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Borderline Health

Borderline Health

Borderline Health

As a "slow-motion genocide" envelops ethnic minorities in eastern Burma, health workers rely on innovative strategies and raw courage to save the lives of mothers and infants.

By Cathy Shufro

The two medics were running to keep up with the young man as he led them through the jungle in eastern Burma. They would reach his village in 90 minutes if they ran all the way.

On that hot afternoon in April, the man had come to Thaw D- village seeking help for his 17-year-old wife. She was nine months pregnant with their first child. When he'd left her at home, her body was jerking with seizures, her eyes rolling back. When he reached the clinic—a one-room bamboo hut—he was so short of breath that he could barely speak. Maternal health worker Naw Tha Mu grabbed the black emergency backpack, called an assistant to come along and followed the husband into the jungle.

Naw Tha Mu had met the woman and her husband the month before, soon after they arrived in the district. The army had invaded their former village and burned it down; Burmese soldiers often torch villages to assert control in their long civil war with Burma's hill peoples. The couple lost everything. They settled near Thaw D- village after hearing about the maternal health workers there.

They'd come to Naw Tha Mu's clinic in March because of the woman's headaches. Naw Tha Mu had given the woman iron for anemia and medicine for high blood pressure. She'd found protein in her urine—a bad sign when combined with high blood pressure. Now, a month later, the seizures signaled that the woman had developed eclampsia, which threatens the lives of both mother and child.

As Naw Tha Mu, 27, traversed the mountain path, she thought of her cousin who had died in childbirth three years before. They had been the same age. After giving birth to a stillborn baby, her cousin had bled to death. There had been no doctor within reach, no skilled midwife, no drugs to stop the hemorrhage. That was not unusual: Burma as a whole has one of the worst health care systems in the world. And the little that Burma does offer is generally denied to villagers in the frontier states of eastern Burma, where ethnic soldiers have resisted the Burmese army for 60 years.

Naw Tha Mu knew that she, too, was in danger as she pushed through the brush and bamboo. They were traveling in a "free-fire zone," where Burmese soldiers are authorized to shoot on sight. Carrying medicine put them doubly at risk. The army contends that anyone with medicine is aiding the rebels.

She had not stopped to ask if travel was safe that day.

Naw Tha Mu was traveling in a "free-fire zone" where Burmese soldiers can shoot on sight. The medicines she carried put her doubly at risk.

BURMA'S HEALTH CARE system was ranked 190th of 191 nations worldwide by WHO in 2000. That ranking reflects Burma's priorities: the government spends about 3 percent of its budget on health and 40 percent on the military, which has ruled Burma since 1962. (The junta has renamed the country Myanmar, a name widely rejected.)

The conflict in eastern Burma has eroded public health. Burmese soldiers routinely force villagers to work without pay—even pregnant women—cutting wood, clearing landmines and building roads. When family labor is diverted, harvests suffer. The army commandeers local men and women by the hundreds to serve as human mine sweepers and porters. Women walking alone risk rape and murder. The army has torched or forced abandonment of more than 3,200 villages since 1996, uprooting a million people, according to the Thailand Burma Border Consortium.

When villagers hear that the army is coming, they run. Sleeping outdoors without mosquito nets, they face a high risk of malaria. Even the rudimentary health care that villagers can provide for one another is disrupted when communities are dispersed. One baby out of 20 is born to a woman hiding in the jungle.

Some observers call this a "slow-motion genocide."

Ten years ago, when Naw Tha Mu was a teenager, a multi-ethnic group of medics came together to fill the health care void in eastern Burma. These "backpack" health workers—today numbering 300—travel on foot to treat sick and injured people. Beginning in 2000, the Back Pack Health Worker Team also began to quantify the effects of violence and displacement on civilian health.

"No one knew what the levels were for very basic health indicators like maternal and child mortality, perhaps two of the most basic yardsticks to measure the health of a population," says Luke Mullany, PhD '05, MHS '02. An assistant professor of International Health at the Bloomberg School, Mullany is affiliated with the School's Center for Public Health and Human Rights, which uses science to support communities whose health is threatened by human rights violations. He also volunteers with the Global Health Access Program (GHAP), a California-based nonprofit that gave technical advice to the Back Pack team.

The Back Pack surveyors found that one in 100 women was dying in childbirth—25 times the rate for maternal mortality in neighboring Thailand. Nine out of 100 babies were dying in their first year; one in five children died before age 5. The death of Naw Tha Mu's cousin and baby was a commonplace event.

"The mortality rates were shockingly high," says Mullany, "especially when compared with the rates in Thailand, just across the border."

The Back Pack Team's 2006 report, Chronic Emergency: Health and Human Rights in Eastern Burma, also analyzed the impact of specific human rights violations on health. Forced relocation almost tripled the death rate for children under 5, and it increased the likelihood of landmine injury by 4.5 times. Helping the Back Pack Health Workers to establish the effects of dislocation fit with the work of the Center for Public Health and Human Rights. Center investigators showed that a child's risk of death in eastern Burma increased fivefold if that child's family suffered three or more violations of human rights. Authors of the study, published last year in the Journal of Epidemiology and Community Health, included Mullany and the founder of the Center, Chris Beyrer, MD, MPH '90, an Epidemiology professor at the Bloomberg School.

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