The [him] moderator wonders whether anyone working inside Burma has a response to Dr Cynthia’s assertions in this AFP article:
"Many groups focus on an issue -- nutrition, HIV. The NGOs in Burma don't have much opportunity to work closely with the community," she says. "Sometimes (people trying to help) have short-term objectives but no long-term vision. We need long-term commitment," she says.
Asian Lives: Myanmar doctor tends wounds from hidden war
15 February 2006
Agence France Presse
Mae Sot: There's no sign marking Dr Cynthia Maung's clinic, but almost everyone on this stretch of the Thai-Myanmar border knows the way.
On a typical day, about 300 people come to the Mae Tao Clinic seeking her care. Most are migrant workers who have fled the fear and desperation that rules just across the river in Myanmar. Many have crossed the border illegally, leaving them in constant fear of deportation and unable to turn to Thai clinics for treatment.
But about one-third of her patients make the grueling and treacherous trek from deep inside Myanmar, across the mountainous border, to seek her help. She is their last hope of receiving even simple treatments that are either unavailable or unaffordable at home.
They come to Dr Cynthia because she is one of them.
When a pro-democracy uprising shook Myanmar's military dictatorship in 1988, the response was brutal. Thousands are believed to have been killed when security forces opened fire on protesters in the streets.
The crackdown sparked an exodus of refugees into Thailand, including Dr Cynthia, who fled along with the rest of the people in the village where she worked in Karen state.
At the time, she expected her exile would be brief.
"We thought to change the political situation in Burma would take three or four months, but now it's 17 years," she says in a meeting room at the clinic.
In those first chaotic weeks in Thailand, she travelled around the border with ethnic Karen leaders, coordinating humanitarian and medical support for people entering the refugee camps. She helped get people into Thai hospitals, and then put together medical teams to coordinate doctors and nurses among the refugees.
Her fledgling organization began as more of an administrative center to coordinate medical services for the refugees. Gradually, she began to receive some sick people who could not go back to their homes, and who weren't sick enough to be admitted to the hospital.
So in February 1989, she began taking in patients, and eventually expanded those services beyond emergency medical care.
-- 'We can't establish infrastructure or facilities' --
Clinic is too modest a word for the sprawling compound that Dr Cynthia has created, just a few kilometers (miles) from the Myanmar border.
The brick and cinder-block buildings house a child-care center, a surgery, a workshop to make prosthetic limbs, a delivery ward, and 120 beds normally filled with patients. The shaded porches outside each room are mostly filled with children playing with pregnant women getting check-ups, and young people waiting for HIV tests.
Pictures of Aung San Suu Kyi, Myanmar's detained pro-democracy leader, hang in many of the clinic's rooms. Many are posters urging her release from house arrest.
The connection between the two women is not lost on the generals in Yangon.
Soft-spoken and simply dressed, her hair pulled back with a purple hair band, 46-year-old Dr Cynthia has been attacked by the junta with the same fervor as it has oppressed the pro-democracy opposition.
The junta has accused her of working with rebel groups, and in 1997 their forces destroyed a network of small clinics she had created inside Myanmar to serve people with no other health care.
But Dr Cynthia is determined to carry on the work she started in Myanmar before the uprisings in 1988.
She grew up in the town of Moulmein, in Karen state along the Thai border, where rebels have been fighting for autonomy for nearly six decades. Conflict was always nearby, but her studies helped her get away.
Among a handful of students who tested into the University of Rangoon, the former name of Yangon, to study medicine, she finished her medical training in the capital just before the pro-democracy uprisings in 1988, and returned to work in a village not far from her hometown.
Despite the efforts of the junta to thwart her clinics on the Myanmar side of the border, Dr Cynthia has found new ways of sending treatment to people inside Myanmar. She recruited and trained medics who strap on backpacks full of supplies and hike through Myanmar delivering medical aid.
"We can't establish infrastructure or facilities, but the health workers go from village to village to provide services," she says.
In Myanmar these backpack medics face certain imprisonment or worse if they are caught. When they return to Thailand, many of them have no legal status and could be deported at any time.
But most of Dr Cynthia's work is with the thousands of people who find their way here to Mae Sot, a town in the mountains on the Moei River that separates Myanmar and Thailand.
