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Living Well in Myanmar

Dengue:
how to spot it,
how to avoid it
CHRISTOPH GELSDORF, MD
livingwellmyanmar@gmail.com

ECOGNISE the mosquito in


the picture? Thats the Aedes
aegypti, and its famous for
acting as the distributor of dengue.
The mosquito has quite a history
and current global reach. It began
travelling across the world with
the African slave trade in the 15th
to 17th centuries, and arrived in
Asia in the 18th and 19th centuries
with the increase in global
exchange. In recent times it seems
to have benefited most from the
international trade in used tyres,
which provide a protected way
for eggs to be dispersed into new
geographies.
Aedes aegypti does well in tropical

75%
The percentage of the worlds
dengue infections thought to occur
in Southeast Asia

and subtropical latitudes, thriving


in Latin American and Asian cities
experiencing rapid population
growth with a resulting urbanisation
that offers breeding opportunities.
The mosquito picks up the dengue
virus from a previously infected
person and passes it along during
its next blood meal. It does this with
remarkable effectiveness, causing
an estimated 50 million infections
per year across approximately 100
countries.
Residing in Myanmar puts readers
of this newspaper in the centre

of the global dengue pandemic.


Seventy-five percent of infections
are thought to occur in Southeast
Asia and the WHO has stated that
Myanmar probably has the highest
incidence of dengue in ASEAN.
This means that families should be
looking out for dengue symptoms
and taking precautions toward
prevention.
Interestingly, most dengue
exposures are cleared by
the immune system almost
immediately after receiving
a mosquito bite, meaning
the infections go unnoticed.
Nevertheless, for reasons not well
understood by Western medicine, in
some instances the virus is able to
replicate sufficiently to cause illness.
The resulting dengue disease can
then develop into anything from
simple flu-like symptoms to a worstcase haemorrhagic fever.
The classic symptoms include
a few days of fever, headache,
pain behind the eyes, muscle
pain, joint pain and perhaps a
rash. From this point most people
recover spontaneously. However,
a small proportion of patients go
on to leak fluid from their blood
vessels. Unfortunately this serious
complication occurs more frequently
in children. Therefore we tell parents
to look out for warning signs such as
new abdominal pain, heavy vomiting,
bleeding from the nose or gums, and
difficulty breathing.
While there is a blood test that
helps doctors diagnose dengue,
there are no specific medicines that
act against the virus. Therefore the
treatment is usually supportive,
meaning we watch patients,
and especially children, very

closely to see which direction the


illness is heading. Occasionally,
worsening symptoms will prompt a
hospitalisation in which the patient
is kept alive with fluids and blood
transfers while we wait for the
disease to run its course.
Because dengue fever cannot
be cured or medically prevented
although several promising vaccine
candidates are in development the
primary approach is containing its
spread by what epidemiologists call
vector control. Attempts by national
health systems and international
NGOs to chemically or biologically
control Aedes aegypti populations
have typically not been very
successful, so solutions have to be
local.
The mosquito breeds in puddles
of clear water, which is why
community-level efforts to reduce
sources of standing water are
important. This includes barrels,
drums, jars, pots, buckets, plant
saucers, tanks, discarded bottles,
tins, tyres and other places where
rainwater collects or is stored. Aedes
aegypti bites in the daytime and
likes to live in cooler dark places
like a closet or under a bed. Risk
of dengue can be reduced to the
extent that the family unit has the
resources to keep rooms screened,
use mosquito repellent and protect
kids with daytime bednets.
Christoph Gelsdorf is an American
Board of Family Medicine physician
who sees patients in Yangon and
California (www.gelsdorfMD.com).
He is a member of the Myanmar
Academy of Family Physicians.
Reader thoughts and questions are
welcomed.

Practitioners of all ages thrill the audience with their


poise and form to as part of the first annual Yoga Day
competition on June 16 ahead of the UN-designated
International Yoga Day on June 21 in a competition
organised by the Indian embassy in Yangon. Demanding
strength and flexibility as well as mental focus and
concentration, yoga stretches back as early as the sixth
century BC in Indian ascetics, and traditionally has a
strong spiritual element at its core.

IN PICTURES

Aung Htay Hlaing

Vital signs
What census results tell us about our nations health
Years

66.8

63.9

Average life expectancy at


birth (both sexes)

69.9

Average life expectancy at Average life expectancy at


birth (males)
birth (females)

71.2

60.6

Average life expectancy in Yangon Region

Average life expectancy in Magwe Region

Births

18.9

15.8

20.1

Annual births per 1000


people (overall)

Annual births per 1000


people (urban only)

Annual births per 1000


people (rural only)

29.9

15.5

Annual births per 1000


people in Chin State

Annual births per 1000


people in Yangon Region

Deaths

62

68

Number of children per 1000 who die


before first birthday

Number of children per 1000 who die


before first birthday (rural only)

41

72

Number of children per 1000 who die


before first birthday (urban only)

Number of children per 1000 who die


before fifth birthday

Disabilities
(4.6% of population)

(1.9% of population)

(2.5% of population)

2,311,250

957,736

1,249,737

People with any form of


disability

People with a mobility


disability

People with a vision


disability

(1.3% of population)

(1.7% of population)

673,126

835,598

People with a hearing disability

People with an intellectual/mental disability

Staff writers Shwe Yee Saw Myint,

Editors Myo Lwin, Wade Guyitt

Khin Su Wai, Myint Kay Thi, Myo Lwin,


Mya Kay Khine, Cherry Thein

Sub editor Mya Kay Khine Soe

Contributors Christoph Gelsdorf,

Photography Aung Htay Hlaing

Jessica Mudditt, Elizabeth Whelan

Cover design Ko Htway

Translators Khant Darli Lin,

Page layout Ko Khin Zaw

Thiri Min Htun

For feedback and enquiries, please contact

wadeguyitt@gmail.com, myolwin286@gmail.com

Cheap drugs build


drug resistance
How income-based healthcare leaves the poor with less,
and all of us at risk
SHWE YEE SAW MYINT
poepwintphyu2011@gmail.com
N Myanmar, where most struggle
each month to make ends meet, nonspecialist doctors charge K1500 (roughly
US$1.50) per visit. Any higher, they say, and
few would come.
If I charge a patient more than K1500 a
day in this township, patients wont come to
the clinic anymore because they cant afford
it, Daw Zar Zar, who owns a private clinic in
South Okkalapa township, told The Myanmar
Times.
Unfortunately, little quality treatment is
possible at such a lower charge, and the cutcost thinking extends to prescriptions as well.
I have to include cheap drugs, for having no
other choice. If I dont, my clinic would have to
be closed down, Daw Zar Zar said.
Because expensive, effective medicine is
unaffordable for most, its the cheap medicine
that brings profit. Unfortunately, it may be
doing more harm than good.
Another private clinic owner, U Myo Zaw,

[Drug resistance] can


happen when people
only take legitimate
medication for a fraction
of the recommended
period. It also happens
when they rely on halfbaked medicine such as
circulates in Myanmar.
has been in the pharmaceutical industry for
10 years. He told The Myanmar Times that cheap
drugs are easily available in pharmaceutical
markets and enter the country from a variety
of sources.
Substandard medicines are just ones
which are about to expire and are being
sold at reduced prices by some companies.
China-made and India-made medicines come
in illegally from the border, and others are
imported by some Indian companies, he said.
The market for most pharmaceutical

companies in Myanmar are small


neighbourhood clinics, which distribute
specific antidotes to selected illnesses.
Often, medications are handed out without
labels, so patients have no idea what they are
taking, according to U Myo Zaw.
In the worst cases, doctors dont describe
the names and kinds of medicines in the
prescription. They dont even give record
books.
U Myo Zaw said most patients dont
understand the process and are afraid to
question the doctors orders.
Also, he added, a part of the reason doctors
are afraid [of labelling] is that if patients knew
the names of medicines, then they would buy
them themselves and wouldnt come again to
their clinics.
Reliant on a system that prescribes them
cheap, unapproved medication that is in turns
not effective, a placebo, or even harmful, those
who must rely on Myanmars healthcare
system are the ones who suffer. But its not
just individuals, and not just the lower or
middle classes. Shoddy care is changing the
entire nature of our relationship to disease.
The threat is something called drug
resistance, which happens when diseases
are not treated effectively, then mutate to
overcome the drugs being used to treat them.
As a result, super-diseases develop, beyond
our power to control them. This can happen
when people only take legitimate medication
for a fraction of the recommended period. It
also happens when they rely on half-baked
medicine such as circulates in Myanmar.
Unsystematic procedures in clinics
and pharmacies, prioritisation of profit by
pharmaceutical companies, a shocking lack
of medical knowledge in the general public
due to decades of underfunded education,
and loose supervision from authorities who
are either bought out or unable to make a
difference can all contribute to mounting drug
resistance.
Drug resistances are occurring in
pneumonia, urethritis, TB and malaria, said
Dr Mi Mi Ko, a member of the Myanmar
Medical Association (MMA).
If diseases are resistant to current
medicines, new medicines would have to be
produced. But in fact, a new medicine could
take up to 10 years to be produced. We need to
prevent drug resistances, said Dr Mi Mi Ko.
New medication isnt the only thing that
needs development.
We are running courses on medical ethics
in the MMA, said Dr Mi Mi Ko, but there is
apparently still little interest in them among
doctors.
Translation by Kyawt Darly Lin

An apple a day? Good start


but itll take more than that
Dr U Chit Soe
Orthopaedist
Patients are afraid of rheumatism caused by
bacteria. Rheumatic fever mainly starts from
strep throat. Thats why unhygienic food and
drink should not be consumed. When strep
throat lingers for three days, I suggest you see
a doctor right away, as it can lead to rheumatoid arthritis. When you have the disease, you
could end up being bedridden by abnormal
bending of joints. Some patients treat that
with folk-medicines, but while folk-medicines
could relieve the pain they wouldnt cure the
disease. If you only come to see us when the
condition is far developed, treatment is costly
and difficult. Another common complaint
in orthopaedics is muscle tension, usually
among those who sit a lot without exercising,
such as those working with computers, tailors, students who study all day and gamers.
For orthopedic health, avoid unhygienic food,
instant noodles, coffee mix and chemicallycoloured food. Exercise at least 15-30 minutes
daily to prevent muscle tension. talk to a doctor if joint pain lasts longer than six weeks.
Avoid folk-medicines as much as possible. If
these suggestions are followed, health costs
and orthopedic problems will decrease in the
long term.

especially from rural areas, sometimes see a


doctor only when their pregnancies are four or
five months along. They should have been seeing a doctor as soon as they knew they were
pregnant, to ask how to stay healthy.

