‘There is No Room for Discrimination in Health Care’

By Kyaw Kha 9 November 2013

Hailed by the international media as “Myanmar’s Mother Theresa,” Dr. Cynthia Maung is the founder of the Mae Tao Clinic, a health center in the Thai border town of Mae Sot that serves both Myanmar migrant workers living in Thailand and ethnic civilians displaced by conflict on the Myanmar side of the border.

Founded 24 years ago, in the wake of a sudden influx of students and other dissidents fleeing from the military crackdown on the 1988 pro-democracy uprising, the clinic provides free medical treatment to an average of 300 patients a day, and has set up schools to educate thousands of migrant children.

Dr. Cynthia—as she is generally known to her admirers—was among those who joined the protests in 1988. When the military seized power in a bloody coup, she fled her native Kayin State for the border, determined to continue fighting for freedom in her country.

Since then, she has won a total of 14 international awards, the most recent being the Sydney Peace Prize, which she received in September “for her dedication to multi-ethnic democracy, human rights and the dignity of the poor and dispossessed, and for establishing health services for victims of conflict.”

As the situation in Myanmar and along its borders changes, Dr. Cynthia sat down with The Irrawaddy’s Kyaw Kha to discuss the future plans of the Mae Tao Clinic.

Question: I’ve heard that the Mae Tao Clinic will be relocating to another area. Why is that?

Answer: We’ve been planning to leave this rental area for the past five years. There are a number of reasons, including lack of space and occasional flooding. We will start construction at the new location in late 2013 and expect it to take four or five years to complete, so I think we will remain here for a few more years.

Q: What is the Thai government’s position on the clinic?

A: Apart from our clinic, there are local and international non-governmental organizations [NGOs] working together with us in providing health services. The Thai government has supported our health activities along the border areas and in Thailand since long ago, especially by accepting patient referrals. For example, if we can’t cure patients in refugee camps, we have to refer them to Mae Sot General Hospital or hospitals in other districts, such as Phop Phra, which always welcome our cooperation.

Q: Have you ever been supported financially by the Thai government or Thai public services?

A: We haven’t received financial support from them, but we have received medicine and other kinds of support. For instance, we have received different types of vaccine from the Thai government. Also, because of their support, we can arrange anti-retroviral (ARV) drugs for 70 HIV patients per year. Besides this, we are also given discounts when we send our patients to hospitals in Thailand.

Q: We’ve heard that international donors have cut their support. What is the clinic’s current funding situation?

A: The amount of financial assistance we received this year is the same as last year. We hope to be provided with the same amount in 2014.

International organizations will make new contracts for our health activities after 2015, so I’m not sure how long we will be able to continue here after that. There will be consultations for the continuation of our services at the end of current contracts. I doubt all of the current health organizations on the border will continue after 2015, but I’m certain that some will remain.

We normally encounter shortages, sometimes caused by delays in transfers of money and medical materials due to changes in the governments that finance our donor organizations. In such cases, we adjust our expenses however we can, for example by reducing patients’ food ration from 20 baht [US$0.60] to 15 baht [$0.50] a day. Also, although we have allotted 800,000 baht [$26,700] for monthly patient referrals to Mae Sot General Hospital, we only send patients with emergency conditions whenever we face funding shortages. We check our expenses once every three months and readjust it in order to meet with our possible income. In some cases, we’ve even had to reduce the number of our employees.

Q: How will you run the clinic if funding from donors decreases in the future?

A: We always have to observe the situation of our international donor organizations. At the same time, we have to look for possible new funding sources. In particular, instead of direct governmental assistance, we have to think about receiving regional funds for malaria and HIV. In some cases, we had to seek funding that we can spend on cross-border needs. For example, malaria is covered by regional funds, which means that we can use that money on both the Myanmar and Thai sides of the border.

Since more and more Western countries, especially from Europe, have shifted their funding to support activities inside Myanmar, financial assistance from those governments to the Myanmar-Thailand border has decreased significantly. However, some NGOs there have organized fundraisers to help us generate income. We have also started targeting some Asian countries for fundraising too.

Q: How have the political changes in Myanmar affected your programs?

A: Although some political reforms have been made in the country, we haven’t seen any change in working programs for health, education and protection sectors. The opening should create space and more opportunities for civil society organizations [CSOs] to better participate in the overall reform process. I am concerned that financial assistance from the international community to our country will not bring long-term benefits for our people if there is no good cooperation between international organizations, the government and CSOs like us.

Our programs—which cover health, education and protection—are running normally at the moment. However, we may face financial shortages in the future and it will be better if we can rely on improvements in the situation in our country then. For instance, instead of referring our patients to Mae Sot General Hospital, it would be better if we could arrange to send them to the hospital in Myawaddy, on the Myanmar side of the border.

It would be best if Myanmar people could receive proper treatment at home and children didn’t have to cross the border for schooling and could have access to education in their own country.

Q: Has the number of patients from Myanmar decreased since the new quasi-civilian government took office in 2011?

A: The number of patients is still increasing, but not like in the past. It used to grow by about 10 percent annually, but these days it’s just 3 to 5 percent. However, there are still many people coming for major problems, such as severe cases of malaria or women who need to have caesarian sections. In the rainy season, when there are outbreaks of malaria and diarrhea, we have around 250 to 300 people coming from inside Myanmar every day.

Generally, our outpatients are evenly divided between those who come from inside Myanmar, and those from the Thai side of the border. However, around 70 percent of our inpatients are from inside Myanmar.

Q: What problems do you think you would face if you relocated inside Myanmar?

A: Through the Burma Medical Association [BMA], founded by Myanmar doctors living abroad and health organizations based on the border, we are already providing technical assistance to the health departments, hospitals and clinics of different ethnic groups [inside Myanmar]. What they need is continuous financial and technical assistance. This will largely depend on how soon the Myanmar government’s Department of Health and border-based health organizations can cooperate. The Mae Tao Clinic will not directly provide services to those hospitals and clinics, but will continue its material and technical support for them.

Q: You have been praised for providing health services to all patients, regardless of ethnicity and religion.

A: Non-discrimination should be the basis of all social activities, whether they’re related to health or education. This is very important for our country. I believe that if our education system is based on non-discrimination, it will have a positive impact on the long-term peace-building process. Likewise, since health is a basic human right for everyone, there is no room for discrimination in the health care system.

We had and still have discrimination at different levels and sectors of our society. I know we can’t change it all right away, but we have to keep trying to eliminate all forms of discrimination.

This story was first published in the November 2013 print edition of The Irrawaddy magazine.