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Brown GR, Blue ZZN. PAs in Myanmar: Courage and humanitarianism required. JAAPA 2022; 35:58-60. [PMID: 36412943 DOI: 10.1097/01.jaa.0000892748.12231.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT Myanmar might be the most recent country to graduate its first class of physician assistants (PAs). The country has a history of medics serving in underserved areas, but graduated its first six PAs in 2020, after a 5-year training program. These clinicians will care for a largely rural population, who live in areas of unreliable infrastructure and security. The PA profession in Myanmar aims to reduce maternal mortality, graduate 75 PAs by 2029, and improve access to healthcare in remote regions.
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Affiliation(s)
- Gina R Brown
- Gina R. Brown is an associate professor in the PA program at Wichita (Kans.) State University. Zu Zae Nar Blue practices at the K. Mu Clinic in Myanmar. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Décobert A, Traill T, Thura S, Richards A. How political engineering can make health a bridge to peace: lessons from a Primary Health Care Project in Myanmar's border areas. BMJ Glob Health 2022; 7:bmjgh-2021-007734. [PMID: 36210071 PMCID: PMC9535148 DOI: 10.1136/bmjgh-2021-007734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/03/2022] [Indexed: 11/20/2022] Open
Abstract
This case study analyses a health project that focused on peacebuilding in addition to service provision, and the impacts of this dual focus in contested territories of Southeast Myanmar. The Swiss-funded Primary Health Care Project provided equal funds to both ‘sides’ in a decades-long conflict, and brought people together in ways designed to build trust. The case study demonstrates that health can play a valuable role in peace formation, if relationships are engineered in a politically sensitive way, at the right time. Whereas much of the literature on ‘health as a bridge to peace’ focuses on the apolitical in health, here the explicitly political approach and the deliberate adoption of neutrality as a tool for engaging with different parties were what enabled health to contribute to peace, using a political window of opportunity created by ceasefires and the beginnings of democratic transition in Myanmar. We argue that this approach was essential for health to contribute to bottom-up processes of peace formation—though the scope of the gains is necessarily limited. Crises like the COVID-19 pandemic and military coup in Myanmar can undermine the resilience and limit the impacts of such endeavours, yet there is reason to be hopeful about the small but significant contributions that can be made to peace through politically sensitive health projects.
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Affiliation(s)
- Anne Décobert
- School of Social and Political Studies, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tom Traill
- Policy and Research, Community Partners International, Yangon, Myanmar
| | - Si Thura
- Executive Director, Community Partners International, Yangon, Myanmar
| | - Adam Richards
- Global Health, The George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
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Lenderts JL, Hoffman SJ, Stitch J. The Role of Culture in Shaping Health Perceptions and Behaviors of Resettled Karen Refugees. J Transcult Nurs 2020; 32:145-152. [PMID: 32037976 DOI: 10.1177/1043659620902836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: While the many health vulnerabilities and challenges experienced by refugees have been previously documented, few studies have addressed the strengths-focused response strategies that women refugees, in particular, engage to navigate health systems and experiences associated with displacement. Our study attempts to document this among members of one group, the Karen, who represent a significant proportion of refugees resettled in the United States over the past decade. The purpose of this study was to explore how a sample of resettled Karen refugee women construct meaning around health, particularly in the context of cultural values, community, and migration. Methodology: This research took place in a series of ethnographic case studies documenting experiences of resilience, identity construction, and mothering among Karen refugee women from Burma. Data were collected through participant interviews with 12 Karen refugee women living in the United States. Interviews were transcribed, coded, and analyzed to identify themes relating to culturally influenced and newly emerging perceptions of health, identity, motherhood, and migration. Results: Participants identified correlates of doing, such as the ability to work and physical energy, as positively related to health, while the inability to do things was negatively related to health. Personal health also encompassed the health of family and community. Discussion: Women in this sample drew on broad, culturally informed ways of being to explain their health experiences. Implications of these findings are presented regarding how organizations and health providers can approach their work with refugees in culturally informed and relevant ways.
