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BURMA: Public Health Ailing Even Before Cyclone Struck

Marwaan Macan-Markar

BANGKOK, May 19 2008 (IPS) - Even before Cyclone Nargis tore through Burma’s populous Irrawaddy Delta, the country’s public health system was ailing. It struggled to survive on a slow drip of funds from the state’s coffers.

Such neglect was courtesy Burma’s military rulers. The junta spends more of the country’s earnings from its wealth of natural resources to bolster the over 400,000-strong army than care for its population of 54 million people. Nearly 40 percent of the gross domestic product (GDP) went to military spending annually, while the public expenditure on health was 0.3 percent of the GDP.

Consequently Burma (or Myanmar) stands at the bottom of global indices on health spending. According to the World Health Organisation (WHO), this South-east Asian country has one of the worst health systems, ranking only one place better than Sierra Leone, which came 191st in a list of countries surveyed.

And that in a country where one in four people live below the poverty line, where over a third of the children under five years are underweight and malnourished, and which has the second highest under-five mortality rate in Asia after war-torn Afghanistan. In addition, Burma has among the highest prevalence rates of killer diseases such as malaria, tuberculosis and HIV/AIDS in the region.

‘’The health infrastructure in Burma has been in decline for more than two decades,’’ says Dr. Chris Beyrer, professor of epidemiology at the U.S.-based Johns Hopkins Bloomberg School of Public Health. ‘’Hospitals are poorly equipped, under-staffed and the medical and nursing staff so poorly paid that they charge patients fees for virtually everything they can provide.’’

‘’Burma has one of the most highly privatised health care systems in the developing world – meaning that patients have to pay out-of- pocket for virtually all services,’’ he added in an IPS interview. ‘’The system was not functioning before the storm.’’

It is a view shared by a Burmese doctor who had worked for seven years at the general hospital in Pyapon, one of the large towns in the delta that was struck by the powerful cyclone. That 100-bed hospital barely received such medical supplies as injections, intravenous drips, tablets for pain and even bandages from the state, she said.

‘’I would only get 10 vials of penicillin a day but had to treat 190 patients in the OPD (out patients’ department),’’ the 54-year-old doctor, now living in exile, revealed on condition of anonymity. ‘’We were overworked and under-funded all the time.’’

And now, over two weeks after the cyclone, which killed close to 130,000 people and severely affected 2.5 million people, the doctor wonders how her former colleagues at Pyapon will cope with the monumental challenge of caring for the cyclone’s victims. ‘’I fear for the children,’’ she sighed.

To begin with, her colleagues will have to deal with the physical damage to hospitals that Nargis left in its wake. Nearly 50 percent of the health centres in rural townships and 20 percent of the main hospitals have been damaged, Dr. Maureen Birmingham, WHO’s acting representative in Thailand, told IPS. ‘’Most of them have missing roofs; some have no running water.’’

International humanitarian agencies like Medecins Sans Frontieres (MSF, or Doctors Without Borders) concur. ‘’In the areas we have been able to assess, we found that the hospital of Piaypon has suffered several structural damages but is still open to patients,’’ Phillip Humphris, MSF’s programme manager for Burma, told IPS. ‘’In Bogale town, nine of the 10 health centres are reported destroyed (and) it is unknown if the staff has survived and where they are.’’

And to prevent more deaths, MSF has rushed in four cargo planes packed with aid that includes water, sanitation equipment and medical supplies. MSF, which has been working in Burma since 1992, is ‘’treating several hundred patients each day’’ in 20 different locations across the delta, in south-western Burma.

The hospitals and health clinics that survived the cyclone will face ‘’high and critical needs resulting from the exposure of large numbers of the population to physical and mental trauma, infectious disease and malnutrition,’’ adds Humphris. ‘’Diarrhoeal disease, respiratory tract infections and malaria are expected to increase in the coming days, and be exacerbated by the poor nutritional status due to lack of food.’’

But there are other outbreaks to worry about. The health threats in camps crowded with survivors include diseases like measles and dengue fever, says Beyrer, who has done extensive research on Burma’s health sector. ‘’There is also the risk of plague outbreaks, since there is endemic plague in rodents in Burma, and rodents too will seek the limited dry ground where people will gather.’’

Such troubling prospects and the desperate need to scale-up aid to bolster Burma’s weak health system have failed to move the junta. The latter has still to lift the restrictions placed on aid workers from foreign humanitarian agencies gaining access to the entire devastated terrain. Consequently, some international organisations estimate that only a fifth of the victims have received desperately needed assistance.

‘’MSF is highly concerned that rather than allowing more access to international teams and supplies into the affected areas, there are increasing restrictions being put in place specifically for expatriates who have expertise on emergency assistance,’’ Humphris revealed. ‘’Given the scale of the devastation and the infrastructure in the area, MSF believes that this restriction in access is limiting our capacity to respond properly.’’

And if the past is any indicator, the likelihood of the junta responding to such appeals to save the lives of cyclone survivors appears dim. After all, it was only in 2002 that a senior military leader admitted, after years of denial, that the country was facing an HIV/AIDS pandemic. Yet what followed brought little comfort to the people living with HIV. The junta placed restrictions on a major international fund committed to combating the killer disease, forcing the latter to pull out.

However, when it comes to their own medical needs, Burma’s generals do not trust their own health system. They fly to Singapore for care as is typical with the country’s strongman, the reclusive Senior Gen. Than Shwe, who suffers from diabetes, hypertension and heart disease.

In early 2007, the 75-year-old flew to a leading hospital in the affluent city-state for coronary bypass surgery.

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