HEALTH, HEALTH CARE AND DISEASES IN MYANMAR

HEALTH AND DISEASE IN MYANMAR

Life expectancy: female— 63.78 years; male—57.8 years (estimated 2005, cCompared to 82—female and 76—male in Japan and 47-female and 42-male in Guinea. [Source: CIA World Factbook]

"Life expectancy" is an abstract and complicated concept a complex formula that attempts to predict the lifespan of children born today by subjecting a hypothetical child born today to the current risk of dying in each bracket he or she mature through until, in effect, the accumulated risk of death is 100 percent.

Children under the age of 5 years underweight: 22.6 percent (2010), country comparison to the world: 26, Infant mortality rate: 67.24 deaths/1,000 live births. The maternal mortality rate in Myanmar is 380 per 100,000 births—almost four times the rate in Thailand and 60 times the rate in Japan, Ryan said. [Source: CIA World Factbook]

Malaria, AIDS, and malnutrition and related diseases are serious problems in Myanmar but the country gets minimal foreign assistance because of its repressive regime. Tuberculosis is a major killer. Myanmar's tuberculosis rate is one of the highest in the world, with 97,000 new cases detected annually.

Major infectious diseases: degree of risk: very high: 1) food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever; 2) vectorborne diseases: dengue fever and malaria; 3) water contact disease: leptospirosis; 4) animal contact disease: rabies. Highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009) [Source: CIA World Factbook]

Paul Theroux wrote in “The Great Railway Bazaar”: “I was dining one evening in Mandalay with some doctors. Outside the hotel, on the dirt road where that morning I had seen a dead dog, its hindquarters in a paper bag, a tonga clattered past—a pony cart with two tiny kerosene lamps aglow next to the driver. The doctors worked at the Mandalay General Hospital (built in 1924), and their talk was of amoebic dysentery and hepatitis. I asked about cholera. The doctor next to me said, "This isn't the season ...but it's coming." "We have been suffering, oh, we have been suffering," said a doctor across the table. He poured himself a glass of warm Mandalay Pale Ale. "Suffering. Not for a decade, but for a century, I should say. For a century. " [Source: Paul Theroux, The Atlantic, November 1, 1971]

See Separate Article on AIDS and HIV in Myanmar

Malaria in Myanmar

Malaria is a major killer in Myanmar. Myanmar suffers 60 percent of all malaria deaths in Asia, U.N. officials say, but it receives little foreign aid. Multi-drug-resistant strains of tuberculosis are spreading within the country and across the border. About 600,000 cases of malaria are reported annually in Myanmar, with 3,000 deaths. Malaria is the leading cause of death for children under 5. [Source: Richard C. Paddock, Los Angeles Times, December 27, 2005 ==]

Malaria is found in rural areas, but there is generally not much of a risk if you stay close to the cities and the beach resorts. Dangerous chloroquine- and Fansidar-resistant strains of malaria are common, especially near the borders of Thailand, Cambodia and Myanmar . Mefloquine-resistant strains have also been reported. Chloroquine, Fansidar and Mefloquine are the preventative anti-malaria medicines people usually take in malaria areas. Be especially careful in swampy areas and during the monsoon season. Malaria has been “practically eliminated” from coastal areas of Thailand (it is still found on some islands near Cambodia).

The most virulent and drug resistant from of malaria (Falciparum malaria) is found along the Thai-Myanmar border. Untreated the disease is often fatal. The disease has largely been kept under control thanks to doctors, using modern diagnostic method and he Chinese herbal "wonder drug" artesunate in refugee camps in Thailand near the Burmese border. The malaria rate in the camps is 1 to 5 percent compared to 25 percent in border regions in Burma. Unfortunately some doctors have been attacked by Karen guerrillas.

Many of the antimalarial medicines sold in Southeast Asia are fake. A study by Lancet in 2001, found that a third of antimalarial drugs sold in Cambodia, Thailand, Vietnam, Laos and Burma contained no active ingredient.

Malaria medication is harmful if it is taken more than several months, consequently local people usually take precautions against being bitten by mosquitos—primarily mosquito netting over their beds and mosquito coils lit in the evenings.

