REACHING REMOTE COMMUNITIES IN NAGA

IN THE MOUNTAINOUS FAR NORTH OF MYANMAR, AN MSF MEDICAL TEAM IS DELIVERING LIFE-SAVING HEALTHCARE TO ISOLATED VILLAGES

An MSF mobile medical unit take a short break on their way to Lahe town in Naga © MSF/Scott Hamilton

An MSF mobile medical unit take a short break on their way to Lahe town in Naga © MSF/Scott Hamilton

An MSF mobile medical unit take a short break on their way to Lahe town in Naga © MSF/Scott Hamilton

Situated in the mountainous far north-west of Myanmar's Sagaing region, Naga Self-Administered Zone is one of the most remote parts of the country.

It is also home to the Naga people - a community living on both sides of the India-Myanmar border.

The Naga people are comprised of many tribes and retain a strong sense of cultural identity. Many in Naga, particularly in the more rural communities, sustain themselves and their families through subsistence agriculture and hunting.

A map of Naga within Myanmar © MSF

MSF's team is based in Lahe Town, a four-hour drive along dirt tracks from Khamti - the administrative centre of the district and the closest available airport. The only two hospitals serving the region are based in Lahe and Khamti.

In the rainy season, journeys between the two towns can take far longer than four hours and may even prove impossible if there are landslides or floods. 

A map of Naga within Myanmar © MSF

A map of Naga within Myanmar © MSF

A map of Naga within Myanmar © MSF

MOUNTAINS AND MOTORBIKES

A mobile medical unit arrive in Wu Hta village, Naga © MSF/Scott Hamilton

A mobile medical unit arrive in Wu Hta village, Naga © MSF/Scott Hamilton

A mobile medical unit arrive in Wu Hta village, Naga © MSF/Scott Hamilton

Mountainous terrain and remote villages make it difficult for people in rural communities to access basic healthcare services, even more so during the rainy season, when some of the villages can be cut off for several months.

MSF has been working in the Naga Self-Administered Zone since 2016; providing primary healthcare, hospital referrals and health education for 15 different villages in Lahe Township, as well as supporting the Ministry of Health and Sports' (MoHS) hospital in Lahe town. MSF also helps with tuberculosis (TB) testing and in organising vaccination campaigns in the communities.

MSF's teams visit each of the 15 villages around once or twice each month. The mobile clinic team always includes a doctor and a pharmacist.

The teams rely mostly on motorcycles to traverse challenging terrain, with some of the journeys lasting up to eight hours.

Given the challenges many people face in reaching healthcare facilities, MSF's mobile teams can be a lifeline in emergencies and for those with serious illnesses.

In 2018, MSF provided more than 8,400 medical consultations to people living in Naga. The most common reasons for patients seeking medical treatment are respiratory tract infections, musculoskeletal pain and diarrhoea.

Low vaccination coverage is also an issue in the remote communities in Naga, leaving people vulnerable to preventable diseases. For this reason, MSF has supported MoHS in carrying out several vaccination campaigns in the past years.

STAYING WARM IN THE MOUNTAINS

A kettle warming over a fire in Hay Khun village © MSF/Scott Hamilton

A kettle warming over a fire in Hay Khun village © MSF/Scott Hamilton

A kettle warming over a fire in Hay Khun village © MSF/Scott Hamilton

Naga is approximately 1,800 metres above sea level. During the winter months, temperatures can drop below zero, becoming particularly cold at night.

Most people live in wooden houses with thatched roofs, indoor fireplaces provide warmth and a place to dry meat and cook.

Fires tend to burn constantly, keeping the houses warm, but making coughs and upper respiratory infections common.

Hay Khun village, Naga ©  MSF/Scott Hamilton

Hay Khun village, Naga © MSF/Scott Hamilton

Hay Khun village, Naga © MSF/Scott Hamilton

A group of Naga people building a house © MSF/Scott Hamilton

A group of Naga people building a house © MSF/Scott Hamilton

A group of Naga people building a house © MSF/Scott Hamilton

Many people carry distinctive "Naga knives" on their backs, used for chopping wood, gutting animals and day-to-day tasks © MSF/Scott Hamilton

Many people carry distinctive "Naga knives" on their backs, used for chopping wood, gutting animals and day-to-day tasks © MSF/Scott Hamilton

Many people carry distinctive "Naga knives" on their backs, used for chopping wood, gutting animals and day-to-day tasks © MSF/Scott Hamilton

GETTING HEALTHCARE TO THE PEOPLE

 A mother and her child speak speak to a doctor from MSF's mobile clinic in Hay Khun village © MSF/Scott Hamilton

A mother and her child speak speak to a doctor from MSF's mobile clinic in Hay Khun village © MSF/Scott Hamilton

A mother and her child speak speak to a doctor from MSF's mobile clinic in Hay Khun village © MSF/Scott Hamilton

KYUN'S STORY

Kyun lives in Hay Khun village and has made her living through subsistence agriculture. She has had an eye condition for 10 years and now receives treatment from the MSF mobile clinic team.

