Daw Su Su lives in a small, neatly-kept wooden house with a tin roof on the outskirts of Pyin Oo Lwin, Mandalay Region. Her house sits on short stilts, raised above the hard-packed dirt road that leads past her front door. The neighborhood is quiet when we visit. The houses are crowded together in close proximity.
Daw Su Su welcomes us with a warm smile and we sit on the floor of the main room to talk, as is traditional in Myanmar culture. She is wearing a blue cardigan and a colorfully patterned ‘htamein’ skirt. She pours us coffee and tea, and offers an array of Myanmar snacks including tea leaf salad.
Daw Su Su is in her early fifties but looks much younger. She has kind eyes and a quiet charm that puts us immediately at ease. Originally from Mandalay, she came to Pyin Oo Lwin with her husband in 1989 after he was posted there with his job. Daw Su Su has four children. Three of them are already grown up, while her youngest, a daughter of 13, still lives at home.
Daw Su Su and her husband were diagnosed as HIV positive five years ago. She is not sure how they became infected. Her husband tragically died of complications related to HIV just one month before our meeting. Daw Su Su is stoic as she talks about him, with just a flicker of grief passing across her face.
Daw Su Su receives support through CPI partner organization New Life. She came to New Life for help when she was diagnosed with HIV as she didn’t know where to turn.
Founded and run by HIV positive community members, New Life provides counseling and support to 800 HIV positive people in communities in and around Pyin Oo Lwin.
After Daw Su Su received her diagnosis, New Life organized peer-to-peer counseling to help her to come to terms with her health status. The organization supported her to seek medical care and start anti-retroviral treatment (now available for free through the Ministry of Health and Sports National AIDS Program), and continues to help her to buy multivitamins and antibiotics that help prevent and treat opportunistic infections.
Due to the stigma that surrounds HIV, Daw Su Su keeps her health status a secret from her friends and family. Even her children are not aware of her situation. This is why organizations like New Life are so important - providing a lifeline of information and support for people living with HIV in Myanmar.
Daw Su Su worries about her children getting HIV. Cultural sensitivities mean that young people in Myanmar grow up with little or no exposure to sex education. They have limited understanding of the risks of sexually transmitted infections, how to prevent them, and the treatment options if an infection occurs.
As our conversation draws to a close, Daw Su Su talks about her hopes. “My wish is that every HIV positive person in Myanmar receives the help and understanding that they need to live full and healthy lives. We don’t want to have to live in the shadows.”
Naw Poe lives with her husband and two-year-old son in Hsar Pwel Htar, a remote village in Myanmar’s Tanintharyi Region in the southeast of the country. The village has no health clinic. The nearest one is about two hours drive by motorbike across difficult terrain. During the monsoon season, the dirt tracks that connect villages are often impassable.
The family’s combined income averages around $75 per month. This is just enough to cover day-to-day essentials but when a family member gets sick, they face potentially catastrophic health costs. “The nearest clinic is far away and it is expensive for us to go there,” explains Naw Poe. “We have to pay for transportation, food, medicine and accommodation. That is too much for our family so we have to go into debt. It is difficult to borrow money from other families in the village because no one has much here.”
Hsar Pwel Htar village is one of the hundreds in which CPI supports a Malaria Post, staffed by a community-based health worker trained by CPI in basic malaria prevention, diagnosis and treatment. This approach is a key part of CPI’s model to invest in community-based health care, particularly in remote and conflict-affected regions where communities have little or no access to other health care services.
In mid-2016, Naw Poe fell ill with a fever, chills and severe headache. Aware that the health worker at the Malaria Post offered free malaria treatment, she went to see her immediately.
“She tested my blood and told me that I had malaria,” Naw Poe explains. “She gave me some pills to take, white and brown, and told me to come back immediately if I felt any discomfort. About one week after I started taking the medicine, I felt much better.”
“She also explained to me how you catch malaria and reminded me to make sure the family sleeps under the bed net every night so that the mosquitoes can’t bite us. We will definitely be more careful in the future.”
“I don’t know what I would have done if she hadn’t been there,” Naw Poe explains. “It was the rainy season, so the track to the nearest clinic was in a bad condition and I probably couldn’t have made it. I could have died.”
For Naw Poe, the new Malaria Post has made a difference. “I used to worry a lot about malaria, for my family and myself. It is better now – we can get advice and free treatment to help us stay healthy. It would be good to have more health services like this in our village. I hope things will continue to get better in the future. That way, when we get sick, we won’t need to travel long distances and spend a lot of money to get treatment.”
Naw Poe is one of 2,360 people that tested positive for malaria and received treatment through CPI’s malaria elimination program in 2016.
At first glance, Daw Ja Ring’s hands are unremarkable. Yet these hands have ushered into the world hundreds of the babies born in Shwe Gyin village, Kachin State, in the last twenty-five years. Daw Ja Ring is Shwe Gyin village’s trained birth attendant, a role she undertook when she was just 18 years old. Now, at 43, she has lost count of the exact number of births she has attended but estimates that it must be at least 300.
Holding court in her modest wooden house perched on stilts at the edge of the village, DawJa Ring is surrounded by mothers and babies whose births she has attended in the preceding months. She exudes kindness and gentle authority – a person used to helping others and confident in her own skills and status.
“I am proud of the work I have done here,” she says. “When I walk down the street, mothers tell their children that I helped bring them into the world. That is a good feeling.” Daw Ja Ring’s role as a village birth attendant is a common one in a country where at least 75% of births continue to take place in the home. The reality for the great majority of mothers-to-be in Myanmar is that health facility-based births continue to remain out of reach.
In 1992, at the age of 18, Daw Ja Ring was called to her first birth. She wasn’t nervous because she had just completed a short training with the Myanmar Red Cross and thought she was fully prepared.
When she arrived at the house, she discovered that the baby was in the breach position and her confidence evaporated. With the mother in the late stages of labor, and without referral options available, Daw Ja Ring had to do what she could. The baby’s hand emerged and she pushed it back in. A short time later, the baby’s foot appeared and she was able to bring the baby out carefully and safely. Both mother and baby came through the ordeal in full health but it was a tough start for Shwe Gyin village’s new birth attendant.
Trained and equipped with the support of Community Partners International (CPI), Daw Ja Ring uses Clean Delivery Kits for the births that she attends. The kits contain essential items that help keep the mother and baby free from infection during the birth. These include sterile gloves, soap, a sterile plastic sheet and swaddling cloth, and a sterile blade to cut the umbilical cord.
With her established status and reputation in the community, Daw Ja Ring’s home has become an unofficial community clinic, with village residents coming to her with many different health needs. She is happy to help when she can.
CPI has trained and equipped village-based birth attendants across Myanmar for almost two decades. Trusted by mothers, embedded in their communities, and an affordable and accessible option for families for whom facility-based care has traditionally been out of reach, Daw Ja Ring and her colleagues are a crucial link in the chain of health.