ANNUAL RREEPPOORRTT 20100 Dear Friends,

Once again, we faced many challenges in 2010. There has been sporadic conflict along the border since the November elections, primarily in the areas of Pho Pra, Mae Sot, Umpiem and Tang Song Yan. As a critical community based organisation (CBO), we continue to Table of help the displaced community in any way we can.

Some that fled have been able to return home, but at Contents June 2011, there are still 6000 – 7000 displaced people scattered along the Thai side of the border. We are looking after many of these people in conjunction with Greeting from Dr. Cynthia...... 3 other CBO’s: they rely on us for food, shelter, protec- Vision and Mission...... 4 tion and health care. Health Services...... 4 Vaccination Program...... On a positive note, after a two and half year struggle, 7 the Suwan Nimit Foundation was finally approved by Pa Hite Clinic and Satellite Clinics...... 8 the Ministry of Interior in April 2010. This is a Ma Cho Cho’s Story...... 9 huge milestone as, through the Foundation, we are Health Support Services...... 10 able more effectively fundraise for boarding houses Ma Myint San’s Story...... 11 and the Emergency Response Team (ERT), among Photo of Dr Cynthia courtesy of James Mackay Child Recreation Center (CRC)...... many other things. As a legally registered charity in Thailand, the Foundation is now able 12 to effectively pursue its objectives. Facilities...... 12 Ma Ohn Mar’s Story...... 13 In collaboration with other health organisations and the IRC health team, we were able Ma Hla Hla Oo’s Story...... 13 to standardise training and curriculum levels for health workers along the border. We have Health Worker Training...... Dr. Cynthia Maung worked with community outreach centres in migrant areas to improve access to women’s 14 Director, Mae Tao Clinic reproductive health care, and have trained a number of people to provide this care, as Reugee Emergency...... 15 well as referrals. Collaboration...... 16 Editorial contributions, design Child Protection...... and layout of this report was Several new buildings and renovations were completed in 2010, including the construc- 18 tion of a new isolation ward for the inpatients department. We are now able to effec- Food and Nutrition Services...... done by the following volunteers: 19 tively separate patients infected with tuberculosis and other contagious illnesses, thereby A Young Student Dreams of Higher Carmen Beltran reducing cross-infection to other patients. The construction of the new Child Recreation Education...... 19 Lisa Houston Centre was one the highlights of 2010. This facility was built specifically for the children of Finance, Administration, and Manage- Michelle Katics Mae Tao Clinic – as patients themselves, or as children or siblings of patients. Here they are able to relax, play and have fun in a safe and educational environment. ment...... Elizabeth Young 20 Jonathan Wexler Advocacy...... 21 In the year ahead, we will continue to meet the ongoing challenges we are faced with, Articles, Media and Resources...... All photos in this report are cour- ensuring we are there for those who need us, and doing all we can to provide the best 22 possible care for our community. Research Projects and Reports...... tesy of MTC staff and Volunteers 23 with special credits to: MTC Staff...... 23 Sincerely, Burma Children Medical Fund (BCMF)...... 23 Elizabeth Young MTC Management and Leadership Team...24 Jonathan Wexler MTC Donors...... Michelle Katics 27 Katie Camarena

All content in this report is copyright of MTC and may not be used or reproduced with- Dr. Cynthia Maung out the consent of the clinic operators. Director, Mae Tao Clinic

2 Mae Tao Clinic Annual Report 2010 Mae Tao Clinic Annual Report 2010 3 Department Most Common Diag- Department Most Common Diagnosis nosis and Activities and Activities Vision And Mission Adult Inpatient • Eye Care •Glasses •Anaemia •Eye Surgery The Mae Tao Clinic (MTC) is a health service The future vision for MTC is to continue pro- •Diarrhoea •Presbyopia provider and training centre, established to viding quality health and social services. •Urinary Tract Infec- •Cataract contribute and promote accessible quality MTC is endeavouring to further promote tion •Myopia health care among displaced Burmese and health education, and improve access to •Gastritis / Ulcer ethnic people along the Thailand–Burma and utilisation of its health services. MTC border. In addition to the comprehensive will also advocate for improved access to services provided at its onsite facilities, MTC quality education for migrant children in the Surgery •Abscesses Laboratory •Malaria testing also promotes general health through part- Mae Sot area and work to strengthen the •Minor wounds and Blood •HIV testing child rights and child protection network nerships with other community based or- •Mass / Lump Bank •Blood collection and stor- ganisations. We work together to implement among local and international human rights and advocate for social and legal services, institutions. MTC serves a broader role as a age as well as access to education for people community centre and centre for advoca- living along the border. cy with respect to issues related to Burma Reproductive Health •Antenatal visits Dental Clinic •Chronic Apical Periodontitis and the displaced community. •Postnatal visits •Root Stump •Family planning vis- •Cavities its •Delivery •Neonatal care •Post-abortion care Health Services •STI treatment

MTC continued to provide health services restricted. After armed conflict broke out in during 2010 to 111,403 patients, compared November, patients faced yet more secu- to 115,567 in 2009, representing a decrease rity and cost to reach the clinic. Normally, of 4%. This may be explained by the secu- half of the patients come from Burma, but in rity situation on the border and the border 2010 this dropped to 43%. Regrettably many Friendship Bridge being closed by the Bur- patients delay seeking treatment due to the mese government since July 2010, making it cost and difficulty of travel, which further in- difficult for beneficiaries to access our servic- creases the cost of care. There were other es. There are significant travel and security changes in caseload, such as a reduction risks for people crossing the border to come in malaria patients, with a drop of over 40% to the clinic, and the movement of people in outpatients and about 50% for inpatients. on the Burmese side of the border is heavily

Department Most Common Diag- Department Most Common Diagnosis nosis and Activities and Activities Adult Outpatient •Acute respiratory Child Health •Acute Respiratory Infection Since April 2009, MTC has been conduct- typically unable to access this coverage. infection •Diarrhoea ing a successful initiative for universal Hep- This has resulted in prevalence among atitis B vaccinations for newborns. For ba- MTC’s antenatal care clients of 8% to 10% •Gastritis / Ulcer •Malaria bies born at the clinic or those registered for many years. The vaccinations offered •Malaria •Anaemia with the clinic within two weeks of birth, a by MTC are the same as those received by •Immunisations free Hepatitis B vaccination is provided. Thai children, and in 2010, 6731 doses were •Supplemental feedings Although universal Hepatitis B vaccinations administered, nearly double that from 2009 •Vitamin A supplements have been offered in Thailand for more (3841 doses). To gain immunity, each child •De-worming than ten years, MTC patients have been must complete the three-dose course.

