Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
at Dr. Cynthia’s
MAE TAO CLINIC
From Rice Cooker to Autoclave at Dr. Cynthia’s Mae
Tao Clinic: Twenty Years of Health, Human Rights and
Community Development in the Midst of War
Visit: www.maetaoclinic.org
The text of the book was compiled from the oral history
of the clinic as related by clinic staff and by Dr. Cynthia
Maung. If it contains any inaccuracies or omissions, it is sure-
ly the fault of the editors. If you feel something is incorrect
or incomplete, we welcome your stories and facts which will
help us to fill out the history of the clinic for future website
updates.
Our first priority was to hear the voice of the clinic staff
and Dr. Cynthia Maung, and to reflect that to you, the reader.
We thank the Mae Tao Clinic staff who took time out from
their daily workload to relate stories and facts for the book.
Finally, we thank Dr. Cynthia Maung for patiently relating
stories and facts from the past. She did this during the quiet
hours of the early morning before the Clinic’s day began and
during holidays when she could afford the extra hours. We
were fortunate that Dr. Cynthia’s memory appears to be as
strong as it was 20 years ago when the clinic began.
When I look at the clinic, I see people working very hard. Sometimes,
there’s a lot of pressure both psychologically and financially. Staff have been
away from their family for many years, and they always hope to go back home.
The people we serve have the same feelings. I think everybody has sad feelings:
When can we go back to our homeland?
But the problems in Burma cannot be solved quickly. Even if the SPDC
collapses or the political opposition wins the election, the country is still trauma-
tized by landmines, prostitution, street children, broken families. People have lost
their dignity and identity. Health services and education are not accessible to the
people. All this cannot be fixed within a few years.
We at the Mae Tao Clinic invite you to join us in providing health care and
building the community on the Thai-Burma border or wherever there is a need in
the world. We hope you feel empowered by the clinic’s successes, rather than
impressed or overwhelmed. We want you to understand that you, too, can take on
such projects. The key is to start small and grow.
We leave you with lessons we’ve learned over the past 20 years in hopes that
our shared experiences may be helpful as you go forward to serve.
2. Try to understand rather than to judge. If you judge people’s beliefs or practices, it’s
harder to work as partners. For example, don’t fault a family for refusing to boil their
drinking water if they only have one pot and it’s needed for cooking. Instead, try to
provide another pot or find a more appropriate method for purifying their water. Under-
stand people’s resources, emotions, and culture before you try to change their behav-
ior.
3. You can’t improve the health of the people without improving their community.
Use a comprehensive, sustainable approach: nutrition, sanitation, clean water, medical
care, and education. If people understand health and human rights, they’ll have the keys
to building a healthy stable community. Then, if those rights are ever taken away,
they’ll work to get them back. If the people aren’t educated, if they don’t have jobs, if
they’re depressed - they won’t be able to care for themselves or their children. They
will starve, get sick, and have accidents. Some daughters will enter brothels and some
sons will join the army. They will have no choice.
4. Train and use local people to work in their own community whenever possible in-
stead of bringing in outsiders to provide services. Locals have a better understanding
of a given political and social situation, geography and culture, and can move around
more easily and safely. And since they’re from the area, they’re more likely to stay and
network with other local leaders to improve the community.
5. Wherever you go or whatever you do, reach out. Don’t isolate yourself. Learn the
language and culture of your neighbors and host country. Work together with humble
farmers, university professors, large NGOs, small community-based organizations.
“Community is not based on ethnicity or country of origin,” Dr. Cynthia says. “It’s
based on human rights, human dignity and security.”
6. Rise above rumors, suspicion and fear. These are the regime’s most powerful weap-
ons. They turn people against each other, erode the community, and destroy the heart.
7. Don’t give up, even when things get really bad. “You can look back over your shoul-
der, and then they win,” Dr. Cynthia says, “Or you can look forward, and you win.”
unaccompanied minors. been honored with many international During their escape to the Thai-
The clinic’s support services in- humanitarian awards, and Dr. Cynthia Burma border, the group passed
clude a lab that processes thousands of has been nominated for the Nobel through many poor villages in ethnic
malaria smears each year and conducts Peace Prize (see Annex: Awards). areas where people had no access to
rapid HIV testing; a rigorous infection MTC represents a model for commu- medical care. When villagers heard
control team; a central pharmacy; a nity-based health care, and as such it Dr. Cynthia was a physician, they
health information team that manages has received many visits from health asked for her help in treating illnesses
the clinic’s registration, patient records, and human rights leaders who have and injuries and the young doctor did
integrated database and financial sys- shared their support and experiences. what she could with what little she had
tems; a community relations team that Last year, the clinic hosted a delegation at that time. Many of the original 14
provides around-the-clock social sup- of Nobel Peace laureates and the then joined other student or Karen groups
port for patients and their families, U.S. First Lady Laura Bush. along the way, leaving just three of the
helps locate missing people, arranges Today, surveying the clinic’s ar- original group. Three other people
funerals, and responds to the needs of ray of accomplishments and its sprawl joined this small band along the way in
those escaping from brothels and im- of simple, sturdy concrete buildings, it the course of the journey, resulting in
migration raids. is remarkable to think that the clinic the six founders of Mae Tao Clinic.
MTC has set up safe houses for started with just a few medical instru- Witnessing the villagers’ enor-
abused women and abandoned chil- ments stuffed into a woven shoulder mous suffering and fear of the military
4 | FROM RICE COOKER TO AUTOCLAVE
made a powerful impression on the opposition groups eventually began to along the border, assessing the health-
fleeing students. Initially, many Bur- cooperate and, for the most part, trust care situation and distributing donated
man students distrusted the Karen peo- each other. paracetamol and quinine for malaria.
ples, a side-effect of a youth spent ab- From the chaos and instability of Later, Dr Cynthia cared for malaria pa-
sorbing the military’s propaganda these early years emerged the key- tients in the home of a Karen leader,
about “ethnic insurgents.” Such is the stones that would guide the clinic for but the house could not accommodate
power of the military’s propaganda the next two decades: Dialogue. Coop- the numbers and soon became over-
machine that these young students eration. Generosity. Trust. Training. crowded.
were not then aware that the junta had When she first arrived in Thai- In February 1989, a Karen family
torched, displaced and abused thou- land, Dr. Cynthia and her friends offered Dr Cynthia and her associates a
sands in ethnic areas, a situation that stopped at Mae La1 opposite Beh Klaw dilapidated wooden stilt-house on the
continues today. The villagers in the refugee camp in the Tha Song Yang outskirts of Mae Sot as a possible loca-
ethnic rural areas were likewise wary district. Here Dr. Cynthia worked at a tion for treating patients. Dr. Cynthia
of the students; due to their isolation small hospital treating those fleeing the and five students moved into the run
they hadn’t heard of the democracy down building. Sein Hein, one of the
movement or the turmoil that had re- 1 Mae La is also known as ‘Beh Klaw’ in Kar- founders, recalls, “When we arrived at
en, which means ‘cotton field’ due to the agricul-
cently shaken the capital. tural activities for which Karen leaders first ne-
the new place for cleaning, I was really
“On the border, for the first time, gotiated permission for refugees to cross into the in despair, seeing the old building al-
area in 1984.
Dr. Cynthia Maung and family (photo: Tom Reese @ Seattle Times)
the democratic movement and the eth- fighting. Diseases were rampant: diar- most falling down in decay with a lot
nic revolution met,” Dr. Cynthia says. rhea, pneumonia and malaria among of spider webs, dirty with charcoal and
The ethnic groups talked of autonomy; them. In addition to the dangers of a surrounded by bush forest.” Naw
the students spoke of democracy and life on the run in jungles, many were Htoo, another member of the original
human rights. The arrival of democra- afflicted by homesickness and a long- group, remembers, “We had nothing!
cy advocates in the traditionally ethnic ing for loved ones who were left be- No mosquito net, no blanket, no food!
strongholds of eastern Burma foment- hind in the disorganized flight. Some I said: Give me 5,000 baht! And I went
ed a political awakening for both stu- tried to return to Myanmar; others de- out and bought 20 pillows and blan-
dents and civilians, as well as those cided to stay. kets” and other basics with which the
seeking greater autonomy and rights After a month or so, Dr. Cynthia’s group set up their clinic.
for the ethnic regions. The two groups’ group moved to Hway Ka Loke refu- The first two years were driven
widely disparate political aims howev- gee camp and there they made contact by a motivation to help fellow refugees
er, initially created distrust. There was with Karen leaders responsible for stu- and was made possible by the creative
also massive confusion in the aftermath dent affairs and with local Thai author- ability to adapt and optimize limited
of the crushed revolution as thousands ities and church groups who were sym- resources. The group cared for students
of people tried to find their friends and pathetic to the people’s plight. recovering from severe malaria, deliv-
families, flee the cities and organize re- Together, they tried to organize, priori- ered food to those who were hospital-
sistance groups. Despite the chaos re- tize and organize treatment for patients. ized, and nursed them back to health
sulting from the military crackdown, Dr. Cynthia visited five student camps after they had been treated. The group
FROM RICE COOKER TO AUTOCLAVE | 5
solicited medicine and food from Cath- mine injuries. The clinic was still these tests. Most would never be able
olic relief workers and other donors. functioning without a microscope, so to afford these tests in Thai or Burmese
At this time the group lacked an auto-
patients with symptoms of fever, chills hospitals.
clave, so Dr. Cynthia improvised by and severe shaking chills (rigor) were When MTC first began antenatal
sterilizing her few precious instruments presumed to have malaria unless the screening, the HIV prevalence among
in a rice cooker, an innovation inspired medics could find other causes. Later
by necessity. pregnant women was 0.8 percent. By
that year, Médecins Sans Frontières 2003, it had more than doubled. Rising
Since nobody else in the group trained Chit Wen and Poo Hjoo to de- HIV rates prompted the clinic to take a
had medical training, Dr. Cynthia be- tect malaria in slides of patients’ blood more proactive approach to the increas-
gan holding informal two hour “dis- using a microscope that had been do- ing risk of infection. To augment its
cussions” at night to teach some of the nated to the clinic. previous program of general HIV edu-
students practical medical skills. Over Around this time, battles raged at cation in factories, clinic staff set up a
the years, the trainings became more Wang Ka, a Karen stronghold near Mae voluntary counseling and testing pro-
extensive, evolving from a week-long Sot, and this unrest precipitated an in- gram to target people at risk for HIV.
seminar, to maternal/child health train- crease in clinic staff. Many of the ado- People who identified themselves as
ing, and finally into comprehensive lescent students from the Karen areas HIV positive were invited to join a
primary health care training. were sent to the clinic for safety. When support network and become peer edu-
Today, in partnership with the Wang Ka ultimately fell to junta forces, cators or home-based health workers
Burma Medical Association (BMA) many of the young students made the for other HIV patients. Today, in an ef-
and volunteer professionals, the clinic clinic their new home, trained as med- fort to decrease HIV transmission from
offers a six-month community health ics and became an integral part of the mother to child, the clinic collaborates
worker course that can be upgraded staff. with Mae Sot Hospital to provide anti-
with an additional ten months of medic In the refugee and IDP camps, the retroviral treatment to pregnant HIV-
training. The clinic also offers special- older students began to marry and start positive women and newborns. Cur-
ized training in obstetric emergencies, families. When mothers-to-be were rently, 13 HIV-positive patients are
pediatrics, eye and dental health, coun- ready to deliver their babies, they came treated with anti-retroviral drugs and
selling, laboratory work, prosthetics to the clinic and slept in the adjacent the clinic continues to work with Mae
and minor surgery, field medicine for room to Dr. Cynthia and Naw Htoo. Sot Hospital to increase the number of
backpack health workers and repro- For the babies who came at night, Dr. patients eligible for treatment.
ductive health for traditional birth at- Cynthia and Naw Htoo were right there While the clinic was focused pri-
tendants. Backpack health workers to help the mothers through their labor marily on the medical needs of those
provide basic mobile medical care to and delivery. on the Thai side of the border, as well
village communities inside Burma, and In 1995, in response to growing as those who could make the cross-
traditional birth attendants (similar to need, the clinic set up a maternal child border journey to receive health care, it
midwives) integrate western medicine health program with a Saturday morn- simultaneously continued to expand its
with traditional medicine to assist in ing vaccination clinic, antenatal care, outreach in Karen State. Typically,
childbirth. family planning, reproductive health mobile medic teams traveled to remote
IN 1990, DR. CYNTHIA WAS in services and a separate delivery room. locations on foot, carrying supplies in
Papun in Karen State with a mobile The following year, 156 babies were back packs or woven bags braced by
medical team when she heard a radio born at the clinic. By the year 2008, their foreheads. During the few days
report about Burma’s election results: the number of women giving birth at that these teams stayed in each loca-
Aung San Suu Kyi’s party, the National the clinic had risen to 2,500 per year. tion, their mobile clinics were crowded
League of Democracy, had won 92 Pregnant women who were se- with patients from distant villages that
percent of the vote with 98 percent verely anemic from malaria had to be in normal circumstances had no access
turnout! But she simultaneously heard referred to Mae Sot Hospital for blood to health care. The need was so great
gunfire in the jungle as Karen troops transfusions. As a way of providing in- that Dr. Cynthia worked with village
and the junta continued to battle. She house blood transfusions for these leaders to set up satellite field clinics in
realized freedom would not come over- women, the clinic decided to set up its Dooplaya and Chogali villages in 1992
night to Burma. own blood lab, complete with HIV and later in the villages of Sa Khan
In 1991, the clinic expanded its testing. The lab was also equipped to Thit, Pa Hite, Mawkee and Mae La Po
services, and began to open regularly screen pregnant women for HIV, hepa- Hta.
from 9 to 12 in the morning to treat an titis B and syphilis. Aside from the The field clinics took a holistic,
increasing number of patients with ma- refugee camp hospitals, this was the community-based approach, providing
laria, respiratory diseases and diarrhea first time that the migrant and displaced basic medical care plus latrines, nurs-
as well as gunshot wounds and land- populations effectively had access to ery schools, nutrition, immunizations,
6 | FROM RICE COOKER TO AUTOCLAVE
vitamins, deworming, simple clean- side Burma. Four remain in prison. school accommodates 440 boarders,
water systems and training in safe de- Over the years, local health pro- and coordinates a health, vision and
livery techniques for traditional birth viders have proven themselves to be dental program for 58 local migrant
attendants. Unfortunately, within five the safest, most effective and sustain- schools. Last year, the clinic also pro-
years the military had attacked and de- able way to provide health care in re- vided emergency funds for food and
stroyed every field clinic except one. mote rural areas affected by armed shelter for 1,440 unaccompanied dis-
Today, only Pa Hite survives; it is a re- conflict. The Back Pack model utilizes placed children in migrant areas of
mote jungle clinic which from Mae Sot local capacity and knowledge by train- Thailand and 295 children displaced in
involves a journey of six hours by road, ing local people and sending them back war zones inside Burma.
another six hours by boat and finally a to work in their own communities. An unprecedented number of
six or more hour walk. Typically, Back Pack teams journey to Burmese migrant and refugee families
In 1998, the year after the clinics headquarters in Mae Sot every six have poured over the border into Thai-
in Chogali and Sukhundit were de- months for more supplies and training. land since the increased military offen-
stroyed, Mae Tao Clinic worked with When Chogali and Sukhundit fell sives of 2007 began in the eastern eth-
medical partners from Karen, Karenni in 1997, the field clinics’ medics fled to nic areas of Burma. They have come
and Mon States to organize the Back Mae Sot with the nursery school teach- seeking safety, jobs and medical care
Pack Health Worker Team (BPHWT). er and a dozen young students. Dr. as the Myanmar military steps up at-
The group’s mission is to provide pri- Cynthia built an open-air bamboo tacks in conflict zones, destroys vil-
mary health care in rural and ethnic school for the children in the fields be- lages, rice fields and food stores, ter-
armed conflict areas where medical hind the clinic; later they moved to rorizes women, and deprives people of
care is scarce or non-existent. Initially Hway Kaloke refugee camp where basic human rights, including the right
there were 32 backpack teams with 120 they were able to attend an established to livelihood.
health workers. Currently, 80 teams, school and live in a treehouse dormi- The Saffron Revolution in Sep-
with three to five members each, de- tory known as the Bamboo Children’s tember 2007 as well as Cyclone Nargis
liver health services and education to Home. After Hway Kaloke was torched in May 2008 also forced more children
more than 160,000 displaced people in multiple times, the children moved to to seek safety and education across the
territory including Arakan, Pa O, Shan Umpium Mai Refugee camp where border. After the September uprising
and Lahu areas. Back pack health they now attend school and are cared in which more than 100,000 monks
work is crucial, but dangerous. The for by clinic staff. Today, the Bamboo and unarmed citizens demonstrated
risks include capture, imprisonment, Children’s Home in Umpium Mai against the military dictatorship, the
injury from landmines, rape and death. houses 154 unaccompanied children. government closed many monastery
In the past decade, seven Back Pack Apart from the Bamboo Chil- schools, a traditional source of educa-
health workers and a traditional birth dren’s Home, the clinic also runs a day tion for the children of families who
attendant have been killed and six ar- school for 1,200 students (children of cannot afford the moribund state edu-
rested while delivering health care in- migrant workers and clinic staff). The cation system in Burma. Although the
Today the clinic’s staff spans a shade trees at the clinic and listen to
range of age, experience, and ethnicity. their story, they will proudly explain
A visitor to the clinic might hear three that they came to Mae Tao Clinic to re-
or four languages being used at any ceive training, to hope for change in
given moment as the staff go about Burma, and that they hope to return
their work. Medics volley in conversa- someday to help their people. They ex-
tion, jumping between Burmese, Eng- plain that there are few such opportuni-
lish and their own ethnic languages. ties for them to gain the training and
Of course, the original founders of the experience necessary to assist their
clinic were from the Karen and Bur- people in Arakan State equal to the
man ethnic groups, however, this was ones that they receive at the clinic.
due mainly to the proximity of the clin- While in the clinic, the medics
ic to Karen State, and the linguistic wear uniforms and identification badg-
needs of the majority of patients. De- es and are respected authorities, how-
spite the traditionally large contingent ever, they dare not travel far from the
of Karen speaking staff, recent years clinic, since most do not have legal sta-
have shown a growing diversity in the tus in Thailand. Whilst this is restric-
languages used in the daily running of tive, the limitations have led to a lively
the clinic’s operations. An example of social scene in and around the clinic.
this diversity is the clinic’s small com- Births, weddings, deaths, and festivals
munity of Arkanese speaking medics are celebrated within the clinic society,
from Arakan State in western Burma. with staff quarters centered around the
In their case, the journey to the clinic clinic grounds. When Dr. Cynthia re-
was long and treacherous, crossing the marks, “This is not only a clinic, it is
entire breadth of the country. If a visi- also a village”, one can see that this ap-
tor takes the time to sit under one of the plies to both patients and staff.