She shrugs off questions about why she decided to stay in Mae Sot when so many of her compatriots, especially trained professionals, have found more comfortable lives overseas. Instead she talks about the importance of building community ties here, both among migrants and the Thai residents, and her concerns for Myanmar's youth.
The cases she deals with open a rare window onto a decades-old conflict that has taken place largely outside the world's view.
--- Wounds from a hidden war ---
Rights activists accuse the regime in Yangon of countless atrocities against the ethnic minorities who live in the regions along the Thai border.
Some have argued that the regime's tactics amount to genocide, with mass killings, forced labor, burning of villages, forced relocations, and the recruiting of child soldiers.
Some of Dr Cynthia's patients bear the wounds of that violence, like the 40 people who came seeking prosthetic limbs after landmine injuries last year. Another 160 people needed repairs or replacements for their artificial limbs.
But most suffer from the side effects of Myanmar's crisis -- the infectious diseases and malnutrition that afflict people forced from their homes either by violence or by desperation.
About 30 percent of the patients admitted to the clinic suffer from malaria, and another 10 percent have HIV or tuberculosis. Many who cross the border for treatment need surgery, from cataract removals to heart operations.
Although three other doctors are on staff, international teams of surgeons visit throughout the year to volunteer specialized services.
Increasingly common are victims of social ills, a consequence of the changing demographics of Myanmar's migrants.
Thousands of new migrants slip across the porous border every year, pushing up the clinic's work by 20 percent from year to year, reaching 60,000 cases in 2005.
Most of the migrants used to be men who came seeking jobs to send money back to their families. Now many families move together, with both parents taking low-wage jobs in factories or on farms, often forced to leave their children at home without anyone to care for them.
-- 'Many children and young people lost their opportunity' --
The changing profile of Myanmar's migrants has also changed the clinic's caseload, with more incidents of malnutrition among children, more unwanted pregnancies and unsafe abortions among young women.
Many of the migrants are illegal, although Thailand established a registration system in 2001.
Last year some 850,000 people from Myanmar registered as migrant workers, which gives them some access to Thai schools and health care, but tens of thousands more are believed to be working in Thailand without documents.
Among those who did register are 63,000 Myanmar children aged under 12. But the education ministry says only 13,500 children from migrant families are attending Thai schools.
Even those who do register often live in abysmal conditions.
Amnesty International last year warned that Myanmar migrant workers are routinely abused, paid below the minimum wage, arbitrarily arrested and forced to live in unhealthy conditions.
Dr. Cynthia says she's especially worried about the fate of the children of these migrant workers, whose chances for a better life she believes have been dashed by the junta.
"Many children and young people lost their opportunity when they were young," she says.
She estimates about 10,000 migrant children live around Mae Sot, and about half go to schools organized by the Burmese community.
But the other half receive no education at all and are often difficult to reach -- either because their parents are itinerant workers who travel constantly, or because they work on farms or other areas too remote for school to be accessible.
For those who are illegal, they can be arrested and deported at any time.
"Sometimes when someone goes for a walk, they get arrested and deported and no one knows. Or the whole family gets arrested and deported," Dr Cynthia says.
The illegal migrants often lead lives of quiet desperation. Afraid to return home but in constant fear of deportation, they tend to live in isolation without friends or family to help them, Dr Cynthia says.
"Also there has been no good community support systems, because people are always mobile. So they have no holidays, no recreation."
The result of that stress is that violence in the home and the workplace appears to be on the rise, she says. Wounds are often left to fester, because workers are afraid of losing their jobs if they take a day off to see doctor.
--- 'We need to have a vision' ---
Despite the hundreds of personal tragedies that enter the clinic every day, Dr Cynthia still believes that Myanmar's military rulers could fall from power.
"I think that they are getting weaker and weaker. They know what is happening in the country but they ignore the problems. They just want to continue their power," she says.
While she believes the international community hasn't offered the constant support that Myanmar needs, she says part of the problem is that no one has a vision for her country's future or for solving its problems.
"Many groups focus on an issue -- nutrition, HIV. The NGOs in Burma don't have much opportunity to work closely with the community," she says.
"Sometimes (people trying to help) have short-term objectives but no long-term vision. We need long-term commitment," she says.
"We still need to have a vision because the thing is, if the situation in the political and social stability still threatens the country, it can affect the neighboring countries, and the global community."
