Myan­mar health au­thor­i­ties strug­gle to pre­pare for Zika out­break

Kuwait Times - - HEALTH & SCIENCE -

YANGON: Myan­mar is largely un­pre­pared for an out­break of Zika, ex­perts say, with the health min­istry slash­ing anti-virus mea­sures due to lack of funds, over­worked doc­tors skip­ping check-ups and preg­nant women say­ing they are in the dark about the dan­gers. Zika has spread to some 60 coun­tries and ter­ri­to­ries since the cur­rent out­break was iden­ti­fied last year in Brazil, rais­ing alarm over the rare birth de­fect mi­cro­cephaly, as well as other neu­ro­log­i­cal dis­or­ders it can cause in in­fants and adults. The World Health Or­ga­ni­za­tion’s (WHO) Myan­mar coun­try head Dr Jorge M Luna, warned Myan­mar was likely to ex­pe­ri­ence more cases of the mos­quito-borne virus that has spread quickly in the re­gion, with the num­ber of in­fec­tions dou­bling in Viet­nam and 33 fresh cases con­firmed in Thai­land this week..

Myan­mar de­tected its first Zika-in­fected pa­tient more than two weeks ago, prompt­ing pledges of in­creased mon­i­tor­ing and stepped up mos­quito-pre­ven­tion mea­sures. But more than a dozen in­ter­views with preg­nant women, doc­tors in pub­lic hospi­tals and gov­ern­ment of­fi­cials show the coun­try of 51.5 mil­lion is strug­gling to in­form the pub­lic about the virus or prevent it from spread­ing.

On a re­cent af­ter­noon more than 100 preg­nant women waited - some stand­ing for more than three hours - in noisy, crowded cor­ri­dors of the Yangon Cen­tral Women’s Hos­pi­tal, the largest such in­sti­tu­tion in the coun­try. “I wanted to ask doc­tors some ques­tions about Zika, but they are very busy be­cause they have to see many preg­nant women at the same time,” said San San Aye, 42. She had heard about Zika from a friend, but was un­sure how it could af­fect her preg­nancy. Myan­mar is strug­gling to shed the legacy of nearly 50 years of junta rule that has left its econ­omy and pub­lic ser­vices es­pe­cially healthcare and ed­u­ca­tion - in tat­ters.

It has only 0.6 physi­cians per 1,000 peo­ple, ac­cord­ing to the WHO, six times fewer than Kaza­khstan. To­tal ex­pen­di­ture on health stands at $20.3 per per­son, about 18 times less than Thai­land, and di­lap­i­dated and over­crowded hospi­tals of­ten lack ba­sic sup­plies. A Reuters re­porter vis­it­ing the Yangon hos­pi­tal did not see any stick­ers or signs posted alert­ing or ex­plain­ing Zika to the women. Healthcare work­ers said they did not know how to ed­u­cate pa­tients about the virus. At smaller pub­lic hospi­tals nurses of­ten carry out check-ups in­stead of spe­cial­ist doc­tors, who some­times do not turn up for sched­uled ap­point­ments, Reuters re­porters found when vis­it­ing two town­ship-level hospi­tals on Yangon’s out­skirts. Dr Than Htun Aung, in charge of Zika emer­gency re­sponse and in­ter­na­tional re­la­tions at the Min­istry of Health, said a short­age of doc­tors meant they could not al­ways at­tend ap­point­ments. He said nurses were qual­i­fied to ex­am­ine the women.

Con­fu­sion, lack of funds

At hastily called news con­fer­ence af­ter the first case of Zika in Myan­mar was con­firmed, Dr Soe Lwin Nyein, who heads pub­lic health depart­ment at the Min­istry of Health, has urged women to avoid preg­nan­cies in the next six months. The state­ment has con­fused some Myan­mar healthcare spe­cial­ists, who said they did not un­der­stand the rea­son­ing be­hind the rec­om­men­da­tion, and whether it meant no more Zika cases were ex­pected af­ter the six-month pe­riod.

That made them re­luc­tant to dis­cuss the risks with pa­tients, doc­tors and nurses told Reuters. The WHO’s Luna said the or­ga­ni­za­tion’s guide­lines were to give cou­ples full in­for­ma­tion about po­ten­tial risks and im­pact on new­borns, but the de­ci­sion on whether to have chil­dren was up to the cou­ple. “You have to give them in­for­ma­tion, good in­for­ma­tion, what is go­ing on, and it’s the cou­ple’s choice,” said Luna.

Than Htun Aung, at the health min­istry, said med­i­cal spe­cial­ists were trained about Zika guide­lines last week. “Dur­ing the train­ing, we told them how to give in­struc­tions to pa­tients on how to avoid sex­u­ally trans­mit­ting Zika,” he said.

But in Yangon, Dr Tun Lwin, who heads the regional pub­lic health au­thor­ity, said Zika was not the pri­or­ity, com­pared with some­times fa­tal dengue fever and other mos­quito-borne dis­eases. He said the regional gov­ern­ment did not pro­vide funds to lo­cal staff to carry out pub­lic health cam­paigns about the virus, but some staff mem­bers cam­paigned spend­ing their own money. The Min­istry of Health’s Than Htun Aung said mea­sures to con­trol mos­qui­toes in cities were pro­gress­ing slowly be­cause of a lack of staff and fund­ing. He added the gov­ern­ment wanted to test all preg­nant women, trav­ellers, and for­eign­ers, but “we do not have the bud­get to test them be­cause the tests are ex­pen­sive”. —Reuters

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