Drug-Resistant Malaria Spreads Rapidly to Thai-Myanmar Border

In April 2012, AFP reported: “Deadly malaria that is resistant to drug treatment has spread rapidly from Cambodia to the border between Thailand and Myanmar, raising concerns of an uncontrollable epidemic, scientists said. A pair of studies published in The Lancet and the journal Science showed how the disease is moving fast into new territory and identified a region of the parasite's genome that may be responsible for mutating in order to survive. [Source: AFP, April 5, 2012 **]

“Malaria that was resistant to treatment with the current standard therapy, artemisinin, was confirmed in Cambodia in 2006 and has since surged 800 kilometers (500 miles) westward to the Thailand-Myanmar border, the researchers said. By studying 3,202 patients along the northwestern border of Thailand near Myanmar from 2001 and 2010 and measuring the time it took them to clear malaria infections from their blood after treatment, scientists were able to show a steady increase in drug resistance. **

“The number of slow-clearing infections rose from 0.6 percent of cases treated in 2001 to 20 percent in 2010. In western Cambodia, 42 percent of malaria cases were resistant between 2007 and 2010, indicating that the Thailand-Myanmar region was swiftly catching up to Cambodia's rates. "Genetically determined artemisinin resistance in P. falciparum emerged along the Thailand-Myanmar border at least eight years ago and has since increased substantially," said The Lancet study. "At this rate of increase, resistance will reach rates reported in western Cambodia in two to six years." **

“The research in the journal Science focused on what was making these parasites different, and found that a region on chromosome 13 of the parasite was strongly associated with slow clearance of infection. They sequenced the genomes of 91 P. falciparum parasites from Cambodia and western Thailand and compared them to parasites from Laos, where resistance to the latest artemisinin-based drugs has not yet emerged. They found seven genes that may be responsible for making the parasite resistant to drugs, and which may explain up to 35 percent of the growing resistance in southeast Asia. **

"We have now seen the emergence of malaria resistant to our best drugs, and these resistant parasites are not confined to western Cambodia," said leader of the study Francois Nosten, director of the Shoklo Malaria Research Unit that studies and treats malaria in the Thai-Myanmar region. "This is very worrying indeed and suggests that we are in a race against time to control malaria in these regions before drug resistance worsens and develops and spreads further." **

Bird Flu in Myanmar

See Southeast Asia

Poor Health in Myanmar

Richard Paddock wrote in the Los Angeles Times, “Officially, one in three children suffers from malnutrition; the real number may be much higher, putting the country on par with some of the most destitute nations in Africa. HIV is rampant. "It's a desperate situation, and people are dying," said one international aid official who questions whether sanctions are doing any good. "The people are beautiful and kind. It's heartbreaking to see them suffer the way they do, especially the children." [Source: Richard Paddock, Los Angeles Times, June 18, 2005]

Thomas Fuller wrote in the New York Times, “ Myanmar remains a place where very basic vitamin deficiencies kill people. Beriberi, for example, is caused by a severe lack of vitamin B1, which is found in so many types of food -- fish, eggs, brown rice, pork and peanuts among them -- that most people need not be concerned about sufficient intake. But in Myanmar, "you have a high level of babies dying from infantile beriberi, which is a disease that you read about in medical school but never thought you'd see a case," said Stephen Atwood, a pediatrician who works as an adviser for UNICEF. "I felt that I was reading a Dickensian novel when I saw this," he said. [Source: Thomas Fuller, New York Times, October 25, 2007 <=>]

“According to UNICEF, 10 out of 100 children in Myanmar die before reaching the age of five. In Thailand, two out of 100 die. A woman has a one in 75 chance of dying in childbirth in Myanmar, compared with one in 900 in Thailand. Because children in Myanmar are malnourished, 32 percent are significantly below the expected height for their age compared with 13 percent in Thailand. Cynthia Maung, a Burmese who runs a nonprofit health clinic” in Thailand near the Myanmar border “has become accustomed to detecting malnourished children. "The skin peels easily," she said. "The hair becomes brittle. The eyes look drowsy. There's muscle wasting -- you can't see the muscles, just bone and skin." “ <=>

“Terrence Smith, a US gynecologist and obstetrician at the clinic, says most of his patients are unnaturally lean. "We do ultrasounds and the transducer goes straight to the organs," he said. In one corner of Smith's ward were two tiny, malnourished newborns dropped off and abandoned by their mothers. Maung's clinic was set up to treat sick patients from Myanmar who cannot afford health care inside their country. The clinic treated about 2,000 patients in 1989 when it opened. Last year, 100,000 Myanmar people came for treatment.” <=>

Health Care in Myanmar

Myanmar ranks among the lowest countries in nearly every category of health care funding. Figures from the WHO show Myanmar spent just $12 per capita on health in 2009, of which only one dollar came from the govern, with the remainder cobbled together by NGOs and patients. That figure was matched only by the Democratic Republic of Congo (DRC), a nation ravaged by war and political instability.

