The Doctors who work on Thai-Burma border
Source : Joshua Schenker,Far Eastern Economic Review (October 12, 2000)
After almost two decades treating refugees from Burma, doctors from MSF are calm in the face of the challenges
For someone working on the front lines of a refugee crisis, Dr. Jane Geary is remarkably sanguine. "In many ways, the medical situation here is as well monitored and capably treated as in a hospital anywhere," she says. "It's almost like a normal job."
Almost. In Umpiam, a camp on Thailand's western border housing displaced people from Burma, the in-patient clinic run by Medecins Sans Frontieres looks like a clinic you'd find anywhere. Patients are hooked up to drips. During breaks, staff knit and stare at posters on the wall. Young nurses, usually drawn from the camp's refugees, check a girl with a broken arm whose friend has brought her junk food to gorge on. They comfort a young mother whose pregnancy has become complicated.
Watching MSF, which won the Nobel Peace Prize last year for its medical work in the world's hot spots, it's hard not to be impressed. The group has been working in camps along the Thai-Burmese border since the early 1980s, and there are currently about 120,000 refugees in these camps.
When MSF began working here, malaria and tuberculosis were persistent scourges. Infant mortality was off the charts. Today, most refugees are as healthy as any Thai citizen. A change in malaria treatment--using drug "cocktails" rather than a single anti-malarial drug--is one factor in the group's success. Preventive activities, such as education about sanitation and nutrition, have also helped to minimize potential problems. And staff have worked to break down barriers with refugees and build up trust--a picture in one clinic shows an MSF doctor at a camp function looking goofy in traditional Karen dress.
Still, with resources stretched thin, the appearance of normality is deceptive. One morning, a frantic, overworked doctor arrives at Umpiam's outpatient clinic, where patients have been lining up for hours. The doctor glides through like Mother Teresa, spending just enough time with each refugee to do basic checks before being swept towards the next patient. Although Thailand has asked the United Nations High Commissioner for Refugees to help convince 110,000 refugees to return to Burma, the number of people flowing into Thailand is rising, as persistent fighting between the rebel Karen National Union and Rangoon's army levels villages inside the Burmese border.
These new refugees carry an ever-increasing variety of strains of disease. Falciparum, the deadly strain of malaria, has not been eradicated along the border. One anaemic young mother wracked by malaria lies on an MSF-affiliated clinic's floor. Illnesses linked to the woman's malaria claimed the lives of her first two children shortly after birth. Now, she's lost so much weight that her body may soon start consuming its own tissues.
There are concerns that a recent massive malaria, typhoid and anthrax epidemic in northeastern Burma could spread to border areas just across from the MSF camps. And psychological problems, predictably prevalent in a population unable to return home, complicate treatment. "Some people may not want to get better," says Dr. Herve Isambert, MSF Thailand director.
Adding to MSF's problems is the resentment--and occasionally violence--directed by local Thais against medical staff who treat refugees. Thais in towns along the border have held rallies opposing expansion of the camps. In the past, the Burmese military has attacked camps, destroying refugees' houses and medical facilities. Geary, though, is once again sanguine. "Security is not a major concern of mine here, not compared to some places in Africa or Central Asia where MSF works," she says. An MSF assistant adds: "It is just an aspect of the job."
After nearly two decades on the Thai-Burma border, and with no sign of the refugee crisis abating, MSF looks set to be doing that job for some time to come.