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Myanmar Programme Reports 


11 July 2013 - Humanitarian Update

Click here for latest humanitarian update from Burma Myanmar that includes a update of the humanitarian crisis in Kachin and Rakhine States where together, over 220,000 people remain displaced and affecting by significant insecurity, lack of services, shelter and basic protection.  AAI continues to look for ways to work with local partners on the ground.

1 July 2008 - Final Report on Cyclone Nargis Emergency Response

The situation in Burma caused by the Cyclone Nagaris in May of this year created a desperate humanitarian emergency. We were aware that a humanitarian response from organisations such as AAI, without previous programs in Burma, was going to make access into the country difficult. However, we were confident that with our skills and expertise we would still be able to find ways, working around the Junta, in the relief effort where our unique skills and abilities would be of important value.

We are thankful that our supporters recognised this and funded what has effectively developed into a valuable relief project for the people of Burma and consequently has lead to longer term capacity building of local groups to respond and cope with this and future disasters.

Click here to read our Final report. 


13 June 2008 - AAI conduct medical training on behalf of partner organisation IMC

AAI began operations in Burma with the intention to conduct direct medical care to the population affected by Cyclone Nargis. After tireless negotiations with Burma Government officials from the Ministry of Health, it became apparent that these operations would not be possible and that the lifting of restrictions, as promised by the Junta and United Nations, would not eventuate.

Based on Burmese government restrictions AAI proposed a course of action that would allow us to continue to provide support to Cyclone affected populations and operate within the restrictions imposed on by the Burmese Government. This meant shifting focus from a direct care project, to providing training assistance to local partners.

The International Medical Corps (IMC), who partner with AAI were appropriate requested that AAI provide medical training for one of the local groups that IMC has been supporting.

Training 

AAI began training development by interviewing directors and staff from local medical teams to assess their requirements, capabilities, availability and current knowledge of clinical 'best practices' in a relief environment.

Based on a training needs assessment a syllabus was formed of training appropriate to the population needs. AAI worked for a number of days to develop a training package. We were very fortunate to have current knowledge on training Burmese though AAI's various other projects on the Thai/Burma Boarder and access to professionals with relevant experience from international operations and operations particularly in Burma . This included Dr. Larry Stock (AAI's Medical Director) and psychologist Lou Ringe, who is an associate of AAI with broad experience with populations from Burma .

The training package developed for the needs of IMC was delivered to seven staff members from the Myanmar Development Foundation/Mingalar Foundation. The breakdown of personnel included four doctors and three non-medical volunteers. This is the typical team arrangement in response to Cyclone Nargis.

The topics covered in the training session were;

Clinic Management in a Relief Environment

  • In this subject safe, efficient means of employing staff and the physical layout of a medical clinic for between 200-400 patients per day in a remote area is discussed. This session prompted many questions from students.

Treatment Protocols for Cyclone Nargis

  • In this subject AAI explain the clinical diagnosis of illnesses and injuries encountered during Cyclone Nargis and best practice treatment regime (available to medical staff in Myanmar ).
  • This is also AAI's chance to question staff to enquire whether they currently use 'best practice/medications'.
  • On this occasion the medical staff questioned used highly appropriate interventions and practices, and displayed a high level of relevant knowledge. This overall level of competence is atypical of Burma trained health staff.

Post Traumatic Stress Syndrome

  • In this topic AAI explained the presentation of PTSD in a relief environment, and the pharmaceutical and psychological interventions that are appropriate for the Burmese indigenous population.
  • On this occasion the group easily assimilated the information and displayed a sensitive understanding of PTSD.

Snake Bite Intervention

  • There is an enormous (not unfounded) fear of poisonous snakes in the delta region, both from villages and visiting teams. We were requested to train teams on an effective intervention for poisonous snake bites that could be passed on to villages. There have been many reported deaths by snakebite, due to the disturbed environment and movement of peoples.
  • An effective intervention for snakebite was taught to the group, and was practically displayed for the team.
  • At the conclusion of the formal part of the training session. AAI encourage a 'question and answer' session where participants can ask any questions on the material presented, or any further information they may require.
  • On this occasion a discussion ensued on the prevalence of Dengue and Malaria in the disaster areas, and on the manifestation of physical signs and symptoms of PTSD, from our experience.

AAI assessed that the training provided on behalf of IMC was received in a positive way, with a highly receptive and appropriate audience. We are confident that the level of assimilation of the training was of a high standard on this occasion.

Nathan Mullins
Program Manager
Access Aid International
Burma Operations

11 June 2008 - Training Report

Since there has been effectively a reversal on decisions to allow new international NGOs access to the Irrawaddy Delta region AAI has concentrated on being a training resource for those local groups who have had access to the affected population.

AAI are in a unique position. We have a highly qualified and experienced medical team, good procedures and knowledge to ensure effective medical care is given to the Burmese people. The local Burmese medical teams currently carrying out the vast bulk of the relief operations in the delta are a stark contrast. They are comprised of untrained volunteers, medical students in various stages of study and a few doctors who are absent from their private or state administered practices. These teams have great local knowledge and enthusiasm, but relatively poor clinical skills in many cases and very minimal experience running clinics in the field. The health care system in Burma is appallingly under equipped to deal with an emergency like this. The teams going to the field are desperate for advice and training assistance.

