BURMA: DELTA HEALTH CONDITIONS CONTINUE TO IMPROVE

UNCLAS SECTION 01 OF 04 RANGOON 000577 SENSITIVE SIPDIS DEPT FOR EAP/EX; EAP/MLS; EAP/EP; EAP/PD DEPT FOR OES/STC/MGOLDBERG AND PBATES; OES/PCI/ASTEWART; OES/IHA/DSINGER AND NCOMELLA DEPT PASS TO USAID/ANE/CLEMENTS AND GH/CARROLL CDC ATLANTA FOR COGH SDOWELL and NCID/IB AMOEN USDA FOR OSEC AND APHIS USDA FOR FAS/DLP/HWETZEL AND FAS/ICD/LAIDIG USDA/FAS FOR FAA/YOUNG, MOLSTAD, ICD/PETTRIE, ROSENBLUM DOD FOR OSD/ISA/AP FOR LEW STERN PARIS FOR FAS/AG MINISTER COUNSELOR/OIE ROME FOR FAO BANGKOK FOR REO OFFICE, USAID/RDMA HEALTH OFFICE - JMACARTHUR, CBOWES TOKYO FOR HEALTH OFFICER PACOM FOR FPA E.O. 12958:N/A TAGS: ECON TBIO EAID SOCI PGOV BM SUBJECT: BURMA: DELTA HEALTH CONDITIONS CONTINUE TO IMPROVE Ref: Rangoon 531 RANGOON 00000577 001.2 OF 004 ¶1. (SBU) Summary. According to UN and NGO officials working in the Irrawaddy Delta, the health situation in the delta after Cyclone Nargis continues to improve. While there have been no disease epidemics, health NGOs report cases of dengue, diarrhea, and acute respiratory infection throughout the region. The number of cases continues to decrease each week. GOB and international organizations continue to work with affected villages to improve water sanitation, provide medical treatment through mobile clinics, and repair Ministry of Health clinics destroyed by the storm. As relief efforts continue, health NGOs working in the delta have improved coordination, providing medical care to thousands of affected villages. During a trip to the Irrawaddy Delta July 8-12, we observed that the ten villages we visited had received some health treatment from either the GOB or NGO mobile clinics. Village leaders confirmed that their people were in good health and that from a health perspective, their greatest concern was securing access to potable water and improving sanitary conditions in the villages. End Summary. ¶2. (U) Between July 8-12, a USAID/OFDA officer, USAID/RDMA Health officer, Econoff, Poloff, and local staff member traveled to Labutta and Ngapudaw Townships in the Irrawaddy Delta. The team visited ten villages - Ye Wei, Zin Ywe Kyi, Sin Chay Yar, Ka Pyo, Gant Eik, Yin Dee Lay, and Sa Kyin in Labutta Township and Thaketa, Gwe Chaung, Kan Seik in Ngapudaw Township. Health Providers on the Ground -------------- ¶3. (SBU) Cyclone Nargis, which struck Burma May 2-3, destroyed much of the Irrawaddy Delta, including more than 250 large public and private health facilities (Reftel). World Health Organization Health Cluster Coordinator Margareta Skold told us that the storm severely damaged 17 Ministry of Health Rural Health Centers (RHCs) and 120 Sub-Rural Health Centers (SRHCs); an additional 800 smaller MOH clinics (one or two person offices) needed renovation. The MOH, working with private businesses and NGOs, have done substantial work to either repair health clinics or construct temporary clinics and restock them with medicines, she noted. Dr. Saw Aung, Medical Coordinator for UNICEF's Labutta office told us that since July 1, 70 percent of the RHCs and SRHCs in Labutta Township and 60 percent of the RHCs and SRHCs in Ngapudaw Township have resumed operations. Consequently, the health situation in the Irrawaddy Delta continued to improve daily as more villages gain access to medical treatment, he opined. ¶4. (SBU) Despite the reopening of RHCs and SRHCs, health NGOs continue to provide much of the medical care in the delta. Dr. May RANGOON 00000577 002.2 OF 004 Win Thin, Project Coordinator for MSF-Holland Labutta told us that many of the RHCs and SRHCs lack trained medical staff or enough medicines. MSF-Holland and other NGOs, such as Save the Children, Malteser, and Merlin, continue to use their mobile medical teams to provide treatment to the most vulnerable populations, often living in villages that lack either a RHC or SRHC. MSF recently opened a total of eight fixed clinics in Labutta and Ngapudaw Townships, which the mobile teams use as a base, she noted. Teams travel around to neighboring villages for up to two weeks at a time. According to Dr. May Win Thin, the MSF mobile teams treat mainly acute respiratory infections, minor injuries, and mild cases of diarrhea. MSF and other NGOs are closely monitoring patients living in camps for signs of psychosocial trauma, which she opined will become more prevalent in the coming months. ¶5. (SBU) During our trip, we observed that the level of medical care varied greatly among the affected villages in the delta. Larger villages, with populations of 2,000 or more, had at least one public or private clinic, staffed by either a doctor or a health assistant. Two villages had at least two doctors who provided care to the village and the surrounding area. Kan Seik, the most vulnerable village we visited, had no clinic, so villagers had to make a trip by boat the closest village. Villagers told us that immediately after the storm, they received free care; however, they now have to pay private doctors for treatment. As a result, villagers were reluctant to seek treatment, they told us. The Sin Chay Yar village leader told us that they also must seek care in a nearby