Dr Thein Myint
Endocrinologist

Itchiness can happen anytime. Pruritus,


including eczema, could break out, and skin
fungal infections are common as well. When
you use or hold cosmetics or products with
chemicals, wear gloves to avoid skin injury.
Fertilizer users should also wear protection.
Skin diseases mostly stem from poor personal hygiene. It is better to take care of your
own personal hygiene in advance, rather than
have to cure a disease later. Also, take care to
avoid UV rays as much as you can.

According to the WHO, 6 percent of older


adults in Myanmar have diabetes. Sometimes
patients think they will be okay as long as
they control their sugar intake, but theres
much more to it than that. In fact, diabetes
mellitus can cause trouble throughout the
body. Managing diabetes involves controlling sugar level, controlling fat levels in the
bloodstream (cholestoral) and controlling
blood pressure from getting too high. To
control cholestoral, avoid particular food.
Diabetes patients should also take statins
that reduce fat, even if the level is already
normal. As diabetes can often lead to obesity,
body weight should be controlled. High-blood
pressure also leads to other problems, as
numbness means you dont notice when you
are injuring yourself until it has grown severe.
Some can even lose an arm or leg. Always see
a doctor if an injury occurs, especially if the
colour of the skin changes. Check your legs
every night when washing. Take kidney tests
once a year and have your eyes checked every
two years. If blood sugar testers are in hand,
test whether it is 130 milligrams, which is the
appropriate amount, every morning. By two
hours after a meal, it should be under 180; after dinner, under 144. People with high urine
sugar level should have blood pressure under
140 and 90 as everyone else, and 130 and 80
is better yet. Oral health is also important, as
wounds and injuries in the mouth take longer
to heal for diabetics. To know the state of the
disease, a hemoglobin A 1B test once every
three months should be enough.

Dr Soe Lwin
Obstetrician and gynaecologist

Dr Myat Nyan
Prosthodontist

Most pregnant women suffer thalassemia.


Some behaviours stemming from traditional
beliefs as dieting and getting massaged
by informal mid-wives are unhealthy and
could be dangerous. Dont diet while pregnant.
Fruits, vegetables, meats and fishes should be
eaten for vitamins, minerals and folic acid to
keep your body in balance. At the same time,
thinking you have to eat for two and stuffing
yourself is not a good habit. It is necessary
to eat a balanced amount, and to consume a
wide range of nutrients. Physical exercise is
also necessary for the health of mother and
baby. Avoid over-strenuous activities the easiest exercise is walking. Pregnant women who
dont do exercises may not be strong enough
to push well and the foetus could be affected.
When people are healthy, they will be happy
before and after giving birth, and that will be
good for their families. Also, pregnant women,

The most common periodontal diseases are


gingivitis and periodontitis. Both are brought
on by neglecting to brush regularly. I advise
patients to brush twice daily, and children
should be taught to brush before going to
bed at the age of two or two-and-a-half, so
they develop good habits brushing and wont
get periodontal diseases later in life. Also, as
adults have more problems with food getting wedged in between teeth as they age, I
advise everyone to use dental floss to remove
plaque. Remember that oral and dental diseases dont start out causing pain. If you feel
pain, the problem is already advanced. Get
your teeth checked at least twice a year. Most
diseases we see are already far gone, which
means costs rise and treatment is excessive.
Dont let the same happen to you.
Myint Kay Thi, additional reporting by Mya Kay Khine,
translation by Kyawt Darly Lin

Dr U Kyaw Kyaw
Dermatologist

Seeing is believing
Cataracts rob our sight, and the people of Myanmar are particularly at risk
JESSICA MUDDITT
jess.muddit@gmail.com

LTHOUGH no data exists as


to the prevalence of cataracts
among Myanmars population,
experts say more needs to be
done to raise awareness about the
condition, particularly as it can cause
progressive deterioration of vision if
left untreated.
Globally, cataracts are the leading
cause of blindness and account for
more than one-third of the worlds
visually impaired people, who
number some 20 million. According
to the World Health Organization,
the vast majority of untreated cases
are in developing countries, due to
lower levels of access to diagnosis
and treatment.
Cataracts are a clouding of the
eyes natural lens, which results in
an opaque, brown or milky white
colouring which obscures vision. It
often occurs as we age, because the
lens protein is prone to degrading
over time. A persons eyesight can
deteriorate in a variety of ways as a
result of cataracts, including a fading
of colours, blurred vision and what is
known as glare an extra sensitivity
to light.
Cataracts can be present from
birth as a result of a congenital
condition, or result from an injury
that inflicts trauma on the eye.
However the onset of cataracts can
also be brought about by lifestylerelated factors or the misuse of
certain medications.
Myanmar Eye Centre is a private
eye clinic in Yangon that was
established seven years ago. It
currently has six eye specialists,
who are known as ophthalmologists.
Approximately one-fifth of its
patients which number around
50 a day are affected by problems
associated with cataracts.
Most patients complain of having
poor vision that has deteriorated
gradually, or experiencing glare, such
as when they stare into the lights

of an oncoming car at night, said


optometrist Dr Phyo Thiri Aye.
Diagnosis of cataracts requires an
eye exam: Although surgery does
not need to follow immediately
afterward, an operation is the only
means of restoring sight and must
not be left too late. Contrary to some
beliefs, neither eye drops nor oral
medicine can be used to prevent or
cure cataracts: Surgery is the only
treatment possible, and its better
done sooner than later.
Cataracts grow denser over
time, which makes surgery more
complicated because it requires a
large rather than a small incision,
said Dr Khin Thida Oo.
The procedure involves removing
the cloudy lens and replacing it with
an artificial one, which stays in the
eye forever more. Dr Khin Thida Oo

quack healers hucksters trained


in neither modern nor traditional
medical practices who are known
to continue to carry out a form of
treatment that dates back to ancient
Greece called couching: hitting the
lens with a pointed object with such
force that it causes the entire lens to
dislodge from where it is attached
within the eyeball and fall to the
cavity in the back of the eye. As well
as being extremely painful, couching
has very high risk of severe infection
of the entire eye and, most often,
requires very thick glasses afterward,
as you no longer have the eyes
natural lens to rely on.
Weve had some patients come
in from rural areas that have
undergone this procedure, said Dr
Aye Thi Han, adding that the patients
find it difficult to perform necessary

said that surgery should take place


as soon as the deterioration in sight
leads to difficulty carrying out daily
activities.
According to the eye specialists
at Myanmar Eye Centre, surgery
is more frequently delayed among
Myanmars rural population, due to
lower awareness about the risks of
leaving cataracts untreated as well
less access to medical care.
Also complicating matters in
remote areas of Myanmar are

visual tasks in the aftermath.


Any means of shielding the eyes
from exposure to direct sunlight will
work to delay the onset of cataracts
and is therefore recommended.
The greater an individuals
exposure to UV rays, the greater the
risk of developing cataracts, Dr Aye
Thi Han said.
Sunglasses that provide UV
protection are one of the most
common methods. Although
sunglasses are unpopular in

Cataracts are a clouding of the eyes lens, shown here in advanced (above) and
moderate stages. Photo: Supplied/Myanmar Eye Centre

Myanmar, fortunately doctors agree


that the ubiquitous sun umbrella
does an equally good job. Those
who are most exposed to the risks
associated with prolonged exposure
to direct sunlight are engaged in
farming a group that makes up
two-thirds of Myanmars workforce.
An added aggravation is the fact
that Myanmar is located in a region
where ozone depletion is higher
than the norm, as is the number of
sunlight hours.
While men and women are equally
predisposed to developing cataracts,
certain cultural factors suggest there
may be a higher prevalence here
among men.
Women are more likely to stay
indoors and men are more often
working in occupations where
injuries to the eyes can occur, said
Dr Aye Thi Han.
Those who consume alcohol and
tobacco also place themselves at
higher risk, with cases of cataracts
occurring in people as young as 40,
according to the doctors at Myanmar
Eye Centre.
There is a further dangerous
practice that may make Myanmars
population more susceptible to
cataracts: the misuse of certain
medications.

Its a cultural thing in Myanmar


for someone who goes to see a
doctor to want to leave with some
sort of medication, even if theres
nothing wrong with them, said Dr
Phyo Thiri Aye.
Even more alarming are the effects
of corticosteroids, which are strictly
intended for a confined period of use.
Corticosteroids are a good and
useful medication for certain
problems, such as inflammation or an
infection like pink eye. But if misused,
they can have a dangerous effect
that includes both cataracts and
glaucoma, said Dr Khin Thida Oo.
Corticosteroids can be bought over
the counter without a prescription
in Myanmar, which causes medical
experts to worry that large numbers
of people are self-medicating to
detrimental effect.
Steroid eye drops can be used to
treat pink eye and theyll think, Oh
this is working well, so its okay. But
pharmacies shouldnt be dispensing
this type of medication without a
prescription and patients shouldnt be
using it without being monitored by an
eye doctor, said Dr Khin Thida Oo.
For more information, contact the
Myanmar Eye Centre helpline on
09-31311304.

