They deliver babies in poorly-lit huts; bind up wounds in make-shift shelters, and dispense vitamins, iron tablets and de-worming medication to malnourished children. Last year they treated 55 people who had been shot and 17 who were injured by landmines. They routinely treat malaria, respiratory diseases and dysentery, advise on sanitation and contraception, and lug their burdens from village to isolated village, hoping the tides of war will soon begin to ebb. They are travelling medics in Burma’s conflict zones, providing primary health care to people who have almost nothing.
Twice a year the medics of the Back Pack Health Worker Team gather in Mae Sot, a Thai town on the Burmese border, to learn, teach, talk and recover from illness and fatigue. At last month’s meeting, the underlying tone was grim. Burma’s first elections in 20 years are scheduled for November, and the military junta’s crackdown on dissenters is escalating. Rebellious ethnic minorities are used to being punished by the army: assaulted, raped, forced to provide free labour, shot, chased, their villages burned – the list of horrors rolls on and on. A central aim of the ironically-named State Peace and Development Council (SPDC) regime is to crush the rebels of eastern Burma, and any resistance from the Karen, Shan, Mon, Karenni and the rest has been met with increased brutality.
In the security of their headquarters in Mae Sot, in a brief respite from the anxiety of normal life, these medics ease away from the stress. They sleep on thin mats on the floor of crowded dormitories, or in huts they have flung up in the rain-sodden yard; they swap stories of hardship, laugh out loud at silly jokes, and pay close attention in various seminars and planning sessions.
Dressed in a bright purple t-shirt and white jeans, gesturing at the blackboard in front of him, Livingstone (who only has one name) looks about 19. In fact he is 37, a back-pack medic, and his life has been hard. Late last year he was shot at by troops from the marauding Burmese army. From one of Burma’s largest minorities, the Karen, who have been at war with the varying manifestations of Burma’s central government since 1948, Livingstone is accustomed to doing it tough. Now all he wants is the measure of peace that real democracy in Burma could bring.
Few expect the elections to achieve much at all, at least in the foreseeable future. The military will maintain its death grip on Burma’s neck, and the minorities will probably continue to get the worst of it. So Livingstone lives with the Karen in the Mergui-Tavoy region in southern Burma, and his family is stashed in the relative safety of a refugee camp over the border in Thailand. He sees his wife and his two young children about twice a year – when he comes to Mae Sot for the biannual medics’ meetings.
He sits down in the bamboo shelter in the Mae Sot office yard and smiles tentatively. “My wife used to live with me in the conflict area, but the SPDC knew I was a back pack worker so they attacked me. My wife and children cannot live there. In the future I want to be with her, but for now, I have to live like this.” He shrugs, and pauses, shaking his head when asked why he doesn’t abandon the struggle and join his young family in the camp. “The community has to face the problem. But I want, one day, if there’s democracy in Burma, I want to live with my wife and children.”
Backpack medics estimate it takes at least five days of walking through the hilly jungle to reach the first village in Livingstone’s allotted district. Some say six days or seven days. But, they say, when you get to the first village, then it’s quick to get to the next one. Many people in the district are refugees – their villages have been burned by the army, and they have been pushed into the jungle where they have tried to start again.
Livingstone says the single biggest problem is the shortage of food. “Some of them can only eat once a day; some people have no rice, only bamboo shoots,” he says. “Some people, they have money, and they could buy rice, but there’s no rice. People get weak, they have malnutrition, then when the SPDC attacks, they have to run to the jungle, and then they get even weaker.”
The Back Pack Health Worker Team, with headquarters in Mae Sot, now has 81 back-pack teams comprising 287 medics traversing the conflict areas of Burma. These teams of medics are supplemented by 630 traditional midwives and 388 village health volunteers. They provide medical care for 180,000 people, a population of Karen, Karenni, Mon, Chin, Shan and others, reaching from the Karen in the south to the Chin further to the north-west. Forty per cent of Burma’s 50 million people are from an ethnic minority, many of them groups with their own government and para-military structures. The SPDC, fearing the fissile nature of a fragmented nation, desperately wants to control these armies and militias.
