their home country. Their plight puts a spotlight on the health and humanitarian crisis created in Burma by the ruling military regime and its military focused policies.

NEEDING HELP: A Burmese child at Dr Cynthia’s clinic near the border. PHOTOS: PHIL THORNTON

Dr Cynthia, in spite of all the awards and kind words showered on her and the clinic, warns that the statistics are not to be misread as an achievement.

"It's not a success story, but a story of failure, the failure of the Burma military regime to care for its people," she said.

A report, Chronic Emergency, by the Back Pack Health Worker Team, an organisation that delivers medical assistance to displaced people in eastern Burma, backs up Dr Cynthia's position.

The report states that one in 10 children will die before the age of one, and more than one in five before their fifth birthday, and one in 12 women will lose their lives from complications of pregnancy and childbirth. Malaria, HIV/Aids and tuberculosis rates in Burma are considered epidemics by international health organisations.

Dr Cynthia says each year the clinic sees up to 20% more patients, due to the ever-worsening humanitarian and economic crisis in Burma. The clinic offers free medical care to Burmese migrant workers, refugees and to villagers displaced by the Burmese army.

"Every year we need more and more money just to catch up. We desperately need long-term donors. Our donors are usually for only a year at a time. This creates a lot of stress for us, as we don't know if we can continue our services."

CROWDED: The sick and injured wait for lab results. A shortage of funds, medicines and other items has hit the clinic as more and more people continue to arrive. PHOTOS: PHIL THORNTON

Dr Cynthia warns the situation in Burma is not going to get better anytime soon.

"It's not just a health crisis, it's now become more complex. It's orphaned children at risk. It's the elderly, a lack of access to education, mental trauma, chronic poverty and food security. Burma has no health system, no social priorities, no welfare planning, there's no level of minimum care."

Dr Cynthia says many isolated communities are without basic necessities such as running water and electricity.

''The people's welfare is not the regime's priority. Citizens are not considered as human beings, but as something to be controlled.''

The Mae Tao Clinic is wedged between two worlds _ the hustle and bustle of Mae Sot's product-packed shops and markets, and the drabness of poverty-stricken Myawaddy on the Burmese side of the Moei River.

Belting back and forth between the two towns are fleets of old, rusting, over-used and exhaust-belching Burmese registered mini-vans. In co-ordinated moves, the vans drop off and pick up mobs of Burmese people at shops, clinics, pharmacies and markets. These people are not shopping for big-name brands or luxury goods. Most are picking up toothpaste, shampoo, headache tablets, cough syrups, soap, detergents, fish sauce, oil, tinned fish, cordial, MSG, instant noodles, salt and sugar.

SPARSE: A lack of facilities hasn’t stopped the influx of people.

Everyday taken-for-granted items on this side of the border, but in product-deprived Burma, hard-to-find or to buy.

From early morning to late afternoon, overloaded convoys of pick-up trucks disgorge people outside Dr Cynthia's clinic, as many as 500 nervous looking Burmese men, women and children in need of health care. Some, like 72-year-old Uncle Min, have travelled a long way to get help. His daughter says they spent 10 days travelling by bus to get to the clinic from far-away Arakan State. The old man sits rock solid without comment as he absorbs the hurt.

''He has eye problems. His left eye is dead, but we came here to try to save the other one. He had treatment in Burma, but it wasn't any good. We heard about the clinic and decided we had to make the trip,'' his daughter says.

Both Uncle Min's son and daughter, like many Burmese people, are scared of the camera and refuse to be photographed _ and for good reason.

''I worry and she worries. We fear authorities knowing we came here. We might lose our jobs and our children won't be allowed to continue their studies.''

Uncle Min has just had eye surgery and is without sight in his good eye until the dressing is removed.

OVER-WORKED: Dr Cynthia Maung at the busy clinic she runs on the Thai-Burma border.

''He's not a happy man, but in two or three days the doctor said his sight will be good, then he'll be happy,'' says his daughter.

The daily hand-to-mouth struggle and grinding fear Burmese people like Uncle Min and his family have to endure highlight the disastrous living conditions the military regime has created for its citizens.

Dr Cynthia explains that the global recession, her existing donors receiving less funds, donor fatigue and rising costs _ medicines, food, electricity, building, clothing and water _ have all played a part in reducing the clinic's ability to generate enough funds to cover their ever increasing patient load.

''This year we estimate a shortfall of about US$650,000 (about 21 million baht). To offset this, our staff volunteered to take a wage cut and have canvassed their friends and relatives to donate what they can in the way of rice and funds, but it won't be enough. We could have cut medicine, patient food or some of our other services, but we all agreed we didn't want that to happen.''

Asuko Fitzgerald, the finance manager at the clinic, says there's international money available, but the clinic is having trouble getting access to it.

''There's a move by international governments to fund more humanitarian projects inside Burma and reduce funding for those on the Thai border, because of what we are, a small community-based organisation and where we are [in Thailand], we're considered not suitable for that money.

''We're not a big INGO (international non government organisation) and we can't compete with them or their resources for government funds. They're big players and we're just a grassroots organisation supporting the most vulnerable people on the border.''

