Beth Adam Letters From Afar - Asia

11/1/07 

Up early and 4 hours back to Chaing Mai. I didn’t mention before but the scenery along this route, as everywhere we have traveled is breathtaking. Lush, rugged and mountainous jungle everywhere.

We arrive at the Four Seasons Hotel in Chaing Mai and eat while looking out at this beauty. We are also fortunate to have a guest speaker, Dr. Voravit Suwanvanichkij, MPH, MD, Dr. Vit to us. Dr. Vit spoke eloquently and with great knowledge and insight about the state of public health in Burma and

Thailand. The below article covers some of the highlights of our discussion:

Cho Cho Win, a Burmese migrant worker suffering from AIDS, shortly before her death in a clinic on the Thailand border. (Nic Dunlop photo)

Burma junta faulted for rampant diseases

By Yasmin Anwar, Media Relations | 28 June 2007BERKELEY – As Congress debates extending political and economic sanctions against Burma’s military regime, a new report from the University of California, Berkeley, and Johns Hopkins University documents how decades of repressive rule, civil war and poor governance in the Southeast Asian country have contributed to the spread of HIV/AIDS, tuberculosis, malaria and other infectious diseases there.Extreme travel restrictions imposed by the Burmese government have forced Médecins San Frontières (Doctors without Borders) in France and the multinational Global Fund to Fight AIDS, Tuberculosis, and Malaria to pull out of the country, and have severely curtailed the work of the International Committee of the Red Cross, according to the report co-authored by researchers from UC Berkeley’s Human Rights Center and The Johns Hopkins Bloomberg School of Public Health. The report was released today (Thursday, June 28), and can be viewed online. U.S. Senators Dianne Feinstein (D-Calif.) and Mitch McConnell (R-Ky.) introduced a bill on June 15 that would extend the U.S. sanctions, set to expire July 26, against

Burma because of continued human rights violations. The sanctions include a ban on imports from

Burma and visa restrictions for members of the government.While 40 percent of

Burma’s annual spending goes to the military, only 3 percent goes to health care, according to the report. The Burmese military junta spends 40 cents per citizen each year on health care, compared to the government of neighboring

Thailand, which spends $61 per citizen a year, the report says.“Military expenditures should be reallocated to support health care delivery,” said Eric Stover, faculty director of UC Berkeley’s Human Rights Center. ”

Burma is not at war with its neighbors, and its security is more profoundly threatened by the rise of drug-resistant malaria and tuberculosis, and by emerging infectious diseases such as avian influenza, than from external military threats.”Stover and fellow researchers from the Human Rights Center and Johns Hopkins launched the project last year to discover the roots of

Burma’s dire disease epidemics and to determine whether international aid could be delivered in a way that is responsible and effective.For the report, researchers traveled to the large Burmese city of Yangon, formerly known as Rangoon, and to Burma’s borders with China, Thailand, Bangladesh and

India. From health clinics in those regions, they gathered data on HIV/AIDS, tuberculosis, malaria and lymphatic filariasis, and interviewed aid officials and health care workers.The researchers found that the widespread distribution of counterfeit antimalarial drugs, coupled with the rise of drug-resistant malaria and tuberculosis, pose a major health threat to the Burmese people, especially those living in border areas where health care is scarce, if available at all.Burma has one of the world’s highest tuberculosis rates and is home to more than half of

Asia’s malaria deaths. Those most vulnerable to disease epidemics there are ethnic and religious minorities, displaced farmers, commercial sex workers and intravenous drug users.Drug trafficking has also played a major role in the spread of HIV/AIDS among intravenous drug users and commercial sex workers, the report says. In addition, aggressive campaigns by the Burmese government and the United Nations Office on Drugs and Crime to eradicate poppy cultivation and heroin production have led to the displacement of tens of thousands of families who have no alternative source of livelihood. Many have relocated to the

Thailand border, where communicable diseases are thriving. Meanwhile, methamphetamine production in

Burma’s border regions is rising.“Decades of neglect by

Burma’s military government have turned the country into an incubator of infectious diseases,” said Chris Beyrer, a co-author of the report and professor of epidemiology at The Johns Hopkins Bloomberg School of Public Health. “While the health situation deteriorates, the junta continues to limit the ability of international relief organizations to reach those most in need.”In 1990, Burmese voters elected Aung San Suu Kyi, 62, as their democratic leader. But the military rejected the election results and placed her under house arrest, where she has remained for most of the last 17 years. During the 1990s, international relief organizations began responding to

