Burma: Health on the Borderlines
Mahn Mahn, co-founder of the Backpack Health Workers, Thailand.
Mahn Mahn's earliest childhood memories are of being in jail. In 1969, at the age of three, Mahn Mahn, his grandfather, his mother and his sister were all arrested and jailed by the Burmese military because his father was a soldier in the Karen army. Upon his father's death three years later, the family was released. The Karen National Liberation Army (KNLA) has been fighting for an independent Karen State in Burma since 1949. Raised in the midst of a civil war that has had a terrible toll on civilians, it is not surprising that Mahn Mahn has dedicated his life to promoting the health of the Karen people.
In the 1980s, Mahn Mahn left his home and headed to the Thailand/Karen border. He started medical training and focused on surgery. After years of working in make-shift medical clinics, however, he grew disillusioned. "You cure one patient and you feel happy. But then another patient comes, and then another." Mahn Mahn knew he needed to find alternative ways of providing health services. He met another health worker, Hser Nay Mu, and together they discussed ideas of organizing a health outreach strategy emphasizing village-level organizing, primary health and prevention. They were planting the seeds for the Backpack Health Worker Team program.
Over the next few years, Mahn Mahn, Hser Nay Mu and other health workers experimented with mobile health teams, travelling deep into Burma to reach remote communities. They developed popular education approaches to encourage villagers to develop sanitation systems, and promoted prevention strategies related to diseases such as malaria. Slowly they built trust with people in these communities and worked together to develop community health programs.
During this period, Burma's military junta was increasingly attacking Karen villages and the number of internally displaced people was growing rapidly. Thousands of people fled into the jungle and mountains or crossed the border into Thailand. It is now estimated that there are between one and two million internally displaced people in Burma, and an equal number who have fled into the neighbouring countries of Thailand, China, India and Bangladesh. Health conditions among these uprooted people are appalling and maternal and infant mortality rates are among the worst in the world.
In 1998, with the support of Inter Pares, Mahn Mahn, Hser Nay Mu, and other colleagues established the Backpack Health Worker Team program. This coalition of health workers from Karen, Karenni and Mon ethnic states provides primary health care to internally displaced communities in Burma, where access to healthcare is unavailable. The teams travel by boat, by foot, even at times by elephant, to provide a range of medical services to displaced people.
The backpack program aims to provide health services as well as equip people with the skills and knowledge necessary to manage and address their own health problems. The work is arduous and dangerous, and a number of the health workers have been killed. In 2005, seventy backpack teams provided health services to about 140,000 displaced people inside Burma. The backpack program includes training for new medics and has a particular focus on upgrading the skills of traditional birth attendants to address the high rates of maternal mortality and morbidity among displaced women.
Despite the gruelling conditions the backpack workers face, Mahn Mahn has retained his energy and sense of humour. He knows that the root cause of health problems among uprooted people is the war. He also knows that health, democracy, and human rights are inextricably linked.
Mahn Mahn never thought about leaving his country to seek a future somewhere else. "Burma is my homeland," he says, "and we must struggle for peace. People ask why don't I leave for my children's sake. But if I stay here I can help maybe ten, maybe one hundred children, maybe more."
In addition to the generous support of our donors, Inter Pares gratefully acknowledges the Asia branch of the Canadian International Development Agency for its support of the Backpack Health Worker Team program.
A study by the Back Pack Health Worker Team, "Chronic Emergency: Health and Human Rights in Eastern Burma," can be viewed at 
www.bphwt.org. The BPHWT also completed a video documenting the health and human rights situation in Burma, entitled "Health Security Among Internally Displaced People in Burma," which can be viewed at www.interpares.ca/en/video/.
| Reviewed November 7, 2006 |  |
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