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Along Thailand's border with Burma, tens of thousands of refuges have few health-care options. At one key clinic, health care workers offer advice for expectant mothers, dental emergencies, prosthetic limbs and medicine to ward of the effects of HIV.
Mae Tao clinic
At the Mae Tao clinic in the Thai border town of Mae Sot, each week children receive vaccinations, especially for hepatitis B, for infants as part of the health care program.
The clinic, which provides care for more than 110,000 Burmese refugees each year, faces growing challenges to assist HIV and tuberculosis patients after the halt of an AIDS antiretroviral program sponsored by Doctors Without Borders (Medecins Sans Frontieres - MSF).
Doctors Without Borders shut down its ARV program on the border before announcing in October this year its complete withdrawal from health-care activities in Thailand, after 35 years. The group said it was leaving after it failed to gain permission from Thai authorities to provide health care for undocumented migrants and "vulnerable populations" in Thailand.
The 20-year Mao Tao clinic says, in its latest annual report, its ARV patients face increased difficulty in obtaining medicine directly from the Mae Sot Thai hospital, because its ARV program was already full.
The director of the Mae Two clinic, Cynthia Muang, says the highly mobile refugee population poses difficult challenges for health-care workers.
"HIV is still one of the big challenges because of the population mobility and vulnerability and economic opportunity, especially for Burma," said Muang. "HIV is still a big challenge because, according to our information or data here, the HIV prevalence among pregnant women is gradually increasing."
Muang began assisting Burmese students fleeing the Burmese military's 1988 crackdown. The clinic now plays a vital role in border community health care system. It also includes villages inside Karen State and supports refugee schools in Thailand. In addition to reproductive health care, the clinic also provides dental care and prosthetics for victims of land mines in Burma.
She says conflict and subsequent social instability between Burma's ethnic communities and government forces have taken a toll on child welfare and health.
"Like nutrition, childhood nutrition, malnutrition, and psycho-social problems because of abuse and drugs," added Muang. "Psycho-social problems have become a challenge and burden because people do not feel safe and they are traumatized. So when we talk about health you really need to promote psycho-social health."
British volunteer doctor Mary Boullier says the clinic's workload focuses on treating respiratory infections, such as pneumonia, and severe diarrhea and vomiting as well as blood disorders. Boullier says families travel hazardous distances to ensure their children receive health care.
"Patients here are very strong and resilient and the amount they go through to get their children to the clinic," said Boullier. "It is only when you start asking questions that you realize how difficult it is even being for them to bring their child to the clinic and the care - the count of sacrifice the parents make for their children here is amazing."
Clinic director Muang says the clinic hopes to ensure on-going support for the communities, as well as promoting sustained development and a safe environment for those people facing life's uncertainties along the Thai and Burmese border.
Last week, Burma's newly formed Human Rights Commission has also warned of thousands of children in Kachin state displaced by fighting in recent months are suffering from psychological trauma, while adults face mounting insecurity because of the on-going conflict.