4 Mae Tao Clinic Annual Report 2010 Mae Tao Clinic Annual Report 2010 5 Health Service Comparison 2009 and 2010 Cases (unless otherwise indicated) 2009 2010 % change Vaccination Program Total Visits 153,703 148,374 -3% Naw Eh is 29 and the mother of three chil- or herself. Total Caseload 115,567 111,403 -4% dren. She lives in Burma, with Total Clients 75,210 71,997 -4% her husband and six other family members. Today she comes to Total Admissions 11,391 10,726 -6% She is one of the hundreds of people that the clinic for a gen- Adult Medical Outpatient Cases 38,578 32,530 -16% cross the Thai–Burma border every week to eral check-up and work or have access to services in Mae Sot. vaccination for her Adult Medical Inpatient Cases 3,448 3,422 -1% healthy baby, after Surgery Cases 8,098 7,509 -7% Naweh was planning to deliver her third a successful delivery Reproductive Health Outpatient son in Myawaddy, but after the elections of at MTC. She is very Outpatient cases 1,464 1,678 15% 2010, the economy of her household was af- happy with the ser- Antenatal Care (client number) 5,612 5,842 4% fected, making it impossible for her to deliver vices provided by her baby at a Burmese hospital. The cost of the clinic, especially Family Planning visits 9.441 8,902 -6% a natural delivery in a hospital in Myawad- with the birth registration certificate. Her Reproductive Health Inpatient dy is 60,000 kyat (approximately USD$9360) only concern is having enough money for RH Inpatient Admissions 4,953 5,276 7% and with surgery it can reach 120,000 kyat. the next visits and being able to cross the Delivery Admissions 2,768 2,804 1% For most of the mothers it is cheaper to have border between Mae Sot and Myawaddy, the baby at home with a traditional birth at- without any security concerns. Just like any Post natal care visits 3,082 3,077 0% tendant, but Naw Eh wanted her baby to caring mother, she hopes to have the re- Child Health be delivered in a medical centre, to avoid sources to come for the next check-up, and Outpatient cases 17,202 15,952 -7% complications or risk the health of her child get vaccinations of her other two children. Inpatient cases 1,605 1,811 13% Primary Eye Care and Surgery The Dental department expanded their ser- The Acupunc- Cases 14,289 13,526 -5% vice hours and is now providing oral health ture team has Eye Surgery Completed 565 742 31% education at local migrant schools. The also expand- Eyeglasses dispensed 8,167 8,335 2% clinic continues to offer a number of differ- ed their servic- Prosthetics and Rehabilitation ent dental procedures, including fillings and es to 6,924 pa- extractions. tients, treating New and Replacement Cases 256 211 -1.5% all kinds of ail- Laboratory and Blood Bank The Prosthetic Workshop has been busy this ments, such as Slides for malaria testing 43,540 37,083 -15% year, providing essential services to over 200 sciatic nerve HIV tests for Antenatal Care 4,064 3,660 -10% patients. Most of the cases we see are the pain, paralysis, back pain, knee joints, and Tests for voluntary HIV counselling & testing 1,296 821 -37% victims of land mines, which, it is estimated, headache, spinal and neural problems. contaminate at least 70% of the 2000km Thai- Dr Ulrich Huehne, a foreign advisor for the Blood donations 1,939 1,698 -2% land–Burma border. Landmine victims are acupuncture department passed away on Dental Cases 5,772 6,038 5% often referred directly to Mae Sot Hospital December 30, 2010 at Mae Sot Hospital. He and are paid for by the International Com- came to MTC at the end of 2009 and helped mittee of the Red Cross. No humanitarian set-up the department by teaching acu- mine clearance puncture techniques he previously learned programmes ex- in . This 74 year old man, original from ist in Burma, and Poland, spent every day at the clinic teach- mines continue ing the staff all he knew including English. to be laid, so we The acupuncture staff are extremely grate- will carry on help- ful, for the time, the kindness and friendship ing the victims in he shared with them. any way we can.