Burma’s neglect of its citizens’ health. By 2004, 41 aid organizations were operating in

Burma with a combined budget of about $30 million, and tens of millions of dollars more aimed at fighting infectious diseases, according to the report.But that changed in 2005 when Burmese government authorities imposed travel restrictions on international organizations. In October 2006, the European Union, along with Australia, Britain, the Netherlands, Norway and Sweden, launched the “Three Diseases Fund” to fight infectious diseases in

Burma. Yet the fund, now worth $99.5 million, faces formidable challenges, including the critical task of ensuring that aid reaches

Burma’s border regions and other areas where infectious diseases are rampant and severe.The report recommends that:·   The Burmese government develop a national health care system in which care is distributed effectively, equitably and transparently·   The Burmese government increase its spending on health and education to confront the country’s long-standing health problems, especially the rise of drug-resistant malaria and tuberculosis·   The Burmese government rescind guidelines issued last year by the country’s Ministry of National Planning and Economic Development because these guidelines have restricted organizations such as the International Committee of the Red Cross (ICRC) from providing relief in

Burma·   The Burmese government allow the ICRC to resume visits to political prisoners without the requirement that ICRC doctors be accompanied by members of

Burma’s Union Solidarity and Development Association or by other junta representatives·   The Burmese government take immediate steps to halt in eastern

Burma the conflicts and human rights violations that are displacing an unprecedented number of people and facilitating the spread of infectious diseases in the region·   Foreign aid organizations and donors monitor and evaluate how aid to combat infectious diseases in

Burma is affecting domestic expenditures on health and education·   Relevant national and local government agencies, United Nations agencies and non-governmental organizations establish a regional narcotics working group that would assess drug trends in the region and monitor the impact of poppy eradication programs on farming communities·   These agencies also collaborate more closely, sharing information, to lessen the burden of infectious diseases in

Burma and its border regions, and to develop a regional response to the growing problem of counterfeit antimalarial drugsMedia Contacts:

David Scott Mathieson; Human Rights Watch:  mathied@hrw.org, 087-176-2205

Voravit Suwanvanichkij, MPH, MD; Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health: vsuwanva@jhsph.edu, 081-240-5720  

After our informative lunch, we visited another impressive AJWS grantee THAI YOUTH ACTION PROGRAMS (TYAP). TYAP began as university based initiative that trained Thai youth to serve as HIV/AIDS peer educators. The program has expanded to include teaching students to take action on a number of other social issues such as drug prevention and minority rights. The school and community based programs help young people develop critical decision making skills, build support networks, and challenge discrimination against minorities and people living with HIV/AIDS. These kids were a true pleasure to witness. They are enthusiastic, well informed and motivated about their schooling. They were eager to share their stories with us and confident in asking us about our lives and our thoughts. This visit was very uplifting.  After our visit with TYAP, we had our first “break” of the tour. We actually had the rest of the afternoon and evening free to do as we pleased. For many of us, including yours truly, this included a 2 hour massage. All of the knots, aches, and pains of the long flights and drives of the trip thus far were erased.  Chaing Mai hosts a night market every night. The night market is quite large and consists of souvenirs, handicraft, Thai silk items, apparel and a great food court of local delicacies. Uh Oh…is it time soon to buy an extra suitcase? 

October 31, 2007Given the current events in Burma, we were fortunate to have AJWS make a quick change in schedule that allowed us to visit the town of Mae Sot and several AJWS grantees to hear firsthand the situation inside of

Burma and along the border areas. Mae Sot is about 4 hours southwest of Chiang Mai on the Thai Burma border and has become a hub for support organizations and humanitarian activities serving Burmese refugees. These activities cover 2 distinct groups, internally displaced persons (inside of Burma) (IDP’S) and refugees (Burmese in countries outside of