Hospital Management Asia


conference coming in September
MYO LWIN
myolwin286@gmail.com

MAJOR regional hospital


management conference
will take place in Yangon
September 3-4, involving over 700
delegates from 30 countries.
The media coordinator of Hospital
Management Asia 2015, Mylene
Alcazar, said the 14th annual
conference will give a boost to
professionals in the industry.
The people will benefit from the
tremendous combined experience
of over 70 international experts
who will be speaking and training
Myanmar hospital managers and
physicians at HMA, said Ms Alcazar.
These physicians and hospital
managers will take back with
them immediately useful tools and
techniques to provide better patient
safety and better and faster patient

services, she told The Myanmar


Times by email.
These physicians and hospital
managers and owners will be able
to meet and interact with the more
than 700 best and the brightest
fellow hospital executives from 30
countries around the region. This
by itself will be a mind-opening and
major educational influence.
She added that, with Myanmar
becoming increasingly connected
with the outside world and a
valuable member of ASEAN, HMA
was among the links that the
country needs to develop.
The HMA event, held at Yangons
Sedona Hotel, focuses on insights,
tools and techniques for hospitals to
improve service and reduce costs.
Organisers say they have received
confirmation from 600 participants,
even though the event is still over
two months away.

Taking stock of traditional med


KHIN SU WAI
jasminekhin@gmail.com

HOUGH it has come to


be influenced by Western
research and techniques,
Myanmar traditional medicine
is still popular. But medical
professionals, and those who value
traditions, are wondering in what
direction our folk medicine may be
heading, and whether any action,
corrective or otherwise, might be
necessary.
Myanmar traditional medicine
dates back to the Bagan era
and reached its zenith during
the Konbaung era (1752-1885).
It is recorded that King Mindon
appointed 11 royal doctors whose
authority to manage the royal
kitchens was so absolute that
the monarch himself could not
interfere with their dictates.
However, under the colonial era,
the glory of Myanmar traditional
medicine faded, and has never fully
recovered its former dominance.
It thrives nevertheless, as can
be seen in the proliferation of its
remedies. Added to the 57 varieties
of medicines produced by state-run
traditional pharmaceutical firms
are thousands of types of medicines
manufactured by the private
pharmaceutical industry. Judging
from the numbers, it is clear that
folk medicine in Myanmar is alive

and well: There are more than 200


state-run clinics, and innumerable
private facilities can be found
almost everywhere.
The chief of Mandalays 100bed traditional hospital, U Than
Gyaung, said that the World
Health Organization accepts
Myanmar traditional medicine.
His hospital has about 100 inpatients and 100 out-patients and
provides treatments to around 120
patients daily. Most are bedridden
and suffering paralytic stroke,
a condition which traditional

medicine claims to be able to treat.


The chief said many factors
combine to explain the durability
of traditional medicine. These
remedies have fewer negative
side-effects. They rely only on local
herbs, thus reducing the need to
import expensive foreign products.
Western medicine demands the use
of modern equipment and enables
the diagnosis of specific ailments,

with precise causes. On the other


hand, such remedies can produce
more negative side-effects. And they
are costly, he said.
The main qualification for
practising traditional medicine is
benevolence, says Daw Htoo Htoo
of Madaya township, Mandalay
Region. Now aged 69, she has been
practising for half a century.
Her grandfather, who owned
nearly 100 farms, used to treat
his many workers with his own
blended traditional medicines. Daw
Htoo Htoo said she had inherited
his skills through her mother.
We took the governmental exam
to get the licence. This was about
1969. The questions were drawn
from the 11 encyclopaedias, she
told The Myanmar Times.
Daw Htoo Htoo practises along
with two traditional medicine
graduates, treating 35 to 40 patients
every day. She runs 12 pharmacies
in Madaya and three in Zay Cho,
and deals with about 200 traders.
Originally a physician, she learned to
blend medicines by herself, she said.
Thagyar yayzin is good for TB and
the lungs and shui for asthma and
coughs. Take zabu dipar for high
blood pressure and obesity, she
said.
Each shop has one room for
blending medicines, one for
treatments, one for making new
blends and one for sales. We provide

Photo:

all healthcare services: producing,


curing and selling.
Daw Htoo Htoo continued,
Traditional medicine is based on
nature, and Western medicine on
effectiveness. In the pharmacy, care
must be taken to protect medicines
from sunlight, maintaining the
temperature, and so forth. Fat
people should be given hot-natured
medicines for laxative because
fats are formed out of water, and
thin people should be given coldnatured medicines. In prescriptions,
things to avoid and affects of the
medicine have to be included
depending on the disease.
Experts say traditional medicine
requires only benevolence. But
most believe that some diseases are
curable and some are incurable with
traditional medicine.
Daw Hnin Aye Nge, 65, said, I
believe in traditional medicine. But

most people dont have a chance to


meet a physician who can prescribe
suitable medicine and proper
food. And knowledge of traditional
medicine is not handed down
effectively because the younger
generation is not interested in it.
Today, medical licences are issued
only by recognised traditional medical
universities to college graduates and
diploma holders. However, it is widely
recognised that there are any number
of unlicensed illegal and so-called
traditional physicians.
The chief of Mandalay traditional
hospital admitted that there is a wide
variation in opinion about the virtues
of Western and traditional medicines.
Even traditional physicians, he says,
are aware that their craft needs to be
upgraded and depends for its success
and its future on public awareness
and support.
Translation by Kyawt Darly Lin

The first 1000 days

Mental health should


always be part of public
social welfare services

Conception to age two provides a once-in-a-lifetime window of opportunity for mother-and-child


nutrition. The Livelihoods and Food Security Trust Fund (LIFT) launched a short video in Yangon on the
importance of good nutrition in a childs first 1000 days, supporting the Scaling Up Nutrition Movement
in Myanmar. In partnership with the Department of Healths National Nutrition Centre, the video was
produced by the LIFT-funded initiative Leveraging Essential Nutrition Actions to Reduce Malnutrition
(LEARN), a consortium of Save the Children International, Helen Keller International and Action Contre La
Faim. Elizabeth Whelan, nutrition project manager at LEARN, writes about the initiative
ROM the time a mother
becomes pregnant until
her childs second birthday
is a period of time that lasts
approximately 1000 days. Globally,
these 1000 days are referred to as
a window of opportunity when
the body and brain of a child are
developing at an incredibly fast
pace and good nutrition can have
lifelong impacts. Consider all that
happens in the first 1000 days of
life: At day number one, when you
were conceived, you were invisible
to the naked eye. By around day
1000, however, you were an eating,
talking, walking two-year-old
human being. At no other time
in life does so much growth and
development happen in such a short
period of time. Fuelling this growth
is nutrition, and the better the
nutrition consumed the better the
start children will have in life.
A strong evidence base has led
to global consensus that good
nutrition makes it possible for
children to reach their full physical
and intellectual potential in life.
Children who are adequately
nourished during the first 1000
days perform better in school, more
effectively fight off disease and even
earn more money as an adult than
those who were undernourished as
children.
Data tell us that children in
Myanmar are being held back
from reaching their full potential.
The rate of stunting is 35 percent
among children under five years
old, according to the MICS survey,
which is the most recent national
nutrition survey carried out by
the government and UNICEF in
2009-2010. That means one in three
Myanmar children is malnourished,

Children who
are adequately
nourished during
the first 1000 days
perform better
in school, more
effectively fight off
disease and even
earn more money
as an adult than
those who were
undernourished as
children.
Please watch and share the
1000 Days video at www.youtube.
com/liftfundmyanmar and, if you
are a member of the media,
please share the video with a
wide audience at all levels of
society. For more information,
contact LEARN: https://
myanmar.savethechildren.net/
our-consortiums/leveragingessential-nutrition-actionsreduce-malnutrition-learn

and shorter than he or she should


be according to international growth
standards.
Although poverty is a significant
contributing factor to poor nutrition,
even children in the wealthiest
households in Myanmar are not
immune to undernutrition. Among
the poorest households in Myanmar,
one in two children is stunted; in the
wealthiest households, nearly one in
five children is stunted.
Fortunately, malnutrition is
preventable. There are steps that
families can take to ensure that
mothers and their children thrive.

Step 1: Ensure that pregnant


women consume sufficient and
diverse foods
Firstly, women who are pregnant
must be well-fed. It is hard work
for a womans body to build a
human being. If a pregnant woman
eats a diverse array of foods in
sufficient quantity, it is more likely
that she will be able to provide all
the necessary nutrients to meet
the needs of herself and her fetus.
Vitamin A, folate and iron-rich foods
are particularly important nutrients
for a pregnant woman to consume.
Unfortunately almost 9pc of
infants in Myanmar are born
underweight, weighing less than 2.5
kilograms. Maternal undernutrition
leads to growth restriction in the
womb, which is concerning given
that damage done during the first
two years is largely irreversible and
has a devastating impact on the
childs future potential, even if a
childs nutrition status improves
after the age of two.

Step 2: Encourage mothers to


practice exclusive breastfeeding

Around day 280 when a child


is born a mother continues
to share all essential nutrients
with her child but now through
breast milk. Breast milk includes
everything a child needs for the
first six months of life, including
water, nutrients, and antibodies to
prevent and fight disease. Despite
the fact that introducing food or
water to a child before six months
of age is dangerous to the health of
the child, in Myanmar the rate of
exclusive breastfeeding is low. The
rate declines over the course of six
months so that by the end of the
sixth month of life fewer than 5pc
of children are being exclusively
breastfed, according to 2010 MICS
data.

Clinical psychologist Dr Nyi Win Hman speaks to MT editor Myo


Lwin about mental health and the workplace
How important is the mental health of
individual workers to an organisation as a
whole?

Photo: Tim Mitzman/Save the Children 2015

and proper disposal of child faeces. A survey


carried out by UNICEF and the Ministry
of Health in 2011 across 24 townships
found that although nearly all infants had
been properly cleaned after defecation,
caretakers of only about one in five children
had properly disposed of the faeces into a
latrine. On top of this, only four in 10 adults
said they washed their hands with soap and
clean water before eating. This is particularly
concerning when we consider child feeding
and food preparation. Lack of hygiene is
dangerous because it can lead diarrheal
illness, which not only makes it harder to
absorb nutrients, but is also a leading cause
of mortality among children under five in the
world.