In the 1950s, Burma was one of the richest countries in Asia. It had an excellent health care system. In the 1990s, the Myanmar government spent only 24 cents per person on health care. The only country that spent less is Sierra Leone.

According to the World Health Organization the world's worst health care systems in 2000 were: 1) Sierra Leone; 2) Myanmar; 3) Central African Republic; 4) Democratic Republic of Congo; 5) Nigeria. Health expenditures: 2 percent of GDP (2010), country comparison to the world: 190, one of the worst rates in the world. Myanmar spends five times more on the military than it does on education and health care combined. [Source: World Health Organization, CIA World Factbook]

Yoshihiro Kimata, a professor at the Okayama University Graduate School of Medicine who has frequently visited Myanmar, “There are only about 30 doctors per 100,000 people, one-seventh that of Japan. Only four universities in Myanmar have medical schools, and the shortage of doctors has become a chronic problem. In rural areas, many residents suffering from burns on their bodies cannot receive adequate treatment. As a result, many Myanmar locals have died from burns. [Source: Hideki Tsujita, Yomiuri Shimbun, March 18, 2012 \\\]

Hideki Tsujita wrote in the Yomiuri Shimbun, “While Kimata has become more determined to save locals from medical hardship, he said, "If we only continue medical support to Myanmar, our efforts will eventually dwindle. The first priority should be to foster human resources in the medical sector." To do so, the university decided to establish the clinical academy to emphasize training doctors as a step to improve medical care in the country. project. "We want to establish a system to periodically send doctors to Myanmar and save many patients there. We also aim to deepen exchanges with Myanmar and promote the university's internationalization," Kimata said. \\\

Health Care System in Myanmar

Lucile Andre of AFP wrote, “The country has a relatively high number of doctors but lacks medicines and wider support systems to treat patients, said MSF head of mission Peter Paul de Groote. "There are quite a lot of trained doctors but you can have many doctors -- if you don't have the drugs, the paramedicals, the nurses, you still don't get anywhere," he explains. And while the state press frequently burnishes the government's image as a provider for its people, with pictures of brand-new hospitals, the reality is markedly different. [Source: Lucile Andre, AFP, May 26, 2012 :::]

"I visited a lot of township level hospitals and I'm always struck by the fact that there are a lot of staff but very few patients," says Mike Toole, a public health expert and adviser to the 3MDG Fund, a consortium of international donors to Myanmar. "Patients just don't go there because they don't get good quality services, there is a lack of equipment, a lack of basic medical supplies, of drugs." :::

Margie Mason of Associated Press wrote: “Wracked by corruption and mismanagement, the country's overall health care system was ranked second worst in the world by the World Health Organization in 2000. The government spent the least of any country worldwide on health in 2009, as a percentage of the country's gross domestic product. Its people pay the price in many ways: 1) Myanmar has Southeast Asia's highest death rates for newborns, infants and children under 5. 2) AIDS kills an estimated 18,000 people a year, and the country remains one of the hardest in which to receive HIV treatment. 3) Tuberculosis is at nearly triple the global rate, and Myanmar has the highest number of malaria-related deaths in the region. 4) More than 90 percent of pregnant women and 70 percent of children in coastal and delta areas suffer worm infestations, a major cause of malnutrition. [Source: Margie Mason, Associated Press, December 16, 2012 <<]

And all this is happening in a resource-rich country that was once the envy of its neighbors. "Decades of disinvestment in health by Burma's rulers, coupled with the collapse of the education system and censorship, have left the country's public health system in ruins, without sufficient trained personnel or supplies to adequately offer basic, affordable health services for most Burmese," said Dr. Vit Suwanvanichkij of Johns Hopkins University. <<

MSF says only a third of the 120,000 people living with HIV in Myanmar who under World Health Organization (WHO) standards should receive antiretrovirals are being treated. The shortage of medicine extends to other serious illnesses including tuberculosis and malaria.

