Dr. Larry Stock (right) conferring with a Karen villager who lost his leg in a landmine accident two years ago. (By Janet Wells / Special to The Chronicle)
The exercise, part of a trauma skills workshop in eastern Burma, was a stark reminder that there are no doctors or hospitals in this war-ravaged sliver of mountainous jungle near Thailand, where ethnic minorities have resisted the Burmese army for 60 years. The country’s military junta provides little health care, or access to international humanitarian groups for an estimated 500,000 displaced villagers, many of whom suffer from rampant malaria, malnutrition and one of the world’s highest rates of land-mine injuries.
In response, Burmese refugees in Thailand developed a unique program, effectively sneaking health care into their own country: A network of tiny mobile clinics now dot eastern Burma, where medics like Eh Dah Zu carry medical supplies in backpacks, walk for weeks through remote jungles and risk capture and injury to reach patients.
Essential health services
“It’s extraordinary, and one of the only examples that exists in the world where refugees and displaced persons themselves are going back into their country to provide essential health services in a situation of clear state failure,” said Dr. Chris Beyrer, professor of epidemiology and director of the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health.
The military junta, known officially as the State Peace and Development Council, or SPDC, likens this health program to aiding the enemy. Since 1998, seven medics and one midwife have been killed by soldiers or land mines, dozens more have been captured and beaten, and their families threatened, according to human rights reports.
Aye Chan, a 28-year-old medic, has been chased and shot at. Four years ago, soldiers detained his father, demanding seven buffalo and $400 in exchange for his life. He paid them and then fled his village. Aye Chan has not seen him since. Like other health workers, he depends on villagers and armed guards for information to escape capture.
“If the SPDC is close, my heart beats fast, knees shake,” Aye Chan said. “We are fleeing, so there’s no time to feel scared. What I am afraid of is losing my backpack. Then I have no supplies, no way to treat patients.”
Once considered the rice basket of Asia, decades of military rule in Burma, which is also known as Myanmar, have taken a blunt toll. The junta’s top generals have reaped profits from mining, natural gas and logging, while reducing the resource-rich country to one of the world’s poorest: Burma ranked 135 out of 179 countries in the United Nations’ 2008 Human Development Index, and is tied with Iraq as the second most corrupt country in the world, according to Transparency International’s 2008 rankings.
Exodus of Burmese
Politics and economics have pushed more than 1 million Burmese into neighboring countries over the past two decades, with another 1 million undocumented migrants in Thailand alone.
Pro-democracy activists, along with the country’s numerous ethnic minority groups, have long been at odds with the government, and none longer than the Karen. Shortly after Burma’s independence from Britain in 1948, the Karen National Liberation Army launched a war for autonomy now entering its sixth decade – the oldest civil conflict in the world.
A government counterinsurgency campaign in eastern Burma has demolished thousands of Karen homes, destroyed crops and conscripted civilians as slave laborers, human rights groups say. As a result, the region has one of the world’s highest maternal and child mortality rates.
Training medics is key
Medic Eh Dah Zu spent four months hiking through the jungle before returning to the Thailand-Burma border region to attend training sessions, deliver patient data, and pick up supplies for her next stint. She earns $20 a month, which covers little more than the rice, chili oil, and seasonings she carries along with a medical kit containing a knife, malaria medicine, antibiotics, intravenous solution, gloves, sutures and anesthetic.
“The villagers are in a bad situation,” Eh Dah Zu said. “I feel good, that this is helping my people.”
But she has had her share of close calls. Last year, she pretended to be a villager’s daughter after soldiers abruptly appeared.
But such risks seem to be no deterrent in recruiting staff for the backpack doctor program.
At a trauma workshop held last month at a village called Tee Moo Kee, 18 medics and 23 less-experienced health workers crammed into the bamboo, open-air classroom, standing on benches to observe the class.
For four days, two trainers – Dr. Larry Stock, 47, clinical professor at UCLA medical school, and a member of Berkeley’s Planet Care/Global Health Access Program; and Frank Tyler, 43, a paramedic and director of operations with Australian Aid International – ran through a gamut of trauma skills, from basic emergency first aid to surgical procedures.
“If they pick up 10 percent of the material, that’s fine,” said Stock, who trekked to the jungle training site in a region off-limits to foreigners. “Some will pick up 80 percent. And it will give every member of a team a deeper understanding of what they might face.”
Such sessions can teach students how to stop bleeding, create an airway, saw through bone – skills that helped Eh Dah Zu save the life of a villager in 2007 after his left foot and ankle were blown off by a land mine.
“There’s no backup out here. They can’t refer a patient,” Stock said. “These medics are it.”
In 1998, with spiraling mortality and disease in eastern Burma, refugee leaders from the Karen Department of Health and Welfare and the Mae Tao clinic based in a Thai border town in Thailand created the Backpack Health Worker Team. The organization is the backbone of a mobile health system capable of operating in a region where government troops and ethnic minority rebels have waged war for decades.
The Karen – the largest of Burma’s ethnic hill tribes – “have a can-do attitude,” said Dr. Larry Stock, of the Berkeley-based Planet Care/Global Health Access Program. “Faced with a health crisis and major trauma, instead of saying, ‘We have no doctors,’ they’ve stepped up and are saving lives.”
China’s “barefoot doctors” of the 1960s provided the inspiration. But while Mao Zedong’s Cultural Revolution celebrated its rural health corps, Burma’s military junta considers it aiding the enemy.
Pilot programs have reduced malaria by more than 85 percent, increased access to maternal and neonatal care, and provided data linking increased mortality and disease with human rights violations, according to public health journals and rights groups.
The backpack doctor model has been so successful that it recently expanded to address ethnic minority health needs on Burma’s China and India borders. – Janet Wells
For more information see Planet Care/Global Health Access Program: ghap.org; Mae Tao Clinic: maetaoclinic.org; Backpack Health Worker Team: www.geocities.com/maesothtml/bphwt