Step 3: Help breastfeeding mothers


nourish themselves and their baby
Women who are breastfeeding have
even greater nutrient requirements
than pregnant women do. The
body of a breastfeeding woman
prioritises the nutritional needs of
her infant, and so if a woman does
not consume a sufficient quantity
of diverse foods, her own body may
suffer. Of particular concern are
food restrictions, based on food
taboos which are practised among
women throughout Myanmar in the
first days or weeks after childbirth.
Although the specific food taboos
vary, many foods containing key
vitamins and minerals such as iron,
protein and vitamin A are restricted
despite the fact that a mother so
desperately needs these nutrients
after enduring childbirth.

Step 4: Caretakers introduce


appropriate complementary foods
once a child turns six months old

Elizabeth Whelan is a nutrition specialist


and the program manager with the LEARN
consortium, which partners with the LIFT
Fund on nutrition.
Photo: Valeria Turrisi/3MDG

Once a child turns six months


old, the caretaker should begin
supplementing breast milk with
complementary foods. New foods
should be introduced gradually to
feed a childs growing mind and

body. Diverse foods which contain a variety


of nutrients will make the child stronger. As a
childs teeth come in and stomach grows, the
texture and quantity of food will change over
time, so that by one year a child is eating all
the same types of food that his or her family
eats.

Step 5: Practice good hygiene behaviours


In addition to having the right food, children
need to be raised in a clean environment
where caretakers practice good hygiene
and where sanitation facilities exist. This
includes safe food storage and preparation,
consumption of clean water, hand washing
with soap and water, access to a clean latrine,

Photo: Tim Mitzman/Save the Children 2015

Photo: Tim Mitzman/Save the Children 2015

LIFT is a multi-donor fund set-up in 2009


to improve the lives and prospects of poor
and vulnerable people in rural Myanmar.
It is funded by the governments of
Australia, Denmark, the European Union,
France, Ireland, Italy, the Netherlands,
New Zealand, Sweden, Switzerland, the
United Kingdom and the United States
of America, as well as, from the private
sector, the Mitsubishi Corporation. The
Fund is managed by the United Nations
Office for Project Services (UNOPS). For
more information, please visit www.liftfund.org

To quote the WHO, The development and


implementation of workplace mental health
policy and programmes will benefit the
health of employees, increase productivity
for the company and contribute to the wellbeing of the community at large. Mental
illness and disability affects not only the
individual but also the family, community,
workplace and the nation as a whole. It
affects productivity and the economy.
The same WHO paper quoted above
describes in detail the importance of mental
health in the workplace in terms of work and
mental health; the role of government; and
putting in place a workplace mental health
policy. An Australian document, Workers
with Mental Illness: A Practical Guide for
Managers, covers the same ground.
Mental health is very important for the
workplace in order to develop and maintain
productivity, health and well-being for both
managers and workers. To mention a few
studies, one in the USA found 18.2 percent
of people had their work impaired by a
mental health disorder in the previous 30
days. Another study in Germany found 5.9pc
of work days lost were related to mental
health.

How could we test the mental status of a


potential employee before hiring?
Screening out workers with potential mental
problems before hiring is part of personnel
selection and screening performed
usually by industrial and organisational
psychologists, or the human resources
department of a workplace. But in terms
of both workers and human rights, those
workers who experience mental health
problems need services for their problems.
The documents mentioned above provide
detailed description of developing and
implementing mental health services as
part of workplace health and safety. If such
services are provided or exist then workers
mental health issues can be approached
properly.

What is the situation of mental healthcare


in Myanmar?
Even in developed countries, mental health
services and resources lag far behind
physical health services. In Myanmar, mental
health services never evolved or developed
to be in line with international standards. In
the developed world, such services are more
community service-oriented (outreach care),

rather than institution-oriented (psychiatric


hospitals). Moreover, the discipline of
psychiatry suffers from being designated as
a very low priority in comparison to other
medical specialisations. No postgraduate
study and training in psychiatry had been
implemented here for a very long time.
Hence, both knowledge, clinical skills and
practices remain sub-standard.
Health (both physical and mental)
constitute human capital. In my opinion,
mental health should always be part of
public social welfare services of a nation
and people, and not for profit, though the
private sector can exist alongside the public
sector.

What psychological associations are


working for the public health in Myanmar?
The Myanmar Psychological Association
(MPA) can provide basic counseling training
survey respondents

25%
Of 5000 workers surveyed in Australia, onequarter took stress-related leave from the
workplace annually

and services and has already organised a


few workshops. I and a few of my colleagues
conducted a two-day workshop for academic
staff on counselling when I was in Myanmar
last year. If you have not yet received a
pamphlet on the various psychological
services of the MPA, please contact its office
at 01-216861 or 216864.

Youre spending some of your time in


Australia. Tell us about the mental health
situation in workplaces there.
Preliminary research shows that Australian
businesses lose over US$6.5 billion each
year by failing to provide early intervention/
treatment for employees with mental health
conditions.A total of 3.2 days per worker
are lost each year through workplace stress.
Stress-related workers compensation claims
have doubled in recent years, costing over
$10 billion each year. A survey of over 5000
workers indicated that 25pc took time off
each year for stress-related reasons. And
work pressure accounts for around half
of all psychological injury claims, while
harassment and bullying accounts for
around one-quarter.

Where we all come from


ROUND 800 women die each
day from preventable causes
related to pregnancy and
childbirth. As the UN prepares to
phase out its millennium development goals, which included the
target of cutting maternal deaths
by 75 percent, Britains Guardian
newspaper asked readers worldwide
to share stories of maternal healthcare provision. Here are some of the
responses.

I gave birth on my wedding day. The


baby was three months early
Toyin Ojora-Saraki, Nigeria
I gave birth to twins on my
wedding day in an urban
maternity hospital in my home
country of Nigeria. The birth was
three months premature, and
midwives and doctors were present,
but there was a fatal delay in
finding an anaesthetist to enable
an emergency caesarean section
by general anaesthetic since an
epidural was neither offered nor
available.
I had been preparing for the
birth in the UK, receiving prenatal
care in London from consultants.
As it was a multiple birth, prenatal
consultants provided consistent
care in the months leading up to my
due date. However, I had to prepare
for my wedding in Nigeria and
had to travel to the country before
my due date. I was assured that
it should be fine to return home,
get married, and make it back to
London in time to give birth.
Yet on my wedding day, and
within only 24 hours, I got
married, gave birth three months
prematurely, and lost one of my
twin babies in childbirth. We were
fortunate, however, that as soon as
the emergency arose, I immediately
received two of an indicated three

steroid injections to help my babies


lungs mature faster.
I came close to death myself,
having become severely anaemic. I
had to fight to save my life and the
life of the surviving twin. In getting
through this harrowing process, my
child and I are very lucky to be here
today. The care following the birth
was diligent, but uncomfortable and
difficult due to a lack of modern
resources.
Three days after giving birth in
the hospital, I suffered from painful
engorgement and had to express my
breast milk. The nurses treating me
handed me a white plastic bucket,
without explaining what I should do.
They began pressing my breasts to
pump milk into the bucket, leading
to a lot of crying and pain on my
part.
Knowing that an experience
like mine is all-too-common for
mothers and infants around the
world is heartbreaking, but it could
have been worse, because, in fact,
14 percent of Nigerian women give
birth without anyone present. Some
of these women if they survive
suffer permanent birth injuries.
Stillbirths often go unrecorded,
let alone lead to counselling. This
is why I started the Wellbeing
Foundation Africa, which works to
improve maternal, newborn, and
child health across the continent.

Healthcare is underfunded in Poland,


but I got the care I needed
Claudia, Poland
I decided to share my story because
I was very satisfied with the care
I received in a public hospital
in eastern Europe and I thought
this might go against the usual
complaints we hear about public
healthcare in this part of the world.
At 35 weeks of pregnancy, I

Women worldwide talk about their experiences giving birth

My hope is that
every woman gets
the choice to get
the care they need.
Name withheld, Malawi
was diagnosed with pregnancy
cholestasis [a liver condition], which
meant I had to stay in hospital until
37 weeks, when a baby is considered
full term, and have an induced
labour. I received excellent care for
the almost three weeks while I was
in hospital, from a team of midwives
in Warsaw. I even got to choose a
vegan diet.
At this hospital, women in labour
are taken to newly renovated rooms,
where conditions are very good:
There is a bath, a private toilet,
birthing balls and mattresses, and
many other items to use for finding
comfort during labour. I gave birth
with the midwife on call, who was
extremely patient and discreet.
Im just happy to say that we got
this very warm, thoughtful care
at a public hospital despite health
systems in Poland and the rest of
eastern European countries being
systematically underfunded. While
I was in the hospital, I read a notice
on the wall which said that state
support for this hospital covers
about two-thirds of the cost of a
birth and that they do need support
from donations and philanthropists,
but it seems that they do manage
in the end to find the funds they
need. Or they manage somehow to
compensate with love and care.

My mother didnt see a doctor for her


entire pregnancy

Photo: Staff

Name withheld, Malawi


This is not my birthing story but my
mothers. She had my brother at age
16 and me at 18 in Malawi. My mum
never talked about her pregnancy
or childbirth experiences, and it was
only recently, on a return home to
see her, that I found out she had
given birth at home with both of
us. She was with her mother-in-law
and older sister both times, and she
was in labour for two days with my
brother. Living in the UK, my idea of
home births is very different from
my mothers experience. She didnt
see a doctor or health professional
for her entire pregnancy or labour.
There was a health clinic about
an hours drive away on public
transport, but she says she never
considered it an option. Her friends
had all given birth at home with
traditional birth attendants, and her
mother-in-law had said that going
to the clinic went against the family
tradition of women delivering in
their villages.
Things were tense with her first
labour, but luckily my brother didnt
require vital care when he finally
arrived. Mum says she felt that God
had watched over her during that
labour. She says that now women in
Malawi dont have to go through the
same thing, and it is the norm to go
to a clinic for at least one visit, even

I could have saved my first child if I


had had the chance to learn about
maternal and child health
Daw Nwe Nwe (sent via World
Vision), Myanmar
I had never heard about
antenatal and postnatal care for
mothers when I was expecting
my first three children. I did not
understand the importance of
immunisations and nutrition.
When World Vision started
working in our community, I got
to learn about the importance of
maternal and child healthcare.
I think I could have saved my
first child if I had the chance to
learn about maternal and child
healthcare earlier. Now, I always
attend maternal, child health
and nutrition awareness sessions.
I also received iron tablets.
I realised that I was not eating
properly while I was expecting
my first three children. But while
I was expecting my fourth child, I
ate nutritious foods and followed
what I had learned, so there were
no problems during delivery. I
only breastfed my daughter, until
she was six months old. She is
healthier than my other children.
Now, I promptly go to the clinic
when my children are sick. I am
afraid I might lose them like my
first child.

if you are delivering in your village.


