In eastern Burma conflict, medics face the same dangers as those they treat

Caring for the displaced in the Burmese jungle – and fleeing with them as the army advances

• • Alisa Tang
  • Guardian Weekly, Tuesday 25 January 2011 13.59 GMT
  • Article history

  

  Displaced ... a Burmese man at a refugee camp. Photograph: Nicolas Asfouri /AFP Weighed down with 10kg packs of medical supplies – as well as her clothes, food and three young children – Hsa Mu Na sets out from her organisation's headquarters in Mae Sot, Thailand, for five hours by car, four hours by boat and three days by foot to a conflict-plagued region of Burma where medical care would be nonexistent were it not for her and her colleagues. "I have to cross streams, go over mountains and through the jungle to get there. I sleep in villagers' homes along the way," said Hsa Mu Na, a 36-year-old ethnic Karen health worker.

  "There's no security, so we can't travel freely. That is the most difficult thing. There is no security and no food, so the health problems are serious. There are no services for obstetric care. It is difficult to transport people who need care." In parts of Burma where communities constantly uproot themselves to survive, clinics are not an option, so Hsa Mu Na and the roving medics of the Back Pack Health Worker Team have become the solution. Hauling patients in hammocks lashed to bamboo poles and hanging intravenous fluid bags off branches to treat the sick as they lie on beds of banana leaves on the forest floor, these local health workers share the precarious existence of their patients and flee with them as the Burmese military advances and attacks. "Instead of setting up permanent infrastructure in this situation, the programme designed had to be more community-based, even though they are displaced or mobile," said Dr Cynthia Maung, a founder of Back Pack and of the 22-year-old Mae Tao Clinic for refugees and migrant workers in Mae Sot, Thailand. "The area where these people work is in conflict zones. They are like other villagers, vulnerable to be casualties to malaria and the same risks as people in the community." Burma's ruling military junta has long waged war with the country's ethnic minorities, who for decades have sought autonomy. In the late 1990s the junta stepped up attacks, razing thousands of villages, displacing half a million people and laying landmines to prevent communities from returning to their land. Established in 1998, Back Pack has recruited health workers from these communities, and brought them to Mae Sot – a sleepy Thai border town that serves as a base for Burmese refugee groups. There they are trained by technical experts from Johns Hopkins School of Public Health and the American NGO Global Health Access Program (Ghap). Loaded up with several 10kg packs of medical supplies, they are then dispatched across the Moei river into Burma for days-long journeys by foot back home. What began as 32 teams of 120 health workers serving 64,000 people in eastern Burma has expanded to 80 teams – 254 medics, 645 traditional birth attendants and 360 village health volunteers – addressing the needs of a 190,000-strong population along the eastern and western borders. Supported by groups including Burma Relief Centre, International Rescue Committee and Not On Our Watch, Back Pack handled 89,000 cases in 2009, on a budget of  about $550,000. Each team leader receives just $33 per month, as a survival stipend to be shared with others in the field. The medics are trained to treat 20 common illnesses, including diarrhoea and pneumonia, as well as malaria, which accounts for a quarter of all deaths in eastern Burma. They delivered 3,600 babies in 2009, and treated 55 gunshot and 17 landmine victims. Since Back Pack's founding, nine of its medics and one traditional birth attendant have been killed by gunfire or landmines. The most recent fatality was last July, when soldiers burned down Thada Dae village in Karen state, and shot a Back Pack medic. Several Back Pack workers have been arrested by Burmese troops, though none are currently in detention. Every six months, some 60 to 80 team leaders return to Thailand for a month. As most are not recognised as Burmese citizens and are stateless, they cross the border illegally, carrying epidemiological data and patient histories. At the Mae Sot headquarters, they are debriefed and updated on medical advances. "In eastern Burma, which may have active conflict or may be unstable, clinic access may not be available," said Jen Leigh, Ghap's field director and one of Back Pack's many partners who graduated from the Johns Hopkins public health school. "We know the best practices, and we use the evidence to help decide what is the best intervention in this setting." Back Pack has trained 1,300 health workers for its own ranks and community-based organisations such as the Burma Medical Association and Karen Department of Health and Welfare, which provide care in more stable areas. Back Pack also mobilises to help elsewhere as need arises. After cyclone Nargis struck Burma's southern delta in 2008, they formed the Emergency Assistance Team to deliver food, water, shelter and health services. When people fleeing Burmese troops crossed into Thailand in June 2009, they created the Karen Community-Based Organisation Emergency Relief Committee. "For myself, I understand that this is my task, these are my people, this is my community. When they are suffering, I have to solve this problem," said Mahn Mahn, Back Pack's secretary and one of the driving forces among the Mae Sot-based Burmese in exile. "When there is oppression beside you, you are not free. If someone needs help, is still suffering, you are not free."