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Middle Island, 19.07.2008

Today, we visited different sites where Malteser International will construct health centres or is already supporting them. With a speedboat, we start our trip in the north and travel to the south. Our first stop is the village Ahtet Puyin. We already came here yesterday and had a coffee, while our boat was being loaded. The people recognise us and greet us friendly; a young woman brings us a corncob as refreshment during the journey. In this village, the health centre has been completely destroyed during the cyclone. The “International Hospital” in Yangon has transitionally sent two young doctors who take care of the patients in a provisional health centre. Per day, around 70 patients come, mainly with diarrhoea and common colds; there were also two patients suspected to be infected with dengue fever. When the two doctors leave the village in a couple of days and return to their hospital in Yangon , Malteser International will take over this temporary centre and will also build a new health centre right next to it, the site is already set: right in front of the pagoda and next to a mother-child-health centre that is supported by the government and operated by a nurse. She is looking really forward to the support of Malteser International.

Our next stop is Magypin. Here, the public 16-bed hospital has received 15 further beds from Malteser International in order to expand its children ward. This clinic has also suffered under the cyclone, the roof and the walls have been severely damaged. Until then, the roof has been partly repaired, but there is still a lot of work to do. The only doctor in the clinic tells us that he has only four nurses to run the whole facility. If you compare these circumstances with a clinic in Europe, you get the shivers. He shows us around the clinic, the operating theatre and the “laboratory”- he himself pronounces it as if the word was written in quotation marks, there is no microscope and no other equipment, only a quick test for malaria can be done here. The doctor is very committed to his work, we see that he really cares for his patients. Malteser International is planning to provide a laboratory, a refrigerator and solar panels for its power supply, because there is not always power here in Magypin – but the vaccines have to be cooled constantly. Then we move on to the children ward. The little patients here mostly suffer from diarrhoea or respiratory infections, most of them are accompanied by their mothers or grandmothers. One of them is the one-year old Mg Thuya who came to the centre with a severe pneumonia a couple of days ago. He is feeling better now and can probably go home tomorrow. He is already moving around like he can’t wait.

Back at the office of Malteser International in Thin Gan Kone: One of our nurses, Nang Thein Hann, comes with me and translates, she speaks a very good English, it’s amazing. Today, the health centre of Thin Gan Kone is closed, because tomorrow is the big day of the official hand-over-ceremony of the centre from the International Hospital to Malteser International and the preparations are going on. We sit down in front of the building with a large number of other people who have come to help or watch. Many of them are former patients, that is why Nang Thein Hann knows them and can establish a conversation easily. A big crowd gathers around us and the people are all keen to talk to me. It feels like it is good for them to talk about what they experienced during the cyclone, that they are happy that someone is listening to them. Many of the stories are similar; they all have horrible memories of the cyclone. Most of them have lost everything, many of them not only all their belongings and their home, but also family members or friends.

Thin Gan Kone is divided into two parts by a river. The bridge that normally connects them was destroyed during the cyclone. Thus, the people in the southern part of the town could not flee to the somehow a little bit safer northern part of the village when the floods came. They were cut off from the two-story monastery and other safer regions. By now, the bridge has been reconstructed and we cross it to get to the people in the southern part of Thin Gan Kone who survived the storm and came back to what is left of their homes. The people on this side of the town also talk openly about what happened to them, they invite me to come and sit in their huts. But no matter how horrible their story is, they all look ahead and plan the future. Such strength and courage are admirable in face of what they experienced. A crowd of children and people accopanies us back to the centre of Thin Gan Kone. There is a lot of work going on, but there is no chaos. The cleaning and reconstruction is going on peacefully and quiet. And the people smile at us as we walk back to the Malteser International teamhouse.

Labutta, 21.07.2008

We are now in Labutta, with around 20,000 inhabitants the biggest city in the Irrawaddy Delta. From here, the assistance after the cyclone started, this is where the people came from their destroyed villages and found refuge in the monasteries of the city. During the phase of emergency assistance directly after the storm, Malteser International distributed relief items like mosquito nets, blankets and hygiene articles to the affected people. Now, almost three months after the cyclone, the monasteries are empty again. But the people didn’t all go back to their villages. About 5,000 of them still live in three camps for internally displaced people around Labutta.

Today, we visit two of these camps where Malteser International is operating a health centre. The first camp is quiet when we arrive. About 2,000 people who fled from the floods and the destruction live here. In no time, a crowd of children has gathered around us, they laugh, giggle, hide, wave. They do what children usually do. It is good to see this after the horrible experiences they went through. On the adults’ faces I can see the traces of the memories and the worries. At the end of July, they have to leave the camps and go back home. But for many of them, there is no home to go to; their huts and houses have been destroyed. They have lost everything and have no resources to start over again. Furthermore, they are scared that another storm might come soon. The memories of 2 May are burnt in their memories.