REFERRAL PROGRAM
MANY PEOPLE DON’T REL- severe fractures in children, and myo- tion, and all blood donor samples are
IZE that the Referral Program is the ma, uterine prolapse and ovarian cysts sent for screening, and some biopsy for
longest running program at Mae Tao in adult cases. testing. MTC also supplies 40 baht per
Clinic. Before the staff of the clinic patient per day for food while at the
Less than 1% of cases are referred to hospi-
had the supplies and capacity to treat tal, but require 15% of the clinic’s budget. Mae Sot Hospital. The referral team
many of the patients that they saw, they provides all transportation, as it offers
were referring them to Mae Sot Hospi- The referral team consists of 10 security which helps patients avoid be-
tal (MSH). In 1988, student camps staff, managed by Saw Tin Shwe. The ing arrested.
were established along the border, role of the staff is to be in regular con-
tact with the clinic departments, coor- The referral staff speaks several lan-
mainly by students who had come from guages ... Burmese, Pwo Karen,
central Burma, and were not from Kar- dinating the travel of referral patients Sgaw Karen, Thai, English, and oth-
en State or border areas. In the begin- to Mae Sot Hospital and then acting as ers.
ning, the cases that couldn’t be treated translator and social support for pa-
Of course not all cases that go be-
in the student camps were referred to tients during their visit to the hospital.
yond the services of the clinic will ac-
MSH through coordination at MTC. For this reason, it is necessary that
tually enter the Referral Program. Mae
At this time, MTC was more like a pa- these staff members speak several lan-
Tao Clinic allocates a monthly budget
tient house, sending 20-25 cases per guages each, possibly including Bur-
which is used to pay for treatment at
month to Mae Sot Hospital. Today the mese, Po Karen, Ska Karen, Thai, and
larger service providers such as Mae
clinic is able to treat malaria cases, and English, and to possess a Thai identifi-
Sot Hospital. Emergency and the most
deal with more severe injuries, but cation card allowing them to travel
severe cases get referred first, but non-
there are still patients that require ser- freely in Mae Sot without threat of ar-
emergency cases do not often get re-
vices beyond the clinic’s capacity. rest. Each morning the referral patients
ferred. Most referred cases are surgi-
The majority of the patients that are gathered at 8:00 am for transfer (an
cal cases, as medical cases can be
enter the Referral Program have often tricky task in the torrential down-
treated at the clinic, with exceptions
crossed the border from Burma for pours of rainy season, as the Referral
being chronic diabetes cases, and HIV
medical services. They are seeking Program does not actually have a spec-
positive pregnant women.
services that are either not available in ified office or covered area for patients
MTC does not handle all patient
Burma, or that they cannot afford; the to meet). Each patient is assigned to a
referrals alone. Since 2004, the Inter-
journey to Mae Tao Clinic however, member of the referral staff. Along
national Committee of the Red Cross
means free health care services. Some with the patients, blood samples are
(ICRC) has been supporting all land-
of the most common cases seen for re- taken to the hospital for testing of renal
mine and gunshot wound cases for the
ferral are congenital heart disease and function, liver function, thyroid func-
first visit to MSH. For follow-up vis-
14 | FROM RICE COOKER TO AUTOCLAVE
its, which most of these complicated tients or patients’ parents need to return this poses a greater challenge than one
cases require, the clinic covers the cost. home to care for other children or re- might think. Saw Tin Shwe explains
Since 2003, the Burma Children Medi- turn to work to support the rest of the that not many medically trained staff
cal Fund has supported complex cases family. When asked what he wishes are interested in working with the re-
for children under twenty, where the for the Referral Program Saw Tin Shwe ferral team, as they do not actually
patient is considered likely to respond easily responds, “more money.” With practice medicine, but rather facilitate
well to treatment. As discussed further a larger budget there would never be a the opportunity for patients to receive
in “2000 – 2004: Building Capacity”, question of which patient takes prece- medical care elsewhere. Moreover,
The Burma Adult Medical Fund simi- dence, or who is more severely ill. At even if a medic were interested, the
larly supports complex adult cases, this point, non-emergency cases do not likelihood that they also speak Bur-
where the patient is considered likely get referred, but with a larger budget mese, Karen, and Thai, and possess a
to respond well to treatment. In all of patients suffering from a wider array of Thai identification card is unlikely. In-
these instances the majority are surgi- conditions could also receive treat- dividuals who have strong language
cal cases, with exceptions being heart ment. skills and possess a Thai identification
conditions that will respond to medica- Emergency obstetrical care com- card are understood to be very valuable
tion instead of surgery. prised of 12% referral cases in late assets to any organization, making
2008, 22% emergency medical cases, them highly employable. Many of
Tuberculosis remains a major concern for
the referral team. There are few treatment and 25% general surgical cases in late these skilled individuals are already
options for cross-border patients. 2008. Two imposing challenges are employed by INGOs, and receive a sal-
chronic budget limitations at Mae Tao ary much larger than most CBOs can
For many years, MTC referred Clinic to refer more patients, and ca- offer, thereby depriving CBOs of a
TB patients to a Médecins Sans Fron- pacity at Mae Sot Hospital to handle much needed resource.
tières (MSF) program in Mae Sot for the ever increasing caseload. Still, Saw Tin Shwe has hope; he
comprehensive treatment. However, MTC sees many neonatal compli- hopes that more staff will understand
with MSF discontinuing this program, cations. Along the border, most deliv- the benefits of working with the Refer-
MTC isn’t able to refer most TB pa- eries still occur at home. As a result, ral Program. Because the Referral Pro-
tients for treatment. Beginning in patients come to MTC after serious gram coordinates closely with so many
2008, World Vision has established a problems arise such as premature la- of the clinic departments, it provides
less comprehensive TB treatment pro- bor, infection or hemorrhage. When employees a unique opportunity to
gram in Mae Sot that does not include these cases have to be referred, the learn about and understand the func-
cross border patients. costs involved are quite high, so the tioning of the clinic on a much larger
The most common referral cases are from clinic continues to upgrade it’s neona- scale than if working as a medic in only
Reproductive Health Inpatient Depart- tal and delivery skill set. one department. Also, to be part of the
ment, and include cesarean deliveries, Besides an unlimited budget, Saw referral team means providing invalu-
post-delivery complications, uterine my-
oma, uterine prolapse, and uterine cysts. Tin Shwe expresses a few other wishes able support to the patients: providing
for the program: as the only referral security in transportation, providing
The manager of the Referral Pro- team member with a medical back- comforting support to sick patients
gram, Saw Tin Shwe, is saddened and ground, it is nearly impossible for Saw who are in a very unfamiliar environ-
frustrated about the patients who still Tin Shwe to take a day off. He hopes ment, and acting as a translator and to
go untreated. He suggests that even if that in the near future the Referral Pro- ensure illnesses aren’t mistreated or go
patients are presented with the oppor- gram gains 2 or 3 new staff members untreated all together.
tunity of entering one of these referral with a medical background, although
programs and go to Chiang Mai Hospi-
tal for treatment, they do not always
take the offer. From his experiences at
the clinic, Saw Tin Shwe provides a
variety of reasons as to why this hap-
pens: a patient or patient’s parents may
lack general health knowledge and fail
to understand the severity of the ill-
ness, the patients and their family fear
traveling to Chiang Mai where they do
not speak the language, and do not pos-
sess official documentation beyond the
referral notice from MSH, or the pa- Patients waiting to go to Mae Sot Hospital.
FROM RICE COOKER TO AUTOCLAVE | 15
First surgery in MTC, Dr.
Cynthia Maung in surgery,
student observing, 1989
REPRODUCTIVE HEALTH
The Reproductive Health Pro- laria, HIV, sexually transmitted infec- of life and death; doing so with a tradi-
gram’s goals are to keep mothers strong tions and anemia. tional sliver of bamboo risks neonatal
and give all children a healthy start. The clinic provides in-depth tetanus, a terrible disease that can be
These themes have been central to training in obstetrics and obstetric prevented by using a sterilized razor
MTC’s mission since 1990, when Dr. emergencies to medics and midwives; blade instead.
Cynthia delivered a student’s baby on it has also trained hundreds of back The need for reproductive health
the floor of the dilapidated house where pack health workers and traditional services at the clinic was identified in
she lived and cared for patients recov- birth attendants in safe birth techniques late 1989, when expectant mothers be-
ering from malaria. Mothers and chil- and provided them with life-saving gan coming to the clinic to deliver their
dren are the future, she told graduating birth kits and supplies for use in remote babies at all hours of the day and night,
students at the first primary health-care villages and ethnic conflict areas. In and to receive care from Dr. Cynthia
training in 1996. “For a good future, the jungle, something as simple as cut- and Naw Htoo, who now leads the Re-
do something good for mothers and ting an umbilical cord can be a matter productive Health Outpatient Depart-
children.” Young medics took the mes-
sage to heart, emblazoning the slogan Delivery at MTC by years
on their shirts.
Today, the Reproductive Health
Department is located in a breezy light-
filled concrete building with a shaded
porch where mothers often cuddle
swaddled newborns while staff mem-
bers sit in a circle, assembling safe
birth kits and rolling cotton hanks into
swabs. The Reproductive Health De-
partment’s inpatient and outpatient
sections provide comprehensive wom-
en’s services including family plan-
ning, gynecology, normal and compli-
cated labor and delivery, neonatal care,
and post-abortion care. Its antenatal
care program offers screening for ma-
FROM RICE COOKER TO AUTOCLAVE | 19
ment. Naw Htoo, who started out with born at the clinic. As the number of die in childbirth; other mothers leave
no medical training, recalls feeling fas- deliveries increased, the clinic added a their infants because poverty or other
cinated, sympathetic and scared the second delivery room. Naw Sophia, circumstances prevent them from pro-
first time she watched Dr. Cynthia de- who now leads the Reproductive viding a good home. In the case of
liver a baby. Since she was the only Health Inpatient department, recalls abandoned children, medics care for
other woman on the clinic’s small staff, that the delivery rooms in those days the infants in the in-patient department
she realized she had to watch and learn; were narrow, dark and they stank; suf- for several months in case family mem-
what if a woman went into labor when fering as they did from their proximity bers return to claim them. After that,
Dr. Cynthia was not available? to nearby toilets. In 2001, the clinic the Clinic works with community-
Maternal mortality rates are over 1,000
built a new, bright and airy building for based organizations to find safe local
per 100,000 live births in the Eastern reproductive health with support from homes for these children.
Burma conflict zones. This compares the Women’s Commission for Refugee The Reproductive Health Pro-
to 360 in the rest of Burma and 44 per Women and Children, as part of the gram has come a long way since those
100,000 live births in Thailand.8
Averting Maternal Death and Disabili- early days when Dr. Cynthia and Naw
Back then, the facilities for ex- ty Program. The clinic added programs Htoo were the only ones at the clinic
for safe motherhood, sexually trans- who could deliver babies. Thanks to
8 Chronic Emergency: Health and Human mitted infections and HIV/AIDs, ado- in-depth obstetric training, medics in
Rights in Eastern Burma, report by Backpack
Healthworker Team.
lescent health care and gender-based the reproductive health department can
pecting mothers were basic and women violence prevention. now manage prolonged labor, handle
in labor had to climb a ladder to get to obstetric emergencies, do vacuum ex-
About ten babies are abandoned in the
the delivery room, where they gave clinic each year. tractions and prevent most post-partum
birth and then recovered as Dr. Cynthia hemorrhages and manage those that do
and Naw Htoo cleaned up around them. A recent challenge has been find-
occur.
In 1995, the clinic set up a maternal ing resources to care for cancer patients
The Inpatient department now
child health program with a separate who come for pain treatment at the
has 25 beds, but Naw Sophia laments,
ground-floor delivery room. It offered clinic and stay until they die because
“It’s still not enough!” Even though
a Saturday morning vaccination clinic, they have no money and nowhere else
the clinic has expanded its capacity in
family planning, reproductive health to go. The department often runs out
this respect, the need for quality repro-
care, gynecological services and ante- of much needed pain medication; find-
ductive health care continues to grow
natal care. Pregnant women went ing more is high on their wish list. An-
as more and more patients come to the
home from their antenatal visit carry- other huge challenge comes in the form
clinic for obstetric and gynecologic
ing small bundles of chicken eggs - a of small swaddled bundles - the 10 or
care.
high iron food to help prevent anemia. so newborns orphaned and abandoned
The following year, 156 babies were at the clinic every year. Some mothers
20 | FROM RICE COOKER TO AUTOCLAVE
Nutrition program at Child OPD.