All of my friends still in Malawi
have received all the basic care that
I would receive here in the UK, but
theyre mostly in the city. My hope is
that every woman gets the choice to
get the care they need.

The public health system is very


good in Germany
Anna, Germany
I had monthly pre-natal check-ups
up to two months before delivery,
then bi-monthly check-ups until
delivery, done by my gynaecologistobstetrician. There was a weeklong prenatal class to prepare for
the delivery, paid for by public
insurance. We hired a housekeeper
as I was too large to do the usual
share of domestic work. Also,
privately I got weekly massages,
weekly lymphatic drainages,
weekly private antenatal lessons,
bi-weekly pre-natal yoga classes,
weekly osteopathy and acupuncture
sessions, weekly prenatal pilates
and aqua fitness classes. I also saw a
personal trainer every week.
After the delivery and two nights
in hospital, we were discharged to go
home. A midwife visited every day
for 10 days after we arrived home.
We had also hired a maternity
nanny to look after the baby. A
paediatrician close to our house
checked the baby after two weeks.
For my personal antenatal care, my
insurance paid for one weekly class.

14%
Percentage of women in Nigeria
who give birth alone, with no one
else present

Privately, I attended four others.


The public health system is very
good in Germany, although we live a
comfortable life in an affluent part
of Germanys wealthiest city. Instead
of buying a new car or expensive
furniture, we paid for excellent care.

My sister-in-law gave birth in an


overcrowded refugee camp
Samantha, Kenya and Canada
My husband spent 10 years in
Daadab refugee camp in Kenya, and
his sister gave birth there. She was
one of the lucky ones who received
care at a clinic, and that saved her
life because she had to have an
emergency caesarean. Most of her
friends gave birth in their homes in
the camp, sometimes for cultural
reasons and sometimes because
they simply didnt have a choice.
The camp is so crowded, and is
growing with around 1000 births
each month apparently. Im so
grateful that my nephew survived
and is now a healthy little boy in
Tanzania, where they were able to
emigrate.
In comparison, I gave birth in
Canada with a midwife present
throughout the birth. I had weekly
check-ups and had visiting homecare for the weeks after. I always felt
safe and cared for, and knew that
if any complications arose there
would be help at hand. How is it fair
that my son had a much greater
chance of survival at birth than his
cousin?

I lost two brothers at a young age


due to no access to basic medical
facilities
Darjat, Pakistan
I was born in a mountain village 750
kilometres away from Islamabad,
Pakistan. My grandmother was there
but no health worker was present.
During the time of my birth in
1959, [we] only [had] the indigenous
knowledge of elder women, but
during my kids time, they were
provided with all the preventative
vaccines and check-ups before and
after birth in the small village, and
later in the town and city. My wife
also had access to basic check-ups
before and after deliveries. I wish we
had had basic medical facilities in
the village where I was born. I lost
two brothers at a young age due to
no access to basic medical facilities.

My baby had to be resuscitated but I


had full trust in the medical team
Lotte, Australia
We had public healthcare and it
was fabulous. Prenatal care was
uneventful and I felt informed.
When I was admitted for labour,
a midwife was with us the entire
time, even when there wasnt
much happening. She was there
unobtrusively in the background
doing paperwork if we didnt need
her, and was right there to assure,
advise and answer questions when
we did. As labour progressed,
things got complicated the babys
heart rate dropped and he had
to be brought [out] quickly with
forceps, then resuscitated but the
wonderful care we had received
up until that point meant that I
had full trust in the medical team.
I am so happy with the birth, even
though it was complicated.
The Guardian

In every state
and region
An interview with Paul Sender, 3MDG fund director
To start, tell us about 3MDG.
The Three Millennium Development
Goal Fund, or3MDG, refers to MDG
4, to reduce child deaths; MDG 5,
to improve the health of mothers;
and MDG 6, to fight communicable
diseases. Our overarching goal is to
help Myanmar develop universal
health coverage an accessible
system providing healthcare to all
citizens. We work with the Ministry
of Health and local communities,
international and local NGOS, and
UN agencies. The Fund combines the
support of Australia, Denmark, EU,
Sweden, Switzerland, the UK and the
US to increase the effectiveness and
efficiency of donor funds.

What do your funds put toward?


Myanmar suffers from high maternal
andchild mortality. At least 2400
pregnantwomen and 70,000 children
die annually thats seven women
and 191 children dying every single
day. We finance work throughout
Myanmar to deliver a continuum of
care to mothers and children which
covers essential services within the
lifetime of a child. This includes
before they are born, through
reproductive health, prenatal care
and health promotion for mothers;
after they are born, through childbirth
services, maternal antenatal care,
promotion of exclusive breastfeeding,
and providing immunizations; and
to age five, through nutritional
supplements, improved sanitation
practices like hand washing with
soap and interventions to reduce the
impact of childhood ailments that
cause preventable deaths.

What are key areas of success?


As of last year, we support essential
health services for about 3.5 million
mothers, newborns and children. Im
particularly excited by the work we do
with the Ministry of Health to ensure
training and skills are improved
using modern training techniques
across every midwifery school and
in supporting over 5000 auxiliary
midwives to be trained in nearly 200
townships over 50 percent of the
national target. Auxiliary midwives
are often the only skilled health
worker available to provide maternal
and child health services, especially in
difficult-to-reach communities.
For our work combating
communicable diseases, 6.9 million
sterile needles and syringes were
distributed to people who inject drugs
in 2014, reaching 35pc of the national
target. A total of 26,661 people who
inject drugs benefited from HIV
prevention and harm-reduction
services, reaching 107pc of 3MDGs
goal and contributing 44pc to the
annual national target. We work with
the National Tuberculosis Program
to find hidden tuberculosis cases,
helping to support, for example,
outreach work to mine workers by
mobile teams equipped with portable
X-ray units.
Health-system strengthening
is a cornerstone of our work
since a robust system is critical
for sustainable progress. We are
financing the World Bank to work

with the government to design a


health financing policy for universal
health coverage. Another milestone
is a financing agreement we now
have in place to expand Myanmars
vaccine cold chain and enable the
introduction of new vaccines to
increase child survival rates. See
www.3mdg.org for more.

Who are the main beneficiaries of


3MDGs services?
We target disadvantaged people,
often in hard-to-reach areas across
Myanmar. We fund partners
that provide HIV, TB and malaria
related services to rural and urban
slum areas across Myanmar, for
example helping populations with
diverse ethnic, religious and social
backgrounds in areas characterised
by high physical vulnerability,
including gold prospecting and
jade mining sites, industrial zones,
prisons, and migrant construction
sites. We have supported mobile
team operations to carry out health
services to impoverished, underserved
and marginalised communities living
in mountainous areas, post-conflict
areas and mobile populations with
little or no other access to health
facilities. The Fund now finances
healthcare delivery in every state and
region of Myanmar.

What are the challenges?


We see challenges as opportunities.
Myanmar has shown dramatic
changes in the political, social and
economic spheres since 3MDG
began in 2012. One challenge is to
continually adapt to ensure our
strategy and goals are aligned with
these changes. For example, the
opening of the country and the
governments increasing engagement
with international partners has
enabled collaborative work to happen
with the Ministry of Health in postconflict areas and with the most
vulnerable populations in Kayah,
Shan and Chin States. Because our
main beneficiaries are the vulnerable
groups and communities, it can be
difficult reach them logistically. We
work closely with local community
partners with a strong on-ground
presence and with the Ministry of
Health to overcome these challenges,
and are proud of the trust and
relationships that have resulted.

How important is 3MDGs work


in achieving the three stated
development goals?
3MDG is the largest development
fund specifically targeting MDGs
related to maternal, newborn and
child health. More significantly, 3MDG
is a multi-donor trust fund where the
Ministry of Health works alongside
the international donors. Our seven
donors discuss and arrive at decisions
with the Ministry of Health, which
has enabled joint work to occur in
sensitive areas like the Wa Special
Region 2 and Mongla Special Region 4,
and fostered support for the ongoing
development of work with other
highly vulnerable groups mentioned
previously.
Myo Lwin

OPINION

Elective C-sections:
too common, too risky?
KIM LOCK
AST month, the WHO warned
caesarean sections should
only be performed when
medically necessary about 10-15
percent of all births, as more often
didnt help mortality rates. Ten
years ago, C-sections in Australia
were performed 19pc of the time.
Now, that number is 32pc.
Caesarean section is major
abdominal surgery, with chance
of: infection, admission to ICU,
hysterectomy, haemorrhage or
death; scalpel lacerations to
bladders, bowels or other organs;
babies being cut; medication
misuse; longer, more painful
recovery; and more potential
for infections, surgical staples
overgrown with skin, excruciating
removal of wound drains, and more
Birth by caesarean can interfere
with breastfeeding establishment,
affect an infants gut and future
health, and increase a womans
chance of repeat caesarean,
exposing her to complications such
as placenta accreta.
What needs to be done? Leah
Hardiman, president of Maternity
Choices Australia, says, A lot of
issues would be resolved through
continuity of care with midwives
as primary carers. This has been
proven time and again through
studies and in practice.
While midwifery is based upon
seeing pregnancy and birth as normal
physiological life events, obstetric

medicine is based upon treating them


as a medical procedure. Obstetricians
are surgeons, and surgeons excel at
performing surgery. Midwives are
paid to wait for labour to unfold and
to act if necessary; obstetricians are
paid to act.
Is it any wonder, when healthy
pregnant women are predominantly

