Molly McCoy
Introduction
When health care systems deteriorate in times of war, innovative heath care delivery strategies must be initiated in order to maintain medical care access for civilians. Stabilizing medical care facilities becomes more challenging when population displacement is inevitable.(1-3) The civil unrest in Burma exemplifies the need for critical attention to internally displaced populations (IDP), who likely have nowhere to safely go for adequate medical care.(1-4) Of particular concern is maternal and child health and delivering obstetric care to the internally displaced populations.
The focus of my analysis will be on the method of care delivery provided by the Mobile Obstetric Maternal Health Workers (MOM) Project. This initiative claimed to reduce infant mortality and increase access to medical care for women who had been displaced from their homes or who could not safely seek medical care.(1,5) This model could be successful as an alternative route of care delivery to reach other internally displaced populations in conflict zones.
Background
The military Junta officially took power in 1988. Democratic elections took place in 1990, but after their loss to Aung San Suu Kyi of the National League for Democracy, the military rulers still refused to relinquish power. By 2004, there were an estimated 526,000 IDPs in eastern Burma; and more than 240 villages had been destroyed, forcibly displaced, or abandoned in the previous two years.(6) Humanitarian access to IDPs continues to be problematic due to non-acknowledgment of an IDP problem from the government and ongoing conflict, making it difficult to obtain accurate statistics, as well as to deliver adequate medical care.(4,7-9)
High rates of maternal and infant mortality have been reported as compared to other nearby developing nations such as Thailand and Malaysia.(10,11) In 2006, the World Health Organization reported a maternal mortality rate of 360/100,000 live births and UNICEF reported an infant mortality rate of 74/1,000 live births.(11,12) It has been documented that 51% of infant mortality in Burma is due to Asphyxia and Sepsis, two avoidable complications with appropriate obstetric care.(13)
Health Care Delivery: Challenges
Today, there is essentially no access to governmental and international nongovernmental sources of healthcare within the conflict regions of Burma; where it does exist, healthcare spending by the State Peace and Development Council is extremely low.(7,9) Displacement and living in zones of conflict make traditional modes of healthcare delivery, such hospitals and clinics, ineffective due to lack of safety, transportation, and education about when and where to seek care.(1,2,5) Innovative health care delivery systems should be implemented to increase the level of medical care accessibility.
International aid groups throughout the world have traditionally focused on a facilities-based health systems approach.(10,14) This approach is practical in creating a comprehensive system in which multiple levels of care, necessary supplies, and many treatment protocols can be offered to patients in one place. However, because of the frequent uprooting of families in Burma, offering access to healthcare from a centralized, stationary facility is not feasible. Permanent-structure health facilities would be vulnerable to military attack—since 1998, 11/33 clinics were forced to relocate, five of which between October 2006-April 2007 according to the Karen Department of Health and Welfare.(1) Health-workers have noted that one major obstacle to delivering medical care in Burma is locating people who need medical attention.(5) With these challenges in mind, the alternative strategy of a floating health services network was considered.
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