US embassy cable - 04RANGOON1386

UNCLAS SECTION 01 OF 02 RANGOON 001386 
 
SIPDIS 
 
SENSITIVE 
 
FOR EAP/BCLTV 
 
E.O. 12958: N/A 
TAGS: PHUM, PGOV, EAID, SOCI, BM, NGO, Human Rights 
SUBJECT: PUSHING A BIG ROCK UP A STEEP HILL: UNFPA TRIES TO 
IMPROVE REPRODUCTIVE HEALTH IN UPPER BURMA 
 
1. (SBU)  Summary:  The UNFPA's three-day tour through upper 
Burma in mid-October for members of the diplomatic community 
and INGOs presented a microcosm of life today in this 
country: a graceful, capable people burdened by a Government 
that takes decisions based on its own interests. End Summary 
 
2.  (U)  The United Nations Population Fund's (UNFPA) local 
representative (Najib Assifi--Afghan) organized and led a 
October 11-13 trip to Upper Burma (Mandalay, Monywa, 
Amarapura, and surrounding villages) for members of the 
diplomatic corps from Rangoon and Bangkok, including poloff. 
The Director of Southeast Asian affairs in the Danish Foreign 
Ministry in Copenhagen also participated, as did 
representatives of Rangoon-based INGOs working on public 
health issues. 
 
Expanded UNFPA Program in Burma...... 
 
3.  (U)  The UNFPA organized the trip to showcase its 
assistance for improved reproductive health in rural areas, 
and to gain additional donor support.  In September 2001, the 
Fund's Executive Board approved an expanded assistance 
program for Burma, 2002-2005, which aims to reduce maternal 
mortality, and to prevent the spread of HIV/AIDS.  The Board 
approved a special budget of USD 20 million for UNFPA over 
the four-year life of the expanded program, thereby doubling 
the amount of assistance (USD 10 million) that UNFPA Burma 
had provided during the '90s.   However, UNFPA Headquarters 
in New York has provided only USD 12 million of the expanded 
budget.  The local office is expected to raise the balance. 
 
4.  (U)  Toward those ends, the Fund took the group to nine 
separate medical facilities around Mandalay and Monywa--four 
hours apart over a rough, washed out road--that it supports 
with information about HIV/AIDS, birth control (including 
distribution of condoms and advocacy for their use); and 
other aspects of reproductive health, including "birth 
spacing" (note: The Government advocates a pro-natal policy 
which precludes "family planning.")  UNFPA Burma has extended 
its support for such programs to facilities in 94 townships 
in 2004, and hopes to reach 100 townships by next year (note: 
There are 324 recognized townships in Burma.)  The UNFPA's 
resident representative estimates that his agency's 
assistance programs currently reach 15-20% of the relevant 
population in the participating townships.  Rather than 
trying to expand beyond the targeted communities, he hopes to 
increase the numbers of people that draw on the assistance 
available in the participating communities. 
 
.....Has Produced Positive Results.... 
 
5.  (U)  At several of the sites visited, smiling Burmese 
teens and twenty-somethings proclaimed the values of "safe 
sex" through condom use.  A villager informed the visitors 
that he and his wife had seven grown children, one of whom 
promptly stood up and proclaimed loudly that she did not want 
to have more than three children.  At a youth center 
supported by the UNFPA, and endorsed by the regional military 
commander, a mixed group of young people performed a play 
that concluded with the hero confiding sadly to his friend 
that he was HIV-positive following an encounter with a 
prostitute.  The hundreds of villagers who watched the 
performance with the UNFPA-sponsored group smiled, frowned, 
and clapped at the appropriate times.  Some of this was 
surely staged.  However, the messages were clear and 
seemingly well received.  At the very least, the activity 
provided a positive environment for youth with little else to 
do. 
 
