As the former military regime waged war against ethnic armed groups in Burma, local people in rebel-held territories lacked access to vital medical services. To remedy a dire situation, a group of courageous paramedics and volunteers took matters into their own hands by traveling from village to village to offer care themselves.
The Backpack Health Worker Team took many risks to reach these villages: The regime viewed the paramedics as traitorous because they were assisting people in rebel-held territories, and it was not uncommon for them to come under attack.
Nai Aye Lwin, a leading member of the paramedic team, recently spoke with The Irrawaddy about how operations have changed since a nominally civilian government came to power in 2011, signing bilateral ceasefire deals with most ethnic armed groups.
Question: What’s the history of the Backpack Health Worker Team?
Answer: After 1992 and 1993, the army carried out large-scale attacks in Karen State, and local people therefore had to flee and hide in forests. Then, paramedics from Mon, Karen and Karenni states, as well as the student army and the National League for Democracy, teamed up to form the backpack health worker team in 1998. The team was made up of 100 paramedics, divided into 32 smaller teams and led by Dr. Cynthia Maung from the Mae Tao Clinic. It mainly focused on primary health care while trying to raise health awareness.
Q: Where do you operate presently?
A: First we operated in Karen, Kayah [Karenni] and Mon states, and then in Kayan, Shan Palaung, Pa-O and Lahu regions. Now we are expanding to Kachin and Rakhine [Arakan] states. A Chin backpack health worker team is also cooperating with us. Mainly, we are engaged in maternal and child health care, public health care, education and prevention.
Q: How do keep your health workers and local volunteers safe?
A: It depends on local people and local organizations. If they say their place is safe, we go there. We build makeshift tents with banana leaves and tarpaulin, and we give medical treatment. We can provide medical treatment in some villages where the ethnic armed groups are in control.
Q: The former military government viewed you as rebels. Why?
A: It was less the government’s perception of us than their perception of places where we were operating. The government labeled those places as dark places, with orders to kill anyone in those places. They didn’t bother to differentiate between health or education workers and armed men. During the war period, the army shot and detained anyone on sight. Health workers and local traditional midwives have died from mine blasts in the 15 years since our team was created.
Q: How big is your team?
A: We have more than 100 smaller teams and each team is assigned to cover over 2,000 people, so we are providing health care to about 200,000 people. Now, our team has about 370 core members, and the membership is at least 2,000 if you include the traditional midwives and local volunteers.
Q: What challenges have you faced?
A: The major challenges are transportation and regional security. Since interest has changed following the political changes of the country, border-based organizations have struggled financially. Our team now only gets 60 percent of the expected contribution from donors.
Q: What are the significant accomplishments of your team?
A: Toilets have become better under the health education program. The incidence of cholera and diarrhea has decreased in Kayah State. Local community organizations have greater trust in our team. International communities have become more aware that the team’s public health care service is reaching more and more people. These are the tangible results.
We have provided local traditional midwives with technological and material assistance, and the mortality rate of mothers and children has declined remarkably compared to the past. Our approach is to go straight to the people and not to wait for the people to come to us.
Q: How have the team’s operations been affected since the new government took the office?
A: We have gained greater freedom and the fear of backpack health workers has subsided. In the past, they were filled with fear going into a village. Now, they can operate and communicate with local people more easily. They can provide health care services more effectively.
Q: The new government has improved infrastructure and raised budgets for remote areas? How will this benefit your team’s activities?
A: Investing only in infrastructure won’t work in a health system. Rather than spending large sums for infrastructure, it is better to ensure emergency health care for local people. Ethnic health care organizations created their health care systems on their own after the conflicts broke out. So it would be the best [for the government] to acknowledge the active organizations in those regions and work in collaboration with them.
