The Health Care Crisis in Burma: Challenges and Opportunities for a Vulnerable Population - Essay Example

 Introduction Most Americans have probably never heard of Burma (Myanmar). Those who have, are likely to associate the country with its most famous citizen, Aung San Suu Kyi. She is the Nobel Laureate who remains a political prisoner under house arrest and who received considerable media attention in the United States when an American illegally reached her compound by swimming across a lake. It is unfortunate that the dismal state of Burma’s health care system does not command similar international media attention. Data compiled by the United Nations and the World Health Organization (WHO) rank Burma dead last (192nd) on their index of health spending. Burma spends forty percent of its annual Gross Domestic Product (GDP) on the military and a meager .3 percent on health care (www.intute.ac.uk.). Several non-profit organizations are providing humanitarian assistance in Burma in an effort to assist local entities in dealing with the burgeoning public health problems. The Global Health Access Project (GHAP) is one of the more visible agencies trying to deal with the crisis in Burma’s health care system. This paper develops the case for a systematic assessment of the current public health conditions in Burma. Specifically, it explores two issues that have been defined in the literature as critical need areas. These are: Maternal health care in general and rates of infant mortality in particular. The spread of infectious diseases with emphasis on Malaria, Tuberculosis and HIV/AIDS. Burma in Context: Demographic, Political, Social and Economic Considerations Burma, initially a colony of Great Britain, was part of the Indian Empire until it achieved self-government status in 1937. It gained complete independence in 1948. The country is governed by a military junta (dictatorship) and is renowned for political persecution, corruption and the violation of human rights. Burma is a nation of fifty-four million people. Although it is blessed with an abundance of natural resources, the country remains as one of the world’s poorest. In 2008, Burma’s GDP per capita was $1,200 U.S. dollars and sixteen million of its citizens (thirty percent) lived below the poverty line. Fifty percent of GDP is generated in the agricultural sector with eighteen percent contributed by mining and forestry. Sixty-eight percent of the population is Burmese and the remainder represents a number of ethnic groups with ties to Thailand, Laos, India and China. The Shan and Karen are the largest of the ethnic groups representing fifteen percent of the country’s population. Burma is embroiled in an ongoing conflict between government forces and private militias of the ethnic insurgents. Over the years, this conflict has consumed millions of dollars in resources and caused the deaths of thousands of innocent people. Health Care Research: Meeting the Challenges Some general population statistics available through GHAP and the WHO serve as a useful introduction to the health care challenges facing the Burmese people. The average life expectancy of an adult Burmese is 61 years. This compares to 71 years in Indonesia and 72 years in the Philippines. The infant mortality rate in Burma is 70.6 deaths for every 1,000 live births. Thailand, by comparison, has 12.5 infant deaths for every 1,000 live births (www.who.intl). Tuberculosis and HIV/AIDS are now at epidemic proportions in Burma. To make matters worse, hundreds of thousands of Burmese refugees have fled to neighboring countries like Thailand and Cambodia to avoid political persecution. The Thai and Cambodian governments are now forced to deal with TB and AIDS epidemics within their borders brought about by the migration of these refugees (Macan-Markar, 2008). A special purpose health facility was created by Dr. Cynthia Maung just to deal with the displaced and migrant populations seeking refuge in those countries that border Burma. The Mae Tao Clinic is one of the major initiatives supported by GHAP and provides medical treatment to over 250,000 Burmese refugees, 160,000 of which live in a refugee camp on the Thai-Burmese border (http://maetaoclinic.org). Research Questions This case addresses two fundamental research questions that have the potential to improve the quality of public health care in Burma. The first research question is; how can the Global Health Access Project and other non-profits improve maternal health care and infant mortality rates in Burma? The second research question is; how can GHAP and the other agencies working in Burma help to reduce the contraction and spread of infectious diseases? Confronting the Challenges GHAP and other non-profit organizations working in Burma face a losing battle if left to address these two public health issues alone. The United Nations and World Health Organization data cited above clearly demonstrate that something needs to be done to address the worsening health care situation in Burma. The facts are irrefutable. Burma is last in the world; 192nd out of 192 countries included in the WHO health study. The time for research is over and time for action is now. The fact of the matter is that the military dictatorship in Burma is unresponsive to the usual political pressures by the non-profits such as GHAP and international agencies such as the United Nations. The regime will continue to ignore calls for change unless something drastic happens. Change requires massive infusions of money to provide the medicines and education that the Burmese people need to combat their health care crisis. The following strategies that are proposed in this case are no doubt controversial and they are certainly political. One thing for sure is that they will bring much needed attention to the health care (and human rights) challenges facing Burma. Strategy 1: GHAP relies heavily upon private donations to accomplish its work. The reality is that the amount of money that GHAP generates is peanuts compared to what is needed. GHAP and the Burmese people need a fund raiser with an international presence to champion the cause. Look at what Bill Clinton was able to accomplish in Haiti raising billions of dollars in private and other international support. Burma needs an individual of the stature of a Bill Clinton or a Bill Gates. Strategy 2: The health care crisis in Burma needs to be brought to the forefront of international attention. This is where the media comes into play. GHAP needs to develop a comprehensive public awareness approach to solving the problems in Burma. A great example where this was successful is the humanitarian tragedy in Darfur. The plight of these people went largely unnoticed until U.S. Senators Durbin and Brownback brought forward bi-partisan legislation proclaiming genocide in Darfur. The international media focused the spotlight on the region and hundreds of millions of dollars in foreign aid poured in. The same can happen in Burma. Strategy 3: Burma is a member of the Association of Southeast Asian Nations (ASEAN). This group includes the protection of human rights as one of its founding principles. Pressure from ASEAN countries and especially Singapore, can yield positive outcomes in Burma. Strategy 4: As noted earlier, Burma spends 40% of its GDP on the military and only .3% of GDP on health care. I discovered through my research that China and India are the two largest suppliers of military equipment to Burma. Moreover, they exchange intelligence information and conduct joint military training exercises. The Burmese dictatorship remains in power because of the military support it enjoys and it is obviously totally dependent upon purchasing weapons systems from China and India. European nations, the U.S., Canada and Australia can utilize their extensive diplomatic resources to pressure China and India to push the Burmese Government to implement health care reform or risk the loss of military support. Conclusion This case examined two important health care issues in Burma; maternal health and infant mortality and the spread of infectious diseases. The case draws heavily upon the work of the Global Health Access Project in undertaking research related to the scope and magnitude of the health problems facing the Burmese people. The case provides four macro-level recommendations aimed at assisting public health professionals in Burma with the difficult task of improving health care for the citizens of this impoverished and vulnerable nation. Bibliography Macan-Markar, Marwaan. “Public health ailing even before cyclone struck.” May 19, 2008. retrieved from www.ipsnews.net. Much of the background information on the health issues in Burma was retrieved from the Global Health Access Project website at www.ghap.org. Some of the economic and demographic data on Burma were retrieved from www.intute.ac.uk. To get a real sense of the dire situation facing Burmese refugees and migrant workers see the materials on the Mae Tao Clinic website at http://maetaoclinic.org. The World Health Organization provides extensive data on every country in the world. See the WTO website at www.wto.intl/countries. Read More