Poor health care system plagues Myanmar

( AP ) - They travel for days though checkpoints, across dangerous roads and past Myanmar's bribe-hungry soldiers to make it to the Thai border. They're not refugees fleeing the junta - they simply want to see a doctor.

Myanmar has one of the world's worst health care systems, with tens of thousands dying each year from malaria, tuberculosis, AIDS, dysentery, diarrhea and a litany of other illnesses. While there are hospitals in the impoverished Southeast Asian nation also known as Burma, only a few can afford to pay hospital workers the various "fees" in the tightly controlled nation fueled by corruption.

"Even if you use the toilet in the hospital you have to pay money," said a 70-year-old man from Phyu Township, who journeyed two days by bus to see a doctor at the Thai border town of Mae Sot and have a cataract removed. He declined to give his name for fear of reprisals.

"They never think of improving health care," he said. "They only pull the trigger. Because they are holding the guns, we have to live like this."

Last year, more than 100,000 Burmese sought help at the 120-bed Mae Tao Clinic in Thailand, where free care is offered through local and international funding and no one is turned away. About half were migrants who work illegally near the border, while the rest live inside Myanmar and make the trip solely for medical care.

"I've been getting treatment from three hospitals inside Burma, but you have to buy everything - even medicine," said Ottoma, a 55-year-old monk who traveled three days from Shwekyin township near Yangon, the city formerly known as Rangoon, for treatment of an enlarged prostate.

"The monks have no money," he said, sitting cross-legged in a traditional maroon robe. "We only get money from people who contribute; but people are very poor."

The flow of people seeking treatment here hasn't changed much since the violent crackdown on pro-democracy demonstrations in Myanmar. The peaceful protests were sparked by anger following government-imposed fuel hikes of up to 500 percent - a move that boosted the cost of everything, including health care.

The sick are issued day passes to enter Thailand, but many bribe immigration officials to stay longer for treatment ranging from land mine injuries to chronic ailments that have festered from neglect or improper care.

"Among the displaced people here, the most threatening problem is in communicable diseases," said Dr. Cynthia Maung, wearing a simple sarong and sandals.

She fled Myanmar in 1988 following a violent crackdown on student pro-democracy protests and started the Mae Tao Clinic a year later in a small house.

Today, the vast compound includes a delivery room, surgical ward and artificial limb workshop. It has a community feel, with women doing laundry as children play on swings and slides outside. But the sounds of rattling coughs and screaming babies, hungry or in pain, fill the rooms.

Many patients come too late and die in the clinic, while newborn babies and the elderly are sometimes abandoned by family who simply cannot afford to care for them, Maung said.

The situation inside Myanmar is complex and health data are often unreliable or difficult to gather, especially from restive areas of the country dominated by ethnic minorities who have been at civil war for decades.

Big killers such as tuberculosis, with nearly 100,000 new cases reported annually, plague the country of 54 million people. The AIDS virus has reached the general population, with more than 1 percent of the nation infected. While the rest of Southeast Asia has largely tamed malaria, it kills 3,000 people a year in Myanmar.

Stephen Atwood, UNICEF's regional adviser for health and nutrition in East Asia and the Pacific, says the military government does a fair job of conducting childhood immunization campaigns and routine vaccinations, but adds it's impossible to assess the health situation in many ethnic areas that are off-limits to foreigners.

Neighbors Laos and Cambodia have poor health systems that perform even worse than Myanmar's by some measures.

But in 2000, the World Health Organization ranked Myanmar's overall health care system as the world's second worst, above war-ravaged Sierra Leone.

One in three Burmese children is malnourished. About 105 per 1,000 children die before age 5 in Myanmar, compared with 19 per 1,000 in nearby Vietnam and 7 per 1,000 in the United States, according to UNICEF.

At least 360 of every 100,000 women die in childbirth, compared with 130 in Vietnam and 17 in the U.S.

Most of Myanmar's health care is funded by international sources, with the government spending only about 3 percent on health annually, compared with 40 percent on the military, according to a report published this year by researchers from the University of California, Berkeley and Johns Hopkins University.

Some countries, however, are reconsidering their aid packages. Japan, Myanmar's largest donor, announced it had canceled a multimillion-dollar grant to protest the death of a Japanese journalist who was among at least 10 people killed when troops fired into crowds of peaceful protesters during the Sept. 26-27 crackdown.

An estimated 90 percent of Burmese live on just $1 a day, and the United Nations ranks the resource-rich country among the 20 poorest in the world following decades of mismanagement under military dictatorship. Tony Banbury, the U.N. World Food Program's regional director, visited Myanmar this month and estimated at least 5 million people were going hungry. He called on donor countries not to neglect the people suffering there.

Travel restrictions, human rights abuses and the government's tight control over humanitarian organizations have forced some agencies to pull out. The Global Fund to fight AIDS, Tuberculosis and Malaria withdrew funding in 2005, though Australia and a number of European countries made up the difference last year.

The French arm of Doctors Without Borders left Myanmar last year and even the International Red Cross issued a rare public criticism in June, denouncing the government for forcing prisoners to serve as military porters among other human rights abuses.

"People who have no money go to a clinic and they cannot get care," said Chit Win, of the Back Pack Health Worker Team, a group that sneaks medical supplies across the border into eastern Myanmar. "Most people say the best thing to do is just wait to die."

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