Mae Tao Clinic has many partners that it works with to ensure the best possible treatment, education, psychosocial and community based care for its patients and clients.
Burma Children Medical Fund (BCMF)
The Burma Children’s Medical Fund (BCMF) was founded in response to the increasing number of patients presenting at MTC who required surgery that the clinic could not provide. Often, the only chance these patients have to undergo surgery is to be referred to a hospital in Chiang Mai. Before BCMF was set up, patients who required surgery only had their symptoms treated at MTC and lived severely incapacitated lives or died prematurely as a result. The aim of BCMF is to give these patients the chance of a healthy life by funding their medical treatment and providing social support. While the treatment of children is BCMF’s priority, we cannot ignore the need for treatment we see in adult patients presenting at the clinic. We also believe that if young adults who have treatable conditions aren’t given a chance, there will be no one to look after their children. As such, we have also established the Burma Adult Medical Fund (BAMF) to treat special adult cases who will respond well to surgery or treatment.
Since 2006, BCMF has helped over 400 patients (completed cases) and each year we find our caseload increasing. We continue to see many patients from all over Burma and we aim to continue treating as many as possible. It is worth noting that many Thai hospitals and large international organisations have referred patients to BCMF for case management, some cases needing full funding not available from other donors. BCMF has worked hard at building a unique relationship with the relevant Thai authorities and stands alone in its ability to facilitate the movement of patients between Mae Sot and Chiang Mai for treatment.
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Burmese Relief Centre (BRC)
The Burmese Relief Centre (BRC) is a partnership that spans the history of the clinic. BRC was set up, in a similar fashion to MTC, as a response to the thousands of Burmese students who had fled the crackdown on the 1988 nationwide democracy uprising and were staying in camps all along the Thai-Burma border. BRC began to collect and distribute food, medicine and clothing to the refugees along the border. BRC staff recall, “My first memory of the clinic is of a dingy wooden shack with rows of Burmese students in longyis lying on the floor with intravenous drips in their arms”. BRC was the first organisation to provide ongoing grants to MTC in 1994, which were used for monthly operating costs. BRC also assisted in setting up the financial and administration system for the clinic, for which they collaborated with Planet Care. BRC and InterPares set up an exchange with the Philippines (psychosocial, health and human rights, reproductive rights) and Guatemala (women’s change). BRC provided crucial assistance in building the advocacy capabilities of the clinic – which are now a cornerstone of the clinic’s works.
BRC also supported the first clinical internship programme in 2002. Their view was that MTC could not solve the health problems on the border alone, and the ethnic health workers needed to be trained and empowered to work inside Burma. This internship programme continues today, with a high demand for seats in the course. Dr Chris Beyer and team conducted the first external evaluation of the clinic, which was facilitated by BRC. They looked at clinic capacity, public health needs, pharmacy system, and clinic protocols.
While BRC has supported the physical needs of many refugees through the years, they were instrumental in fostering the community based organisations activities. They have played an important role in advocacy and community building activities. BRC promotes the development of civil society organisations that will provide the foundation of a democratic future in Burma.
Brackett Refugee Education Fund
Although the Brackett Refugee Education Fund (Brackett) was founded in 1997, the staff had been personally involved in the clinic since January 1992. For example, Brackett produced the first annual report of the clinic in 1995, and provided English language and computer training for staff. One Brackett staff member recalls, “At that time, it was a very small, poor place”. After Brackett was founded, they started the school for Dr Cynthia’s children and children of the staff. Brackett is understandably proud of this accomplishment – the original school has evolved to be the CDC today, with over 1,000 students, from kindergarten through to Grade 12. Today, Brackett continues to provide support for schools, medics, scholarships and other areas of need for the internally displaced populations in Burma.
