Aung Lin Tin is a tiny, struggling scrap of humanity. Born six weeks prematurely, he weighed 1.08 kilograms when he arrived. He couldn’t suckle. He had a fever. He lost more weight in his first days of life. His mother, Tin Zar, is 24 years old and a Karen – one of the long-battling people living along the Thai-Myanmar border.
An illegal migrant, Tin Zar lives in Thailand’s northern border town of Mae Sot with her husband who labours on construction sites. Aung Lin Tin is her first child; she has no identification papers in Thailand, no right to Thai healthcare, and no money to pay for doctors or hospitals in Myanmar. Her situation is grim, but care is free at the clinic and, like most Karen, Tin Zar is remarkably resilient. She has already weathered a lot of storms in her life, and her child is alive.
“That’s my baby,” she says in halting English, dabbing at the child’s tiny stick-like limbs with a tissue and beaming. Prescribed antibiotics at the Mae Tao clinic, the infant is far too small for a nappy. He lies on tissues that Tin Zar whips away when necessary. A tube in his nose delivers oxygen; another down his throat delivers nutrition.
An Australian doctor, Kate Bruck, a long-term consultant at the clinic, looks at Tin Zar tending her child. “I couldn’t tell you the outcome for this baby,” says Bruck. “I don’t have a crystal ball. But at home this baby would not have survived.”
The Mae Tao clinic is frighteningly long way from the bars and cafes of Brisbane’s West End, from the city’s doctors and health centres, from the pharmacies with all manner of medicines to cure most of modern Australia’s ailments: this is life on the edge.
A pharmacist with a degree from the University of Queensland, and a comfortable life in West End, Peter Branjerdporn made the giant leap from the streamlined ease of modern city living to this clinic on the remote, jungle-wrapped border of Thailand and Myanmar.
Just a few kilometres from the river border, the Mae Tao clinic treats hundreds of patients who stream in from Myanmar for much-needed assistance; for medicine, for help. To live. Many hundreds of thousands more of these villagers are living illegally in Thailand, where they cluster near the border, but they have no papers, no rights, no health care. Mae Sot is a town of refugees and aid workers.
Working for many months as a volunteer in the Mae Tao clinic, Branjerdporn saw the pain first-hand, and it still haunts him. The clinic offers the only hope for many patients who are ill, distressed, injured or disabled. Now Australian government aid to the clinic has been cut. With the end of the military junta in Myanmar, and with ceasefires declared in a number of the ethnic conflicts, including the decades-long Karen battle, the official thinking is that Myanmar refugees and illegal immigrants should leave Thailand and go home.
“After a couple of days in that town, you start to take on some of the trauma,” Branjerdporn says from his home in West End. “You can’t help it; you can feel it in the air. They’re resilient, but only because people have been through so much. It’s in their eyes, in the children’s eyes. Some of these children have never been citizens, of any country. Two or three generations of being stateless, and denied everything. They’re denied basic human rights.”
Vital health care is delivered by the Mae Tao medics. Few of them have medical degrees or even much high-level training, but they perform minor operations and provide care for critically ill patients. Foreign doctors, many of them volunteers, provide advice. The clinic is a basic place, a collection of ramshackle buildings connected by concrete paths. Beds are boards, without mattresses, sheets or pillows. Family members provide patients with food, and often sleep in the wards, in beds or on the floor. Walls and floors are often less than pristine.
One patient might have lost a leg to a landmine or a traffic accident. Another might have a septic infection from a botched amateur abortion. Others are simply deathly ill with malaria, or dengue fever, or they have babies limp and listless with persistent diarrhoea. One in five infants dies before they turn five in Karen state, the long Myanmar province that runs down the side of the Thai border just over the line from the Mae Tao clinic. It’s one of the worst infant mortality rates in Asia: a rarely noted catastrophe still happening in that shiny new tourist destination of Myanmar.
