Doctors without borders? 2002 Ramon Magsaysay Awardee Cynthia Maung set up a small clinic to give medical assistance to refugees along the Myanmar-Thailand border.  Her ramshackle structure has since grown to a 120-bed health facility and she has began deploying ‘Backpack Medics’ because “If the sick and the wounded cannot come to us, the clinic goes to them.”  Dr. Maung’s story proves that kindness and compassion, and not just doctors, are borderless.

Photo courtesy of www.smh.com.au
Photo courtesy of www.smh.com.au

Braving checkpoints and soldiers eager for a bribe, landmine-littered forests, and roads made treacherous by monsoon rains, thousands of Burmese make the journey to Mae Sot across the border into Thailand every year. Neither refugees nor migrant workers, they are ordinary folk unable to afford medical treatment inside their country, prompting them to take great risks to seek the help of the Mae Tao Clinic in Mae Sot. For many Burmese, this is the only place they can hope to receive care.

In the 1980s, when Cynthia Maung was a young doctor working in the remote hillside villages of Burma, she witnessed the struggles of her country’s ethnic minorities. A Karen herself, Maung saw how families lost entire life’s savings or fell into crippling debt to pay for medical treatment. On top of the expense, they often had to bring their own medicines, bandages, and needles as hospitals were poorly equipped and often reused supplies.

In the same decade, Burma was experiencing severe strife. The military junta, which came into power in 1962 through a coup d’état, was waging a campaign against pro-democracy groups, inflamed anew by the government’s monetary policies that effectively devalued the currency and plunged millions into poverty. Protests against the junta seemed to have reached a fever pitch on August 8, 1988 when students organized peaceful demonstrations in Rangoon and other cities in the so-called “8888 Uprising”. The dictatorship responded by ruthlessly gunning down the protesters.

Bare earth and a rice cooker

Soon after the reprisals, Maung, who was working with activists in her village, decided to flee. Along with other young doctors, she made her way to the eastern region of Burma, traveling under the cover of darkness and finding shelter in forests and isolated villages, providing medical aid as they passed through. Eventually, Maung and her friends crossed the border into Thailand.

It was in Mae Sot where Maung eventually decided to settle. Initially intending to care for wounded and malaria-stricken students fleeing the junta, the young doctor soon discovered a burgeoning health crisis in the tense border region. Burmese refugees were living in deplorable conditions. Malaria and tuberculosis were rife and many had not seen a health worker. A quietly determined woman, Maung sprung into action. Operating from a dilapidated building with bare earth floors, Maung famously used a rice cooker to sterilize her instruments. From foreign relief organizations, she sought donations of medicines and supplies. With staff of six and the simplest medical equipment, the Mae Tao Clinic’s mission had officially begun.

Health care in crisis

While information from the secretive regime is difficult to obtain and verify, especially in areas where civil war is ongoing and foreign aid workers are not allowed to enter, community-based groups and relief organizations operating in Burma believe that the country is confronting a severe health crisis. Several consider the collapse of the health care system as a direct result of decades of misrule under military dictatorship. With a population of 50 million, Burma invests 0.5% of its gross domestic product on health. By comparison, 40% of government expenditure goes to the military. This translates to official health care spending of $0.40 per person per year, in stark contrast to $61 in neighboring Thailand.

Photo courtesy of www.nippon-foundation.or.jp
Photo courtesy of www.nippon-foundation.or.jp

The mortality rate among Burmese children below five years—105 per 1000—is the highest in Asia, with 60% of children’s deaths caused by preventable diseases, such as pneumonia, respiratory infections, diarrhea, and malaria. About 360 of every 100,000 women die in childbirth, three times the global average. The World Health Organization once ranked Burma’s overall health care system as the second worst in the world. In particular, eastern Burma’s health demography exhibits the same patterns as in war-ravaged Sierra Leone. Nearly 100,000 new cases of tuberculosis are reported each year in Burma, while over 1% percent of the nation has been infected with HIV/AIDS. Annually, 3,000 Burmese die from malaria, a disease that has largely been tamed in Southeast Asia. Worse, in the border with Thailand, a multidrug-resistant strain of malaria has emerged, the spread of which will have catastrophic consequences for the region.

Maung believes the government should be held accountable for the health crisis. “Because of a lack of resources and disinvestment in health, people are dying,” said Maung in an interview with the Bangkok Post in 2010. “We want the international community to consider this as a crime against humanity.”

The plight of the Burmese has not escaped the world’s attention. About 90% of Burmese live on $1 a day, according to a United Nations report. While the country is resource-rich, Burma’s health care is mostly supported by international aid. However, restrictions on humanitarian assistance and on travel as well as human rights abuses forced some agencies to withdraw. Burma’s largest donor, Japan, canceled a multimillion-dollar aid package to protest the death of a Japanese journalist, killed when government troops fired into crowds of peaceful protesters during the monk-led “Saffron Revolution”. Local community-based organizations and individuals such as Maung, though short on resources and under constant threat of human rights abuses, have been struggling to fill the gap in the health care infrastructure.

