2
Finance and human resource effecting Myanmar’s healthcare sector HTOO THANT
T
hailand which is Myanmar’s immediate neighbour, yearly earns millions of foreign currency from overseas patients by providing them with international standard treatments and its state-of-the-art medical facilities where as Myanmar due to lack of human resources and finance makes it is difficult even to cover the local healthcare sector. According to the ASEAN healthcare communiqué, some ASEAN member countries receive assistance to provide international standard healthcare compared to some western nations so health services are even much cheaper. Therefore, these countries yearly receive millions of dollars from overseas patients who come for medical treatment. Thailand’s medical tourism earns US$ 2 billion per year which is about 40 percent of other ASEAN counties health tourism sector. Although questions were raised at Hluttaw sessions regarding healthcare, reply from the concerned ministry was that not to mention medical tourism, at present even to cover healthcare for the citizens are unable due to constraints of financial and human resource, meaning healthcare workers. Currently, even expanding township level hospitals to provide medical cover to the rural populace are difficult, hospitals in towns and cities are also facing difficulties to appoint sufficient amount of doctors says Dr. Myint Htwe, Union Minister for Health and Sports. “Construction of new hospitals, extending and renovating existing hospitals, constructing service apartments and building new 16-bed sub township hospitals all depend on the budget allocated. In this process approximately about 40 sub township hospitals can be constructed during a financial year,” Dr. Myint Htwe, Union Minister for Health and Sports explained to the Pyithu Hlauttaw session on June 5. Doctors who have to serve in far-flung areas such as border areas face difficulties for dwelling, so the cost of building living quarters
for them have to also be added in the budget,” the Union Minister added. Hluttaw MPs usually raise questions based on the difficulties that their constituencies are facing such as to extend rural medical centers, to appoint more midwives and nurses and also to provide sufficient amount of doctors, medicines and medical equipment to towns. Even in Yamethin, the nearest township to Nay Pyi Taw does not have a sub township hospital so people who dwell in rural areas face much difficulties in receiving medical treatment and even lose their lives said U Tun Tun Win, Hluttaw MP of Yamethin township. U Zone Teint, another Pyithu Hlauttaw MP from Chi Phwe township in Kachin State said that although there is a 500 bed hospital in Myitkyina for the whole state, there are no specialists to treat patients so people feel very sad and in times of emergency, they always have to travel to either Mandalay or Yangon for medical treatment which cost them a fortune. “ For instance, there are no specialists such as neurologists, cardiologists, gastroenterologists and urologists in this hospital, so patients have to travel either to Mandalay or Yangon for treatment but as travel expense, hospital fees etc..are so high some even cannot afford to go and have to give up their lives” said a native who had experienced this kind of situation. The Union Minister said that there are still many difficulties to fulfill the health services of the states and regions. “If I have to be straightforward, when a state or region request for a 500 bed hospital another state or region also raises the same request. Therefore due to the actual situation, when a 500 bed hospital is provided, together with the hospital, medicines and medical equipment can be provided. However, it is impossible to provide human resource such as doctors, technicians to that hospital immediately. Although the situation is obvious it is difficult to fulfill it.” Therefore the Ministry is nurturing more specialists. For this year 2017, there are plans to nurture 642 specialists, 820 in 2018 and 767 in 2019. Although previously there were plans to increase the human resource such as specialist, this plan was not implemented. Nevertheless, plans have been drawn up for the years 20182021.
The Yangon Children’s Hospital (YCH) is a major public hospital in Yangon.
Emergency assistance provided to a patient in an ambulance. Photos: Zarni Phyo
At present, there are five 200 bed region and state level hospitals, 10 central level hospitals and 30 specialist hospitals. There are also 1123 township and sub township hospitals in Myanmar. Although the WHO indicates that it is necessary to have three beds for every 1000 patients, it is still unclear that how many beds are there for patients in a country like Myanmar with a population of about 51 million. According the 2015 statistics of the WHO, in countries that are low in development, fundamental healthcare and prevention for a person is approximately US$60 but in Myanmar the allocation for the Ministry of Health and Sports is only just K1000 billion says Dr. San Shwe Win, Pyithu Hluttaw MP of Yekyi Township in the Ayeyarwaddy Region. So if calculated with the allocated budget, the health expenditure for a person would only be US$20. However, since the fiscal year 20112012, the government has increased the expenditure of the healthcare sector. According to the approved statistics K86.581billion for 2011-2012, K381.254 billion for 2012-2013, K484.383 billion for 2013-2014, K661.882
billion for 2014-2015, K840.976 billion for 2015-2016, K831.052 billion for 2016-2017 and for the current 2017-2018 financial year K1077 billion has been allocated. As for Malaysia, the healthcare expenditure in 2013 was US$13.7 billion and is expected to rise to US$22.9 billion in 2018. In the case of Singapore in 2015, 11 percent of the GDP, which amounts to S$76.9 billion, was allocated for the health sector. Although the expenditure for the health sector of those countries are much higher than Myanmar, there are healthcare tourism which support their health sectors. During 2015, there were 600000 health related tourists who visited Malaysia where the country received millions of US dollars. In the Philippines, the government and the private sector are working to together as Public-Private Partnership(PPP) to raise the healthcare sector. Similarly in Myanmar, a health insurance system should be set up to relieve the burden of the public said Dr. San Shwe Win. “Change in social-economic system, increase of growth rate, occurrence in new types of diseases, lack of healthcare knowledge, scarce in health funds and lack of medicines are factors that directly affect the public. So when this kind of situation arises people have to bare about 80 percent of the total cost which is a burden for them. Therefore, a system which can effectively support the government’s healthcare system and provide necessary healthcare to the public, some kind of a health insurance scheme should be set up,” he said. “Myanmar’s healthcare expenditure is only five percent of the total budget and is far more behind the expenditure of other low-income countries where their expenditure is nine percent. A lot of fatalities happen due to unaffordable treatment cost,” says U Win Win, Hluttaw MP of Ingapu Township in the Ayayarwaddy Region who commented on the burden people face in their daily lives regarding health matters. Translation by Khine Thazin Han, Kyaw Soe Htet and Zar Zar Soe
4 Myanmar’s health sector is still underdeveloped. The country needs to build capacity by adding doctors and nurses to cope with the growing number of patients. In general, low income patients continue to rely on state owned hospitals, particularly Yangon General Hospital. To find out the latest situation at the city’s most popular hospital, Myanmar Times reporter Myint Kay Thi interviewed the hospital’s Medical Superintendent Dr Aye Ko Ko about the working conditions of its doctors and nurses, and the cost of drugs and medical equipment.