CIVIL CLINICS
the maintenance of the clinics, such as
the upgrading of equipment and facili-
ties, and in the monitoring and evalua-
Cho Gali, the first of the civil State, and helped to facilitate the estab- tion of the civil clinics. Below, three
clinics, provided the framework for the lishment of clinics in other ethnic areas medics recall their experiences work-
subsequent clinics. It was constructed as well. When the clinics were estab- ing with civil clinics established by
by the local villagers using bamboo lished, they treated common illnesses MTC.
and leaves. It provided services to such as malaria and diarrhea. A promi-
people from approximately eight sur- nent feature of these clinics was their
rounding villages with both outpatient cooperation with local midwives, or CHO GALI CLINIC:
and inpatient services, and ran three traditional birth attendants (TBAs),
main programs that were integrated who were the frontline health service Cho Gali was the first clinic es-
with the medical services: maternal providers of maternal health care in tablished by MTC. Initially, villagers
health care, school health, and water isolated areas. The clinics worked with were skeptical of the clinic and contin-
and sanitation. TBAs to enhance safe practices for ued to use traditional medicines. Even-
MTC did not have the resources birth - including identifying the signs tually, as the services proved effective,
to provide a salary for the medics. of danger during pregnancy and labour villagers came to trust the clinic and to
Each staff member received food and - and on introducing safe hygiene prac- use it. According to Say Hae, a teacher
board, and 2 longyis and 2 shirts a year. tices. who worked in the area for many years
Each month the clinic as a whole re- Education was another defining before and after the clinic was set up;
ceived 1 bar of soap, 1 tube of tooth- feature of the civil clinics, which were the clinic had a positive effect, particu-
paste, and a ½ kilo of washing powder, supported by local teachers in the area larly on the community’s view of edu-
as well as menstrual pads for women. who could see the benefits of the clin- cation. She says that parents in the
ics first-hand in the children they were community started to send their chil-
Between 1992 and 1994 five clinics were
established in the Karen State. Due to mili- teaching. Both health workers and dren to school in much greater num-
tary attacks, none remain in their original teachers would work together to de- bers. Say Hae remembers one family
locations. One was re-established in Pa velop school health programs. In addi- in particular. The father was arrested
Hite and still operates today. tion, according to Dr. Cynthia, the clin- by the SPDC and subsequently disap-
The idea of establishing civil ics became the centre of many peared, presumed dead. The mother
clinics in Karen State came to fruition communities. As the community, in- became very ill soon after and was di-
in 1992 when one of the Mae Tao Clin- cluding women’s groups, teachers and agnosed with breast cancer. She soon
ic’s mobile medical health workers village leaders, became more closely died, leaving behind two children. The
working in Dooplaya came to Dr. Cyn- involved and worked with the clinic clinic staff cared for these two children
thia and asked her to set up a clinic in for the benefit of their communities, and provided them with an education
the area. The medic introduced her to the role of the clinics within these com- in the village. They then attended one
the local health authority, and after munities expanded. of the migrant schools on the Thai side
several discussions, they agreed to set Over the years, more health work- of the border, and recently they were
up Cho Gali clinic. MTC eventually ers trained by MTC, who came from resettled in the USA.
established five civil clinics in Karen diverse ethnic backgrounds (including In 1997, the SPDC attacked Cho
24 | FROM RICE COOKER TO AUTOCLAVE
Gali, and the surrounding areas, forc- Staffs of Cho Gali civil clinic in 1993.
ing the entire village to flee. The SPDC
and DKBA currently control the area.
Say Hae says she has returned once
since they were forced to flee and says
that the clinic has been destroyed and
there is no longer any health care for
any villagers who returned to the area.
SA KHAN THIT:
According to May Soe, a Mae
Tao Clinic medic who began working
at Sa Khan Thit in 1995, this clinic
mainly treated pregnant women and buildings are abandoned and de- traditional beliefs are still incorporated
patients with malaria. In addition, stroyed. into community attitudes toward
there was a refugee camp nearby on the health. Pa Lae Paw remembers that
PA HITE:
Thai side of the border that had no clin- some villagers had come to the clinic
ic, and so staff would often travel there to get help for a pregnant woman who
to treat people. May Soe says that had been sick for a week. Staff from
many children were abandoned at the The clinic that is now based in Pa the clinic made the trip out to her vil-
clinic and she remembers one case in Hite, in Karen State, has had many in- lage to render assistance. They ex-
particular; a young boy who came to carnations. Prior to being located in Pa plained that she needed to go to the
the clinic who had no parents. Clinic Hite, it was at different locations in the clinic for treatment or she would die.
staff cared for him and sent him to surrounding area, but was attacked by Before she would go, she wanted to
school, and he now works for MTC. the SPDC several times, and medics consult the spirits in the jungle. Know-
The same day that Cho Gali was and villagers were forced to flee. Each ing she would die if she did not go, a
attacked, Sa Khan Thit was also at- time the clinics were attacked they had medic hid in the jungle and, posing as a
tacked by SPDC forces, but unlike Cho prior warning and were able to save spirit, told her that she must go. When
Gali, clinic staff had prior warning and most of their supplies by hiding them she got to the clinic, she was treated for
were able to flee to Thailand before in the jungle - although sometimes they malaria and given two blood transfu-
fighting began. When they moved, were destroyed by elephants or other sions. The baby was born safe and
they had to take the 11 abandoned chil- animals in the area. well and they are both still alive today.
dren they were caring for with them. Prior to the establishment of the These days, the training for com-
They spent three nights on the Thai clinic in the area, traditional beliefs re- munity health workers creates a formal
side of the border, near Sa Khan Thit, garding medical practices were preva- integration of the two practices. For
and then made the journey to Mae Tao lent; beliefs which were sometimes at example, certain traditional beliefs re-
Clinic. May Soe has not been back to odds with western practices. The com- garding prevention and hygiene can be
Sa Khan Thit since, but says that she munity now regards western health effective and are highlighted. The
has heard that all the equipment and care in a more positive light; however, health workers learn how to comple-
ment the services of traditional healers
and work side by side with them.
Pa Lae Paw says that she is un-
sure about the future of Pa Hite clinic,
she says that, at least for now, the situ-
ation is stable. Back in 2001 the SPDC
attacked the area and the medics had to
flee, but Pa Lae Paw asserts that they
were merely lucky that time as the
KNLA protected the area and saved the
clinic, adding that the security situa-
tion and the isolation of the clinic are
some of the most difficult challenges
Field visit to Ler Per Her civil clinic with supporters. they face.
FROM RICE COOKER TO AUTOCLAVE | 25
ment of separate departments, ulti-
mately leading to better, standardized
treatment of patients and the adoption
of established protocols. After the ex-
pansion, the Medical OPD had a larger
space with four separate exams rooms;
three for seeing patients and one for
administering medication. A mere six
medics completed all of the renovation
work.
In 2000, the Medical OPD moved
into a new building with six exam
rooms, four for general care, one for
chronic disease patients, and one for
malaria cases. It is currently staffed by
12 full-time medics, but staff may
number up to 35 when there are stu-
dents doing their practical training.
Two medics work together in each
Medic examines patient. exam room, normally seeing only one
patient at a time, but sometimes seeing
MEDICAL OUTPATIENT
two at a time if the department is over-
whelmed with patients.
BANK
• blood typing
• cross-matching for blood transfu-
sions
Since its inception in 1989, ma- in Mae Sot Hospital. This wasn’t a • urine analysis for glucose levels
laria has been the most common illness sustainable or cost-effective approach, • HIV rapid tests.
presented at Mae Tao Clinic; thus it so in 2000, MTC with the support of HIV screening began in 2001, as
made sense for the clinic to have labo- MSH, set up a blood donation centre an antenatal care service for pregnant
ratory facilities with the ability to per- and blood bank for the blood transfu- women in collaboration with Mae Sot
form malaria screening, rather than re- sions performed at the clinic. Since Hospital (MSH) on their Prevention of
lying on an external laboratory.
Laboratory work first began at MTC in
1992, with a staff of approximately Malaria Slides Processed
four tucked away in a small corner with
2 microscopes, and a freezer. The staff
performed malaria screening, hemo-
globin testing for anemia, and blood
typing.
In 1995, the clinic began blood
donor screening on a case-by-case ba-
sis, but there was no storage facility for
donations. In 1996, there were 36
transfusions, still using case-by-case
screening, using mainly clinic staff as
the donors. If there were no donors
available, blood was purchased from
MSH. In 1997 MTC began collecting
blood from factory workers in order to
keep sufficient inventory and stored it
28 | FROM RICE COOKER TO AUTOCLAVE
Mother to Child Transmission
Fixing the slide.
(PMTCT) program. In 2003, the Vol-
untary Counseling and Testing (VCT)
services began. In 2008, the PMTCT
screening was ‘insourced’ to MTC
which provided quicker results for im-
proved post-test counseling and fol-
low-up care, as well as lower costs.
This led to the expansion into two lab
rooms, along with separate HIV and
malaria rooms. MTC Laboratory staff
was given the opportunity to tour the
MSH lab, blood donation centre, and
blood bank facilities, learning the poli-
cies and procedures being utilized
there, and receiving training for cross-
matching donors to recipients.
BLOOD DONATION
CENTER nate. This poses a challenge, as factory quality control protocols, with regular
workers have very limited free time, internal and external controls per-
The Blood Donation Center ser- with the entire process of risk assess- formed. Hsa K’Paw greatly appreci-
vice at MTC now encompasses the col- ment and donation by up to 100 people ates and understands the benefits of
lection, screening, storage and admin- having to be completed in a few hours. these collaborations, “We stand by our
istration of over 1,000 units of blood This is also seen simultaneously as a protocol, but sometimes we need ideas
each year. All donors are unpaid vol- valuable opportunity to provide donors from others. We have to share with
unteers, with the safety of the blood with health education about transmis- other people and learn from other peo-
supply ensured through the universal sible diseases, in particular, HIV and ple.” He also works to ensure that the
screening (by MSH) of donated blood hepatitis. other laboratory staff understand this,
for hepatitis B and C, HIV, syphilis and Laboratory Manager, Hsa K’Paw “I want them to understand everything,
malaria. Most often donors are factory goes to great lengths to ensure the qual- to be able to do all the work in the lab,
workers that come as a group to do- ity of the lab work. There are rigorous and know who to contact if they have a
problem. To contact MSF, MSH,
SMRU….I want the next generation to
know members of other organiza-
tions.”
Hsa K’Paw views the Laboratory
Training program as an opportunity to
share this information and insight be-
yond the clinic. Laboratory training
participants come from various ethnic
groups inside Burma and then return to
their communities once the training is
complete. Saw Hsa K’Paw lets the
trainees know that he is available to
help even after they finish the program,
“They contact me if they have a prob-
lem. I am able to give them help, and
ideas. I am proud to affect all of the re-
gions of Burma.” It is this attitude that
contributes to the lab having a much
greater impact on border communities,
making the many tests run each day
Malaria microscopy.
only a small part of the contribution.
FROM RICE COOKER TO AUTOCLAVE | 29
Water and Sanitation staffs building MTC needed to improve existing
a water supply system. waste-water management systems.
The local community had been com-
plaining about the run off from the
clinic, and MTC wanted to maintain a
positive relationship with the local au-
thorities and community. Therefore,
the construction and stabilization of
ponds for waste water was undertaken.
The clinic also concentrated on the re-
duction of vectors (mosquitoes) and
vector-borne diseases by introducing
vector eating fish into the pond, thus
decreasing contamination in local
When the MTC founders arrived in Mae Sot, they had no money, equipment, supplies, nor accommodation. Thank-
fully, a number of local kind-hearted souls stepped in to help. Father Manat Supalak of the Mae Sot Catholic Church, and
Monty Morris of Christ Church Thailand assisted in arranging safe accommodation, medicine, and food. They also assist-
ing in fundraising, advocacy, and helping set up initial partnerships and connections with Mae Sot Hospital. Starting in
1992, Médecins Sans Frontières provided crucial in-kind donations of medicine which continued until 1997, along with
assistance in setting up the laboratory.
Medic checks a pregnant woman’s blood pressure at Reproductive Health OPD (photo: James Mackay, www.enigmaimages.net)
CHILD PROTECTION
with BMWEC on an inclusive educa-
tion program with activities including
SERVICES
standardizing curriculum for primary
schools, training teachers and research
on improving access to the Thai educa-
MTC opened one of the first day formation sharing and capacity build- tion system.
care centres in the Mae Sot Area in ing programs for migrant teachers. In Even children who cross the bor-
1995. As the children continued to July 2000 the group changed its name der with their parents often end up in
grow, the next obvious step was the de- to the Burmese Migrant Workers Edu- boarding facilities. The parents often
velopment of a primary school; thus cation Committee (BMWEC), and the do not find full time employment, and
began MTC’s Children’s Development group began working tirelessly on even if they do, the wages are so low
Center in 1998, one of the many mi- fundraising, advocacy, capacity build- that they can barely afford to feed their
grant schools that would open in the ing, and curriculum development. The family let alone send their children to
Mae Sot area. increased level of coordination and school. If the parent is lucky enough to
Burma ranks fifth worst in the world on
standardization of services has lead to find full time employment it often
education spending at 1.2% of GDP. 15 stronger programming, with the com- means that they stay at the factory or
munity showing a greater sense of farm where they are working, with the
Some parents also wished to send ownership in the education system. boss requiring the children to begin
their children to Thai schools, but were There have certainly been chal- working as soon as they are able. Par-
faced with difficulties when they lenges; work continues in standardiz- ents realize that sending their children
couldn’t provide supporting birth reg- ing the curriculum used among the mi- to a boarding facility will ensure ac-
istration documents for their children. grant schools, a very difficult task cess to an education as well as three
In response to this, as well as to ad- when a community of people from meals a day for their child and safety
dress the issues of statelessness, teach-
ers, health workers, and other con-
cerned individuals worked on raising
awareness and assisted with establish-
ing documentation for migrant chil-
dren.
Until 2000 there were no formal
meetings between the migrant schools,
but in April 2000 that changed when
thirteen schools came together to form
the Burmese Migrant Education Work-
ing Group, through which there were
regular meetings revolving around in-
15 CIA World Factbook, 2009.
42 | FROM RICE COOKER TO AUTOCLAVE
from child labor.
In response to major increases in
the number of boarding children, the
organizations working with education
and boarding facilities in the Mae Sot
area began a collaborative response
through the development of the Coor-
dination Team for Displaced Children’s
Education (CTDCE). With three work-
ing groups: the Boarding House Work-
ing Group, the Education Working
Group, and the School Health Working
Group, the CTCDE works to provide
emergency food assistance to boarding
houses, as well as develop a registra-
tion system for boarding children, child
protection policies, and standards of
care for boarding houses.
With so many concerned individ- system, and providing students with have come as a stop-over before reset-
uals and organizations coming together the necessary life-skills to prosper tling in a third country. Staff turnover
to address the challenges of child within the community (as the majority continues to be a major problem among
rights, education and security, progress of students will not have the opportu- the migrant schools.
can certainly be seen, but challenges nity to attend formal post-secondary Of course, none of these chal-
still lie ahead. Many of the children education). With so many disparate lenges will put a stop to the tremendous
suffer from psychosocial illness – they considerations, the development of a efforts being made by the community;
have come from conflict zones and standardized curriculum has been far it is a community of people which
have often witnessed or experienced from easy. seeks to foster strength, hope, and
great violence and human rights abus- The diversity of the teacher popu- knowledge in the future generations.
es. Work is being done to support these lation is also a challenge; these are in- Dr. Cynthia puts it simply, “working
children, to provide them with tools for dividuals with various levels of train- on child protection is a collaborative
stress management and to appropriate- ing, who come from different ethnic effort,” and this strong partnership be-
ly deal with conflict, helping them to groups, political backgrounds, up- tween the Thai and Burmese commu-
be part of a diverse community and to bringings and ultimately, with different nities means that work will continue
participate in the healing of the com- understandings of the situation in Bur- towards ensuring the rights, safety,
munity. ma. Furthermore, these individuals growth and development of the chil-
The diversity of the border popu- have come to the border with different dren on the border.
lation is certainly a celebrated concept goals; some have come to stay, some
at MTC, with the slogan “unity in di-
versity” seen throughout the commu-
nity, on posters and the backs of t-
shirts, but this diversity also imposes
challenges. Curriculum development
for such a diverse collection of ethnic
groups living in a Thai community has
been a particularly difficult challenge.
It is a community that that wishes to be
integrated into whilst simultaneously
maintaining a sense of identity and cul-
ture. The curriculum providers have
also been faced with the problems of
which languages should be taught,
what history, which political views?
Moreover, there is the challenge of
finding a balance between the strong
academic focus of the Thai education Some working group member of Child Protection Service.
EYE CLINIC
tries.
• Globally, about 85% of visual impair-
ment and 75% of blindness could be
prevented or cured.17
Since the mid-1990s, the Mae few instruments and were often short
Tao Eye Clinic has: of glasses with optical power high In 1997, the Eye Clinic began fa-
• Facilitated more than 2,000 enough for patients with poor vision, cilitating on-site eye surgery in part-
eye surgeries to restore sight lost most- according to Aung Phy, one of the orig- nership with the KarenAid surgical
ly due to cataracts and glaucoma, the inal eye medics. The team persevered team from the United Kingdom under
world’s leading causes of blindness however, and by the end of 1996, the the auspices of the International Res-
• Trained almost 1,000 health eye care medics saw more than 30 pa- cue Committee. Initially, the team vis-
workers in basic eye care and eyeglass tients daily and started an outreach ited the clinic for one week each year,
refraction program in Karen State (later discon- performing at least 10 surgeries per
• Conducted periodic eye tinued for security reasons). visit. Now, the team visits the clinic
screenings for more than 5,500 chil- Over the next 14 years, the Eye three times a year and performs 400 to
dren in 58 migrant schools and provid- Clinic’s services expanded significant- 500 surgeries annually, mostly for
ed vitamin-A in conjunction with the ly. In addition to its original services glaucoma and cataracts. These surger-
Mae Tao Clinic School Health Pro- the Eye Clinic now facilitates eye sur- ies are invaluable; many blind people
gram. gery for cataracts and glaucoma; con- arrive for surgery almost totally reliant
• Dispensed more than 60,000 ducts eye screenings and eye-health on others, and come out of surgery with
pairs of eyeglasses training for teachers in migrant schools; their independence restored. “If you
• Dispensed 30 artificial pros- treats eye infections such as trachoma are blind,” says Aung Phy, “the only
thetic eyeballs for patients blinded by (the leading infectious cause of blind- way of life is staying home, only eating
eye infections and landmine-related ness in the world), and runs mobile and sleeping. You cannot do anything,
eye injuries eye-health outreach in Thailand’s Mae you cannot go anywhere by yourself.”
