Karen State, Burma (Myanmar) has been an area of heavy conflict for over 70 years. When most people look at areas of conflicts, they look at combat deaths, injuries or other trauma-related issues. However, the more serious issues are ancillary to combat—because of a war or other type of civil unrest, you have a severe lack of primary and preventative healthcare. From there, you have a myriad of medical issues that could have otherwise been easily treatable or even preventable in the first place.
Dr. Jack Chamberlain has been working in Burma for 15 years now, instrumentally involved in building a system of healthcare along with the Karen people, as they have survived seven decades of war and finally found themselves in a cease-fire. The difficulties of accessing reliable (or any) healthcare have made it so the child mortality rate is three times higher than the rest of the country, and the maternity mortality ratio (number of women dying in childbirth) is “more than 50 times than the U.S.”
According the World Health Organization (WHO), pneumonia “accounts for 16% of all deaths of children under five years old.” In 2015, pneumonia alone killed 920,136 children across the globe, and this remains a serious problem in rural areas of Burma as well. But Dr. Chamberlain says that “most of those cases are easily treated with antibiotics, they just need the access and someone who knows what they’re doing to provide it.”
However, just relying on foreign aid workers is putting a bandage on a problem that needs a more permanent fix. They need infrastructure, training and funding. Dr. Chamberlain, along with local healthcare leaders, have started a new program that aims to do just that: the first of its kind, called the Earth Mission Asia Physician Assistant Training Program (EMA PA Training Program). It is a five-year program focused on developing Karen healthcare professionals and building a system that will hopefully last long beyond Dr. Chamberlain and any of his current staff.
The first year of this program isn’t in Burma at all, rather, it’s in the neighboring and welcoming country of Thailand. There, they learn a number of things to include a solid understanding of English. “There’s a lot more simple medicine written in English and available online, if you just know the language,” Dr. Chamberlain said, “and it also enables them to email willing consultants back in the U.S. or other English-speaking countries if need be.” They also must learn simple math and basic science. They are in Thailand legally and travel there under student visas.
They then travel back to Burma and study at the “Ther Ray-Dau Pae” clinic for their 2nd-4th years. While the clinic has not yet been turned into a full-blown hospital, it gives the students hands-on experience under the watchful eye of experienced Karen medical practitioners licensed with the government.
The fifth and final year is a kind of “internship” where the would-be Karen PAs explore certain areas of interest, such as midwifery, pediatrics, public health, trauma or more.
There is a new class every year, and the first class is currently on their third year, conducting clinical rotations at Ther Ray-Dau Pae clinic. As with any new program, the system will likely evolve as time goes on. As PAs, they will not be the same as PAs from the U.S., but will be focusing on things that they will commonly see in those more rural areas of the Burmese jungle. After they graduate, they owe five years of service to the Karen people as healthcare professionals.
All of this is possible under the cease-fire between the Karen and the Burmese government, and it’s under those shakey agreements that finally allow for education and health to make these kinds of strides. Dr. Chamberlain says that they are all constantly hoping that the agreement holds or even progresses.
The Karen leaders have called this an “internship period” since no one is really sure what’s going to happen, as a cease-fire is not the same as a peace treaty. No one knows whether or not the situation will devolve back to violence, stay in the purgatory-like state of cease-fire, or hopefully, one day, land an official peace agreement.
“Another interesting detail,” Dr. Chamberlain added, “when you start getting to the details of “what do you include in peace talks? You include ideas of convergence. For example, if you have Karen midwives, you have to figure out whether or not they meet the standards of the Burmese government. Are they held accountable to Burmese standards in Karen territory? Or visa versa? What governing authority manages those standards across the board? There’s just a lot of unknown territory here we need to navigate.”
Images provided by Dr. Chamberlain.