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

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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

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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.

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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.

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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.