Burma). Many of these people are tribal and represent the Karen, Shan, Akka, and Mon ethnic peoples. There are several long established refugee camps located in the vicinity and by and large these serve as relative safe havens for the refugees. Services being provided include human rights training, education, humanitarian assistance, and healthcare outreach and services. The first AJWS grantee visited here was EARTHRIGHTS INTERNATIONAL (ERI). Earthrights mission is to address environmental exploitation and human rights abuses in

Burma. ERI provides 1.) Leadership training and education that develop human rights and environmental activists who can train their communities to secure and defend earth rights. (Earth rights are defined as the intersection of human rights and the environment) 2.) Legal action against earth rights abuses which seek to apply domestic and international law to hold corporations and others accountable for their actions and 3.) Advocacy campaigns that bring together human rights and environmental activists, affected communities and concerned individuals to raise public awareness about the issues.

EARTHRIGHTS staff met us at the nonprofit heath clinic started and run by Dr. Cynthia Maung, “Dr. Cynthia” to the local community. Dr. Cynthia is a Burmese who came to the Thai side of the border in the late 1980’s and has been here ever since. A tireless humanitarian, Dr. Cynthia recognized the need to serve an expanding population of IDP’S, refugees, and migrants from her home country. For most people in these groups, Dr. Cynthia’s clinic is the only source of healthcare and she set up her clinic to treat sick Burmese who could not afford healthcare services in

Burma as well as the continuously expanding refugee and migrant populations. This clinic served about 2000 people in 1989 when it first opened and currently is the primary means of healthcare for more than 100,000 Burmese last year.  The types of problems treated here are what we in the developed world hardly consider anymore. Malnourishment is a huge problem…you don’t see obesity here, only people who don’t know where or when their next meal will come from.

Burma’s healthcare “system” was ranked one of the worlds least responsive and it remains a place where basic vitamin deficiencies kill people. The clinic provides maternity, pediatric, surgical, prosthetic, lab and pharmacy services. Beriberi, caused by a severe lack of vitamin B1 is still found here and there are many babies dying from infantile beriberi. B1 is found in foods such as fish, eggs, brown rice, pork and peanuts…many people here only have access to white rice… People here are afflicted with and die from ailments that we no longer are concerned with or even think about.

The clinic is primitive by our western standards and by Thai standards as well but for the majority of Burmese here, this is their only source of healthcare. If not for the selfless efforts of Dr. Cynthia and her dedicated staff and volunteers these Burmese would have no access to medical treatment. In addition to being a clinic, it was apparent that the clinic compound serves as a community for these displaced Burmese. This “community” serves a wonderful need and is a fine example to our communities and how we as a community can always do more. These people here with absolutely nothing work so hard and so selflessly…

My father, a survivor of the holocaust, was naturalized in 1945 and what this has meant for him and my whole family is recognized and appreciated. Dad said from as early as I can remember, “Those born in America don’t appreciate

America” and I must admit, there is truth in these words. We are indeed fortunate to live in

America.

“Life, liberty, and the pursuit of happiness” is one of the most famous phrases in the United States Declaration of Independence. These three aspects are listed among the “unalienable rights” of man.These rights are ones we often taken for granted and we must keep in mind that our roles could easily be reversed with the oppressed and disenfranchised around the world. A role of the dice and we are here and they are there. Happiness and all that it entails we expect as a basic right by our western values and is brought down to earth quickly when happiness in the context of these Burmese and 40-50% of humanity is knowing that you have the next meal for yourself and your family. I try to keep this in mind when I bitch and complain about petty things.We later met with the HUMAN RIGHTS EDUCATION INSTITUTE OF BURMA (HREIB), an NGO, non-profit Burmese institute for human rights education in

Burma. HREIB was the first organization along the border area with this focus. Once again, we experienced the commitment, enthusiasm, empowerment, and tireless efforts of this AJWS partner. The continuing sense of how slowly change occurs and how committed these people are in light of this is truly impressive.HREIB provides human rights education, grassroots level gender equitable knowledge and skills based training, capacity building training of trainers programs, and produces impressive training materials, guides and publication.HREIB also produces human rights documentation via video that depicts the lives of displaced persons in

Burma. We viewed a very moving video of last’s months “Saffron Revolution” which showed footage of the brutality that was never seen on any major news network. At risk for their lives, these brave educators sneak back into