Interview with Dr Aye Ko Ko, Medical Superintendent of Yangon General Hospital MYINT KAY THI Q: How many departments are there in Yangon General Hospital and what kinds of diseases are treated there? A: Yangon General Hospital was upgraded in 2016 to a hospital that can provide 2000 beds. It’s also a teaching hospital. As a result of the upgrades, many new departments were formed. They are the tropical medicine department, hormonal disease treatment department, and hand surgery department. The Pharmacology Department previously had three patient wards, but it has been upgraded to four wards. There are Doctors and nurses are also assigned to these wards. Other necessary equipment and drugs have also been provided. Currently, there are 27 departments. Besides Obstetrics and Gynecology, Yangon General Hospital has an emergency department, injury units, cancer center and other health services. Q: How large a staff is Yangon General Hospital operating with? And, can you talk about the full payment, cost-sharing, and freeof-charge health services? A: If you add specialists and assistant doctors, the number of doctors are more than 400. With the addition of assistant nurses, there are more than 700 nurses. More than 60 new assistant nurses have been appointed. But red-uniformed nurse, numbering about 300, are currently idle. We need more nurses, Currently the number of patients are more than the number of nurses. Drugs are not under the cost-sharing system,
as basic medicine and emergency department drugs are provided free of charge. But, patients have to bare the cost of some medicine that have run out as there are a lot of patients at the hospital. For this year, Yangon General Hospital’s yearly drug expenditure for the emergency department is K5.3billion. That’s why, in the long run, we cannot continue giving out free drugs. There is also a plan by the government to establish a health insurance system. That topic is being discussed in the Hluttaw. If it is approved, there might be changes in the drug treatment system. Q: Yangon General Hospital seems to have become overcrowded due to large number of patients receiving treatment. Are there any plans to expand the wards? A: The main reason is the cancer patients. There have been a lot more cancer patients lately. The number of patients receiving tube feeding and chemotherapy has risen, so there is some overcrowding. The construction of a five-storey wing intended for cancer patients is near completion and will probably be finished around November. Another new five-storey building will be constructed by the Ministry of Construction facing Anawrahta Road. After those buildings are transferred to us, it will be used as a patient treatment wards for sick patients. As soon as we’ve completed all these tasks, patients will be able to stay comfortably at a spacious hospital. Also, the Neurology Department has been relocated to North Okkalapa Township, so patients can be diagnosed there.
Dr. Aye Ko Ko, medical superintendent of Yangon General Hospital. Photo: Myint Kay Thi
Q: Can you tell us about the improvement of treatments and medical equipment at the Yangon General Hospital, and what can patients expect when they come in for check-up? A: This hospital has all the modern equipment of a 2000bed hospital, such as Positron emission tomography, computed tomography (PET-CT), and cancer scanning device. Before, you had to go to Bangkok or Singapore to get PET-CT scans, but now you can do it at Yangon General Hospital. Other necessary equipment and devices have also been installed, and we will try to install more new devices as they become available. Also, fingers
that are accidently chopped off or cut can be reattached, if the patient is brought in time to the hand surgery department. Furthermore, successful treatments can be provided to patients at the emergency department with a thoracis aortic aneurysm or rupture. Those with blocked bold vessels resulting in stroke will be given clot-bursting medicine. Of course the success of treatment rate depends on the patient’s age, the prevalence of the disease, and the time taken to reach the hospital. The number of patients receiving treatment daily at Yangon General Hospital is between 300 to 400. The emergency
department sees 500 patients a day. And the number of inpatients is 2000 to 2500. They come from every region and state. Q: What programmes are planned by Yangon General Hospital in the future? A: There are plans to open a new medical treatment department. Under a project planned by the Ministry of Health and Sports, pharmacies will be reopened at Central Hospitals, and canteens will be opened, with the aim of providing patients with clean, affordable meals. Those are the current plans, which I believe will be fulfilled by the end of 2017. Translation by Kyaw Soe Htet
HEALTH SUPPLEMENT 2017 Deputy Editor-in-Chief:
Staff writers:
Photography:
Cover design:
Myo Lwin
Nay Aung, Htoo Thant, Hein Min Latt, Myint Kay Thi, Pyae Thet Phyo, Khin Su Wai, Win Aung, Maung Zaw
Aung Htay Hlaing, Zarni Phyo, Naing Wynn Htoon, Nyan Zay Htet
Tin Zaw Htway
Editor: Win Aung
Sub-editor: P Vijian
Cover Photos: Shutterstock
Layout design: Khin Zaw
For feedback and enquiries,please contact
[email protected]
5
Rural healthcare expectations NAY AUNG
M
agwe region located in the central part of Myanmar has twenty five townships and according to the 2014 census urban population constitutes only fifteen percent of the total region. Therefore, eighty five percent of the people live in rural areas. In spite of its high population ratio, access to healthcare is still weak in those rural areas according to local residence. The topography of the region which is a combination of plains and mountains makes it more difficult to reach and rural residents on mountain ranges often experience barriers to healthcare that limit their ability to obtain the care they need. So most rural people are still reluctant to rely upon sub-rural health centers (SRHC) and they prefer traditional and folk medicines, a health assistant assigned in Taungdwingyi township said. Regarding healthcare, a residence in Min Hla Township said, “For an ordinary sickness, we just get the injection from the woman (illegal health practioner) in the village. That woman is a native of this village. She learnt while a health assistant (HA) came to the village. Due to a variety of access barriers, township medical officials are unable to come to the villages frequently.” As for aches and pains, villagers buy the
