Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Public Health Problems on Burma Frontiers
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most western governments refuse to provide such aid, but there are those who argue
this should change. They argue that the humanitarian situation inside Burma is so
bad that they cannot wait for democratic change before taking action. Once there,
they hope to be able to function without government interference.
Many of them, however, have faced severe restrictions and rules imposed by the
regime that interfere with their ability to work effectively with the local population.
The regime often harasses and intimidates those who try to work closely with foreigners.
It is hard to evaluate whether more good or harm is done by humanitarian
organizations working inside Burma under current circumstances.
There are certainly urgent needs that must somehow be met now: from cleaning
up Burma’s blood supply, to distributing AIDS test kits, to making antiretroviral
drugs available to HIV positive mothers to prevent transmission to their children.
But whatever individual agencies do to meet these specific needs, I don’t believe they
can do anything under the current circumstances that will “solve” Burma’s public
health problems. There is no strictly public health solution to the public health
problems of the Burmese people; no strictly humanitarian solution to the humanitarian
crisis they face. Burma itself must change. It needs institutions that are committed
to serving their people and a people who are free to help themselves. Otherwise,
international aid can serve as little more than a bandaid.
The question those who favor providing assistance within Burma must ask is
whether the aid will make it easier for the government to divert even more funds
away from health and education, thus prolonging its rule and the very suffering we
wish to alleviate. I believe there will be times when the answer to that question will
be no—when small scale NGO efforts inside Burma can provide limited benefits to
local populations. But often, the answer will be yes, and in the long run outside help
is not an answer in the absence of internal change.
I think it’s interesting that the junta leader Khin Nyunt’s recent admission of
Burma’s AIDS crisis came during an easing of tension between the military and the
democratic opposition, led by Aung San Suu Kyi. Even a small improvement in the
political climate seems to have improved the climate for an honest discussion of
Burma’s public health needs. We cannot pretend that the health of Burma’s people
can be separated from the health of its society; we must wish for, and work for,
improvements in both.
Suggested Reading
1. Beyrer C. Shan women and the sex industry. Testimony to the US Congress, 1999.
2. Luxenburger C et al. Clinical features cannot predict a diagnosis of malaria or
differentiate the infecting species in children living in areas of low transmission
rans. R Soc Trop Med Hyg 1998; 92:45-9.
3. McGready R et al. Epidemiology, malaria, and pregnancy. Am J Trop Med Hyg
1984; 33:717-25.
4. McGready R, Nosten F. Falciparum malaria in pregnancy. Aust N Z J Obstet
Gynaecol 1995; 35:468-9.
5. White NJ. Drug resistance in malaria. Brit Med Bulle 1998; 54:703-15.
6. White NJ. Why is it that antimalarial drug treatments do not always work. Ann
Trop Med Parasit 1998; 92:449-58.
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