AAI start training sessions with an extensive explanation of the physical set up and layout of an emergency field clinic designed to see between 100 to 300 patients per day. We suggest considerations for planning that team leaders have to take into account and we look at how it must be staffed and resourced. Gathering Health Information is important and we detail how this information can be fed back into the emergency surveillance reporting system as it stands. In Burma there is no effective mechanism for reporting this information to the Ministry of Health. AAI also train in triage procedures and then priorities outside of acute conditions. AAI impart upon the trainees the importance on control of resources and community expectations.

The AAI training team then convene a group discussion on the problems the teams have faced, or queries they may have and attempt to design solutions as a group.

The next session will detail a number of common conditions that the local medical teams will see in the field, which staff may not have the clinical experience to deal with, or for which they require a refresher course in interventions.

The specific initial topics covered in AAI medical training include Upper respiratory Tract Infections, Diarrheal Problems, Fever and Wound Management. In response to concerns raised by previous students, AAI have added to the training recognition and treatment of PTSD. This condition has created a great deal of concern in the groups we have contacted and through consultation with mental health experts, we have developed a short, simplified package.

The groups that AAI have trained so far have returned to the field and are, on average, able to see about 250 patients per day. They have much greater access and effectiveness in the local population than the token international NGO teams that have been granted limited access. This local teams report very similar difficulties as we see in many medical relief operations, and need advice from the AAI team of experts to plan, act and react to the desperate situations they are facing.


10 June 2008 - AAI commences medical training courses to local NGO's

I have spent the last two weeks attempting to negotiate our position and gain the correct accreditation, for relief operations, according to the Myanmar Government.

In that time I think I have been able to build up a clear picture of the lives and challenges for the people of Burma, and tribulations and superstitions of the government. All around me are examples of the strange logic applied by the government, to everyday life in Burma . In Burma you can get 45 and 90 Kyat notes. Reportedly, these strange denominations were inspired by superstition and were meant to be lucky for the economy. You can decide for yourself how successful that has been; the official exchange rate is around 6 Kyat per US Dollar. At a market in town, at an unofficial black market dealer, I get 1130 Kyat per US Dollar.

Much has been made of the difficulties the international relief community has had in reaching the effected population. There is a sort of assumption that local groups have free access to these areas, but this is not the case. The groups who succeed in gaining the most complete access do so with secret meetings and cover stories for staff working in areas other than their home locations. Health workers, many of who are illegally absent from their government sponsored positions or studies, conduct relief operations in secrecy in lightning trips to the Irrawaddy Delta area.

These groups have been cobbled together by people who have seen the difficulties in access by the international aid community, and through duty to the community, have decided to help. They have no experience in operating health clinics or organisation on this scale. After a number of meetings between these groups, and us at Access Aid International, we have developed a training package intended to help them conduct clinics. The training involves managing clinics and health information, and gives some interventions for disease and injuries they encounter.

Delivering the training has given us a unique view of their experiences out in the delta. The training has to be conducted in private places, in groups of confidants away from prying eyes. Participants are nervous but really desperate for information that can help the recipient population. We gain their trust with examples of our common experiences in running clinics for similar populations we and give them the benefit of our experience and training. The students are keen and share their worries and queries with us. Without pretext they explain the gaps in their knowledge and the inexperience they feel dealing with the situation. The people of Burma are reserved with outsiders and proud, and to me their ability to explain these feelings shows both their faith in us and the pressure they feel to perform to their best for the community. They are doing a great and admirable job in the circumstances, and we too acutely feel the pressure to provide them with effective and appropriate training. We are constantly developing the training and designing reference tools to assist them in their work. They are our connection to the most effected populations and need all the support we can provide.


29 May 2008 - International Medical Teams trying to access the Irrawaddy Delta

Access Aid International (AAI) is an international medical NGO that provides niche medical relief capabilities in remote and inaccessible areas at times of crisis. Knowing that it would be difficult to obtain access to the areas where our work was needed there was a debate about whether and how to assist the survivors of Cyclone Nargis. It was decided that the scale of the tragedy and the insufficiency of the available assistance warranted our presence and our serious effort.Aside from the mangled billboards and the shining patches of new roofing iron, the casual visitor to Yangon could be excused for forgetting that Myanmar ( Burma ) has just experienced its worst natural disaster in over a decade. The community has resolutely pulled together and much of the mopping-up in the country's largest city is well underway. Outside Yangon it is a different story. The UN and humanitarian agencies estimate that over half of the 2 million plus people affected by the cyclone are still yet to receive assistance. This number, like so many others, is a well informed guess, because assessments of all the affected areas are still not complete.

AAI faced a double hurdle in establishing our relief operations. Not only were we requesting access, but we were requesting access as a previously unknown NGO within Myanmar ( Burma ). Arriving in Yangon at the same time as UN Secretary General Ban's breakthrough on access for international workers, AAI's rapid response team have joined those who are pioneering requests for permissions through the Ministry of Health, Ministry of Police, and Ministry of Defence. Once these government permissions are obtained we will also be seeking permission from local township authorities to give assistance to people in their area.

