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Annual Report, 2002 - Clinic

Over US$10,000 was provided by Burma Lifeline in support a clinic in the Burma boder area for the period July, 2002, to December, 2002.

Established in April of 2001, the cinic is located very near the Thai-Burma border. Its purpose is to provide free basic health services for people from Burma who have no other access to health care. The clinic founder and director is a medic and Secretary of the Shan Health Committee and has been active in delivering health care since 1975. (The Shan Health Committee is an example of Shan people empowering themselves despite their adverse circumstances, by taking the responsibility of developing their own effective health care initiatives). A small amount of money donated by some local Shan people helped set up the clinic, but was inadequate for ongoing operation. Therefore, we were pleased when additional foreign funding to cover six months of operational costs was provided by Australian People for Health, Education, and Development Abroad Inc. A further twelve months of funding was donated by Burma Lifeline of the USA.

Curently, the clinic has ten male medics and one female medic. Two elderly female "traditional birth attendants" continue to provide limited services. Also, three people are being trained in laboratory skills, by qualified instructors at a refugee camp in the area. Three other people, themselves amputees, are concluding a one-year training program in the manufacture and fitting of prostheses. This training will address a present and growing need.

Clinic buildings are simple, made from bamboo and thatch. These materials are practical for the area, easily accessible, and come at a reasonable cost. However, they require more frequent repair and replacement than is necessary with sturdier building materials. (We have had some problems in other locations with Thai landowners appropriating buildings when they are of more expensive and durable construction, so this is one method of avoiding that difficulty). There is no electricity at the clinic; previously we had a generator for occasional use, but it is no longer functioning.

The target population is comprised largely of people from the Shan, Akha, Lahu, and Palaung ethnic groups, plus a few from the Wa. Since knowledge of the clinic has spread throughout the refugee community, more patients who have no other option are traveling here for treatment. In addition to the people from the camp, many patients now presenting at the clinic for treatment are from the local area. Shan migrant workers in Thailand, as well as a very few Thais from nearby villages, are now also coming for assistance. The caseload has increased more rapidly than anticipated, illustrated by the attached clinic records.

Activities

• Outpatient clinic : 7,533 cases in the 12 month period from November, 2001 to October, 2002.
• Inpatient clinic : 592 case in the 12 month period from November, 2001 to October, 2002.
• Laboratory : one microscope, basic urinalysis and malaria smears.
• Minor Surgery : Most surgery is referred to the Thai hospitals due to limitations in equipment, resources, and training. Minor procedures such as incision and drainage of abscesses, and removal of foreign bodies from extremities are performed using only local anaesthetic.
• Pre/Post Nate care, Reproductive Health : Basic prenatal care, physical exams, tetanus vaccinations, screening for malnutrition, pre-natal vitamins and minerals, and supplementary diets.
• Child Nutrition : Malnourished children are given supplementary diets and weighed every two weeks to track progress.
• Dental Care : Dentistry is not performed at the clinic by medics. However, last year a volunteer dentist team from the USA visited to treat patients.

Patients referred to Thai Hospitals

129 patients were referred to Thai hospitals between November, 2001 and September, 2002. Cases refered were HIV, severe skin infection, landmine injuries, difficult labor, hernia, renal stone, blood transfusion, tuberculosis, and major surgery.

Future Ptential Programs and Needs

• Infant Immunization Program : Presently, there is no immunization program in place for infants or children.
• Midwife : The two traditional birth attendants are elderly and not always available. We hope to send two female medics for the one year midwifery course.
• Back Pack Health Worker Team : Backpack workers would provide access to healthcare in the local border area where healthcare is currently unavailable.
• Public Health Education Worker : An outreach program would provide information on nutrition, basic hygiene, oral hygiene, prevention of diarrhoeal diseases, TB, HIV, and malaria to nearby villages.
• Landmine Victim Rehabilitation and Prosthesis Fitting : Landmines continue to be planted in conflict areas and around civilian settlements. Three Shan medics, themselves amputees, have nearly completed training in the manufacture and fitting of leg prostheses. We hope to set up a workshop and provide material for them to carry out this program.

Difficulties and Obstacles

In addition to the complicated security issues already mentioned above, the population, served by this clinic and outreach programs, is under constant threat of violence and/or deportation, according to their situation.

Shan people inside Burma are exposed to active armed conflict, landmines, and the depredations of the SPDC (Burmese Military) troops. There are reports that people both inside and outside the forced relocation areas are still being tortured, imprisoned, or summarily executed (for example, see "Unsettling Moves - the Wa forced resettlement program in eastern Shan state" by the Lahu National Development Organization, April, 2002, and "License to Rape - the Burmese military regimes use of sexual violence in the ongoing war in Shan State, Burma" by the Shan Human Rights Foundation and the Shan Women's Action Network, May 2002). There are also continuing accounts that villagers are used as forced labourers, often as porters for SPDC troops. In some cases porters are forced to walk ahead of troops through mined areas, as "human mine sweepers" (Though many hoped that Aung San Suu Kyi's release from house arrest might also indicate a change in SPDC policy towards ethnic groups, such human rights violations continue in Shan State and other ethic areas).

Migrant workers in Thailand also exist in a tenuous situation, as many did not earn enough to afford the official ID cards offered by the Thai authorities in 2001. It is therefore dangerous for them to travel, even locally, as they are subject to deportation, fines, or imprisonment if apprehended at checkpoints or searches.

Fortunately the clinic has survived to date through good relationships with various parties, including the Thai landowner, the hospital several kilometers away (patients with problems beyond the capability of the clinic are referred there, although funding these relatively expensive cases is a challenge), and various other Thai authorities. Both the target population and the clinic find it difficult to plan for the future. As previously mentioned, the clinic is as secure as possible given the circumstances, but we usually ask for only six months funding at a time, rather than for the whole year. we feel this is the best solution in the present situation, maintaining responsibility to our funders while enabling us to deliver basic health care.

Financial Summary

Funds from Burma Lifeline - US$10,000

Detailed Expenditure, July - December, 2001

medicine	US$5000
medicine transports	US$200
patient referrals	US$850
patient food	US$750
child nutrition	US$400
maternal nutrition	US$400
staff support	US$1400
staff transport	US$650
generator fuel	US$200
office costs	US$150
total	US$10,000