6 Mae Tao Clinic Annual Report 2010 Mae Tao Clinic Annual Report 2010 7 Official delivery certificates have been is- sued by the Reproductive Health Inpatient Department, and guidance to processing Ma Cho Cho’s Story official birth certificate with the Thai author- ity was given to parents who hold Thailand stay permit. However, more than 50% of Originally from Rangoon, Ma Cho Cho, was thousands of kilometres avoiding military parents/caretakers have returned to collect trafficked to the Chinese border along with checkpoints along the way, finally arriving in MTC delivery certificates which were to be other 7 girls at the age of 15. She described Myawaddy. There she learned about Mae collected on the same day as their postna- the first months as blurry and confusing be- Tao clinic. During a routine prenatal check- tal care appointment. MTC has identified cause she was injected with drugs to keep up she learned that she was HIV positive. a need for increased community aware- her submissive almost daily. After nearly a After weeks of counselling, she decided ness and support for follow-up visits both year living with her captor, she became to proceed with the Prevention of Mother for health and documentation purposes. In pregnant. Tired of the abuse and not know- to Child Transmission Treatment (PMTCT). 2010, 2,708 children born at Mae Tao clinic ing her future, she planned her escape with Months later, her healthy baby was deliv- received birth registration papers. Among three other girls. While their captor was out ered and put into the care of Social Action these, 2572 (95%) were non-status in Thai- of town for business, they ran away with just for Women (SAW), a partner organisation of land, 50 (2%) were Thai citizens and foreign- The treatment of HIV has become a sig- some pocket change and food. Mae Tao Clinic. Her baby has been saved ers with temporary or permanent status, and nificant issue for MTC since Médecins Sans from being born with HIV and has been giv- 86 (3%) were parents who have migrant reg- Frontières (MSF) closed their Anti Retroviral Mae Cho Cho suspected her mother of sell- en a chance for a healthy life. istration papers. (ARV) program in Mae Sot area in 2010. We ing her to the traffickers, so she couldn’t go have taken on the 46 HIV positive patients home. Three months pregnant, she walked As in recent years, the treatment of tubercu- that MSF were treating, and have been pro- losis remains one of the most important un- viding them with antiretroviral medication of sanitation systems in villages, village health education, installation of water and sanita- solved challenges for the next year. MTC is while we pursue measures to assure they tion facilities and ongoing staff training. currently working with World Vision to provide will continue to receive treatment in the fu- care to some of these patients, but severe ture. New patients that meet the criteria for All current communications are done through a new satellite telephone system, this has limitations in funding and resources exist. ARVs are referred to the Mae Sot Hospital for improved the information sharing with MTC staff. World Vision works with Mae Sot Hospital to treatment. Unfortunately this does not guar- provide treatment to patients with the in- antee that they will receive treatment, as The following trainings were conducted for Pa Hite and satellite clinic staff during 2010: fection, and MTC can refer patients to this the Thai program is already full; patients are programme, but they only qualify for treat- accepted only as vacancies occur. There • Community Health Volunteer Training ment if they live in the Mae Sot area. remains a large unfulfilled need for proper • Data Collection Workshop, CHW Training management of HIV infection, including • TBA Follow-up Training for sections ARV medicines, in the migrant community • Data collection workshop served by MTC. • IMCI Workshop • Malarial management workshop • Universal precaution workshop

Pa Hite Clinic and Area Outpatient Inpatient Pa Hite Clinic Satellite Clinic Caseloads Population and Satellite Clinics Pa Hite Clinic 2,136 6,887 227 Ka Pu Clinic 1,955 4,456 260 Mae Tao Clinic also supports the Pa Hite The Pa Hite and satellite clinics have three Clinic which serves 62 villages with a popu- main areas of focus: clinical, which focuses Ka Na Del Clinic 2,192 4,340 484 lation of 9974for curative, preventive, moth- on inpatient and outpatient medical con- er and child health and training new health sultations and treatment, laboratory diag- Kel Pa Clinic 2,943 3,736 116 workers. Currently, Pa Hite Clinic has four nosis for malaria and patient referrals. The small branch clinics and two nursery schools reproductive health focus includes Tradi- Tha Thwee Del Clinic 748 2,178 317 in the Pa Pun district. Starting in 2009, Pa Hite tional Birth Attendant (TBA) training, antena- cooperated with Karen Department Health tal and postnatal care and the delivery of Total 9,974 21,597 1,204 and Welfare (KDHW) to provide immunisa- babies. The school health area focuses on tion, infant feeding and nutrition services in student health, including Vitamin A supple- the Pa Hite clinic area. ments and de-worming, as well as the setup

8 Mae Tao Clinic Annual Report 2010 Mae Tao Clinic Annual Report 2010 9 ents are inpatients; however and hygiene issues. The cen- and fresh fruit – with the sup- many of these young chil- tre also provides snacks to port of private donations. dren also bring along their each child – a carton of milk younger siblings for whose A playground has been built care they are given respon- with help from Ryan Parkes Health Support Services sibility. Children partake in from Ideas Playground, and activities such as arts and ongoing commitment from The Health Information Sys- Central Pharmacy contin- suicide prevention, mental crafts, music-making, sto- Ben Wallace, an Austra- tems (HIS) department has ued its services to the clini- health awareness and stress rytelling and library time, lian artist who developed a been developing a relation- cal departments in the year management for MTC staff free play, outside physical mural for the outside of the al database which entered 2010 by providing central- and CDC staff and students. games and exercises, as centre and around the play- pilot testing by some depart- ised purchasing and logistics During the year 2010 the well as educational games ground. ments. This effort is intended for medicine supplies. centre had an average of which include social, health to improve data quality, 69 patients per month and capture and storage. In De- MTC continued to provide performed 418 individual cember, training on the new Social and Rehabilitation counselling visits. system began for the de- Support Services to patients partment programme man- by providing services such agers. The end state will be as patient transport when real-time data entry by the needed, accommodation Ma Myint San’s Story departments. in the patient house for those unable to return home dur- The Laboratory processed ing recovery, support for vul- Ma Myint San is 34, he was born due to complications resulting 37,083 malaria screenings, nerable long-term patients, and is from Phyuu, from a prolonged labour, he would be 14 and 3,660 HIV tests, among funeral services, supplemen- Burma, although years old now. Her second child, who is 11 other clinical diagnostic tary nursing care for HIV/ she is now living in years old, was also born at home in Burma, tests. The Blood Bank coop- AIDS patients, a library, and The Child Recreation Center Thailand. She has but her other two children, 8 and 2 years old erated with factories in the orphan care. Transportation (CRC) opened its doors in come to MTC to respectively, were both born at MTC. When Mae Sot area, reaching a and security is provided to February 2011, with the sup- receive post-abor- Ma Myint San realised how sick she was, sev- donor population of 2,218. patients when needed. Ex- port of UN Women’s Guild tion care, resulting en days after her failed abortion, she knew The blood transfusion team amples include follow-up and Burma Border Projects. from an abortion that MTC would be able to help her. The has implemented a set of vaccinations, PMTCT, and This is a brand new space administered by a staff from the Reproductive Health depart- quality control indicators for Antiretroviral Treatment, dedicated to the children of Traditional Birth At- ment completed her abortion by manual the upcoming years. As for malaria follow-up visits, and Mae Tao Clinic. It aims to pro- tendant (TBA). The vacuum aspiration, and her infection is now the Volunteer Counselling prosthetic patients. Many vide fun, learning and care. TBA was not able being treated by IV antibiotics. She is slowly and Testing Unit, the number patients, especially those The project continues to be to fully remove the recovering, and will hopefully be able to of clients decreased by 24%, that are considered high- supported through private foetus, and Ma return home soon. She is receiving counsel- from a previous 1,296 to 980 risk, do not have enough funding by BBP volunteer Myint San developed a severe infection. ling about the dangers associated with this clients. The closure of the money to return home or re- Derina Johnson, who was This was her sixth pregnancy, and her sec- type of abortion, as well as family planning border at Mae Sot and the turn to the clinic for critical brought on board by BBP af- ond abortion; she has three living children. advice, so she can avoid a similar situation security issues of the area follow-up visits. ter a request from Dr Cynthia Her first baby was born at home in Burma, happening again in the future, have influenced the flow of for the further development but unfortunately he died two minutes after clients coming for counsel- The Counselling Centre of- of child and youth psycho- ling. fers individual counselling social services. The staff are sessions as well as special- trained by BBP in psychoso- The Infection Prevention Unit ised group discussions and cial health and therapeutic increased the central ster- relaxation sessions. Between practices, as well as general ilisation of instruments for July to December 2010 the management of the centre. clinical departments. An ad- centre has offered: ampu- ditional autoclave was do- tee support group sessions, Currently the centre is open nated which supplement- home visits and community to children between the ed the existing autoclave, awareness meetings. Dur- ages of 4 and 12 years, who which suffered from main- ing this period, community are inpatients of the clinic tenance issues this year. The awareness sessions included as well as those whose par-