The Mae Tao Eye Clinic started La District.16 The patients come from nearby facto-
in 1995 in an open-air bamboo shed. The Mae Tao Eye clinic has also ries, farms and refugee camps as well
There, the first group of three eye care become a base for eye training. It fa- as from inside Burma, from mountain
medics began doing eye exams, man- cilitates eye health training as well as villages and cities as far away as Man-
aging basic eye diseases, and refract- primary eye care training for nurses, dalay. Most have cataracts or glauco-
ing and dispensing donated eyeglasses interns, health assistants, backpack ma, but others have been blinded by
after being trained by the Border Eye medics, teachers and community health accidents; landmines, illness, infection
Program. It was a modest beginning, workers who see patients in clinics, or inappropriate applications of tradi-
with the medics initially seeing three to
16 World Health Organization, Fact Sheet 282, 17 World Health Organization, Fact Sheet No.
five patients a day. They worked with May 2009. 282, May 2009.
FROM RICE COOKER TO AUTOCLAVE | 47
tional medicines. In 2007, 87.5 percent
of the more than 500 surgeries were for
cataracts, and 72.5 percent of patients
came from Burma, mostly from Karen
State. The incredible impact that these
surgeries have on the patients is evi-
dent in the fact that simply through
word of mouth, each round of surgeries
sees a longer queue of patients.
Weeks before the surgery team
arrives at MTC, hundreds of visually
impaired patients begin arriving at the
clinic grounds. Many require the assis-
tance of a family member or friend; all
are hopeful of receiving surgery that
could restore their vision. Although
the surgery is provided free to the pa-
tients, it can still pose financial diffi-
culty. Most of the patients or their fam-
ilies must borrow the money or sell an Vision screening.
animal to pay for transportation to the
clinic. In recent years, so many people the surgical team only had enough time eye clinic program manager, one clini-
have come seeking surgery that the to operate on approximately two thirds cal supervisor, one optometrist, and
clinic hasn’t had enough space to house of them. Patients journey from so far several community health workers and
everyone. Patients and their families and have so much at stake, the eye community health volunteers. As in
have had to sleep in storage rooms, the medics say, that it’s heartbreaking to other departments, the resettlement of
janitor’s closet, and outside under trees. see their hopes dashed. senior eye medics to other countries
For a few weeks, the grounds are Unfortunately not all patients can continues to be a challenge. Their
crowded, yet friendly, as if the clinic be helped. Their vision loss may have years of training and experience are
were hosting a convention; two free been caused by untreatable genetic dis- difficult to replace.
meals are provided per day and the eases, or scratched corneas requiring The Eye Clinic must serve this
sightless are able to share conversation expensive corneal replacement, an ad- large community with very basic in-
and experiences. vanced procedure the clinic does not struments, limited supplies of eye-
Unfortunately, some must go perform. glasses, and limited space to manage
away disappointed. Last year more Currently, the Mae Tao Eye Clin- high volumes of patients during surgi-
than 800 people arrived for surgery; ic has twelve full-time eye medics, one cal events. Most of the Eye Clinic’s
challenges though, revolve around ac-
cess; it’s difficult for many patients to
La La is 40 years old and has recently had eye surgery at Mae Tao Clinic (MTC), and sadly
was not able to regain her vision. She is from Pago Division, Shwe Kynn Township in Bur- get to the clinic because of high trans-
ma, but has been working in the Mae Sot area for four years with her husband and family. portation costs, risk of arrest, and in-
ability of family or friends to leave
La La is married with two children, a boy aged 6 and a girl aged 12. When they lived in
work to accompany them. That makes
Burma, three of her cousins and three of her uncles were murdered by the SPDC. Her hus-
band moved to Thailand first, and she followed later with the children. They did farm work it hard for the clinic to do follow up
in the Pho Pra area when they first arrived. She says her children do not go to school in care and to assess long-term success
Burma as they were living in a conflict area, and in Thailand they do not go as her family has rates. It also means that some glauco-
to move around to find work. She says her husband is also injured and in pain with a hernia,
ma patients are forced to delay their
and they cannot do strenuous work. They water plants and help planting beans on farms but
she is worried that it will become increasingly difficult for them to work and earn money. At treatment until it is too late, after high
the moment, her husband is still working even though he is in pain, and he earns about 2,000 eye pressures have already permanent-
baht a month and one tin of rice for the family. ly damaged their vision.
La La says that she had heard about MTC from many people in her area. However, it is bit-
tersweet for her as she came here to get better, and has still lost her eye. She says that in
normal circumstances when her family is sick with, for example, malaria, they would not
come to the clinic as it is too difficult for them to travel. She says that they will only make
the journey when they are really desperate.
CHILD OUTPATIENT
cords goes into reports, which help
with funding, and provides a picture of
DEPARTMENT
the population serviced to aid research.
Child OPD also shares information
with Thai Public Health, which pro-
Although the Child OPD official- with tiled floors, see about 100 patients vides it with vaccines.
ly opened in 1998, its vaccination pro- per day, have electricity, a fan, a refrig- The program has expanded to
gram began as early as 1995. As part erator and storage space. They have cover referrals for patients to Mae Sot
of Maternal and Child Health services, their own pharmacy too, as well as Hospital and Chiang Mai Hospital for
every Saturday the vaccination pro- desks and a computer. cases that the clinic cannot treat. This
gram was run. For two days each has mainly been facilitated through the
Twice a week, Child OPD immu-
week, sessions were held for antenatal nizes over 100 children for diseas- Burma Children Medical Fund
care and family planning. In 1997, the es such as Tuberculosis, Diptheria, (BCMF). This fund was set up through
nutrition program was upgraded to in- pertussis, Tetanus, Measles, Polio, the clinic to finance the treatment of
clude growth monitoring, a feeding and Hepatitis B. children externally. BCMF organizes
program for the malnourished, nutri- According to May Soe and Dixie, transfers for children, and a few adults,
tion education, Vitamin A supplements, in the first few years after the depart-
deworming, and the development of a ment opened, it serviced mainly chil-
child health record. dren of migrant workers from Burma,
Prior to establishing the depart- who already lived in Thailand, but as
ment, adults and children had been the clinic has expanded and more peo-
treated together, but as numbers of pa- ple became aware of its services, they
tients and staff rose, Child OPD was have increasingly seen cross-border
separated, whereupon staff become patients. Their demographic is now
more specialized. When it first opened, about 50% from the Mae Sot area and
the department had only 5 staff mem- 50% from inside Burma.
bers and saw 30-40 patients a day. It The department maintains its
was housed in an open area with a roof, original focus on curative care, immu-
which had only concrete floors and nization, growth monitoring, nutrition
limited equipment. May Soe, the de- assessment and malnutrition, and is
partment manager since 2002, and Di- committed to treating the common ill-
xie, a medic in the department since nesses it sees, such as malaria, pneu-
2000, like to say it was a roof with no monia, diarrhea, and acute respiratory
building. Now they have a building Preparing medication
infections. However, the department
FROM RICE COOKER TO AUTOCLAVE | 51
to Thai hospitals, where they can get A medic consultation to mother.
the life saving surgery they need.
These surgeries are often relatively
simple and cheap, but without BCMF
they would be beyond the means of
most patients.
May Soe and Daisy maintain that
the feeding program carried out on im-
munization days is a very important
aspect of the work they do. This pro-
gram provides milk powder to families
with twins, children with cleft palates,
and children with no mothers or HIV
positive mothers. May Soe and Daisy
also say that the most common illness-
es the department sees are malaria,
pneumonia, diarrhea, acute respiratory
infections and malnutrition. There have
been many challenges for May Soe and
Daisy in the daily running of their de-
partment. One of the most trying oc- whose parents usually do not know BCMF. May Soe related that the moth-
currences is when parents leave their what is wrong. They can’t get treat- er was very happy and relieved at not
children at the clinic and never return, ment or even diagnosis in Burma, and being forced to give up her child.
which has happened three times so far. this is highly stressful for them. May May Soe and Daisy have many
Also, like the clinic as a whole, the de- Soe remembers one such case where aspirations for the future of their de-
partment is continually growing, and the mother had become so distraught partment. They hope one day to ex-
there is still a great need for more prior to coming to the clinic that she pand into two departments, Curative
space. had contemplated giving up her child. Care and the Immunization and Feed-
Nevertheless, there have been The staff at Child OPD was able to ing Program. They would also like to
many uplifting experiences within the properly diagnose the child as having a have more space to build a play area
department. For instance, staff often congenital heart condition, which was for the children who come to the clin-
sees young patients with heart disease, subsequently treated with funding from ic.
CLINIC LIBRARY
The Mae Tao Clinic library grew dramatically since its original incarna-
out of the idea that providing books to tion as a box of books at the clinic that When the library opened in 2001 it was
staff and patients would relieve stress only seeing up to 30 people a day. Now
staff shared and swapped with each it provides services to over 100 people
and tension, while at the same time other before 1994. The library now has per day.
providing information and education. approximately 100 visitors daily and
The aim of the library is to provide re- over 5,000 books. The library official- are coming to borrow books. He says
lief from boredom, as well as serving ly opened in 2001 when it was decided that patients and staff now often re-
an educational tool. This is reflected in to turn the expanding collection of quest books from him, which shows
the array of books the library now of- books into a proper library. When Hla him that people are engaging with lit-
fers to its patrons. These range from Thein took over the running of the li- erature and the library’s services. Hla
medical texts and literature on human brary in 2003, he was the only staff Thein would like to see the library de-
rights and politics to love stories and member; now there are seven staff velop in the future. He hopes that one
novels. members on the team running the li- day he can get the medical texts trans-
Dr. Shee Sho was very active in brary from 8am-9pm daily. lated into Burmese from English, since
establishing and organizing the library Despite the expected challenges currently it is only possible to get them
services and KWO members helped of obtaining more books and retrieving in English. In addition, he would like
with the numbering and registering them from borrowers, Hla Thein is to see the library have an exclusive
system. Hla Thein, the library manag- proud of the library. He is most proud space that is not interrupted by meet-
er, says that the library has changed of the fact that more and more people ings.
52 | FROM RICE COOKER TO AUTOCLAVE
challenges for the medics is to manage
the psychosocial aspects. While the
death rate is very high, the community
spirit of the patients is unbreakable.
The HIV/AIDS patients stay in the
clinic for a long time, become a close-
knit community, and take care of each
other.
Unfortunately, there is no space
in the ward for relaxation or recreation
for long-term patients, and many don’t
have sufficient clothing, blankets or
basic necessities. One byproduct is
that the visual impact for visitors can
be a shock. Desperately poor patients
arrive with few basic necessities and
after long travel. The patients often
leave with blankets, meaning that the
clinic is constantly in short supply,
some patients are accompanied by an
entire family who may sleep under
INPATIENT DEPARTMENT
floor. While they may receive good
care and treatment, there may be visual
shock at the patient’s physical appear-
In 1998, about 80% of admissions displaced already, they fear getting ance in the crowded and disorganized
were related to malaria. Over time, the split up by circumstances if they don’t ward. Dr. Cynthia stresses the impor-
range of illnesses treated has become travel together. For example, in the tance of looking past the initial appear-
broader – but the constant over time case of arrest or deportation, they could ance, avoiding judgment, and looking
has been that patients arrive at the clin- have great difficulty finding one an- more closely at the most important ele-
ic with illnesses in advanced states. other again. The family may not have ments – quality of care and strength of
Since many patients arrive with termi- the resources to travel back and forth to the community.
nal illness, the IPD functions part of the clinic every day, or have difficulty Under the misnomer of a “clinic”,
the time like a hospice. Working con- travelling freely due to security. Some- Mae Tao Clinic also functions as a hos-
stantly with terminal patients has a times, the family members will search pital facility, with several inpatient de-
strong impact on the younger health for some work in Mae Sot while at- partments (IPD). Until 1999 there was
workers. If the patients could have a tending to a sick family member. only one inpatient department, treating
higher level of health knowledge, act One might be tempted to declare medical, trauma, reproductive health,
more on prevention, and obtain treat- victory when a patient’s condition has and child inpatients all in the same
ment earlier, many of the conditions, improved and is able to go back home. space. In 1999, the continually grow-
such as malnutrition for example, However, for many patients, this mere- ing patient population led to the expan-
would be preventable or treatable. The ly heralds the beginning of the next set sion of the clinic and separation of de-
IPD also faces family issues – a patient of challenges. They may not have partments, eventually resulting in the
may be dropped at the clinic by friends money to get back home, face security Medical, Children’s, Reproductive
or family, however, these people fre- and travel challenges, and their old job Health, and Trauma/Surgery IPDs that
quently cannot afford to miss work in may no longer be waiting for them exist today.
order to be their attendant. The respon- even if they do complete the journey
Today the Medical Inpatient Depart-
sibility falls upon the medics to support without incident. ment has 50 beds, with overflow space
patients who face death without friends In order to carry out their duties for another 10-20 patients, and the Chil-
or family. successfully, the IPD medics must pos- dren’s Inpatient Department has space
In other cases, the whole family sess medical ability, as well as the abil- for 20 patients, with overflow space
also available.
travels to the clinic together. They may ity to counsel patients, support them,
live far away and are unfamiliar with and refer them to other clinic social Established in 1999, the Medical
Mae Sot. If the family is migrant or services. One of the most difficult IPD was a combined service for both
FROM RICE COOKER TO AUTOCLAVE | 53
adults and children. The most com-
mon cases seen continue to be malaria,
acute respiratory infection, and diar-
rhea, with a continuing increase in the
number of chronic cases being seen at
the clinic, including cancer, sclerosis,
hypertension, nephritic syndrome, and
heart disease. Among children, malnu-
trition is also a common case, and this
was one of the leading reasons for the
development of a separate Children’s
IPD in 2005; children with weakened
immune systems needed to be separat-
ed from patients with contagious ill-
nesses.
Beyond the regular patient casel-
oad, staff of MTC must be prepared for
the unexpected, such as the cholera
outbreak in 2007, or other effects of
extreme weather seen in tropical cli- I see sick patients, and I can’t do any- resettle in a third country, “We are hu-
mates. The rainy season from May to thing for them, I feel very sad. And man beings. We want to improve our
September for example, always brings when the patients die…we see a lot of lives. If we are just living, with noth-
an increase in the number of patients death.” ing to hope for…people don’t want to
arriving with malaria. Also, the further The Medical IPDs are also live like this.”
word spreads of the services of MTC, plagued with the challenge of staff re- There is hope that the future will
the more chronic cases are presented at tention. Saw Muni summarizes the see the training of more long-term
the clinic. Even in a well-equipped, plight well, “If we look for our strong staff, especially as there are more plans
modern hospital setting, these cases points…we have trained a lot of med- for expansions in Medical IPD. As an
would be an extreme challenge. ics. If we look for the weak points…we example of possible future develop-
have trained a lot of medics that have ment, the department still requires bet-
IPD is open 24 hours a day, 7 days a week
with three shifts per day and 80 staff. left.” With the introduction of a reset- ter isolation of patients with communi-
tlement program in 2004, the clinic has cable diseases, especially now that
For severe cases that cannot be suffered extensive loss of staff, but there is no longer an external Tubercu-
treated at MTC, the referral program to Saw Muni expresses the understanding losis program to send patients to.
