Burmese Band-Aid

The Mae Tao clinic on the Thai-Myanmar border saw 100,000 patients last year. For Burmese refugees and ethnic minorities in the area it is a lifeline, but in the bigger picture, it’s just a Band-Aid.

MAE SOT, Thailand - In the middle of a thatch building a ten-year-old boy waves a fan over the motionless, naked body of his two-year-old sister lying on a woven mat.

She is sick with malaria, like so many others at this clinic, but the ravages of fever have given way to her exhaustion. For now she sleeps.

Malaria, a preventable disease in this century of advanced medicine, is still rampant on the border between Thailand and Myanmar (formerly known as Burma), separated here only by the Moei River.

The Mae Tao clinic, an unregistered medical center on the Thai side of the border, treated more than 6,300 cases of malaria in 2005 — by far the most prevalent disease.

Life on the border » View

"The Burmese government isn't doing anything about mosquito abatement," says Terry Smith, a physician from Davis, Calif., who has volunteered at the clinic for as long as 18 months at a time. "More than 75 percent of our cases come from Burma."

The clinic was founded by Cynthia Maung, one of the first in a wave of refugees to seek asylum on the Thai-Myanmar border, following the violent crackdown of a short-lived pro-democracy movement in 1988 by the ruling military regime. Then known as the State Law and Order Restoration Committee (SLORC), the regime is now billed as the State Peace and Development Council (SPDC). The military has governed Myanmar and viciously suppressed dissent for more than four decades.

Dr. Cynthia, as she's known at the clinic, fled to the Thai city of Mae Sot and joined other Burmese refugees, mostly ethnic Karen people who have been at war with the Burmese government since the country's independence in 1948. At 58 years, it's the longest active civil war in the world.

The clinic has grown to be an essential lifeline both for Burmese refugees living in Thai refugee camps, as well as mostly ethnic Karen people living on little slivers of border land inside Burma.

The clinic is supported by several non-governmental organizations and does not charge for its services. But it's by no means flush with cash.

Despite Dr. Cynthia's increasing profile — a mention in Time Magazine as a Global Health Hero and several international awards, including one from the Dalai Lama — the clinic faced a severe shortage of operating funds in 2004.

Considering the breadth of the clinic's work, it's easy to see why. In 2005 it received nearly 100,000 patient visits — an average of 275 patients a day.

Some of them never go home. Twenty-nine year-old Mya Aye has lived at the clinic since 2001. That's the year she became an above-the-knee double amputee. She says she was gathering bamboo shoots near her home when she stepped on a land mine.

Refugee lifeline» View

"I can't live at home," she says, "my father is dead and my mother is very old. There wouldn't be anyone to take care of me."

At the clinic she spends most of her days moving around on a pair of crude, prosthetic legs, about half the size of normal legs. The black foot on the end of each false leg looks more like a flipper, with an inflexible fixed position.

Aye says random people will feed her at the clinic and she sleeps on a mat outside the surgical center.

Land-mine victims are a significant part of the patient load at the clinic, so much so that a prosthetic department was added, along with a program to train new technicians.

According to the Land Mine Monitor Report, the Mae Tao Clinic provided 181 prosthetic limbs to land-mine survivors in 2004. And while the artificial limbs may lack in realism and range of motion, they make up for that in cost efficiency and reduced patient wait time.

Thirty-year-old Sanpannyuny was cutting wood in Burma when he stepped on a land mine that blew off his right leg below the knee. The clinic's prosthetic technician, a Thai man named Steel, made him a new one through plastic injection molding in less than three days at a cost of 300 Thai baht ($9).

The program receives support from Clear Path International, an anti-land-mine organization. 

Sanpannyuny says his limb will be essential; he has a wife and three children to provide for and without the prosthetic he's unable to work.

In the neonatal department new mothers — again, mostly Burmese refugees or citizens still living inside Burma — rest with their newborn children.

Any Nygo, 22, is exhausted but happy. She gave birth last night to a son with no complications, although she is having trouble producing breast milk, possibly because of dehydration. Her husband, Klawlin, has brought her some food and bottled water.

"We haven't named him yet," she says of her son, "we're just happy he's healthy."

That's not the case for many of the mothers who come here.

Dr. Smith points to a large board outside the neonatal department. It's filled with names of mothers-to-be who have been admitted with malaria. For a pregnant woman, malaria can lead to many complications, including premature delivery and low birth weight for the newborn.

"It's a preventable disease," says Smith. "But either the Burmese government doesn't want to do anything about it, or it's just complete neglect. They spend more than 40 times more on their military than they do on health."

But as much as the Mae Tao clinic does help, Smith knows it has limits.

"This clinic isn't registered in Thailand," he says. "We're allowed to work here because of the refugee problem, but this isn't the final solution to the problem. It's just a stopgap. The final solution lies on the other side of the border."

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