10 Mae Tao Clinic Annual Report 2010 Mae Tao Clinic Annual Report 2010 11 vated after the postnatal care building was ing room space, and a new reproductive completed. The renovations have provided health outpatient’s area. Medical outpa- more space for patients to sleep, improved tient’s was planned to move into the vacat- Child Recreation Centre (CRC) delivery, neo-natal and exam rooms and a ed reproductive health outpatient’s area. central station for staff, from which they can Unfortunately however, just after the original see all patients. clinic was demolished, the funding for the At first, when his colostomy as his family were not able to new building fell through. At this stage we the CRC afford treatment to reverse the procedure. The original clinic site was removed in April haven’t been able to secure further fund- opened, the Having an opening in his abdomen and no 2010 to make way for a new building to ing, so none of these plans have been able staff encour- access to ‘colostomy bags’ (which are used be used for antenatal care and immunisa- to come to fruition. aged Saw in the more developed world), means that tions, a “Well-Baby” clinic, office and meet- Khaing Htoo children with this condition often have a per- to go and sistent odour. He was often called “smelly” participate by other children. in the ac- tivities at the The staff at CRC encouraged him to play centre, but and taught him about hygiene. He soon Ma Ohn Mar ‘s Story he refused to learned how to keep his body clean. He go. The staff began to play with the other children more, explained to finally gaining confidence in himself. In the him that the end, he understood the purpose of the cen- Ma Ohn Mar is 33 centre was a tre and was excited to visit every day. No- years old and lives in place for the children to play games and body had to call him anymore. the Burmese border to relax their mind while staying at the clin- town of Myawaddy. ic temporarily. Finally, he followed the staff A few days later, he was admitted to a hos- She and her husband and came to the centre. pital in Chiang Mai for surgery under the travelled by boat and Burma Children Medical Fund (BCMF) pro- car to get to MTC to On the first day, he did not play with the gramme. When he returned to the clinic, he deliver their first child. other children and just fell asleep. Saw Kha- was very happy. Before he went back to his Ma Ohn Mar knew ing Htoo suffered from a condition known as village, he came to see his friends and staff that the risk of com- Ma Hla Hla Oo’s Story imperforate anus. He was born without an at the centre. He even showed them his scar plications during her anus and had emergency surgery in Burma and explained to them how he had been birth was high, and when he was a baby to create an open- treated in Chiang Mai. Early the next morn- that if she delivered ing for the large intestine (through the ab- ing, he went back to his village in Burma. at MTC, she would re- Ma Hla Hla Oo is 38, domen) in order to pass stool. This is called ceive comprehensive and free care. When and has come to a ‘colostomy’. He has grown up living with her son, Poe Sanay, was born he was happy MTC with her sister to deliver her third Saw Khaing Thoo’s full story: http://www.burmachildren.net/our-cases/success-stories/children/khaing/ and healthy; when he was just three days old, however, he developed haematuria – child. Her first two blood in his urine. Ma Ohn Mar is very grate- babies were born in ful for her decision to come to MTC to have hospital in Burma, by her baby, as he is now being treated for this caesarean section Facilities condition, and is expected to make a full re- but now that she is covery. living in Thailand, Ma Hla Hla Oo has come Facilities continue to be improved in order A new isolation ward was completed in July to MTC so that she to accommodate increasing patient case- for the medical inpatient department. It is can deliver her baby loads and child protection needs. The con- used to help control infectious diseases such naturally and safely, struction of the Community Training Centre as respiratory tract infections, diarrhoea and and for no cost. Her second baby died of was completed at the end of December tuberculosis. We completed a new post- dengue fever at just nine months old. Al- 2010. This facility will be used for health natal care building in October which now though she knows there is no vaccination worker and other vocational training. Fur- provides the reproductive health depart- for dengue, she hopes that by having her ther construction is needed for areas such ment with a private consultation room, birth new baby vaccinated here, it may be able as a teachers’ room, and library and semi- registration area, staff area, and a space for to avoid contracting a similar illness and dy- nar rooms. staff training and meetings. The reproduc- ing, as her second baby did. tive health inpatients facilities were reno-

