Myanmar's crimes against public hea

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Myanmar's crimes against public health

By CESAR CHELALA 
Special to The Japan Times

The Japan Times
May 9, 1998

Since assuming power in 1988, Myanmar's military junta has transformed a
country with a vibrant economy into one of the most backward and repressive
countries in Asia. The continuing deterioration of the economic situation
and a leadership more interested in keeping its own privileges than in the
welfare of the population have had a significant negative impact on the
health of Myanmar's people, particularly its children and women.

According to UNICEF, the national infant mortality rate in 1996 was 105 out
of every 1,000 live births, as compared to 33 in Vietnam, 31 in Thailand and
11 in Malaysia. One million children are reportedly malnourished, 9 percent
to 12 percent of them severely so. The high rate of babies with birth weight
below 2,500g (estimated at 23.5 percent in 1991) is probably a reflection of
the high malnutrition levels among pregnant women.

As in many other developing countries that lack potable water and adequate
sanitation, major causes of children's disease and morality in Myanmar are
intestinal and respiratory infections, malaria, malnutrition?which the
government has tried to address through a family health care program?and
vaccine preventable diseases.

Diarrheal diseases in children under 5 account for approximately 18 percent
of all deaths and are the second most important cause of death in children
in that age group. Mortality rates increase sharply when diarrhea is
complicated by malnutrition or other diseases. Because of poor sanitation,
cholera outbreaks occur every year in Myanmar, particularly during the rainy
season. Preventing disease in children has been rendered more difficult by
the widespread lack of essential medications. Reportedly, medicines donated
by international agencies are stolen by corrupt military officers and sold
on the black market.

The Universal Child Immunization program, which aims at immunizing children
against vaccine-preventable childhood diseases, and which is conducted with
UNICEF's support, reaches less than 60 percent of children nationwide and an
even lower percentage in some areas. Achieving higher immunization rates has
been hindered by security concerns, transportation problems, lack of
electricity?essential for keeping many vaccines?and shortage of health
workers, especially in remote border areas.

Women in Myanmar face considerable health problems due to poor living
conditions, inadequate health services and lack of basic education. Maternal
mortality rates, an important indication of the quality of women's health
care, are 580 per 100,000 live births, as compared to 80 for Malaysia and 10
for Singapore. Most maternal deaths in the country are due to induced
abortions, largely conducted clandestinely and under unsanitary conditions.

Although midwives are the main providers of health care to women in rural
communities there is a shortage of them, particularly in rural areas of
minority states. Only 10 percent of the rural population has direct access
to maternity care provided by a midwife. UNICEF (which has compiled among
the most complete health statistics in the country), has provided
substantial support so that midwives can meet the basic health needs of
people at the community level.

AIDS continues to be an important public health problem in the region,
particularly in Myanmar in 1996, the World Health Organization estimated
that approximately 500,000 people in the country ?close to 1 percent of the
total population?had been infected with HIV. Some experts, however, believe
that the real figure is at least twice as high.

The health situation of the population cannot be isolated from the political
situation in the country. Under present conditions, it is possible that
people's health will continue to deteriorate. The only way to reverse this
situation is for the government to revise its priorities and set the health
and well-being of the people over military buildup. Given the track record
of this regime, however, only a drastic change in government will make this
possible.

Cesar Chelala is an international medico/ consultant residing in New York.

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