Ms Asuko explains the clinic's accountability is to the Burmese people who seek health care at the clinic, but she fears their needs may get ignored by international governments in their rush to work inside Burma.

''We can't just leave them. A big INGO operating out of New York, London or Brussels can remotely cut services, we can't, but if we don't get extra funding we will have to reduce what we do.''

Ms Asuko is right _ there is international money earmarked for Burma. The UN's Office for the Coordination of Humanitarian Affairs (Ocha) compiled a list of ''funding, commitments, contributions and pledges'' to Burma, and it totals just over $200 million. Burma also earns billions from its natural resources, but the regime moves it offshore for their own use, Sean Turnell, an economist from Macquarie University in Sydney says.

Burma receives between $1 billion and $2 billon a year from its sales of natural gas to Thailand alone.

In spite of the well-documented difficulties of working with Burma's military regime, the international aid industry has fixed Burma firmly in its sights as a place in need of urgent assistance.

Human Rights Watch (HRW) described Burma's humanitarian crisis as ''one of the worst in the world'', and says one third of its citizens lives beneath the poverty line on about a $1 a day. Human Rights Watch have identified 13 United Nations agencies, funds and programmes operating in Burma and another ''54 registered and operational INGOs working there''.

David Mathieson, Human Rights Watch's, Burma researcher, stresses that humanitarian aid should not be a competition between government controlled areas and border conflict zones.

''Many donors feel nervous about sending aid 'cross border', but not sending aid will render already desperate populations even more vulnerable.''

Mr Mathieson blames the military regime's economic incompetence and mismanagement for Burma's crisis.

''The humanitarian and development mess that is modern Burma is the direct result of the regime's misrule, greed, incompetence and complete lack of concern for the welfare of its people,'' he said.

Mr Mathieson says accusations of mismanagement against the regime are well founded as the regime spends most of its money on military hardware, or ''symbolic modernisation projects like bridges, roads and the new capital city in Naypyidaw''.

A John Hopkins School Of Public Health report, The Gathering Storm, estimates that the Burmese regime spends as little as ''3% of national expenditure on health, while the military, with a standing army of over 400,000 troops, consumes 40%''.

HRW's Mr Mathieson says the regime's fiscal irresponsibility has created a disaster.

''It will take at least a generation to repair. Burma is a rich country where people should not be poor, but the natural wealth of the country is being sold off to foreigners and the profits hoarded by the regime's elites,'' he said.

And those revenues are substantial, explains economist Mr Turnell, speaking by phone from Sydney, Australia.

''In 2008/9 the regime spent around $US85 million on post-Nargis relief and construction compared with over $600 million committed in funds by the international community. This $85 million is less than two weeks of gas export earnings for the regime.''


Dr Aung, who has worked for nearly a decade in Burma's hospitals, says the health system has been neglected for years and is in need of a massive overhaul.

''It is soul destroying being a doctor. They [the regime] treat doctors and sickness as security problems and not as health issues. If we report health problems we're told it's not our business,'' he said.

Dr Aung, in his mid-thirties, says he wants to use his training and skills to help sick Burmese people, but admits trying to do that in Burma is a nightmare. Dr Aung cites a recent incident at Insein Hospital that ended a doctor's career.

''A student bitten by a cobra was admitted. She wanted to treat him, but there was no serum. She transferred him and he died. His family complained and the Ministry of Health lied and said all hospitals had serum. They punished the doctor by taking away her medical licence and forcing her to retire. All she wanted to do was treat her patient, but now her career is over.''

Dr Aung says doctors in Burma are frustrated by the lack of equipment and medicine needed to do their job.

''We want to help people. Most of the medicine is out of date _ it's worse than useless _ it's dangerous, causing some diseases to be drug resistant. We live in a crazy world; we can't report ill health or disease outbreaks. Talking to you can cause problems for me. I would not be allowed to go back, my family would be harassed and I would not be allowed to work as a doctor.''

Dr Aung reveals that the government does not provide fund for doctors or hospitals, but they also lie about it.

''They take no responsibility. I was sent to a remote hospital. We didn't have enough nurses, doctors or staff. We had no equipment and no medicine to treat people. We had to buy it ourselves. The government say they supply hospitals, but it's a lie, they always lie. Hospitals have nothing.''

Dr Aung says even getting access to basic but essential items such as running water and electricity are a problem.

''We have the buildings, that's about it. We plan our operations between 6pm and 10pm as electricity use is restricted. In one hospital, the medical supervisor wouldn't let us operate as he feared there would be no electricity for lighting, suction tubes, oxygen or ventilation.

''We treated a six-month-old baby admitted with pneumonia with antibiotics, but we couldn't give oxygen. The baby recovered, but suffered brain damage. In some areas if patients want electricity they have to buy the fuel for the generator.''

Dr Aung says not all Burmese people are equal or need to rely on the under resourced and run-down local hospitals.

''If government officials and their families are sick they get treatment abroad, they go to Singapore or Thailand and they use state money to pay their bills. It's not justifiable. I have many horror stories and none good about working in [Burmese] hospitals. Our patients just wait to die.''

Dr Aung says the number of women who die from abortion complications haunts him.