Doctors and Hospitals in Myanmar

There are only 703 hospitals and 12,464 doctors. Hospitals are in very poor condition, and funding for medical care and training is inadequate. Physicians density: 0.457 physicians/1,000 population (2008). Hospital bed density: 0.6 beds/1,000 population (2006). In 2004, the Myanmar government said that between 1989 and 2004 the number of hospitals rose from 140 to 757 with 22 opened in the previous year alone.

A typical hospital for a town of 200,000 is empty and boarded up, with only a few nursing attendants on duty. One of nurse attendant in the town of Hsipaw told the New York Times, “There is no medical service here except a few doctors in a private clinic who charge a lot.”

Aung San Suu Kyi said, “”If you walk into any hospital in Rangoon and you will be surprised—no equipment, no medicines. People going into a hospital have to buy their own medicine. They have to take their own equipment and there are even cases were to have supply their things like surgical gloves, surgical spirits—even the most basic equipment has to be supplied by the patient. So all the hospitals offer are expertise, the expertise of the staff and because their staff are ill paid—even that is hard to come by.”

Margie Mason of Associated Press wrote: “The lack of care is obvious at the country's main hospital, Rangoon General in Yangon. Its once stately British colonial red-brick facade sprawls across a huge campus, but the grounds are cluttered with filth and weeds and food vendors sell cheap snacks to patients' relatives near open sewage gutters. Inside one ward, dozens of patients are packed into an open room. Some drift in and out of sleep while others twist in obvious pain as family members fan them. [Source: Margie Mason, Associated Press, December 16, 2012]

In the mid 2000s doctors were paid the equivalent of $15 a month, teachers, $15. Sometimes you can see small shops with “neurosurgery” sign out front. There are stories of golf club and tennis racquet salesman doubling as dentists and eye doctors.

Dedicated Midwives and Village Clinics in Myanmar

Reporting from Zee Phyu Kwin in rural Myanmar, Margie Mason of Associated Press wrote: “In her long scarlet sarong, crisp white shirt and nurse's cap pinned neatly in place, Khin Aye Nwe looks as though she belongs in a modern hospital. Instead, the midwife's clean sandals scuff across the dusty cement floor of a dilapidated clinic in Myanmar's Irrawaddy Delta. She covers a territory spanning 15 villages with 3,000 people, delivering babies, immunizing children and treating everything from malnutrition to malaria in an area where 80 percent of young children and pregnant women are anemic. [Source: Margie Mason, Associated Press, December 16, 2012 <<]

“Despite the neglect, Nwe and a small army of other dedicated women have continued to fan out across the country's vast rice basket to help the sick. They walk, ride buses, climb inside rickety boats and hop on the backs of motorbikes to reach patients who have no other source of medical care. The work is exhausting, and Nwe knows no matter how hard she pushes herself, it will never be enough to help everyone. <<

“Off the rocky, rutted dirt track in a faraway corner of the Delta where midwife Nwe works, UNICEF — not the government — has been running a program that provides vitamin- and mineral-packed sachets called Sprinkles to 3,000 children under age 3. The micronutrients are added to food to help ward off anemia caused by a lack of iron in an area of the country routinely hit by flooding and disasters — Cyclone Nargis killed more than 100,000 people in 2008. <<

“Nwe quickly rattles off a wish list of improvements she'd like to see: more health workers and supplies, better infrastructure and transportation for staff and patients. But she's also quick to note that the government has doubled staffing at the local health center to deal with the heavy patient load. Doubled, that is, from one to two. It's a very small thing, she knows, but it's enough to make her hope for more. And that's something she never would have dared in the past. <<

Relying on NGOs for Health Care in Myanmar

Lucile Andre of AFP wrote, “Starved of funds and medicine during decades of military rule, doctors at a clinic in Yangon offer their usual advice to one of Myanmar's newest HIV patients -- come back when you're sicker. In a country with one of Southeast Asia's biggest armies but a healthcare system in tatters, scarce antiretroviral drugs are given only to those with the advanced form of the illness. "If I don't get the treatment, I'm worried the disease will get worse," a 47-year-old farmer told AFP at the clinic run by charity Medecins Sans Frontieres (Doctors Without Borders) after she was diagnosed with the virus. [Source: Lucile Andre, AFP, May 26, 2012 :::]

"Patients are upset, it is difficult to tell them... but we cannot refer them anywhere, the government doesn't have it (medicine) either," said Soe Yadanar, one of four doctors at the clinic in a poor Yangon neighbourhood, which has more than 2,000 registered patients."We tell them they can come back later. But they know the situation in Myanmar," she added. :::

“Under the junta NGOs were banned from public hospitals and in effect ran a parallel health service, but now they are calling for closer cooperation with the government to extend the reach of healthcare. "We need to start thinking about a long-term health system where we can all work together," argues de Groote.