Obstetricians are
surgeons, and
surgeons excel at
performing surgery.
managed by surgeons, that rates of
surgery are high? Authorities often
cite the rising age and bodyweight
of birthing women and womens
request as the cause of increasing
caesareans. But researchers argue
where a woman lives and whether
she has private health insurance are
the most influential factors.
Women often report feeling
pressured, even bullied into surgery,
describing a conveyor-belt cascade
of intervention: An induction gel
leads to ruptured membranes,
which leads to a drip, which leads
to an epidural, which leads to
failure to progress and being told
caesarean is the only option.
Babies struggle with these

interventions; foetal distress then


requires emergency surgery. But
many routine interventions done in
supposed help of women and babies
may not be helping at all.
As they grow common, caesarean
has become normalised within our
culture, and its seriousness often
downplayed. Women are placated
with a false innocuousness of
surgery, and told not to chastise
themselves if natural birth plans
are interrupted. This reassurance
might be well-meaning, but women
are adults capable of understanding
facts and deserve to know where
they are being grossly let down.
Undoubtedly caesareans can
save lives. Skilled obstetricians are
vital to our maternity care system
and any woman who makes an
autonomous, informed decision to
elect caesarean should have the
unequivocal right to do so.
But women and care-providers
are not making choices in a vacuum.
For a long time, medicine was a
men-only sphere where womens
bodies were seen as inherently
flawed. Childbirth was considered
an undignified, frightening and
dangerous procedure. This attitude
lingers today: Out of 900 daily births
in Australia, roughly 300 are done
by caesarean, despite the WGO
estimating only 90 require surgery.
In our ongoing fight for womens
reproductive rights, reducing our
caesarean rate to reflect womens
needs should be an urgent priority.
The Guardian

10
BANGALORE

Indias street
dentists filling
gap for the poor
GNORING noisy buses and
curious onlookers, street dentist Allah Baksh plunges his
hands into a patients mouth to fit a
sparkling set of dentures for US$12
in the Indian city of Bangalore.
With his plastic stool, mirror and
glass cases of teeth on display, Mr
Baksh, 54, is among hundreds of
such dentists frowned upon by their
licensed counterparts in rapidly
modernising India.
But he insists he is providing an
essential service to 10s of millions of
poor who cannot afford a visit to a
sterilised clinic.
There are millions of poor people
in this country who cannot pay for
expensive dental treatment, Mr
Baksh told AFP in between customers at his makeshift clinic, where his
tools include a large metal file.
But they also have a right to be
treated and look good, he said as he
mixed pink gum paste with his bare
fingers on a teaspoon.
I know this is not hygienic at all,
but if I start using sophisticated
tools the poor man wont come
here.
Mr Baksh never formally trained
as a dentist. He learned his skills
from his father, who came in 1984
to the sleepy southern backwater
which has now transformed into
a regional IT hub and thriving me-

tropolis.
Alongside his younger brother,
son and nephew, Mr Baksh set up
their clinic 14 years ago outside a
bus stand. Together they make and
fit dentures for some 20 customers
a day.
A full set of teeth, moulded and
ready to fit in 30 minutes, costs
as little as 800 rupees ($12). A
single false tooth sells for 50 rupees
($0.80).
Tools are thoroughly washed in
soap and water but not disinfected.
The teeth in all shapes and sizes
are made in China and in India from
dental cement. Soft pink adhesive
is then moulded for gums and the
teeth are stuck in, with the dentists
saying their handiwork lasts for at
least four years.
India passed a law in 1948 allowing only licensed dentists to treat
patients, but the legislations vague
and outdated wording about exactly
what constitutes a dentist has allowed many unregistered ones to
operate.
In big cities such as New Delhi
and Mumbai, street dentist numbers
have dwindled in recent years on
growing awareness of contracting
HIV/AIDS and other diseases, rising
customer income levels, and a surge
in dentist graduates.

Traditional Indian dental worker Allah Baksh takes measurements for dentures from a customer at his roadside stall at KR
Market bus stand in Bangalore. Photo: AFP

They still thrive in smaller cities


as well as towns, although few
perform root canals, fillings or other
operations.
There must be thousands of

I know this is not


hygienic at all,
but if I start using
sophisticated tools
the poor man wont
come here.
Allah Baksh, street dentist

them, Ashok Dhoble, secretary


general of the Indian Dental Association, a private body of licensed
dentists, told AFP.
The oral healthcare [industry] is
in its infancy and surprisingly we
dont have even figures on qualified
dentists in India.
Mr Dhoble said 30,000 graduates
join the profession every year, but
India still has only one dentist per
10,000 people in urban areas and
about 250,000 in rural areas, according to the US National Library of
Medicine.
Mr Dhoble also rejected economics as a justification for unhygienic
care.
Ban them and they will be forced
to look for another job. We cant
have cheap treatment as an excuse
to continue this practice, he said.
In Delhis crowded old quarter,
third-generation dentist Satvinder

Singh, 48, takes a lunch break from


treating patients on the pavement.
Numerous posters advertising his
services are propped up around him,
as a multitude of vendors jostle for
space.
A few decades ago I used to get
30 customers a day. I hardly see two
now, said Mr Singh, adding a few
decades ago traders from a nearby
spice market, Asias largest, would
line up for his false silver and gold
teeth, considered a status symbol.
Earlier rich and poor would
equally visit us. But now we are
looked down on, he said.
For his part, Mr Baksh remains
adamant he is improving the lives
of the poor, and that his family will
continue the tradition.
We have thousands of satisfied
customers, who not only pay us but
give us their blessings.
AFP

Something to chew on
MYA KAY KHINE
mya.simplefly@gmail.com

ENTAL implant treatment is on the rise


in Myanmar, though remains much more
expensive than other options available
locally for replacing rotten teeth.
Tooth replacement comes in three forms
removable dentures, fixed bridges and
implants, says implant prosthodontist Dr Myat
Nyan. He founded Sakura Dental Implant
Centre in 2010, and says coverage on MRTV-

Dr Myat Nyan and (right) staff.


Photos: Supplied/Sakura Dental Implant Center

4 shortly afterward brought attention, and


patients, to his door.
Dental implants in Myanmar are not
handled in hospitals, he says, though they are
done in the University of Dental Medicine in
both Yangon and Mandalay.
Dentures and fixed bridges replacement are
not surgical procedures and all patients can
have them done. But dental implant replacement is a surgical procedure, so patients
should be in good health overall, said Dr Myat
Nyan, adding that patients with chronic illnesses such as diabetes, leukemia, un-control
hypertension or bleeding disorders may not be
good candidates for implants.
Dental implants provide several advantages
over other replacement options. With implants,
it is possible to replace a single tooth without
sacrificing the health of neighboring teeth. The
replacement is also more similar to a natural
tooth, making eating easier and talking more
comfortable. The implant may last for years or
even decades. Dental implants are firmly held
in place by titanium posts, making for a more
comfortable fit that wont disturb the surrounding teeth.
A fixed bridge is not similar to ones natural
teeth. It may take up a wide area on the gum,
so it is not always comfortable for the patient.
The implant, however, doesnt use extra materials, as it simply fills the existing space, said
Dr Myat Nyan.
Implants, he said, are also more expensive

than other replacements, however, and require


greater consultation prior to surgery, making
them more time-consuming to arrange. Healing can also take several months, and regular
consultations and follow-ups are necessary.
The surgical process lasts two hours, and
involves drilling into the jawbone and then
sewing the gums to heal. Over the next oneand-a-half to three months, the implant and
the bone are allowed to bond together to form
an anchor for the artificial tooth. A temporary tooth replacement can be worn over the
implant site until the real implant is inserted
again, which may or may not require a second

surgery, depending on how well the titanium


roots have taken hold.
Other Asian countries like Singapore and
Thailand are more expensive for general dental
treatment than Myanmar. And also the cost of
a fixed bridge there is no difference from that
of an implant. But in Myanmar, general dental
treatment is cheap, but implants cost five times
more than other options, due to the complex
process requiring expensive precision components and instruments, said Dr Myat Nyan.
Fixed bridges and removable dentures cost
between K300,000-K600,000, depending on the
dental centre.

11

How the abortion taboo is killing women


Illegal, unsupervised, unsafe, abortions happen every day in Myanmar and with society more worried about protecting
womens dignity than their health and wellbeing, women are dying as a result
CHERRY THEIN
t.cherry6@gmail.com

LEGALLY banned in the public health


sector, including hospitals and clinics, any doctor caught performing an
abortion can lose his or her licence to
practice, and even be sent to prison.
More than this, they are seen as
having defamed the prestige of the
entire profession of medicine.
Not to say that abortions arent
performed in Myanmar. Theyre just
not performed legally; theyre not
performed not safely; and most
often theyre not performed by
anyone with proper medical training.
As is the case worldwide, two
schools of thought on abortion exist here : the so-called pro-choice
camp, who believe a woman has, or
should have, the right to choose to
terminate her own pregnancy; and
the so-called pro-life camp, who believe that terminating a pregnancy is
murder in any circumstance, which a
woman must not be allowed to do.
In all countries, of course, each
camp argues from a position of public policy as well as social, cultural
and religious norms. In Myanmar, as
in other countries with strong traditional beliefs, abortion is generally
construed as not just illegal but immoral as well, due to Buddhist beliefs
which feel the taking of life is a sin.
What else traditional societies
have in common, however, is a lack
of easily available contraception and
a lack of public discourse about its
proper use, which means that unplanned pregnancies do happen, and,
as a consequence, so do abortions,
as women are left feeling they have
no other choice to make. Myanmar
culture frowns upon women pursuing greater knowledge of sex because
it goes against traditional teachings
which say sex even knowledge
about sex damages her dignity.
However, if she ends up pregnant, it
is she, not her male partner, who will
be left to deal with the burden. And
the stigmas are heavy.
Death threats can result from surprise pregnancies, even from ones
own family. As a result, some women
try to hide the growing evidence and
give birth anonymously, then either
raise or giving away the newborn.
Others seek more drastic measures.

