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Five teams of top, young journalists set out from Myanmar's commercial hub of Yangon to better understand how the country is changing under a reform-minded government. Travel along with these 20 reporters — 11 Burmese and 9 American — as they journey the ancient Burma Road, through the country's capitals past and present, down the Irrawaddy Delta, onto Inle Lake and across Yangon itself at a critical time in the country's history.
Five years after Nargis, Myanmar's Delta is slowly building the health care system it never had before.
BOGALAY, Myanmar — Five years ago, torrential rain and winds of up to 160 miles per hour pounded the Irrawaddy Delta, a low-lying region at the southern tip of Myanmar where the Irrawaddy River spills out into the Andaman Sea.
Cyclone Nargis lasted two days, but by the time it was over it had leveled villages, carrying away thousands of the thatched palm huts residents here in Bogalay have constructed along the river banks, exposing their occupants to the full might of the spiraling winds. By the time Nargis subsided, 140,000 people were dead, 800,000 were displaced, and 2.4 million required immediate humanitarian assistance, according to the UN.
Fresh out of medical school at 26, Dr. Ye Phyo Kyaw had been working at nearby Pyapong Hospital for just a few weeks when Nargis made landfall.
He was one of just three doctors there working around the clock to provide care in the midst of what was quickly becoming a humanitarian crisis. After decades of government neglect of many facets of the country’s development, Nargis made flaws in Myanmar’s health care system glaringly apparent. Since 60 years of military rule gave way to a nascent democracy in 2011, the current President Thein Sein’s government has been struggling to reverse that legacy of neglect.
“Those were the worst days,” Ye Phyo Kyaw recalls. “And it just got worse, day by day.”
“If you don’t have money, you can’t reach the care you need.”~Saw Tin Myaing
The storm surge contaminated key sources of drinking water in the area; sanitation was poor as villagers who lost their homes gathered in crowded makeshift camps. The chaos was made worse by a military regime with an isolationist streak that refused to open its borders to international aid. Humanitarian workers and boxes of medications stood in limbo at airports in Thailand for nine days while the situation on the ground rapidly deteriorated.
Every day, Ye Phyo Kyaw struggled to treat hundreds of patients suffering from acute diarrhea — which spread rapidly from one unwashed hand to the next and which quickly became lethal, particularly for infants, in a community where patients could not hydrate.
A military truck arrived with supplies, the doctor remembered.
“The military officer walked around the hospital next to the beds of the patients and said, 'You have free medicine, enough medicine for 10 years,'" he added.
But there was a problem. The truck contained some medications, but it didn’t have the antibiotics needed to treat diarrhea. Ye Phyo Kyaw raised the problem with his superiors, who told him to make do with the supplies they had.
Because of the extreme loss of fluids, without antibiotics many patients would die unnecessarily, he explained to the military at the time.
As Ye Phyo Kyaw remembered the scene, his eyes brimmed with tears.
“They were gone…so many gone,” he said, his voice trailing off.
Soon, Ye Phyo Kyaw said, doctors at Pyapong Hospital received instructions from the Ministry of Health: Do not record the diagnosis as gastroenteritis or diarrhea. Ye Phyo Kyaw said he was warned that if he diagnosed the cases as diarrhea, he would be fired. It was quickly apparent to him that the military was more concerned that revelations of a widespread outbreak would embarrass the junta than it was about saving lives.
Ye Phyo Kyaw was stunned.
Speaking in English, he said, “As a doctor I feel like I am breaking my own ethics. I see that this is the disease, but why can’t I diagnose or write it or speak up?”
Four months later, he was transferred to a different hospital far from Pyapong.
Under the military regime, Myanmar’s public health system was virtually non-existent. The government spent just 1.9 percent of its gross domestic product (GDP) on health care in 2007, the lowest rate among all countries for which the World Health Organization gathered data. In 2008, the country had one of the highest rates of infant mortality in Asia, second only to Afghanistan.
Government expenditure on health care has doubled under the new leadership. Still, Myanmar currently spends less than $2 per citizen annually. Tuberculosis, HIV and malaria are nearly twice as common in Myanmar than the regional average of Southeast Asia. Though there are signs of improvement, limited access to health care and a lack of infrastructure continues to plague the country, particularly in rural areas such as the Delta.