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Medical services are ailing in Chin state

Cash boost fails to cure impoverished region's health woes

Medical services are ailing in Chin state

Ling Mang sits with two of her children inside her home on the edge of Kampetlet, Chin state.

John Zaw, Kampetlet

January 2, 2014

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Ling Mang received a shock when the bill for her operation arrived. The surgery and medication costs for her cesarean section were expected, but the additional bill for gasoline was not. Receiving only two hours of electricity each day, this hospital in Kampetlet, in northwestern Myanmar’s Chin state, requires the aid of an antiquated generator to keep its lights and machines running.

For Ling Mang, the realization provided an added strain. “I was in pain following the operation and could not stop worrying about the money,” the mother of four told from her wooden house on the edge of Kampetlet.

A survey of Chin state’s health indicators by UNICEF last year produced dismal results, with the region, already known as Myanmar’s poorest, ranking bottom on a range of measures: rate of antenatal care, birth registration, and rate of births with qualified doctors present.

The road leading to this small hospital below the town is unpaved. A converted minivan sits outside, the closest thing Kampetlet has to an ambulance. Inside the hospital’s main ward, spartan and unheated, patients sit on 25 beds, cloaking themselves in thick blankets to brace against the cold and damp.

On average, Myanmar has one doctor to every 2,600 patients. Here there is only one trained doctor, Mya Shwe War, who is forced to provide for a catchment area of 15,000 people.

In the 18 months Mya Shwe War has been here, no new equipment has been provided. Apart from her husband, who doubles up as her assistant, she is on her own.

A recent government-led incentive to double the wages of doctors working in remote parts of Myanmar has failed to net any results. No one will come to Kampetlet – in the winter temperatures drop dramatically, and in the rainy season the town is more or less cut off, with the roads connecting it to the nearby town of Mindat prone to landslides.

“We have an ultrasound machine [donated by a monk] but there is no one here qualified to operate it,” Mya Shwe War says wryly. “We get deliveries of medicine once a year.”

A doctor in Yangon or Mandalay may receive only $150 per month against her $300, but still the incentives to relocate to Chin state are lacking. City-based health professionals often clock out for the day and then work long into the night as private practitioners, where the financial difference can be made up.

That has its own problems, however. Doctors, tired from the day’s work, can see up to 20 patients an evening, who each receive only a very short window of assessment, given the pay-per-patient system invites rushing. The problems are compounded by poor record-keeping, meaning that precious time during appointments is often taken up with the patient explaining their history.

On paper, things have improved, with the nationwide healthcare budget having increased by 78 percent as part of broader economic reforms. That means little in Kampetlet, however, which still receives only $2 per person each year for health care. The government provides an additional $16 a month for diesel, but in these rusty generators that lasts around 10 hours.

Chronic food insecurity also plagues the region. Chin state suffers from sporadic, freak rat infestations that occur when the bamboo flower blooms. Millions of the vermin ravage crops and grain stocks. In 2008 and 2010, the situation was so bad that Chin state was declared a famine zone. The knock-on effects from 2010 still impact on day-to-day living.

“Rats still come and eat crops,” says Mang Thang, 70, the head of the small village of Hla Laung Pan, reachable only by a forest trail high above Kampetlet. “Seasonal rains also destroy crops, so we have to get a loan from others to buy rice for our daily meals.”

In 2010 the villagers were rationed to two bowls of rice a day. That has now risen to three, but nutrition in the form of beans and cabbage is in short supply. Current food production there lasts only six months, so villagers have to look elsewhere for meals, pushing them into terminal cycles of debt.

The French NGO Solidarite International has an office in the town, and has set up what it calls “compound vegetable farms”, micro-scale vegetable patches with intensive cultivation. It is trying to introduce coffee growing here to reduce the damaging shifting cultivation practices used for centuries by Chin hill tribes.

Aung Khant, base manager for the NGO, says that beyond agricultural productivity, the poor infrastructure presents another major obstacle to trading, with access to the main markets in Chauk and Mandalay often cut off during the rainy season. With the main industry here being agriculture, and productivity desperately low, many Chin are unemployed and forced to forage for food.

The raft of problems resulting from poverty all comes together to compound health problems. The area surrounding Kampetlet is the least developed of impoverished Chin state, its people effectively the poorest of the poor.

Back in the hospital, Mya Shwe War bemoans the decrepit state of affairs here – there is no blood bank in the town, meaning that people who require transfusions after road accidents need to be shuttled onto Mindat. That journey took reporters three hours in the dry season along potholed dirt roads; during the monsoon, it is un-navigable.

While the Myanmar government’s 78 percent boost in healthcare expenditure may sound like cause for celebration, the ugly reality is that life in southern Chin state remains locked in the same cycle of misery and deprivation it has for decades.

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