Kyun lives in Hay Khun village © MSF/Scott Hamilton

"I’ve always lived here [in Hay Khun village - several hours' off-road driving from Lahe].

"I’ve made my living growing rice and corn in the mountains, but I don’t work anymore – now my husband and my daughter, Kyakin, grow food for us to eat. She also has three children.

"It’s so much easier to see the MSF doctors when they come here. It was different when I was young – when someone was sick, there just wasn’t anywhere to go."
KYUN | MSF PATIENT

"I believe I am around 70 years old, but I’m not sure. There have been a lot of changes in Naga since our ancestors’ time – now we wear a lot more clothes! The traditional style is to wear a lot less.

"The nearest big towns for us are Lahe and Khamti, but it takes a long time to travel to either town, and you need a motorbike.

"I first went to see the MSF doctors because of my eye – it feels itchy and hot, and it’s been this way for ten years now. I only started seeing the doctors recently, and they’re working on my treatment."

Kyun lives in Hay Khun village © MSF/Scott Hamilton

Kyun lives in Hay Khun village © MSF/Scott Hamilton

Kyun lives in Hay Khun village © MSF/Scott Hamilton

Kyakin from Hay Khun village © MSF/Scott Hamilton

Kyakin from Hay Khun village © MSF/Scott Hamilton

Kyakin from Hay Khun village © MSF/Scott Hamilton

KYAKIN'S STORY

Kyakin is Kyun's daughter. She also visits the mobile clinic, along with her children.

Kyakin from Hay Khun village © MSF/Scott Hamilton

"It’s important that I keep busy, so I can feed the family. We have pigs and chickens, but most of our food comes from farming.

"My husband suffers from the cold – he gets rashes and joint pain, but he still works in the fields.

"I went to the MSF clinic for the first time yesterday for a pregnancy test. I already have three children – I delivered all of them at home by myself."
KYAKIN | MSF PATIENT

"The most important thing for me is that they are educated, I would be sad if they had the same life I have – having to farm every day for food is exhausting. It’s especially difficult to work without cows to pull the ploughs because we need to do everything manually."

KAMOR'S STORY

"If it weren’t for MSF, I wouldn’t be alive today. Before I had medicine, I was so sick that I couldn’t move from my bed. But now I feel healthy and fit again. Before being treated, my whole body hurt and especially my chest.

Kamor lives in Wu Hta village © MSF/Scott Hamilton

"I’m not sure of my exact age, but I think I’m over 80. I’ve seen a lot of changes in my life. I remember the different tribes fighting when I was young, and the establishment of Lahe township.

Because I couldn’t move, the MSF doctors came and treated me in my house. They gave me diet supplements as well, to help me get stronger.
KAMOR | MSF PATIENT

Before the Christians and Buddhists and then the doctors came, we used to rely on a shaman when we were sick – sometimes they would tell us to sacrifice an animal.

"I’ve always been a farmer, but I don’t work anymore, so now my family support me with food and I stay home and cook."

Kamor lives in Wu Hta village © MSF/Scott Hamilton

Kamor lives in Wu Hta village © MSF/Scott Hamilton

Kamor lives in Wu Hta village © MSF/Scott Hamilton

COMMUNITY SUPPORT

Patients wait beside an MSF Land Cruiser to see the mobile medical team © MSF/Scott Hamilton

Patients wait beside an MSF Land Cruiser to see the mobile medical team © MSF/Scott Hamilton

Patients wait beside an MSF Land Cruiser to see the mobile medical team © MSF/Scott Hamilton

Many of MSF's staff working in Naga are from the region itself. Some describe working for an organisation like MSF as a way to support the community.

JOHN SAW HLAING | ASSISTANT PROJECT COORDINATOR

Assistant project coordinator John Saw Hlaing © MSF/Scott Hamilton

"I’ve been working with MSF since the project began in Naga. First, I worked as health promoter.

"MSF provided me with specific training before I started. Then I went on to become a logistics supervisor and now I’m assistant to the project coordinator.

"I like working with MSF. It’s important for me, because our people in Naga need more in terms of healthcare."
JOHN SAW HLAING | MSF ASSISTANT PROJECT COORDINATOR

"I think that MSF’s health education has made an impact: people are beginning to see healthcare differently here, and the provision of effective medicine has made a difference."

