The government pledges more investment into the dilapidated system
MAE SOT, Thailand — Maw Lwin Khine lives with her husband in a small wooden home with a thatch roof. They don’t have electricity, running water or a phone. The couple sells flowers, earning roughly 2,500 kyats (US$3) a day.
They were managing fine until Maw Lwin Khine, eight months pregnant, went into labor.
Maw Lwin Khine’s aunts packed up food, loaded her into a horse cart and took her to a hospital in eastern Myanmar’s Karen State. Her husband followed on a bicycle. At the hospital, the doctor determined that Maw Lwin Khin, 28, had high blood pressure and needed a Caesarian section. The doctor performed the operation, but the baby had already died.
The difficulties did not end there.
The government-run hospital charged 200,000 kyats for the operation and another 300,000 for medicine and supplies. The couple pulled together their life savings and borrowed the rest – about 455,000 kyats – from friends.
“We had no money left so we decided to come here.”
~Maw Lwin Khine
Two weeks later, Maw Lwin Khine became sick again. She had a high fever and her body swelled up. The couple couldn’t afford to return to the hospital. Instead, they decided to visit a clinic in neighboring Thailand that offers free health care and serves Burmese. They borrowed 26,000 kyats and traveled 11 hours to Mae Sot, a border town in Thailand.
Recent news coverage of Myanmar has focused on promising developments in this long-suffering nation: the nascent political reforms, the election of Nobel laureate Aung San Suu Kyi to parliament, and the West’s suspension of sanctions.
However, little attention has been paid to a more immediate need: affordable, decent health care.
Thanks to restrictive policies and a lack of investment, Myanmar’s current health care system is a disaster. Patients like Maw Lwin Khine are so desperate for affordable, quality medical attention that they travel long distances to cross an international border to get it.
“We had no money left so we decided to come here,” Maw Lwin Khine said at Mae Tao Clinic. Her cheeks looked puffy, her lips swollen and her eyes heavy with exhaustion. Yet she said she felt better. She said she has received good care, and for free.
Half of the patients at Mae Tao Clinic, which began as one house in 1989 and now spreads over a large compound and serves more than 100,000 people a year, come from inside Myanmar, also known as Burma. The other patients are Burmese migrants living in Thailand.
“Word of mouth in Burma has brought so many women from such far places because they’re desperate,” said Meredith Walsh, who for the past five years has worked at the clinic as a reproductive health technical advisor. She said she has seen patients come from as far as Rakhine State in western Myanmar.
The military junta that ruled the country for a half century spent very little on health care — roughly 2 percent of GDP in 2009, according to the World Health Organization. By comparison, the United States spent eight times more of its GDP. Neighboring Thailand spent more than double.
The international community has donated limited resources to Myanmar because of difficulties ensuring the money gets into the right hands.
“Relative to its population and income, Burma is one of the world’s smallest recipients of international assistance,” economist Joseph Stiglitz wrote during a trip to Yangon in March.
In addition to resources, the government restricts where and how aid organizations can operate, blocking the delivery of medical services.
The result has been a health care system that in conflict areas, does not exist, and in large cities, is too expensive for ordinary people, according to experts inside Myanmar and on the Thai border.
Health during conflict
Since Myanmar gained independence from the British in 1948, it has been wracked by armed conflicts and fragile ceasefires with civilians and ethnic rebels. In areas that are disputed or that have fragile ceasefires, services are extremely limited, according to Human Rights Watch senior Asia researcher David Mathieson.
During fighting, the army has even destroyed clinics, Mathieson said, sending mortar rounds into a village to disperse residents before destroying all civilian infrastructure including health facilities.
The health of Myanmar’s women has been one of the biggest casualties.
The maternal mortality rate for women in Myanmar is 240 deaths per 100,000 live births — “not an acceptable standard, and it is for preventable reasons,” the UN Population Fund’s representative for Myanmar, Mohamed Abdel-Ahad, told GlobalPost. In neighboring Thailand, the rate is 44 deaths per 100,000 live births.