Burma where they can carry on their mission of training others about their human rights and also document ongoing events.We ended this amazing day with a short visit to the BORDERLINE WOMEN’S COLLECTIVE, another AJWS grantee that provides shared marketing space for handmade items created by women from the border area. This collective and fair trade shop provides internship opportunities and workshops in product design, price setting, marketing, and other small business skills for refugee and ethnic minority women’s groups. There was much in the way of local and ethnic handicraft and we were all very happy to provide additional support to this group through the groups multiple purchases of their beautiful products.  After this visit, we went to the actual border of Thailand and Burma. This is truly a “bridge over troubled water”. We could not cross but this is a “fluid” border where people are passing back and forth, whether it be via the bridge or by swimming or floating across the river. There was a noticable number of Thai military here and we were cautioned to not take pictures at the risk of having our cameras confiscated.

Tuesday, 10/30/07Gotta go, gotta go…many partners to visit but so little time. Chiang Rai and north to the Golden Triangle is a beautiful and rugged area that certainly deserves further exploration but we are off this morning to Chiang Mai. We start off at 8am sharp except, as I explain to our Thai guide for a couple of “stragglers”. Straggler is a word unfamiliar to him and I must explain this bit of English slang to him. I’m not used to group tours but being a “yekke”, straggling is something that I personally do not do. Once the “stragglers show up, he fully understands the term and we get on our way to Chiang Rai’s southern cousin, Chiang Mai. By this time in the journey, all study tour participants have removed the name tags and are getting to know each other. We have a very diverse, interesting, and compatible group of 13 tour participants and 4 AJWS staff. Major cities like Boulder, Chicago, Atlanta, New York, Sebastopol, New York, Washington, Philadelphia, and

Loveland are represented. It is a fun and interesting group. It is a very scenic 4 hour drive and we have several stops along the way to break up the drive, buy unknown and interesting snack foods and the very, very best iced Thai coffee. I’ve traveled in

Thailand several times prior to this trip and seen many, many temples on those journeys. It is still quite a draw to many, but honestly for me (and with no disrespect), visiting temples is something that just doesn’t do much for me and honestly, if all I do is view them from a distance and see all of the glittering and shining structures, I am OK with that. Nevertheless, our first stop is at a huge white, glittery structure which was is still in the process of being built after many years by I believe a king who passed away with the knowledge that it wouldn’t be finished in his lifetime. As I described my interest in temples, I sort of “zoned out” the explanations but did walk around and look at the structure inside and out. Some very contemporary paintings were on the inside of the temple and I can describe the whole thing as interesting but let’s get an iced coffee and move out… Our next stop an hour or so down the road would be more interesting and would help set us up for our meeting with our afternoon partner visit.

Control over the HIV-AIDS epidemic has been a relative success story in

Thailand. In part, this success has come through the efforts of a creative Thai social entrepreneur. There are a group of retail shops/ cottages that go by the name of “Condoms and Cabbages”. Proceeds from this venture fund sex education and distribution of condoms. Several of us purchased memorabilia and souvenirs from this enterprise.

We continue our journey and arrive in Chiang Mai, where we check into the beautiful Chedi Hotel and have lunch. Now fat and happy after our very physically active morning bus ride, we proceed to our visit to AJWS grantee EMPOWER FOUNDATION. One of Judaism’s highest values is that of freeing a captive. EMPOWER is a great example of people gaining freedom through empowerment and education. In its most simple form, EMPOWER stands forE =educationM =meansP =protectionO =ofW =womenE =engaged inR =recreationEMPOWER is a sex workers rights organization that promotes economic opportunity, training, education, outreach, and support for migrant sex workers. This is accomplished through computer training, Thai and English literacy, non-formal education, counseling, health information, alternative livelihood, advocacy, and translation.As many here are migrants and have no education at all, EMPOWER provides collaborative education opportunities. These efforts help to give these people confidence to become part of the wider society.My sense is that they do great work here and the results are obvious. We had discussions with this group and the pride, self confidence, and empowerment of these women is impressive. We had a very candid discussion and question and answer session that were inspirational, enlightening, and thought provoking.By now my study group partners were learning about me what my wife already knows…I am “THE INTEROGATOR”. I have a great interest in knowing about things at a detail level. Many of these women were the primary providers for their extended families. I had a question that was gnawing at me…How did these women feel about having the responsibility…the burden of being the sole support for their families, even to the extent that they were putting brothers through school? They unanimously said that they felt a great pride in supporting their families. They then asked me if I had a family, how many people I supported, and if I was proud of supporting my family. I answered Yes, 3 and Yes again. They responded rightfully that they are supporting many more people than I am so they are even more proud…touché’! These are confident, proud, empowered and responsible young women. I am very impressed. They also expressed that for many people, it is more important what they do versus who they are. They are correct. Think outside the box.We headed back to the Beautiful Chedi Hotel for a quick shower and to our dinner program. We had a guest speakers from AJWS grantee MIGRANT ASSISTANCE PROGRAM (MAP). MAP program areas are community health, education, women’s empowerment, and labor rights and advocacy to assist the large number of Burmese migrant workers. Recently their work has expanded to address violence, exploitation, and human rights.