MOSES MAWLAN | HEALTH PROMOTION OFFICER

Health promotion officer Moses Mawlan © MSF/Scott Hamilton

"As a health promotion officer, I try to promote positive changes in people’s attitude to health. I travel to remote villages with our mobile clinics and provide health education to the community.

"I come from Naga, but even for me communication can sometimes be challenging – there are many tribes, and a lot of them have their own languages.

During the rainy season the roads and paths become far more challenging, and small streams swell to the size of rivers – in some cases we need to use rafts to cross them."
MOSES MAWLAN | HEALTH PROMOTION OFFICER

"I mainly focus on behavioural change, asking how I can encourage people to lead healthier lifestyles. Some people still stay at home even if they are sick, and that’s not good.

"Because there were no medical staff coming to the rural villages until recently, people have little health knowledge. For people who have lived most of their lives without medical care as a part of daily life, seeking healthcare isn’t a natural instinct.

"For me, it’s important that we change people’s mindset when it comes to health, and the way to do that is through health education.

"Travelling to the more rural villages is particularly difficult during the rainy season. The roads and paths become far more challenging, and small streams swell to the size of rivers – in some cases we need to use rafts to cross them.

"There are times when we have to carry our motorbikes – sometimes mountain paths collapse from landslides, creating sheer drops. Sometimes travel just isn’t possible, and we have to cancel some of our outreach activities.

"I will never quit my job because of these challenges. I think that experiences like this are important. Many challenges can be found in life, but we can only find solutions if we confront the challenges."

JOSHUA PAKAW HLAING BU | FINANCE AND HR ASSISTANT

Finance and HR assistant Joshua Pakaw Hlaing Bu © MSF/Scott Hamilton

I joined MSF in October 2017, beginning as a translator and now I’m the finance and HR assistant. Before joining MSF, I worked as an English teacher.

"I was born and brought up in Naga, and when I was growing up it was very underdeveloped. In the last few years things have really begun to change, especially with the establishment of new roads and bridges. I care about the development of this community.

"I wanted to work with MSF because I want to be able to help the community here, especially when it comes to healthcare – it’s something we need, and health education in particular."
JOSHUA PAKAW HLAING BU | FINANCE AND HR ASSISTANT

"When my friends ask me who I work for, I explain that MSF is a humanitarian organisation, specialising in different kinds of medical care.

"In the future I hope to run a small hostel for students coming from the rural villages to study in Lahe town, to ensure they have a place to stay.

"My goal is to contribute to the development of Naga’s youth, either through healthcare as I’m doing now, or through education."

MA MAY SANDI AUNG | NURSE

Nurse Ma May Sandi Aung © MSF/Scott Hamilton

"I like working with MSF because I feel we’re providing healthcare for people who really need it.

"I can’t even remember how many times I’ve told my family about how we give healthcare to those in need, how much it would cost them otherwise, and how well our staff work together as a team. My family is probably tired of hearing about my work all the time!

"I came to work in MSF’s Naga project because I wanted to be close to the patients, to work with them in their villages and to provide medical care directly.

"My mother is a midwife and she used to work in Wa Self-Administered Division. She’s an inspiration to me – I’ve wanted to be a nurse since my childhood.

"I read a lot about Naga and Lahe before I joined this project. I knew about the transportation challenges too, but I want people to receive medical care – even if they’re hard to reach. The challenges we face as a team bring us closer together."
MA MAY SANDI AUNG | NURSE

"Here in Naga, there is little health education and people don’t trust strangers easily. Not everyone realises that they can come to the MSF mobile clinics for treatment.

"Because of that, we work a lot with village administrators – they help to introduce us to communities, build trust, and explain our services."

Assistant project coordinator John Saw Hlaing © MSF/Scott Hamilton

Assistant project coordinator John Saw Hlaing © MSF/Scott Hamilton

Assistant project coordinator John Saw Hlaing © MSF/Scott Hamilton

Health promotion officer Moses Mawlan © MSF/Scott Hamilton

Health promotion officer Moses Mawlan © MSF/Scott Hamilton

Health promotion officer Moses Mawlan © MSF/Scott Hamilton

Finance and HR assistant Joshua Pakaw Hlaing Bu © MSF/Scott Hamilton

Finance and HR assistant Joshua Pakaw Hlaing Bu © MSF/Scott Hamilton

Finance and HR assistant Joshua Pakaw Hlaing Bu © MSF/Scott Hamilton

Nurse Ma May Sandi Aung © MSF/Scott Hamilton

Nurse Ma May Sandi Aung © MSF/Scott Hamilton

Nurse Ma May Sandi Aung © MSF/Scott Hamilton

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