A little boy comes to the health centre, crying. He hurt is knee and is being taken care of. The doctor and the nurse of Malteser International tell us that in the beginning there were around 200 patients every day. Most of them came with diarrhoea and respiratory infections or because of general weakness. There are way less patients now, about 60 each day. From the tent where the provisional health centre is located, you can see the water tanks that Malteser International has constructed to provide clean drinking water for the people in the camp. This probably prevented and still prevents at least some diseases. Clean water is scarce in camps like this.

At our next stop, the atmosphere is different. This tent-city is bigger than the first one, about 3,000 people live here. In the entrance aisle of the camp, the tents of various relief organisations are located; one of them is the health centre of Malteser International. When the people will leave the camp and the health centre therefore will be closed, the medical staff of Malteser International will follow the people and provide medial assistance in their villages. The doctors and nurses are all young, happy and motivated – this makes the depressing and hopeless atmosphere a little better. You can see the suffering in people’s faces. It’s impossible to take their horrible experiences away, but it’s possible to treat their physical wounds and to help them to be strong for the future. And this is what Malteser International is doing.

Today I met an elderly lady. I was very impressed by the story she told me. She lost her husband and her house during the cyclone. But she does not give up. I cannot forget her and though I decided to write down her story: Daw Khin Mya is smiling while she’s telling her story. This happens frequently after people
experienced something horrible; it is kind of a self-protection-mechanism to deal with the memories. Day Khin Mya will never forget her memories of the night of 2 May 2008, when cyclone Nargis hit the coast of Myanmar, killing ten thousands of people and destroying hundred thousands of homes.

„First came the wind“, the 63-year old woman says. “A very strong wind with a deafening noise. Then came the water.” Daw Khin Mya is sitting in what she has reconstructed of her former big wooden house on the banks of the river in Thin Gan Kone, a little city on Middle Island, in the western part of the Irrawaddy
Delta in Myanmar. Now she is living in a little hut, repaired here and there with plastic sheets provided by humanitarian organisations.

Thin Gan Kone is divided into two parts by a river. During the cyclone, the bridge was destroyed, cutting off the southern part of the city to the somehow safer northern site, leaving the people in the south without many ways to get out. Daw Khin Mya lives in the southern part of the town. When she wanted to flee form the water, she realised that the bridge had broken and that she had to find another way out. Together with her husband and some neighbours, she took a small boat. The wind was still blowing at full speed and the water had gained strength persecuting them. When her husband tried to save other people
from drowning, he fell in the water and could not make it back in the boat. He died in the floods. Shortly after, the boat fell over, leaving all passengers at the mercy of nature. Fortunately, all 16 passengers survived and found refuge in a storage house far away from their home village. At this point of the story, Daw Khin Mya pauses. She holds one of her grandchildren sitting on her lap, still smiling.

The next morning, when the storm had continued its way towards Yangon to then disperse, she came back to Thin Gan Kone. Everything she once owned was gone.
With the help of her five children, she reconstructed her little hut. During her escape, she hurt her knee and she was also suffering from diarrhoea. So she went to the health centre in Thin Gan Kone. This centre as well as further four other health centres on Middle Island are now being operated by Malteser International. But the physical pain Daw Khin Mya is feeling is not the worst – she also suffers from anxiety and depression. These wounds are not that easy to heal. Malteser International is therefore going to send lay-counsellors to Middle Island to assist the people to cope with their experiences and memories.

But after all she has been through Daw Khin Mya does not give up on life. Her husband and she used to work in the fishery industry. And even though the water has taken everything she owned and her husband, she still wants to live close to the river and start fishing again. Daw Khin Mya walks through the streets of her village. She stops to talk to her neighbours who have all experienced similar tragedies that night of 2 May 2008. Then she turns to the little hut where her daughter and grandchildren live. Smiling, she waves me good-bye as she takes of her shoes to enter the small home.

Mayu Kan / Sittwe region, 29.07.2008

Today, I leave the disaster region for a visit in one of the other project regions of Malteser International in Myanmar. Very early, in the pouring rain, we start our trip to the Mayu Kan peninsula close to Sittwe, in the north west of Myanmar. Here, Malteser International has been implementing a project to improve the water and sanitation as well as the health situation in 26 villages since 2006.