As my overview of

Burma was quite abbreviated, I would recommend getting a copy of Christina Finks book, “Living Silence”. Here you will find a much more complete analysis of the historical and contemporary situation in

Burma.

After our morning orientation, we traveled several hours to a tribal village in the border area. Here we visited with an AJWS partner, Hill Area and Community Development Foundation (HADF). HADF is one of over 300 civil society partners in 39 countries that are supported by AJWS. Currently, AJWS has more than 100,000 supporters and takes a grassroots/ holistic approach to it’s support of it’s grantees. Most of the projects deal with human rights service delivery, hunger, poverty, disease, and social justice through the efforts and support of the Jewish community. The activities of AJWS and it’s partners empowers people to make change in their lives and the lives of those in their communities.  This is accomplished through a human rights lens and includes advocacy relating to the grantee’s work. HADF is one of 21 partners in Thailand and Burma, 6 of which are in Thailand and 15 in

Burma. The village that we visited and which HADF is located is high in the hills along the Thai-Burma border. The village residents are ethnic hill tribe people mostly belonging to the AKKA tribe. The area is very remote, mountainous, and is lush and thick jungle. A beautiful area on the surface but with many issues and problems inside. HADF programs center in the areas of education and advocacy, sustainable agriculture and environmental conservation, women’s empowerment, and health promotion. Many of the same ethnic groups live on both sides of the border. Due to the long standing situation in

Burma, many people have migrated over the border and settled in villages on the Thai side. Culturally the people are the same and they have historically welcomed these refugees. As the situation in

Burma has intensified, the number of refugees has increased dramatically and has become a burden on the already impoverished villages to which they have settled. HADF provides support for the hill tribes and collaborates with many NGO’s and government entities to promote community development, protection from harmful policies and sustaining of tribal culture. They do much work with the youth, who increasingly must move to the more urban areas in order to find work to support themselves and their families. HADF provides education to youth to prepare them as they migrate as human trafficking is common and in many cases they are taken advantage of and abused.

This was our first meeting with a project partner and was representative of all the partners that we visited in that they are all highly motivated, empowered, and dedicated to their work. It was very inspirational for me to see people living in what by western terms are “primitive” conditions and environment and how the leadership is accomplishing repair and change to their world. We were treated to a cultural exhibition of tribal costumes and dances as well as a tour of the village. We were fortunate to spend time in the home of a villager and were able to discuss with her through an interpreter her life and the life in her village. The attitude of the people is unbelievable. Our lives are so far from this…On the way back to the hotel, we stopped at the Golden Triangle, the intersection of Thailand, Burma, and

Laos.

On Monday, 10/29 Christina Fink, author or “Living Silence” spoke to us about Burma in orde to orient us to the situation within the country as well as what is happening in the border areas.  Since 1962

Burma has been controlled by a military junta. This junta has been and continues to be completely repressive and cruel. 