Tools of the trade


Abortions are mostly carried out
by mid-wives or even the pregnant
women themselves. As the practice
is illegal, the tools are necessarily
improvised and therefore radically
unsafe.
The most common technique to
end a pregnancy is by breaking open
the amniotic sac. To do so, a stick is
rammed inside the vagina. Materials
range from bamboo to steel or iron;
implements range from branches
broken off trees to the ends of umbrellas. Sometimes, as an alternative,
acid is poured inside.
Whatever the method, the attempt
is to end the pregnancy the health
and welfare of the mother comes a
distant second.
Some use ma yawe yo, a branch of
a ma yawe tree which has the characteristic of expanding when wet. It

is inserted into the vagina, it absorbs


moisture and swells. The possible
consequences range from bacterial infection to physical damage to
internal organs.
Hiring such services cost between
K150,000 to K300,000 in Yangon,
depending on the experience and
expertise of the individual. While
there are no official statistics on
abortion rates, East and South Dagon
and South Okkalapa township are
said to be common places to procure
one in Yangon, with services easily
available in neighbouring Bago and
Ayeyarwady regions as well.

Unplanned results
Dr Aye Thida, consultant and obstetrician/gynecologist at Thingyan
Kyaung Hospital, told The Myanmar
Times that the general public needs
more awareness and knowledge
about family planning and reproductive health to prevent women
resorting to such desperate methods
to end an unwanted pregnancy.
There are many cases of women
determining to get an abortion
because information and health
services are hard to access, Dr Aye
Thida said.
The stigma of an unwanted
pregnancy, however, could only be
outweighed by the stigma of an attempted abortion. Those suffering
complications are reluctant to seek
assistance, even when the aftermath
proves life-threatening.
When they have induced abortion, septicaemia [blood poisoning]
is likely. But they dare not to see the
doctor or go to a clinic or hospital
because they afraid of being scolded.
Some are afraid of being arrested.
In desperate situations, a woman
may come to the hospital only when
septicemia has already infected the
kidney, affecting her ability to release
urine. Most induced abortions, Dr Aye
Thida said, lead to damaged kidneys.
Unsure about how to best take
care of themselves generally, many
women are particularly uninformed
about treatment options for the
many gynecological problems they
will face throughout their lives. Without safe space to ask questions and
trusted medical experts to ask them
too, they resort to whatever means
they can think up themselves.
Dr Aye Thida recalled a woman
who, wishing to end a pregnancy,
asked her three children to jump on
her belly 100 times. Sadly, she later
died from the internal injuries that
resulted, the pressure having damaged her uterus and intestines.
I was surprised at how she dared
take the risk. But there are many implausible induced-abortion-related
cases, Dr Aye Thida said.
She recalled another case in
which healthcare workers spoke to a
practitioner of traditional medicine
whose method of ending pregnancies
involved inserting a chicken feather
into the vagina. The man confessed
surprise at the fact that woman got
infections as a result of this procedure. I have no idea how women got
infected. I know hygienic practice I
use one feather for one client. And
I only snatch a feather when they
come and ask me to, she recalled
him saying.

We were struck dumb with disbelief, Dr Aye Thida said, not knowing
whether to blame him or burst out
laughing.
Of course, she and other experts
know such rudimentary techniques
are all too common, and are no
laughing matter. According to a 2015
United Nations Population Fund
(UNFPA) report, 200 mothers die
per 100,000 live births in Myanmar.
Of these deaths, 20 follow induced
abortions.

The abortion booms


Some women cross the border to
neighbouring countries, where
clinics display signboards advertising, in Myanmar language, artificial
insemination and abortion services
described, respectively, as putting
babies in and taking babies out.
As evidenced by the number of
patients seen at Yangon hospitals in
the aftermath of botched procedures,
however, many seek abortion procedures right at home.
While many have heard of baby
booms spikes in birth happening
nine months after a period in which
more couples than average have sex,
usually due to some period of unusual social upheaval like a holiday,
a weather event that keeps everyone
indoors or the end of a war less
commonly discussed are abortion
booms.
Hospitals in Myanmar consistently
see two annual waves of patients
arriving with complications due to
botched abortions: two months after
Valentines Day in mid-February, and
two months after Water Festival in
mid-April.
That means that, in mid-April and
mid-June, Dr Aye Thida deals with
the fallout two induced abortions
and one septic shot per day.
Such holiday periods warrant
particular targeting by campaigns
to promote contraception use, she
said. A recent targeting of pharmacies by police during Thingyan, in
which a round-up of date-rape drugs
saw legitimate contraception being
swept from the shelves as well, was
particularly wrong-headed, she said.
Using condoms is one of the
options for contraceptive practice. I
wonder why the authorities withdrew condoms during this past water
festival, she said.

Knowledge is power
Daw Nang Phyu Phyu Lin, co-chair of
Gender and Equality Network, said
another factor that needs to be addressed head-on, particularly in rural
or ethnic areas, is male chauvinism,
which keeps women from gaining
knowledge and making decisions
about their own best interests.
There are still many women kept
ignorant and uninformed, who do
not even know their own bodily functions and periodic cycles, Daw Nang
Phyu Phyu Lin said.
Traditional culture and social
norms, she said, make advocating
family planning and open discussion of reproductive health difficult.
Such topics remain taboo to discuss
with women, in spite of the fact that
women, as potential child-bearers,
are put at far greater risk than men
when undergoing sexual activity.

Most advice for women, when it


comes at all, can be reduced to a
simple word dont with girls
being taught that boys are thirsty for
sex and that its best to keep ones
distance. What to do if thats not
possible if one is in love, or, worse,
coerced or forced into sex, by a
trusted partner or an attacker isnt
made clear.
Even for married women, misinformation and peer pressure affects
childbearing and childrearing decisions. Daw Nang Phyu Phyu Lin said
rural areas especially see pressure
to keep getting pregnant until one
brings up a boy, with female children
less desirable and therefore seen as
easier to terminate.

There are many


cases of women
determining to get
an abortion because
information and
health services are
hard to access.
Dr Aye Thida

We heard a lot about this in the


fields God wants you to have child,
so dont stop. If the ultrasound
result said girl, okay, you can do an
abortion. But in some occasion no
matter boy or girl you must give birth
until you get a boy, Daw Nang Phyu
Phyu Lin said.
Women are not robots, and the
uterus is not a child-making machine. But many women are considered like birthing robots, she said.
Dr Sid Naing, a public health practitioner, told The Myanmar Times it is
essential to give contraceptive technique and health service effectively.
He said societys attempts to protect
women from sexual knowledge is
done, in most cases, with good will,
but in practicality it bring more problems. So-called protectors, namely
policy makers, religious leaders and
society, need to know more about the
lives and struggles of those they seek
to protect, he said.
The protectors are not always
next to the protected ones. It is essential to give awareness, knowledge
and capacity to them so that they
can protect themselves, and create
easy access to get safer ways, he
said, identifying the poor, the uneducated and rural residents as being
among the most vulnerable.

An ounce of prevention...
Health sector workers contacted for
this article suggested offering sex
education as part of the mainstream
education curriculum, as well as
opening youth clinics which could
offer confidential counseling, as
two of many ways to keep women
from needing, or undergoing, such
induced abortions. Combined, these

factors could help reduce the rates


of teenage pregnancy especially
particularly frightening for women,
given the stigma against pre-marital
sex and intimate relationships at a
young age.
Workers also advocate awareness
programs covering contraceptives
and family planning through government information bodies. Even
television programs which are upto-date and appropriate for todays
lifestyle could do valuable service
in spreading valuable, life-changing
information, they say.
For instance, one traditional sort of
birth control often relied upon in the
months after having a child is the
fact that, in a process called lactation
amenorrhea, women who are breastfeeding infants do not menstruate
for six months, and therefore will not
conceive during this time. However,
with busy schedules, many women
are turning to bottles to fill in the
gaps, which can affect the bodys
natural processes and renew in some
instances renew fertility. As many
women rely on the traditional belief
in breastfeeding as a way to control
pregnancy, they may put themselves
at risk of conceiving another child
unexpectedly. Doctors therefore urge
women to get a birth-control injection 45 days after childbirth, whether
or not their period has returned.
Spreading the word about these
issues would do much to prevent
unwanted pregnancies.
Lastly, health workers say, it is a
must to practise a holistic approach
to preventing unwanted pregnancies before they happen, by increasing health services and supporting
contraceptive tools and services
across the board, in every corner of
the country. A higher budget and
more qualified personal, they say, is
urgently needed in the health sector.
In 2011, the government spent 1.74
percent of its budget on health. For
the 2015-16 year, the budget stands
at K757 billion (US$757 million), still
only 3.3pc of the overall budget. As
a comparison, defence was allotted
11.1pc.
Most government hospitals, including Thingyan Kyaung where Dr
Aye Thida practises, offer information, counseling and free contraceptive techniques. But while they offer
intrauterine devices or birth control
pills, they cant afford the DepoProvera birth-control injection, which
is too costly for government hospital.
Morning-after pills are not licenced
here either, meaning that only the
ones smuggled in from India, China
or Thailand and sold under-thecounter are available.

The cost of keeping quiet


While Myanmar society generally
finds it impolite to talk about sex,
sexual organs and sexual practices,
the desire for decorum ultimately
brings far more unpleasant realities.
Demand for better options increases
daily, yet information, support and
services remain hard to access.
Whatever ones opinion on abortion,
it is clear the laws against it are not
enough to prevent women from having them nor to keep them from
being in a position where they feel
the need to seek one.

