Health cooperation at border critical

Health cooperation at border critical

Last week I was awarded an honorary medical doctorate from the University of Ubon Ratchathani. To receive an award of such high regard was a huge honour, and it was a privilege to be given it by Her Royal Highness Princess Maha Chakri Sirindhorn.

To accept a doctorate from an academic institution in Thailand is particularly special since I have been living and working here at the Mae Tao Clinic (MTC) in Mae Sot, Tak province, for the past 25 years. It is the first time a Thai academic institution has recognised the work we have done.

Although our clinic is located 700km away, both of our organisations are similar in that we work on Thailand's borders to develop solutions to expand health access for rural and mobile populations. The MTC also supports the Thai Border Health Master Plan, an initiative that will not only expand access to health services for migrants in this country but will also serve to advance public health along the borders, and I look forward to increased coordination between government health institutes as well as with non-government and community organisations, such as ours.

Recent changes to the work permit system and improvements in access to health insurance for migrant workers have been welcome changes, expanding access to particularly vulnerable groups such as those with HIV and pregnant women.

However, there are still significant barriers.

The costs involved remain unaffordable to the many undocumented migrants in Thailand, particularly for those with families. Information on how the system works is still confusing.

Half of our patients are migrants working in Thailand, of whom 80% are undocumented, struggling to make ends meet as day labourers.

Significant changes have also unfolded in my home country, Myanmar, in the last two years. The clinic was able to help facilitate a meeting between Myawaddy Hospital on the Burmese side and Mae Sot Hospital on the Thai side.

Despite being less than 10km distant, this is the first time all three of us have been able to officially meet in over two decades. As a result, there has been more coordination between our institutions. This is key for improving public health, not just in this Thai-Myanmar border area but also beyond, as communicable diseases do not recognise borders. Local health authorities in Mae Sot have long recognised this reality and have been our partners, along with other local and international health organisations, in empowering the people to manage their own health.

Yet in our communities, much remains to be done. Decades of civil conflict have resulted in thousands of children born without citizenship and the protections that entails. In addition, community health workers continue to provide vital services despite lack of recognition and accreditation, liable for arrest at any time.

Indeed, our clinic remains illegal in Myanmar, and the country's colonial era Unlawful Associations Act remains in place, with potential imprisonment for any who simply meet with us, should the Burmese authorities choose to enforce this. Myanmar's health crisis, particularly for rural communities, continues.

Although the Burmese government recently increased its expenditures on health, it is still well under US$10 (320 baht) per person per year; Thailand's equivalent figure is closer to $200, and there has been little tangible change in the health of the peoples of Myanmar, particularly in impoverished, rural, ethnic communities.

Myanmar's official health indicators such as maternal mortality ratios and infant and child mortality rates remain among the worst in the region.

Comparable figures for Eastern Myanmar, where conflict, abuse and poverty have rendered much of the population without access to proper healthcare, are far worse and can resemble other better-known humanitarian disaster areas such as Somalia.

With official international humanitarian access impeded, the Mae Tao Clinic collaborates with ethnic health service providers to deliver basic health services for these communities, which would otherwise not have access to such services at all. Many others simply cross the border to access care unavailable at home and, for most of the last 25 years, 50% of our patients have come from Myanmar specifically for healthcare.

Such initiatives not only reduce premature deaths and preventable sickness for these communities but also have been instrumental in monitoring and curbing the spread of infectious diseases with international ramifications, such as measles and influenza.

To me, the true measure of change in Myanmar will be the cessation of armed conflict and human rights abuses, when people provide a vote of confidence in the country's changes by returning home in safety and dignity; when they no longer have to travel far distances, across borders, to access basic education and health care services.

Earlier this year, we received news that Australian government support for the Mae Tao Clinic would not be continued. Other colleagues have also experienced a withdrawal of international funding for migrants and displaced populations in Thailand border areas, often overlooking that Myanmar's acute humanitarian crises continue unabated despite the changes in Nay Pyi Taw and Yangon.

Despite these setbacks, we will continue to work with our communities in Eastern Myanmar, helping to provide health services and to train health workers who are able to provide health care, empowering communities to play a role in their own health management, particularly when the government continues to fail to do so.

Cynthia Maung is founder and director of the Mae Tao Clinic, founded in 1989 on the Thai-Myanmar border.

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