12 Mae Tao Clinic Annual Report 2010 Mae Tao Clinic Annual Report 2010 13 In addition to the core health worker train- mental health topics. MTC staff continue to ing, a number of seminars, workshops and upgrade their knowledge and skills through short trainings were conducted. Topics in- ongoing trainings and workshops on com- Health Worker Training cluded specific clinical areas, computer puter use, malaria, medical ethics, leader- skills, health information systems, environ- ship, public health, female condoms, dental MTC conducts numerous training cours- ing, newly trained nurses, medics and other mental health, human rights, community hygiene, child protection, blood transfusion, es to recruit and strengthen the capacity health volunteers staff MTC as well as vari- management, management skills, and hepatitis B and HIV advanced workshops. of health care workers serving the ethnic ous health facilities on either side of the Thai- populations of eastern Burma living in both land–Burma border. The following training Thailand and Burma. After completing train- programmes were conducted in 2010: Refugee Emergency Core Health Worker Training Duration Male Female Total In November 2010 armed conflict broke out and media team and finance team. Internship programme health care workers 10 months 10 29 39 the Burmese border, nearMae Tao Clinic. Many have concluded that the conflict situ- from ethnic minority areas of Burma strength- More than 20,000 civilians fled into Thailand, ation in Burma will continue. This will mean en their clinical skills. three civilians were killed, and more were more refugees, and large numbers of inter- injured. As fighting spread north and south nally displaced people. We will respond by along the border,people went into hiding raising funds as needed, delivering health Community Health Worker (conducted at 6 months 20 32 52 for fear of returning to Burma. The local Bur- services and humanitarian assistance in col- Pa Hite) comprises classroom and clinical ro- mese community immediately mobilised laboration with our community and NGO tations for entry level health trainees. to assist those in need. Over 20 community partners, and continue to advocate for hu- organisations came together to organise a manitarian treatment of refugees and end- Health Assistant Training for those who have 12 months 14 41 55 health team, assistance team, information ing the cycle of violence. already completed nursing or community health worker training comprised of class- room and clinical rotations. Community Health Volunteer (evening class) 3 months No funding Emergency Team is open to anyone who wishes to work in a available MTC supports the emergency team, by al- non-medical capacity at MTC and has no lowing trained staff from the clinic to be prior experience. part of their mobile teams. “Unfortunately, people cross the border searching for a EMOC training follow-up (RAISE project). 2 months 10 10 safe place. The families living on the bor- derline are unable to work or return home. They lack food, shelter and medicine. Their villages are surrounded by landmines; this Basic Dental Care training for medics work- 3 months 7 2 9 is why they can’t go back. We are their ing in the dental department at MTC. only support”, explains an MTC programme manager, who is also a member of the emergency team. Displaced mother and baby (Pho Phra), treated by mobile Lab Technician training for medics working in 4 months 4 12 16 team doctor. Picture provided by Emergency group team. Currently, the team visits and provides ser- the laboratory at MTC. vices to various sites in the area, as need- ed. They collect vital information that helps To find out more about the register the changes on the conditions of current emergency, the displaced population in Pho Phra. They Visit: www.facebook.com/fcobforum distribute food and medicine and perform check-ups. Emergency cases are sent to MTC.

14 Mae Tao Clinic Annual Report 2010 Mae Tao Clinic Annual Report 2010 15 • From December 8 – 9, two MTC staff attended the “Cross Border Health Service Map- ping” in Chiang Mai, organised by TBBC and IRC. MTC and Partner Staff: • From November 29 – December 1, MTC staff attended a meeting in Chiang Mai hosted We’ll be there for those who need us by Norwegian Church Aid. This was a multi-organisation meeting focused on Rights Based Approaches.

Staff from Mae Tao Clinic and many partner Most of these staff members are young and community-based organisations have been energetic, but like most of us, juggle spous- working harder than ever since November es, children and their jobs on a daily basis. to assist those taking refuge along the bor- Aing in the relief effort shows visible strain der. Those assisting in the efforts must also from time to time. They worry about those Outreach Health Services Highlights ensure that their ‘day jobs’ carry on provid- who try to go back home and face land ing services. Certain staff are pressed into mines and human rights abuses. They also service due to their knowledge of the situa- worry about those in hiding who face the School Health The School Health teams visit schools for displaced children in the tion and ability to navigate the security situ- onset on rainy season and malaria danger. migrant areas to provide services such as vision screening, nutri- ation. Local authorities face a delicate bal- But with a laugh and a smile, and support tion, water/sanitation assessment, first aid supplies, polio-vaccina- ance of border security and humanitarian from their family and co-workers, they carry tions, de-worming and vitamin A supplements and dental care. concerns This can make it difficult for these on, and will be there for those who need The target population is 10,000 students from 52 schools. staff members to deliver dry food supplies, them. Those in hiding do not want to stay in Adolescent Repro- The Adolescent Reproductive Health Network is a community- conduct health checks and organise treat- Thailand, they would like to return to Burma, ductive Health based group comprised of 9 organisations that empowers teenag- ment for serious cases through MTC and but cannot do so due to the lack of health ers to responsibly address reproductive health issues through out- partner NGOs. facilities, educational and livelihood op- reach, education and counselling. portunities and infrastructure, as well as the Home-based care Through regular home visits, MTC staff provide hygiene packs, sup- ever-present danger of landmines. for people living with plementary nutrition, supplementary nursing care, and medication HIV/AIDS for opportunistic infections. There are also monthly support group meetings. In 2010, MTC made 1,422 home visits. Peer educators raise awareness in the community and provide care for terminally ill patients. Counselling Centre Community awareness meetings, home visits, boarding house mas- Collaboration ters meeting, parent and teachers meeting.

During 2010, MTC continued actively to col- tions (CBO’s), Thai organisations, and Inter- laborate with Community Based Organisa- national Organisations. Highlights include:

• Dr. Cynthia and MTC staff attended the 1st International Congress on Women’s Health in Bangkok in January. At that congress, MTC presented the post abortion care project which was done in collaboration with the Mae Sot General Hospital. • MTC attended the national level meeting organised by the Thai Ministry of Public Health, the topic was “Master Plan for Border Health” in Mae Sot. • From July 22 – 23, MTC staff attended the “Seminar on Migrant Children Situation; Rights to Education, Health, Individual Status and Child Protection in Thailand” in Bangkok. It was organised by the Migrant Education Task Force, Migrant Working Group. • From August 18 – 20, MTC staff attended “The 3rd National Migrant Health Conference on 2010” in Bangkok. It was organised by the Thai Ministry of Public Health, Migrant Work- ing Group and UNFPA. • Since August, MTC has received vaccines from the National Health Security Office, in- stead of the Department of Disease Control, Ministry of Public Health. All the vaccines provided are the same as those administered to Thai children. • On October 14, Dr. Cynthia Maung and two MTC staff attended the book launch of “Reproductive Health in Humanitarian Setting” the revised version of the Inter-Agency Field Manual at the Austrian Embassy in Bangkok. • From December 7 – 8, two MTC staff attended the gender equity policy development workshop in Chiang Mai.

