Support Backpack Healthworker Teams in Burma

Over the past 6 months, Burma Humanitarian Mission has supported the Backpack medics’ children with school and food support.  The Child Development Center – the school where the children attend classes – runs from mid-June through May each year.  At the start of the school year, children received the requisite school supply items:  uniforms, clothes, backpacks, lunch boxes, and stationary items (pens, pencils, paper, notebooks, etc).  Food items are purchased monthly.

The global pandemic has impacted the children’s education.  Thai authorities have imposed a very strict quarantine/isolation policy.  (For instance, travel between cities is largely prohibited.  When a person does travel, the traveler must quarantine for 14 days in the new location before mixing with the population).  In-person instruction has been curtailed at the CDC.  A few of the children live with the Backpack medic staff and have access to the internet; however, the majority of students do not.  For these children, each week, they collect paper copies of their schoolwork for their individual study in the CDC dorms where they live.  Older students strive to assist the younger students as best they can.  The medics’ staff also assist as they can.  

During this timeframe, 14 female medic trainees completed their course of instruction to become backpack medics.  The instruction occurred in an isolated, safe village along the Thai-Burma border, just inside Burma.  Thay Bay Hta is extremely remote, with no permanent electrical power or running water.  The women completed the 8-month course in December and have returned to their communities to join backpack medic teams. 

Backpack Medics focus on these core areas:

• Medical Core Program - providing responsive primary care to treat injuries, illnesses and disease.
• Mother-Child Health Program - providing ante-, delivery and post-partum care.
• Community Health Education and Prevention Program (CHEE) - provide community education and materials to reduce likelihood of disease and promote healthy environments.

Stories of the Medics:

"I’m Lway Poe Khaung.  I’m the Field-in-Charge medic for a Pa’laung backpack medic team in Northern Burma.  My team operates in northern Shan State, near the Kachin State border.  There is fighting in this area between my people, the Pa’laung and Burmese army.  The fighting has been going on since 2011.

"In 2020, COVID is a big concern.  I came to Mae Sot to get training and supplies.  We use our CHEEP to teach villagers about COVID. We teach them how to not get it or not spread it.  Here in Mung Ding Pa village, we put up posters to help the villagers.  Despite COVID we still treat all the same conditions."

For the past 7 decades, Burma’s army has waged a war against its ethnic minorities living in Burma’s border states.  The world witnessed the army’s blitzkrieg against the Rohingya, yet it is unaware of the continuous oppression and violence inflicted upon the Kachin, Palaung and Shan in northern Burma and the Karen in eastern Burma.  As a sample of the violence, in July of last year, Burma army soldiers raped and strangled Nhkum Nang Htang, a 48-year-old mother of two, in Nam Sung village in northern Burma.  This year, on January 2^nd, soldiers shot 2 men gathering wood outside their village.  On May 1^st, Burma army soldiers attacked Nam Gat village, burning several homes and stealing livestock and food.  These attacks are a stream of oppression and isolation the Burma army imposes on the country’s ethnic minorities.

The WHO reports 587,000 people are internally displaced with an equal number living in isolated villages. These 1.2 million people have no access to health care.  In these areas, the health impact of the isolation is devastating:

-        135 newborns die/1,000 births (IMR)

-        7.2 women die/1,000 births (MMR)

-        11.6% of the population suffer from Malaria

-        2.8% of the population suffer from Dysentery and pneumonia

In response, in 1999, ethnic minorities and BHM began partnering to formalize Backpack Health Worker Teams (BPHWT).  In partnership, we recruit, train, equip and deploy backpack medic teams back into the conflict zones.  Today, 114 teams are deployed providing support to 306,000 people.  Teams are comprised of 4-5 medics and travel to 9-12 IDP camps/isolated villages a month.  Typically, each team treats 750+ patients and help deliver 30+ babies a year.  The results are inspiring:

• IMR is down to 1.5 deaths/1,000 births
• MMR is down to 2.6 deaths/1,000 births (doubled from previous year)
• Malaria Morbidity has dropped to 0.7% 

BHM’s annual budget averages $250,000 with half dedicated to BPHWT and half to education programs.  BHM’s board consists of 4 members, providing governance.  1 Program focuses on medics with 4 dedicated to education projects.  All project leads are volunteers.

BHM’s vision is empower a healthy and educated Burma through grassroots partnerships.  We team up with leadership from ethnic communities from and in Burma in a capacity building approach.  The people from Burma are motivated to care for and support their own people – we seek to empower them to realize their goals in the areas of healthcare and education.

The backpack medic program has made solid and positive gains since 1999.  We have grown from 32 teams to 114 teams, supporting 306,000 people.  The teams helped deliver over 3,300 newborns with an IMR of 1.5 deaths/1000 and an MMR of 2.5 deaths/1,000.  Malaria morbidity has dropped from 11.6% to 0.7% (all stats for 2019). Our medic teams have a solid training program, proven formularies for medicines, an effective medicine/medical equipment supply network, teams with a balance of seasoned and young dedicated medics and proven abilities to care for the villagers in  IDP  Camps and isolated villages.  They’ve become self-governing, self-training and self-led.  

The sudden arrival of COVID-19 pandemic is an unexpected barrier to continued success.  The teams lack the tools, training and supply items to confront, mitigate and treat COVID-19 illnesses.  The risk to our program of not having a COVID countering plan is an enormous loss of life.  

