Burma’s health woes traversing borders

Preventable infectious diseases and a raft of other health concerns are spilling over Burma’s border into neighbouring countries, causing a headache for regional health systems and a tragedy for its citizens.

The situation is largely a “man-made crisis”, said Dr Vit of the Center for Public Health and Human Rights, Johns Hopkins University at a seminar yesterday at northern Thailand’s Chiang Mai University.

Diseases such as lymphatic filariasis, a possible precursor to Elephantiasis which causes debilitating swelling of the limbs, has been generally eradicated in countries such as Thailand. This has been achieved through a combination of public health spending, policy and co-ordination, which has come at a cost of around $500,000 per year in Thailand.

Vit notes that the incidence of filariasis in Thailand is only along the Burmese border provinces of Tak, Mae Hong Son and Kanchanaburi, where all cases occured among Burmese migrants. He added that only 10 percent of infected persons showed symptoms of the disease, which is transmitted through mosquitoes, indicating that the fact that two cases had been reported in the northern Thai city of Chiang Mai in 2004 made it likely that far more undiagnosed cases exist.

Thailand’s Mahidol University of Tropical Medicine corroborated, noting that “another strain of bancroftian filariasis [similar to lymphatic filariasis], found in immigrant workers from Myanmar [Burma], has been reported in Thailand”.

Vit highlights the disparity in spending between the regional countries as an explanation for the disproportionate occurrences: China has spent roughly $US66 per person on health each year and Thailand around $US122, while the Burmese government spends around $US1, although he notes that the Thai government does treat migrants so not all of this would go to Thai citizens.

Burma’s spending equates to 0.9 percent of government expenditure, while the average regional figure is around 10 percent. This effectively means that at least 89 percent of Burma’s health spending comes from household expenditure or charitable endeavours. Such figures prompted the World Health Organisation (WHO) in 2000 to rank its service 190 out of 191 global countries.

The UN Development Programme estimates however that GDP per capita in terms of purchasing power parity (PPP) is around $US881 in Burma, while in Cambodia, another impoverished regional nation, it is $US1619.

PPP is an attempt at estimating the spending power of a nation’s populace. The figures mean that Burmese would be less able to purchase adequate healthcare, given the woeful state of the economy.

This is further reflected in the diseases which are of most concern in Thailand and Burma. In Thailand the major killers are those of old-age such as, diabetes, accidents, cancer of the liver and cardiovascular disease. Burma’s however are diseases of poverty, with diarrhoea, malaria, tuberculosis (TB) and malnutrition, which UN figures claim a third of children suffer from, causing the most concern. This was despite the junta’s claim that they had met the Millennium Development Goal target of eradicating TB.

Despite such claims from the regime, published figures for TB treatment programs in Thailand’s Tak Province have indicated that almost 40% of patients in some programs are crossing the border simply for basic TB treatment, unavailable at home. Meanwhile, ongoing inability to access longterm care is translating into disproportionate rates of drug resistance, and subsequent sickness and death, amongst migrants from Burma, posing a threat to Thailand’s TB control efforts. He is at pains to add however that Burma “is not a poor country”, given that it is one of Asia’s largest exporters of lucrative natural gas.

The pariah’s health results are even worse in ethnic areas, with health indicators in eastern Burma comparable to war-torn African nations. Infant mortality rates in eastern Burma, for instance, were around 73 per 1000, whilst in Sudan it is 69 per 1000.

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