Two years ago, all started with a survey amongst the people in the villages to see what exactly their needs are. Then, together with the inhabitants, the plan was made about how to go on. For example, the survey had shown that the construction of latrines should be a major point on the agenda: Malteser International was going to provide the materials for the construction, but the villagers themselves had to decide how many latrines they needed and where they wanted to build them. Furthermore, staff members of Malteser International distributed mosquito nets (namely 5165 – every household in the project’s catchment area received one) and water filters. In addition, health promoters educate the people about risks of diseases like malaria and the importance of clean drinking water. Water ponds are being cleaned and rebuilt so that they will stay clean in the future.

In That Yet Chaung, a small community with about 145 households, we meet the village leader who proudly presents us his new latrine. Here, the people are very engaged and committed to make a change. “Before we started with the construction of the latrines, we had a meeting, every household had a vote. The result: every household wanted to get its own latrine”, the chief says. And so it was done. Where before there were only five latrines for 128 households there is now one latrine for each family. Malteser International provides a basic set for the construction, the people often bring additional material to make the latrines more stable and look better. “The inhabitants of this village take such good care of their latrines that they will easily last ten to 15 years”, Julio Sosa, project manager at Malteser International in Sittwe, says.

Laughing, the village chief tells us how before, people often fell in the water pond because its edges were muddy and slippery, making the water dirty. This can’t happen anymore since Malteser International built a new concrete stair for the villagers to reach the water. Furthermore, the vialgers together with Malteser International plan to construct a fence so that animals won’t go drinking from the pond anymore. That will make the water even safer for drinking.

We walk back through the village to the boat. Everything is very clean and in order. The rain is still heavy and the paths turned into little rivers. Before the arrival of Malteser International and the installation of the latrines, the waste water of many families flew across here…

In total, we visit three villages in which Malteser International works in the sector of WASH (water, sanitation and hygiene). But this is not all: the organisation is currently also constructing five health centres in this region where before there was not even one. Up until today, the medical care is being taken care of by midwives that are each responsible for up to seven villages and work from home. A new health structure is therefore urgently needed. When the construction of the health centres will be finished, the Ministry of Health will take over and sustainably operate them. Of course, they are all provided with latrines and rain water harvesting tanks. And they are cyclone-proof, which is very important in this region where cyclones regularly strike in the beginning of rainy season, destroying many buildings. The construction is going on at full speed; the hand-over will take place soon.

It is good to see how the people here on Mayu Kan are happy about the assistance and how they commit themselves actively in the planning and implementation of all project measures. They even founded committees to take care of their new facilities like the ponds and fences when they were built. In addition, the access to health care will be secured. This combination will hopefully change the situation of the people for the better in the long term, even after Malteser International will have left the area. The stone just needed to start rolling.

Kha Moung Zeik, 01.08.08

After visiting the project close to Sittwe, I went further north to Maungdaw, where Malteser International is supporting the people in very remote areas. During a trip, I had the opportunity to see some of the activities in the projects in person.

After a long journey, we arrive in Kha Moung Zeik. During the rainy season, it is especially hard to get here – since most of the “roads” are not passable by car, we are travelling by boat. Along the river, you can see the every day life of the people. In this part of Myanmar, very close to the border with Bangladesh, almost 95 percent of population are Muslims. They often don’t have good access to healthcare and education. Since 2004, Malteser International has been implementing a broad programme to improve the health situation of these people.

In Kha Moung Zeik, we visit a school, where Malteser International has constructed two rain water harvesting tanks, six latrines and two hand water pumps. The principal of the school tells us that before they had the water tanks, drinking water had to be supplied by villagers and that it was very difficult to have water in the dry season. Now, the students have clean water all year long. The hand water pumps were constructed to wash the hands after using the latrines. For the children, our visit is a very welcome change and distraction during the school day. Curiously, they look out of the classrooms. One teacher even interrupts his lesson to come outside with his pupils and to show us one of the rain water harvesting tanks and how they make use of it.

Our next stop is a “Mother Child Centre” (MCC) close to the school. Here, undernourished children between two and three years get one meal per day on six days of the week. The room is provided for free by a villager and two kindergarten teachers cook for the children. As “payment”, they can also eat here with two of their children. Malteser International provides the money for the food and makes sure that the little ones and their families find their way
to one of the 26 MCCs operated by Malteser International. Once a month, Malteser International organises growth monitoring sessions in the villages. If the children do not weigh enough for their height, staff members of Malteser International talk to the parents and offer them to send their child to a MCC.  Surprisingly, not all parents agree to do so, because some mothers do not have time to accompany their child, others cannot or do not want to leave the house to go to a MCC.