In eastern Myanmar, the number spikes to 721 deaths per 100,000 live births. In conflict-affected areas, mothers die in more than one out of every hundred births, according to a 2012 report by Ibis Reproductive Health.
“It really all comes down to the lack of access for basic reproductive health care,” said Cari Siestra, one of the report’s authors.
Most women give birth on their own or with an unskilled traditional birth attendant. There are few clinics available for complications, and those that exist have limited medications or procedure options, Siestra said. The lack of access to skilled birth attendants and lack of knowledge about emergency obstetric care leads to the high number of maternal deaths in the region, according to the Ibis report.
The government — long wary of “meddling” foreigners — has also forbidden most international non-governmental organizations from working in these areas. The most egregious example occurred in 2008, when the junta initially prevented international aid workers from accessing victims of a devastating cyclone.
The government has been so wary of outsiders that health workers who receive training and supplies from Thailand are treated as criminals, according to Dr. Cynthia Maung, the founder of the Mae Tao Clinic.
Sitting in her clinic’s library, she recalled an incident from two years ago when one of her health workers assisted with a delivery. A government official learned that she had been trained at the border and kicked her out of the community. Mere association with Maung, world-renowned for helping student activists and displaced peoples, is dangerous.
Nine babies later
Although Myanmar is rich in natural resources and the elite live well, for most women poverty is a major factor in the maternal health crisis. Poorly educated women lack basic health knowledge, and in nearly a third of the country, they do not have access to free contraceptives, according to UNFPA.
The lack of birth control leads to unwanted and unhealthy pregnancies, and to life-threatening abortions, said Siestra.
Even in central Myanmar, where people are largely shielded from the fighting, women’s health has suffered as a result of the country’s extreme poverty and lack of services. Health care investment has been so low that in rural areas one government midwife has to oversee as many as 40 to 50 villages, according to UNFPA’s Abdel-Ahad.
In South Dagon, a hot and dusty satellite town in outer Yangon, Kyi Sein, 35, sits on the floor of a monastery, waiting to be seen by a volunteer doctor. She leans back and slides her hand under her large belly covered by a bright red top. She is pregnant with her ninth child.
As a line of sweat forms on her upper lip, Kyi Sein says she can’t afford this child. Her husband works as a laborer, earning about 3,000 kyats a day. She earns a little sewing designs on her friends’ clothes. The couple wants to keep their children in school but cannot afford the fees and cost of books, which add up to about 10,000 kyats a year for each child.
“I want my children all to go to school,” Kyi Sein says. “But it is expensive for living costs, food.”
Kyi Sein says she never heard about family planning or spacing out births until she visited this clinic – after already having seven children. She tried to use birth control before this latest pregnancy, but she was too late. She says she will try again.
A time for change
As Myanmar goes through this time of transition, it remains to be seen how a new, reform-minded government will impact the health of the country’s women. While clinicians and advocates in Yangon and on the border say they have not seen tangible changes yet, they are hopeful.
“For us it is unbelievable,” said Dr. Kyaw Hlaing, who has worked in Myanmar since 1990 and with CARE for the past 12 years. “Very surprising for us to see the government change dramatically. But it’s a bit early to say [what the effect will be].”
The government has indicated it will quadruple its health expenditures. The reform process is expected to bring more funding from international donors. The first census will be conducted in three decades, enabling health specialists to identify population needs. And restrictions on access to areas of the country are beginning to be loosened.
At John Hopkins University in April, Health Minister Pe Thet Khin said that the system has been “compromised,” and faces a shortage of providers and educators, inadequate facilities and substandard care for women and children, according to the John Hopkins University Gazette. He said a top priority for the new government will be improving maternal and child services, especially in the rural areas.
The health ministry will focus on hiring more doctors, securing supplies and renovating hospitals, he told Reuters in March.
UNFPA’s Abdel-Ahad said the government’s recent increase in resources to health and education services is a big improvement. But Myanmar has a long way to go, and the money’s “still not enough.”
