Category Archives: Myanmar

Accessible Healthcare Requires Local Participation: Dr. Cynthia Maung

The Mae Tao Clinic, known locally as the Student Clinic, in Mae Sot, Thailand, near the Myanmar border, has been providing basic healthcare services for internally displaced persons (IDP) and migrant workers for three decades.

With the changing political landscape in Myanmar and bilateral ceasefire agreements signed between the Myanmar government and ethnic armed organizations in 2012, the clinic has seen a reduction in aid from the international community, forcing it to end some healthcare services. However, the number of patients seeking healthcare at the clinic—from Karen State and elsewhere in the country—has not declined.

Despite facing many challenges in providing basic healthcare services—including maternal and childcare services and providing education to the children of migrant workers in Thailand’s Tak Province, as well as issuing birth certificates to the newborn babies of migrant workers—it continues to operate.

Since Myanmar’s peace process began, a consistent sticking point in talks has been the reintegration of refugees displaced by decades of fighting. Dr. Cynthia Maung, the clinic’s founder, said it is important to include the experiences and perspectives of local health workers when considering future health sector development in ethnic areas as part of interim arrangements outlined in the nationwide ceasefire agreements.

On the occasion of the 30th anniversary of the founding of the Mae Tao Clinic, in June, The Irrawaddy’s Associate Editor Nyein Nyein spoke with Dr. Cynthia Maung about healthcare services and her views on the implementation of the peace process.

Most patients seeking healthcare at the clinic have been from areas affected by armed conflicts along the Myanmar-Thailand border. After the ceasefire, whom are you mainly providing healthcare services to?

Although there are ceasefires, basic healthcare alone is not enough for the IDPs and migrant workers to receive all-accessible healthcare services. It also depends on their incomes, jobs and the stability of local populations.

Without an income, a job and a stable populace, IDPs become migrants. Moreover, not all migrant workers are from the border areas of Kayin State alone. Every year, many people from other parts of the country—including the Bago, Ayeyawady and Yangon regions—come to Thailand. As a result, there are always new people arriving here. The number has never dropped. It can be assumed that the number has increased.

Many migrants’ children are born here. It isn’t yet possible for migrant workers to go back as they have their jobs here, so they send their children to school here. As a result, child rights protection and education have become part of the clinic’s operations.

For healthcare services inside Myanmar there are ethnic group-based healthcare service teams providing basic healthcare in their respective areas. We continue to train health workers and provide technical assistance as much as possible.

Sometimes, patients seeking healthcare at the clinic need to be referred to government hospitals in Thailand. We also encourage programs to refer patients to government hospitals [in Myanmar]. We are cooperating with government hospitals especially in the maternity and childcare sector so that patients can get services there [in Myanmar]. Patients with injuries or chronic diseases are still coming here to Thailand.

Even though there is a ceasefire, we need to give priority to providing accessible healthcare services to all. When it comes to maternity services and childcare, we give priority to vaccination, family planning and taking care of pregnant women.

For vaccination and pregnancy care, some people are still coming to us in Thailand, as we have enough trained healthcare workers and we are in close geographical proximity. They are receiving healthcare services here depending on the type and level of services they need.

Some well-to-do people go to private Thai clinics or to Mae Sot Hospital. Not all of them come to us. Some 30 percent of patients seeking care in private hospitals and township hospitals along Thai-Myanmar border are Myanmar citizens.

What role does the clinic play in providing healthcare services to repatriates?

There are two types of repatriates: refugees who officially lived in refugee camps and those who did not. Most migrants tend to commute repeatedly even after they return home. One or two years after they go back in Myanmar, then they come back again. It is difficult to predict [their movements].

Healthcare service providers along the border continue their assistance to such migrants. When they return from refugee camps to their areas, especially along the border, there are healthcare services provided by ethnic organizations and health workers from civil society organizations. When they return to such places they can continue to receive healthcare services.

However, there are some limits for patients with chronic diseases. If an ethnic healthcare organization cannot provide treatments, for instance, for HIV or TB, we have programs to reconnect them with government healthcare services.

Currently, there are some pilot programs on the national level to combat HIV, TB and malaria. However, it is not accessible to all patients. Therefore the access to treatment for patients with chronic diseases including mental illness, HIV and TB is still limited.

How many patients affected with infectious diseases like HIV does the clinic treat every year?

We currently have some 4,000 HIV patients. We know this from those who took blood tests for pregnancy, blood donation and other tests each year. There are 150 new cases every year.

