Providing Care, Giving Hope

A Look at One Clinic Filling the Healthcare Gap in Karen State

Saw Thay Duh Gay arrived at the Jungle School of Medicine-Kawthoolei (JSMK) thinking he was coming to have his leg amputated. Two days earlier, while working on a chainsaw crew, his leg had been broken under a falling tree. It was broken in two places with one bone fragment floating. A large wound over the fracture was too swollen to close (pictured above). Infection was a serious concern. These were prime conditions for amputation and medics from a local clinic referred him out with that prognosis. However, the JSMK staff, who provide medical care to 12 villages in the area, thought it might be possible to save his leg. In a fully equipped hospital, the surgery would use a fixation device to hold the bones in place while they healed for several months. This wasnt available at JSMK; instead, under anesthesia, the team manually cleaned, trimmed and realigned the bones, thoroughly washed the wound, and started to sew the edges of the wound together. Over the next week as the swelling improved, the sutures holding the open wound were daily cinched up, bringing the edges of the wound together until it was completely closed over the bone. With antibiotic treatment for infection and complete immobilization of the leg, the patient showed great improvement and amputation seemed no longer necessary. After several weeks at JSMK, Saw Thay Duh Gay walked home.

Saw Thay Duh Gays story is just one of many in Karen State, where things like remote locations and poverty make for a challenging healthcare situation. Sometimes, there is no medical care within a reasonable and affordable distance for villagers daily lives. Sometimes fighting between armed groups or attacks from the Burma Army push villagers deeper into the jungle to hide, far away from medical care. Other times, government healthcare is physically accessible, but high costs and discrimination against ethnic minorities dissuade villagers from seeking care.

This healthcare gap can be found in all the ethnic states where villagers face similar challenges and includes not only acute care needs but public health as well. For example, of the 16 other health facilities in the JSMK area, JSMK is the only one implementing a routine vaccine program. With measles and polio outbreaks in Karen State throughout 2019, the 600 kids from the JSMK vaccine program were the only ones in the area protected from the diseases. Previously, a cholera outbreak in southern Karen State and a measles outbreak in Nagaland claimed many lives and showed just how life-threatening this gap can be.

The exact scope of the problem is difficult to determine, as accurate facts and statistics about healthcare in Burma are challenging to obtain. Most available numbers reflect the population of central Burma and not the ethnic areas, where both outside aid and general access are either tightly controlled or explicitly forbidden by the central government. JSMK is just one clinic working to bridge the healthcare gap in Karen State and, for villagers like Saw Thay Duh Gay, it is one clinic that makes all the difference.