Health: The Things We Take for Granted

Seeing a doctor for a routine check-up, receiving urgent treatment in a hospital, getting the right medication for a sick child – these are all things that most of us can access fairly easily on a day to day basis. In the remote corners of the world, these everyday necessities are much more difficult to come by.

Deep amongst the mangrove lined channels of Myanmar’s Ayeyarwady Delta, an area which suffered massively following Cyclone Nargis in 2008, there are communities who rarely make contact with the outside world. For many women living in these circumstances, pregnancy is the first time they will decide to seek out health care – but finding it can be a challenge in itself.

Such was the case for Daw Mar Mar Htay, who lives in a small village in Bogale district. At 41, she gave birth to her first child. Complications could easily have arisen, due to her age and out of term pregnancy. Thankfully she was referred to the hospital in Ka Don Ka Ni village, a ninety minute journey from her home. “I was told by the young volunteer in my village that I could get good health care here at the hospital, so I decided to come for my first visit seven months ago and came back three more times. Everything went well.”

Ma Hnin Si from Myin Ka Kone village, Mawlamyinegyun Township, was also in a precarious situation, pregnant with twins. The local community midwife helped her to have a safe delivery. "San Thida is a long experienced auxiliary midwife; she was visiting me and visiting me again, helping me. I was aware of the risk and it was a relief when the midwife came with me to the hospital."

As Dr. Zaw Lin Htet, who is based at the hospital in Ka Don Ka Ni, explains: “Transportation is very complicated as it is done by boat through the thousands of small waterways.   During the monsoon season, pregnant women arrive exhausted by the end of their trip.   Can you imagine being pregnant and in pain due to some complications and needing to reach the nearest hospital which is one or two hours away by boat?”   

Delayed, inadequate treatment and the lack of an efficient referral system result in unnecessary loss of life, but since IOM started to support training for midwives, doctors and health volunteers, ensuring patients are referred to hospitals in more complex cases, the figures have been steadily improving.   Maternal deaths decreased by 45 per cent in 2013 and although under-five deaths are still at unacceptable levels, they too are slowly declining.

People on the move are particularly at risk of slipping through the healthcare net, as they are difficult to identify in the first place, and even harder to keep track of.   The delta is home to large numbers of migrant workers, who mostly come from other towns or rural areas to work seasonally in the paddy fields.   There are also itinerant ‘boat families’, who live on small boats that ply the waterways.   “They are often not used to having to access health care, but pregnancy and childbirth are crucial times when many needless deaths can be prevented as long as health workers are available and properly trained.   Community based workers, many of whom are volunteers, form the backbone of this system,” said IOM’s Chief of Mission in Myanmar, Kieran Gorman-Best.   Once communities are identified, locations are plotted using GPS, migration trends mapped and health needs assessed.

Another preventable killer in the region is HIV transmission and AIDS, which IOM is already dealing with in the south-east of Myanmar in particular.   Last year, over 4,000 migrants were covered by IOM’s HIV prevention programmes in Myanmar, a significant proportion of whom were female sex workers.   The HIV positivity rate has halved since the programme began in 2011, and support groups are empowering affected individuals through building up communities to stand up for their members’ interests.

Just as there is a need for International Women’s Day, it’s also imperative to recognize and respond to the fact that female migrants’ health needs are often specific and complex, requiring the support of other women in the form of nurses, doctors and midwives. Of course, men need to be a part of that process, too – and they are, as health workers, aid workers, and supportive family members.

See our photo story on IOM’s work in the Ayeyarwady Delta.