Planet Care – Global Health and Access Programme – Foundation for the People of Burma
MTC has continued to strike a balance for many years between receiving assistance from outside and maintaining itself as a sustainable independent community managed organisation. One of the first outside supporters of the clinic was Ben Brown, who found Dr Cynthia with the help of a map sketched on a napkin in 1989. Staff recall, “He helped Dr Cynthia who had recently fled Burma herself, treat sick villagers in a small wooden building with dirt floors, without medical books or diagnostic tools except a thermometer, a blood pressure cuff and a stethoscope. With a small cadre of refugee medics Ben went on mobile missions into border villages cut off from access to medical care by the war. Ben continued to go back to Mae Tao Clinic twice each year, bringing supplies and teaching valuable skills.”
Bob Condon was motivated by Ben’s involvement and commitment and got involved himself. He raised money for the clinic and recalls, “Thanks to many generous people there was enough money to pay for the make-shift lab in an old two-story barn in Mae Sot”.
For many years, Planet Care worked side by side with Global Health and Access Programme (GHAP). Planet Care brought medical teams of doctors and nurses who travelled along with medics to civil clinics, and conducted training for medics. Planet Care provided the first international volunteer administrator. This was the first time that international volunteers with critical skill sets were identified and supported by a stipend so that they could stay for long periods of time. In 2006, GHAP and Planet Care merged, and continue to work today as an important partner of the clinic.
In 2011, GHAP merged with and was renamed as Foundation for the People of Burma (FPB), and remains an important partner.
Karen Department of Health and Welfare (KDHW)
The KDHW provides relief inside Burma during conflict or disasters. It has worked in partnership with MTC since 1992, when the first midwife training was conducted in Ah Zin Village at Paw Taw Moo Hospital.
KDHW has been a key partner of MTC in supporting IDP populations inside Burma. In 1996, MTC and KDHW organised the first Health Information Management Seminar in the Karen state. This seminar covered service delivery methods, establishing standards of care, and fostering community participation. KDHW invited community-based organisations and INGOs to coordinate health programmes in Karen State.
Burma Medical Association (BMA)
Founded in the Karen State, Burma in June 1991 by a group of medical professionals led by Dr H. M. Singh, the National Coalition Government of the Union of Burma took the initiative to coordinate and join forces across ethnic groups to create the association. BMA coordinates public health policies and the promotion of health care among refugees, migrants and IDPs from Burma. Since its inception, BMA has provided medical and first aid training to community health workers and mobile medical teams on diverse topics like reproductive health, HIV prevention, and has provide health education materials in different languages.
In 2000, Dr Cynthia became Chairperson of the BMA, which formalised her and MTC’s role as a mentor and technical advisor to the group, providing training and technical assistance. BMA has been the key partner in an innovative pilot programme in the border area, the Mobile Obstetric Maternal Health Workers Project (MOM). The project involves collaboration between John Hopkins Centre for Public Health and Human Rights (USA), Mae Tao Clinic, Global Health Access Program (USA), and local Burmese Health Organisations. The goals of the project include improving access to essential maternal health interventions among vulnerable communities in eastern Burma, capacity building, delivering evidence-based maternal and newborn health care and providing information to inform service delivery strategies in similar settings.
These days, BMA is supporting over 30 clinics inside Burma, serving approximately 200,000 people across six states. BMA serves eight different ethnic areas in Burma spanning the Thai, Indian and Chinese borders.
Mae Sot Hospital (MSH)
Throughout its first few years, MTC worked in collaboration with MSH treating minor wounds and malaria cases. Over the last 20 years, MSH has continued to provide invaluable support to the clinic by not only providing medical treatment and standardised records, but also training staff, donating supplies, and aiding with laboratory quality control.
The medical referral programme that started in 1989 was initiated and supported by Father Manat Supalak and local Catholic Church organisations. The referral programme included patient transfer and food support. The most common referrals in the beginning were severe malaria cases that required transfusions. Today, MTC is able to treat malaria cases, although if the patients progress to renal failure they are referred. These days, there are still approximately 60 patient referral admissions per month that go to MSH for a variety of treatments, including some surgical procedures and caesarean delivery. For each of those patients, there can be up to twenty hospital visits, so the referral staff and Mae Sot Hospital can be very busy!
MSH has helped with the development and necessary training of staff, and, in the past, assisted with our blood donation screening, and even provided blood if the clinic did not have enough. MSH has also helped facilitate the ordering of equipment and supplies through medical companies in Bangkok, as the clinic originally did not have the capacity to do this on its own.
