In the depths of the jungle in Karenni State villagers are facing a health crisis that rivals disaster situations in Africa. This health crisis affects the entire population of Burma, however, those hardest hit, are ethnic minority groups, like the population of Karenni State, where there is still an active armed resistance movement. For them, this is not an abstract theoretical issue, but a crisis that is engulfing their families and communities.
Within Karenni State we can split the population into three groups: rural (villagers), urban (people that live in towns) and semi-urban populations (people who live somewhere between villages and towns). The distances between some of these different populations are, most times, less than 50 kilometres; however their living standards and access to health care vary dramatically. The health situation for those from towns, even though it is better than what rural people receive, it is still drastically inadequate.
In urban areas there are hospitals and medical clinics, operated by the government, local non-governmental organisations and an unnamed international NGO. Health services from these providers are allegedly free or affordable; however this is not the case. In reality it is very expensive when you go to the hospital. When you go to the hospital the first question the staff will ask you is: do you have any money? If you have money they will look at what disease you have, but because they do not have any medicine at the hospital, they will write down what the patient needs and the sick person, or their family and friends has to go and buy the medicine and bring it back to the hospital.
The salaries of health workers employed by the government are very low – so low that they have difficulties making ends meet. When they have to support a family on this wage, further hardships arise. In order for health workers to be able to survive they often have to take second jobs (resulting in the hospitals or clinics being understaffed or closed) sell medicines on the black market (resulting in their being no medicine in the hospital) or charge extra for medical services (making health care unaffordable for most people). In order to break this cycle, salaries for health workers need to increase and this will only be possible if there is a change in the attitudes of the junta’s echelon and their policies.
Additionally, most health workers are not properly trained. There is a lack of qualified health workers in Burma, especially in ethnic minority areas, such as Karenni State, where access to education is limited. Consequently, staff in clinics and hospitals often lack the necessary skills to diagnose and treat diseases and injuries effectively, which can lead to death or permanent disability.
...staff in clinics and hospitals often lack the necessary skills to diagnose and treat diseases and injuries effectively, which can lead to death or permanent disability
However, it is not only in hospitals and clinics in urban areas where under-qualified staff are providing medical treatment. In semi-urban and rural areas travelling nurses go from village to village offering medical treatment in return for payment (either money or goods). However, these nurses have rarely received any medical education and they often engage in very unsafe practices, such as reusing hypodermic needles. Patients that do receive appropriate medical treatment from these nurses usually do not receive the whole treatment, as the nurses divide the treatments meant for one person among many, rendering the treatment inadequate. These nurses treat the provision of health care to the populations as a for-profit business rather than a public service.
In semi-urban areas there are some clinics, however, these rarely have medicines, and are only open part of the time. Additionally religious groups, non-governmental organisations and health workers from Thailand can reach some people in semi-urban areas. However, the assistance that they can offer is only a tiny amount of what is needed. For groups working cross-border and others that do not have permission from the State Peace and Development Council to work in the health sector in Karenni State they do so at great risk to themselves. The SPDC deems the activities of these groups illegal and if the Burmese army catches workers they will simply disappear – never to be heard of or seen again.
People living in rural areas are reliant on religious groups, cross border health workers and travelling nurses for health care. These groups, while doing their best, are working in a civil war zone with limited resources, medical knowledge and experience. They cannot always reach communities in need, and the assistance that they offer is only a tiny amount of what is required.
In areas where people cannot access medical treatment many villagers use traditional medicine. Sometimes traditional remedies work, however, they are often inadequate, such as when someone stands on a landmine. In many cases people with knowledge of traditional medicine are the only ones who can offer any relief to villagers who are in pain or ill. Knowledge about traditional medicine is past down from one generations to the next orally. However some do not want to share their knowledge and it is being lost.
The living standards of the population have a large impact on the health situation. All people in Karenni State are living a subsistent existence, doing little more than surviving from day to day. A portion of the population’s daily diet only consists of rice and a few vegetables, which is inadequate for anyone’s nutritional needs. Additionally, the systematic violation of human rights in Karenni State by the Burmese army and Karenni ceasefire groups (who act as a proxy army for the military junta) and less systematic violations by the Karenni armed resistance movement undermine the people’s survival structures and their livelihoods. Poor living standards result in poor health conditions and when combined with a perpetual lack of adequate health care, leads to a health crisis.
Additionally, people do not always have access to clean drinking water. In Karenni State there are not many rivers and villages are not always located along a permanent water source. To have a permanent water supply villagers build dams to store water following the rainy season. The dams that people build to store water are their only supply of water, which means that villagers use water to bath, clean cooking utensils, sanitation and drinking. Animals also use this water to bath, drink and do unsanitary things.
However, these dams are not big enough and most people face water shortages during summer. In some cases people have to walk 45 minutes each way to collect water in the midst of a civil war zone. So that people do not have to travel too much, they limit the amount of water they use leading to further unsanitary conditions which affects people’s health.
Last year the Backpack Health Workers, a cross border organisation that provides health care and medicine to communities in Burma’s ethnic areas, released a report called “Chronic Emergency” which documented the health crisis that people in side eastern Burma (which includes Karenni State) are facing. This report concluded that the health situation in eastern Burma is comparable to the worst disaster zones in the world. From their research a number of alarming statistics about the health situation in eastern Burma emerged (please see the box on page 4).
However this health crisis is not just an issue that affects Karenni State and Burma. Many people from Karenni State migrate to other areas in Burma and neighbouring countries, mainly Thailand, looking for work or seeking asylum. As these populations cross international boundaries they bring with them diseases and illness that can then be transferred to the local people. Populations along Burma’s borders with Bangladesh, India, China, Laos and Thailand are susceptible to HIV/AIDS, drug resistant malaria and drug resistant tuberculosis that are coming from Burma, along with the people. Additionally, sick populations that have migrated to a new country add stress on the national health care system and non-governmental organisations that provide medical services – stretching their already thin resources further.
In order to help the people in Karenni State a solution that addresses the root causes of the health crisis needs to be found. The health problems in Burma stem from constant mismanagement of the country by the military junta and to the SPDC needs to drastically change their governance system or to allow others to rule. While this is a long-term solution, stopgap measures can save lives. People need access to medicine and qualified health care workers to administer treatment. Additionally education can play a vital role in preventing illness, as can programmes that work to improve people’s living standards.
Access to adequate health care is a universal right - it is not a privilege for the rich or those born in the west. One in five children in eastern Burma dies before their fifth birthday. That is 20 per cent of children that will never go to school, turn five or reach their potential. This is simply unacceptable. Our outrage needs to be loud, it needs to be bold and it needs to be now. Do not allow your silence or ambivalence condone the silent dying of a large part of the Burmese population.
This article was written by Burma Issues staff and is based on information collected by four Karenni field staff, Khu Meh Reh, Khu Ei Reh, Khu Poe Reh and Khu Ko Reh, during their trips to Karenni State from October 2006 to March 2007.
The Health Situation in Eastern Burma
Infant Mortality: 91 per 1,000 live births
Under 5 Mortality: 221 per 1,000 live births
15.7 per cent of children are at different levels of malnutition (as measured using the mid-upper arm circumference)
Proportion of the population positive for Malaria: 12.4 per cent
Lifetime risk of Maternal Death is 1 in 12 women
Statistics taken from "Chronic Emergency: Health and Human Rights in Eastern Burma", a report by the Back Pack Health Worker Team 2006
To go to the other articles published in the June/July 2007 BI Newsletter click on the links below:
...staff in clinics and hospitals often lack the necessary skills to diagnose and treat diseases and injuries effectively, which can lead to death or permanent disability