In the meantime, many among Myanmar's impoverished population will continue to rely on foreign NGOs for help. Mying Maung Maung, a 37-year-old carpenter, says he had to turn to MSF when he needed treatment for tuberculosis and HIV.After several years of antiretroviral treatment, the father-of-four stopped responding to the medicine, in part because he did not stick to the strict timetable of taking his dose. "I don't have a watch, I had to find clocks... but they always have a different time," he said. :::

Deathly Ill Suffer as NGO Leaves Myanmar

The UN-initiated Global Fund to Fight Aids, Tuberculosis and Malaria withdrew from Myanmar in 2006 due to restrictions placed on it by the military regime, although a European-led fund has formed to try to fill the gap.

Richard C. Paddock wrote in the Los Angeles Times, “A growing humanitarian emergency has sparked fears that thousands could die of disease and malnutrition in Myanmar. The Global Fund to Fight AIDS, Tuberculosis and Malaria, which is financing worldwide efforts to combat the three diseases, cut off $87 million in funding for Myanmar this year, citing a lack of cooperation from the ruling junta, which continues four decades of military control.[Source: Richard C. Paddock, Los Angeles Times, December 27, 2005 ==]

“If other major donors don't come forward, U.N. officials say, thousands of people will die, including as many as 5,000 AIDS patients who were supposed to receive antiretroviral drugs under the five-year Global Fund program. "The Global Fund was never given a chance to function," said Charles Petrie, the chief U.N. official in Myanmar. "Without exaggeration, people are going to die because of this decision. People who survived the regime are going to die because we are not able to provide the humanitarian aid to help them survive the disease." ==

“With the lack of action by the government and the shortage of aid funds to nongovernmental organizations, all three diseases targeted by the Global Fund have become epidemic in Myanmar and pose a threat to neighboring countries China, India and Thailand. In cutting off aid, the Global Fund acknowledged that the health situation in Myanmar was "extremely precarious" and said, "These diseases could soon reach catastrophic proportions, affecting the entire region." ==

“The Global Fund initially granted $98 million for healthcare programs in Myanmar, which is almost the size of Texas. In May, however, security officials became concerned about foreign aid workers traveling around the country and imposed strict travel restrictions. The Global Fund concluded that the aid could not be distributed properly and, in August, cut off $87 million in funds that had not been disbursed. The travel restrictions were lifted soon after. ==

‘Some foreign aid workers here contend that the Global Fund's decision to withdraw from Myanmar was the result of political pressure from the United States and hard-line democracy advocates in Washington who have the ear of key members of Congress. Global Fund spokesman Jon Liden, however, denied that politics played any part in the decision and said the program was terminated because Myanmar had reneged on its commitment to let aid workers travel. "The claim that political pressure was building on us and that we were looking for an excuse to get out is totally unfounded," Liden said. ==

Red Cross Closes Two Myanmar Offices over Junta Limits

In 2007, Reuters reported: “The International Committee of the Red Cross (ICRC) said it had shut two of its offices in Myanmar because restrictions by the military government had brought "near-paralysis" to its operations. The Swiss-based organisation said its staff were unable to conduct visits to detainees in former Burma or run independent operations in sensitive border areas, compromising its mandate to provide neutral humanitarian aid. [Source: Reuters, March 15, 2007 //\\]

"The ICRC's humanitarian work in Myanmar has now reached near-paralysis ... A recent meeting with the Ministry of Home Affairs made no headway," ICRC director of operations Pierre Kraehenbuehl said in a statement. "The ICRC has therefore decided to close two of its offices, one in Mawlamyine (Mon State) and the other in Kyaing Tong (East Shan State). It is carefully considering whether to keep open its remaining field offices," the statement read. //\\

Over the past year, the ICRC has cut its expatriate staff in Myanmar to 16 -- from 56 -- because of the junta's restrictions. It halted prison visits in 2005 because of official insistence that ICRC staff be accompanied by government-affiliated agencies. In 2005, the United Nations cut of assistance to fight AIDS, malaria, tuberculosis and other diseases because of travel restrictions imposed on AIDS workers.