6.  (U)  The UNFPA's guests also received briefings on 
training programs for midwives, assistant midwives, and 
"Community Support Groups."  Members of the latter were said 
to be ordinary villagers who, following one or two days of 
training, are capable of serving as liaisons between 
villagers and medical facilities in larger villages and 
townships.  At the Women's Medical Center in Mandalay, an 
energetic British nurse sponsored by the WHO showed the 
visiting group how she taught Burmese midwives to get women 
into the most comfortable positions to give birth.  The 
trainees were on the floor of a hospital for this purpose as 
the group entered the training facility. 
 
.......But Probably Not Enough 
 
7.  (SBU)  The obstacles to improving health care in rural 
Burma, however, are enormous.  Maternal mortality rates in 
the country are currently around 60 per 1,000 births, 90 per 
1,000 in more remote areas.  Data are hard to verify, but 
some 80 percent of all births are thought to occur in homes. 
Morbidity rates while giving birth are considerably lower 
among women in the major urban areas, but the Government's 
capacity to provide medical care of any kind to village 
dwellers is limited.  The political will to do so in the 
ethnic areas is even more tenuous.  For example, a German 
doctor based in Rangoon with "Malteser Germany" (INGO with 
home office in Cologne) bemoaned the extreme lack of medical 
care in Northern Rakhine State during an earlier conversation 
with poloff, telling the latter than an entire generation of 
Muslim youth in that state is growing up malnourished. 
 
8.  (SBU)  The structure is not in place within the Burmese 
Government to address these problems.  One of the Burmese 
doctors who briefed the UNFPA-organized group said, in 
response to a question, that he received a salary of kyat 
8,000 per month (approximately eight USD).  He also said he 
is one of three doctors serving a population of 150,000. 
Another Burmese doctor, currently the head of surgery in 
Mandalay and an outspoken critic of the SPDC, told poloff 
privately on the margins of the official trip that the GoB 
has diluted and shortened medical training so much that it 
will adversely affect the quality of care in the future. 
 
Beggar Thy Neighbor....... 
 
9.  (SBU)  Burma's neighbors are not helping.  In some cases, 
they are part of the problem.  The Malaysian Ambassador to 
Burma confided that his government had recently reached 
official agreement with the GoB to bring 100 qualified 
Burmese doctors--including ten specialists--to Malaysia on 
three-year assignments.  This would be mutually beneficial, 
stressed the Ambassador: the Burmese doctors will make good 
salaries while working in modern facilities and the Malaysian 
Government will be able to offer more health care to its 
citizens living in rural areas.  Moreover, added the 
Ambassador, the Malaysian Embassy in Rangoon is issuing some 
120 visas to Burmese citizens every day to take up jobs in 
Malaysia.  Rangoon-based recruiters identify prospective 
staff to meet requirements sent by needy employers in 
Malaysia. 
 
......While the Government Looks On 
 
10.  (SBU)   Army troops, including military intelligence 
officials, and police were much in evidence throughout the 
October 11-13 trip.  In addition, members of the Myanmar 
Maternal and Child Welfare Association (MMCWA), a GONGO run 
by Burmese military wives, played a prominent part in the 
group's program.  During a visit to a MMCWA facility 
supported by the UNFPA in Amarapura, a local MMCWA official 
said her organization had a total of 3.79 million members 
countrywide.  The MMCWA has a staff member assigned to the 
UNFPA's office in Rangoon to help direct the agency's 
assistance projects. 
 
11.   (SBU)  Final Comments:  The UNFPA trip was, in several 
ways, a microcosm of life today in Burma.  For three days, 
members of the group saw a graceful, capable people, willing 
and able to employ foreign assistance to good advantage; and 
an international organization that is trying hard to 
contribute to improved living conditions.  These developments 
are taking place under a government that controls--for its 
own benefit--the way the assistance is delivered while not 
supporting the related processes and doing little to 
contribute to the longer-term goals.  The overall result is a 
declining standard of living and increasingly depleted 
populus. 
Martinez