Burmais made up of many ethnic groups. The Burmans make up close to 70% of the population and the balance is made up from Shan, Karen, Rakhine, Chinese, Mon and others. Many of the ethnic peoples live along the border areas and are literally tribal and living in jungle villages. The borders between Burma, Thailand and

Laos are disputed and the ethnic groups/armies serve as a buffer. The ethnic peoples are anti-communist and the Thai government doesn’t want a merger of Thai and Burmese communists. There has been a historical “sacking” of the Thais by the Burmese and this has created a mythology and the Thais do not want armed conflict with the Burmese. Burma is a former British colony and gained independence from

Britainin 1948 (sound familiar?). The ethnic autonomy movement began in 1948 and the ethnic Karen people have been at war with the central Burmese government continuously since 1949. There have been ceasefires with the other ethnic groups but not peace. The military junta took power in 1962 and all business’ were nationalized at that time. The military junta is very cruel and repressive. There has been no economic or other planning. It is common for the junta to conscript people into forced labor. Also, children as young as 10 years old are forcefully brought into the military in order to increase the numbers and further control the population. Since the junta controls all monies, the military, except for the Generals do not pay the soldiers and instruct the soldiers to “make due” in any way they see fit. This includes taking over rural villages and hill tribe ethnic areas, stealing their food and homes. This, as well as other activities has caused mass migrations of people into the jungle and to the border areas of

Thailand. The problems today consist of a struggle for ethnic autonomy and to restore democracy in a continuously worsening economic situation.

Burma’s population is 47 million and for millions, malnutrition, lack of access to healthcare, and complete personal and political repression is the norm. Most of the population is either too poor or too isolated to have a voice in change since their main “occupation” is simply survival. In Burma, 10% of children die before reaching the age of 5 as opposed to 2% in

Thailand. A woman has a 1 in 75 chance of dying in childbirth as opposed to 1 in 900 in

Thailand. The Thai-Burma border is 1400 miles long and is disputed in areas. Heroin and methamphetamine cross freely over the border and drug use is a big problem in this part of the world. Thailand also gets much of it’s energy from Burma to the tune of $2 billion, which is 40% of

Burma’s total exports. Thailand is

Burma’s largest trade partner. China is also a very large trade partner and because of these “partnerships”, neither Thailand nor

China apply any serious pressure on the military government.

For Burmese living in

Thailand, there are 140,000 refugees who have some degree of safety but live with many restrictions. There are around 1000 activists who have no legal status and 2 million migrant workers (only 10% of whom are registered) who are subject to human trafficking and exploitation. Many of these groups do not speak the Thai language, are isolated, and have no access to human services. Refugee camps in

Thailand were first established in 1984. Residents of these camps are literally people without a country and receive only basic needs.

 

Wow…what a busy, interesting, and emotional 5 days. Sorry for not posting earlier but we have been on the go from early morning to late evening every day and honestly, given the schedule and the jet lag I am now just getting to it. After my last posting, I flew 14+ hours from LA to Taipei and immediately caught my next 3 1/2 hour flight to Bangkok. I arrived in Bangkok at 2am and took a room at the airport hotel. My flight to Chang Rai was the next day (or technically the same day) at 1PM. Unfortunately, sleep did not really come at all so I stared at the ceiling until about 6am and finally fell asleep. My cell phone rang at 8:15am and that’s “all she wrote” as far as sleep is concerned. In any event, I caught the flight and arrived in the Chang Rai airport at about 3PM. Unbeknownst to me, there were 4 other study tour participants on the same flight. We were picked up  by our AJWS tour service and then drove to a beautiful hotel about 1 hour away that sits right at the Golden Triangle. For you geography buffs, the Golden Triangle sits at the intersection of Thailand, Burma (Myannmar), and Laos and is on the Mekong River. This used to be the source for the majority of opium and heroin production and there is actually quite a fine museum close to our hotel…the Opium Museum. My room overlooked the Mekong River, Burma and Laos. The area is extremely mountainous and rugged and is composed of very dense rain forest. After arriving, we had a welcome dinner where I met the other 12 tour participants and 4 AJWS staff members. I was fortunate to sit at dinner with our speaker for the next morning, Christina Fink. She is an American author married to a Burmese activist and lives in Thailand. I read her book, “Living Silence” prior to the trip and found both the book and the author very enlightening about the history and current events of Burma. The area is just beautiful. As I was to learn in the upcoming days, underlying the outward beauty of this area is a human rights and social justice crisis that has existed continuously since 1949 with additional significant events occuring in 1962, 1988, and again this month. This week has been a first hand and up close look at the complex history, politics, and issues as well as the people and organizations working for change.