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FROM MYANMAR (BURMA) Dr Samantha Tuckwell is working with Médecins Sans Frontières in northern Myanmar (Burma) and is on her first mission. She is from Alstonville, in northern New South Wales, and worked at the Cairns Base Hospital immediately before joining Médecins Sans Frontières. In my first mobile malaria clinic in Myanmar, the silent anticipation that had filled the waiting area was suddenly broken by the screams of a child. A 12-month old boy was writhing in his mother’s lap as she unflinchingly started pinching the skin of his back and chest. I was told that this was makalaung, a common traditional practice intended to “draw out illness”. The child had been sick with malaria for several days. The local rural health centre could not offer treatment and, as a result, his body was marked with days of makalaung while they waited for our clinic to visit their village. Having seen it once, I began noticing evidence of this practice all around me. The skin is crushed and pinched until capillaries burst to create long vertical stripes on the neck and purple welts over the trunk and limbs, red circles are suctioned onto the forehead and fingertips and the skin around the anus are pierced to release drops of blood. Traditional medicine is an important part of any country’s culture. However in Myanmar, the frequency with which this decorative placebo is used, in the absence of access to effective medical care, is a telling consequence of a 20 cents per capita annual health budget. Médecins Sans Frontières has been working in Myanmar since 1994. The project I am involved in is based in Kachin State, the most northern state of Myanmar, bordering China. Kachin State is dissected by the Irrawaddy River, and has a landscape of mountains covered in tangled jungle and fields of brilliant frog-green rice paddies. Our project has three main field sites, and covers mobile malaria clinics, a tuberculosis program, HIV/AIDS education and home-based care, and sexually-transmitted diseases clinics. Our mobile malaria clinics travel monthly over remnants of roads to remote
villages where malaria is endemic; spleens have to be hoisted out of laps in order
to squat and children struggle with chronic anaemia. In these villages, the leaders
commonly thank Médecins Sans Frontières for the significant reduction
in malaria-related mortality, especially of children and pregnant women. Médecins Sans Frontières has a small pilot project starting soon in the capital, Yangon, treating HIV+ people with anti-retroviral drugs. This is a small but very significant step, especially in a country where the people are all too familiar with not having access to medical care and essential medicines.
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