12

World health check-up


Photo: AFP

Drug-resistant typhoid epidemic in Africa


Drug-resistant typhoid has become an invisible
epidemic in Africa, scientists said May 11 after an
unprecedented probe into the disease.
In Nature Genetics, the team said sequencing
more than 1800 samples of typhoid bacteria
from 63 countries revealed a rise in a multidrug-resistant (MDR) strain, H58, which does not
respond effectively to frontline antibiotics.
They said H58 has recently acquired mutations
that blunt newer drugs and is displacing varieties
sensitive to antibiotics.
H58 likely spread from South Asia to Southeast
and western Asia then to East Africa over the past
30 years, leading to an ongoing, unrecognised
MDR epidemic within Africa.
According to the World Health Organization,
about 21 million are infected with typhoid every
year, 216,000-600,000 of whom die.
The disease is caused mainly by Salmonella typhi
bacteria in food or water contaminated with the
faeces or urine of infected people.
In many developing countries, typhoid is
controlled through drugs, and lax use of them is
helping the resistance problem.

Seasonal sickness? Blame your genes


Nearly one-quarter of our genes change activity
levels according to the season, scientists say.
In a study published in Nature Communications
on May 12, researchers analysed 22,822 genes,
and found 5136 operated at higher or lower levels
depending on the season. They believe immune
systems could be subtly affected by seasonality.
Lead scientist John Todd of the University of
Cambridge said the discovery was both really
surprising but also obvious.
It helps explain why so many diseases, from
heart disease to mental illness, are much worse in
the winter months, he said.
The team looked at blood samples and fatty
tissue provided by 16,000 people living in the
northern and southern hemisphere and in
equatorial Africa.
The difference was most marked among donors
from Iceland, where there is nearly 24 hours
of daylight in summer and nearly 24 hours of
darkness in winter.
Samples taken from people in equatorial
regions, where the seasons are less distinct,

IN PICTURES

AFP/Isaac Kasamani

showed less pronounced variations.


In samples from the west African country
Gambia, genes in immune cells in the blood were
more active during the rainy season from June to
October, when mosquito-borne diseases such as
malaria are on the rise.
Researchers believe a gene called ARNTL that
plays a part in inflammation the defensive
process that is also implicated in many autoimmune diseases is seasonally influenced
Vaccination may also be more effective in winter
than in summer.

Hand grip reveals hearts health


Testing peoples hand strength could be an easy
way to screen for risk of heart attack or stroke, The
Lancet reported May 13.
Nearly 140,000 patients aged 35-70 in 17
countries were monitored over four years. During
checkups, the patients were asked to grasp a
gadget called a Jamar dynamometer, which
measures muscle strength.
Every 5-kilogram (11-pound) decline in grip
strength was linked to a 16-percent increase in the
risk of death from any cause over four years.
The decline was also associated with a 7pc
increased risk of a heart attack and a 9pc
increased risk of a stroke.
Hand grip was found to be a better predictor of
early death than systolic blood pressure.
Age, tobacco and alcohol use, education level
and employment status were all taken into
account. There was no link, though, between grip
strength and diabetes, respiratory disease, injuries
from falls or fractures.

Daily 30 minutes exercise key to old-age health


Elderly men who do 30 minutes of physical
activity six days a week are likely to have a 40
percent lower risk of death compared to couchpotato counterparts, researchers said May 14.
The evidence comes from a major project in
Norway called the Oslo Study, in which doctors
enrolled thousands of men born between 1923
and 1932, giving health checkups and surveying
them about their lifestyle and physical activity.
Launched in 1972-3 with a first survey of nearly
15,000 men, the survey was repeated in 2000 with
the 12,700 still alive, of whom 5700 were able or
willing to continue. By 2011, deaths had reduced
this total to just under 3600.
Researchers were struck by the impact of
regular physical exercise during the 2000-2011
period, when volunteers were in their 70s or 80s.
A mortality reduction of 40 percent was
associated with a moderate use of time [30
minutes, six days a week] irrespective of whether
the activity was light or vigorous, the study said.

A 3D-printed artificial limb is assembled at the Comprehensive Rehabilitation


Services Uganda (CORSU) in Wakiso on April 24. In the past, plaster cast
sockets connecting prosthetic limbs to a persons hip took about a week to
make, and were often too uncomfortable to wear. Plastic printed ones can be
made in a day and are a closer, more comfortable fit. The scanner, laptop and
printer cost US$12,000; the materials cost $3. Recipient Jesse Ayebazibwe, 9,
was overjoyed. I felt good, like my normal leg, he said. I can do anything now
run and play football. His grandmother, Florence Akoth, 53, who carried him
the 2 kilometres to school after his leg was crushed and his life shattered, was
also thrilled.

Among those who exercised vigorously with


hard training several times a week the lifespan
was a whopping five years longer than among
those who were sedentary.
Physical activity should be targeted to the
same extent as smoking with respect to public
health prevention efforts in the elderly, they said.

Put a cap on Red Bull, espressos


Drinking the caffeine equivalent of more than four
espressos a day is harmful to health, especially for
minors and pregnant women, the EU food safety
agency said May 27.
In a study representing the first time that
the risks from caffeine from all dietary sources
have been assessed at EU level, the EFSA
recommended that an adults daily caffeine intake
remain below 400 milligrams a day.
The recommendation came at the request of
the European Commission, the EUs powerful
executive body. Regulators said the most worrying
is not espressos and lattes but Red Bull and other
energy drinks, hugely popular with the young.
The main message of the report is that
consumers must account for caffeine
consumption from sources other than coffee, an
EU spokesperson told AFP.
Caffeine intakes from all sources up to 400 mg
per day consumed throughout the day do not give
rise to safety concerns for healthy adults in the
general population, except pregnant women, the
120-page report said.
Expectant mothers should not exceed half that
amount, the agency added. For under-18s, the
limit is 3mg per kilogram of body mass.
An adolescent who drinks a coffee, a Coke,
and two or three Red Bulls every day would easily
exceed this limit, said the EFSA spokesperson,
who wished to remain anonymous.
Of all respondents, about one-third of adults
said they were regular consumers of energy
drinks, with 12 percent of those guzzling them
down four or five days a week.
Alarmingly for regulators, a whopping 68
percent of 10- to 18-year-olds were regular users
of energy drinks with 12 percent of them heavy
consumers.
Caffeine levels in energy drinks can vary greatly,
the agency said, between about 70mg per litre to
400mg.

Teen bullying leads to adult depression


Nearly one in three cases of depression among
young British adults may be traced to having been
bullied as adolescents, a study said June 2.
Researchers published figures in The BMJ journal
to back anecdotal evidence that victimised
teenagers often go on to struggle later in life.
They had trawled through the findings of a large
project in Bristol, western England, that tracked
14,500 residents since the early 1990s.
In one phase of the project, nearly 4000
participants completed a questionnaire at the age
of 13, and were assessed again five years later for
symptoms of depressive illness.
Out of 683 people who reported they had been
bullied at least once a week at the age of 13, nearly
15 percent were depressed at 18.
This was nearly triple the rate for teenagers
who had not been picked on.
When other possible causes were added to the
mix such as behavioural or mental problems or
family difficulties the statistical link with adult
depression weakened, but the rate was still twice
as high as for non-bullied peers.
Among those frequently victimised, 10pc
experienced depression symptoms for more than
two years, the study found. In the non-bullied
group, only 4pc suffered a depression lasting so
long.
As many as 30pc of depression cases identified
may have been the result of bullying, researchers
said, though the study could not show direct
cause-and-effect.
Anti-bullying programmes in schools have been
disappointing, noted the researchers.
Interventions during adolescence could help to
reduce the burden of depression later in life.
AFP

WHO chief
Margaret Chan.
Photo: AFP

World Health Organization


68th Health Assembly
Geneva, Switzerland
May 18-26, 2015
Post-antibiotic era looms
Germanys Chancellor Angela Merkel
on May 18 urged all countries to help
combat the misuse of antibiotics,
which is fuelling drug resistance and
allowing long-treatable diseases to
become killers.
What is important is to see to it
that the effectiveness of the existing
antibiotics is ensured and that we use
them for purely medicinal purposes,
she told diplomats and health experts
at the WHOs main annual conference.
Ms Merkel said Germany had
already agreed to a global plan for
addressing the growing problem of
antimicrobial resistance, drafted by
the WHO.
A WHO report in April however
revealed major gaps in all regions of
the world in addressing the problem
and reining in overuse and misuse of
antibiotics.
Without urgent action, it said, the
world could be headed for a postantibiotic era in which common
infections and minor injuries that have
long been treatable once again become
killers.

End malaria by 2030?


Countries have agreed to rid the world
of malaria almost completely over the
next 15 years, the WHO said May 21.
Diplomats gathered in Geneva
agreed to a plan to cut malaria cases
by 40 percent by 2020 and by 90pc by
2030.
The plan also calls for completely
eliminating malaria in at least 35 new
countries over the next 15 years.
Pedro Alonso, head of the WHOs
Global Malaria Programme, called the
targets ambitious but achievable and
said they would bring us very close to
eradication.
He insisted the targets were, if anything,
edging on the conservative side.
About 200 million people are
infected with malaria each year,
with around 600,000 dying from the
mosquito-borne disease. Children
under five account for at least threequarters of those deaths.
Africa where 50pc of households
have no access to insecticide-treated
nets, and 60pc of malaria cases go
undiagnosed and untreated accounts
for 90pc of the worlds malaria deaths.

Some 30 nations have dangerously


weak health systems: WHO
About 30 countries have health
systems as dangerously weak as the
ones that allowed Ebola to ravage
Guinea, Liberia and Sierra Leone, the
WHO has warned.
We must reverse the trend in global
health where we wait for the fire to
flare up, run to put it out but then
forget to fireproof the building, said
senior official Ruediger Krech.
At least 28 other countries
worldwide, mainly in Africa, but also in
Asia and Latin America, had similarly
weak systems, he said, and ouring in
money will not fix the problem, as
corruption is rife in many countries.
AFP