16 Mae Tao Clinic Annual Report 2010 Mae Tao Clinic Annual Report 2010 17 A Young Student Dreams of Child Protection Higher Education... The MTC Child Protection is the area but are unable to 10,800 students from 58. The a connected network of ser- provide a safe environment, School Health team coop- Saw Than Min, age 17, has been attending now finished 11th grade. Last month he ap- vices designed to provide food and shelter for their erated with Shoklo Malaria the CDC school for the last two years. Secu- plied for a program that will allow him to ac- shelter, food, education and children, due to their illegal Research Unit (SMRU) for the rity and lack of resources made him follow cess the Thai university system after a one protection for displaced status and economical situ- vaccination programme. his brother to Mae Sot. His brother advised year English training course. children. Under the UN Dec- ation. him to apply to CDC and keep studying. laration of Human Rights, Given the vulnerability of This ability to ‘bridge’ into the Thai Univer- the children accompany- The department has also de- displaced children from Every day he goes to school and studies Ge- sity system is a rare opportunity for a young ing their parents across the veloped an education pro- Burma, MTC has been col- ography, Mathematics, Natural Science, Bi- Burmese student, but opens many opportu- border as well as those born gramme that supports the laborating with other CBOs ology, Thai, Burmese and English. He lives at nities. These opportunities might be taken stateless in Thailand have a Pa Hite nursery school with of the Coordination Team the dormitories of the school, just 5 minutes for granted by young people in other parts universal right to education. 68 students, and the Chil- for Displaced Children’s Ed- away. During his free time he plays football, of the world, but it is a precious chance at In 2005 the Thai government dren’s Development Centre ucation (CTDCE) to estab- spends time with friends and reads at the li- a future for those who are lucky and work passed a resolution, stating (CDC) school, with the goal lish a Child Protection Policy brary. He also likes to translate documents hard in the migrant schools. that all children living in Thai- of providing quality educa- for children living along the from Burmese to English. Saw Than Min has land should have access tion to Burmese and ethnic border. Similarly, MTC sup- to education regardless of minority children for day ported CTDCE member or- race, nationality or legal sta- care through to 12th grade. ganisations which led to the tus. In 2010, the CDC kept the Committee for the Protec- number of students to 1,148 tion and Promotion of Child Food and Nutrition Services which was capped at a 1% Rights (CPPCR) implement- increase due to full enrol- ing the Standards of Care for Food security has become a major con- order to make up for funds needed to buy ment, compared to a 14% boarding facilities. The Stan- cern at MTC. It has emerged as a growing rice and other dry food items. Regrettably, increase in enrolment during dards of Care addresses ar- funding gap due to ever increasing patient funding from other programmes such as 2009. eas such as child-to-staff caseloads and children arriving from Burma medical equipment and facilities had to be ratios, job descriptions and for child protection and education. In most used for the food funding shortage. But for- The Dry Food Programme recruitment policies for staff, cases, the ration for dry food items had to tunately, we received several donations of provides food rations to documentation procedures be reduced by alternating between beans equipment in kind, which made up for the 2,522 students in boarding for children, mechanisms for and tinned fish, or going without garlic in shortfall. houses. Dry food such as preventing child abuse, and rice, salt, beans, tin fish and principles of child participa- Food services under the MTC umbrella include: sweet powders are provid- tion in all aspects of board- ed. A total of 24 migrant ing house life. • Food for patients and attending family (rice soup and 2 meals per day). Extra food boarding houses and six IDP is provided for inpatients unable to take regular food. boarding houses were sup- Dry Food Programme Rations • Supplementary feeding programmes for children and pregnant women, this in- ported in 2010. When we have sufficient funds, we provide each child on our dry food cludes, for example, rations for malnourished children. The School Health pro- programme with the following rations • Food for CDC students and boarders. gramme addresses a broad- per month: • Food for Bamboo Children’s Home borders. The Boarding House com- er target population of chil- • 13kg rice • Food programme for Boarding Houses. ponent of the programme dren in the Tak province. • 1L oil • Food for staff and family. provides food, health ser- The programme performed • 2 tins of fish vices and accommodation vision screenings, nutrition • ½ kg of beans The increase in the number of children has fluctu- to 665 displaced children and water/sanitation assess- • 45g seasoning ated in the last 6 months, due to the crisis in De- through the CDC and Bam- ments, first aid supplies, po- • 650g salt cember 2010 and the closure of the border since boo Children’s Home board- lio-vaccinations, bi-annual July 2010. The number of children attending schools When we do not have enough fund- ing houses. The majority of prophylactic de-worming in eastern Burma has reduced, due to security rea- ing to provide all six items, we alter- the children living at board- and Vitamin A supplemen- sons. ing houses have contact tation, dental and oral care; nate bi-monthly between fish and with their parents, who live in reaching approximately beans, and seasoning and salt.

