- The Washington Times - Friday, March 2, 2007

With an empty plastic bag in her hand and a purse on her shoulder, she crosses into Burma every morning among the stream of Indian traders. To officials on both sides of the border, she’s just an ordinary businesswoman hurrying to shop in the popular Chinese markets in Namphalong, Burma.

But as soon as the 35-year-old tribal woman is beyond the sight of Burmese immigration officials, she neatly folds the vinyl bag and puts it in her handbag, before turning into one of the nearby villages to start her day’s work as a community health worker.

“Every day I meet intravenous heroin users, prostitutes and ordinary villagers to explain how they can prevent infectious diseases like HIV or hepatitis,” said the Burmese woman who lives in Moreh, a border town in the northeast Indian state of Manipur. Concerned about her safety, she did not want to be photographed or identified by name.

“I also advise people on how to get medical help in Burma or India in case they get the diseases.”

As a growing number of international charities suspend operations in Burma because of increasing pressure from Burma’s military junta, community health workers like this woman do their best to provide basic medical care to some of Asia’s most vulnerable people.

AIDS, malaria rife

In a country where HIV/AIDS and malaria are rife, the activities of any health worker are overwhelming. UNAIDS, the United Nations agency coordinating the global fight against the disease, estimates that about 620,000 people in Burma 15 to 49 years of age are infected with HIV. But on the border, where the junta casts its shadow over every section of society, health workers face the additional burden of risking their lives daily when they go to help the ill.

“Sometimes in the villages, I also distribute essential medicines supplied by NHEC,” the woman said, referring to the National Health and Education Committee, organized by Burmese pro-democracy activists in exile. “Although I’m doing exactly what a community health worker does elsewhere in the world, I often have to work undercover to save myself from being troubled by the military.”

To maintain her false identity as a trader in the eyes of the Burmese border police, she carries cheap clothes or consumer goods from markets in Tamu, south of Namphalong, every evening for some shops in Moreh.

Junta cracks down

Lamlhing Touthang, a Namphalong-based health worker, recently returned home after participating in a monthlong HIV-care training camp in Manipur. On her return, she was interrogated for more than five hours by Burmese military intelligence officials, who suspected her of having a role in “anti-national” activities, suggesting that she doubled as a political agent for the pro-democracy activists in exile.

“From my bag [Burmese intelligence officers] got nothing except some NHEC pamphlets on awareness about AIDS and malaria,” she said.

“Yet they ordered me not to go out of the country again for ‘so long’ in the future. They also told me not to maintain any communications with the NHEC.”

Now Ms. Touthang and her Burmese colleagues have officially become volunteers at a small Burma-based health nongovernmental organization — a new role that helps keep intelligence officers at bay.

“Just to avoid trouble in the field, our health workers flaunt the identity cards of some Burmese NGOs,” said Dr. Aung Kyaw Oo, India-based chairman of NHEC’s western region. “But NGOs operating under many restrictions imposed by the military regime have no access to the developed world in which they could obtain modern care and treatment for HIV victims in Burma.

“Except for a few hospitals in cities, there are no trained government doctors to handle HIV victims. As many as 85 percent of HIV carriers live in rural areas. If the junta allowed international medical aid groups to function freely inside Burma, the problem would have not have become so acute.”

Charities forced out

Under pressure from the junta, many international medical charities are winding up their operations in Burma. In 2005, Global Fund for HIV/AIDS, Tuberculosis and Malaria canceled its $37.5 million program in Burma, citing government restrictions on its movements that made functioning nearly impossible. Doctors Without Borders pulled out of Karen and Mon states last year for similar reasons.

In October, the International Committee of the Red Cross (ICRC) was ordered to close all its offices outside Rangoon after it reported rampant infection of HIV and other infectious diseases among prison inmates in the country.

Then in December, after the shutdown was criticized by many international agencies, Burma hinted it could allow the reopening of ICRC field offices, but would not allow the organization to make prison visits or give them access to detainees.

According to UNAIDS, the western part of the country is most neglected as far as HIV and AIDS treatment is concerned. The agency reported recently that not a single AIDS patient received free anti-retroviral drugs from the government.

“If the rule book is followed, all HIV-infected children should be given ART [anti-retroviral treatment]. But not one of the estimated 8,000 to 10,000 children in Sagaing division and Chin state have access to these vital medicines. It’s a horrible example of indifference meted out to its HIV-positive children by a government,” said another Manipur-based NHEC executive, who asked to be identified only as Dr. Thura.

Quacks spread HIV

“Many quacks are still spreading HIV dangerously in rural areas, and many villagers — to get common medicines injected — are still receiving help from intravenous heroin users who make injections with used needles and charge half of what it would cost at a doctor’s clinic,” she said.

“In terms of awareness, most HIV-affected areas [in Burma] today are in the same phase that neighboring Thailand or India were in 15 years ago. At least on humanitarian grounds, urgent intervention is necessary.”

Early last year, two workers of the Burmese Solidarity Organization — a pro-democracy group working with NHEC — were abducted by Burmese commandos from Moreh. NHEC officials shut down their medical sites and moved to Indian villages farther from the border.

In early February, the Indian army shut a temporary NHEC medical camp at an Indian border village in Mizoram, where India-based NHEC doctors were training Burmese health workers who secretly provide medical care in Burma. India-based Burmese health activists charged that the Indian army forced the closure of the medical camp and harassed Burmese doctors and other health workers to please their Burmese counterparts.

But despite such threats, the NHEC has started to build homes where orphans of the HIV/AIDS crisis in the Indian border districts of Manipur and Mizoram will have refuge once they leave Burma. The orphanages will also function as hospitals where trained doctors will be on hand.

Epidemic ‘worsening’

“With the logistical help of friends in India and some Western countries, we are going to start these orphanage-hospitals where we hope to be able to provide anti-retroviral therapy [ART] on a regular basis as well,” said Dr. Aung Kyaw Oo. “In the absence of ART, the epidemic in Burma is worsening.”

Dr. Thura said that in the past three months, NHEC workers received more than 2,000 requests from gravely ill Burmese AIDS victims in Chin and Sagaing.

“Since the numbers of such poor people seeking free ART are constantly on the increase [in western Burma] and it’s impossible for us to help such a huge population settle in India, we have also sent proposals to our friends seeking help in starting ART relief centers in border districts close to Burma,” Dr. Thura said.

She said 80 percent or more of suspected HIV carriers in Burma do not know they are carrying the virus, and sex workers do not carry condoms because it is considered proof of prostitution.

Funding no problem

Shalom, another Manipur-based medical NGO trying to combat HIV and AIDS, is setting up two hospices in the border towns of Moreh and Champhai.

Its director, Dr. Vanlalmuana Pachhuau, said funding often is not a problem for such projects when they were targeted to serve the people inside Burma. “The miseries of HIV and AIDS victims in Burma are well-known around the world. A number of funding agencies are ready to fund our projects and by the middle of next year we hope to open hospices.”

But Dr. Aung Kyaw Oo fears the planned HIV relief projects run by NHEC in Indian border states run the risk of being targeted by the Burmese junta.

“When the SPDC [ruling junta] cannot allow an organization as apolitical as the ICRC to serve the Burmese people freely, it can never tolerate us because it thinks we are spies and a part of a Western network engaged in attempts to overthrow the military government,” Dr. Aung Kyaw Oo said.

“Since it will not be able to order the closure of our projects, because they’re not based in Burma, [SPDC] could go to the extent of placing a ban on patients seeking any relief from us or any agency outside the country.”

Writer-photographer’s name withheld for safety.


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