We arrive just in time for lunch, about 25 children sit on the floor and eagerly spoon up their bowls. On the other side, some mothers and grandmothers are sitting around. Today, in addition to the two kindergarten teachers, a health educator from Malteser International came to talk to the women about balanced nutrition and its importance. The women listen attentively and we hope that they have the financial means to actually follow the advices. But there is reason to be confident, because many of the little ones look already better than they looked when they came here for the first time. We say good-bye to the group and start our way home.

The outpatient department (small health centre) and the attached malaria-unit operated by Malteser International are situated right next to the team compound. So our way leads right through the “waiting room” (on here, this means the whole area around the outpatient department) and pass the open windows of the treating room. The malaria unit is very busy, the patients have to be registered, then a drop of blood is taken which is then examined under a  microscope by a laboratory technician. If the test is positive, the patients receive medicines or, in severe cases, are referred to a health centre that is located at about six hours walking distance.

If the test is negative but if they still have pain, the patients go right next door to consult the doctor of Malteser International. Of the 80 patients tested so far today, the malaria test was positive in 50 percent of the cases. Malaria is a big risk factor in this region and the centre of Malteser International is the only facility in this remote area where it is screened and where medicines are subscribed and handed out. The doctor next door mainly treats diarrhoeas and respiratory infections. He and one nurse work like on the assembly line: Every day, about 100 patients come to see them – there is no time for long breaks. It’s been a long day, even for us, who were only visiting the projects. The staff members of Malteser International who work here day by day, trying to improve the situation of the people, are really admirable. They don’t "just" do their job; you can see that they really like what they are doing and that they are committed to the people for whom they work. This evening they sit outside on the team compound and I can hear laughter and giggling. Until ten o’clock, when the generator is turned off and the only thing I hear are the sounds of the amazingly beautiful and lively nature in this remote region of Myanmar.

Ta Man Thar, 3 August 2008

During a trip to the region in the north of Maungdaw in the northwest of Myanmar, I have the opportunity to personally get to know some of the project activities of Malteser International here. Today, I am in Ta Man Thar.

There is no hospital in the remote village of Ta Man Thar. It’s the rainy season right now and the “roads” are not usable, therefore, to get to the closest “clinic”, the people here have to walk up to six hours or, if they can afford it, take a boat for two hours. Pregnant women therefore don’t have a possibility to get regular medical check-ups, a fact that sometimes leads to complications during pregnancy and delivery since risk pregnancies are not detected on time. But there are traditional birth attendants here. They are mostly women from the village that have been assisting deliveries for many years, but never had training for doing so. The women in the villages trust these attendants and respect them very much. To make use of this existing structure, Malteser International is supporting traditional birth attendants with training and urgently needed material.

When she is not assisting a delivery or attending a pregnant woman in the region, Noo Ru Jun works at home, like most traditional birth attendants. I enter the windowless, dark hut and it takes a couple of seconds for my eyes to adjust to the dark. Then I see how many people have gathered – about 20 women
and almost as many children sit on the floor and cook, chat or play. Among them are three mother-child-health-workers of Malteser International. On a regular basis, they visit the traditional birth attendants to train them and to inform them on how to detect a risk-pregnancy and what to do in such cases. “I have been doing this job for over 20 years now, Malteser International has been supporting me for the last four years,” Noo Ru Jun tells me while she auscultates the belly of a pregnant woman close to delivery with an ear trumpet and then palpates the abdomen. “Everything is ok, the head is on the right side,” she smiles and tells the future mother to sit up again. “Before, when there were complications, I didn’t know what to do. Now, I refer the women to a health  centre or clinic. I also learned how to deliver twins – what caused difficulties before.” Furthermore, Malteser International regularly provides the traditional birth attendants with material like soaps and gloves as well as with medicines like painkillers. The staff members of Malteser International also inform them about balanced nutrition during pregnancy. Noo Ru Jun then carries this knowledge to the villages. One young woman with a child in her arms smiles at me. “I am very happy that Noo Ru Ju assisted me during the delivery. If she wouldn’t have been there, probably nobody would have assisted me, maybe a woman from the village, but she would not have known what to do”. The atmosphere is very pleasant and friendly. All the women accompany me back outside where the men are waiting; they are not allowed to enter Noo Ru Jun’s “examination room”.