Mae Sot Hospital (MSH) becomes a and acceptance for those that choose to There is also the hope for greater coor-
possibility. Department Manager, Saw A child get severe pneumonia.
dination and partnership with other
Muni, and the staff of the Medical IPDs health organizations, Mae Sot Hospi-
are charged with the unenviable task of tal, and the Thai community. Commu-
deciding who will be referred for treat- nicable illnesses such as TB quickly
ment and who will not be. There are become devastating public health is-
procedures and protocol to follow, but sues that don’t recognize borders. The
this does not make it easier. Staff must increase in cross-border patients re-
first consider the potential survival rate quires greater collaboration in the com-
of the patient, and then the cost of treat- munity to battle health issues.
ment, referring only the patients that The IPD cannot alone solve the
require a one-time visit to the hospital, problem of cross-border tuberculosis,
and not ongoing hospital visits. Of malnutrition, lack of health care inside
course these decisions are made in de- Burma, or the extreme social and eco-
veloped countries, but not to this ex- nomic challenges of the patients. The
tent, and not on a daily basis. Frustra- IPD aspires to treat the patients with
tion and sadness is evident when the best care possible with its resourc-
talking with Saw Muni. “I am sad be- es, utilizing strong collaboration with
cause we cannot treat all of the patients, other clinic departments as well as oth-
we don’t have enough facilities or er organizations to address the broader
enough money to refer the patients. If issues that result in its high caseloads.
54 | FROM RICE COOKER TO AUTOCLAVE
FINANCE & ADMINISTRATION
Prior to 1992, medical supplies
Finance team at work.
were donated, and the clinic survived
using various donations-in-kind. For-
tunately, there were regular monthly
and quarterly donations from organiza-
tions such as Médecins Sans Frontières
of rice and medicine. If patients were
referred for treatment at Mae Sot Hos-
pital, supportive church groups would
pay the hospital directly. From 1993
onwards, funding for running costs
was donated by organizations such as
the Burmese Relief Center. This pro-
vided funding for basic necessities of
the staff, phone bills, and other admin-
istrative costs. Fortunately, other
groups began to provide funding as
well for running costs.
In parallel, there was a need to
develop the medical administration.
For example, there was initially only
one medical record and log book for- caused MTC to begin catering to spe- clinical space grew and began to sprawl
mat which was used by all departments. cific donor requirements. More staff across the grounds into new buildings,
Separate antenatal care, family plan- was required to monitor supply and more coordination was needed. After
ning and delivery records format were medicine expenses and to match those 1999, departments were established as
developed in 1994. In 1995 the first to donor requirements, and the order- decentralized entities with some cen-
annual report was published, but until ing system needed to be decentralized. tral coordination. Each department
1999 there wasn’t a dedicated staff of This development allowed each de- now has a program manager who man-
professional administrative staff. Until partment’s program manager to inde- ages logistics, staff issues, budget and
1999 a small office team managed to pendently manage logistics, staffing supplies. There is also a clinical super-
reply to correspondence or requests to and expenses. Furthermore, although visor, and shift leaders for the inpatient
the clinic. However, 1999 marked the each department was able to send re- departments. In each department one
beginning of building out the adminis- quests to the central pharmacy, they person manages the pharmacy - if there
trative and finance backbone of the also kept a separate pharmacy storage is enough staff, this is a separate per-
clinic. The first clinic administrator area, and in this way individual depart- son, but many times the program man-
and accountant were appointed, and ments operated like tiny hospitals. ager does this in addition to their other
the first audit conducted. For many Throughout the early years, MSF duties.
years MTC didn’t keep its own records had been providing quarterly medicine When a new department is creat-
– all receipts and records were sent donations-in-kind, but this eventually ed, a new logbook and report format is
back to the donors and MTC didn’t proved insufficient for the clinic’s created. At the outset, however, there
have its own finance system. There- caseload. From 1999 onwards, donors was no consistency or complete data
fore, financial audits were done within began providing grants that were used across the reporting formats which
the donor organizations. In 1999 the for quarterly medicine orders through a made it difficult to consolidate infor-
clinic started to keep its own receipts local supplier. Terre Des Hommes mation into an annual report. In 2002 a
and financial records which could be (TDH), for example, supported specific data coordinator was appointed to
audited. areas in the clinic. Due to growing do- oversee logbooks, data entry, and data
The other change from 1999 was nor requirements, the clinic needed to quality. This coordinator trained clini-
the method of ordering supplies and change the ordering system. More cal staff to do data entry, but their clin-
medicine. From 1989 – 1999 there people were needed to monitor medi- ical skill set was not suitable, and this
was a central ordering system, but in- cine expenses and to ensure these resulted in staff turnover. When the
creased grants with specific purposes matched donor requirements. As the data department was finally established
FROM RICE COOKER TO AUTOCLAVE | 55
and data entry staff was hired, the data ductive Health areas. The support of processes continues to this day. To
quality improved. (For further discus- the WCRWC for two years enabled re- support this initiative full time finance
sion see the Health Information Sys- view and revision of the logbook for- manager was appointed in 2005. While
tems chapter) From that time on, data mat, establishment of a data collection the title might mislead one to thinking
quality has continually improved and system, revised medical reports, and a the role was mainly related to “bean-
obtaining consolidated figures across facility checklist. An important facet counting” or tallying the financial fig-
the clinic and reporting to donors has of current clinic operations also began ures, the role encompasses fund rais-
become easier and more accurate. – the exit interview. This has enabled ing, auditing, reporting, and process
In addition to the establishment MTC to better understand patient ill- improvements to ensure clear report-
of the data department, a concomitant nesses, situations, and satisfaction. ing. In 2007, a procurement team was
driving factor behind administrative The program also introduced quality established, which set a policy as well
developments in the clinic was the in- assurance measures such as updated as managed the procurement and logis-
creasing role of MTC as a refugee ad- clinical protocols and medical case au- tics of the clinic. Recognizing the im-
vocate and social service provider and dits. This project was the beginning of portance of dialogue with donors, the
coordinator. From 2000 onwards, the MTC’s monitoring and managing of first meeting inviting all donors to dis-
increasing population of migrants and health care delivery quality. cuss clinic issues was held in 2007.
health problems, gave rise to more Once MTC had set up the ac- These annual meetings cover issues
NGOs working with migrants. MTC counting system, changes and require- such as funding needs, standardization
Noddle factory
location at current office.
decided to appoint its first migrant ments began to increase exponentially. and schedule issues.
health coordinator. Until then, the Some donors, for example, require Prior to the appointment of the
clinic had restricted its activities to separate financial reporting, in which clinic administrator, public relations
providing services, referring patients case a specific accountant needs to be duties were shared by clinic staff. The
to other NGO services, and recording appointed to that project. Even though frequency of visits from donors, uni-
case counts. However, there was no some projects have these standalone versities, media and civil society began
system to monitor the quality of ser- finances, the overall clinic finances to increase with the clinic’s notoriety
vices provided. The Migrant Health must always be integrated for reporting from 2000. Finally in 2008, an interna-
Coordinator set out to monitor care in purposes. Initially, an international tional volunteer was appointed to lead
the migrant community, but this was volunteer was appointed but each year Public Relations. This led to clear
just the beginning of a broader advo- a new person would take the role. The guidelines for media tours, referring
cacy role the clinic would begin to play other challenges were that some donors visitors to departments, and visitor
both locally and internationally. required quarterly reports, while others protocols. This role has now been tran-
On the clinical side, in 2001 a required half-year reports. The clinic sitioned to local staff. These days, the
program in collaboration with the needed to be able to strengthen the sys- local staff continues to increase its
Women’s Commission for Refugee tem to support timely reports contain- ranks of young, multi-lingual, educated
Women and Children (WCRWC) ing both narrative and financial infor- and polished members who are capable
brought improvements to the Repro- mation. The strengthening of these of taking the lead in this area.
56 | FROM RICE COOKER TO AUTOCLAVE
STABILITY AND SECURITY
FOR MAE TAO CLINIC
With 20 years of service under its belt, the Mae Tao Clinic offers its
community a sense of stability and security. In a region which continues to
endure ongoing conflict and volatility, it is reassuring to know that there is
a community-based organization such as the Mae Tao Clinic which has
been able to offer hope for the future for over two decades. Yet, there have
been times in the last 20 years when the services and the existence of the
Clinic were questioned, possibly even threatened. Dr. Cynthia explains,
“In the late 1990’s, the attacks came across the border into Mae Sot. At
that time, all the clinic staff slept together in one building. There was a
woman brought to MTC for care since she was terribly traumatized who
would wake up in the middle of the night screaming. One night when at-
tacks were not uncommon, she woke up screaming. By the time I saw
what was happening, wondering if there was an attack, the whole staff had
already fled. I noticed they each grabbed a bag and ran out the door. It
was only at that moment I realized that everyone slept with their belong-
ings packed, ready to go, ready to flee at any moment.”
As the Clinic has continued to grow, its visibility has increased - cer-
tainly in the eyes of international supporters, and even among the host
community where the Clinic maintains as low a profile as possible to avoid
unnecessary tensions with the local community. Being without official
recognition as a Thai-registered organization, the Clinic has operated dis-
creetly, giving importance to the kind understanding of the host commu-
nity leaders and taking care to engage in full cooperation with local au-
thorities. Even then, there have been times when MTC faced challenges,
for example, due to changes in the interpretation of the work permit
rules.
Each time the Clinic has come under pressure, Thai senators empa-
thetic to the situation along the Thai-Burma border, and other prominent
international supporters, have come to the rescue and have helped to forge
deeper ties between the Clinic and concerned parties so that discussions
could continue. Situated in the complex reality of competing politics and
economics, the Mae Tao Clinic has had to work hard at balancing the
needs of its people – both patients and staff, against the turmoil that sur-
rounds it. Each day may bring a new crisis to its door, each year a larger
clientele to treat and heal. Even after 20 years, the sense of stability and
security that the Clinic will be there for those who need it is continually
challenged by the changing landscape of the local context.
Long term funding security is a constant challenge. The events of
2004, for instance, resulted in one of the more severe crises in the clinic’s
history, when a large influx of cross border patients came at a time when
there were no new increases in funding. There are still some fundamental
concerns that keep the Clinic on its toes besides funding issues – such as
not being able to own the land that the Clinic stands on, not being able to
secure long-term documentation and residency in Thailand for its staff,
and not being able to own assets in its name. Lamentably, these issues
sometimes negatively affect the operations of the Clinic, and thus the Clin-
ic strives to ensure greater security and stability as opportunities arise. In
the end, it is clear that recognition and support at all levels - locally, na-
tionally, and globally - are essential elements in ensuring that the Clinic
can continue to serve its community and provide hope for the day when a
democratic Burma can emerge.
FROM RICE COOKER TO AUTOCLAVE | 57
PARTNERSHIPS: 1995 - 1999
• In 2007, Back Pack Health equipped to treat the disease; instead, two to five members, and overall serve
Worker Team (BPHWT) distributed they educate patients about TB and re- about 160,000 people displaced by
de-worming medicine, vitamin-A tab- fer them to other service providers for civil war in Burma. Back Pack Teams,
lets, latrines, soap and health education treatment. laden with 100 kilograms of supplies,
to 21,962 students and 1,009 teachers • In the past 11 years, seven back often walk more than 1,000 kilometres
in 353 schools. pack health workers and one traditional to deliver health care in ethnic conflict
In the IDP areas, BPHWT ad- birth attendant have been killed while areas.
dresses three areas: medical, public delivering health care. One health The focus of the Back Pack mod-
health promotion prevention, maternal worker, imprisoned in 2005, and three el has been to train local people in pri-
and child health. village health volunteers remain in mary health care and some specialties
• The medical program treats ma- prison. Two health workers captured in so they can serve their own communi-
laria, diarrhea, acute respiratory infec- 2007 were released after payment of ties. Typically, Back Pack teams visit
tions (ARI), anemia, worm infestation “fines.” The junta regularly steals med- Mae Sot every six months where they
and war injuries. Malaria is the most ical supplies. re-supply and attend training. Each
common disease, followed by ARI, The Back Pack Health Worker team then shoulders 100 kilograms of
worm infestation, anemia, diarrhea and Team began in 1998 with 32 teams in provisions and heads back over the
dysentery. the Karenni, Karen and Mon areas. border, traveling mostly on foot through
• Tuberculosis is a growing major Today, there are 80 team which have mountainous jungle terrain. Their des-
health problem among internally dis- expanded their territory, also reaching tinations are the rural and ethnic armed
placed people. In 2007, back pack into Arakan, Chin and Shan areas. In conflict areas where medical care is
teams identified 430 suspected cases of the Shan areas, there are Lahu, Pao and scarce or non-existent. Walking as far
TB. Back pack health workers are not Shan teams. These teams each have as 1,000 kilometres in a single trip, the
teams provide a range of medical care
along with community health educa-
tion and prevention, and maternal and
child healthcare services. In bamboo
classrooms and simple encampments,
health workers teach villagers sanita-
tion and hygiene, how to breastfeed,
nutrition, and how to prevent landmine
injuries, malaria, diarrhea, avian influ-
enza and HIV/AIDS.
BPHWT’s maternal/child health
program includes family planning and
breastfeeding education. In a place
where one out of 12 women dies in
pregnancy or childbirth, BPHWT has
A Backpack medic gives Vitamin-A to IDP children. trained 720 traditional birth attendants
58 | FROM RICE COOKER TO AUTOCLAVE
in safe birth techniques and provided months had double the chance of dy- lagers to prevent disease? “Malaria is
them with life-saving birth kits and ing, and triple the chance of becoming a disease we can prevent with bed nets.
supplies. BPHWT’s mission is to malnourished. In the 12 months after Are we going to provide bed nets? Or
equip people with the skills and knowl- being forcibly relocated, the study are we going to treat the people who
edge necessary to manage and address found a five-fold increase in the risk of are sick right now? Prevention is bet-
their own health problems, while work- landmine injury for both children and ter, but at the same time, health work-
ing towards long-term sustainable de- adults.19 Destruction of families’ food ers have a moral obligation to help the
velopment. “Human rights violations supplies and crops not only increases sick,” says BPHWT executive director
have commonly been reported by rights malnutrition, but also increases the Mahn Mahn.
organizations, but the association be- chance of landmine injury and malaria Despite this dilemma, back pack
tween violations and health indicators as people are forced to forage in the health workers treat as many patients
has not been quantified” prior BPH- jungle and sleep in beds lacking mos- as they can and distribute whatever bed
WT’s work in this area. A study was quito nets. This is a particularly impor- nets they have with the realization that
undertaken in collaboration with Johns tant statistic providing that at any given nets may get left behind when people
Hopkins University in 200418 Which time, 12 percent of the displaced popu- flee a burning village. “Because so
used epidemiologic methods to dem- lation is infected with Plasmodium fal- many people are displaced, the diseas-
onstrate links between human rights ciparum, the most deadly form of ma- es will be coming again and again,”
abuses and adverse health outcomes. laria. Mahn Mahn says. “I always say: Stop
The report found that children who had With limited resources and such the human rights violations among
been forcibly relocated in the last 12 high rates of disease, it’s always a chal- these communities! Health care is an
lenge to prioritize: should efforts be issue that could bring people together
18 “Population-based survey methods to quan-
focused on treating the ill, or should who would otherwise be fighting each
tify associations between human rights viola-
tions and health outcomes among internally dis- resources be directed at teaching vil- other,” Mahn Mahn says. “People need
placed persons in eastern burma” Mullany et al, to meet, understand and trust each oth-
Journal of Epidemiology and Community Health, 19 Chronic Emergency: Health and Human
Rights in Eastern Burma, 2007.
er.”
2007; 61:908-914.
PROSTHETICS DEPARTMENT
the support of Clear Path International,
the monolimb was introduced. Light
and partly vacuum-formed, the mono-
• Burma is second only to Afghanistan cial leg to heal. “In our culture, the limb promises faster production and
in the number of new landmine victims man is the leader of the family and easier delivery to IDP areas, but re-
each year. more responsible for taking care of the quires complex and precise techniques.
• 95% of the program’s clients come family,” says Saw Maw Kel. Many Today the shop’s crew of 6 can make
from Burma
landmine survivors suffer humiliation more than 200 limbs a year, using both
From the outside, the prosthetics and shame when their injury makes lamination and monolimb methods.
department looks like another plain, them dependent on the loved ones they Throughout the program’s histo-
heavy concrete cinderblock building -
one among the many that form Mae
Tao Clinic’s maze of structures. Inside
the bland façade however, is a work-
shop that gives hope to landmine vic-
tims – hope in the form of prosthetic
limbs, food and shelter, social support,
and the knowledge and expertise of
staff that know firsthand the difficult
journey that landmine survivors have
made.