medicines advertised in the media from the nearest shops. However if the situation gets worse they just go to that woman to take an injection. “Let alone health assistants, even administrative authorities barely visit the villages which are on the mountain ranges so when the elderly and children fall sick we have to carry them on our shoulders to the sub- rural health centers, but if the situation deteriotates we have to take them to the nearest clinic” said village administrator U Phone Naing from Htaw Zar village, which is situated on the mountain range west of Magwe region. In these areas, although civil societies are helping out and providing assistance in projects such as anti-malaria campaign, they still lack in providing basic healthcare which is most important for the villagers. An official from the Myanmar Medical Association said that transportation plays a vital role in the health sector of rural areas. Road connectivity is one of the main difficulties for rural healthcare. A walk through ascending and descending parts to some villages on the mountain range from the nearest traffic road will take at least three to four hours. Just about two months ago a sad event occurred due to difficulties in transportation, where a midwife was
unable to arrive on time to deliver the baby from a pregnant woman. Although the child was born by the help of the villagers it died about an hour later. Many residents from these villages are still facing a situation where women give birth while working in the fields and then they have to take home their newborn babies in bamboo baskets. “When elderly people are ill or feel week, I give them intravenous vitamin injections and for normal fever I also give them injections, which I learnt from a midwife about three years ago of the village track where I live,” says a woman who is providing healthcare to the villagers. Another danger which falls upon the villagers in central Myanmar is snakebites, especially a venomous snake. “When a person is bitten by a snake, a rope is tied just above the place where it is bitten and let him swallow cowhage seeds, which is the traditional medicine for the first aid treatment for snake bites. Then the patient is taken to the nearest medical centre,” said Mai Pan Yi, the in-charge of the youth network of Nge Pe township. “Although they say that there are sufficient amount of antivenin in township hospitals, there are only four ampoules in each village track medical centers,” said a health official.
A nurse providing health assistance to villagers. Photo: Nay Aung
An anonymous person said that one village track medical centre in Taungtwingyi Township had to take care of 13 village tracks which include 48 villages. So it is questionable whether that village track medical centre was able to handle snake bite cases where there are so many snakes in the central regions of Myanmar. Previously there was no antivenin in every village track health centre but now they say that sufficient amount of antivenin has been provided to all the village tracks in the region. Villagers from those village tracks say that they have purchased antivenin on a self-helped basis in an attempt to save the lives of their villagers. However a health official said that although these villages have purchased antivenin in case of snake bites, nobody has any training how to use or when to give this antivenin injection when a snake bite occurs.
Antivenin injection cannot be given to the patient without having any knowledge as side effects may be severe. When a health official inquires who injects the antivenin to the patient, nobody has the answer and it is difficult to stop them or give advice from using antivenin without any knowledge. Due to lack of health services, healthcare conditions are still worrisome in villages in Magwe Region. Although natives of this region have been expecting for skillful health assistants till to date they still have to depend on their traditional medical treatments to survive. Therefore, people in rural areas are still longing for the day when professional health workers will arrive to their villages and take care of their health so as for them to carry out their daily livelihood in peace of mind. Translation by Zaw Nyunt
6
Why go abroad for medical treatment? Most privileged class prefer foreign hospitals due to the treatment and services provided
Air ambulance service has become part of the package for taking treatment abroad. Photo: Bangkok Hospital
MYINT KAY THI
W
hen a person or if one of his family members becomes ill, not to mention chronic illness but just even a minor illness, the first thing that comes into that person’s mind is anxiety. Therefore, as soon as a person gets ill, he or she goes to a nearest medical clinic or hospital to receives medical treatment. Improved health standards are included as most important sectors of a country and for good healthcare system not only the government is responsible but also the private healthcare sector which can play a vital role. Due to change of time and improvement in systems, many high grade hospitals have opened up throughout the country, so patients have many choices for their healthcare. Then again as there are now services which provide assistance for medical treatment abroad, which has become popular among the privileged class to travel overseas for medical treatment. Nowadays a lot of Myanmar people who can afford travel to countries such as Thailand, Singapore, Malaysia and India for medical treatment. There are also representative offices of those hospitals in Myanmar, so these offices provide all necessary assistance for a patient from Myanmar to travel to that particular country for medical treatment. The expense for treatment in hospitals of those countries vary from one another as well as expenses of package programmes differ depending on the treatment. However before travelling to a particular country for medical treatment, the expenses for diagnosis of the disease, treatment, and all necessary services provided by that hospital can be discussed thoroughly with the representative office before hand so as the patient and his family will have a clearer picture for the trip. These representative offices can arrange everything for the patient to arrive comfortably to that hospital for treatment. There are also package programmes from just general checkups to major operations. All these can be discussed before travelling to the hospital, in that particular country. “Most of the patients from Myanmar travel to Bangkok for medical treatment and some travel to Singapore, Malaysia, and India. Some even travel to western countries for treatment.” said Dr. Theingi Win, business development director