The COVID pandemic has created a significant roadblock to our ability to provide medical care. As these communities are primitive – with no electricity, running water, let alone medical labs – thus they lack the foundational ability to respond as developed nations are (with testing, etc). As a result, we must develop presumptive diagnostic protocols to diagnosis patients, treat them, educate and isolate the effected families and communities.

A second, more insidious barrier we face is the public perception of Aung San Suu Kyi’s ascension to “State Counselor” and her party controlling parliament.  Many organizations equate this new dynamic as proof that Burma is now a democracy and the civil war has ended.  As a result, they are reducing funding to BPHWT and other cross-border community organizations.  BPHWT has seen a 40% reduction in grants over the past 3 years.  The impact is that BHM and BPHWT have very little flexibility within the existing budget.  We face the unpalatable choice: Are funds diverted from the mother-child health program, medical care, or community health education and prevention to confront the pandemic?  The impact would be a rise in morbidity and mortality rates for areas relatively under control.  
In response to COVID, in 2020 we will:

1. Train backpack medics in procedures on how to teach IDP communities processes to mitigate the spread of COVID (handwashing, cleaning surroundings, social distancing, and isolation for those infected).

2. Train backpack medics in procedures in how to use presumptive diagnostic techniques to identify potential COVID patients and treatments for them (which medications to use, personal protection equipment (PPE) use, patient isolation options.

3. Equip and deploy 84 backpack medic teams to IDP camps and isolated villages – supporting 225,000 people in IDP camps/isolated villages.  This execution phase of our plan will support a community health education program – so villagers know the COVID risks, how it is transmitted, what symptoms to look for, treatments for potential mild, moderate and severe cases (to include risk factors for the more susceptible population), measures to prevent its transmission to healthy people and measures to mitigate its transform from those with it).  The execution phase will also support the medics using presumptive diagnostic tools (high temperatures, patients presenting WHO identified symptoms like cough, loss of smell/taste, body aches, etc.) and then treating the patients with basic medicine (Tylenol equivalent), rest, isolation and fluids.  The execution phase will also include detailed documentation of COVID patients – date, name, location, symptoms, treatments, effectiveness of isolation and outcomes, when possible.

4. At 6- and 12-months, collect medics’ patient care data to compare and contrast COVID-19 infection rates, survivability for COVID-trained teams with non-trained teams and locations without mobile medical, COVID-equipped support.

5. Use this comparison to assess the viability of presumptive only techniques to contain, mitigate and treat an isolated population while identifying additional protocols for these resource-constrained, impoverished communities.

The impacts of our project are multi-faceted. First, we will develop and refine presumptive diagnostic, treatment and educate communities that have no access to more developed medical facilities or supplies. Without the training and supplies, COVID-19 impact on the more than 1.2 million ethnic minorities in Burma could be devastating. The fact that the Burma army is actively blocking western relief organizations assistance reinforces their genocidal objectives with these impoverished and underserved ethnic minorities in Burma. We will make a dramatic impact to prevent that catastrophe.

Second, the program we develop and refine will be immediately available to other underserved regions of the world.

Third, we will show that this approach can be extremely cost effective. The grant funding will allow us to train, outfit and deploy 84 backpack medics teams with a COVID presumptive diagnostic kit, treatments and educational programs to supplement the existing backpack medic team medicine and suppliers. The 84 teams will support an IDP/isolated population of 210,000 people. The incremental cost will be $0.31/person supported.

Fighting the COVID pandemic is a herculean challenge for developed nations: wide spread testing with immediate results, ICUs and advanced medicines for treatment, and possibly future vaccines. Imagine those communities who lack the basic infrastructure of electricity and running water – without something developed, the tragic loss of life will be astronomical.

Our presumptive COVID diagnostic, treatment and education effort is the optimal approach.

In 2019, Burma Humanitarian Mission supported Backpack Medics operating in isolated regions of Burma where the Burma Army continues to wage an aggressive campaign against the country’s ethnic minorities.

For over 7 decades, Burma’s ethnic minorities have endured oppression.  As part of a community-based response, the ethnic minority groups formed backpack medic teams to care for their own.

• Men and women are recruited from among the villages they will serve.
• Medics undergo a 9-month training program before joining a seasoned team.
• Teams consist of 3-5 medics and travel among 9-12 isolated villages or IDP camps each month.

In 2019, BHM’s backpack medic teams:

-       Supported a population of 78,183 people

-       Treated 23,722 patients

-       Delivered 1,116 babies

-       Trained 22 new medics

-       Provided 1,858,282 doses of medicine and supplements

-       Provided 10,151 de-worming treatments to children

-       Provided 10,863 vitamin A treatments to children

-       Achieved an Infant Mortality Rate of 2.7 deaths per 1,000 births – down from 135 deaths per 1,000 births from the baseline year of 2002-2003.

-       Achieved a Maternal Mortality Rate of 1.6 deaths per 1,000 births – down from 7.2 deaths per 1,000 births from the baseline year of 2002-2003.

Backpack Medics focus on three core programs:

• Medical Care Program (MCP) – providing responsive medical care to treat injuries, illnesses and disease.
• Mother-Child Health Program (MCHP) – providing ante-, delivery and post-partum care.
• Community Health Education and Prevention Program (CHEPP) – provide community education and materials to reduce likelihood of disease and promote healthy environments (via clean water, sanitation, etc).