Saw Maw Kel is a sturdy Karen
gentleman who founded the Mae Tao
Clinic’s prosthetics program at the end
of 2000 and has been a driving force in
its development ever since. A land-
mine survivor himself, Maw Kel expe-
rienced the psychological wounds that
accompany the physical injury – a
Prosthetic workshop at MTC.
wound that takes more than an artifi-
64 | FROM RICE COOKER TO AUTOCLAVE
A landmine
ry, most of the prosthetics trainees have long journey of rehabilitation. At the
been landmine survivors themselves. Mae Tao Clinic, in addition to pros-
Ninety-five percent of the Mae Tao thetic limbs, patients receive food and
Clinic’s Prosthetics Program’s clients housing, and social support services.
come from inside Burma. Moe Khar, They also get gait training – in essence,
now the prosthetics department man- relearning how to walk. The clinic be-
ager, says that 17 out of 20 patients that gan offering mental health counselling
come each month have lost their limbs specifically for prosthetic patients in
to landmines. Accidents, disease, and 1998. Today prosthetics patients can
congenital defects make up the remain- get help at the clinic’s counselling cen-
ing 15%. The vast majority need lower ter that opened in 2006.
limbs. When a client needs an upper In addition to the successes, the
limb, a sponsor is sought to purchase program faces hurdles that are beyond Artificial leg
and deliver the materials for an artifi- the clinic’s control. The supply of arti-
cial arm. ficial feet, ordered from Cambodia by nancial future seems secure, as an Ital-
The Mae Tao Clinic refers newly- Handicap International, often cannot ian community organization has guar-
injured landmine and gunshot wound keep up with the demand. It is difficult anteed the clinic’s prosthetics program
victims to Mae Sot Hospital for stabili- to find local people willing and able to long-term support. Eventually the
zation and initial surgery. In 2004, the give physical therapy and limb mas- clinic hopes to produce artificial feet
ICRC began supporting the referral sage to patients, and lastly, with such a in-house to reduce the reliance on sup-
program by paying for patients’ initial small staff, the shop acutely feels the ply from the outside.
medical expenses and conducting as- loss of experience and knowledge The legacy of the Mae Tao Clin-
sessment interviews. After their ampu- when a technician resettles overseas. ic’s program will not only be the land-
tations, landmine survivors begin a Fortunately however, the program’s fi- mine survivors it has served, but the
many technicians that have graduated
Saw Maw Keh
from the program’s prosthetics work-
shop training. Some from ethnic mi-
norities have returned to their commu-
nities inside Burma to apply what they
learned in Mae Sot, bringing hope to
landmine survivors who are unable to
make the arduous trek to the border.
For Saw Maw Kel, the satisfaction
comes from seeing amputees make the
mental journey from victim to survi-
vor. Though the prosthetic limbs are
an imperfect replacement for what was
physically lost, they are pivotal to re-
covering a wholeness of being. “I am
happy and proud,” Maw Kel says, “to
see those who have lost parts of their
body like me, regain confidence and
struggle for life without giving up.”
FROM RICE COOKER TO AUTOCLAVE | 65
tral database that the clinic could use
for planning, budgeting, and reporting
to donors.
Thanks to the generosity of for-
eign donors, getting computer hard-
ware and software has not been the
main challenge. Rather, the biggest
obstacles are developing staff with da-
tabase skills and knowledge, keeping
the system going as experienced staff
leave and new staff come on board, and
educating clinical staff on the impor-
tance and value of information.
Some of the best examples of the
system at work are in communicable
disease public health. As tuberculosis
emerged in recent years on the Thai-
Burma border, the clinic used its health
information system to determine the
HIS staffs working time.
proportion of cases coming from Bur-
ma. In 2003-2004, Tak Public Health
HEALTH INFORMATION
conducted a pilot project with MTC,
helping the clinic improve its data-
SYSTEMS
base’s ability to monitor 19 infectious
diseases of public health importance.
Getting accurate information on pharmacists can still dispense the prop- During a cholera outbreak on the bor-
time is the mission of the health infor- er medications, and babies are still de- der in 2007, the information in the
mation systems department (HISD). livered. Without these numbers how- clinic’s database was used to conduct
How many cases of a certain disease ever, planning, a crucial element in the surveillance for the deadly diarrheal
has the clinic seen? What is the per- development of the clinic and the ser- disease.
centage of female patients? Where do vices it provides, is impossible. How In 1995, MTC had only two computers –
the clinic’s patients come from? These can you know how many anti-malarial one for Administration, another for a DOS
are the types of questions that the HISD pills to order for July unless you know learn-to-type program.
seeks to answer, but before the devel- the number of patients with malaria Today HIS has 24 desktop computers and
11 laptops spread across 12 departments.
opment of an electronic health infor- you saw this June or last July? How
mation system, answering such basic can you know how much money to The next big step planned for the
questions was laborious. It meant flip- budget for medications and supplies clinic’s health information system is to
ping through pages and pages of clinic for the Trauma and Surgery Depart- introduce a fully centralized database.
logbooks to get each patient’s name ment unless you know the numbers of Today, to update the clinic’s main data-
and diagnosis, retrieving cardboard different surgical procedures that were base, staff members have to copy the
medical charts from a filing cabinet, done? In the mid-1990’s the clinic data entered on the computers of each
interpreting the sometimes messy started recording this information in of the clinic’s twelve departments onto
handwriting of busy medics, and re- computerized spreadsheets using Mi- memory stick “pen drives,” walk to the
cording the information in another log- crosoft Excel. The information that health information system office, plug
book to be added, divided, and ana- was stored at first was basic: name, the drives into the office’s main com-
lyzed. Not only was each step of this age, gender, and diagnosis. While Ex- puter, and import the data into the cen-
process time-consuming to do by hand cel is good for mathematical analysis, tral database. After 2009, the data en-
but was prone to error as well. A line it is not so good for storing informa- tered by each department will
in a thick logbook might be overlooked, tion. The clinic started using an elec- immediately travel via a computer net-
a name misspelled, a diagnosis missing tronic database program for its medical work to be stored in a single modern
from the chart, or numbers added in- inpatient department in 2000. By 2004, SQL server database. This will de-
correctly. almost all of the clinic’s departments crease the errors associated with manu-
Of course, even without the num- were entering information into their al information transfer, and allow the
bers, the basic work of the clinic can own Microsoft Access databases, main database to be updated more
continue. Medics can still see patients, which were then combined into a cen- quickly.
66 | FROM RICE COOKER TO AUTOCLAVE
REGISTRATION / MEDICAL RECORDS
DEPARTMENT
The function of the Registration/ as to not have any incriminating evi- room for many different spelling varia-
Medical Records Department is to cre- dence of their visit to Mae Tao Clinic; tions.
ate, file and be able to quickly retrieve for others it may be that they actually Beginning in mid-2007 new pa-
any one of more than 100,000 medical do not know their date of birth or even tient registrations were directly entered
records. Every person coming to Mae the name of their village. For Moe Oo, into the HIS database. In less than 2
Tao Clinic first goes to the Registration head of the Medical Records Depart- years, the Registration/Medical Re-
Department where they are given a ment, and his staff, the difficulties then cords Department has entered more
unique registration number that will lie in translating the information from than 130,000 patients into the HIS da-
follow them for all subsequent visits. Burmese or one of the many ethnic lan- tabase and is adding patients at a rate
In addition to serving as the medical guages into English, which leaves of 40,000 to 50,000 each year.
record for the patient, records are the
source for quality assurance and case
reviews. Being able to retrieve the pa-
tient records of those who, for exam-
ple, had fatal outcomes from malaria or
came from a specific area of Burma,
entails identifying the patients through
the Health Information Systems and
then reviewing the care they received.
There are formidable constraints
in the Medical Records Department
that are unique to a health care facility
that serves migrants and displaced per-
sons. Due to security concerns, some
patients may give a different name or
address on successive visits in order to
remain anonymous. Others feel it is
necessary to throw away their registra-
tion card before returning to Burma so Central registration department
HIV STORY
1992: • Home Based Care (HBC) begins workers had about the disease. Since
• Mae Tao Clinic medics trained to – 15 to 40 PMTCT clients in pro- condom use was and continues to be
recognize the signs and symptoms gram stigmatized, high school drop out rates
of HIV/AIDS • Cotri for prophylaxis begins20 are high, and the population is very
• More patients admitted to the In- • Monthly meetings of PLWA (peo- mobile, the staff feared a high level of
patient Department with the com- ple living with aids) support group misconceptions. Even if the miscon-
plications resulting from AIDS. begins ceptions were addressed, condom
1995: • MTC enters agreement with Fam- availability was limited due to constant
• HIV testing introduced with the ily Health International (FHI) to economic pressure on the community.
beginning of the blood donation/ provide voluntary counselling and
Condoms were outlawed in Burma until
transfusion program. testing and to expand perinatal 1992.21
• Rapid tests for HIV, Hepatitis B services for HIV positive women.
and C, and syphilis performed at Expands services for post deliv- Facing this confluence of public
the MTC Laboratory. ery, home visits, follow-up care, health dangers, in 2000 MTC, Thai
• MTC begins working with HIV and opportunistic infection. Public Health authorities, and Burma
cases and referring antenatal care 2004: Medical Association conducted the
cases to Mae Sot Hospital. • All testing for the Blood Transfu- HIV/AIDs KAP (knowledge and prac-
1998: sion Program sent to the laborato- tices) Survey. This was the first time
• HIV testing for pregnant women ry at Mae Sot Hospital. this type of survey focusing on migrant
receiving antenatal care begins. workers had been conducted. The re-
• Between 1998 and 2001, some fi- Prior to 1999 the clinic staff had a sults showed that the community had
nancial support for the testing pro- reasonably good understanding of poor knowledge of the disease – typi-
gram received, significantly boost- prevalence via blood donors, antenatal cal misconceptions included the ideas
ing participation to approximately and other testing; what staff members that antibiotics could prevent HIV, and
75 percent. Women’s Commis- lacked however, was a good under- that transmission wasn’t possible with
sion’s support for the Reproduc- standing of what information migrant only one exposure, and community
tive Health project facilitates be- 20 A preventive treatment of AIDS-related op- leaders and teachers were typically re-
portunistic infections with a cheap and safe, luctant to have the sensitive discus-
ginning of testing for all pregnant broad-spectrum antibiotic called ‘cotri-moxa-
women. zole’, which can reduce HIV-related death rates 21 Burma: the impact of armed conflict on chil-
2003: by up 50%. dren, p 11.
68 | FROM RICE COOKER TO AUTOCLAVE
sions that HIV education entails, espe- constituting a positive step forward in convincing messages since new clients
cially with adolescent students. Since preventing mother-to-child transmis- can identify with them.
that time, willingness to discuss the is- sion, this program didn’t include treat- Currently, one of the major ven-
sues has improved. ment of opportunistic infections, home ues for HIV testing is the blood dona-
“… UNAIDS estimates that [in Burma]
based-care, or nutritional support. tion center, with most donors being
HIV prevalence among pregnant wom- The voluntary counselling and factory workers. Every year the clinic
en is currently about 2 percent. Such a testing (VCT) program began in 2003. conducts an HIV education and coun-
prevalence rate is well above the 1 per- It is a free, confidential and anonymous selling workshop for this section of the
cent benchmark that indicates a gener-
alized epidemic in which HIV infection
HIV/AIDS counselling and testing ser- migrant population. The factories
has spread from high-risk groups to the vice offered six days a week at the work with MTC both on education as
general population”… “The HIV/AIDS clinic. Partners of all positive clients well as providing blood donors. Twice
situation in [in Burma] therefore has are also encouraged to go to the VCT a year MTC provides HIV counselling
important regional considerations.
Pregnant women have a high preva-
center. VCT is a rapid test which pro- and testing for factory workers. Ulti-
lence rate of up to 13 percent in the ar- duces results in thirty minutes, so the mately, the factory delegates become
eas of highest HIV/AIDS impact. The clinic can offer pre and post-test coun- HIV education supporters, as well as
high infection rate among pregnant selling. VCT clients have a higher coordinators for blood donation.
women and the lack of anti-retroviral
drugs imply a rapidly increasing rate of
prevalence of HIV infection than the Clearly though, the migrant and
mother-to-child HIV transmission.” 22 general population since the majority cross-border communities are not com-
of them present with symptoms of a posed solely of the factory workers. In
From 2001 to 2003, MTC joined sexually transmitted disease, indicat- recognition of the complex demo-
the Perinatal HIV Prevention Trial ing a higher risk for exposure to the graphics of these communities, MTC
(PHPT), a collaborative pilot project virus. has tried to enable a peer support net-
that provided no-cost testing for all an- Before the HBC program, pa- work for the migrant community, as a
tenatal care patients. Blood samples tients were often lost to follow-up since means of taking advantage of opportu-
were sent to the laboratory at Mae Sot there was no organized means of con- nities to network, provide HIV preven-
Hospital and then combined with data tacting them. This was especially tion education, and raise awareness.
from three other sites in Thailand. problematic for pregnant women who This happens through both community
Anti-retroviral medications were given tested positive. The idea of HBC is collaboration as well as medical col-
to those testing positive in order to pre- that by providing home visits, the clin- laboration, for example with Mae Sot
vent mother-to-child transmission. ic can ensure continuity of care while Hospital.
Both mother and infant received fol- increasing opportunities for counsel- Some people come Thailand to
lowed up visits, and milk formula was ling on risk reduction, personal care avoid the stigmatization they would be
provided to replace breast milk. Whilst and health education. The home-based subjected to, were they to be treated in
22 UNFPA, “United Nations Population Fund care staff is generally persons living Burma. At MTC, patients feel they
Proposed Projects and Programs: Recommenda-
tions by the Executive Director; Proposed Spe-
with HIV who have decided they want have a safe and accepting environment
cial Assistance to Myanmar”, 13 July 2001. UN to help others. They carry the most for treatment. MTC achieves this by
Doc DP/FPA/MMR.
Providing ration to PLWHA.
PUBLIC RELATIONS
By the late 1990’s, MTC had relocation. He coordinated with the
bloomed into something more than a various departments in the clinic, as
small medical clinic. The MTC um- well as with CBOs and trained a di-
brella began to provide various social verse staff. Staff diversity in the PRC
services, education, and community was essential in order to communicate
oriented services. The medical staff in all the ethnic languages used at the
began to spend more time providing clinic, as well as to have staff with
direction to patients on non-clinical is- backgrounds ranging from migrant
sues, drawing their focus away from communities to refugee camps. The
their clinical work. At the same time, PRC was formed in 2003 in order to
there were a growing number of young efficiently communicate information
people who had either arrived from to the many patients coming to Mae
Burma, migrant communities or refu- Tao Clinic. Previously, patients who
gee camps. These young people were needed information would simply ask
articulate, energetic, and in search of the closest person to them, often a
opportunities to contribute. It was a medic. This resulted in medics being
natural to apply the skills of these distracted from the job at hand while
young people to form a Public Rela- they clarified something for the patient.
tions Centre (PRC); but who could It was decided that MTC needed a pub-
train them and be a leader? It proved lic relations service to ensure effective
difficult to find an appropriate leader dissemination of information and free
for the undertaking, since only senior up the medics to concentrate on their
members in the clinic had a good un- work. When it started, the PRC con-
derstanding of security issues, how sisted of a tin roof over a concrete floor.
partner organizations worked, and how It was responsible for taking care of
the various departments in the clinic emergency patients and others who
functioned. The leader would need needed assistance, and for providing
good communication and organization directions and information to patients.
skills. The name, “Public Relations
Fortunately an ABSDF (All Bur- Centre” might be misleading, since the
ma Students Democratic Front) leader PRC has a much broader role which
who had plans to resettle agreed to lead includes social services coordination.
the effort to set up the centre until his These services include: providing in-
DENTAL CLINIC
What to do if your molars ache, rate department in a newly constructed canals, 87 scalings, 289 resin fillings
gums swell and the shooting pain in concrete suite that has three donated and treated 18 oral cancer patients for
your jaw keeps you awake at night? If chairs and high-speed pneumatic den- pain.
you’re poor and from Burma, you head tal drills. Led by clinical supervisor Almost all the patients seeking
for the Mae Tao Dental Clinic (MTDC), Dr. Kyaw Zayar, a dentist from Burma, dental care at the Mae Tao Clinic have
where trained dental workers examine, and clinic manager Gay Moo, the 6- never before visited a dentist. In addi-
diagnose and, when necessary, drill person staff is specially trained in den- tion to their primary complaint, eight
and fill cavities, scrape away plaque, tistry and sees 20 to 30 patients daily, out of 10 patients also have cavities
perform root canals and extract infect- resulting in the treatment of approxi- they aren’t aware of. The problem,
ed teeth - for free. mately 4,000 patients in 2008. In the dental medics say, is that most patients
first half of 2008, the dental clinic per- have little education and don’t under-
Dental Clinic saw about 4,000 patients in stand the importance of oral hygiene.