of Global Assistant Travel Medical Services. She also said that patients have begun to use the air ambulance service. “In cases of emergency, and if the patient or family request for air ambulance service, we can provide this service which can transfer the patient to that hospital in a particular country within six hours. There are at least one or two cases every month. These kinds of patients are mostly from Yangon and Mandalay and use this service to Bangkok and sometimes to Singapore,” said Dr. Theingi Win. The lowest rate of the air ambulance service can be aproximately about US$14500. If the patient uses this services two assistants for the patient, a medical team including a doctor and a nurse will also accompany the patient for the journey. Then when the patient arrives to that country the hospital arranges everything for the patient to be admitted on time. “There were also cases from the children’s hospital, which were transferred by this service. Then again there are patients who use this service for medical checkups for heart, bone, brain diseases and also for nervous system. However some patients have to travel by this service on the advice of the doctor” said Dr. Theingi Win. Most of the patients who have experienced medical treatment in overseas hospitals say the doctors pay special attention and discuss in detail with the patient and if necessary, advanced medical equipment and special devices are used when it comes to treatment, so it is very satisfactory for the patient and the family members who accompany the patient says some people who have take medical treatment in foreign hospitals. “There are so many different kinds of advance medical equipment and devices and as there are only about ten to fifteen patients, the doctors can pay more attention to explain about the disease to the patient and the patient also has an advantage of raising questions about the disease in detail, “says Ko Phyo Thu who had the experience of taking medical treatment in Malaysia. He had to travel to Malaysia to have an operation for sinusitis at the Sunway Hospital and the total expanse for this operation was about K2000000 in local currency he said. “I had to stay for a day in the hospital and after the operation had to see the doctor again. During that one day stay in the hospital, the hospital provided three means,
morning, noon and night and also provided in between meals like hot drinks such as Ovaltine, Milo, biscuits and cookies, so it was about five meals within a day. Here in our country Nasal endoscopy is performed but as there are so many patients, the doctor cannot pay attention to each and every patient said Ko Phyo Thu who shared his experience of receiving treatment here. “I took my mother to Singapore for medical checkup and she had checkups for her heart, kidney, liver, and also for diabetes and the total cost was about K700000 to K1000000 but the service was satisfactory. If the doctor finds a disease he explains what kind of treatment will be the best for the disease, what kind of drugs should be given and what kind of precautions should be taken. He is also very patient and answers all the questions that the patient and accompanying family members would like to know.” said Ma Zarchi, who took her mother to Singapore for medical checkup. ”After being admitted to hospital, patients need not worry where or which department should they go for a checkup as staff personally take the patient to the concerned department. There at that department patients don’t have to wait for its turn and there are also interpreters provided for those who are unable to communicate in Thai or English language. Here the patient has to find the right department for the checkup and also have to bribe them. When a patient inquires about something there is nobody to explain to the patient. That’s why we decided to go overseas to have the medical checkup,” said Ma Cho Cho, who went with her husband to Bangkok for a general checkup. “My husband and I went to Bangkok for general checkup. As my age is over 50 the total cost for the checkup was Baht19000 and my husband who is over 40 the cost was just over Baht15000. Being a promotion period, we got the checkup with a special discount rate. The checkup took only about half a day and soon after checkup the doctor explained the results. Both of us were each given about half an hour to consult with the doctor. Then within three to four days the full set of results of the checkup was issued. However, if the patient is unable to stay for that period in Bangkok, can return here and get the full results from the representative office of that hospital, which is very
convenient,” said another couple who went to Bangkok for medical checkup. Most of the people in our country who can afford prefer to have their medical checkups with specialists, state-of-the-art medical equipment and advance medical treatment so they travel abroad for treatment said Dr. May Myat Zaw, an official from the Malaysia Healthcare Travel Council (MHTC) representative here in Yangon. Most travel to Malaysia for treatment in heart disease, In vitro fertilization (IVF), liver diseases and Gastro intestinal illnesses. It is said that in Malaysia, the success of In vitro fertilization (IVF) is about 65 to 68percent. “In 2011, there were only about 5600 Myanmar citizens who went to Malaysia for medical treatment but it has increased and now there are about 11000. The Malaysia Healthcare Travel Council (MHTC) expects that in the coming year there will be a rise of 30 to 40percent of patients to Malaysia. Each and every country has its own rules and regulations concerning healthcare systems so the expenses on medical treatment differ from one country to another. However, in Malaysia due to the strict rules for hospitals, charges cannot exceed than the limits prescribed by the Ministry of Health,” said Dr. May Myat Zaw. To have a medical checkup in Malaysia the lowest average rate can be US$100 and it differs according to the package of the checkup. For Cardiac surgery approximately the rate will be US$10000 to 15000, for In vitro fertilization (IVF) is from US$ 5000 to 6000, Surgery for Spinal cord and nervous systems can cost about US$17000 to 19000 and for thigh surgery can be from US$12000 to 13000. Therefore, if somebody is planning to travel overseas to have medical treatment should first consult with the doctors from the hospital that the patient has chosen. If that hospital has a representative office in Myanmar it would be very convenient for the patient and that office will explain the treatment and expense and whatever the patient would like to know,” said Dr. May Myat Zaw. As an old saying goes that prevention is better than cure, one should eat healthy meals, take daily exercises and live a healthy lifestyle so as to be strong and live a long and happy life. Translation by Win Thaw Tar, Kyaw Soe Htet and Zaw Nyunt
8
Available at:
No. 22, Pyay Road, Mayangone Tsp, Yangon. Tel: 01-664363
Breakfast
Fingertip Oximeter
Lunch
Dinner
Available at:
Yee Shin Co., Ltd. No. 25-26, Bogyoke Aung San Rd, Bahosi Housing, Lanmadaw Tsp, Yangon. Tel: 01-211915
Available at: Market Place by City Mart
9 Available at:
Sports Engineering And Recreation Aisa (Myanmar) Ltd.