18 Mae Tao Clinic Annual Report 2010 Mae Tao Clinic Annual Report 2010 19 The food programme for Boarding Houses children coming from 23 different boarding (with CTDCE) has barely managed to cope houses, through the dry food programme. with increasing food prices, placing the pro- MTC plays a major role in the coordina- gramme under continued budgetary pres- tion of this programme, including securing sure and constraints. For the year 2011, MTC funding, procurement and distribution, and Advocacy expects to support approximately 2,850 monitoring and evaluation. Due to the continued situation in Burma and cross-border support. For child protection, on the border, MTC continues to increase its MTC advocates for increased collabora- advocacy activities. MTC has continued to tion between CBOs, government and civil increase interactions at all levels, from lo- society, along with the alarming increase cal community based organisations, other in funding needs. For cross-border support, Finance, Administration, and Management communities in Thailand, Thai universities, MTC illustrates the ongoing needs inside Bur- and international governments and organ- ma, which are best served by multi-organ- The MTC management committee is com- Due to budget constraints and the emer- isations. The main focus of MTC’s advoca- isation collaboration from both within and prised of the programme managers for gency situation, the clinic was unable to cy activities includes child protection and outside Burma. Some advocacy highlights each department and the Clinic Director. achieve the full funding of all programmes Important activities in 2010 included the re- during 2010. Extreme measures had to be • In February, MTC and CDC welcomed four members of ASEAN Inter-Parliamentary vision of financial policies and procedures taken, including a 10% salary reduction for caucus and advocated for the problems of children and patients from empowering the procurement policy. Also, all staff and a decrease of boarding house Burma. training and building of financial skills of the rations as part of the dry food programme. • Dr. Cynthia travelled to the for an exchange programme related repro- MTC staff was conducted, especially re- The crisis also postponed the expansion of ductive health issues in March. garding software and database manage- the boarding houses supported by the clin- • On August 20-22, 2010 Mae Tao Clinic, in collaboration with Green Wave Radio ment. ic. Some project funds had to be redirected (Bangkok), organised fundraising activities at “Siam Paragon” in Bangkok. This event into the emergency, in order to cope with raised awareness about MTC within the Thai community. immediate needs. • On October 19, 2010 Dr. Cynthia attended “Book launch on Diagnosis Critical” at The goals for 2011 include: the Foreign Correspondents Club of Thailand, Bangkok. • On October 23-28, 2010 one of Mae Tao Clinic’s staff attended “7th East-West Dia- • Achievement of full funding and change of accounting programme logue Gender Equality and Development” Barcelona, . • Financial training for staff • On October 27, Mae Tao Clinic’s staff attended the National Human Rights Com- • Outreach to partner organisations about financial management mission Meeting in Bangkok, which was a fact finding presentation, related to a field • Clearing of internal control memorandum, as a response to the audit recommen- trip of NHRC to Mae Sot regarding the refugee crisis along the border. dations

In 2010, the fundraising strategy was also and video. For institutional donors, outreach upgraded. Increased outreach and focus to expand the donor base also saw early on individual and community supporters successes. These efforts will continue in 2011, saw early success. Outreach to individual with the addition of a full time fundraising donors was conducted through social net- manager and continued expansion of out- working, and increased use of stories, photo reach.

20 Mae Tao Clinic Annual Report 2010 Mae Tao Clinic Annual Report 2010 21 Articles, Media and Resources Research Projects and Reports

• Mae Tao Clinic Website “Diagnosis Critical”. This report reveals that the health of populations in conflict-affected http://www.maetaoclinic.com areas of eastern Burma, particularly women and children, is amongst the worst in the world, a result of official disinvestment in health, protracted conflict and the abuse of civilians. • Mae Tao Clinic Facebook Group: www.facebook.com/MaeTaoClinic http://maetaoclinic.com/wp-content/uploads/pdf/Diagnosis%20critical%20-%20Eng- lish%20web%20version.pdf MTC in the News: “Community-based assessment of human rights in a complex humanitarian emergency: • “Karen Doctor See Little End to Humanitarian Crisis in Eastern Burma” September 2010 the Emergency Assistance Teams-Burma and Cyclone Nargis” http://www.voanews.com/english/news/Karen-Doctor-Sees-Little-End-to-Humanitarian- http://www.conflictandhealth.com/content/4/1/8 Crisis-in-Eastern-Burma-103235659.html "The Mobile Obstetrics Project Improves Health of Mothers in Eastern Burma" • “Malaria Control Drive Reaches out to Migrant Workers”, October 2010 http://www.jhsph.edu/publichealthnews/press_releases/2010/mullany_burma_mom_proj- http://www.irrawaddy.org/article.php?art_id=19630 ect.html

• Dr. Cynthia visits sister organisation in Philippines with Interpares: http://www.interpares.ca/en/publications/bulletins/html/201009/index.php

• The story of BCMF and MTC patient, Ma Wint: www.bangkokpost.com/news/health/202985/ma-wint-hopes-for-a-cure MTC Staff www.bangkokpost.com/news/investigation/213141/compassion-finds-a-cure-for-ma- wint Clinic Staff in 2010 Male Female Total Clinical Service 150 84 234 Clinic in Crisis: http://www.bangkokpost.com/news/investigation/37069/clinic-in-crisis Admin / Logistic 16 62 78 Supportive Services 37 53 90 • Artist Jane Birken visits Mae Tao Clinic: Social and Outreach 76 44 120 http://www.irrawaddy.org/article.php?art_id=18469 Services Pa Hite Clinic (IDP) 32 44 76 Video: Child Protection Ser- 8 7 15 • Join the Mae Tao Clinic YouTube Channel! vice http://www.youtube.com/user/MaeTaoClinic CDC and BCH board- 9 19 28 ing house • The story of BCMF and MTC patient, Wai Yan Kyaw: Total 328 313 641 http://www.youtube.com/watch?v=SIFhYFsQWuc

• Messages from Mae Tao Clinic, February 2010: Burma Children Medical Fund (BCMF) http://www.youtube.com/watch?v=R5as8vcSRFg Zar Win When he was born the wound was open Htwe was and doctors were certain that he would get born with an infection and die. As a last resort, his a large parents brought him across the border to growth on the Mae Tao Clinic. Medics and doctors at his lower the Clinic also believed there was little hope back (me- for Zar Win Htwe. His mother was shown how ningomy- to care for his wound and was told to come eolocele – back in a month. A month later, she returned a protrusion and to everyone’s surprise, his wound was of the membranes which cover the spine). looking better. He was referred onto Chiang

