Documente Academic
Documente Profesional
Documente Cultură
Dengue:
how to spot it,
how to avoid it
CHRISTOPH GELSDORF, MD
livingwellmyanmar@gmail.com
75%
The percentage of the worlds
dengue infections thought to occur
in Southeast Asia
IN PICTURES
Vital signs
What census results tell us about our nations health
Years
66.8
63.9
69.9
71.2
60.6
Births
18.9
15.8
20.1
29.9
15.5
Deaths
62
68
41
72
Disabilities
(4.6% of population)
(1.9% of population)
(2.5% of population)
2,311,250
957,736
1,249,737
(1.3% of population)
(1.7% of population)
673,126
835,598
wadeguyitt@gmail.com, myolwin286@gmail.com
Dr Thein Myint
Endocrinologist
Dr Soe Lwin
Obstetrician and gynaecologist
Dr Myat Nyan
Prosthodontist
Dr U Kyaw Kyaw
Dermatologist
Seeing is believing
Cataracts rob our sight, and the people of Myanmar are particularly at risk
JESSICA MUDDITT
jess.muddit@gmail.com
Cataracts are a clouding of the eyes lens, shown here in advanced (above) and
moderate stages. Photo: Supplied/Myanmar Eye Centre
Photo:
Children who
are adequately
nourished during
the first 1000 days
perform better
in school, more
effectively fight off
disease and even
earn more money
as an adult than
those who were
undernourished as
children.
Please watch and share the
1000 Days video at www.youtube.
com/liftfundmyanmar and, if you
are a member of the media,
please share the video with a
wide audience at all levels of
society. For more information,
contact LEARN: https://
myanmar.savethechildren.net/
our-consortiums/leveragingessential-nutrition-actionsreduce-malnutrition-learn
25%
Of 5000 workers surveyed in Australia, onequarter took stress-related leave from the
workplace annually
My hope is that
every woman gets
the choice to get
the care they need.
Name withheld, Malawi
was diagnosed with pregnancy
cholestasis [a liver condition], which
meant I had to stay in hospital until
37 weeks, when a baby is considered
full term, and have an induced
labour. I received excellent care for
the almost three weeks while I was
in hospital, from a team of midwives
in Warsaw. I even got to choose a
vegan diet.
At this hospital, women in labour
are taken to newly renovated rooms,
where conditions are very good:
There is a bath, a private toilet,
birthing balls and mattresses, and
many other items to use for finding
comfort during labour. I gave birth
with the midwife on call, who was
extremely patient and discreet.
Im just happy to say that we got
this very warm, thoughtful care
at a public hospital despite health
systems in Poland and the rest of
eastern European countries being
systematically underfunded. While
I was in the hospital, I read a notice
on the wall which said that state
support for this hospital covers
about two-thirds of the cost of a
birth and that they do need support
from donations and philanthropists,
but it seems that they do manage
in the end to find the funds they
need. Or they manage somehow to
compensate with love and care.
Photo: Staff
14%
Percentage of women in Nigeria
who give birth alone, with no one
else present
In every state
and region
An interview with Paul Sender, 3MDG fund director
To start, tell us about 3MDG.
The Three Millennium Development
Goal Fund, or3MDG, refers to MDG
4, to reduce child deaths; MDG 5,
to improve the health of mothers;
and MDG 6, to fight communicable
diseases. Our overarching goal is to
help Myanmar develop universal
health coverage an accessible
system providing healthcare to all
citizens. We work with the Ministry
of Health and local communities,
international and local NGOS, and
UN agencies. The Fund combines the
support of Australia, Denmark, EU,
Sweden, Switzerland, the UK and the
US to increase the effectiveness and
efficiency of donor funds.
OPINION
Elective C-sections:
too common, too risky?
KIM LOCK
AST month, the WHO warned
caesarean sections should
only be performed when
medically necessary about 10-15
percent of all births, as more often
didnt help mortality rates. Ten
years ago, C-sections in Australia
were performed 19pc of the time.
Now, that number is 32pc.
Caesarean section is major
abdominal surgery, with chance
of: infection, admission to ICU,
hysterectomy, haemorrhage or
death; scalpel lacerations to
bladders, bowels or other organs;
babies being cut; medication
misuse; longer, more painful
recovery; and more potential
for infections, surgical staples
overgrown with skin, excruciating
removal of wound drains, and more
Birth by caesarean can interfere
with breastfeeding establishment,
affect an infants gut and future
health, and increase a womans
chance of repeat caesarean,
exposing her to complications such
as placenta accreta.
What needs to be done? Leah
Hardiman, president of Maternity
Choices Australia, says, A lot of
issues would be resolved through
continuity of care with midwives
as primary carers. This has been
proven time and again through
studies and in practice.
While midwifery is based upon
seeing pregnancy and birth as normal
physiological life events, obstetric
Obstetricians are
surgeons, and
surgeons excel at
performing surgery.
managed by surgeons, that rates of
surgery are high? Authorities often
cite the rising age and bodyweight
of birthing women and womens
request as the cause of increasing
caesareans. But researchers argue
where a woman lives and whether
she has private health insurance are
the most influential factors.
Women often report feeling
pressured, even bullied into surgery,
describing a conveyor-belt cascade
of intervention: An induction gel
leads to ruptured membranes,
which leads to a drip, which leads
to an epidural, which leads to
failure to progress and being told
caesarean is the only option.
Babies struggle with these
10
BANGALORE
Indias street
dentists filling
gap for the poor
GNORING noisy buses and
curious onlookers, street dentist Allah Baksh plunges his
hands into a patients mouth to fit a
sparkling set of dentures for US$12
in the Indian city of Bangalore.
