MAE SOT, Thailand, Jul 17 2012 (IPS) – From a wooden, weather-beaten building on the edge of this border town, Mahn Mahn charts dangerous missions deep Myanmar (also Burma) for the 2,000-odd health workers under his wing.
These tours, through the mine-infested stretches of eastern Myanmar, include supplying basic maternity kits for pregnant women from the country’s ethnic minorities.
Beneficiaries of these humanitarian forays by the Back Pack Health Worker Team (BPHWT), the non-profit group that Mahn Mahn is secretary of, include the Karen, Karenni, Mon and Shan communities.
In staying its course, this group, which began its mission over a decade ago, implies that little has changed on the ground despite ceasefire agreements signed over the past 10 months between the reformist government of President Thein Sein and armed ethnic groups.
The communities affected by the decades-long conflict on the mountainous, jungle terrain of the Thai-Myanmar border are highly vulnerable. Human rights groups estimate that the fighting has rendered 500,000 villagers as internally displaced persons (IDPs).
“If you want to know about the impact of the conflicts, start with maternal mortality (MM) along eastern Burma the worst in the country,” says Mahn Mahn, the 48-year-old medic from the Karen ethnic minority. “One in 12 pregnant women risks dying because of complications.”
His words are echoed by other international and local public health organisations working along the Thai-Myanmar border. In eastern Myanmar, MM rates have hovered between 721 and 1,200 per 100,000 live births compared to Myanmar’s national average of 240 per 100,000 live births.
These MM rates “dwarf the rates in Thailand (44 deaths for 100,000 live births), leaving women in eastern Burma with the worst pregnancy outcomes anywhere in Asia,” noted a report released this February by the Global Health Access Programme (GHAP), a U.S. non-governmental organisation.
The report, ‘Separated by Borders, United by Need’, describes the reproductive health crisis as a “public health emergency.” The absence of skilled birth attendants, lack of access to contraception, limited health information and absence of health clinics within easy reach have fuelled such deaths at childbirth, it said.
Too many women dying of complications arising from unsafe abortions and post-partum haemorrhage also expose the level of human rights violations perpetrated by Myanmar’s military during its armed campaigns against ethnic rebel groups.
The government’s official policies in the conflict zones work to deny healthcare to the ethnic minorities and prevent international humanitarian organisations from stepping in.
“We have documented that the experience of human rights violations is correlated with negative health outcomes,” says Jen Leigh, field director for GHAP. “Households that have experienced forced displacement have higher odds of infant and child death, child malnutrition and failure to use contraception.”
In a region where, according to surveys, some 18 percent of women of reproductive age are malnourished, stories of MM cases come as no surprise.
“From the information I gathered, attending trainings with midwives or health workers from our partner organisations, it appears like everybody knows somebody who died of pregnancy-related complications,” Leigh said in an IPS interview.
Little wonder why the Mae Tao clinic in Mae Sot, run by the legendary Dr. Cynthia Maung, has become a magnet for pregnant women along the border. Its reproductive health team delivers between 3 -15 babies daily as part of a free service.
Last year saw the clinic assisting a record 3,033 live births, up from the previous year’s 2,758 live births.
Close to half of the women who gave birth at the clinic came from across the border, following antenatal care they had received from Dr. Cynthia, an ethnic Karen who has won six international awards for her humanitarian work at the clinic since 1989.
But deep in the conflict zones, where the guns have gone silent, women have no choice, no hope for clinical care when giving birth. “Between 80 to 90 percent deliveries are at home with untrained midwives,” says Dr. Cynthia, as she is known here. “Only four percent have access to emergency care in a clinic.”
“There is a need for more trained birth attendants in those areas,” she told IPS. “They could save lives if they know safe birth techniques and be supplied with birth-kits. Even cutting an umbilical cord properly is a matter of life and death.”
Dr. Cynthia’s clinic has helped the BPHWT train women from remote areas about safe birthing practices. Over 800 local women have been given training trained and supplied with sterilisation equipment, gloves and razor blades to cut umbilical cords.
“The communities have begun to depend on our trained birth attendants,” says Mahn Mahn. “We are helping women who are unable to make it to the Mae Tao clinic or the few other clinics in the ethnic areas.”
He expects this local variant of a mobile health service to continue. After all, the BPHWT, which has 95 teams that fan out across the rugged terrain with health supplies slung behind their back, handles other health emergencies too, such as aiding landmine victims.
“It is going to be a long time before the ceasefires become meaningful for communities along the border,” Mahn Mahn notes. “Let’s say it will be so when the MM rates come down.”
