IOM Doctors Improve Health Care, Warn of Poverty after Cyclone Nargis

The banks of the Irrawaddy river – a vast glistening expanse of water – are dotted with a spider's web of muddy channels overgrown with lush vegetation.

An hour by Zodiac speedboat west of Bogale, one of the townships worst hit by Cyclone Nargis in May 2008, IOM's Kyae Chan Chaung Pyar (KCCP) fixed clinic – a white canvas frame tent sheltering under a bamboo and Nipa palm thatch superstructure –  can be reached by channel at high tide.

The clinic, which treats some 60 people a day, serves 11 villages or over 4,200 people and doubles as a base for mobile IOM medical teams serving neighbouring villages.
 
"We live in Mawlamyinegyun and come here by Zodiac every morning. We then split into two groups. A doctor and nurse stay here at the fixed clinic and a second team takes the boat to other villages for mobile clinics. Then we all meet up again in the evening," smiles Dr Kyaw Thura Thein, a young GP from Yangon.

Outreach mobile clinics, which are held in monasteries or the homes of village elders, can involve hours of bumpy, but essential Zodiac travel for IOM's 54 doctors and nurses who work two-weeks-on two-weeks-off shifts in the delta.

Most spend six days out of seven camping in the five fixed tent clinics to which they are attached, all of which, with the exception of KCCP and Yuzana 2, are too remote to allow daily commuting to nearby towns.

"Both the fixed and the mobile clinics provide treatment and health education – particularly in areas like hygiene and reproductive health - but we also refer serious cases to the township hospitals. In the past three months we've referred over 200 patients with serious conditions – that means not just diagnosis, but also taking them there by boat and bringing them back after treatment," says Dr Kyaw Thura Thein.

The IOM medical referral system, which received a boost in November with the donation of five new, locally built fibreglass  and steel "ambulance boats" from the NGO Americares, is freely available to other agencies and offers an important service to delta villages, most of which are only accessible by boat.

"The new boats are not as fast as the Zodiacs, which were donated by USAID right after the cyclone and have been invaluable, but they are comfortable and safer at low tide when there are sharp tree stumps and other debris in the channels," says IOM Mawlamyinegyun Field Coordinator Thein Ohn, a genial, elderly man, who oversees the whole operation from under a battered bush hat.

The KCCP clinic's mixture of fixed and mobile primary health care, referrals and health education is now replicated at four other locations in three of the delta townships worst hit by the cyclone - Yuzana 2 in Mawlamyinegyun; Kyun Thar Yar and Nga Kwat in Bogale and Seikma in Pyapon.

Sites were selected in consultation with township medical officers and the Department of Health, who picked locations where existing sub-rural health centres had been destroyed and needed to be replaced or renovated.

In KCCP, IOM and the Japanese NGO HUMA have already started to construct a new, steel reinforced brick building next to the tented clinic. They have also sunk a 500 ft deep tube well to provide fresh water for the village.

But at Nga Kwat, another IOM tented fixed clinic two hours away by speedboat, an adjacent government bamboo and wood sub-rural health centre and birthing house stands empty, while patients  queue to be seen by the IOM doctor.

"We are worried that when IOM's project ends (in March 2009) the government clinic will not be able to cope. They only have a midwife and there is never enough medicine," says Village Head Shwe Win.

The population of Nga Kwat, which lost 188 people in the cyclone, has actually expanded since the disaster, according to Shwe Win. "About 40 families came here from other villages – perhaps because the IOM clinic was here, but also because they could not go back to the places they came from. They're very poor, because they don't have land, but they get some work as casual labourers in other villages," he says.

IOM Bogale Field Coordinator WinMyint, an unflappable, smiling man who studies his staff through unruly hair and gold rimmed spectacles, agrees that combating poverty, particularly among families displaced by the cyclone, is now the biggest challenge facing the government and the international humanitarian community in Myanmar.

"Restarting livelihoods and helping people to generate income is now critical. Immediately after the cyclone we (the government and the international community) met people's immediate needs – food, shelter,medicine. But the cyclone took away their means of making a living - their fishing boats, nets, farm tools, seeds. So they can't make the money they now need to repair their houses and pay for things like healthcare in the future," he observes.

An IOM shelter survey of 57 villages badly affected by the cyclone, conducted in September with UK DFID funding and published in November, suggested that over two thirds of 1,746 families surveyed earned less than USD 8 a month.