Internally displaced persons (IDPs), estimated at 446,000, have been identified as the most vulnerable group in Burma’s health crisis. Many were forced out of their homes and farms by the armed conflict, their livelihood and food sources razed to the ground and their villages planted with land mines to prevent future return. Many fled to Thailand to escape the fighting but were unable to find work legally. Wallowing in poverty, hungry, and exposed to communicable diseases, IDPs are the main target community of Maung’s Mae Tao Clinic.

Serving Burma’s neediest

From the ramshackle structure where Maung first began her mission in 1989, the Mae Tao Clinic has grown into a 120-bed comprehensive health care facility providing inpatient and outpatient medical care for adults and children. It has a delivery room, a surgical ward, a trauma unit, and a laboratory. The clinic also offers eye care, dental care, and blood bank services. For Burma’s thousands of land mine victims, hope for mobility has been restored through the clinic’s prosthetics workshop and rehabilitation services. Maung also helped train staff who run satellite clinics in camps of ethnic minorities and IDPs spread throughout the border.

Each year over 200,000 refugees, IDPs, and migrant workers—most of them the neediest of Burmese society, such as the acutely ill, mothers, and children—receive care free of charge from the Mae Tao Clinic. Most patients suffer from malaria, tuberculosis, HIV/AIDS, or from untreated injuries. About 700 Burmese civilians trained as medics comprise Maung’s staff. An average of 400 patients arrive daily, many of them traveling for days through jungles and hills on foot or on improvised stretchers borne by family members. Destitute and often desperate, they slip through the porous border between Burma and Thailand in the hopes of saving life and limb.”People come here with a lot of pain and suffering,” Maung said in 2007. “Some of them arrive on their last legs in search of help… We won’t turn anyone away or leave them to suffer alone.”

Today Maung, who has made the clinic her home, focuses not only on the health of “at risk” groups but also on the effects of the civil war on the mental and psychological health of the IDPs and refugees. Decades of fighting and displacement have left scars on both bodies and psyches. The fabric of Burmese society has also been torn by the conflict and Maung expects new challenges to arise from this.

“Backpack Medics”

If the sick and the wounded cannot come to the Mae Tao Clinic, the clinic goes to them. As a response to the destruction of clinics in the border areas by Burmese military raids, in 1998, Maung trained the Back Pack Health Worker Team, which operates in refugee camps in Thailand and in villages in rural Burma. The group consists of 300 ethnic Karen, Mon and Shan health workers—itself an amazing testament to multiethnic cooperation among the Burmese. From an initial 35 teams, there are now 70 providing services to about 150,000 internally displaced persons and villagers in remote areas.

In teams of three to five, the “Backpack Medics” travel across mountainous terrain and rural hinterlands, often deep in the conflict areas. Battling adverse weather and crossing free-fire zones, they carry bulky supplies of medicines from Thailand into eastern Burma in rucksacks and wicker baskets. The health workers treat diseases and injuries, distribute birth kits to expectant mothers, give dietary supplements to children, and provide training in health, hygiene, sanitation, and nutrition.

Some medics have been maimed by gunfire or mines while carrying out their mission. Others have been killed. Each year many are arrested and tortured by the Burmese government, which views health workers as threats to the regime. Yet the success of these mobile health teams trained by Maung is undisputed. In areas where the “Backpack Medics” operate, deaths from malaria decreased by 48%, while deaths from dysentery went down by 51%. “We are Dr. Cynthia’s medical Marines,” said one medic.

Self-reliance and empowerment

Maung’s life-saving humanitarian work from across the border in Thailand has not endeared her to Burmese authorities. She was declared a traitor by the military junta and, like the refugees she helps, she has not been able to return to Burma in over two decades despite living within sight of her homeland. Death threats have reached the doctor, who is accompanied by unarmed volunteer bodyguards when she appears in large gatherings. But in the Mae Tao Clinic, she is known as the gentle “Dr. Cynthia” who mingles with patients with friendliness and familiarity.

Amid the chaos and strife of civil war and a total breakdown of systems, Maung has built a sturdy independent health care infrastructure from scratch through determination, resourcefulness, and collaboration. She has done so to benefit Burma’s most vulnerable and has stepped in where governments have failed to provide. Her selflessness and compassion have provided a lifeline to internally displaced persons and refugees. Most would have perished if not for the Mae Tao Clinic’s intervention.

The Mae Tao Clinic, with its Burmese staff and its programs that train Burmese to help their own communities, stands out an example of self- reliance and empowerment under the direst and most challenged conflict situations in the world. It stands as probably the last best hope for thousands in the Thai-Burma border to receive medical care. As the clinic continues to make a marked difference in maternal and infant mortality rates among Burma’s IDPs and refugees, Maung and her team improve and save lives and rebuild communities. By encouraging collaboration among ethnic groups in the border region, she has shown it is possible to cooperate towards shared goals under complex circumstances. Furthermore, Maung’s work with the Back Pack Health Worker Team has helped to raise awareness of the plight of persons living in conflict zones. The “Backpack Medics” she has trained are, at great personal risk to themselves, going where doctors cannot reach and saving lives of mothers and children. Maung and the many individuals she has trained and empowered are the best hope for Burma’s future. “Many sick people in Burma have nowhere to go,” Maung said. “But we’re here for them.” Burma’s IDP and refugee communities could not have found a more formidable advocate and supporter.