T3 treadmill with track connect console
E5 elliptical with track connect console
C3 upright bike with track connect console
G7 multi gym
USD 3664
USD 4944
USD 2596
USD 3795
Star City, Kyaik Khauk Pagoda Road, Building A-2, Wing-C, Unit# 5772, Thanlyin Township, Yangon, Myanmar. www.searasports.com Tel: 056 23224 Ext: 1303
HEALTH SHOPPING GUIDE Baby Drops Available at: Grand Pharmaceutical Co., Ltd. No. 15/19. Zawgyi St, Lanmadaw Tsp, Yangon. Tel: 01-221997
Available at:
Available at: No 28. Pyay Road, Hlaing Township, Yangon. Tel: 09-73222365
No 296, A-12, Ayeyarwon Road, Thaketa Township, Yangon. Tel: 01-551591
10
It’s the birthright of a child to receive full vaccination The Ministry of Health and Sports conducts monthly immunization programmes for people to be vaccinated MYINT KAY THI
V
accination is an effective method to keep an eye on the public’s health; when a sufficiently large percentage of a population, whether an adult or a child has been vaccinated, they become protected from infectious diseases that occur regularly or occasionally. Therefore, every child should complete the routine vaccination of childhood on a normal schedule and by this way disease and mortality rate of children in a nation, under the age of 5 can be significantly reduced, says health experts. As polio vaccine was discovered, this crippling and potentially deadly infectious disease was eradicated. Children who were vaccinated by this vaccine were protected from polio and it was a further step of improvement regarding the children’s health condition.
Vaccination process taking place at a school.
In Myanmar the government provides every individual child with ten types of vaccines free of charge. Furthermore, the Ministry of Health and Sports is striving to include three new types of vaccines for diseases such as Japanese encephalitis, diarrhea and cervix cancer within a period of three years. In regard to the whole country, approximately 80 to 90 percent of the population is covered by vaccination. Although the vaccinated percentage of the population can be seen as satisfactory, there are still about10 to 20 percent of children who do not receive the full yearly vaccination scheme or losing the opportunity to be vaccinated. The children who do not receive regular vaccination can be categorized into two groups: The first group consists of children from far-flung areas of the nation or places encountering conflicts and the second group
are children from suburban areas that move around with their vagabond groups, according to officials from the Ministry of Health and Sports. Professor U Saw Win, a pediatrician commented that “It is impossible for the maternal nurses to vaccinate the children of parents who wander around. So, if these kinds of people miss the process, it is their duty to get to the nearest vaccination station to be vaccinated. I strongly advice these kind of parents to try their best so that their children will not miss this opportunity”. “Being vaccinated is the birthright of every child. Therefore, both the government and respective officials from the concerned ministry are trying their best to fulfill this task. Vaccines are safe because they are produced only after international tests. Every child should be fully entitled to every vaccination provided by the government and
Nurse preparing a vaccine.
they should get full coverage of immunization every time they are vaccinated, so that the immunization can fully provide protection against diseases, said Professor U Saw Win. The National Vaccination Program which is under the Ministry of Health and Sports, monthly perform the operations of the immunization programme which is conducted by staffs from the health department and people can also get vaccinated at government clinics and hospitals. Furthermore in an attempt that the immunization programme covers all children and for those who have missed this routine operation, ninety eight hospitals with a total of 100-beds each, which are under the Ministry of Health and Sports have opened up immunization centers around the country, to ensure that the immunization programme covers all children and to easily get vaccines. The government’s immunization program
11
Township health official collecting data for vaccination in a school. Photos: Naing Wynn Htoon
which is free of charge covers 10 types of vaccines; such as BCG, 5-in-1(diphtheria, pertussis (whooping cough), tetanus, hepatitis B and encephalitis), polio, pneumonia, measles and rubella for children from infants to 18 months. “The government provides 10 types of vaccines free of charge with the assistance of international organizations. So parents should not miss this great opportunity which is provided for their children,” said Professor Saw Win. During the launching ceremony of hospitalbased immunization programme which was held in May, Union Minister for Health and Sports Dr. Myint Htwe in his speech said that immunization process is a basic foundation for universal healthcare coverage and
Myanmar’s initial healthcare project. The Union Minister also added that vaccines are the first healthcare service for newly born infants to stay healthy throughout their lives,” “Vaccines will be effective only if they are fully dosed. If they are not completely vaccinated, the diseases cannot be prevented perfectly. Some vaccines cannot prevent the disease with only one dose. It is not dangerous if the vaccines are over limits. In some developing countries, there are about 17 types of vaccines which are vaccinated to a child. Myanmar is also now vaccinating about 10 types of vaccines than other more than some South East Asian countries. Vaccines can change the lives of people. They can cure the diseases and also for polio. Therefore, vaccines are the most effective way for the healthcare
Advertise in monthly special supplement? ..........................................................
CALL: 392676
of the public,” said Professor U Saw Win. Centers have been opened where these vaccines can be taken and also educational programme for parents regarding these vaccines. We explain to the parents that there are ten types of vaccines being vaccinated to children. These vaccines not only cure deadly diseases but also make children grow healthy and intelligent, said Dr Htar Htar Linn. “In some cases there are children who are brought to hospital but have not taken any vaccination yet. Therefore, we have to vaccinate them when they reach here. The services of hospitals are not only to cure illnesses but also fulfill the needs of children. Therefore, we decided to open clinics where children could be vaccinated,” said Dr Htar Htar Lin, Deputy Director of Expanded
Programme on Immunization (EPI) under the Department of Public Health. “I regularly vaccinate my children at the ward dispensary. I take my children there because doctors there vaccinate the required vaccines. If the children are sick, they suffer and on the parents side not only have to spend a lot but also have to worry,” said Daw Soe Soe Htet, who is a mother of three children. To vaccinate ten types of vaccines to a child cost about US$50. International organizations such as GAVI and UNICEF are providing assistance for these vaccines. In the fiscal year 2016-2017 the cost for each child for these vaccines was US$6.7 and donors provided the cost for the expenses. Translation by Kyaw Soe Htet, Zar Zar Soe and Khine Thazin Han
12
Organic Organic fruits. Photo: Shutterstock
Organic food that play a HEIN MIN LATT
I
n our country, there are some people who live in constant fear. They worry about everything, no matter how unreal the perceived threat seems to be. These people always fear about power outbreaks, water shortage or even the rise in cost of living then there are some who although have the own car, take a taxi to go about during raining season in fear that their car might break down on a in flooded road. Some even fear they might not get a space to park their car so they place a stool or an object in front of their house or apartment just to reserve a parking spot for their vehicle. Some people fear a damaged power cable might fall on them while walking in the street so they constantly look above, at the power lines. There are some who worry they might fall in to the drain and always look down while walking. Still, there are others who imagine that while they are walking on the road, a loaded logging truck may spill the load of logs and crush on to
them. Some even worry about being snatched when they go out at night times. So don’t these worries seem ridiculous? Yes, each and every human being has the right to be worried or be afraid about any matter. There is nothing wrong about being worried or being afraid. However there is one thing that people should really worry and fear. These are pesticides and other poisonous chemicals used in growing fruit and vegetables that can be putting people at risk of developing cancer in their later life. There are also the soft drinks, which have become a part of the younger generation’s everyday life. Carbon dioxide is responsible for the tangy taste, sparkle and preservation of the soft drink, but is a harmful substance which can cause severe cell damage in our body. According to scientists, chemical fertilizers reduce the soil’s beneficial organism population and interfere with the plant growth and these artificial fertilizers have been used since early 18th century. Ammonia which was invented in Germany in 1920s adds nitrogen which can support plants to grow. Later on chemical pesticides were invented.
