Underground medics: rebuilding Burma's ruin

Rosalie Smith

May 27, 2009 (DVB), Government spending on healthcare in Burma ranks among the lowest in the world, eclipsed by the wealth of public money that lines the pockets of the army.

While the Southeast Asian pariah state has no external enemies, indeed it has not been at war with another country since 1956, 40 per cent of its budget goes on military financing. Alongside this, the meagre three per cent used to support almost 50 million people pales in comparison.

In 2000, the World Health Organisation ranked Burma's healthcare system second worst in the world, one notch above Sierra Leone, a country whose infrastructure has been obliterated by a decade of civil war.

Burma cannot use the same excuse. Wild financial mismanagement by the ruling junta, resistance to offers of aid from overseas, and a myopic focus on its own military might has caused a total breakdown in national healthcare. One of the largest groups of people in Burma paying the price for this are the internally displaced persons (IDPs).

Hospitals in Burma operate on a very rudimentary basis, lacking in vaccinations and other drugs, and riddled with corruption. In this context, IDPs are forced to rely solely on emergency health care.

Into this void have stepped voluntary medics, who travel into Burma's remote areas where the concentration of IDPs is often high. In Burma's eastern states alone there are over half a million IDPs who have fled either to escape the conflict between the Burmese army and armed ethnic rebel groups, or to avoid forced relocation by the army.

One such group is the Back Pack Health Worker Team (BPHWT), operating out of the Thai-Burma border town of Mae Sot. A BPHWT report published in 2006 found that child victims of forced relocation are 2.4 times more likely to die and around three times more likely to suffer from malnutrition than children allowed to stay in their own homes. Ironically, after fleeing, the use of contraception falls drastically as well. IDP's are also nearly five times more likely to get injured by landmines, given the frequency with which they move from one location to another.

In this context, the 'free agents' of Burma's underground healthcare system are invaluable. Another multi-ethnic volunteer organisation, the Free Burma Rangers (FBR), has conducted over 350 humanitarian missions of one to two months into the most conflict-heavy areas in Burma. They provide emergency shelter, food and clothing, along with medical care, and continue to document human rights violations inside Burma. Per mission, up to two thousand patients are treated.

Reversing a slide

In 1997, 500,000 people were found displaced in Karen state. Many schools and clinics had also been forcibly relocated. Compared to 1997, however, there are now 10 more clinics in Karen state, operated by FBR along with some partner organizations.

"Figures should be going the other way," said Thauwa A Ta from FBR.

"In 2004 and 2006, the Burmese army conducted more offensives. Since the 2006 attack, however, there are again 10 more clinics and there are also more schools."

Landmines, forced labor and the constant threat of Burmese army's attack are only a small part of the health risks that IDPs face. Many preventable or curable diseases, such as diarrhea or vitamin deficiencies, can be fatal to IDP's. Cholera, malaria and haemorrhagic dengue fever are endemic in Burma.

Ethnic Back Pack Teams work closely with local community leaders in areas where no healthcare is available. Training for Back Pack Medics is rigorous, with at least one year's experience in the field compulsory.

"Basically, everyone must finish at least six months basic medical training, and every six months we do an upgrade short course or a workshop," director Mahn Mahn explained.

The work these grassroots organisations do is highly dangerous. According to the first Geneva Convention, health workers should be offered protection. This, however, does not apply in Burma.

In the first eight years of the BPHWT program, seven backpack medics and one traditional birth attendant were killed, either from landmines or at the hands of the Burmese army. The Free Burma Rangers have also lost team leaders to disease and attacks.

An FBR member known only as Monkey acknowledged the tense environments they work in.

"Once the army was 10 minutes from where we conducted our mission. We were hiding in a small forest," he said.

"The villagers told us not to worry, they would protect us. I looked at the villagers; they were very calm so I wasn't scared anymore."

Currently, there are 49 FBR teams and 70 Back Pack Teams operating in eastern Burma. The relief these organizations bring, however, is still inadequate compared to the extent of medical assistance needed.

"All FBR help to internally displaced people inside Burma is maybe 10 per cent of what is needed," Thauwa A Ta admits.

"The army will eventually win. In 20 years there might not even be people in these areas anymore."

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