In the third part of this Special Report, “Beyond Aung San Suu Kyi: Women in the New Myanmar,” GlobalPost’s Hanna Ingber returns to Myanmar, also known as Burma, where she lived for a year under the harsh rule of the military junta, and brings us the stories of women the world has not seen nor celebrated, but who have worked quietly and persistently toward change.
More Related Stories
- I'm not achieving my dreams!
- The most popular Tumblr porn
- Slave descendants seek equal rights from Cherokee Nation
- Snapchat is secretly storing your photos
- Peace Corps to allow gay couples to volunteer together
- Facebook's hate speech problem
- Rand Paul: Congress should apologize to Apple, not the other way around
- When my home was destroyed
- Okla. mother's tearful reunion with her 8-year-old son
- New campaign compares gun control to anti-LGBT discrimination
- Study: Salt Lake City is gay parenting capital of the U.S.
- You are less beautiful than you think
- "Ghetto" tour lets you gawk at New York's poor
- Teen activist to meet with Abercrombie CEO
- Watch: Family emerges from storm shelter after tornado
- Okla. tornado survivor reunited with dog trapped in rubble live on camera
- My miscarriages made me question being pro-choice
- Why I tried to be a punk
- I'm terrified of the cicada onslaught
- Limbaugh: No one willing to impeach the first black president
- SAT's right answers are all wrong
Featured Slide Shows
The week in 10 picsclose X
- 1 of 11
Lisa Montgomery embraces her nephew Thursday after a tornado tore apart her home in Cleburne, Texas. The twister killed six people and destroyed entire swaths of the North Texas town.
Credit: AP/LM Otero
Jack McMahon, the defense attorney for abortion doctor Kermit Gosnell, speaks outside the Criminal Justice Center in Philadelphia Tuesday. His client was convicted of killing three babies in his clinic, and will serve multiple life sentences.
Credit: AP/Matt Rourke
A photo taken Monday captures Vice President Joe Biden's response to a Milwaukee second-grader's innovative proposal to end America's epidemic of gun violence. This guy!
Credit: AP/Jenny Aicher
Sen. Rand Paul, R-Ky., flanked by a grouper-eyed Michele Bachmann, addresses the IRS' admission that it targeted Tea Party groups in advance of the 2012 election. In an op-ed for CNN Thursday, the Kentucky senator slammed the president for his faux outrage.
Credit: AP/Molly Riley
Ousted IRS chief Steven Miller is sworn in on Capitol Hill Friday. Miller testified before the House Ways and Means Committee on the extra scrutiny the agency gave conservative groups applying for tax-exempt status.
Credit: AP/J. Scott Applewhite
Attorney General Eric Holder pauses as he testifies on Capitol Hill before the House Judiciary Committee Wednesday. Holder is under fire, among other things, for the Justice Department's gathering of phone records at the Associated Press.
Credit: AP/Carolyn Kaster
O.J. Simpson sits during an evidentiary hearing at Clark County District Court in Las Vegas, Nev., Thursday. Simpson, who is currently serving a nine-to-33-year sentence in state prison for armed robbery and kidnapping, is using a writ of habeas corpus to seek a new trial.
Credit: AP/Las Vegas Review-Journal/Jeff Scheid
Major Tom to ground control: On Sunday astronaut Chris Hadfield recorded the first music video from space, a cover of David Bowie's "Space Oddity."
Credit: AP/NASA/Chris Hadfield
When it rains it pours. President Barack Obama speaks during a news conference Thursday with Turkish Prime Minister Recep Tayyip Erdogan, inexplicably inspiring an #umbrellagate Twitter meme.
Credit: AP/Jacquelyn Martin
A smoke plume rises high above a road block at the intersection of County A and Ross Road east of Solon Springs, Wis., Tuesday. No injuries were reported, but the the wildfire caused evacuations across northwestern Wisconsin.
Credit: AP/The Duluth News-Tribune/Clint Austin
Recent Slide Shows
- 1 of 11
Salon is proud to feature content from GlobalPost, an awarding-winning international news site that focuses on original reporting from journalists stationed around the world. GlobalPost combines traditional journalistic values with the power of new media to offer a fresh perspective on global developments.