Among the pesticides are the chemical pesticide, plantpesticide and bio-pesticide. Only plant-pesticide and biopesticide should be used. Then again,chemical pesticides can also be dangerous. Experts found that chemical pesticides can seriously damage the consumers’ health and they have educated farmers and cultivators not to overuse pesticides. They also talked about the adverse effects of chemical pesticides. Some farmers and cultivators use chemical pesticides abundantly as they see these chemical pesticides can eradicate pests quickly. However these chemical pesticides can be absorbed in the fruits or vegetables that they grow and can cause danger to the human body once these contaminated fruits or vegetables are consumed. If large amount of chemical pesticide is consumed, it will cause dizziness, headache, stomach ache and nausea. Furthermore red rashes could occur on the skin and, in some cases, could claim the lives of the consumer. Chemical pesticide consumed in small amount may not show
13
which will overcome fear vital role in our daily lives symptoms but as the time goes by it can damage the nerve and respiratory system. In recent years there have been rumours that chemical pesticides and fertilizers are being excessively used in growing vegetables and fruits. There is also news spreading within the public that food producers are using chemicals to make the colour of the fruits more attractive. There are reports about food producers using Shellac on apples to restore the fruit’s natural wax and gives a shiny coating; people preserving bean curd by soaking in Formalin; placing plastic water bottles in hot boiling cooking oil and when the plastic is absorb in the oil, potatoes are fried in this oil to make them more crispy. There were even reports that dyes are used not only in shrimp paste but in producing dry prawns and pickled tea leaves to make their colour more attractive. As so much news have emerged the concerned associations are also taking these reports seriously and have begun to examine all the fresh produce as well
as checking food processing plants and factories in an attempt to prevent these kinds of harmful foods from circulating in the markets. Consumers are becoming more aware of these kinds of foods and they are paying more attention on organic foods, which remove the dangers or at least the fear they are facing in their daily lives. All kinds of foods produced by organic fertilizers do not pose dangers to consumers. Organic fertilizers are derived from animal matter, animal excreta (manure), human excreta, and vegetable matter, such as compost and crop residues. Naturally occurring organic fertilizers include animal wastes from meat processing, peat, manure, slurry, and guano. Organic fertilizers have been used in agriculture for generations and its products are most safe for those who consume it. In organic planting, natural fertilizer and natural insecticides are used. Growing vegetables planting fruits are carried out in a natural way so they are able to stand natural
disasters and bad weathers. More importantly, organic planting does not use chemical pesticides and fertilizers in growing vegetables and fruits. Organic fruits may not have beautiful colours and may not be large in size, but they can give the real taste of a natural fruit. They do not have chemical smell and they are safe for consumers. In foreign countries shopping centers and super markets, organic fruits are sold on separate counters. Also here in Myanmar in super markets like Market Place, organic fruits are displayed on separate counters and their prices are usually more expensive than other fruits. So people who live in compounds and have spare land can plant their own organic fruits and grow organic vegetables using natural fertilizer and natural insecticides. Just one last good advice to all who are health-conscious: make sure to consume organic fruits and vegetables which can make you healthier and free from fear. Translation by Win Thaw Tar and Khine Thazin Han
14
How to live a healthy lifestyle Although it may not be easy to commit, healthy lifestyle is most important for human’s life WIN AUNG
I
n a lifetime of human beings, health is the most important physical and mental condition which is happiness free from diseases and illnesses. However, as all human beings are not the same, the temperament also differs from one another. If one may inquire which is most important and prefer between health and wealth, the prompt reply of the majority will be wealth and only then comes health. Right, although wealth is essential in human life, obviously, health is more important than wealth which is the same concept as mine. Wealth cannot buy health despite having the ability to acquire the best medication in the world. One may be wealthy but if health is affected how can he or she be able to enjoy the wealth possessed and all this wealth will be no more significant to their lives. A person, whose health is affected, will not be able to enjoy the pleasures of life like others. For instance, when an unhealthy person sees people in good health enjoying life, the
immediate desire that comes to his or her mind is to be like those who are healthy or even give up all their possessions to be healthy. There is also the preaching by Lord Buddha regarding health where it says health is the greatest gift, contentment the greatest wealth, faithfulness the best relationship. Therefore, it is most important for everybody to be knowledgeable to live a healthy life. People, young or old unnecessarily die every day due to lack of health knowledge. Therefore it plays a vital part in having a healthy life. So what is this healthy lifestyle and why so important to us and how can we gain this greatest gift of life? Many believe, a healthy lifestyle implies looking good and feeling good. Most people say that they want to be healthy but do they really imply to gain a healthy lifestyle? To become a healthy person, it is important to avoid smoking, drinking excessively, avoid using drugs, and avoid eating unhealthy food, to exercising regularly and having a balance weight. Then again a healthy diet also plays an important part in a healthy
Girls participate in health exercise on the banks of Kandawgyi lake.
