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.