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Affiliation(s)
| | - Sarah J Hoffman
- University of Minnesota School of Nursing, Minneapolis, MN, USA
| | - Jaci Stitch
- University of Minnesota School of Nursing, Minneapolis, MN, USA
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Martin SJ, Rowe KS, Hser N, Htoo HE, Khin R, Smith KA, Arnold RW. Compared Near-Vision Testing With the Nintendo 3DS PDI Check Game on the Thai-Burma Border. Asia Pac J Ophthalmol (Phila) 2019; 8:330-334. [PMID: 31385820 PMCID: PMC6727928 DOI: 10.1097/apo.0000000000000251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 06/03/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND A near vision game has been developed for the autostereoscopic screen of the Nintendo 3DS console. Ease of use and time for testing by non-English-speaking patients was not known. METHODS Adult and pediatric patients in a remote Burma clinic were compared with US military staff with each performing conventional near acuity, Stereo Fly, and Ishihara color in addition to PDI Check game, so results could be correlated and timed. RESULTS Seventeen Burma adults (aged 19-58), 20 Burma children (aged 7-15), and 14 US military staff (aged 21-36) completed the testing. Conventional testing correlated with PDI Check for stereo (P < 0.001), acuity oculo dexter (P < 0.01), acuity oculo sinister (P < 0.01). For visual acuity and stereopsis, the intraclass coefficient was 0.55 [95% confidence interval (CI) 0.28-0.72] and 0.62 (95% CI 0.41-0.77) respectively, but with few color deficient cases color was 0.30 (95% CI -0.05 to 0.60). The time in seconds to complete near vision testing with PDI Check (172 ± 27, overall; 198 ± 34, Burma; 99 ± 20, military) was significantly (25% ± 18%) briefer than conventional testing (226 ± 31, overall; 270 ± 34, Burma; 126 ± 20, military). The Burma patients took significantly longer than the military staff (234 ± 25 vs 112 ± 14, P < 0.01). Time for Burma children did not differ from Burma adults for PDI (109 ± 47 vs 217 ± 54, P = 0.42) and for conventional testing (266 ± 51 vs 275 ± 52, P = 0.80). CONCLUSIONS Non-English-speaking Burma children and adults were able to reliably perform 3 types of near vision testing with a Nintendo 3DS game 25% quicker than the 2 to 3 minutes for conventional methods. They were slower than experienced US military staff adults.
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Affiliation(s)
| | - Kayla S. Rowe
- Alaska Blind Child Discovery, Alaska Children's EYE & Strabismus, Anchorage, AK
| | - Nay Hser
- Jungle School of Medicine Kawthoolei, The Free Burma Rangers, Karen State, Burma
| | - Hser Eh Htoo
- Jungle School of Medicine Kawthoolei, The Free Burma Rangers, Karen State, Burma
| | - Ray Khin
- Jungle School of Medicine Kawthoolei, The Free Burma Rangers, Karen State, Burma
| | - Kyle A. Smith
- Alaska Blind Child Discovery, Alaska Children's EYE & Strabismus, Anchorage, AK
| | - Robert W. Arnold
- Alaska Blind Child Discovery, Alaska Children's EYE & Strabismus, Anchorage, AK
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Purkey E, Htoo SN, Whelan R, Mhote NPP, Davison CM. Creating a locally driven research agenda for the ethnic minorities of Eastern Myanmar. Health Res Policy Syst 2019; 17:64. [PMID: 31242918 PMCID: PMC6595672 DOI: 10.1186/s12961-019-0465-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research funding and production is inequitably distributed internationally, with emphasis placed on the priorities of funders and international partners. Research capacity development, along with agenda-setting for research priorities can create agency and self-sufficiency and should be inclusive of all relevant stakeholders. Myanmar is a fragile state, where decades of conflict have created a weakened healthcare system and health research sector. The population of Eastern Myanmar have long had their healthcare needs met by community-based organisations and ethnic health organisations operating within Eastern Myanmar and the adjoining Thai-Myanmar border. Despite a transition to civilian rule, the current context does not allow for a truly participatory health research capacity development and agenda-setting exercise between the health leaders of Eastern Myanmar and the government in Yangon. In this context, and with a desire to enhance the capacity, legitimacy and agency of their organisations, the health leaders of Eastern Myanmar are seeking to develop their own health research capacity and to take control of their own research agenda. METHODS Approximately 60 participants from 15 organisations attended a 3-day forum with the goals of (1) developing research capacity and interest through a research conference and methods workshop; (2) using a nominal group technique (NGT) to develop a locally driven research agenda; and (3) supporting the development of local research projects through ongoing funding and mentorship. RESULTS Participants were actively engaged in the workshops and NGT. Participants identified a broad range of health issues as priorities and were able to develop consensus around a list of 15 top priorities for the populations they serve. Despite availability of ongoing support, participants did not pursue the opportunity to engage in their own research projects emerging from this forum. CONCLUSIONS The NGT was an effective way to achieve engagement and consensus around research priorities between a group of healthcare providers, researchers and policy-makers from a variety of ethnic groups. More active involvement of senior leadership must happen before the energy harnessed at such a forum can be implemented in ongoing research capacity development.