2008, and extracted 1,907 teeth in the first
formed 1,907 tooth extractions, 26 root
half the year alone. “Dental care is very important,” says
medic Lawkwa. “It is a part of health.
The Mae Tao Dental Clinic start- Before, people didn’t understand. They
ed in 2001, opening three days a week only (associate) malaria and diseases
as an adjunct to the clinic’s surgery de- like that with health. [A tooth infec-
partment. At first, the clinic had only tion] starts because of lack of knowl-
one syringe and a handful of dental edge about how to clean and take care
mirrors and tools for extractions. The of the mouth. It gets worse, sometimes
surgical medics, who had attended a turning into an abscess if you do not
dental training in Bili Htoo, saw three get appropriate treatment. Lots of suf-
to five patients a day. Patients came to fering, pain, fever. It can cause osteo-
the clinic complaining of tooth pain, myelitis, an infection of the bone.”
jaw swelling and abscesses. Some- For impoverished patients, it’s
times the medics couldn’t figure out common to delay treatment until an in-
what caused the problems, but they fection rages out of control. Patients
could treat the symptoms by cleaning say they’d be forced to spend their life
teeth, giving antibiotics, draining ab- savings if they went to a doctor or den-
scesses, and, when needed, extracting tist in Burma, so they wait, hoping the
teeth. infection will clear up by itself. “It’s
Today, the dental clinic is a sepa- Dentist working in clinic. not a problem for the rich man,” Lakwa
FROM RICE COOKER TO AUTOCLAVE | 75
says, “but it’s a BIG problem for the Dental medic examines patient.
daily workers and the poor people.”
When the dental medics ask why pa-
tients didn’t come earlier, “Most of the
patients say they can’t leave their work,
they have no transportation, they have
no money. So the dental problem gets
worse and worse,” according to Lawk-
wa. The medics recall the sad story of
a 9-year-old girl whose father brought
her from Burma with a fever and swol-
len face caused by an infected tooth.
The dental medics wanted to admit her
to the pediatric ward, but her father
needed to return Burma to farm. So
they gave the family antibiotics and
asked them to come back for follow-
up. By the time the girl finally re-
turned, the bacteria had spread to her
bloodstream. They sent her to Mae Sot
Hospital, but it was too late; she died of filling. They asked her to return in a Through the School Health Program in
septicemia. week for the permanent filling - enough 58 migrant schools, the medics tour
People struggling to earn enough time for the calcium hydroxide to kill schools with colorful posters showing
to feed themselves can’t risk losing bacteria and for the swelling to de- healthy food (fish, vegetables, fruits)
their jobs. Yet many employers de- crease. But she didn’t have another and unhealthy food (candy, ice cream,
mand long hours from their workers, day off for two months. If she left Coke) choices. They warn children not
giving them only one day off every 60 work to return before then, she risked to chew betel because doing so chroni-
days. This makes it nearly impossible losing her job and getting arrested cally increases risk of oral cancer, a
to go to the dentist when necessary. An without a worker I.D. (which her em- painful disease that causes swelling
example is a young woman who came ployer held). There was nothing to do and ulcers inside the mouth and can
to the dental clinic during the holidays but wait two months and hope for the lead to death. In 2007, the dental clinic
with a toothache so painful she could best. diagnosed more than 20 cases of oral
not eat or sleep, causing exhaustion The dental medics know preven- cancer, but because treatment is be-
and weight loss. The medics found a tion is the best treatment. They hope to yond the clinic’s resources, it could of-
very deep cavity. They performed a improve oral health by teaching chil- fer these patients only pain medica-
root canal, cleaned the area with calci- dren the importance of brushing their tion.
um hydroxide, and put in a temporary teeth and avoiding sweet foods. Over the years, the Clinic devel-
Medic teaches children about dental hygeine.
oped its dental services with support,
technical training and donations from
generous volunteers, including Dr. Mi-
chael Travis from Colorado, who has
visited the clinic annually since 2004
and donated much of the machinery,
filling materials and instruments; and
Dr. Bo-im from Korea, who trained the
medics to clean and scale teeth and
perform root canals in 2008. The den-
tal medics dream of offering x-rays and
dentures at the clinic someday. Their
short-term wish list is for small dental
instruments, an atlas color endodontic
book and a dental surgery book so they
can learn more and provide better
care.
A mother and child visit Dr. Cynthia Maung’s clinic. A patient receives treatment
the border in Thailand, and is making a In a two-room shack, she started embody Dr. Cynthia’s vision.
difference in her community by pro- doing amputations and delivering ba- The Burmese physician says
viding essential services not available bies using instruments sterilized in a young people should be taught “not to
to most residents of the poor region. rice cooker. Young volunteer medics feel as victims.” Instead, she says, they
Mothers line up with children, trained by Dr. Cynthia treat everything should see themselves as “people who
waiting for immunizations. In another from landmine injuries to gastroenteri- can change or improve the situation.”
line, couples with newborns wait for tis. With donations from NGO’s and Dr. Cynthia is reviled by Burma’s
documents certifying their children foreign governments, including the military government. To the generals,
were born in Thailand. The documents United States, Dr. Cynthia’s work has a she is a terrorist and an insurgent. To
take the place of birth certificates Thai- reputation for a making a little money the thousands she treats and trains, she
land refuses to issue. These people are go a long way. Each year 150,000 peo- is a saint.
refugees, and in the eyes of Thailand’s ple come here for treatment. Those VOA News, 2008 (photos: P. Laput)
FROM RICE COOKER TO AUTOCLAVE | 81
HEROIC EFFORT: Youngster plays mum. (photo: Phil Thornton)
around trying to help older women Choo is not shy. "She's liked by the Choo's very good, but she's vulnerable,
carry their food trays and pulls funny other patients, she helps where she can. she's a baby looking after a baby."
faces to make the other children in the I look at my 11-year-old daughter and I
ward laugh. can't imagine her doing this. I'm happy by: Phil Thornton, Bangkok Post
May Soe, a mother of three, says she only has to think about playing. 2009
COUNSELLING CENTRE
refer patients, and when staff should
visit the centre themselves. The coun-
selling staff continues to run the De-
For the displaced Burmese popu- these mental health care skills to the partment Awareness Program, which
lations living along the Thailand-Bur- organizations working along the bor- has successfully led to the continual in-
ma border the ongoing experiences of der was certainly beneficial, but with crease in the number of patients ac-
socio-economic struggle, physical and the population of displaced Burmese cessing the Counselling Centre.
psychological trauma, endless human people continuing to grow, and more For those requiring psychosocial
rights abuses, chronic illness, exploita- and more people accessing health care assistance, the Counselling Centre pro-
tion as migrant workers, and being tar- at MTC, more needed to be done to ad- vides incredible support, but at times,
geted for human trafficking have re- dress the increasing psychosocial due to insurmountable obstacles, the
sulted in many psychosocial challenges. needs. Both staff and patients of the outcomes sought by both patients and
As the population living along the clinic needed greater psychosocial sup- counselors are not always attainable.
Thailand-Burma border quickly grew port – they needed confidential coun- Saw Than Lwin explains the challeng-
throughout the 1990s, it became evi- selling, in a private space, from coun- es and frustrations of not always being
dent to Dr. Cynthia and other commu- selors with more advanced skills. In able to help all of the patients they see,
nity leaders that psychosocial support response, preparations began in 2004 “Some patients come with social prob-
was needed for this population. for the development of a separate lems related to natural disasters or
In 1999, a Mental Health Coun- Counselling Centre at MTC. chronic diseases, where their commu-
selling Training was coordinated A new building was constructed, nity no longer accepts them. We can-
through the assistance of international providing a space for the Counselling not provide social services, like finding
organizations, for 32 participants in- Centre as well as the HIV Voluntary work and places to stay.” He also re-
cluding MTC medics and schoolteach- Counselling and Testing Program. called the story of a patient who had
ers, as well as individuals from other Further training sessions were con- been suffering from stress and depres-
local organizations. This was an intro- ducted, providing basic knowledge and sion as a result of not being paid by the
duction to the basic concepts and tech- skills in mental health care, as well as factory owner he worked for. “How
niques of mental health care. The fol- tools for specifically addressing the are patients supposed to address prob-
lowing year, a Child Psycho-Social now endemic psychological trauma. lems like this when a complaint to the
Training was conducted, for 32 partici- In 2006, mental health services became authorities is risking arrest and depor-
pants from MTC and other local orga- part of the primary health care offered tation back to Burma?” In these cases,
nizations, focusing on basic principles at Mae Tao clinic, with December 6th the counselling staff rely on their com-
of childhood behaviour and develop- marking not only Dr. Cynthia’s birth- munity networks, referring patients to
ment, children’s rights, and program day, but also the official opening of the other organizations such as the Migrant
development to enhance children’s Counselling Centre. Program Manag- Assistance Program (MAP) for labour
mental health. The introduction of er, Saw Than Lwin recalls that the first issues, or Social Action for Women
FROM RICE COOKER TO AUTOCLAVE | 85
(SAW), for women and children escap-
ing abusive environments, who need a
safe place to stay and access to income
generation and education opportuni-
ties.
In the future the Counselling
Centre hopes to further expand these
invaluable community networks.
There are plans to conduct regular
Community Awareness workshops,
where other organizations providing
social services will be invited to learn
about the services of the Counselling
Centre, and to share information about
their own services. Saw Than Lwin
views this as an opportunity to ulti-
mately help more patients, by either
referring them to the appropriate orga-
nizations or eventually offering servic-
es that are not already provided by an-
other organization in the community.
As the Counselling Centre is still a
relatively young program, the immedi- RESEARCH
ate future will also involve further Research at MTC is a reflection Initially, research was done when
skills training and capacity building. of the evolution of MTC as a whole, external organizations were able to
International volunteers, of various evolving from service provider into provide resources and expertise. How-
mental health backgrounds, have program manager, community orga- ever, MTC has been increasing the pro-
played a large role in the development nizer and advocate. Initially, there was portion of internally based research
of the center, providing regular mental only medical action-oriented research, projects with the aspiration to improve
health training programs that have been focused on medical treatment out- areas such as program design and poli-
tailored to the specific needs and re- comes. Today, the goals of research cy. Over the years, clinic staff was able
quests of the counselling staff. The lo- touch upon program development and to learn from others who conducted re-
cal staff is eager to further develop assessment, resource allocation, per- search as partners. Research was first
their skills, to understand how other formance monitoring and broad-based introduced in the clinic in 2001 through
countries work to support citizens who understanding of community health the reproductive health monitoring
are suffering psychosocial problems, care needs. evaluation project. This project helped
and to transfer their gained knowledge Since the clinic patient popula- the clinic staff to develop an under-
to supporting fellow Burmese people. tion is predominated by migrant work- standing of how to conduct research
Even though the staff express a ers in Thailand and IDP populations in and to utilize the findings. The benefits
need for further training, they are able Burma, it is important to understand included improved clinical assessment
to celebrate the positive effects already these populations for the purpose of ef- skills, facilitating peer supervision
seen at the Counselling Centre; Saw fective program design. However, as through case review, an increased abil-
Than Lwin says that, “We are very noted by the European Union, “Wheth- ity to demonstrate program effective-
proud of our experiences. Some pa- er internal or cross-border, both forced ness, ability to promote cultural ex-
tients are completely better after their and voluntary (economic) migrations change through enhanced counselling
treatment. It makes us very happy to occur on a relatively substantial scale. skills and increased issue awareness
work through their problems, to under- However, data collection on the differ- for adolescent health, sexual health,
stand their feelings.” To further de- ent types of migration is almost non- gender based violence and mental
velop this department will increase the existent…. Economic migration is a health. The success of this research en-
invaluable psychosocial support being difficult phenomenon to grasp in Bur- couraged collaboration on future Re-
provided to the displaced people of ma/Myanmar, due to large inaccessible productive Health projects.
Burma, giving them counselling, cop- parts of the country and migrants’ fear When MTC did begin doing in-
ing techniques, and possibly a renewal to tell their story”.25 ternal research the areas of most im-
of hope. portance were communication, Sexual
25 The EC-Burma/Myanmar Strategy Paper and Gender Based Violence, and clinic
(2007-2013) P 37.
86 | FROM RICE COOKER TO AUTOCLAVE
staff. For the Mae Tao Clinic, research nator, Saw Aung Than Wai laments this accurate monitoring over longer peri-
is an opportunity to gain accurate in- situation, “They just don’t know how ods of time is required. The less
formation about the health situation on useful the information could be.” straightforward areas include monitor-
the Thailand-Burma border. Unable to MTC participates in many collab- ing complex reasons behind patient de-
rely on the Burmese military junta for orative research projects done in part- cisions regarding how and when to ob-
accurate information, the clinic has nership with other local and interna- tain health care, along with cultural
taken it upon itself to retrieve it. Twen- tional organizations and institutions. norms.
ty years on, the two main reasons for These collaborative efforts lead to a As the Research Program is still
participation in research remain: to better understanding of the border relatively new at the clinic, with the
learn about the health situation of per- community on a whole, exposing the majority of research activity happening
sons living along the border, and to real situation that this population is in the last couple years, the program
better evaluate and improve the ser- faced with. This research allows the still has some major developments
vices of the clinic. organizations involved to undertake ahead of it. The hope is to develop a
The first internal MTC research more effective advocacy for the people, research working group, first within
was in 2005, and there have certainly especially in the global arena. These the clinic, and then among the CBO
been many subsequent challenges collaborations have also lead to better community. The working group would
along the way. For staff to work in the coordination between local organiza- function to develop general policies
community conducting surveys and in- tions, as well as between these organi- and procedures, especially addressing
terviews, there is a constant security zations and the local community. issues of ethical research. With a strong
threat, as they may not have the proper As the research has begun to in- background in research work, Saw
identification papers. It has also taken corporate more topics revolving around Aung Than Wai understands the bene-
extensive training to introduce research health impacts and community assess- fits of research, but also voices a strong
skills and concepts to staff, and this has ment, MTC faces typical research chal- concern for ethical and psychosocial
to be re-taught often in response to a lenges. Qualitative research is easier considerations when working with the
high staff turnover. A lack of knowl- to understand when data and facts can vulnerable population living along the
edge surrounding research, its proce- be collected, but MTC finds that anec- border. Even now, there is very little
dures and it benefits among the target dotal evidence must inform data inter- research conducted inside Burma, with
population are further problems. pretation. The accuracy and quality of legal, security and logistical challenges
Whether research is done within the the data collected should be constantly continuing to create obstacles. With
community or among staff at the clinic, challenged, especially in the context of about 50% of the clinic patients com-
a general lack of understanding of the trying to understand social rather than ing from Burma, MTC staff struggle to
goals and benefits of a research project technical measures. The more straight- understand the patient situations, health
can lead to poor participation. Thus, forward areas include monitoring prev- care options, and outcomes.
the information is not as informative as alence of illnesses and quality improve-
is sometimes hoped. Research Coordi- ment, in which case consistent and
INFECTION PREVENTION
greater success than others; in 2006 it
was decided to move towards more
UNIT
standardized protocol. An infection
prevention working group was brought
together with its first task being to
prevention techniques such as hand evaluate the current procedures of each
In the earliest stages, a rice cooker was washing and using protective barriers department. From this initial evalua-
used to clean one set of instruments. such as gloves, but there was not al- tion it became apparent that external
Since there were five to ten procedures a
day, it took time to do so many steriliza-
ways a monitoring and evaluation sys- factors were playing a major role in
tions. tem within the departments to ensure medics not properly adhering to the
The clinic worked for nearly two years these actions were being performed. In procedures. Therefore, the second task
with one rice cooker until an autoclave 2000, the blood transfusion, HIV pre- of the working group was to focus on
was donated.
vention programs, and medical waste improving supplies and logistics; how
Infection Prevention Unit was not disposal programs were upgraded and could a person be expected to wash
officially established until 2008, but as Mae Sot Hospital staff came to the their hands if sinks weren’t always
with so many sections of Mae Tao clinic to demonstrate appropriate tech- working properly or there wasn’t any
Clinic, the activities of the Infection niques for labeling and separation of soap? Facilities were improved, and
Prevention program started long before medical waste. changes were made to the management
there was an official title for them. For The Reproductive Health Moni- of supplies, including ordering and
example, the Laboratory was the first toring and Evaluation Project initiated storage, resulting in improved avail-
department to formalize safety proce- in 2002 was a two year project, imple- ability of soap and other sterilization
dures. Staff received training and pro- mented to improve quality of Repro- products. These improvements to sup-
cedures for specialized blood with- ductive Health services. The post- ply management and logistics certainly
drawal techniques, sample handling, abortion care training within this lead to enhancements in medics’ infec-
and sharps disposal. The growing clin- project included an “infection control” tion prevention behaviors, but they
ic required universal precaution proce- section within the monitoring and eval- were not the only influencing factors to
dures to maintain quality of service and uation training component. The staff consider.
in 1994, a universal precaution work- began using a monitoring and evalua- Another external factor influenc-
shop was held, highlighting needle tion checklist that included such things ing adherence to infection prevention
holding techniques and medical waste as: hand washing, using gloves cor- procedures was a lack of knowledge;
disposal. rectly, and using barriers such as masks even though all medics were receiving
All health care related trainings or gloves. This was an opportunity to training on the topic during their initial
conducted by MTC over the years have ensure that infection prevention proce- health care training, it was decided that
contained a universal precautions mod- dures were being followed. Training this was not enough: upgrade trainings
ule, with staff learning basic infection included sterilization techniques, via were needed. In 2008 a new Infection
88 | FROM RICE COOKER TO AUTOCLAVE
Prevention Unit (IPU) was established,
with ongoing upgrade trainings incor-
porated as one of the responsibilities of
the staff in this unit. An added respon-
sibility of the IPU is the sterilization of
medical equipment and the preparation
of bandaging materials, such as gauze,
for the clinic departments.
