The [him] moderator knows that he had better not tangle with Mr Parker. But delaying the publishing of this article by a day or two might have allowed people working inside the country to add their views.

The report is excellent and must be read in its entirety. It is attached for you to do so.

The [him] moderator is pleased to be responding to the following recommendation: “Donors and the international community will likely need to explore all possible avenues, including bypassing state controlled media, to share health information with the people of Burma.” [him] is doing just that.

But he is disappointed with the only concrete recommendation made for action inside the country: “Those donors who do intend to work in Burma should endeavor wherever possible to focus on increasing support for aboratory capacity, lab staff, better disease surveillance and reporting.” Supporting only laboratories may only allow people to be observed as they die. Laboratories were quite competent in monitoring the spread of the HIV epidemic years before action was taken.

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Burma’s Health Situation a Regional Problem, Says Report
Clive Parker
28 March 2006

March 28, 2006—A new appraisal of Burma’s healthcare system released today says the country is facing a worsening humanitarian crisis with the potential to wreak increasing damage on the health of people both inside and outside the country.

The report—produced by the John Hopkins Bloomberg School of Public Health based in Baltimore, Maryland—says the junta’s failure to offer its citizens adequate healthcare means more resistant strains of malaria and tuberculosis are developing in the country. Similarly, the report concludes that Burma is a melting pot for increasingly diverse strains of the HIV virus, and is at risk of failing to adequately monitor and contain bird flu, with potentially deadly results both nationally and outside the country.

The John Hopkins study—which was funded by the Center for Public Health and Human Rights and the Bill and Melinda Gates Population and Family Health Institute—was presented to US State Department officials during a briefing on March 24.

“There is a growing humanitarian crisis in Burma. We document how the ruling government’s policies have restricted nearly all aid and allowed serious infectious diseases to spread unchecked,” said Chris Beyrer, one of the main authors of the study. “The Burmese junta is increasing restrictions on humanitarian assistance and public health, while the health of Burmese people deteriorates, posing a widening threat to Burma and her neighbors.”

Although a World Health Organization report said last week that Burma was one of five “high burden countries” that was expected to meet detection and treatment targets for TB, the John Hopkins study contends the situation may be much worse. Although data is scarce for most diseases in Burma, the study says this is especially true in the case of TB which is estimated to have infected 40 percent of Burma’s more than 50 million people.

The prevalence of black market treatments exacerbated by a lack of funding for approved drugs, adequate laboratory facilities and testing means that Burma is already suffering a dangerous increase in drug-resistant cases of TB, with instances twice as high as the regional average.

The situation with malaria—Burma’s biggest killer—is equally alarming, the report concludes, with counterfeit drugs causing a rise in resistance to the remedies most commonly used globally, a problem which makes treatment more expensive.

“Reported funding from the government has not risen to match the problem,” the document says.

Many cases of the disease remain unreported due to the inaccessibility of Burma’s largely forested periphery, which remains afflicted by fighting between ethnic insurgency movements and the Burmese army. The result is a huge number of people receiving no treatment for the disease, which translates into high mortality rates, the report concludes.

With regard to Burma’s HIV crisis, the report notes that the junta’s budget of US $22,000 per year to fight the disease is woefully inadequate. This is highlighted by the fact that the main laboratory serving upper Burma is unable to conduct tests considered “the minimum standard for accepted monitoring for AIDS care and a key indicator of when to begin antiviral treatment.”

The UNAIDS Rangoon office was unavailable for comment today.

The report said the latest disease to afflict Burma—avian influenza—could prove to be the most adept at taking advantage of the junta’s inadequate efforts on healthcare: “With the global spread of bird flu, there is a fear that if a human form of H5N1 were to take hold in Burma, it could potentially spread unchecked for weeks or months before anyone knew about it,” Beyrer said. “Uncontrolled spread of any disease, especially an emerging disease like H5N1, poses a serious health threat to Burma’s populous neighbors, like China and India, as well as the rest of the world.”

Burma first reported the outbreak to the outside world on March 13. Meanwhile, the Food and Agriculture Organization today sent one of its officials, Dr Wantanee Kalpravidh to Rangoon for the second time since the disease first appeared, to further asses Burma’s response. It has previously said it may supply training to Burmese laboratory staff in a bid to help the country fight the disease.

Commenting on the claim in today’s report that Burma’s ability to conduct bird flu surveillance outside of Rangoon and Mandalay was “uncertain,” the FAO said there was no way to gauge whether this indeed was the case.

“That seems to me to be speculation,” Laurence Gleeson, an FAO official based in Bangkok told The Irrawaddy. “I know that they are relatively poorly resourced, that they are relatively lacking in training and experience to deal with an epidemic of this sort. The FAO does not want to be dragged into any political debate about the regime. Instead we are at the disposal of governments and cooperate with a large range of development partners…to try to curb the spread of the disease.”

Suggesting strategies to alleviate Burma’s humanitarian suffering, the John Hopkins team recommended greater funding for cross-border humanitarian projects and called for opposition to the junta’s increasing restrictions on international aid agencies.

Burma’s Ministry of Health, the UN Development Program’s Rangoon office and Medecins Sans Frontieres Holland were also unavailable for comment.

http://www.irrawaddy.org/aviewer.asp?a=5600&z=154