Mountains, Bridges & Barricades: The Challenges of COVID-19 Prevention in Myanmar’s Naga Self-Administered Zone

A health worker from the Eastern Naga Development Organization travels to remote villages in the Naga SAZ to conduct COVID-19 prevention activities. Photo: Courtesy of the Eastern Naga Development Organization

In Myanmar’s restive and remote Naga Self-Administered Zone (SAZ), there are only two medical doctors to serve the needs of an estimated 130,000 people. In April 2020, with the COVID-19 pandemic threatening communities across Myanmar, Community Partners International (CPI) supported local civil society organization the Eastern Naga Development Organization (ENDO) to raise awareness of COVID-19 risks and prevention measures in 108 remote villages in five townships: Lahe, Leshi and Nanyun in the Naga SAZ, and the neighboring townships of Hkamti and Pansaung.

Situated in the northern tip of Myanmar’s Sagaing Region, bordering the Indian State of Nagaland, this mountainous frontier tract is one of the poorest, least-developed and most isolated areas of Myanmar. The Naga SAZ was created under Myanmar’s 2008 Constitution which granted three townships in this region - Lahe, Leshi, and Nanyun - some independent legislative powers under a “leading body” of representatives. However, in practice, the SAZ has little autonomy from the central government.

The majority of the population is ethnic Naga, a group of more than 40 tribes who inhabit India’s Nagaland State and northwestern Myanmar. Minority Shan, Kachin, and Bamar ethnic populations also live in the Naga SAZ. This region has experienced decades of unrest, with Naga independence movements in Myanmar and India engaging in protracted struggles with their respective governments.

While the Naga SAZ has been relatively quiet in recent years, occasional skirmishes erupt, and deep mistrust of the Myanmar government persists. The isolation and legacy of conflict make it difficult for the Myanmar Ministry of Health and Sports (MoHS) to recruit health workers to work in the Naga SAZ, and when they do these health workers are not easily accepted or trusted by local communities. Community-based health organizations like the ENDO, staffed by Naga community members, are better able to establish trust and rapport when providing the first line of community-based health care.

A village in the Naga SAZ. Photo: Courtesy of the Eastern Naga Development Organization

CPI began working with the ENDO in 2018, supporting emergency medical response activities focused on infectious disease and nutrition. In 2019, CPI supported the ENDO to operate mobile health teams providing primary health care to remote villages. The ENDO has established relationships with local communities and ethnic armed organizations that enable it to operate safely in the Naga SAZ and surrounding areas.

​By launching COVID-19 prevention activities in early April, CPI and the ENDO’s goal was to get in early with accurate information and help communities to establish basic prevention measures. During the community education sessions in each village, the ENDO health workers focused on developing understanding of COVID-19 transmission and symptoms and underlined the importance of prevention measures such as regular hand washing, respiratory etiquette, and physical distancing. As people in the Naga SAZ frequently cross the border into India to work and study, the health workers also emphasized the need for returnees to self-isolate for a minimum of 14 days after their return.

A health worker from the Eastern Naga Development Organization conducts a COVID-19 education session in a remote village in the Naga SAZ. Photo: Courtesy of the Eastern Naga Development Organization

A health worker from the Eastern Naga Development Organization issues community announcements about COVID-19 in a remote village in the Naga SAZ. Photo: Courtesy of the Eastern Naga Development Organization

The mountainous terrain and fragile road infrastructure make it difficult to travel. It can take many arduous hours on dirt roads and bridle paths to reach villages. Many routes to villages are only passable on horseback, by motorcycle, or on foot. Damaged roads, precipitous climbs, and rickety bridges over fast-flowing rivers and creeks make journeys hazardous. During the rains, villages can be cut off for long periods due to damage caused by landslides and flash floods.

Eastern Naga Development Organization Project Coordinator Vang Sing (right) in front of COVID-19 prevention posters in a village in the Naga SAZ. Photo: Courtesy of the Eastern Naga Development Organization

Vang Sing, a Project Coordinator with the ENDO who leads a team of 14 health workers, explains: “We traveled from Hkamti to Lahe by motorcycle and it took the whole day. Our target villages are two to three hours away from each other. We brought fuel with us for the whole journey. Some of the paths are very dangerous and difficult to travel on.”

A health worker from the Eastern Naga Development Organization negotiates a perilous path on the way to remote villages in the Naga SAZ to conduct COVID-19 prevention activities. Photo: Courtesy of the Eastern Naga Development Organization

Health workers from the Eastern Naga Development Organization cross a bridge on the way to remote villages in the Naga SAZ to conduct COVID-19 prevention activities. Photo: Courtesy of the Eastern Naga Development Organization

Health workers from the Eastern Naga Development Organization negotiate a muddy road on the way to remote villages in the Naga SAZ to conduct COVID-19 prevention activities. Photo: Courtesy of the Eastern Naga Development Organization

Health workers from the Eastern Naga Development Organization rest briefly while on the way to remote villages in the Naga SAZ to conduct COVID-19 prevention activities. Photo: Courtesy of the Eastern Naga Development Organization

The ENDO mobile health teams faced several other obstacles. In some cases, they found the entrances to villages barricaded as rumors of the COVID-19 pandemic had already reached the community. Information can be slow to reach these communities, and their isolation can amplify misinformation. They had to negotiate entry with community leaders so that they could conduct COVID-19 community education sessions and put up information posters.

“There are no telephone or internet communications in the Naga SAZ,” explains Vang Sing. “Only radios are available. Some communities are panicking about COVID-19 because of misleading and incomplete news that they heard. They don’t have accurate information about prevention methods.”

Another obstacle is language. Naga communities speak many distinct languages and dialects. The ENDO mobile health teams needed to ensure that they were able to communicate effectively with all communities that they visited. They used interpreters, simulations, and images to get their messages across.

The entrance to Nyanching village in the Naga SAZ. Photo: Courtesy of the Eastern Naga Development Organization

Health workers from the Eastern Naga Development Organization put up COVID-19 information posters in a remote village in the Naga SAZ. Photo: Courtesy of the Eastern Naga Development Organization

Health workers from the Eastern Naga Development Organization put up COVID-19 information posters in a remote village in the Naga SAZ. Photo: Courtesy of the Eastern Naga Development Organization

Despite the challenges, Vang Sing is glad that his team could help early on in the COVID-19 pandemic. “I am glad to be able to reach out to these communities that have limited access to health services and little information from health authorities,” he says. “I would like to do more to improve the lives and health of Naga people.”

Moving forward, CPI will continue to support the ENDO mobile health teams to deliver primary health care services and COVID-19 prevention and awareness-raising. CPI is also helping the ENDO to procure supplies including face masks, gloves, and soap to help equip isolated government station hospitals in the Naga SAZ.

These COVID-19 Emergency Response activities were made possible with financial support from Community Partners International’s private donors and the Access to Health Fund.

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