In the Karen region, the troops of the SPDC and its proxy militia, the Democratic Karen Buddhist Army (DKBA), do battle with the Karen National Liberation Army (slightly complicated by a few seemingly divided DKBA loyalties, and by the fact that the DKBA has now been officially transformed into an SPDC ‘border guard force’). All sides use guns. All use landmines of varying degrees of sophistication.
Many displaced villagers are forced by the military junta to work as porters or to build dams or roads, or even clear landmines, for no pay. The army’s mindless brutality is astonishing. The back-pack medics report that in March this year, a 35-year-old Karen woman from Ko Lu village in Kler Lwee Htoo district was walking home from visiting her father. She had her five-year-old son and her five-month old baby boy with her when she came across a squad of troops. Scared, she ran.
The soldiers, from the Burmese army’s Light Infantry Battalion 369, opened fire, shooting the five-year-old in the head and killing him outright, and shooting the woman in the abdomen and her five-month-old in the thigh. She managed to struggle on to Ko Ta village, where a back-pack medic bound her wounds and those of her infant son so they could be carried to yet another village, Ler Taw Lu, to get away from the rampaging soldiers. The baby died that evening. The troops then burned down Ko Ta village and laid landmines in the fields and on various paths frequented by the villagers.
The Back Pack Team director, Mahn Mahn, says the SPDC has for decades had a policy of “four cuts”, to deny food, information, recruits and funds to rebel minorities. Now, he says, it’s one cut, and he points a finger at his head and pulls an imaginary trigger. And medics try and pick up the pieces.
Funded by various international agencies and running to a budget of about 19 million Thai baht a year ($650,000), the Back Pack Health Worker Team operation is perennially short of cash. Even though the medics get a measly stipend of 1,000 baht a month (about $34), the budget is tight. Some government aid agencies, Australia’s aid body AusAID included, are wary about committing funds to cross-border aid. Australia this year beefed up its aid to Burma to a total of $50 million a year by 2012-13, in response to the “dire humanitarian situation in the country and in recognition of the immense task faced by current and future generations of Burmese”. But this aid is only for projects run from inside Burma, with the approval of the SPDC junta.
The aid agencies don’t want to jeopardise those projects by getting the SPDC offside, nor do they want to irritate Thailand, which accommodates the various cross border aid groups on sufferance. And the agencies add they are quietly worried about the difficulties of checking on the medics’ work in the dangerous conflict zones. One big aid organisation, the Back Pack Health Worker Team ’s largest donor, refused to even discuss its funding of the back-pack medics.
Apparently a few aid agencies are concerned, too, about the possible use of child soldiers for protection and security, but Mahn Mahn flatly denies the medics ever use child soldiers for anything. Some security is occasionally used, he concedes, for such matters as the perilous but essential crossing of roads, where troop squadrons are most likely encountered, but adults provide the protection. “(Some government agencies) are concerned about the monitoring, but we do have our own monitoring,” he says. “They believe they can go through Rangoon to remote areas. But that’s impossible. Burmese government does not permit NGOs in these areas.”
Nine backpack team medics have been killed since their parent organisation began operations in 1998 – dead because they were shot, or because they stood on a landmine. Last year two were arrested. “Danger is the nature of our operation,” Mahn Mahn says. “This is the only way we have. If an SPDC team meets someone in the jungle, they will shoot. The SPDC shoots everyone.”
The most recent SPDC murder of a medic was in July. Troops attacked Thada Dae village in Pa Pun district. Artillery rounds were fired into the village, destroying over 70 houses and the high school, and pushing about 1,000 locals from Thada Dae and four nearby villages into the jungle. The back-pack medic was killed in the attack. Troops then laid landmines nearby, as some sort of mad deterrent against return.
Mahn Mahn wanders out to the bamboo shelter to see how the workshop is going. The audience is listening intently to a Thai aid worker, who is talking about lessons to be learned from power struggles in Rwanda, pointing out that grievances must be addressed, or they fester. One young man is wearing a brilliantly red t-shirt, with a statement emblazoned on the back in both English and Karen. “Karen Culture, Saw Ba U Gyi’s Four Principles: For us surrender is out of the question; We shall retain our arms; The recognition of the Karen State must be complete; We shall decide our own political destiny.” Regarded as the founding father of the Karen revolution, Ba U Gyi was killed by the Burmese army exactly 60 years ago last month (August).
