Monday, March 10, 2014

Unintended Consequences

A child at the Mae Tao Clinic, in Mae Sot, gets post surgical exam in the clinic's surgical ward. 

There are unintended consequences to almost decision we make in life. Most times we go through our routines and don't even consider them. Sometimes though they have ramifications for people far removed from the decision makers. The situation for Burmese refugees and migrants on the Thai border is an example of unintended consequences on a large scale. 

There are hundreds of thousands of Burmese living in Thailand. Some are living in refugee camps along the Thai-Myanmar border but many, many more are living in Thailand as migrant workers or economic refugees. Even though the political and economic situations are improving almost every day in Myanmar, Burmese are still coming to Thailand.

Even as Burmese are coming to Thailand, the assistance available to them is diminishing. This isn't because there isn't a need or because NGOs and aid organizations don't care. Ironically, it's because Myanmar's improving political situation is drawing aid dollars from Thailand to Myanmar. 


Children play marbles with rocks at the Sky Blue School, a school for Burmese children in Mae Sot. The school ran out of money to pay teachers earlier this year and the teachers went three months with no paychecks. An emergency grant from the Burmese Migrant Teachers' Association is keeping the school open. 

Only three or four years ago, before Myanmar's democratization got underway, NGOs in Myanmar faced significant restrictions on where and how they could operate. During the recovery from Cyclone Nargis, for example, NGOs weren't allowed to leave Yangon. As a result not many NGOs worked openly in Myanmar and their work was a tiny percentage of what was needed. 

That was then and this is now. 

Now NGOs are allowed to work with relative freedom in most parts of Myanmar. As a result, more and more NGOs are opening offices in Yangon and elsewhere in Myanmar. Organizations that had to work surreptitiously are now working openly. It really is a new day in Myanmar. 

The unintended consequence of Burma's new day is that there are fewer resources available for Burmese in Thailand. 

The resource pie, if you will, is very finite. With so many humanitarian crises in the world (Sudan, Syria, Philippines to name three recent ones) it's hard to generate more for assistance for Myanmar. At the same time, the resources available to Myanmar, which used to be used mostly in Thailand, are now being used in Myanmar and Thailand. Every dollar spent on the Burmese side of the border is a dollar not available on the Thai side. 
A woman from Myanmar gets treatment for tuberculosis at an isolated sanatorium about 40 minutes north of Mae Sot. Her 11 year old daughter (foreground, back to camera) lives at the sanatorium with her and is her main caregiver.

Different organizations are dealing with the new reality in different ways. 

The most glaring resource cuts are happening at the refugee camps north of Mae Sot. Many are having their rice and other food rations cut

At the Sky Blue School, a small school near Mae Sot, funding has taken a hit. The school went three months with no money to pay teachers. The school got an emergency grant earlier this year and is solvent for now. 

The Mae Tao Clinic, in Mae Sot is one of the oldest and largest organizations helping Burmese migrants on the entire border. It's well funded by contracts from donor government aid organizations, like USAID and AusAID. But the clinic lost its AusAID contract last year and its USAID contract expires next year. The clinic is changing to face new realities. It still provides medical care for hundreds of thousands of Burmese but it's doing more and more community building and is transitioning into a training role for people who will work in Myanmar. It's also establishing community health centers and clinics in Myanmar. Until two years ago Mae Tao's workers in Myanmar went in under cover as "back pack medics." They faced arrest and possible death sentences if they were caught by the Burmese military junta.

At the Sanatorium Center for Border Communities, on an isolated, barren hilltop north of Mae Sot, the changes in Myanmar are having a double impact. NGOs the Sanatorium partners with are facing resource cuts at the same time, because of the changes in Myanmar, more and more people are coming to the Sanatorium to get treatment for TB. 

The changes in Myanmar means more people are free to travel. Myanmar has one of the highest TB rates in the world. People are now able to travel to Yangon or Mandalay, where TB treatment is available but there are long waits and it's expensive. So they're packing their bags and coming to the clinic near Mae Sot, which accepts anyone and is free. 
A woman at the Mae Tao clinic waits to see a doctor. 

This isn't a story with good guys or bad guys. There isn't anyone who wants to see the progress made in Myanmar reversed or for the Burmese government to crack down on NGOs. This is a story about unintended consequences and hard decisions and the need for more. More aid. More resources and more awareness. 


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