Chronic Problems for Burma’s Health System

By Rric Randolph 8 March 2013

RANGOON — In a tiny clinic on the outskirts of Rangoon, a patient is complaining that she has too much snot up her nose. The young doctor picks up a torch to peer down her nostrils and says he cannot see a problem, but the patient pulls out some x-rays taken by a local hospital and says she worries there may be a cancerous growth.

Rather than ply her with medication and a raft of further tests, Dr Win (name changed) sits her down and explains that the problem is not serious. It takes 10 minutes, but she leaves reassured.

In Burma’s under-resourced health system, this approach is almost revolutionary. Hundreds of doctors operate private evening clinics around Rangoon and other cities, but for many, the priority is to cram in as many patients as possible and dole out medicine, regardless of whether it is needed.

“Most patients just want an injection when they come here. They don’t care if it is really needed. That is the mindset that has developed,” said Dr Win. To keep the patients happy, many doctors simply administer placebos, such as vitamin or glucose shots, he says.

“The doctors know it’s unethical, but they do it anyway. They do not have time to talk to their patients and really explain. They just want the patients to keep coming back because they need the money.”

Dr Win is something of a rarity, supported by an international charity that tries to improve the quality of local care in Burma by paying doctors a salary so that they do not have an incentive to charge for unnecessary treatments, and encouraging them to spend more time talking to patients. Having operated in Burma for years, it has preferred to stay anonymous and out of government control.

Burma’s evening clinics exist because government doctors need to boost their meager salaries after-hours. The chronic lack of investment across the health sector—particularly in education—can lead to dangerous consequences.

“I have seen many cases of misdiagnosis and bad treatment,” said Dr Win. “One patient came to me recently with a dog bite. The previous doctor had not given him a rabies vaccine and had stitched the wound, which you must never do. It was badly inflamed and infected. He could have died.”

An even more serious concern is the quality of the medicines. An estimated 70 percent of drugs administered in Burma are unregulated.

“It is much cheaper to get medicines from the black market through border trade, so many doctors do that to save money. Their customers are very poor so they have no choice, but it can be very dangerous,” said Dr Htin Paw, CEO of the private Sakura Medical Center in Rangoon.

A UN report in 2009 found that Burma had one of the lowest health expenditures in the world, spending just US $7 per person, or 1.8 percent of its annual budget. This has improved to some extent, with the government reportedly earmarking 3.9 percent of its 2013-14 budget to health.

But it will take a long time for Burma’s crumbling government hospitals to make up for past under-investment. In the meantime, the shortfall falls on the patients.

“It cost me 700,000 kyat [about $800] for my wife to give birth to our child,” Kho Nai, a resident of Ahlone Township in Rangoon, said recently while waiting at a local clinic. “I even had to buy a razor blade so they could shave her. Every time we go into the hospital waiting room, they just want more and more money. Even the porters are asking for money just to push the trolley or sweep the floor.”

The opposition National League for Democracy (NLD) has called on the government to start making proper budget plans for health.

“The government claims that it is sharing costs with the patient. In reality, the patients have to pay for everything,” said Phyu Phyu Thin, a member of Parliament for the NLD.

“They should have a plan for the whole year. At the moment, they buy the medicine all in one go, so they run out very easily and it is hard to buy more. We need to start ordering our medicines from foreign countries, or we will continue to have many problems.”