Myanmar post-script

Trip Start Oct 11, 2009
Trip End Mar 18, 2010

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Saturday, November 21, 2009

We enjoyed a final, busy, week in Myanmar, finishing off our work and making our farewells. Sad to leave after a magical five weeks there, albeit with much to look forward to as well, not least just pure time off.

Merlin was immensely rewarding and a great chance to develop a non-tourist perspective on Myanmar. We especially enjoyed the training sessions (leadership facilitation, excel, communication and time management) and a workshop we did with the senior management team to help define roles better. It was also good for Melora and me to work together for once. There is a draft of the strategic plan floating around and lots of good ideas from Melora on how to make the community health worker programme more effective.

The CHWs are the core of Merlin's work in Myanmar – volunteers selected from each village who are educated in basic healthcare, the diagnosis and treatment of malaria and TB, water and sanitation and maternal and child health issues. All work in parallel to the basic health service that is supposed to be in villages but many posts are vacant or physicians will only see people privately as their state pay is so low. The CHWs have to see patients between farming or fishing and the challenge is to find a way for them to do such things more sustainably and effectively – ideally earning some money as they go, perhaps selling basic health related items based on what people need. A demand led approach is critical and Merlin is looking to move from distributing for free model (imperative during the humanitarian crisis period) to a recovery or "normal life" model when ideally people to pay, even just a tiny amount, to contribute towards the care they need and cover some of the CHW costs. There is also the challenge of dealing with focused donor funding – one of the upcoming grants is for TB only which makes you wonder what happens if someone presents to a CHW with malaria instead. There is a desperate need for the donors to move to more long term horizontal funding model covering all primary healthcare needs rather than lone diseases. Merlin is also experimenting with community insurance pools as there is a limit to what the CHWs can do and many of the complicated cases that get referred go nowhere as people can’t afford to get to the hospital let alone pay for treatment when they get there. Difficult to do this all this justice in just one paragraph.

We certainly come away with a better sense of the challenges of getting things done in Myanmar. It is difficult to think of anywhere else, perhaps other than North Korea, where the government makes access for humanitarian aid so difficult. Some programmes never started as the government wouldn’t give access and others stopped at least for a few years as permits were suddenly revoked. There has been increasing dialogue of late which is very encouraging but with the elections next year things will likely get more difficult again before any change. There is, amazingly, hope things might change, but I won’t be holding my breath.

Dinner party conversations invariably turn at some point to the regime and views range from the pragmatic to the paranoid. We had to come into the country on a tourist visa, which basically restricted our access to the field sites Merlin covers. As a tourist in the main sites one is left well alone, other than by people trying to sell art  and the occasional clumsy attempt to draw you into a discussion on politics. Whether a curious local or military intelligence remains to be seen, but “The Lady” is a topic best avoided.

Out in the field things seem different - one guy we met now gets a lift home from his agent and so long as one avoids the obvious topics they seem perfectly friendly. Email and phone calls are apparently scanned for the words “bomb” and “drugs” but there are also some great stories about tapped telephone conversation with calls suddenly straying into black list topics either being cut off call or just occasionally a Burmese voice will also enter the conversation and either request the topic not be discussed or ask the Francophone members to revert to English so they can understand what is going on! There was one wonderful story of a conversation between protesters near a monastery – “We want democracy!”. Asked one protester to another “Who is Democracy?” to which the response was “Aung San Suu Kyi’s husband”.

On a totally different note, the wholesale and fish markets were a fascinating early morning visit – see photos, and we had a wonderful, very entertaining evening with one of Myanmar’s top photographers who had used a friend in Bangkok as a model for one of his recent shoots. Some great portfolios of art and commercial work as well as some great shots of the post-cyclone delta and other work that can’t be shown in Myanmar. He was arrested as a student in the 1970s during the university protests for a public funeral for the Burmese Secretary General of the UN, U. Thant. After 30 days in jail he was given the choice between signing a paper saying he’d never seek to study again in Myanmar and more time in jail. So began 24 years of exile.
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