Healthcare out of reach in Myanmar's Chin State

In northwestern Myanmar's mountainous Chin State, Lu Lein, a widow in her late 50s, often finds breathing difficult, her heart palpitations are worrying, and even small efforts can be exhausting, but she has no idea what these symptoms mean. She lives in a village an hour by motorbike over rocky hills from Kanpetlet, the nearest township.

"The only thing I can do is take rest when I feel like that. I can't afford to get treatment in the town," she said. People in her village of some 130 people said a health worker comes once every three months, but only to immunize children, not to treat illness.

Primary healthcare is still out of reach for most people in Chin State, one of the most remote, isolated parts of the country, where three-quarters of the people, who mostly depend on small-scale farming to survive, hover below the poverty line, said aid workers.

Poor transport and the state's rough terrain mean rural residents often have to walk for days to reach medical care in the nearest town. Some arrive close to death while others do not survive the journey.

"As healthcare is not easily available, many people rely on the traditional remedies for seasonal [monsoon] sicknesses," said Myo Min Zaw, assistant surgeon at the state-run hospital in Kanpetlet. "Only when they are seriously ill do they come to the hospital."

Respiratory infections, malaria and diarrhoea are the most common childhood illnesses in the state, according to the UN Children's Fund (UNICEF).

Compared to children under age five nationwide, those in Chin are most affected by undernourishment, stunting (they are shorter than they should be for their age), a sign of chronic malnutrition, and wasting (their weight is too low for their height.) a sign of acute malnutrition.

The health indicators are dismal. Chin State has the lowest rate of antenatal care in the country, as well as the lowest tetanus vaccine coverage, the lowest rate of births with skilled attendants present, and the lowest birth registration, according to the latest Multiple Indicator Cluster Survey.

Despite health education efforts by the government and NGOs, health awareness and hygiene levels among local people remain low, say health workers.

It is not for lack of facilities. Chin has nine hospitals with a total of 750 beds, 15 "station hospitals" - health facilities smaller than town hospitals, but larger than rural health centres - nine maternal and child health centres, and more than 330 village health centres. But staffing the health facilities has been difficult to accomplish and most facilities are seriously underserved.

According to UNICEF, there are 64 doctors for 342 posts, which means around eight out of 10 doctor's posts are vacant across the state, and out of 349 posts for midwives, 108 are vacant - a 30 percent shortage. The state has long struggled to fill rural posts, where working conditions and pay have been described to IRIN as "discouraging".

Where there are no doctors

With few other options available, rural residents often turn to traditional healers, who are present in almost every village and benefit from the lack of formal medical assistance.

"No wonder… people rely on quack doctors," said Joseph Kung Za Hmung, founder and director of a local NGO, Country Agency for Rural Development (CAD). "They have no choice but to rely on them."

In Ye Laung Pan village, home to some 280 residents and more than one hour from Kanpetlet, people turn to the elected village head to diagnose ailments and prescribe medicine. "I know something about health," said the village head, Thang Nai, 36, who learned how to treat illnesses from medics while he was in the national army. "I only want to help my people who can't go to the town."

Others turn to their faith. In Hla Laung Pan, village head Naing Law said 85-year old Aung Lay is the recognized "spirit medium", and some villagers ask him to pray to local spirits for their health. "For those who can't go to the town for treatment, he is a man of hope."