Myanmar Australia Conolly Foundation. November 2015. Queue outside the MACF temporary clinic in the hill village of Leik Tho, Myanmar. Photo: Dr Tim Peltz.
Zalattni Press sits in a low, nondescript building behind a simple family-run restaurant in Yangon’s Seven Mile district. Below its front step, chickens scavenge around the base of tangled jasmine bushes and ever-increasing amounts of traffic block the main road metres away.
Until late 2015, the operation had only a single, old-fashioned printing press, often run in the dead of night. Buddhist scripts bundled with string now commonly leave the building, but, in the kleptocratic Myanmar of military rule, the press – partly funded by the small Sydney-based charity, Myanmar Australia Conolly Foundation (MACF) – became a secret frontline in the medical education of the country’s most poorly served.
“Nowadays, it is not so sensitive. We just did it quietly, we didn’t do any ceremony,” says Dr Sai Kyaw Han, who, with editor Dr Sai Hla, oversaw the clandestine nascence of a Shan version of developing world health guide, Where There is No Doctor, in 2006, nearly a decade before November’s historic election victory by Aung San Suu Kyi’s National Democratic Party.
Myanmar Australia Conolly Foundation. November 2015. Queue at the MACF temporary clinic in the hill village of Leik Tho, Myanmar. Dr Raymond Wong sees a patient. Photo: Dr Tim Peltz.
Factions of the country’s 6 million ethnic Shan people are engaged in civil war against the Burmese Army in a struggle for independence that has lasted for more than five decades. The regime monitored every publication in the country, treating those who published ethnic literature unforgivingly. For a population let down by an almost non-existent, bribe-riddled health system, the Burmese long ago learnt to rely on their own wits to safeguard children’s futures, despite the risk to their own safety.
Translated into Shan by Dr Sai Pe and Sai Kong Sid, the guide and its sister version, Where Women Have No Doctor, with their clear illustrations and straightforward instructions, were able to quietly spread among the ethnic Shan population well beyond the reach of the government’s rudimentary and chronically neglected healthcare system.
Without access to any doctor in remote areas, the book soon became a boon, if not a lifesaver, for the rural sick and injured – not least insurgent troops, for whom the guide is a critical element of a piecemeal medical education.
A girl from the island of Seikkyi, one of Myanmar’s poorest neighbourhoods holds the book “Where women have no doctor”. Photo: Daisy Dumas.
Sai Pe would get up at 2am to take advantage of the only hours of electricity in the city. He and his wife printed the books under cover and then went to work when the sun rose.
It was, says MACF’s Dr Joyce Conolly, an act of huge bravery. Over the 15 years that she and her husband, Sydney Hospital hand specialist Professor W Bruce Conolly, have worked in the country with their medical charity, she has watched the book go from clandestine to tolerated. The odds were long and the press’ owner, U Sai Nyunt Lwin, was imprisoned in 2006 for five years.
“It was a risk to ourselves,” concedes Sai Kyaw Han. “The government did not want to see those ethnic people working actively like this.”
The books are just one small cog in a well-developed social network across the country.
“Civil society groups in rural areas are very active for any emergency or development works,” he explains. “The network distributes help. They can’t rely on authorities for help. People don’t expect much from the government.”
Tales of annual health budgets that cover just four months of the year, no access to doctors and the ever-present and overwhelming drought of medical supplies and skills meet MACF on visits from Yangon to remote hill villages. According to the World Health Organisation, the state spent $37 on healthcare per capita in 2013. In Australia, the figure was $4191.
Nowadays, an online version of Where There is No Doctor is available via the Hesperian foundation, and a local update by Zalattni is underway and due to be published this year, funding permitting. It is hoped that the book will eventually reach every one of the country’s 17,000-plus Shan speaking villages.
Many in Myanmar are waiting patiently for a smooth transition from military control. The country may be on the cusp of change, but few expect that change to come quickly – and the need for Where There is No Doctor is likely to persist for decades.
Yangon is a city of dualities. Where there is extreme wealth, there is also acute and widespread poverty. Open sewers, no rubbish collection, slums and a desperate need for doctors, hospitals and healthcare shape a city that is, right now, in a state of monumental change. High rise buildings are beginning to overlook huddled street vendors, a Mercedes Benz billboard advertising the “best car in the world” stands spitting distance from the gross inadequacy of North Okkalapa hospital, its barely equipped wards choked with the sick and injured and without such luxuries as screens, mattresses or running water. There is one entirely free hospital in the country, the Muslim Free Hospital, where every religion and economic class is welcome. Elsewhere, bribes are commonplace, exacerbating the local mentality that healthcare exists only for those who can afford it.
In the village of Leik Tho, high in the hills a slow three hours east of the city of Taungoo, a lone doctor serves the population of 40,000. Besides a pagoda, its gold leaf glinting in the sun, the village is dominated by a convent where nuns keep neat vegetable gardens and fish from rectangular ponds.
When we arrive, the 28-year-old doctor is nearing the end of an operation on a boy whose hand is severely infected. No local anaesthetic is used – the boys in this village are “strong and tough,” he says with a smile.
Yes, he needs help, he says, but only one doctor is allowed per village and so he focuses on realistic goals for now: he urgently needs a suction machine, some surgical instruments and a vehicle.
Just a year ago, the route into the hills was treated gingerly not only because of its hairpin bends, wooden bridges and landslides. The township sits in highly-prized betel nut forests and is controlled by the military whose hill camps are fortified by porcupine-like fences of sharpened bamboo stakes. Armed soldiers manned checkpoints every two kilometres. Villages were commonly disbanded, their men made refugees in their own valley. Every family here knows a man who has been imprisoned or disappeared, we are told by one local.
Things have softened in the last 12 months, we hear time and time again. Our party of about 15, led by MACF’s Myanmar head, Dr Raymond Wong, has pre-arranged clearance and word has spread that a group of Australian and Burmese doctors will be visiting the valley, their services free and open to all. Over 200 locals, most of whom are farmers and their families, turn up for the open clinic, watched by three soldiers. At a similar MACF clinic two years ago, there were about 25 soldiers.
But for locals’ health care and living standards, change is yet to arrive.
“Although there’s been this election success after 25 years, you wouldn’t know it as far as I was concerned, except they’re less worried in their faces,” says Prof Conolly during the clinic, where patients with mouth cancers (caused by betel nut chewing), multiple sclerosis and suspected malaria are seen to alongside worryingly common appearances of diabetes, alcoholism and – as in the developed world – stress-related back problems. Arrangements are made for cancer sufferers to be taken to the nearest chemotherapy centre, seven hours away in the capital. Two teenage boys with MS are given wheelchairs, provided to MACF by the Rotary Club. They leave, for the first time in their lives, not on their fathers’ backs.
“There’s frustration in not being able to do more but then the recognition that unless this team of ours had not come to support Dr Wong, these people would not be able to afford to go for medical treatment in town. They would not be able to afford medicines,” the professor, who is in his 80s, says.
“They have a sense of being helped and a sense of being respected and they have a degree of confidence in the future.”
The doctor’s hospital ward – a single room with four slatted wooden beds and little else – is entirely occupied by young men with alcoholic neuropathy.
As we leave, the 28-year-old cautiously shows some optimism for life after the long-awaited government transition: “I hope I may be joined by one more doctor next year.”