Rural Public Health on the India-Burma Border

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GHAP believes that access to health care is a basic human right, and the people living at the India-Burma border do not have access to adequate health care and therefore are denied a fundamental human right.

I want to give my profound thanks to the InterExchange Foundation for the Christianson Fellowship, which provided me the opportunity to spend a year working abroad at the border of Burma (Myanmar). I spent a life-changing year as Global Health Access Program’s (GHAP) India Fellow providing technical assistance and capacity-building support for public health programs operating at the India-Burma border.

I started 2010 training on the Thailand side of the border. In Mae Sot, GHAP has been operating and expanding programs since 1998 and has been in good company along with various government aide programs, international organizations, agencies of the United Nations, and other small and mid-sized NGOs that provide support and services to refugees, migrants, and internally displaced Burmese. Dr. Cynthia Maung, founder of the Mae Tao Clinic in Mae Sot, has gained international renown for her phenomenal efforts to bring free health care to the community and has been recognized with the 1,000 Women Nobel Peace Prize Nomination.

This recognition, among other awards and honors for outstanding commitment and achievement, has attracted international attention and support. Mae Sot is an active, vibrant community welcoming international volunteers and staff to participate in a diverse range of projects in health, education, and vocational training and offers an active social scene including trivia nights, karaoke, pool parties, and the chance to escape the hot season with a mocha frappe in an air-conditioned coffee shop.

The India-Burma border, however, is the complete opposite. During college, I spent a semester studying abroad in Pune, India, but this experience did not prepare me for border work - the food, people, and culture could not be more different. No international NGOs hold permanent offices in Aizawl, the capital city of Mizoram, an Indian state bordering Burma and Bangladesh. When I paid a visit to the government tourist registration office in October for my periodic mandatory foreigner registration, only 436 visitors had preceded me that year.

Shops, restaurants, and the one bus in town shut down at 6:00 p.m. If you wanted to eat on Sunday, you needed to buy your food on Saturday or make other meal plans because the entire city is closed while the 90-percent-Christian population attends church. The city of Aizawl is perched on a mountain top, which means most goods travel long and arduous journeys before they are available for sale, and they come with a price tag that reflects the cost of the imports.

The Christianson Fellowship ensured I could afford to buy fresh produce and several local outfits, which I feel played a big role in helping immerse me in this often foreigner-averse culture. When I traveled north to Churachandpur, Manipur, I was in an even more remote area with one paved road through the center of town and electricity only a few hours per day. To further illustrate how remote and unfamiliar this area is: it took me three days to find a shop that sold tissues!

I found community mostly through my work with GHAP. As the only India Fellow for the year, three local staff gave me an orientation to life at the India-Burma border and in turn, I did my best to share my expertise in organizing training and logistics, ordering supplies, managing and analyzing data, and writing reports. Though he was the youngest staff member, S.A. had been involved in GHAP’s work with malaria control and Vitamin A and deworming distribution since the inception of the program in 2007. I was disappointed when he left the program in August to pursue other ventures, because he had made incredible accomplishments in building his skills in managing all aspects of the malaria program and he trained me in India’s national guidelines on best practices of malaria treatment.

S.A. grew up in rural Chin State in Burma and did not have the opportunity to complete formal education. Instead, he went through an apprenticeship to become a medic. His adeptness at learning led him to master both spoken and written English and financial management, and he navigated his way around a database with impressive ease. I admire S.A. for his accomplishments despite the hardships he faced in his youth and I’m grateful that he warmly welcomed me. I felt we formed a strong team and together we tackled challenges like when our shipping company held up our supply of Paracheck, the rapid diagnostic test used to test for Plasmodium falciparum, the most deadly form of malaria with a high prevalence in the region. We ultimately conquered this challenge by garnering support from the local hospital and sending their letters of support to the shipping company who had held our shipment due to a paperwork technicality.

K.T. educated me on the struggles of the Burmese people living under the military junta. As a member of the 1988 student uprising, K.T. has lived since then as a refugee and has worked tirelessly to promote democracy and advocate for equality and human rights. GHAP believes that access to health care is a basic human right, and the people living at the India-Burma border do not have access to adequate health care, and therefore are denied a fundamental human right.

In our work with GHAP, I found that both K.T. and I were motivated by our belief that everyone should be afforded his or her rights and this helped us to persevere through challenges, like finding a new training location on short notice and making the two-hour trip from Churachandpur to Imphal each time they received a Vitamin A shipment so we would have enough to cover the twelve-and-under population in the target villages. We also worked hard to develop training-of-trainers (TOT) modules to teach medics how to pass on their skills to village health volunteers. K.T. graciously welcomed me into his home, which is one room that he shares with his wife and two children and all the materials for his wife’s weaving business. K.T. and his wife make sacrifices so their two daughters receive the best education available to them, which is quite costly. I admire K.T. and am so grateful I had the opportunity to learn from him.

Mimi was my roommate in Churachandpur, so I had the opportunity to get to know her as roommates do. Mimi was most often my translator from Burmese and Mizo language to English and introduced me to her friends and family, so I experienced much of the India-Burma border through her eyes.

She works part-time as a journalist and her job with GHAP coordinating the reproductive health program was her first exposure to public health. While both of us do not describe ourselves as “math people,” Mimi really struggled to understand the concept of indicators. We spent hours reviewing the counts, percents, and averages used to monitor and evaluate the program with the data collected. One day everything clicked and Mimi and I celebrated her achievement of accurately explaining all the program indicators by going to the only restaurant that serves naan bread, our favorite.

In addition to the highs of success, I also witnessed the hardships of lack of health care on the border with Mimi. Together we visited a small clinic that treated severely ill people from Burma who were sick from upper respiratory infections, malaria, tuberculosis, and AIDS. Unaware of the methods of HIV transmission, one patient we met contracted the virus from her husband, who was a preacher and school teacher but had injected opiates with an unclean needle as a teenager and was living with HIV before they met.

Medications for HIV and AIDS are extremely difficult to find in the rural Sagaing Division in Burma and the husband and wife came across the border to India for treatment after they were both extremely ill. Each of them passed away from complications due to AIDS within a month of the other, leaving behind two small children. Mimi and I were there as the community tried to raise funds to transport the woman’s body back to her village in Burma. They were terrified that the funeral procession would not be permitted to travel back across the border because of widespread myths about the cause and transmission of HIV and AIDS. Mimi helped me see and understand the challenges of this situation, and I am forever indebted to her for allowing me into her life and for her friendship.

After this year, I feel even more certain of my chosen career path: to strengthen health programs for those who had to flee their homes due to disaster or fear of persecution. I plan to return to school to study public health and I hope to return to work abroad with displaced populations throughout my career.

I know my experience with GHAP helped me grow as an individual and made me a more aware global citizen. I am grateful to the Christianson Fellowship and the InterExchange Foundation for acknowledging how influential a work-aboard experience can be and for supporting me and others who go abroad to work in public health, environmental conservation, education, development, human services, and other sectors to try to improve conditions for vulnerable groups and strive for universal access to human rights.