22 Mae Tao Clinic Annual Report 2010 Mae Tao Clinic Annual Report 2010 21 Mai for specialist treatment in July 2010 and Now he can do it with ease and he is a lot MTC was supported by the following international and Thai volunteers: underwent surgery to remove his meningo- more active. He can even stand up! myeolocele. The surgery was a success and BCMF was set up in 2006 at the Mae Tao Clinic and Dr. Alan McCreery Dr. Jen Sheehan Sam Marynowicz Zar Win Htwe does not cry as much as he aims to fund the health care of seriously ill children Albert Company Dr. Jerry Ramos Samantha Ngaw used to. He is no longer in pain and is now a presenting at the Clinic who require treatment, such Alex Preston Josephine Wacker Samuel Francis happy baby. His parents are also very hap- as surgery, that the clinic cannot provide. If left un- Dr. Ana Julieta Kanchana Thornton Shuting Zhuang py. His father says that before the operation, treated, these conditions would result in death or a Dr. Aung Myint Karen Behringer Tajrina Hai Zar Win Htwe could not straighten his legs. significant disability. Dr. Aya Tanabe Kasper Haun Dr. Takayuki Abe Dr. Alice Khin Katie Camarena Dr. Terry Smith Zar Win Htwe’s story (and photos!): http://www.burmachildren.net/our-cases/success-stories/children/zar-win/ Barbara McCreery Dr. Les Sheehan Dr. Toru Yoneda Join BCMF’s Facebook page: www.facebook.com/burmachildren Birgit Wacker Leslie Cenci Dr. Ulrirch Huehle Find out more: www.burmachildren.com Chayuth ‘Ger’ Chamnans- Lisa Houston Victoria Harris eth Louis Berk Warapree Tangseefa Christopher Bradley Mercedes Founior Whitney Haruf Claire Siva Michelle Katics Dr. Win Myint Than Dr. Constanza Belleta Dr. Nancy Murakami Samuel Francis MTC Management and Leadership Team Derina Johnson Dr. Nubuo Saito Shuting Zhuang Dr. Georgia Wyatt Pattinee Suanprasert Tajrina Hai Department Programme Manager Department Programme Manager Ida Kankker Dr. Raff Nathan Inge Sterk Romain Kramarz Child Outpatient Naw May Soe Administrative Child Inpatient Saw Mu Ni Human Resources Mahn Win Tin MTC hosted medical students from the following institutions: Registration Mahn Moe Oo Health Informa- Lin Yone Surgery Saw Eh Ta Mwee tion Systems / Data Australia University Ohio State University, USA University of East Anglia, UK Eye Naw Tamalar Wah Australian National Univer- Oxford University, UK University of Glasgow, UK Medical May Tri Finance Liza Lopez sity, Canberra, Australia Peninsula Medical School, University of Outpatient Training Brandeis University, USA UK University of London, UK Medical Inpatient Saw Mu Ni Brighton and Sussex Medical Sheffield Hallam University, University of Minnesota, USA Training Centre Naw Eh Thwa Reproductive Naw Sophia Hla School, UK UK University of Sheffield, UK Child Protection & Outreach Health Inpatient Dartmouth Medical School, State University of New York, University of Sydney, Austra- USA Syracuse, USA lia Reproductive Sabel Moe School Health Saw Thar Win East Tennessee State Univer- Touro University California University of Texas Medical Health Outpatient CDC (school) Mahn Shwe Hnin sity, USA College of Osteopathic School, Houston, USA Dental Hsar Bwe Moo CDC Food Pro- Min Niang Edinburgh University, UK Medicine, USA University of Warwick, UK Acupuncture Saw Ler Wah Say gramme Keele University Medical University of Aberdeen, UK University of Washington, Medical Support Services MTC Boarding Li Li Aung School, UK University of Birmingham, UK USA Houses (CDC and King’s College, London, UK University of Calgary, Cana- University of Western Syd- Laboratory Saw Hsa K’Baw BCH) Medical University of Vien- da ney, Australia na, Austria University College, London, Blood Donation Naw Shine Pa Hite Clinic Main Pharmacy Naw Klo Nottingham University, UK UK Pa Hite Pro- Saw Kyi Soe Referrals Saw Tin Shwe gramme Manag- The following organisations and individuals provided donations of equipment, instruments, Infection Control S’ Htun Oo er supplies or medicine to MTC: Sanitation Ko Tin Tun Ka Pu Satellite Saw Pah Lu Mr. Ami Zarchi Fortuna Inter- Gift of Happiness Founda- Dr. Larry Muller MD (World Patient Support Clinic In Charge national LTD tion Aid- USA) Food Programme Naw Htoo Ka Na Del Satellite Saw Ka Ni Bumrungrad Hospital Help Without Frontiers Mae Sot Hospital for MTC Clinic In Charge Catholic Office for Emer- Mr. Hidemitsu Ueji () Partners Relief and Develop- Prosthetics Saw Maw Kel Kel Pa Satellite Aye Moe Moe gency Relief and Refugees Mr. John Manning Dr. Taka- ment (Mae Sot) Clinic In Charge (COERR) yuki Abe Dr. Raff Nathan – Ami Zarchi VCT/STI Saw Than Lwin DJO International – Cindy Julia Hanebrike Mr.Touy Chianese from Helio Tha Thwee Del Saw Law Du Public Relations Tinn Shwe Server K. Uun K Ooy and husband Suppy Co.Pty.LTD Satellite Clinic Library Bam Zan Greenware In Charge Transportation Saw Sunny Aye Financials for 2010 will be released as an annexure on www.maetaoclinic.com and not included in this report

24 Mae Tao Clinic Annual Report 2010 Mae Tao Clinic Annual Report 2010 25 MTC Sponsors & Donors

We would like to thank all of our Your donations and all forms of sup- donors and supporters in Thai- port allow us to continue our work. land and around the world. Thank You!

Additional Donors Asian Human Rights Foundation Australian Volunteers International Brackett Foundation Burma Action Ireland Child's Dream Columbia University (RAISE project) David Kingston Foundation Difaem Free Burma Alliance Green Wave Radio (Thailand) IPPFEASOR Sprint Initiative Karen Refugee Camps Women's Devel- opment Group Not On Our Watch Seo So Moon Church Friends and supporters of Mae Tao Clinic

26 Mae Tao Clinic Annual Report 2010 Mae Tao Clinic Annual Report 2010 27 P.O. Box 67, Mae Sot, Tak 63110, Thailand 865, Moo 1, Intarakiri Road, Tha Sai Luad, Mae Sot, Tak Province 63110, Thailand T: 055-563-644 F: 055-544-655 [email protected] maetaoclinic.com