''Colleagues estimate as many as 10,000 women die each year. The Ministry of Health disputes their findings and refuses to help, and this figure is just for Rangoon.''

A World Health Organisation health fact sheet on Burma supports Dr Aung's estimation that many Burmese women are at risk from unsafe abortions, and says: ''Abortion is illegal in Burma and is considered the leading cause of maternal mortality, with at least 50% of maternal deaths and 20% of all admissions resulting from unsafe abortions.''


The numbers of Burmese people coming to Dr Cynthia's clinic is staggering. The clinic is not flash. It might have started out as a clinic, but it has grown to resemble a small village. Its cluster of rambling concrete sheds is connected by a dusty track that churns to mud when it rains. Most of the wards are simple breeze-block constructions on bare concrete slabs, but inside the wards medics treat patients with care.

Mae Tao Clinic's report for 2009 documents that 29,874 cases turned up at out-patients, 3,918 people were admitted as inpatients, another 7,074 cases received surgery, 13,438 children were seen at the child health department, 9,782 people came for eye care, 1.545 people received eye surgery, 221 new cases needed artificial limbs fitted and 4,741 people required dental treatment.

One medical man who sees the value in the work done by the Mae Tao Clinic is the Deputy Director of Mae Sot General Hospital, Dr Ronnatrai Rueangweerayut.

Dr Ronnatrai has worked in public health for 32 years _ 30 of those in Mae Sot _ and speaks highly of the clinic.

''Very few people can achieve what Dr Cynthia has done. Her medics help us control and prevent the spread of disease. We both apply good public health measures and we work on vaccinations programmes together. Diseases don't recognise borders and humanitarian care doesn't either.

''You have to vaccinate children travelling back and forth on both sides of the border _ it's a pointless exercise just targeting one group. The clinic trains people from Burmese villages to administer vaccines. This is important to help stop the spread of infections.''

On May 6, a news item in the Bangkok Post confirmed Dr Ronnatrai's treatment of communicable diseases was government policy. It stated that the Thai Ministry of Public Health ''provides polio vaccinations for migrant workers' children under the age of 15. The programme is in its second year and coincides with the schedule for inoculation of Thai children''.

Dr Ronnatrai doesn't say it, but a close look at the figures show that as well as Dr Cynthia's Clinic, Mae Sot Hospital is absorbing much of the costs of treating Burma's ill health _ as many as 25% of its in-patients are Burmese. Dr Ronnatrai says the hospital treats all legally registered workers and spends about 50 million baht a year on people who have no means to pay.

''It's a struggle for our hospital to find the budget to look after these people, but we do, we have to take preventative measures as we try to prevent the spread of deadly diseases and MTC co-operates with us to achieve this.''

Dr Ronnatrai says Thailand is again starting to see diseases, sourced to Burma, that they thought had been controlled, such as filariasis, a mosquito borne disease that can result in elephantiasis.

The John Hopkins School Of Public Health report, The Gathering Storm, says: ''Burmese migrant workers are more likely to be infected with filariasis than any other population group in Thailand.''

Considering all the reports and credible evidence that points to Burma's public health system being non-existent, it is highly unlikely that in Burma people are being treated in any systematic way by public health professionals for filariasis or any other infectious diseases. The Burmese regime is content to leave that to its neighbours.

The Bangkok Post article indicates that the Thai government recognises the risks if it doesn't take preventative measures, and the costs associated with treating cross border infections by allocating 472 million baht for Thai border hospitals to provide medical services to stateless people. The news item said many of the border hospitals incurred debt as a result of treating patients who did not have a registered nationality papers.

Dr Ronnatrai says Dr Cynthia's clinic performs an effective public health role in stopping the spread of infections and disease. ''It's the first barrier in identifying potential problems. This is crucial in us being able to respond quickly to infections and disease outbreaks.''

The failure of the Burmese regime to help and care for its own people has placed a massive burden on its neighbours and the Mae Tao Clinic. Dr Cynthia admits she is doing it tough. Her clinic is cash strapped and in the present economic climate she is having difficulty knowing where to source new funds.

Dr Decha Tangseepa, who teaches political science at Thammasat University in Bangkok and who specialises in forced displacement on the Thai Burma border, says the work the clinic does is essential.

''It's [the clinic] a gift to the suffering people of Burma. I've spent 11 years on the border doing field work. People come here [Mae Sot] without legal status, they have no choice, but they still come. Without the clinic local health services would explode. Dr Cynthia has shown her commitment for more than 20 years and the dedication of her staff speaks for itself.''

Inside one of the small, windowless concrete rooms, a small fan ineffectively pushes hot air around, and Dr Cynthia stares deep, as she considers her clinic's future funding and the future of Burma.

''Burmese people are getting poorer. We are not only treating migrants and refugees, but people from the cities and from the other side of Burma need help. In my time here I have never seen the patient caseload decrease, and it won't until there's years and years of stability and security.

''The people of Burma will never give up. They love their country and their children. And our clinic will never stop caring for them.'


Birmania por la Paz, esta desarrollando proyectos de Protección Materno Infantil, Escuelas y Entrenamiento con la Clinica MTC