From am­bu­lances to fu­ner­als, vol­un­teers prop up Myan­mar health care sys­tem

The China Post - - FEATURE - BY PREETI JHA

With lights flash­ing and sirens blar­ing, vol­un­teer am­bu­lance driver Myint Hein weaves through traf­fic­choked Yan­gon, a life­line in Myan­mar where health care was crip­pled by decades of chronic un­der­fund­ing dur­ing junta rule.

Emer­gency ser­vices were one of the many ca­su­al­ties of mea­ger public spend­ing and the re­tired bus driver is help­ing to plug gaps in a coun­try still lack­ing a cen­tral­ized am­bu­lance sys­tem.

“I saw some peo­ple die be­fore they could reach hos­pi­tal be­cause there was no timely trans­porta­tion or am­bu­lance,” the 54-yearold said of ac­ci­dents he fre­quently en­coun­tered on the lengthy Yan­gonMan­dalay high­way.

Now a vol­un­teer at Noble Heart, a lo­cal NGO pro­vid­ing free am­bu­lance ser­vices in Yan­gon since Jan­uary, he is try­ing to bol­ster the mot­ley smat­ter­ing of state and char­ity-run ve­hi­cles serv­ing his fast-grow­ing city where peo­ple nor­mally turn to fam­ily or friends dur­ing med­i­cal emer­gen­cies.

This cul­ture of self-re­liance is par­tially a legacy of the mil­i­tary era where vast spend­ing on de­fense came at the ex­pense of health or ed­u­ca­tion.

While bud­gets have in­creased since 2011’s end of out­right army rule, Myan­mar — the world’s fourth-fastest grow­ing econ­omy — is still one of the low­est spenders on health care as a share of GDP.

Ac­cord­ing to the latest World Bank fig­ures health spend­ing in­creased from 0.2 per­cent to just over 1 per­cent of GDP from 2009 to 2013.

In con­trast 4.3 per­cent of GDP in 2014 went to the mil­i­tary, ac­cord­ing to the Stock­holm In­ter­na­tional Peace Re­search In­sti­tute.

Small groups like Noble Heart have their hands full.

But like most of the other am­bu­lances on Myan­mar’s roads they are only ba­si­cally equipped and trained, of­fer­ing more a trans­port ser­vice than full-fledged emer­gency care.

Slow Im­prove­ments

It’s a hole the quasi-civil­ian gov­ern­ment is fi­nally pay­ing at­ten­tion to in a cru­cial elec­tion year where they face-off against Aung San Suu Kyi’s op­po­si­tion, who are ex­pected to make vast gains if the Nov. 8 polls are fair.

“We have am­bu­lances but they are not fully equipped. Peo­ple who use them are not trained, it’s just trans­port. There’s no sys­tem at all,” Maw Maw Oo, as­so­ciate pro­fes­sor at Yan­gon Gen­eral Hos­pi­tal’s emer­gency medicine depart­ment, told AFP.

Un­til 2012 Myan­mar “didn’t have emer­gency care,” he said, point­ing to the launch of his own depart­ment as well as a new diploma in the sub­ject and emer­gency medicine posts.

This year the coun­try will welcome its first fleet of 230 emer­gency am­bu­lances, aim­ing to roll out ser­vices start­ing with the main high­way be­fore ex­pand­ing to Naypyi­daw, Yan­gon and Man­dalay, the doc­tor added, with plans also to launch a hot­line and train-up its first-ever paramedics.

There have been sub­stan­tial im­prove­ments to a sys­tem where pa­tients used to ar­rive for oper­a­tions armed with their own nee­dles and medicines due to a con­tro­ver­sial cost-shar­ing scheme that saw the sick pay more than the state.

As a re­sult of in­creased gov­ern­ment fund­ing, since Au­gust 2014 emer­gency care has been free to all, and now other ser­vices in­clud­ing some blood tests are also with­out charge.

But pa­tients still bear 54 per­cent of to­tal healthc are spend, ac­cord­ing to the coun­try’s WHO rep­re­sen­ta­tive Jorge Luna.

The state “fund­ing and pro­vi­sion of care is frag­mented,” he told AFP, with “in­ad­e­quate spend­ing” par­tic­u­larly in ru­ral and con­flict-wracked bor­der re­gions.

Those Who Can Leave

At an evening clinic run by the non-profit lo­cal group Bet­ter Burmese Health Care on the out­skirts of Yan­gon vol­un­teer doc­tor Win Than Naing is hun­gry for change.

“For decades we’ve been closed off from the world ... med­i­cal ed­uca- tion and in­no­va­tion just stopped,” said the 30-year-old, pin­ning his hopes on bet­ter pol­icy in a coun­try des­per­ate to catch up with its neigh­bors.

But as cam­paign­ing en­ters full steam, par­ties — in­clud­ing Suu Kyi’s NLD — have re­vealed lit­tle de­tail of what such poli­cies may en­tail.

Sur­geon Tin Myo Win, the NLD health chief who is also Suu Kyi’s long­time per­sonal doc­tor, told AFP he rec­om­mended the next gov­ern­ment spend “more than 10 per­cent of GDP” on health.

But the party’s re­cently re­leased man­i­festo con­tains no such com­mit­ment nor does it lay out con­crete plans for im­prov­ing the coun­try’s health.

For now the wealthy, and even lower-in­come fam­i­lies who can cob­ble to­gether the cash, es­cape across the bor­der to Thai­land or Sin­ga­pore for their health care needs, es­pe­cially for harder-to-treat dis­eases such as can­cer.

Ad­verts tar­get­ing this grow­ing mar­ket dot the city and at Yan­gon air­port posters shout of new pack­ages from Thai hos­pi­tals of­fer­ing free round-trip flights.

But these deals are out of the reach for most in the im­pov­er­ished na­tion.

For the poor even death comes at a hefty price with fam­i­lies some­times left in debt by fu­neral costs.

“Ev­ery day around 10 peo­ple are too poor to af­ford a ser­vice,” said Hla Myint, vice-chair­man of the So­cial Wel­fare So­ci­ety, which has been pro­vid­ing free fu­ner­als in Yan­gon since 2012.

At a cre­ma­tion site, his team of vol­un­teers carry in the latest body, a 93-year-old man whose wife couldn’t af­ford the ex­pense.

“We cover gaps that would oth­er­wise be ne­glected,” he says.

AFP

In a photo taken on Aug. 20, fam­ily mem­bers pray dur­ing a fu­neral cer­e­mony at the Yay Way ceme­tery on the out­skirts of Yan­gon, Myan­mar.

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