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Affiliation(s)
- Eva Purkey
- Department of Family Medicine, Queen's University, 220 Bagot street, Kingston, Ontario, K7L 3G2, Canada.
| | - Saw Nay Htoo
- Burma Medical Association, PO Box 156, Mae Sot, Tak, 63110, Thailand
| | - Rachel Whelan
- Community Partners International, 81 University Avenue Road, Shwe Taung Gyar Ward (1), Bahan Township, Yangon, Myanmar
| | - Naw Pue Pue Mhote
- Burma Medical Association, PO Box 156, Mae Sot, Tak, 63110, Thailand
| | - Colleen M Davison
- Department of Public Health Sciences, Faculty of Health Sciences, Queen's University, Carruthers Hall, 62 Fifth Field Company Lane, Kingston, Ontario, K7L 3N6, Canada
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Cha J, Surkan PJ, Kim J, Yoon IA, Robinson C, Cardozo BL, Lee H. Human Rights as Political Determinants of Health: A Retrospective Study of North Korean Refugees. Am J Prev Med 2018; 55:271-279. [PMID: 29934018 PMCID: PMC6257994 DOI: 10.1016/j.amepre.2018.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/07/2018] [Accepted: 04/02/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The gravity, scale, and nature of human rights violations are severe in North Korea. Little is known about the mental health consequences of the lifelong exposures to these violations. METHODS In 2014-2015, a retrospective study was conducted among 383 North Korean refugees in South Korea using respondent-driven sampling to access this hidden population. This study collected information on the full range of political and economic rights violations and measured post-traumatic stress disorder, anxiety and depression symptoms, and social functioning by standard instruments. Multivariate regression analysis was performed with the adjustment of political, economic, and demographic variables in 2016-2017. RESULTS The results indicate elevated symptoms of anxiety (60.1%, 95% CI=54.3%, 65.7%), depression (56.3%, 95% CI=50.8%, 61.9%), and post-traumatic stress disorder (22.8%, 95% CI=18.6%, 27.4%), which are significantly associated with exposures to political rights violations (ten to 19 items versus non-exposure: anxiety AOR=16.78, p<0.001, depression AOR=12.52, p<0.001, post-traumatic stress disorder AOR=16.71, p<0.05), and economic rights violations (seven to 13 items versus non-exposure: anxiety AOR=5.68, p<0.001, depression AOR=4.23, p<0.01, post-traumatic stress disorder AOR=5.85, p<0.05). The mean score of social functioning was also lower in those who were exposed to political (adjusted difference= -13.29, p<0.001) and economic rights violations (adjusted difference= -11.20, p<0.001). CONCLUSIONS This study highlights mental health consequences of lifelong human rights violations in North Korea. Beyond the conventional approach, it suggests the need for a collaborative preventive response from global health and human rights activists to address human rights in regard to mental health determinants of the 20 million people in North Korea.
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Affiliation(s)
- Jiho Cha
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Pamela J Surkan
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jaeshin Kim
- Dankook Center for Dispute Resolution, Dankook University, Yongin, Gyeonggi, Republic of Korea
| | - Isabel A Yoon
- Department of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, California
| | - Courtland Robinson
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Barbara Lopes Cardozo
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hayoung Lee
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Social Development, Korea International Cooperation Agency, Seongnam, Gyeonggi, Republic of Korea
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Khan MS, Schwanke-Khilji S, Yoong J, Tun ZM, Watson S, Coker RJ. Large funding inflows, limited local capacity and emerging disease control priorities: a situational assessment of tuberculosis control in Myanmar. Health Policy Plan 2018; 32:i22-i31. [PMID: 29028226 DOI: 10.1093/heapol/czx062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2017] [Indexed: 11/13/2022] Open
Abstract
There are numerous challenges in planning and implementing effective disease control programmes in Myanmar, which is undergoing internal political and economic transformations whilst experiencing massive inflows of external funding. The objective of our study-involving key informant discussions, participant observations and linked literature reviews-was to analyse how tuberculosis (TB) control strategies in Myanmar are influenced by the broader political, economic, epidemiological and health systems context using the Systemic Rapid Assessment conceptual and analytical framework. Our findings indicate that the substantial influx of donor funding, in the order of one billion dollars over a 5-year period, may be too rapid for the country's infrastructure to effectively utilize. TB control strategies thus far have tended to favour medical or technological approaches rather than infrastructure development, and appear to be driven more by perceived urgency to 'do something' rather informed by evidence of cost-effectiveness and sustainable long-term impact. Progress has been made towards ambitious targets for scaling up treatment of drug-resistant TB, although there are concerns about ensuring quality of care. We also find substantial disparities in health and funding allocation between regions and ethnic groups, which are related to the political context and health system infrastructure. Our situational assessment of emerging TB control strategies in this transitioning health system indicates that large investments by international donors may be pushing Myanmar to scale up TB and drug-resistant TB services too quickly, without due consideration given to the health system (service delivery infrastructure, human resource capacity, quality of care, equity) and epidemiological (evidence of effectiveness of interventions, prevention of new cases) context.
