Myanmar, a country of 50 million people, diseases like diarrhoea,
malaria and measles are rife. And there’s a growing
fear that HIV/AIDS could run rampant. The International Federation,
together with the Myanmar Red Cross Society, are tackling
endemic diseases and the spread of HIV/AIDS
Myanmar’s eastern Shan state, in the golden triangle
between China, Laos and Thailand, people were getting sick.
No one knew why they were getting sores on their skin and
wasting away. Maybe it had something to do with people leaving
their mountain villages and crossing the borders to work in
restaurants or massage parlours, or on construction sites.
No one talked about the new illness. Just as they didn’t
talk about children who had constant diarrhoea. Or about adults
with regular bouts of fever and shaking chills — classic
symptoms of malaria.
In many rural villages, says Yvonne Ginifer, a health delegate
with the International Federation, people didn’t even
know how their behaviour influenced their health.
“The people of one village didn’t have any understanding
of the concept of health. They didn’t even know when
they were sick. They didn’t know they could do anything
about their health. They had a ‘go with the flow’
Now the silence is ending. It’s hard to know how many
people in Myanmar are HIV-positive. The government says the
number is 177,000. But the Joint United Nations Programme
on HIV/AIDS (UNAIDS) estimates the number might be as high
as 1 million, and warns that Myanmar might be on the brink
of the most serious epidemic in Asia. Many cases aren’t
reported and deaths are often attributed to tuberculosis,
diarrhoea or malaria. Unlike other Asian countries, infection
rates in Myanmar are continuing to rise.
out to rural communities
For the past two years, the International Federation and
the Myanmar Red Cross Society have been working to reduce
the incidence of endemic diseases and the spread of HIV in
eastern Shan state, a region with a highly mobile population.
The Chinese border is just 85 kilometres from the state capital
Keng Tung; the border with Thailand is 160 kilometres away.
There is anecdotal evidence that traffickers recruit women
from this isolated, cut-off area for sex work.
The Australian Red Cross and the Australian Agency for International
Development fund a three-year community-based pilot health
project, costing more than US$ 380,000.
Starting with basic health information, Red Cross staff and
volunteers have gradually won the trust of people who survive
on small, isolated farms and often have little or no access
to education. Gradually, they have been able to broach the
taboo subject of HIV and the myths and misconceptions surrounding
“When I started, HIV wasn’t a topic of conversation,”
says Ginifer. “But now it is. People are intelligent
and hungry to learn. Until now there’s been such a lack
of resources and information. People don’t know how
to protect themselves from HIV. It isn’t something that’s
discussed openly in Myanmar, let alone in these little villages
near the border.”
The Red Cross faces plenty of practical obstacles. In some
villages, people spend days out in their fields during certain
times of the year, making them hard to reach. In the rainy
season, hillside roads turn into mud and rivers become impassable.
Other difficulties are cultural. Each village is unique,
with its own mix of languages and ethnic groups including
Wa, Kachin, Shan, Akha and Lahu. To reach its audience, the
Red Cross recruited volunteers from different ethnic groups.
Then educational material had to be developed, translated
and tested to make sure it was appropriate to different cultures.
These volunteers then work in their own or neighbouring villages.
Often villages have their own political system. Wan In village,
for example, has a new village headman every week. It’s
a job that rotates among a group of male elders in this Buddhist
village where people are from the Shan ethnic group. So every
time the Red Cross came, they had to speak to a new man and
win him over.
Still, there have already been improvements, such as in reported
cases of dysentery or diarrhoea. Village shops report they’re
selling more mosquito coils and fewer pills to treat malaria.
In fact, the improvements in two villages visited by the
Red Cross aroused the curiosity of the people of Wan In village,
says an elder. “We saw two other villages become clean
and healthy and we wanted it too.”
Twenty-three people from Wan In, a village of 135 people,
have already been introduced to the basic concepts in a community-based
first-aid course. It was a struggle to get women on the course,
in a village where men are always put forward first. What
was the most important topic in the course? Three young women
who have been trained are too shy to answer.
Another woman, Pa Sein, 40, replies: “The most important
thing I learned was how to treat injuries, like cuts you get
in the paddy field. Health education is a new topic for us,
so we’re interested in everything.”
Pa Sein has three children, aged 15 to 25, and one grandchild.
“I now know how to care for women who give birth. In
the past we gave birth by ourselves if it was a normal birth,
or we went to hospital if there were problems.”
Neighbouring Hu Nar village, home to 216 Christians belonging
to the Kachin ethnic group, has worked with the Red Cross
for 20 months. The headman supports this collaboration, which
includes monthly health talks, training and technical assistance
with water and sanitation.
“Before we knew the Red Cross name but we didn’t
understand it,” says the headman. “Now we can
understand what the Red Cross is doing. I’m proud to
work as a Red Cross volunteer for the village. We can see
a big improvement in living conditions in Hu Nar.”
Some traditional remedies remain. People drink water infused
with a herb to cure diarrhoea. And they scrape the neck with
a coin to take away pain or fever. Mo She shows us vertical
red marks on his neck from where he pinched the skin to cure
a cough, which is nearly gone now, he says.
Ginifer says some of the other remedies were riskier. “When
we asked them what their preferred first treatment was, a
lot of people said injections. There were a lot of injections
around but what they were, we didn’t know.”
Baptist minister Kom Kwe says people have fewer injections
now — so they are saving money as well as avoiding health
Once people see the basic health care knowledge working,
they come back for help with more sensitive topics. Once a
villager timidly told the Red Cross that there was someone
with HIV in the village. Red Cross members visited the person
and spent time with him, giving him encouragement. This surprised
and impressed villagers, who had been so afraid of HIV that
they had shunned the person. After the man died, the Red Cross
took his very ill five-year-old son, also HIV-positive, to
a clinic for treatment, where he gradually improved.
After watching this response, village elders, who had initially
said the burden of caring for someone with HIV who was going
to die anyway was too high, asked the Red Cross to provide
training in the care of people with HIV/AIDS.
As well as working on basic health education in remote villages,
the Red Cross concentrates on people in the state capital
Keng Tun whose behaviour might put them at risk: young people,
construction workers and motorbike taxi drivers. Red Cross
volunteers and staff train peer educators, hold discussion
sessions, run campaigns and distribute educational materials
and condoms. A Red Cross survey found 71 per cent of taxi
drivers had had contact with a peer educator and had basic
information about HIV, so the system is working.
for other regions
The Red Cross hopes the benefits of the pilot programme
will spill out far beyond eastern Shan state, says International
Federation head of delegation Joanna MacLean. Keng Tung branch
could be a model for enhancing branches across Myanmar.
“It presents a move from a top-down way of determining
priorities towards a community-based approach. Another departure
from the usual is that it uses participatory adult learning
concepts,” she says.
“So far the Keng Tung pilot project has been very promising.
Staff and volunteers are growing in expertise and experience,
and communities are participating with enthusiasm. Already
rural communities are making changes in their behaviour, and
we can see changes in their health. We think this project
is extremely useful not just for the local communities and
the Red Cross branches, but for developing the Myanmar Red
Cross Society as a whole.”
Rosemarie North was International Federation regional
information delegate in Bangkok.
ICRC activities in Myanmar
Established in Myanmar since 1986, the ICRC is primarily
involved in the following tasks:
• Visits to detainees
• Restoration of contacts between detainees and
• Cooperation with the Myanmar Red Corss Society
International Federation activities in Myanmar
Working in Myanmar since 1992, the International Federation
is primarily involved in:
• Support of community-based health and disaster
• Capacity building at the National Society and
•Coordinate international operations
• Building relations and soliciting funds from