We refer patients who need treatment to Myawaddy Hospital [in Karen State] since the support program for migrant workers by the Global Fund was stopped in 2017. We currently refer most of the patients to Myanmar, but some patients went back to their own villages; if so, we cannot reach out to them.

How is the clinic surviving amidst shortages of funding assistance?

The international governments and their development programs—which now have direct assistance programs in Myanmar and cooperate directly with the government—have reduced their assistance for healthcare services in Thailand since 2012. This has had a great impact on our organization as well as on hospitals in Thailand. There have been no funds for this [Thai] side of the border.

For emergency childbirth, we refer patients to Mae Sot Hospital. This is because of the differences in staff and medical equipment between the Mae Sot and Myawaddy hospitals. We refer those who do not need emergency operations to Myawaddy Hospital. Because it is cheaper to get treatment in Myanmar than in Thailand, we send them to Myawaddy and continue to help them with social assistance.

There are some patients, including those with chronic diseases, we cannot refer to Mae Sot Hospital. If the patients can afford the costs, we refer them to Mae Sot Hospital, but as we cannot take responsibility for the costs, we cannot help all patients’ referrals.

Besides, we cooperate with some organizations for patient referrals as we alone could not provide such services anymore.

This is also true for some programs at home [inside Myanmar]. Because the clinics or hospitals in Myanmar can get access to funding to provide direct services, we do refer patients to them, but we try to manage to provide for our staff’s needs, including their salaries and necessary technical support (skills development). However, we cannot afford to pay their wages fully and have had to reduce their pay to 80-85 percent of their previous salary, depending on our funds. [Comparatively], we received as much as 70 percent of our funds from [international] governments in the past, but their funding support is now at some 30 percent.

We try to secure the rest of the funding by applying for funds from foreign embassies in Thailand in cooperation with our partner organizations. There are some Thai individuals and organizations that help fundraising for us among Thai communities too.

Then our international partner organizations also organize fundraising campaigns for us in their respective countries, including the U.S. and the U.K. We also organize fundraising campaigns here. However, we still do not have a strong financial source at the moment. We are trying to sustain ourselves with income programs for the future.

Another source we raise some funds from is the public and parents. For example, we collect 10 or 25 percent of healthcare costs or school admission fees from migrants with their consent. Those who cannot afford this contribution will not have to pay it.

If a patient seeking surgery can contribute only 10 percent of the cost, although we’ve set the fee at 25 percent for such patients, we will accept only 10 percent. Some of them can’t afford anything. Although we expect to get 25 percent of healthcare cost from patients, we may actually receive only 5 to 10 percent of it. We also cannot use that method for all patients. We cannot do this for emergency patients. Patients who do not need emergency treatment and those with chronic diseases can contribute money for blood test fees. There are also programs to collect financial contributions from patients for their costs if they need to be referred to Mae Sot Hospital. Another way is accepting donations of medicine and medical equipment. There are some people in Mae Sot who regularly donate food or medicine.

How is the clinic cooperating with governments or ethnic armed organizations to provide healthcare services to people in border areas?

We are not working alone. We cooperate as part of a group called the Health System Strengthening Working Group, which was reorganized as the Health Convergent Core Group in 2012. The group focuses in areas not just in the eastern part of the country but on all other states, including Shan, Kachin, Rakhine, and Chin.

We are working toward having a better healthcare system among ethnic healthcare organizations, and we also have programs in cooperation with the government.

We have some negotiations with the government for our health workers, including midwives, to become the government-recognized health workers in their villages.

The purpose is [for us and the government] to mutually recognize each other and to make the best use of local health organizations and their strengths. It is a way to exploit human resources for local development.

Mae Tao clinic has trained many refugees and members of ethnic organizations to become health workers, but there is no arrangement that officially recognizes them as health workers or provides them licenses to treat patients [especially in remote ethnic areas where access to healthcare is challenging]. This is a challenge for us.

When it comes to the peace process, it is necessary to coordinate with the government for health systems, social work and other systems for local people, and it is also important to recognize them and make improvements. Only then will we be able to create an accessible healthcare system for all.

It is difficult to create a good healthcare system without the participation of the local people and local health workers.

This is because if we want to build trust politically, geographically, [across different] languages and traditions, we need to find out ways to foster cooperation between health workers and organizations as well as between government health organizations and ethnic-led health organizations.

All this is related to the health sector. How about education and the issuance of birth certificates—what are the challenges in cooperating with the current or with previous governments on these issues?