The poor state of Myanmar’s health care system was made painfully clear after Cyclone Nargis, which killed an estimated 120,000 people. At that time Reuters reported: “Ten thousand pregnant cyclone survivors are in urgent need of proper care in Myanmar, William A. Ryan, a spokesman for the U.N. Population Fund, said. More than 100 women give birth every day in the area affected by the cyclone. "The destruction of health centers and loss of midwives have greatly increased the risks," he said. "It is clear that many pregnant women do not have anywhere to go to deliver with skilled assistance." [Source: AP, June 11, 2008]

What is More Important in Myanmar: Democracy or Health Care

Some aid workers here question what they contend is a strategy of withholding assistance from Myanmar in the hope of bringing down the regime. "The idea of grinding them down so they will rise up is morally suspect, even if it could work," one foreign aid worker told the Los Angeles Times. "The idea that an impoverished, downtrodden population is more likely to rise up is not true. They spend all their working hours trying to find their next grain of rice." [Source: Richard C. Paddock, Los Angeles Times, December 27, 2005 ==]

Richard C. Paddock wrote in the Los Angeles Times, “The looming health crisis in Myanmar sparked debate among aid workers here and pro-democracy advocates outside the country over which should be the highest priority: preventing a humanitarian disaster or bringing down the regime. One Washington-based advocate who insisted on anonymity said that blame for the lack of aid should be placed squarely on the regime and that the international community's focus should be on bringing about political change in Myanmar. ==

Brian Williams, the UNAIDS country coordinator for Myanmar, likened the cutoff of medical aid to withholding food from people at a refugee camp. "If there were refugee camps and you stopped feeding people, you would be accused of murder," he said. "Here, if you are able to provide aid to people in need, then you should do so. If you need to reach people, you have to work with the authorities who are in place." ==

‘The regime's actions have been costly. Despite its overwhelming poverty, multiple epidemics and dearth of social services, Myanmar receives less international humanitarian aid per capita than almost any country in the world, including others with repressive governments."What I deplore is the low levels of international assistance," said Guy Stallworthy, Myanmar country director of Population Services International, which would have received a share of the Global Fund money to finance its AIDS prevention program. "When you put that together with the military regime, it's a horrendous situation." ==

Improving Health Care in Myanmar

Lucile Andre of AFP wrote, “In an effort to address the funding crisis, reformist President Thein Sein, whose nominally-civilian government took over from the junta in March 2011, has quadrupled the health budget for 2012-2013. "It is a good start, but it is coming from a very low base," says Toole. "It will need massive investment... with comparable investment by the government and donors, it would probably take at least 20 years, and possibly 30, to catch up with Thailand." [Source: Lucile Andre, AFP, May 26, 2012]

Margie Mason of Associated Press wrote: “As the country continues opening its doors to the outside world are symbolizing a new era. A parade of high-ranking global health officials also have recently filed through the country, taking stock of what's left of the health system and vowing to help rebuild it. UNAIDS last month named Suu Kyi a global advocate to raise awareness of stigma and discrimination against HIV patients, a daunting problem in the country. [Source: Margie Mason, Associated Press, December 16, 2012 <<]

“Myanmar has taken a few encouraging steps. Its new health minister, Dr. Pe Thet Khin, is a pediatrician with firsthand knowledge of the challenges. He said he hoped new partnerships and collaborations with foreign universities would improve the quality of the country's health system. He added that infant, child and maternal health was considered a top priority. He said the country is producing enough doctors, nurses and other health workers but that the quality was "a bit compromised" due to a lack of funding. "The economy, as you know, was not very good over the past 20 or 30 years, partly because of sanctions but partly because of some mismanagement," he said. <<

The new government has quadrupled the health budget, but it is still low and much of the budget increase went to paying health workers' salaries. National studies are also needed to provide a clearer picture of the true state of health, especially from restive areas where ethnic minorities have been at civil war for decades and travel was previously forbidden."The system here is so far behind," said Eamonn Murphy, UNAIDS country coordinator. Myanmar once had a strong health and education system and could recover, he said, "but it's just going to take time and it's going to take a serious commitment from the international community, not just financial but technical." <<

Assembly-Line Cataract Surgery Brings Sight to Hundreds Myanmar's Blind

Decades of isolation, military rule and woeful health care have left Myanmar with a particularly high rate of blindness. A 2005 survey conducted by the South Australian Institute of Ophthalmology in the rural Meiktila district of central Myanmar found that 8.1 percent of the population there was blind.