The images of the Mae Tao clinic stayed with Brandjerdporn, and he has done his best to raise money to help the clinic — playing in concerts with his band, Peter B and the Homeless Souls, and making recordings to sell on the internet. Like many other Australian professionals who have volunteered at Mae Tao, he was upset when he learned the Australian government had decided to cut aid funding to the clinic, after it was decided “future support (will) focus on preparing refugees to return home when conditions permit”.
True, the military regime that ruled the country for five decades has retreated and a new quasi-democratic administration has been in charge in Myanmar since early 2011. Yet the people of Myanmar continue to stream into the clinic, both from across the border and from the fringe towns of Thailand. Health care in Myanmar remains notoriously poor. The Myanmar government spends as little as 3 per cent of GDP on health services (yet as much as 21 per cent on the military), and although clinics and hospitals are nominally free, in reality they are substandard and the cost is high.
“There’s a couple of hundred patients a day,” Branjerdporn remembers, adding those patients were so desperate to get to the clinic that some travel for days through Myanmar to get to Mae Sot, and others pay bribes they can’t afford to authorities along the way. “Even though they don’t have much money, they just have to pay”, he says. “That’s how bad it is (in Myanmar)”. He fears the Australian aid cuts will add to the pain and misery of people who have already had far too much misery in their lives.
Born in Australia, Branjerdporn spent his childhood in Bangkok with his Thai parents. His family moved to Brisbane when he was 15, and now he counts both Thailand and Australia as home. Volunteering for an Australian government-funded position at the Mae Tao clinic in 2012, he and his wife and toddler daughter moved to Mae Sot for several months. Despite aid-worker training and a lot of research, the Mae Tao medical care came as a shock to the university-trained pharmacist.
“It took me a couple of months to really understand how little pharmacology they knew,” says the 36-year-old pharmacist. “Once I worked it out, we were able to aim it at the right level. I wish I’d known that before. People who hardly had a high school education were dispensing retro-virals (for HIV)”. Branjerdporn laughs. “It’s mind-blowing, the fact that it has 13 departments – it’s a hospital, really. The tiny amount of funding they get, it’s amazing they can do all that stuff.”
Let Let Win’s leg looks dangerously painful. Sitting awkwardly on her board bed in a Mae Tao ward, she looks up and tries to smile, shifting her leg and wincing. Swollen, dark and shiny with a long stitched wound, her calf was operated on last year, in a hospital in Karen state. But a month after the surgery, the 24-year-old still hadn’t recovered. A Buddhist monk in her village suggested she visit the Mae Tao clinic. So with her husband and her father and mother-in-law she made the decision to come to Thailand. Her mother stayed in Karen to look after the family smallholding. They have already forked out a great deal of money in Myanmar for ineffective medicines, “so much”, her husband says, and now they are just hoping some new treatment might work. Let Let Win is seven months pregnant.
They will stay, they say, until the baby is born, and Let Let Win has recovered and ready to go home. Her mother stayed in the village to look after the farm, where they grow rice and corn. “We will wait here,” Let Let Win says sadly. “It’s all we can do.”
If her condition should prove serious, her choices will be limited. The Mae Tao clinic can’t offer chemotherapy, or complicated surgery. The staff provide as much care as they can, but it remains basic. The local Thai hospital sometimes assists, and there is a local aid organisation that can help with more complicated surgery for children, but adults with complications have few options.
“There are days when you have to say, ‘this is what we can do; this is what we can’t do’,” Branjerdporn says. “It’s a daily thing for a lot volunteers there. I grew up in Bangkok; I’ve been to fairly remote places in Thailand, but even as a Thai person, I was just … ‘oh my god, what is this’?”
Dr Cynthia Maung fled military-ruled Myanmar soon after the famous student uprising of 1988 and set up Mae Tao clinic with almost no resources. Decades later, the clinic has grown massively, now treating about 100,000 patients a year: babies vaccinated, illnesses and injuries treated, health advice provided, medicines dispensed. Maung has shown Laura Bush, the wife of former US president George Bush, through the wards, and held innumerable high-level meetings with diplomats and generals.