The first challenge is the need to create programs to make local healthcare systems and ethnic education systems acceptable to all in terms of government policies.

However, there is no program to thoroughly discuss healthcare and education policy. Although they were discussed to some extent [during the political dialogues], it can generally be said that there is no discussion on topics like healthcare and education systems that are in line with federalism.

In regard to the issuance of birth certificates, in ethnic areas, the ethnic health workers deliver newborn babies. A birth certificate includes correct data such as place of birth, parents’ names, origin and ethnicity. Whether it is in education or birth certificates or healthcare, statistics and information that are documented need to be correct. It is one of the topics we need to discuss further.

This is because sometimes there are problems such as misspelled names due to different dialects, or not having the real name, or discrepancies between names written on birth certificates and on the family’s household registration documents issued by civil servants [in governmental departments]. As some people are moving from place to place and do not have household registration documents, their places of birth sometimes cannot be determined. These are challenges we have experienced.

To address all these issues, it is very important [that the government] cooperate with local civil society organizations and local health organizations.

Written by Nyein Nyein
Source: The Irrawaddy
Published on 18 July 2019

#MeToo in Myanmar: Two documentaries on how the global movement has inspired women to speak out

More and more women in Myanmar are sharing stories about experiences with sexual abuse and their struggle to combat gender discrimination. Here are two documentaries which show women speaking out against violence and standing up for gender equality.

The documentary “Metoo Myanmar,” produced by Myanmar Journalism Institute for Mizzima TV and released in April 2019, investigates the problem of sexual violence in society and how it continues to victimize many women despite the passage of laws meant to protect vulnerable segments of the population.

The documentary features women who became victims of human trafficking, domestic abuse, and sexual harassment in the workplace. It narrates particular stories of young migrant women who were forced to marry Chinese men near the China-Myanmar border, teenagers raped by relatives and even a Buddhist monk, and wives moving on from traumatic relationships.

In November 2018, the UN Population Fund (UNFPA) released a short film featuring the voices of women who talk about their experience of gender norms, gender inequalities and women’s rights in Myanmar.

“The films explore gender inequality as the root cause of violence against women and girls, and they carry the voices of women and men who are both ordinary and extraordinary at the same time,” according to an introduction provided by UNFPA.

Both films note how the global #MeToo movement has inspired a growing number of women in Myanmar to bravely confront their abusers and speak out against sexual violence.

One of them is Eain Chit, a famous singer in the country who shared in the “Metoo Myanmar” film the instances when she received sexual offers and was asked to sing and dance privately in front of rich customers.

After narrating more cases of abuse involving women who were harassed and attacked, the documentary points out the need to enforce laws intended to defend women’s rights

Myanmar has signed the United Nations Convention on Anti-Discrimination Against Women in 1997, but all stories in this documentary prove that special laws to protect women don’t work in here. On the contrary, it’s more likely rape and other sexual violence against women is increasing.

According to government figures, reported rape cases went up from 671 in 2016 to 897 in 2017.

A major challenge in advancing women’s welfare is resisting feudal thinking like the concept of hpon which promotes the supposed superiority and positive spiritually of men over women. This unequal status between men and women has forced the latter to remain quiet if they experience sexual violence. It has promoted a culture of fear linked to the concept of men having a natural right to dominate women. But since 2018, the #MeToo movement has given confidence to many women in Myanmar to question hpon.

In an interview with Tea Circle, an online forum focusing on Myanmar issues, researcher and activist Aye Thiri Kyaw cites a #MeToo-inspired incident in 2018:

…a few teenage girls publicly denounced a popular and famous fortune teller, saying that he had sexually abused them when they visited him a few years back. Their public declaration was a surprise to people, given the age of the girls, and the social prominence of the fortune teller.

She adds that a number of women have also accused an NGO leader of harassment and sexual assault.

Also interviewed on Tea Circle was Kachin activist May Sabe Phyu who explains the motivation of some abused women to share their stories:

Women in Myanmar have suffered in silence. Now they understand that sexual violence is not their fault. They hear other women’s stories, and they realize that their stories will never be heard unless they speak out.


Written by Mong Palatino
Source: Global Voices
Published on 15 July 2019

Academic’s study of migrant workers wins prize from ILO

HÀ NỘI — A Vietnamese academic, Hạnh Nguyễn, has won the 2019 Regulating for Decent Work Prize from the International Labour Organisation (ILO) for her study of the conditions of female migrant workers in Myanmar’s garment factories.