Robin McDowell of Associated Press wrote: “ Now the veil of darkness is starting to lift, thanks in part to an "assembly line" surgical procedure that allows cataracts to be removed safely, without stitches, through two small incisions. Nepalese surgeon Sandut Ruit, who helped pioneer the technique, oversaw nearly 1,300 operations at two massive eye camps in 10 days in October, with dozens of local ophthalmologists looking on and helping. [Source: Robin McDowell, Associated Press, October 31, 2013]

Despite improvements over the last two decades, the vast majority still use a microincision surgical technique that requires two sutures. Doctors were confident the no-stitch procedure — cheap, easy to learn and taking as little as five minutes — would catch on quickly. "This is a turning point in our cataract history," said Dr. Tin Win, the chief of Yangon Eye Hospital. He said his goal is to have all 60 eye centers in the nation of 60 million using the procedure by the end of next year. He says he will pass on the information to all doctors, together with training manuals and videos, at a nationwide eye conference in early November. "If we succeed, we can double our cataract surgical rate," he said. "We can start getting rid of our cataract backlog."

Several organizations focused on preventing blindness have focused on Myanmar as a country in particular need of help. Ruit, who travels throughout the developing world holding free mass eye camps, was working in Myanmar for the first time. He and his team were initially scheduled to perform 1,000 surgeries, but added nearly 300 patients due to the overwhelming response by potential candidates. After the operation, some patients expressed hope they would be able to work again. Others were eager to see the faces of their children and grandchildren.

Health Customs in Myanmar

The Dry Zone area is sweltering in the hot season. People often move their beds and furniture outside and sleep outside and gossip late into the night. When it is very hot some Burmese drink a cup of coffee. The idea is that the coffee makes the drinker sweat and the sweat cools the drinker.

Burmese believe that sickness or even death can be caused by taking baths in the afternoon or being exposed to the hot sun.

Maybe due to the fact the health care system is so poor family members are expected to take care of sick relatives while they in the hospital, supplying them with food and keeping them company. It is not unusual for an extened family to camp outside the hospital, cooking meals for the sick on a wood fire.

When a person is seriously ill, his or her relatives and friends are normally informed. Once informed, the friend or relative has an obligation to visit the sick person. Normally, gifts on such occasions are fresh fruits or canned cereals. [Source: Myanmar Travel Information]

Posters in Burmese schools remind students that washing their hands is a way to prevent cholera. Cholera was common in Yangon in the 1990s because of contaminated water and poor sanitary condition. [Source: Joel Swerdlow, National Geographic, July 1995]

Traditional Medicine in Myanmar

The use of traditional forms of medicine remains important, especially among the ethnic minorities. Few young people, however, receive training in these forms of medicine by an aging group of traditional healers and many traditional practices and the knowledge of traditional remedies are being lost. [Source: Countries and Their Cultures everyculture.com ]

In traditional medicine there is a system of curing and healing based on notions of a balance of elements in a patient.

The dendrobium orchid, which is collected by the truckload in the Kachin Province of Myanmar is used in Asian and Ayurveda medicine and in some places is more highly valued than ginseng. There has been some discussion of cultivating the orchid commercially and making medicines with it.

The mezali tree is a medicinal tree which Myanmar herbalists use to treat a variety of stomach ailments. It has a slightly bitter taste and purported curative properties. This leafy and flowery tree grows wild in many parts of Myanmar. Its tender leaves and flower buds are edible. Soups, curry, salads and other dishes are all made with of Mezali. Especially in cold season. November to February. Mezali is recommended as a medicinal vegetable for all ages. It is believed that on that Full moon night all medicinal properties of herbal flora are concentrated in Mezali Tree. Therefore Myanmar people eat Mezali salad on the Full Moon night of Tazaungmon. There is a legend saying that the Mezali tree was visited by the guardian God of herbal flora. [Source: Myanmar Travel Information]

Mezali salad is a favorite. Ingredients: Some Mezali Buds about 100gm; 2 - 3 Potatoes; 2 - 3 Onions; Some peanuts; Some roasted sesame seeds; Some garlic; Some salt; Some oil; 2 Lemons. Preparation: First Mezali is boiled for about 20 minutes. Then the water is dripped. Some boil the Mezali for another time to make the bitterness lesser. Boil the potatoes and peel off the skin. Peel off the garlic and fry with oil for dressing. Peel off onions and cut into small pieces and wash with water. Ground the peanuts. It is prepared with boiled Mezali buds seasoned with ingredients such as ground peanut. roasted sesame. fried garlic. fresh pealed onion. cooking oil. fresh lime and salt. throughly mixed. Mezali salad is very appetizing. It is served as a side dish or a sort of dessert with hot tea.

