Dr Cynthia Maung says that obstacles to the health of cross border communities remain in place, even as Burma goes through political and economic reforms.

Recently she was awarded an honorary medical doctorate from the University of Ubon Ratchathani. Her Royal Highness Princess Maha Chakri Sirindhorn presented the award.

Dr Cynthia first founded MTC in 1989, after she had fled Burma during the then military government’s brutal crackdown against the 1988 pro-democracy uprising. She is the recipient of international humanitarian awards, including Australia’s only prize for peace, the Sydney Peace Prize and Southeast Asia’s Ramon Magsaysay Award. She is one of TIME magazine’s “Asian Heroes”.

Dr Cynthia noted the changes taking place in Burma, and how they affected MTC’s work. “Significant changes have also unfolded in my home country, Burma, in the last two years. The clinic was able to help facilitate a meeting between Myawaddy Hospital on the Burmese side and Mae Sot Hospital on the Thai side.”

She said that this was the beginning of MTC working with Myawaddy Hospital. “Despite being less than 10km distant, this is the first time all three of us have been able to officially meet in over two decades. As a result, there has been more coordination between our institutions This is key for improving public health, not just in this Thai-Myanmar border area but also beyond, as communicable diseases do not recognise borders. Local health authorities in Mae Sot have long recognized this reality and have been our partners, along with other local and international health organisations, in empowering the people to manage their own health.”

A Difficult Road Ahead

Dr Cynthia said that much needed to be done despite recent reforms. “Recent changes to the work permit system and improvements in access to health insurance for migrant workers have been welcome changes, expanding access to particularly vulnerable groups such as those with HIV and pregnant women.”

And MTC continued to be the only major clinic providing life saving health care to thousands in the Mae Sot area. “With official international humanitarian access impeded, the Mae Tao Clinic collaborates with ethnic health service providers to deliver basic health services for these communities, which would otherwise not have access to such services at all.” She said. “Many others simply cross the border to access care unavailable at home and, for most of the last 25 years, 50% of our patients have come from Myanmar specifically for healthcare.”

She noted that Mae Tao clinic was still illegal in Burma, “ our clinic remains illegal in Burma, and the country’s colonial era Unlawful Associations Act remains in place, with potential imprisonment for any who simply meet with us, should the Burmese authorities choose to enforce this.”

Mae Tao Clinic

The cost of decent health care treatment in Burma was prohibitively expensive, so the demand for MTC’s services was still high, “The costs involved remain unaffordable to the many undocumented migrants in Thailand, particularly for those with families. Information on how the system works is still confusing,” she said, adding “half of our patients are migrants working in Thailand, of whom 80% are undocumented, struggling to make ends meet as day labourers.”

According to Mae Tao’s latest annual report, the clinic treated 148,561 people last year. In that time 3,319 babies were born, 268 prosthetic limbs were fitted and 240 future medical staff were trained in five separate training courses.

And Burma’s expenditure on health care remained miserably low, particularly when compared to the country’s spending on defence. Burma’s civilian president – an ex-general – Thein Sein dedicated only 3.9% of the national funds to health while 21% of the budget went to defence last year. Individual health care spending was “still well under US10 (320 baht) per person per year,” Dr Cynthia said, while “Thailand’s equivalent figure is closer to $200, and there has been little tangible change in the health of the peoples of Myanmar, particularly for rural communities.”

Eastern Burma a “Humanitarian Disaster Area”

Plagued by years of conflict and instability meant that some areas of Eastern Burma were more like “Somalia” in terms of the health situation. “Burma’s official health indicators such as maternal mortality ratios and infant and child mortality rates remain among the worst in the region.” She said, adding, “Comparable figures for Eastern Myanmar, where conflict, abuse and poverty have rendered much of the population without access to proper healthcare, are far worse and can resemble other better-known humanitarian disaster areas like Somalia.”

Adding to the complex situation, civil strife has left many children born without citizenship for either Burma or Thailand. “In our communities, much remains to be done. Decades of civil conflict have resulted in thousands of children born without citizenship and the protections that entails. In addition, community health workers continue to provide vital services despite lack of recognition and accreditation, liable for arrest at any time.” She said.

MTC is also facing funding shortfalls with the Australian government abandoning funding at the end of this year. Dr Cynthia said that MTC was not the only NGO in the border area to be affected. “Other colleagues have also experienced a withdrawal of international funding for migrants and displaced populations in Thailand border areas, often overlooking that Myanmar’s acute humanitarian crises continue unabated despite the changes in Nay Pyi Taw and Yangon.

In the past, the Australian Government had contributed an estimated $AU 500,000 per year, around 20% of MTC’s funding.

Dr Cynthia concluded that Burma still had a long and difficult road ahead to peace and stability. “To me, the true measure of change in Myanmar will be the cessation of armed conflict and human rights abuses, when people provide a vote of confidence in the country’s changes by returning home in safety and dignity; when they no longer have to travel far distances, across borders, to access basic education and health care services.”

Dr Cynthia Maung’s opinion piece – ‘Health cooperation at border critical’ originally appeared in the Bangkok Post on the 23rd December and can be read here: http://www.bangkokpost.com/opinion/opinion/386207/health-cooperation-at-border-critical