It has also been identified that ex-
ternal monitoring and evaluation is a
necessary practice for each department,
and may also lead to improved behav-
iors. The hope is to begin regular ex-
ternal evaluations, both external to the
department, and external to the clinic.
Before this happens though, the work-
ing group and staff of the IPU continue
to work towards updating, improving,
and standardizing a checklist for use
throughout the clinic departments.
One of the departments that the
IPU works closely with is the Water
and Sanitation Department. Together,
PHARMACY
they are currently working on improv- Originally, MTC didn’t have a tient also prescribes and explains the
ing medical waste management, with cash budget to purchase medicine, and medications. The Communication and
changes to handling procedures, and the Catholic Church, supported by Fa- Language Assessment Research Proj-
future plans to address storage proce- ther Manat Supalak, donated medicine ect launched in 2005 provided insight
dures as well. and supplies for the first two years of that lead to improvements. The re-
New challenges are presented in the clinic’s existence. Each week, the search revealed that patients usually
relation to the broadening range of ser- staff would go to a supplier in Mae Sot understand their diagnosis, but mix up
vices provided by the clinic, and by the and collect the supplies, choosing what doses of their medications. This led to
wider range of illnesses treated. This was needed; items such as quinine, tet- establishment of a new system which
combination increases threats and ne- racycline, paracetemol, gauze, and created medicine bags marked with
cessitates continually improving tech- spirits. Visitors donated any other dosage and time of day indicated in
niques. Each department appoints a medicine. From 1992 until 1997, Mé- pictorial form. Staff with additional
person who looks after infection pre- decins Sans Frontières (MSF) donated language skills was also added at this
vention; however, further steps need to medicines on a monthly basis, com- time to avoid language barriers. Phar-
be taken to ensure new staff members prised of twenty medications on an es- macy staff members need to speak
are trained, and that supplies are al- sential drug list. The MTC pharmacy various languages – the estimated
ways available. Today, the ‘wish list’ also acted as the distribution center for breakdown of patient languages is 52%
of the IPU is a new autoclave. The five other student camps along the bor- Burmese, 34% Karen, with the remain-
clinic has already outgrown the current der for a few years, until they began to der speaking other ethnic languages.
autoclave, and it cannot sterilize some work directly with their donors. Whilst Further, about 20% of patients have
instruments. The desire of Sandy and there has been direct donation of medi- never been to school, and only 37% of
the IPU team is clear; to reduce the risk cal supplies, customs duty charges those who had attended reached grade
of infection, both for the staff and pa- have hindered pharmaceutical compa- 4.
tients. With the dedicated staff con- nies from making direct donations. The first medical supplies and
tinuing to work as they have done, it is Just as in any health care setting, medications that Mae Tao Clinic used
only a matter of time before this will there is a challenge in ensuring patient to treat patients were donated from
happen. understanding of their medication and sympathetic supporters in the Mae Sot
treatment. After the clinic had identi- area. As the patient population grew,
fied difficulties with the patients’ un- and the donations no longer met the in-
derstanding of both their ailments and creasing need, the clinic began pur-
treatments, a protocol was established chasing medical supplies from local
whereby the medic who sees the pa- markets and pharmacies. It quickly be-
FROM RICE COOKER TO AUTOCLAVE | 89
came apparent that this was not very a quarterly order. In 2008, an old the medications are of good quality,
cost-effective and so, in 1998, through kitchen space was renovated, provid- and verifying that the medications are
the assistance of Mae Sot Hospital, the ing an office and large storage space used for the proper illness, in the prop-
clinic began ordering supplies from for a new Central Pharmacy. A net- er doses. The staff of the Central Phar-
medical companies in Bangkok. worked computer system was devel- macy is in a unique position because,
Until 2008, all pharmacy services oped which now allows for each de- unlike the other clinic departments,
were conducted out of a pharmacy at- partment to order medications from the which work relatively independent of
tached to the Medical Outpatient De- Central Pharmacy on a weekly basis, each other on a day-to-day basis, the
partment, with a small storeroom sup- resulting in efficient and accurate de- pharmacy is linked to nearly every de-
plying medications to the rest of the livery of supplies to each department. partment. The pharmacy staff can be
clinic departments on an “as needed” This also means a more accurate in- looked to as a valuable source of medi-
basis. Each department had their own ventory system and simplified quarter- cation information; they are always
small pharmacy area to store their in- ly supply orders to wholesalers in willing to discuss how a medication is
ventory, with each department placing Bangkok. This system helps to save properly used and any precautions that
money and prevent the medication should be observed. The hope for the
shortages that occurred frequently in future is that more medics will utilize
the past; shortages which required ex- this valuable support.
pensive emergency medication pur- Naw Klo explains that plans for
chases to be made from pharmacies in the future incorporate continued devel-
Mae Sot. opments with the new networked com-
puter system. As more and more in-
MTC now stocks over 470 items.
ventory and patient information is
The medications used at the clinic stored electronically, work can be done
follow the Burma Border Guidelines to cross-reference pharmacy records
(BBG), a publication put together by directly to patient records, specifically
the health organizations working along data on the medications prescribed.
the Thailand-Burma border in a move This will allow for even further effi-
to standardize care offered along the ciency and cost-effective work to be
border. done in the Central Pharmacy. A senti-
ment expressed time and time again at
Much donated-in-kind medicine must be
thrown away, either spoiled or expired.
Mae Tao Clinic is the desire to im-
prove; the Central Pharmacy is no ex-
All of this work is coordinated by ception. Naw Klo echoes the wish to
a dedicated group of medics who have continually learn and develop, “We are
all been trained in pharmacy manage- always willing to learn, if others want
ment. They are responsible for keep- to give us more information, [or] make
ing track of inventory levels, ensuring suggestions.”
90 | FROM RICE COOKER TO AUTOCLAVE
PARTNERSHIPS: 2005 - 2009
Access Program (GHAP), the Mae Tao to this changing dynamic and increased
INTERNATIONAL Clinic, the Back Pack Health Worker responsibility.
PARTNERSHIPS Team and Mobile Clinic ethnic
groups—have been able to establish a
In 2008 a strategic planning meet-
ing on migrant health was held to dis-
network of 12 mobile health centers in- cuss challenges and opportunities to
As mentioned in the Research side Burma that serve as capacity collaborate. This was coordinated by
Chapter, MTC began to conduct more building sites for 33 maternal health the Thai Ministry of Health and result-
research in recent years. International workers, 147 health workers, 350 tra- ed in a Strategy Paper. Subsequently,
partners facilitating MTC staff learn- ditional birth attendants and other com- each participating organization was
ing more about how to conduct re- munity participants. obliged to include the recommenda-
search, and more importantly, to lever- Although the long-term objective tions in their approach. These included
age the results for service improvements of the project is to reduce maternal and ensuring migrant workers’ access to
and advocacy. neonatal morbidity and mortality the Thai public health system, manag-
The School Health Team at Mae among IDPs within eastern Burma, the ing health insurance for migrant work-
Tao Clinic collaborated with Tokyo primary aim is to increase access to ers, increasing effectiveness of com-
University and other CBO partners proven antenatal interventions and to munity health volunteers, increased
(BMWEC, Burmese Migrant Teachers basic emergency obstetric care. The funding, and increased collaboration.
Association, SAW) on a research proj- centers provide proven and appropriate The last five years were not so
ect regarding school health assessment antenatal, peripartum and postpartum much characterized by new partner-
and evaluation for all migrant schools newborn and maternal health interven- ships, but rather gaining important
which have students grade 1-4. The tions, and are sites for standardized traction in the existing partnerships
results of the baseline survey provide a collection of program indicators, as and collaborations. An important ex-
basis to engage the teachers in dialogue well as referral centers for specialized ample is the Coordinating Team for the
about future planning for environmen- emergency obstetrical care. Displaced Children’s Education (CT-
tal health in their schools. DCE), which was formed to intervene
Maternal and Child health is an-
LOCAL
in the current crisis of education and
other area which has benefitted from protection for Burmese children in
international research partners. The COLLABORATION September 2007. The team is com-
CONTINUES TO
RAISE project aims to improve cross- prised of Burmese community leaders,
border reproductive health care through teachers and health workers who are
the upgrading of clinics and health GROW committed to assist displaced children.
worker skills inside Burma. Through MTC has been involved with CTDCE
this project, facility checklists, data As noted previously, MTC was for the Emergency Dry Food Program,
collection, standardization of care, established purely as a service provid- securing emergency food supplies for
community assessment and the train- er. These days, MTC plays a much boarding facilities, as well as develop-
ing curriculum were upgraded. This broader role in areas such as program ing Child Protection policies and Stan-
project created a more standardized management, policy development, and dards of Care for boarding facilities.
training curriculum and ongoing pro- collaboration. MTC’s nascent under- This type of collaboration is very
cess of improving data collection and standing of these areas has developed powerful if it can be implemented ef-
health services. quickly and its partner engagement has fectively. Of course, there are many
The Mobile Obstetric Maternal evolved along with this role accord- challenges ahead, but the engaged ap-
Health Workers (MOM) Project em- ingly. These days, the wide scope of proach of the Thai Ministry of Health
ploys a unique approach to addressing programmatic areas in which MTC’s coupled with the tenacity and dedica-
the dire neonatal and maternal health partners operate is a reflection of the tion of the community-based organiza-
situation among internally displaced evolution of the clinic’s role. MTC’s tions should provide opportunity for
persons (IDPs) living in eastern Bur- partnerships with the Thai Ministry of much improvement in the coming
ma. In partnership —the Global Health Health and other stakeholders testifies years.
MTC is looking to the future with a view to stronger partnerships with local
and international organizations. MTC will continue to train and groom medical
professionals to increase the expertise in the community. The umbrella of social
services which address psychosocial and education issues continues to expand.
MTC also looks to the future of the community. In the past, ethnic groups
inside Burma had strong civil societies which fostered support for health, educa-
tion and social support. This has been dismantled by militarization. It was not
through active fighting that this occurred – it was through the systematic control
of resources such as land. Forced relocations, loss of livelihood opportunity, and
military conscription are among the tools which have led to communities sepa-
rated and without identity.
The way forward will require education, social change, and collaboration
between community groups and CBOs. If civil society and community is strength-
ened in the border area, this will provide the ability to rebuild civil society inside
Burma when it is finally possible.
Everyone should raise their voices. Not just politicians, but women, chil-
dren, workers, and every individual.
Finally, the younger generation is our future leadership. Some might think
that the legacy of Mae Tao Clinic will be hundreds of thousands of patients treat-
ed and comforted. Mae Tao Clinic hopes that our legacy will be a stronger civil
society, and a generation of young leaders who have been trained, encouraged
and groomed to lead.
In 1999 Dr. Cynthia was unable to attend the award ceremony in Washing-
ton, D.C., so Jimmy Carter presented the award via video conference to Bang-
kok. Dr. Cynthia’s acceptance speech was broadcast via satellite to Washington,
London, India, and Ghana. Jonathan Mann died an untimely death in September
1998, but he and Dr. Cynthia would have a lot to discuss if they could have met.
He brought the world’s attention to the basic notion that improved health cannot
be achieved without basic human rights, and that these rights are meaningless
without adequate health. Dr. Cynthia works daily towards this ideal.
Dr. Cynthia Maung was included 1,000 women from more than 150 countries who were jointly nominated for
the Nobel Peace Prize. The number 1,000 is symbolic, as the 1,000 women nominated represent innumerable women
worldwide who are engaged in the cause of peace and human dignity.
2005 MITWELT-NETZWERK
AWARD (GERMANY)
Jointly awarded with Daw Aung San Suu Kyi for their selfless
sacrifice in promoting pro-democracy activities, freedom, and human
rights in Burma. “This is the first time the award has gone to Burmese
ladies. The prize committee selected them for their sacrifices and devo-
tion to the freedom of Burma, democratic struggle and social work,”
said Ms. Teresa Salar, assistant secretary of the prize selection commit-
tee.
The award is presented annually to persons who have made re-
markable contribution to the development of cultural, scientific or hu-
man rights anywhere in the world.
98 | FROM RICE COOKER TO AUTOCLAVE
2008 “THAN KHUN PHAN DIN” AWARD
(THAILAND)
Burma Children Medical Fund (BCMF) National Health and Education Committee
http://www.burmachildren.com/ http://www.nhecburma.org/
Burmese Migrant Workers Education Committee (BMWEC) Social Action for Women
http://www.bmwec.org/ http://www.sawburma.org/
“For Choo, it’s all work and no play” – Bangkok Post article on BBP psychologist Elizabeth Call’s discusses her impression of the
December 20, 2009 Dr. Cynthia Maung and the conversation that led to the creation of
http://www.bangkokpost.com/news/investigation/29651/for-choo- Burma Border Projects.
it-all-work-and-no-play http://www.youtube.com/watch?v=-9ZJfTAIXo0
“Saving Lives on the Burmese Border”, BBC Article from March VOAvideo report, “Refugee Doctor Treats Burmese Victims”
2007 http://www.youtube.com/watch?v=HtupmwRi8d0
http://news.bbc.co.uk/2/hi/asia-pacific/6418645.stm
The First Lady Laura Bush visited the Burmese refugees camp and
“In Pictures: Border Healthcare” – BBC photo report from March the Mae Tao Clinic, where she met thousands of refugees and Dr.
2007 Cynthia Maung. 2008
http://news.bbc.co.uk/2/hi/in_pictures/6419435.stm http://www.youtube.com/watch?v=TTACB_tVDJM
Burma Journal: The Hard Work of Healing a Bitter Pill for Doc- Trailer for the documentary film, “Crossing Midnight.” Directed
tors. November 2009. by Kim A. Snyder for the BeCause Foundation, 2009.
http://www.politicsdaily.com/2009/11/21/burma-journal-the-hard- http://www.youtube.com/watch?v=-f63-n0RRos
work-of-healing-is-a-bitter-pill-for-doc/
Today show article about Mae Tao Clinic, 2009
“Burmese Patients Continue to Flock to Mae Tao Clinic” Indepen- http://today.msnbc.msn.com/id/26184891/#30577978
dent Mon News Agency, November 2009.
http://www.monnews-imna.com/newsupdate.php?ID=1590 Time Asia Heroes Profile, 2003
http://www.time.com/time/asia/2003/heroes/cynthia_maung.html
“Dr. Cynthia Maung: Healer of Broken Souls” Time Magazine,
2003.
http://www.time.com/time/asia/2003/heroes/cynthia_maung.html
Paula Bock
Tom Buckley
Atsuko Fitzgerald
Gary Hallemeier
Michelle Katics
Jolene Lansdowne
Jacqui Whelan
Tao Kwan-Gett
Naing Min
INTERPRETER
Eh Mwee
Mae Soe
Maung Maung Tinn
PHOTOS
Nathalie Dusseaux
Richard Humphries
Michelle Katics
MTC staff
Olivier Ouadah
Tom Reese
delivery certificate 44 K
donations in-kind 93
Dr. Kanoknart Pisuttakoon 35 Karen National Union 9
Dr. Kyaw Zayar 75 Karenni Nationalities Health Worker Organization 59
Dr. Shee Sho 52 Karen Women’s Organisation (KWO) 52, 77
Dr. Singh 34 Kway Kaloke refugee camp 44
Kyaik Dom 34
P U