The paper, titled “Expectations vs Reality: The Well-being of Female Migrant Workers in Garment Factories in Myanmar”, focused on workers’ well-being within the context of the economic and social transition in Myanmar.

The award was presented by ILO Director-General Guy Ryder at the conclusion of the 6th Regulating for Decent Work Conference, held at the ILO’s Geneva headquarters.

The prize recognises the best paper by an emerging scholar from a developing country.

Hạnh said she planned to turn her paper into policy recommendations.

“The recommendations will be submitted to the Ministry of Labour, Immigration and Population of Myanmar as concrete action to empower female migrant workers in garment factories,” she said. “This has never been in place in the country before.”

In her research, Hanh examined how the concept of material and non-material well-being is understood, as well as the experiences of female migrant workers in the labour-intensive garment industry.

She presented her paper at the three-day conference which brought together researchers from across the world to discuss new ideas and policies that could help shape a better future of work. — VNS

Source: Vietnam News

Published on 12 July 2019


Thailand: Two million migrant workers allowed to register

Bangkok (NNT/VNA) – There is good news for more than two million migrant workers in Thailand after a meeting of the Committee on the Migrant Worker Management Policy agreed to allow migrant workers from Cambodia, Laos and Myanmar whose work permits expire in 2019 and 2020 to renew their work permits without leaving the country.

Deputy Prime Minister Gen Prawit Wongsuwan chaired the meeting of the Committee on the Migrant Worker Management Policy which approved guidelines for the management of migrant workers in 2019-2020.

It allows 2,056,467 migrant workers from Cambodia, Laos and Myanmar whose work permits have not yet expired, excluding those who were imported under the MoU system and those who hold a passport or documents used to replace passports that are still valid on the date of application for a temporary stay permit, to be permitted to stay under the MoU without having to travel out of the Kingdom.

hey will be allowed to stay in the Kingdom for not more than two years. Each seal of permission allows them to stay in the Kingdom for a period of not more than one year.

They are divided into two groups: 587,533 migrant workers whose work permits will expire before March 31, 2020, who are allowed to work until September 30, 2021, and 1,468,934 workers whose work permits will expire from March 31, 2020 onwards, who will be allowed to stay working until March 31, 2022.

Migrant workers who don’t want to stay in the Kingdom of Thailand, have to return to their country of origin at the end of the work permit. However, if they wish to work in Thailand again, they must legally return to Thailand or under the MoU system only.

The results of the meeting will be presented to the Cabinet within two weeks for approval. Then, migrant workers will be allowed to apply for a work permit and ask for permission to temporarily stay in the Kingdom from August 15, 2019, or within 15 days of the Cabinet’s date of approval. – NNT/VNA

Source: Vietnam Plus

Published on 15 July 2019


Permit extensions mulled for workers

The Ministry of Labour will this month ask the cabinet to approve its proposal to extend work permits for migrant workers for another two years.

There are about two million eligible migrant labourers from Laos, Cambodia and Myanmar.

The policy will save time and money for both labourers and employees, Sutthi Sukoson, permanent secretary for labour told reporters after a meeting with Deputy Prime Minister Prawit Wongsuwon, in his capacity as acting labour minister.

“Under this proposal, both migrant workers and their employers will find it more convenient when they contact the ministry’s one-stop service centres for the renewal of the workers’ work permits as these workers will no longer have to return home, as was required in the past,” said Mr Sutthi adding that the ministry will table the proposal to the cabinet sometime in the next two weeks.

It is hoped the new policy will come into force in time for workers in the fishery sector whose permits are due to expire between September and November of this year.

Apart from granting more years, the Ministry of Labour is developing an online platform for permit renewal, said Phetcharat Sin-ouy, director-general of the Department of Employment.

The system will allow workers to file documents and make appointment dates for renewing their permits.

Upon successfully registering for their work permit renewal, a migrant worker will be assigned a 13-digit ID, which will be connected to the government’s database of work permits granted to foreigners working in Thailand, she said.

That will help to make the work permit database more complete and labour authorities will be able to track these migrant workers more effectively in their task of ensuring the only do the specific types of work they are permitted to do, she said.

The online platform, she said will also help labourers save money when renewing their permits. The Thailand Development Research Institute found that migrant workers were charged hundreds of baht by agents and employers just for filing in documents and setting appointment dates.

Written by Penchan Charoensuthipan

Source: Bangkok Post

Published on 9 July 2019


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