Published on August 18, 2005

The Mae Tao clinic near Mae Sot on the Thai-Burmese border caters to thousands of Burmese from the strife-torn Karen state

Years of fighting in Karen state in the northeast of Burma have created one of Southeast Asia’s worst humanitarian crises.

The low-scale civil war between ethnic Karen rebels and the Burmese army has had a severe impact on hundreds of thousands of people.

Recent reports from the border indicate little change in the long-running saga. Burmese troops are still targeting civilians and forcibly displacing large numbers of poor villagers, according to a report by Human Rights Watch.

“Extrajudicial killings, sexual violence and forced labour continue to characterise the tactics of an unreformed and unaccountable Burmese army,” Brad Adams, head of Human Rights Watch (HRW) in Asia, told a press conference in Bangkok in June.

Interviews with 46 ethnic Karen showed that forced displacement remains rife, and that conditions in parts of Karen state are hellish. Problems range from land-mines to lack of access to education and health services, lack of consistent access to food and the inability to farm without disturbance.

More than 650,000 people are internally displaced in eastern Burma – and HRW says that’s a “conservative estimate”. Some groups put the figure as high as two million, Adams said.

Health services in Karen state have been rated among the worst anywhere by the World Health Organisation. HIV, tuberculosis (TB) and malaria are allegedly rampant. And diseases such as elephantiasis, normally rare in Thailand, have also been reported among Burmese refugees.

Given the scale of the problem – which constantly spills across the border – it’s hardly surprising that an institution like the Mae Tao clinic came into being.

This small makeshift clinic, set up on the outskirts of Mae Sot in 1989, has become a haven for sick and injured Burmese Karen, who often walk for days and risk arrest by crossing the border to get there.

The Mae Tao facility was established by Karen doctor Cynthia Maung, who fled to the border with a group of refugees after the brutal army crackdown the previous year. It started with two to three rooms and six staff, but has grown dramatically in the 16 years since.

Dr Cynthia, as she’s known, has won many awards for the vital work done by the clinic, which treated more than 70,000 Burmese refugees and “illegals” last year – the bulk of them for free or little cost.

In late June she was one of four displaced Burmese women nominated for the Nobel Peace Prize, along with 39 others from the Mekong region, in a mass nomination of 1,000 outstanding women around the globe.

Health services at Mae Tao, while below general Thai standards, are significantly better than what ordinary Burmese get across the border, where medical facilities are woefully under-stocked and overpriced.

The clinic also supports education and social services. “We do community education and school health promotion and train community midwives to do health work. And we work in partnership in providing cross-border assistance – medicines and supplies,” Dr Cynthia said.

The clinic is dependent on foreign aid and welcomes foreign medical volunteers. It also operates in delicate circumstances, much at the goodwill of the Thai government.

More than 140,000 Burmese live in refugee camps along the border, many of them just south of Mae Sot. Some have lived in the camps for 20 years, waiting for a political solution that might allow them to “go home”.

A coalition of international aid groups known as the Thai Burma Border Consortium (TBBC) helps refugees in the camps look after themselves. Dr Cynthia said TBBC is one of the main backers of the Mae Tao clinic along with Canada (CIDA), the US (USAid), the Netherlands and Italy.

Burmese get to Dr Cynthia’s via the Myawaddy checkpoint, the town opposite Mae Sot, or discreet points north or south of there on the Moei River, where they hitch a ride in a boat or are pulled across in an inflated inner tube. In some places during the dry season they simply walk across the border.

Tens of thousands of Burmese work in factories in Mae Sot and Tak province, and some of these workers also prefer to go to the Mae Tao clinic for cheap medical treatment, although they should be eligible for treatment at government hospitals if registered.

The clinic’s running costs are incredibly cheap by Western standards. Dr Cynthia put the figure at Bt36 million-Bt40 million – just under US$1 million – a year.

“That includes medical supplies, medicines, lab testing, X-ray referrals, some logistics, water, electricity, travel, facility improvement, equipment, and capacity building for health workers,” she said.

“Plus our community outreach programme and backpack [medic] teams are another Bt20 million-Bt25 million. And there’s maternal and health teams, plus food and nutrition.”

On a previous tour of the clinic we met a Canadian surgeon in the trauma section, on his fifth spell as a volunteer here. He showed us the operating room, which is small and very basic – no anaesthetic, X-ray or even plaster for patients.

Nearby was a mine victim, who had been there for three weeks. There was also an old woman with a broken leg, a man aged about 80 with a hernia, plus a young man with septis in his right leg. Despite their injuries, the mood was buoyant.

The clinic has an outpatient and inpatient service for children and adults, plus a trauma department, reproductive health section for women with gynaecological problems or pregnancy checks, an eye clinic, nutrition centre for babies with malnutrition, and a prosthetics department, mainly for land-mine victims. The staff perform blood transfusions, plus checks for malaria and HIV.

“International volunteers are important, because people here can’t go and study,” Dr Cynthia said. “So we need people who have public health and a clinic background, as well as teaching skills, because people here can’t go away.

“The problem is very few [Burmese] people register [as labourers in Thailand], because the cost of work permits are very high. And as long as the situation in Burma doesn’t improve, they will come to seek health services here. The [Thai] public health officials acknowledge this is the reality.”

Kanchana Thornton, an Australian-Thai nurse, is the clinic’s coordinator for child health. She’s worked full-time at Mae Tao for more than four years, liaising with Thai government agencies.

“Mae Sot [hospital officials] understand that, if there was no Mae Tao clinic, they would be inundated with Burmese seeking healthcare. We have 150 to 200 people a day [seeking care or treatment].”

Indeed, Mae Tao and similar clinics in other towns on the border, such as Ranong in the South, form the front line against the spread of infectious diseases such as HIV, TB and malaria, which are rife in some parts of Burma.

Mae Tao does drug immunisations twice a week. On Saturdays they also supplement patients’ diets by making big pots of food. “About 75 per cent of children brought to the clinic have some form of malnutrition,” Kanchana said.

Complicated long-term medical cases trouble her the most. “Land-mine cases are too severe. We send them to Mae Sot hospital. The others, we take them to Chiang Mai hospital.”

With a lot of foreign aid directed to victims of the tsunami, staff at Mae Tao fear that funding is drying up. And Dr Cynthia is keen to upgrade the clinic.

“We need to keep on improving the facility. We already provide a service, but we should have a minimum standard of service,” she said.

Jim Pollard

The Nation

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