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Affiliation(s)
- Mishal S Khan
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore.,Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Sara Schwanke-Khilji
- Division of Hospital Medicine, Oregon Health and Science University, Oregon, USA
| | - Joanne Yoong
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore.,Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | - Zaw Myo Tun
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | | | - Richard James Coker
- Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.,Faculty of Public Health, Mahidol University, Bangkok, Thailand
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Davis WW, Mullany LC, Schissler M, Albert S, Beyrer C. Militarization, human rights violations and community responses as determinants of health in southeastern Myanmar: results of a cluster survey. Confl Health 2015; 9:32. [PMID: 26445595 PMCID: PMC4595128 DOI: 10.1186/s13031-015-0059-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 09/17/2015] [Indexed: 12/03/2022] Open
Abstract
Background The Myanmar army and ethnic armed groups agreed to a preliminary ceasefire in 2012, but a heavy military presence remains in southeastern Myanmar. Qualitative data suggested this militarization can result in human rights abuses in the absence of armed engagements between the parties, and that rural ethnic civilians use a variety of self-protection strategies to avoid these abuses or reduce their negative impacts. We used data from a household survey to determine prevalence of select self-protection activities and to examine exposure to armed groups, human rights violations and self-protection activities as determinants of health in southeastern Myanmar. Methods and findings Data collected from 463 households via a two-stage cluster survey of conflict-affected areas in eastern Myanmar in January 2012, were analyzed using logistic regression models to identify associations between exposure to state and non-state armed groups, village self-protection, human rights abuses and health outcomes. Close proximity to a military base was associated with human rights abuses (PRR 1.30, 95 % CI: 1.14-1.48), inadequate food production (PRR 1.08, 95 % CI: 1.03-1.13), inability to access health care (PRR 1.29, 95 % CI: 1.04-1.60) and diarrhea (PRR 1.15, 95 % CI: 1.05-1.27. Direct exposure to armed groups was associated with household hunger (PRR1.71, 95 % CI: 1.30-2.23). Among households that reported no human rights abuses, risk of household hunger (PRR 5.64, 95 % CI: 1.88-16.91), inadequate food production (PRR 1.95, 95 % CI: 1.11-3.41) and diarrhea (PRR 2.53, 95 % CI: 1.45-4.42) increased when neighbors’ households reported experiencing human rights abuses. Households in villages that reported negotiating with the Myanmar army had lower risk of human rights violations (PRR 0.91, 95 % CI: 0.85-0.98), household hunger (PRR 0.85, 95 % CI: 0.74-0.96), inadequate food production (PRR 0.93, 95 % CI:0.89-0.98) and diarrhea (PRR 0.89, 95 % CI:0.82-0.97). Stratified analysis suggests that self-protection strategies may modify the effect of exposure to armed groups on risk of human rights violations and some health outcomes. Conclusion Militarization may negatively affect health in southeastern Myanmar, and village self-protection activities may reduce these impacts. As southeastern Myanmar opens to international health and development interventions, implementing agencies should consider militarization as a determinant of health and design interventions that can mediate its effects. Such interventions should take into account existing self-protection strategies, seek to provide support where possible and, at all times, take care not to unintentionally undermine them. Electronic supplementary material The online version of this article (doi:10.1186/s13031-015-0059-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- William W Davis
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Luke C Mullany
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Matt Schissler
- Department of Anthropology, University of Michigan, Ann Arbor, MI USA
| | - Saw Albert
- Karen Human Rights Group, Mae Sot, Thailand
| | - Chris Beyrer
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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