lifestyle. However, only by following these rules it would not be enough to gain a healthy lifestyle. In today’s fast changing world, technology has become so advanced that there are TV games, Internet, cell phones etc… which most of the younger generation especially schooling age are addicted too. Not only in our country but around the world in each and every country, the younger generation have become so addicted that they spend many hours a day on the Internet, playing TV games, chatting on cell phones and giving too much of their time even shortening their resting hours. At the same time today’s younger generation are consuming unhealthy food which is dangerous for their health in the long run. To make the matter even worse, there are alcohol, drugs which are the most dangerous for a person’s health. Nowadays, most of the teenagers to adults consume alcohol and drugs which can shorten their life span. When a child or adult becomes addicted to one of these habits, they lose interest to take up sports or exercise and will never
Early morning exercise for elderly persons. Photos: The Myanmar Times
become a healthy person for the rest of their lives. Every human being has so many things to do in their lives, maybe for themselves or obligations in work places and for matters relating to family and friends. Therefore a healthy lifestyle may not be easy to commit to. When a person is unable to fulfill these obligations, tension rises and becomes stressed which can hinder a person’s health. When a person is stressed he or she becomes fatigued and later on it affects the health. That is why one should not stress for each and every small matter or things that comes across his or her daily life. Priority should be given to obligations and solved each at a time where stress can be reduced. Most people think that regular medical checkups are essential to have a healthy life. Yes, it might be right for those who are wealthy and can afford to go to hospitals, especially to special clinics for regular checkups. But that is only for a few privileged. However not everybody are in the same situation. One may even argue that taking medical checkup need to go to hospitals, special medical clinics and consulting and receiving medical treatment from medical practitioners but here the financial matter comes in. So what should we do to become healthy persons? That is why by following the mentioned steps such as avoid smoking, drinking excessively, eating unhealthy food, using drugs, which are most dangerous for health, giving too much time on the computer and other modern gadgets, and trying to avoid in stressing for every little matter that comes across in daily life. But these steps are not sufficient to make a person healthy. The best way to have a healthy life is to exercise regularly. For
instance people, who live in homes with compounds, doing sports and even gardening at home, can make a person healthy. However, city dwellers living in apartments where they are unable to do these kinds of activities, another option is trying going to the nearest gymnasium and taking up exercise lessons. Even then if that situation does not permit due to financial constraint, try to take a daily walk for at least half an hour which is the best ideal for people of all ages and fitness levels for those who want to be more active. According to medical reports, regular brisk walking has shown to reduce risk of chronic illnesses, such as heart disease, diabetes, asthma, stroke, high blood pressure, osteoporosis and even some kind of cancers. One last advice to live a healthy lifestyle is to have self-confidence which is extremely important in almost every aspect of our lives. If we look at our own lives and those around us, we will see that in searching for happiness we spend most of our time and energy, our external conditions such as increasing our wealth and possessions, enhancing our reputation and finding better partners. Though we may succed in acquiring these external conditions, we will never enjoy the lasting happiness that we desire if we don’t have self confidence. Without selfconfidence, we will never be able to avoid the evil doings which may affect our lives that will end up in damaging our health. So let’s practice this healthy lifestyle by staying away from unhealthy habits, avoiding unhealthy food, doing exercise regularly, having enough sleep, reducing stress, and last but not least having self confidence which will make us healthy and happy throughout our lives.
15
Food and vitamins A layout of healthy and delicious home-made dishes. Photo: The Myanmar Times
Consuming well-balanced healthy food provides most vitamins a human body needs WIN AUNG
C
hoosing foods each day that are rich in vitamins and minerals is the best way your body is receiving what needs to be healthy. Supplements can be beneficial, but the key to vitamin and mineral success is by comsuming a balanced diet. Vitamins are organic compounds necessary for the healthy functioning of our bodies. We need vitamins to help us grow, to make out bones, muscles, skin and organs strong as well as to protect from infections. Deficiencies in vitamins can become serious problems to our bodies. The best way to receive enough vitamins for a normal growth and development comes from the fresh foods that we consume daily. Vitamins are classified as either water-soluble or fat-soluble. In human beings, there are thirteen vitamins: four fat-soluble (A, D, E, and K) and nine water-soluble (eight B vitamins and vitamin C). Water-soluble vitamins dissolve easily in water and, in general, are readily excreted from the body. Therefore, vitamin consumption can be indicated by urine output. Many types of water-soluble vitamins are produced by bacteria. Fatsoluble vitamins are absorbed through the intestinal tract with the help of fats. The best way to get enough vitamins is to eat a balanced diet with a variety of healthy foods. In some cases, one may need to take vitamin as supplements. However it should bear in mind that sometimes high doses of vitamins can cause health problems. Vitamin A, from the fat-soluble category can be obtained by consuming liver, fish, orange, ripe yellow fruits, leafy
vegetables, carrots, pumpkin, squash, spinach, soya milk, milk products such as butter and cheese. Vitamin A, not only prevents night blindness but also lower the mortality rate of cancer. Another fat-soluble vitamin is Vitamin D, which can be obtained from fish, eggs, liver, mushrooms, cod liver oil, oily fish, fish roe, Sardine, Tilapia, Tuna , Cereals, Tofu, low fat fruit yogurt, and various kinds of milks. Vitamin D increases intestinal absorption of calcium, iron, magnesium, phosphate, and zinc. Vitamin D can prevent heart disease, diabetes, obesity, muscle weakness to name a few. Vitamin E can prevent cancer, heart diseases, eye disorder and prevent or slow the decline of mental function such as Alzheimer’s disease. A variety of foods such as vegetable oils like safflower oils and soybean oils, Nuts, such as peanuts, hazelnuts, and, almonds and seeds like sunflower seeds, green vegetables, which are spinach and broccoli, fruits like mangoes and Papayas are also among the best sources of vitamin E. Vitamin K, which is also a fat-soluble vitamin helps to prevent calcification of arteries which is one of the leading causes of heart attacks. It works by carrying calcium out of the arteries and not allowing it to form hard plaques within the arteries. It also increases the amount of protein required to maintain bone calcium, reducing the risk of osteoporosis. Vitamin K is also effective in reducing the risk of prostate, colon, stomach, nasal, and oral cancers. Vitamin K is found plentiful in green vegetables such as spinach, swiss chard, lettuce, cabbage, kale, cauliflower, broccoli, and brussels sprouts and some fruits such as avocado, kiwifruit and grapes,