With his plastic stool, mirror and
glass cases of teeth on display, Mr
Baksh, 54, is among hundreds of
such dentists frowned upon by their
licensed counterparts in rapidly
modernising India.
But he insists he is providing an
essential service to 10s of millions of
poor who cannot afford a visit to a
sterilised clinic.
There are millions of poor people
in this country who cannot pay for
expensive dental treatment, Mr
Baksh told AFP in between customers at his makeshift clinic, where his
tools include a large metal file.
But they also have a right to be
treated and look good, he said as he
mixed pink gum paste with his bare
fingers on a teaspoon.
I know this is not hygienic at all,
but if I start using sophisticated
tools the poor man wont come
here.
Mr Baksh never formally trained
as a dentist. He learned his skills
from his father, who came in 1984
to the sleepy southern backwater
which has now transformed into
a regional IT hub and thriving me-
tropolis.
Alongside his younger brother,
son and nephew, Mr Baksh set up
their clinic 14 years ago outside a
bus stand. Together they make and
fit dentures for some 20 customers
a day.
A full set of teeth, moulded and
ready to fit in 30 minutes, costs
as little as 800 rupees ($12). A
single false tooth sells for 50 rupees
($0.80).
Tools are thoroughly washed in
soap and water but not disinfected.
The teeth in all shapes and sizes
are made in China and in India from
dental cement. Soft pink adhesive
is then moulded for gums and the
teeth are stuck in, with the dentists
saying their handiwork lasts for at
least four years.
India passed a law in 1948 allowing only licensed dentists to treat
patients, but the legislations vague
and outdated wording about exactly
what constitutes a dentist has allowed many unregistered ones to
operate.
In big cities such as New Delhi
and Mumbai, street dentist numbers
have dwindled in recent years on
growing awareness of contracting
HIV/AIDS and other diseases, rising
customer income levels, and a surge
in dentist graduates.
Traditional Indian dental worker Allah Baksh takes measurements for dentures from a customer at his roadside stall at KR
Market bus stand in Bangalore. Photo: AFP
Something to chew on
MYA KAY KHINE
mya.simplefly@gmail.com
11
Unplanned results
Dr Aye Thida, consultant and obstetrician/gynecologist at Thingyan
Kyaung Hospital, told The Myanmar
Times that the general public needs
more awareness and knowledge
about family planning and reproductive health to prevent women
resorting to such desperate methods
to end an unwanted pregnancy.
There are many cases of women
determining to get an abortion
because information and health
services are hard to access, Dr Aye
Thida said.
The stigma of an unwanted
pregnancy, however, could only be
outweighed by the stigma of an attempted abortion. Those suffering
complications are reluctant to seek
assistance, even when the aftermath
proves life-threatening.
When they have induced abortion, septicaemia [blood poisoning]
is likely. But they dare not to see the
doctor or go to a clinic or hospital
because they afraid of being scolded.
Some are afraid of being arrested.
In desperate situations, a woman
may come to the hospital only when
septicemia has already infected the
kidney, affecting her ability to release
urine. Most induced abortions, Dr Aye
Thida said, lead to damaged kidneys.
Unsure about how to best take
care of themselves generally, many
women are particularly uninformed
about treatment options for the
many gynecological problems they
will face throughout their lives. Without safe space to ask questions and
trusted medical experts to ask them
too, they resort to whatever means
they can think up themselves.
Dr Aye Thida recalled a woman
who, wishing to end a pregnancy,
asked her three children to jump on
her belly 100 times. Sadly, she later
died from the internal injuries that
resulted, the pressure having damaged her uterus and intestines.
I was surprised at how she dared
take the risk. But there are many implausible induced-abortion-related
cases, Dr Aye Thida said.
She recalled another case in
which healthcare workers spoke to a
practitioner of traditional medicine
whose method of ending pregnancies
involved inserting a chicken feather
into the vagina. The man confessed
surprise at the fact that woman got
infections as a result of this procedure. I have no idea how women got
infected. I know hygienic practice I
use one feather for one client. And
I only snatch a feather when they
come and ask me to, she recalled
him saying.
We were struck dumb with disbelief, Dr Aye Thida said, not knowing
whether to blame him or burst out
laughing.
Of course, she and other experts
know such rudimentary techniques
are all too common, and are no
laughing matter. According to a 2015
United Nations Population Fund
(UNFPA) report, 200 mothers die
per 100,000 live births in Myanmar.
Of these deaths, 20 follow induced
abortions.
Knowledge is power
Daw Nang Phyu Phyu Lin, co-chair of
Gender and Equality Network, said
another factor that needs to be addressed head-on, particularly in rural
or ethnic areas, is male chauvinism,
which keeps women from gaining
knowledge and making decisions
about their own best interests.
There are still many women kept
ignorant and uninformed, who do
not even know their own bodily functions and periodic cycles, Daw Nang
Phyu Phyu Lin said.
Traditional culture and social
norms, she said, make advocating
family planning and open discussion of reproductive health difficult.
Such topics remain taboo to discuss
with women, in spite of the fact that
women, as potential child-bearers,
are put at far greater risk than men
when undergoing sexual activity.
An ounce of prevention...
Health sector workers contacted for
this article suggested offering sex
education as part of the mainstream
education curriculum, as well as
opening youth clinics which could
offer confidential counseling, as
two of many ways to keep women
from needing, or undergoing, such
induced abortions. Combined, these
12
IN PICTURES
AFP/Isaac Kasamani
WHO chief
Margaret Chan.
Photo: AFP