village, but that the doctors still provided treatment free of charge. How can doctors request payment when people have no money to buy food, he asked. ¶6. (SBU) NGOs working in the delta have improved their coordination, to avoid duplication and overlap of activities. Dr. Thant, leader of an MSF-Holland Mobile Clinic working in Gwe Chaung village, told us that the health NGOs working in Ngapudaw meet routinely to discuss activities and seek ways to improve villages' access to care. The four health NGOs working on Middle Island in Ngapudaw Township - MSF-Holland, Save the Children, Merlin, and Malteser - have divided up the island, with each NGO taking responsibility for specific villages. At the national level, the UN Health Cluster is working with NGOs to map out the affected villages, denoting which organization is providing what service to villages to prevent overlap and maximize services. Limited Cases, But No Disease Outbreaks -------------- ¶7. (SBU) Both Dr. Saw Aung and Dr. May Win Thin emphasized that neither UN agencies nor NGOs have observed any widespread outbreaks of disease in the delta, beyond what is normal this time of year. RANGOON 00000577 003.2 OF 004 Immediately after the storm, there were many cases of diarrhea and dysentery, but once villages received clean water, the number of cases substantially dropped. Mobile teams reported that in the first month after the storm, they primarily treated patients for injuries sustained by the storm. Health cluster officials described scattered cases of dengue and malaria, as well as isolated cases of tetanus and measles. ¶8. (SBU) Village leaders told us that there were no major medical issues in any of their villages. The health assistant from Gant Eik (village population 2,860) explained that immediately after the storm, she treated up to 100 patients a day, primarily injuries, acute respiratory infections, and mild diarrhea cases. Currently, clinic staff treat 30-40 patients a day. Like other villages in Labutta and Ngapudaw, Gant Eik received medical and hygiene kits from NGOs such as Merlin, Save the Children, and MSF. ¶9. (SBU) Despite reports that dengue and dengue hemorrhagic fever were on the rise in the delta, we found only a few villages that had any dengue cases. According to WHO Vector-Bourne Disease Expert Dr. Leonard Ortega, the MOH, working with NGO partners, began larvaciding operations and educational outreach on the dangers of dengue and malaria in Labutta and Ngapudaw in early July. None of the villages we visited had seen any of the MOH activities, although some, on their own initiative, were conducting dengue and malaria educational outreach. Water and Sanitation Desperately Needed -------------- ¶10. (SBU) According to village leaders, access to water and sanitation ranked third among their concerns, after food and permanent shelter. Many villages in Labutta and Ngapudaw were in the process of working with NGOs to clean their water ponds, pumping water out and using lime and other chemicals to sanitize the area. However, this process can take up to several weeks, and most of the villages lacked the diesel to power the water pumps. Consequently, the villagers were using pots and tarps to collect rain water. While this system allowed them to store potable water, it also provided a breeding ground for dengue-carrying mosquitoes. Several villages had UNDP-provided water tanks for water collection systems, which were built more than ten years ago. The villages with UNDP water tanks reported far fewer cases of diarrhea and dysentery, probably due to the provision of clean water quickly after the storm. ¶11. (SBU) During our tours of the villages, we noticed that most villages had very few latrines, with up to 25 people using one latrine in some villages. In Kan Seik, the village had a total of 60 latrines before the storm; currently there are five remaining. RANGOON 00000577 004.2 OF 004 Village leaders informed us of their plans to repair latrines, but they lacked the funds to purchase new commodes. Health assistants agreed on the urgency for improved sanitation. In Gant Eik, the RHC sent one medical assistant to surrounding villages to explain the importance of clean water and sanitary conditions. Comment -------------- ¶12. (SBU) Health conditions in the delta continue to improve, not because of the efforts put forth by the Burmese Government but rather because residents took the initiative to improve their own situations. NGOs remain committed to providing medical supplies and treatment to affected villages. Before the storm, the Rural and Sub-rural Health Centers provided minimal service at best. Currently, due to lack of medicines and medical equipment, government health workers provide even less care. Until Burma develops an improved health care system, villagers in the delta will remain dependent on private clinics and mobile medical teams, as long as they remain operational, for treatment. Because of the regime's paltry funding of the health system, the Nargis disaster relief assistance has brought improved health care to the delta. How long this continues depends on UN and INGO continued access to the delta.