A gentle and unflappable woman, Maung doesn’t hesitate. She sits on the lino floor in a clinic building to talk to five young women cradling their newborns and waiting to be taken to Thai government office to register the babies’ births. Shy and smiling, the young women answer Maung’s friendly questions. Yes, they know about contraception and how to use it and, yes, they will have their babies vaccinated. About 3,000 babies are born at the clinic each year and, tragically, about 600 young women with botched and septic abortions are admitted for treatment. The clinic offers contraception, Maung says, “but we need more outreach programs so they can access those services; not everyone can come here regularly”.
After battling for years to maintain the clinic’s services, let alone expand them, she now faces a huge funding shift. Life is changing on the border, and international priorities are shifting. The US is the clinic’s biggest donor (the second-biggest was Australia) and the US grant ends in 2015. “The USAID office is now officially in Yangon, so the possibility of funding for Burma (Myanmar’s former name) has to go through Yangon,” Maung says placidly. “So we will have to see how to do that.”
The massive refugee camps along the border, she explains, are home to 450,000 people from Myanmar, but outside the camps there are many more who have fled the violence and uncertainty and who are living without documents, and they make up the bulk of the clinic’s patients. Others come from inside Myanmar, sometimes travelling half-way across the nation to the get to the clinic.
A 48-year-old farm worker from Bago, north-east of Yangon, U Soe Soe is learning to walk again. He shuffles forward, slowly and carefully. A year before he arrived at the Mae Tao clinic, a heavy load of timber fell on his leg, breaking it, perhaps badly. His boss took him to Yangon by train for emergency treatment. Shrugging, he says the doctors in Myanmar capital city decided they had to amputate his leg above the knee. “There was a lot of pain,” he says. “It hurt to walk on it. They had to amputate because I could not walk any more; or anyway, they thought it was better to do an amputation.”
U Soe Soe is not a wealthy man, and he couldn’t afford to pay for a false leg in Myanmar. So he travelled hundreds of kilometres east, to the border, to the Mae Tao clinic, where a prothesis was fashioned for him for free. Mae Tao staff taught him how to walk with the plastic leg, and after 12 days, he is ready to leave. “I would like to say thank you; the staff are very patient and charitable, giving support to Burmese people”. With a wife and two sons, aged eight and nineteen, U Soe Soe is anxious to get back to Bago and start working again. “I will keep working for my family. There might be difficulty for me, if I have to lift something, but I have to support my family. I will keep working.”
The clinic is a magnet; both for the people from Myanmar who are unwell or injured and for western specialists who rotate in and out, providing advice on patients and helping train the medics. Kate Bruck, an Australian doctor who has worked in disaster zones all over the world, including Cambodia, Kosovo and Macedonia, and who now spends a lot of her time working at the Mae Tao clinic, says the Karen people are the most resilient she has ever known. And although the civil war in Karen state now seems to be over, they are still suffering. “We’re still seeing some pretty bad malnutrition,” Bruck says. “There have been two really bad floods in the last six months, and we know that will have an impact, so we’re not expecting great improvements.”
But the staff and doctors at Mae Tao will keep up their efforts to making life a little bit better for the many dispossessed and displaced people of Myanmar who flock to the clinic. For his part, Peter Branjerdporn will try to get back to the clinic for another stint of volunteer work, but he has two young children now, so it could be difficult.
And he will keep trying to raise money to help. Peter B and the Homeless Souls have run a couple of fundraising concerts in Thailand and a couple in Brisbane, and he plans another one in Brisbane soon. He wants to make sure the Mae Tao clinic keeps providing basic health care to those people who need it so much. “They don’t have anywhere else to go,” he says. “That’s the best they’ve got.”
Peter B and the Homeless Souls: (www.pbhs.bandcamp.com)
Photos by Brennan O’Connor