IOM Doctors Improve Health Care, Warn of Poverty after Cyclone Nargis
The banks of the Irrawaddy river – a vast glistening expanse
of water – are dotted with a spider's web of muddy channels
overgrown with lush vegetation.
An hour by Zodiac speedboat west of Bogale, one of the townships
worst hit by Cyclone Nargis in May 2008, IOM's Kyae Chan Chaung
Pyar (KCCP) fixed clinic – a white canvas frame tent
sheltering under a bamboo and Nipa palm thatch superstructure
– can be reached by channel at high tide.
The clinic, which treats some 60 people a day, serves 11
villages or over 4,200 people and doubles as a base for mobile IOM
medical teams serving neighbouring villages.
"We live in Mawlamyinegyun and come here by Zodiac every morning.
We then split into two groups. A doctor and nurse stay here at the
fixed clinic and a second team takes the boat to other villages for
mobile clinics. Then we all meet up again in the evening," smiles
Dr Kyaw Thura Thein, a young GP from Yangon.
Outreach mobile clinics, which are held in monasteries or the
homes of village elders, can involve hours of bumpy, but essential
Zodiac travel for IOM's 54 doctors and nurses who work two-weeks-on
two-weeks-off shifts in the delta.
Most spend six days out of seven camping in the five fixed tent
clinics to which they are attached, all of which, with the
exception of KCCP and Yuzana 2, are too remote to allow daily
commuting to nearby towns.
"Both the fixed and the mobile clinics provide treatment and
health education – particularly in areas like hygiene and
reproductive health - but we also refer serious cases to the
township hospitals. In the past three months we've referred over
200 patients with serious conditions – that means not just
diagnosis, but also taking them there by boat and bringing them
back after treatment," says Dr Kyaw Thura Thein.
The IOM medical referral system, which received a boost in
November with the donation of five new, locally built
fibreglass and steel "ambulance boats" from the NGO
Americares, is freely available to other agencies and offers an
important service to delta villages, most of which are only
accessible by boat.
"The new boats are not as fast as the Zodiacs, which were
donated by USAID right after the cyclone and have been invaluable,
but they are comfortable and safer at low tide when there are sharp
tree stumps and other debris in the channels," says IOM
Mawlamyinegyun Field Coordinator Thein Ohn, a genial, elderly man,
who oversees the whole operation from under a battered bush
The KCCP clinic's mixture of fixed and mobile primary health
care, referrals and health education is now replicated at four
other locations in three of the delta townships worst hit by the
cyclone - Yuzana 2 in Mawlamyinegyun; Kyun Thar Yar and Nga Kwat in
Bogale and Seikma in Pyapon.
Sites were selected in consultation with township medical
officers and the Department of Health, who picked locations where
existing sub-rural health centres had been destroyed and needed to
be replaced or renovated.
In KCCP, IOM and the Japanese NGO HUMA have already started to
construct a new, steel reinforced brick building next to the tented
clinic. They have also sunk a 500 ft deep tube well to provide
fresh water for the village.
But at Nga Kwat, another IOM tented fixed clinic two hours away
by speedboat, an adjacent government bamboo and wood sub-rural
health centre and birthing house stands empty, while patients
queue to be seen by the IOM doctor.
"We are worried that when IOM's project ends (in March 2009) the
government clinic will not be able to cope. They only have a
midwife and there is never enough medicine," says Village Head Shwe
The population of Nga Kwat, which lost 188 people in the
cyclone, has actually expanded since the disaster, according to
Shwe Win. "About 40 families came here from other villages –
perhaps because the IOM clinic was here, but also because they
could not go back to the places they came from. They're very poor,
because they don't have land, but they get some work as casual
labourers in other villages," he says.
IOM Bogale Field Coordinator WinMyint, an unflappable, smiling
man who studies his staff through unruly hair and gold rimmed
spectacles, agrees that combating poverty, particularly among
families displaced by the cyclone, is now the biggest challenge
facing the government and the international humanitarian community
"Restarting livelihoods and helping people to generate income is
now critical. Immediately after the cyclone we (the government and
the international community) met people's immediate needs –
food, shelter,medicine. But the cyclone took away their means of
making a living - their fishing boats, nets, farm tools, seeds. So
they can't make the money they now need to repair their houses and
pay for things like healthcare in the future," he observes.
An IOM shelter survey of 57 villages badly affected by the
cyclone, conducted in September with UK DFID funding and published
in November, suggested that over two thirds of 1,746 families
surveyed earned less than USD 8 a month.
Nargis, a freak storm which struck the Irrawaddy delta on 2nd May
2008 left 140,000 people dead and some 2.4 million others severely
affected. IOM's emergency response to the disaster has included
delivery of medical aid to some 57,000 patients in over 700
villages; emergency shelter materials for some 45,000 families; and
distribution of relief items including mosquito nets, waterproof
clothing and household items such as blankets, kitchenware, jerry
cans and hygiene kits. It has also delivered four prefabricated
clinics, that will serve as prescreening centres for station
hospitals in Dedaye, Pyapon, Bogale and Labutta townships. It is
currently working to distribute roofing and reconstruction
materials to some 6,000 households in affected urban areas. It is
also working with local and international partners to train
communities to help them cope with the psycho-social impact of the
disaster. IOM's response to Nargis was made possible through
funding from the UN Central Emergency Response Fund (CERF), Japan,
the USA, the UK, Switzerland, Denmark, Americares, UMA and Chevron