MTC has been working with MSH since 2001 in the Perinatal HIV Prevention Project. This subsequently developed into the Preventing Mother to Child Transmission Programme (PMTCT) at the conclusion of the trial. As part of this programme, the clinic conducts HIV counselling and testing, and if the mother tests positive, she delivers her baby at MSH, with all appropriate medication for transmission prevention supplied. Both health facilities also work together on the Post-Abortion Care Quality Improvement Project, in coordination with Darwin University, Australia.
Dr Cynthia sees the relationship between Mae Tao Clinic and Mae Sot Hospital as a paradigm, “This is a model for how a migrant or vulnerable population can be supported. This is the example of the relationship that should exist between the government and CBOs. It improves coordination and access to health care service”. Dr Cynthia hopes that the international community will learn from this example and that health practitioners are able to glean a better understanding of the role of CBOs and how to work effectively with them.
Back Pack Health Worker Team (BPHWT)
The Back Pack Health Worker Team began in 1998 with 32 teams in the Karenni, Karen and Mon areas. Today, there are 80 teams that have expanded their territory, reaching into Arakan, Chin and Shan areas. In the Shan areas, there are Lahu, Pao and Shan teams. These teams each have two to ﬁve members, and overall, serve about 160,000 people displaced by civil war in Burma. Back Pack Teams, laden with 100 kilograms of supplies, often walk more than 1,000 kilometres to deliver health care in ethnic conﬂict areas.
The focus of the Back Pack model has been to train local people in primary health care and some specialties so they can serve their own communities. Typically, Back Pack Teams visit Mae Sot every six months where they re-supply and attend training. Each team then shoulders another 100 kilograms of provisions and heads back over the border, travelling mostly on foot through mountainous jungle terrain.
Their destinations are the rural and ethnic armed conflict areas where medical care is scarce or non-existent. The teams provide a range of medical care along with community health education and prevention, and maternal and child healthcare services.
Karen Women’s Organisation (KWO)
After the December 1996 attacks in Dooplaya and February 1997 attacks in Hway Kaloke, KWO stepped in to support the affected women and children. MTC has been working in partnership with KWO ever since, initially on emergency relief and later, to set up community projects. KWO has set up libraries, nursery schools and income generation projects in the refugee and IDP camps. Starting in 1999, KWO worked together with MTC to write funding proposals and to build the capacity of both organisations. Over the years, KWO has worked alongside MTC to further advocacy and community development. These days, MTC and KWO work together on programmes for Traditional Birth Attendants, Maternal Health, Adolescent Reproductive Health, and Child Protection.
Karenni Nationalities Health Worker Organisation
MTC has support the organisation’s activities by setting up clinics in the Karenni State and providing both medical and administrative training to staff. Staff exchanges were carried out to facilitate knowledge transfer across the organisations. In 2008, they underwent prosthetic training at MTC, and are now able to produce their own prosthetics.
Shan Health Committee (SHC)
After the massive forced relocation of over 300,000 Shan people in 1998, the Shan Health Committee established the Tin Tad Clinic on the Thai side of the border, which still operates today in Fang. MTC helped to establish this clinic, which is now being recognised by the Thai Ministry of Health as a model clinic for migrant workers in Thailand. MTC also performed several exchanges similar to those done with the Karenni Nationalities Health Worker Organization, in which SHC sent their medics to MTC to gain practical experience. The partnership has extended in recent times, seeing the creation of a prosthetic workshop and laboratory trainings.
Adolescent Reproductive Health Network (ARHN)
ARHN is a network of organisations that includes Karen Women’s Organisation, Social Action for Women, Palaung Women’s Organisation, Karen Youth Organisation, and the Burmese Women’s Union, among others.
ARHN provides culturally appropriate reproductive health information and education to adolescents by working with schools and communities, reaching both students and the target population. This approach provides the opportunity to discuss gender equity, youth participation, peer support networks, family planning, self-esteem, and raising awareness on issues such as unsafe abortion.