Ideas About Health and Food in Myanmar

In traditional Burmese medicine, foods are divided into two classes: heating (apu za) or cooling (a-aye za), based on their effects on one's body system, similar to the Chinese classification of food. Examples of heating foods include: chicken, bitter elon, durian, mango, chocolate, ice cream. Cooling foods:, pork, eggplant, dairy products, cucumbers, radish. The Burmese also hold several taboos and superstitions regarding consumption during various occasions in one's life, especially pregnancy. For instance, pregnant women are not supposed to eat chili (for the belief that it causes children to have sparse scalp hairs). [Source: Wikipedia +]

The country's diverse religious makeup influences its cuisine, as Buddhists avoid beef and Muslims pork. Beef is considered taboo by devout Buddhists because the cow is highly regarded as a beast of burden.Vegetarian dishes are only common during the Buddhist Lent (Wa-dwin), a three-month Rains Retreat, as well as Uposatha sabbath days. During this time, only two meals (i.e. breakfast and lunch) are consumed before midday to observe the fasting rules (u bohk saunk) and abstinence from meat (thek that lut, literally 'free of killing') is observed by devout Buddhists. Throughout the rest of the year, many foods can be prepared vegetarian on request, but the bulk of Burmese food is prepared with fish or meat broth bases. Also, many of the several ethnic groups prepare at least one inherently vegetarian dish (notably cuisine from the Shan people).

Burmese that are serious about the worship of nats abstain from pork. Some serious Buddhists avoid eating animals with four legs. During Buddhist Lent many abstain from eating eggs, meat and fish and eat a vegetarian diet.

Spirulina

Burmese believe that consuming Spirulina (a kind of blue green algae) makes you healthy, promotes long life and makes one free of diseases because “nearly all vitamins are proportionately in it.” Spirulina is found in volcanic crater lakes and the natural lakes having a high PH level. In Myanmar, Spirulina is produced in the lakes of Twintaung, Twinma, Taungpauk and Yaekharr. Yaekharr Lake is located between Sagaing Hill and Min Wun Hill in Sagaing Division of central part of Myanmar. Here the Myanmar Pharmaceutical Factory in Sagaing Division produces a variety of drugs and cures made of Spirulina. [Source: Myanmar Travel Information ~]

In the first stage of the Spirulina production process the water is pumped from the lake. The pumped water contains a 6:1 ratio of water to Spirulina. Pure Spirulina can be obtained from the pumped water by sieving it three times using a technique called ‘Flat Plane’. Spirulina is also sieved by Tube Plane technique. The sieved Spirulina put through a hydraulic press, which makes it noodle-like, and dried in the sun. To produce dried powdered Spirulina two methods are used: one by the natural sun’s heat and the other by chemical processes. The Spirulina dried by chemical processes is better than the one dried by sun’s heat. ~

To make Spirulina pasta the Spirulina powder is blended with flour and mixed with egg and mineral water. Spiral shaped noodles are produced by using machine. The noodles are steamed for three minutes to become hard and dry. After cooling. Spirulina pasta is ready. Spirulina pasta is rich in protein, vitamins and minerals. Spirulina is added to medicated Thanakha, the facial paste worn by women and children. Biomin. a kind of natural tonic, contains Spirulina, Aloe Vera and honey. ~

Image Sources:

Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, Lonely Planet Guides, The Irrawaddy, Myanmar Travel Information Compton’s Encyclopedia, The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Newsweek, Reuters, AP, AFP, Wall Street Journal, The Atlantic Monthly, The Economist, Global Viewpoint (Christian Science Monitor), Foreign Policy, burmalibrary.org, burmanet.org, Wikipedia, BBC, CNN, NBC News, Fox News and various books and other publications.

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© 2008 Jeffrey Hays

Last updated May 2014

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