which are also high in vitamin K. In the category of water-soluble vitamins there are Vitamin B and Vitamin C. Vitamin B play important roles in cell metabolism. There are eight types of vitamin Bs. B vitamins are particularly concentrated in meat such as turkey, tuna and liver. Other sources for B vitamins include pulses or beans, whole grains, potatoes, bananas, chili, peppers, nutritional yeast, brewer’s yeast, and molasses. Another water-soluble vitamin, which is Vitamin C is found in food and used as a dietary supplement. Vitamin C helps to repair and regenerate tissues, protect against heart disease, decrease bad cholesterol and common cold. Vitamin C is important in the treatment of rheumatoid arthritis. As many fruits and vegetables contain vitamin C, it is easy to obtain through foods. Apples, asparagus, berries, broccoli, cabbage, melon (cantaloupe, honeydew, watermelon), cauliflower, citrus fruits (lemons, limes, oranges), kiwi, fortified foods (breads, grains, cereal), dark leafy greens (kale, spinach),peppers (especially red bell peppers, which have among the highest per-serving vitamin C content. However, if one consumes healthy and well-balanced food, vitamins would not be necessary. A well-constructed diet supplies not only provide the vitamins which are needed daily, but also other important non-nutrients that are lack in vitamins. Therefore, it is possible to conclude that vitamins are really good, because they help us keep our body in shape providing it with lacking elements but by consuming a balance diet we will be able to get sufficient amount of vitamins and minerals the natural way.
16
Unknown mixed medicines still on demand Although dangerous, unknown mixed medicines are still a common source of healthcare among the grassroots
An elderly lady preparing unknown mixed medicine for her ill family member. Photos: Aung Htay Hlaing
KHIN SU WAI
D
aw A Nge Lay said her elderly mother has to take some unknown mixed medicines for common ailments. She added that these unidentified mixed medicines are usually taken to alleviate headache and flu symptoms as they are cheap, effective and easily available from local drugstores. “They are not to treat serious illness. If I feel ill, I just take some mixed medicines sold in my ward. The bad thing is I don’t know what types of medicines are mixed together. I don’t even know if these medicines are expired or whether I am allergic to it. The good thing is I can buy them easily,” she said. It has been more than a decade-long habit of the people of Myanmar to take some unknown mixed medicines prescribed by small shop and stores in the neighbourhood to treat common
cold and cough, for temporary or long-term. Some combined medicines are branded as Myanmar traditional medicines and sold on the market. Some are found to contain oral steroids in powder form. The combined medicines are cost effective, easily available and are widely used as most ill-informed people are reluctant to go to the clinics or hospitals unless they have some deadly disease. The combined medicines alleviate symptoms of disease temporarily without addressing the underlying causes. Most people used the combined medicines because they think they are cured as the symptoms disappear. “The combined medicines are very dangerous. Although they are bad, people are still taking them because they are cheap, easily bought, and fast to relieve the symptoms. People are aware that combined medicines are bad, but they still don’t want to see the doctors because of sparing
too much time in clinics. It is also difficult to see a doctor as doctors are usually busy with hospital duties,” resident Dr Soe Naing Win from Tagaung Township hospital branch told the Myanmar Times. He remarked that during his residency in rural areas, 5 out of 10 patients he treated were taking or had taken the mixed medicines. He added that he had treated a 56 year old patient from Lat Lote village in Depeyin Township of Sagaing District, who went blind by taking some combined medicines for over a year believing that it would cure his knee pain. “Due to the compounded medicines, the most common side effects are that the people suffer stiffness in the nape and their faces become puffy but they think they are getting fat due to a good rest. It is most common at my clinic. Therefore, I make them stop taking compounded medicines. Some people oblige to
my advice. The main point is that we have to educate the public and also control the people selling compounded medicines. These are the duties of the authority. We have to say is that it is dangerous to take these medicines. They come to us with a pack of medicines, which are all compounded medicines,” said Dr Soe Naing Win. At the second regular meeting of the first Pyithu Hluttaw, the Minister for Health answered about the danger of compound medicines and that they are prohibited. According to the National Law section 16, nobody is allowed to sell, store or distribute medicines or raw materials without licenses but due to the weakness of regular checks, the situation still prevails. The Health Department had issued notice of not to take compounded medicines. For example, in 2016, announcements were made about the dangers of these medicines and to avoid them. However, due to lack of knowledge, most people in rural areas still depend on compound medicines. “Most of the people who come to me are farmers. As they have worked in the fields all day long, they use compounded medicines for their stiff muscles and for arthritis of limbs and swelling joints. They also use it in an attempt to prevent from catching cough, cold, and headache. As they cannot afford to have healthy food, they take these medicines. They presume that these medicines can provide them with all the health they need. Most who are lack of knowledge about medicines think that they look good when they are chubby and rely on these medicines to gain apatite so as to gain weight. They take these medicines to cure swollen joints and from losing appetite. Most of these kinds of people not only take these medicines by themselves but also advice others to take them,” he said. “When they have to see a doctor, the cost is high and also have to listen to the doctor’s advice of the danger of these medicines. Therefore, to avoid all these, they rather depend on compounded medicines,” he said. “The compounded medicines are still in circulation and need time to be eradicated. Success can only come when the population fully accepts the danger of these mixed medicines. Then again persuasion plays a vital role to reduce the dangers of mixed medicines, he said. Translation by Swe Zin Moe and Khine Thazin Han
