Guidebooks will say Yangon is most famous for the beautiful Shwedagon Pagoda, a sacred Buddhist site and major tourist attraction. But bring your eyes down from the towering golden spires to the streets, and the view can be somewhat less appealing.
RANCID RUBBISH: Piles of refuse remain uncollected in an alleyway behind Yangon’s 48th Street.
Some say it is smelly, some say it is busy, while others say it is expensive. But all agree Myanmar's main commercial city is dirty. In the city centre it is common to see people tossing rubbish on the street, spitting betel nut juice onto the footpath, discarding leftover food in alleyways and urinating on the roadside.
Sitting at his betel nut shop on Anawrahta Road, Aung Naing says: ''People don't have rules. They throw rubbish away carelessly. It is not good for public health. They know it, but it's a normal practice.
''You can see that this central area is a prime example,'' he says, pointing to his neighbouring shop where rancid waste and betel nut juices can be seen on the roadside.
His neighbour jumps into the conversation and adds: ''It is a problem that the city's six million people live and experience every day. During the hot season, it is dirty and smelly.
''But it is worst in monsoon season. We got localised flooding here simply because rubbish blocks the drains and canals.''
Yangon residents say that due to the poor system of refuse collection, drains in the city are full of waste food, damaged materials and other rubbish; major floods can happen after less than a day of non-stop heavy rain. They also say there are not enough rubbish bins in the city.
Young resident Mon Yan says the lack of rubbish receptacles makes life difficult even for people who are conscious of the waste problem. ''I throw rubbish carelessly sometimes, simply because I don't see any bins nearby,'' he says.
TAKING OUT THE TRASH
Yangon produces about 2,000 tonnes of rubbish daily, according to local media reports. The city has several rubbish dumps, but the main one is in Hlaing Tharyar township, on the city's southwestern outskirts.
According to Yangon municipal authorities, the main types of waste being produced by the city's inhabitants are kitchen refuse, commercial and factory waste and building debris.
The Japan International Cooperation Agency (Jica), the international development arm of the Japanese government, is working alongside the Yangon City Development Committee (YCDC), the city's administrative body, to help solve some of these problems by modernising the city after decades of low investment during military rule. As part of the ''Greater Yangon'' project, Jica hopes to upgrade the city's drainage facilities and sewage system, in addition to improving its water supply.
Noriko Sakurai, an adviser to the Japanese foundation, said the YCDC department for pollution control and cleaning launched an initiative in April last year to provide different garbage bins for wet and dry waste, but not enough bins had been supplied.
Maki Morikawa, another adviser assisting Jica with infrastructure plans in Yangon, said a research team working with local authorities had also identified a wide array of problems with public transport in the city.
Despite political and economic reforms under Myanmar's quasi-civilian government, municipal departments are often criticised for failing to handling flooding, while local authorities also draw public ire for their failure to handle traffic congestion in the city. Poor water supplies, on-and-off electricity, accumulation of rubbish and traffic jams are daily problem for Yangon residents.
''The government claims that Myanmar enjoys democracy. But they have many things that need to be done,'' says taxi driver Soe Lwin.
''For example, garbage in Yangon is a big problem. People carelessly throw rubbish and there is no solid action taken against them. Even the authorities lack discipline.''
BARRIERS TO EDUCATION
In May, environmentalists in the city planned to clean up some litter-strewn streets and public spaces over a weekend, but were stopped by municipal authorities. The environmentalists, led by Free Funeral Service Association founder and former actor Kyaw Thu, began a campaign in two townships to educate the public on the importance of proper waste disposal. The group also planned to collect rubbish in the city centre, but were contacted by a municipal committee and told they were forbidden from doing so. No reason was offered for the ban.
Smelly and polluted floodwater in Yangon often leads to skin irritation or more serious diseases for residents. On many city streets, food vendors commonly set up tables alongside piles of garbage. Rubbish can be smelled, and rats often run around local shops and restaurants while customers eat.
Simon Tyler, deputy head of mission of of Medecins Sans Frontieres in Myanmar, the international medical and humanitarian aid organisation, says malaria, dengue fever, gastroenteritis and diarrhoea, the common cold and flu, and viral infections are the most common diseases during the monsoon season.
''Both [typhoid and gastroenteritis outbreaks] are common during the wet season due to poor water and sanitation conditions. Flooding can also create further risk in rural areas where ponds are used for communal water sources,'' Mr Tyler says.
He says illnesses caused by poor sanitation are generally diseases where mosquitoes are the primary vector, such as dengue fever or malaria, or water-borne diseases such as gastroenteritis and diarrhoea.
Scabies and other fungal infections are common where poor personal hygiene is the main contributing factor. The risk is often increased when poor water and sanitation conditions are present.
Hla Cho, a physician at International SOS Clinic in Yangon, says: ''If we can't effectively provide public health eduction, building new hospitals will not be effective. There is no point treating patients in hospitals and clinics if we ignore public health education. There is almost no awareness.''
He said public health education, public awareness and individual responsibility are important factors to help improve health conditions in the country.
''Public health education among ordinary people is still poor. For example, people throw garbage carelessly, but there is no legal action against those people. There is no law enforcement,'' Dr Hla Cho says.
''There is a lack of awareness about individual responsibility. It is very important to be responsible for our own actions so that they don't affect others. For example, people spit while driving.''
HARD FACTS TO SWALLOW
Mosquitos can been found in the city's canals, drains, old hand-drilled wells and in other garbage dumps, contributing to outbreaks of malaria, which is a leading cause of death in Myanmar according to 2010 figures from the World Health Organisation.
Many Myanmar people rely on street food as the foundation of their diets because it is cheaper than eating at restaurants, although often less sanitary.
The majority of street-food consumers are day labourers who earn about 50,000 kyat (1,630 baht) a month and can barely afford to feed themselves.
Tour company driver Ko Lin says he has no choice but to eat at street stalls as he cannot afford anything else. He is aware of, but unfazed by, the health risks.
''All people have to die one day,'' he says. ''I know it is not good for my health. But I can't always pay for expensive food and I don't have time to cook as I have to drive all day. So, I eat cheap street food. Now, it is normal for us to eat street food. I have no problem.''
Consumers, especially tourists and other foreigners, complain that street food often upsets their stomachs. Ko Lin recalls one of his tour groups who became victims of Yangon's unsanitary food vendors.
''One evening, I brought them [the tourists] to a cheap local restaurant. All of them had upset stomachs later that night. They blamed me for that, so now I always eat separately and send tourists to more expensive restaurants.''
Ko Lin says he also suffered stomach problems after returning from a stay in Malaysia.
Myanmar food is often extremely oily and salty, with large amounts of MSG used in soups and curries.
Cooking oil is rarely changed in cheap restaurants, posing cancer risks.
Life expectancy in Myanmar for men is around 60, while women can expect to live until around 65 _ it is in the bottom 20 of the 148 countries where life expectancy records are kept, according to the WHO.
Asked about his health awareness, Ko Lin replies that he doesn't expect to live a long life, acknowledging that ordinary people like him who consume unhealthy and unclean food often suffer from health problems.
''I don't expect to live longer than 50. I'm afraid I wouldn't be able to work and earn a living if I was older then 50. I'm okay with that. It's enough for me.''
SORDID STENCH: In an alleyway in central Yangon, the pavement is hidden by stacks of uncollected trash.