It’s easy to romanticise Burma’s ethnic minorities, after all, most of them have been struggling against the iron brutality of the SPDC for decades. But the various militias and armies are not simply freedom fighters; they could also be deemed as security for large organisations with vested interests that extend into the murky depths of illicit business. Drugs money plays an important role in the finances of various ethnic groups, and the militias and armies can be brutal to anyone who gets in the way. The SPDC is obsessed with bringing the militias into the fold by transforming them into border guards, a plan most have been stoutly resisting for some time.
And in the middle of all these violent and competing interests live the ordinary people of Burma’s minorities, who risk losing a foot, or a leg, or their lives to landmines when they walk in the jungle; who are raped, beaten, and shot with impunity; and who leave behind everything they have worked for when they flee from the guns. The UN High Commissioner for Refugees estimates there are 450,000 displaced people in Burma, and 150,000 refugees in nine closed refugee camps along the border in Thailand – not to mention many tens of thousands more who have no official recognition.
The constant harassment and flight takes its toll on villagers’ health. The on-going conflict, combined with political considerations, makes it difficult to come up with accurate estimates of health statistics. But a 2008 paper on maternal health services in eastern Burma, published in the US Public Library of Science journal, reviewed all previous data and estimated that one in five children in the conflict zones die before they reach the age of five. Another paper, published last month (Aug) in the same journal, estimated more than one in 100 births in the disturbed Shan, Mon, Karen and Karenni regions of eastern Burma killed the mother.
Hsa Muna knows how hard life can be for pregnant women, or women with infants, living in a district where shooting and oppression is a way of life. A 36-year-old Karen woman from the difficult district of Kler Lwee Htoo, two months ago she moved to Thailand’s Mae Sot for a sabbatical after seven years of constant anxiety in the field. She remembers a day in 2008 when she could hear the guns, and ran with her children into the jungle.
“That day, people were fleeing to a secure area, and we had to take care of the sick people,” she says. “I could hear the shooting. We had to carry the children. Friends helped. Single people helped. I had the energy, because I took a lot of material to the jungle that we needed. I could hear the guns. But when we came back I had no energy, and everything was heavy.”
When she was younger, and she had no children, she helped other women with babies run from the guns, and once in her enthusiasm ran off with a friend’s child, fleeing from the troops. But the friend didn’t know she had the child, and naturally, panicked. Hsa Muna laughs as she tells the story.
As soon as the seminar under the bamboo shelter is over, Hsa Muna rushes off to pick up her children from school, but she rings some time later to say she can’t find them, and she might be a bit delayed getting back. She smiles a lot, and casually swats a toddler who won’t stop niggling at her, but there’s no mistaking the fact that her life has been far from serene. Wearing a bright pink golf shirt with the blue cross logo, Hsa Muna says the SPDC’s relentless attacks have escalated recently. “Many people were killed by the SPDC last year, many were injured. But I don’t know exactly how many. They were shot here, here, here,” she says, as she points to her chest, her arm, her thigh.
She has treated patients who had been shot, removed the bullets when she could, eased their pain with Ketamine, and, if at all possible, referred the serious cases to a clinic in Thailand. But she had no electricity to work with, and no transportation. She laughs at the very idea. “It’s very difficult in the rainy season,” she says, noting that getting about was mostly a matter of traversing narrow paths in the jungle, carrying medical supplies and food on her back. She pauses for a long time, looking at her feet. “I was afraid of land-mines.”
In Kler Lwee Htoo, as in Mergui-Tavoy, hunger stalks the land. Hsa Muna says the villagers commonly eat just rice and salt, or rice and a little chili. SPDC attacks have driven farmers from their crops and their animals. The district was already a temporary home to people who had been forced to leave villages elsewhere. Now, she says, they have been forced to leave again. “They have no land, no property, and they have to provide for their families,” she says, shaking her head.
Now she and her three young children, ranging in age from two to seven, are safe in Thailand, but her husband has elected to remain in Kler Lwee Htoo and help their people. “I feel safety here, there’s no shooting,” Hsa Muna says. “But I miss a scene in my eyes, how our life was when we were together.”