The birth attendants are a big support for the women, but when complications arise, they cannot do much since they have no sufficient medical training. Emergency cases have to be taken to a midwife, a doctor in one of the two State Hospitals or to one of the health facilities of Malteser International. During this weekend, the outpatient department of Malteser International in Ta Man Thar is without a doctor or nurse that is why, early in the next morning, someone knocks on our door: a young woman has strong bleedings and suffers from anaemia – she is nine months pregnant, more or less, she says. Due to  financial constraints, Malteser International cannot provide individual transportation to a hospital for all emergency cases in the region. But since we travel in the direction anyway, we take the pregnant woman, her mother and her little son with us in our team-boat to Kyein Chaung where a doctor will assist her.

We arrive there well and in the afternoon, we visit the young woman in the hospital where she got an infusion. The doctor tells us that in a couple of hours, at three o’clock in the afternoon, he will do a caesarean. The hospital basically consists of two big rooms - one for the male patients, one for the female patients - and a surgery room. Malteser International recently constructed an incinerator for the medical waste. The organisation also takes care of the
treatment costs and gives some money to the patient and one accompanier for them to be able to buy food during their stay, because meals and caretaking can not be provided by the hospital.

We leave the young woman and start our way back to Maungdaw. But I can’t stop thinking about her and at about half past three in the afternoon, I ask myself how she and her baby are doing and if the caesarean went well.

The next morning, I receive the information that the caesarean did go well, but that the baby was already dead. The mother is doing as well as the circumstances admit, she is recovering from surgery. Of course, this is very sad news. But at least, the young woman made it to the hospital to survive and to be able to see her little son, who is already there, grow up and to take care of him.

Maungdaw, 05.08.08

Back from the northern, remote part of Maungdaw Township in the northwest of Myanmar, I am now in the city of Maungdaw where the programme office of Malteser International for this region is located. Today, I visit some surrounding villages with Dr. Aye Mar Lwin, Tuberculosis Officer at Malteser International and Noor Kakin, Senior Health Educator at Malteser International. We start early in the morning, because it’s the time when the tuberculosis-patients take their medicine every day. If they don’t take it regularly, they risk to develop resistances towards the medication, making the treatment very difficult if not impossible. On the way, Dr. Aye Mar Lwin explains to me how the treatment of tuberculosis-patients is handled at Malteser International:

In the villages, health educators hold educational sessions to inform the population on the symptoms of tuberculosis. If they have these symptoms, the health educators advise them to go to a screening centre of Malteser International where a free pre-test is done. If this is positive, they will be referred to the governmental hospital where sputum examinations on three successive days and an X-ray give the final result. If this one is positive as well and the patient really suffers from tuberculosis, he receives medication on a monthly basis for at least six months. Malteser International takes care of the costs for the examinations and for the travel costs that arise when the patients have to come and pick up their medicines every month.

In the villages of the region, Malteser International has trained Direct Observed Treatment (DOT) providers that visit the patients every morning to make sure that they take their medication. They note their visit every day in a small registration booklet. These DOT-providers are not employed by Malteser International, they just receive a small incentive for assisting the patients. Once a month, the health educators of Malteser International visit the DOT-providers and each patient to see, if everything is going well or if they need anything.

We enter a little hut where Noor Kanin holds a health education session together with the local DOT-provider. Many women and children have gathered and there is also one elderly man. Usually, woman and men are not supposed to be so close together, that is why Malteser International always organises two sessions. The very experienced health educator conducts the session with a lot of élan and motivation. With posters, he explains his audience how they can recognise tuberculosis and what they can do to prevent the disease. He also points out the importance of a good nutrition during the treatment, because the therapy can have strong side effects and can be very consuming. For the people who cannot afford this, Malteser International, together with the World Food Programme of the United Nations, is organising a monthly food-distribution where food is provided for poor families of tuberculosis-patients. “It is important to also think about the families. If we only give food supplies for the patients, they will share their portion with the family and not have enough for themselves,” Dr. Aye Mar Lwin explains. At the end, the women ask some questions. Most of them are about what they can do when they detect symptoms of tuberculosis in themselves or their children. Noor Kakin then suggests to go to the screening centre of Malteser International. “One of the problems before was that the people didn’t even know what the symptoms of tuberculosis are. They often did not recognise it and didn’t get any treatment, which can lead to dead and to the infection of other people.”

At the end, we visit two patients who have been getting treatment for a couple of months already. You can see that the medication took a toll on their strength, but they are already feeling better since they started with the treatment. They are still weak, but soon, they will be back to a healthy life. And thanks to regular visits from the health educators of Malteser International and the DOT-providers, they know how to prevent an infection with tuberculosis in the future.

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• Federal Foreign Office (Germany)
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• United Nations
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• Voluntary Organisations in Cooperation in Emergencies

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