Health Challenges Continue in Naga After Measles Outbreak

By Nan Tin Htwe 17 November 2016

HTAN KHAW LAMA, Sagaing Division — “What will I do if she dies on the way,” 46-year old U Par Noon asks as he sits beside a wood fire in his traditional windowless Naga home, his facial expression unpredictable in the dark, smoke-filled room.

A few steps away, his 10-year-old daughter Ji Koon lies on a bamboo bench. Her two sisters sit by her side, watching Ji Koon’s colorful necklace rise and fall as she breathes heavily. After being sick for three months, a village health officer has confirmed that she has measles and must be hospitalized. But U Par Noon is afraid of losing his daughter on the way, as the nearest hospital is a three-day walk or an overnight motorbike ride in good weather.

Looking down on the Naga houses surrounded by green mist-capped mountains, Htan Khaw Lama appears to be a simple, peaceful, isolated village. However, this village of some 40 households lost 26 villagers when a deadly measles outbreak hit in June and July.

The village is more than 50 miles away from Lahe Township. There are no cars—only motorbike or travel on foot—making it seem all the more remote. The trip to Lahe crosses muddy roads, jungle passes and streams. Large parts of the path traverse a two-foot wide cliff, paved by villagers using hoes. For some portions, walking is the only option.

U Par Loon and his family have dinner inside his home. (Photo: Nan Tin Htwe)
U Par Loon and his family have dinner inside his home. (Photo: Nan Tin Htwe)

The measles outbreak began in June and killed more than 80 people across the Naga Self-Administered Zone, located in northern Sagaing Division close to the border with India. The Ministry of Health attributed the deaths primarily to malnutrition.

The village of more than 300 people has never had a government health officer or clinic available to treat basic illnesses until the outbreak.

“We did not receive a reply for a week,” said U Chu Tite, the chairman of Htan Khaw Lama village who sent a villager on a motorbike to Lahe Township for help when the disease appeared.

“Most of the village was sick. If we had a health officer, I don’t think as many people would have died,” he said.

Thant Zin Oo, an assistant health officer from Lahe T

Htan Khaw Lama village in late September. (Photo: Nan Tin Htwe)
 Htan Khaw Lama village in late September. (Photo: Nan Tin Htwe)

ownship hospital was one of the first to respond to the outbreak. The cause was still unknown at the time and he said other staff members were afraid to go because the disease was killing dozens of people.

Thant Zin Oo and his team packed two medical kits and traveled two nights and three days to get to Htan Khaw Lama.

“It was pouring. We had three motorcycles but we had to leave one motorcycle on the side of the road after the engine died,” he recalled.

When he arrived at the village in the late afternoon, he heard the howls of dogs and the cries of sick villagers.

“Every house had people lying in pain. It was incredibly sad,” he said.

27-year-old Arr Lee receives treatment for his injuries. (Photo: Nan Tin Htwe)
27-year-old Arr Lee receives treatment for his injuries. (Photo: Nan Tin Htwe)

He sent blood samples to Lahe Township and then on to Naypyidaw. The first night, he treated more than 80 patients. Over the next few days, he assisted more than 200 patients.

“It was difficult. They did not want to come to us so I had to go to every house. They didn’t want injections. When they got sick, they just drank and rubbed dog and chicken blood on themselves,” he said

On top of transportation challenges, villagers also suffer due to communication issues. The majority of them only speak a Naga dialect and there are no phone lines in the village.

“We didn’t have information for two months. Twenty-four people died during that time,” said Dr. Hein Htut Swe, a Lahe Township medical officer. “They never received measles vaccines. This has been a problem for years,” he said.

The Naga region has three townships—Leshi, Lahe and Nanyun. The remote area is home to more than 120,000 people. From the commercial capital of Rangoon, the most accessible township of Lahe is two flights, a ferry ride and a three-hour motorbike ride away.

Naga children in Htan Khaw Lama village. (Photo: Nan Tin Htwe)
Naga children in Htan Khaw Lama village. (Photo: Nan Tin Htwe)

Renting a motorbike in the area can be expensive. A trip from Lahe to Htan Khaw Lama can cost up to 200,000 kyats (about US$150) in the rainy season.

“On June 6, people started dying but we knew only on July 23. There was no information coming from the village,” said U Thein Zaw, director of the Naga Self-Administered Zone administrative office in Lahe.

Lahe is the only city in the Naga region with 24-hour electricity, which only began in January. There is no internet and spotty 2G phone service.

Inside Lahe hospital, 31-year-old U Khan Yan from Ka Yee village sits on a hospital bed next to his wife who does not speak Burmese. She holds their crying four-month-old son who was diagnosed with jaundice. When his son got sick and would not stop crying, U Khan Yan walked three hours to the nearest hospital in Donhee. His son’s condition did not improve so the doctor sent him on to Lahe. He hitchhiked to Lahe and the car that took him broke down for two hours on the way.

“I don’t know what happened. He just kept crying. We didn’t have any money so we couldn’t go anywhere,” said U Khan Yan, who grows rice and corn to feed his family. His son never received any vaccines and subsisted on rice brought from his village while he was hospitalized for 10 days.

Htan Khaw Lama Village (Photo: Nan Tin Htwe)
Htan Khaw Lama Village (Photo: Nan Tin Htwe)

“There is no doctor in our village. It would be good if there were one so we wouldn’t get this tired,” he said.

The health challenge continues in Burma, which ranked 190 out of 191 countries in a World Health Organization report, with only 2.3 percent of the GDP spent on healthcare.

Monywa native and 22-year-old nurse May Thu Zaw was dispatched in September to Kham Ma Lar village, a one-hour drive from Htan Khaw Lama. She said she had to do work that was beyond the scope of her training.

“For some diseases, I need instructions from doctors. But in Naga, we can’t really communicate.  In other areas, we are not allowed to give injections to children who are under five. But here, if we don’t, there’s no one to do it,” she said.

However, 27-year-old Arr Lee thinks any healthcare is better than none. He received treatment from a nurse for an arm injury he suffered while cutting wood to build a new home.

“I like having medicine. If there’s not medicine, I just leave it,” he said as a dim solar bulb cast light around a bamboo clinic in Htan Khaw Lama.