Meanwhile, local people in the worst affected regions have been organising and helping themselves. But the situation is far from stable. Drinking water remains a critical issue. People in the Irrawaddy Delta typically use shallow wells and drinking ponds to gather their water. These water sources have been contaminated by the storm surge associated with the cyclone. People have resorted to gathering water from drains, a strong risk for waterborne disease vectors.

While people living around towns and major population centres have congregated in camps made up of temporary shelters, many people from small villages have elected to stay where they are. Because the entire water system of the delta has changed, many of these families will be very difficult to locate. Local NGOs were quick to respond in their own areas, many of them hiring transport and buying locally available supplies to deliver to remote affected populations. Churches and community groups are looking after their own people as well as caring for others in the same geographic area. Because of complications with navigating the changed waterways, many have taken a haphazard approach, leaving relief supplies with various communities until their stocks are exhausted. The Local NGO Resource Centre and Myanmar Information Management Unit have both been working hard to gather and collate the available information, but much work remains to be done before a coordinated and comprehensive picture exists.

AAI will direct our resources to working alongside this community-based response and providing a high quality, disaster medical capacity through mobile clinics in the least accessible areas of the Irrawaddy Delta. Our medical personnel are currently congregating in Bangkok , awaiting visas to join the rest of the team in Yangon. The debate about whether and how to respond has now become a race to reach critically affected families who are isolated from towns and major distribution points. 


27 May 2008 - Situation Report

The destruction in the communities near the airport is shocking. Everywhere large trees have been wrenched from the ground and man-made structures are tortured into new shapes. We are caught in the classically violent monsoonal rainstorm on the short drive into Yangon .We have been in Burma for four days now, but it only takes about five minutes, before the plane has even stopped taxiing on the runway, to understand the level of damage inflicted by Cyclone Nargis.

I go to meetings designed to co-ordinate the efforts of the humanitarian community and figures are quoted for the loss of human life. 50,000, 100,000, one million homeless, two million homeless. The estimates are just that, guesses designed to help for planning purposes. The numbers are incredible and hard to put into context. A large, packed sports stadium in Australia may hold 100,000 people-I always need some false sense of perspective when I think about the numbers of dead in these disasters.

In Yangon buildings with a solid structure have stood against the main force of the cyclone, but many have had roofs removed altogether or damaged. People are back in their homes for the large part, repairing damage and getting business and services back up and running. It takes incredible effort-virtually every family has been touched by death. As we arrange relief operations and conduct ourselves in this environment people routinely tell us of the family members they have lost. They mourn; they are sad and frustrated, but they are not helpless or hopeless. The people I have met have an inspiring capacity for stoically holding on, and working regardless of adversity.

I have visited Yangon in happier times and sombre mood now is palpable and everywhere. The city is functioning but wounded. I hope for the inhabitants of this sprawling vibrant city that repair is fast. In the past I travelled around Burma with the relative freedom of a tourist, enjoying the countryside and culture, with no pressing mission or concern. This time, we have an urgent mission, we have the concern, but have not been allowed outside the confines of Yangon . The UN Secretary General addressed this situation on The 25th of May, and we have been promised greater access to the affected population, but the detail of this access is still to be determined. I hope it can be in time to stop the health of the population sliding to an even lower level.

In the delta area the destruction is complete in every senses of the word. I know this only from snatched conversations and photos passed out through people travelling through Yangon , appealing for help for their families. The emergency relief efforts that have got down there are insufficient and late. There is still a massive relief operation urgently required to save the lives of people at risk of complication of injury and disease.

At the UN Pledging Conference on the weekend, the international community showed its solidarity and support for the population of Burma with further pledges of nearly 50 million USD. My message is that ordinary people also need to show their support to the people of Burma , and the relief operations that are ongoing. Groups like Access Aid International cannot continue their work without support from people who are aware and want to help.


25 May 2008 - Situation Report

AAI's international medical teams who have been waiting for entry visas for over two weeks, are once again gearing up for deployment as the UN Secretary General announced concessions by Myanmar's (Burma's) top general. The concessions include allowing international aid workers visas and access to the worst affected areas. AAI and the international humanitarian community are still waiting for clarification on the new procedures.

Meanwhile, the team in Yangon has been meeting with local NGOs and local teams returning from areas where access is still restricted. One local organisation that had delivered supplies by boat in the lower Irrawaddy Delta shared how they had come across a village of 500 people where every home had been destroyed and many lives lost. This was the first distribution of humanitarian assistance that the village had received in two weeks. The UN estimates that of the 2 million people in the 15 worst-affected townships, only 470,000 (23%) have been reached by aid workers.


23 May 2008 - Situation Report

Restrictions on entry in to Myanmar (Burma) and access to affected areas have impeded AAI's ability to deploy medical teams to assist cyclone survivors. Many local organisations that do have access to the affected areas are struggling to provide aid and calling to specialist organisations like AAI for assistance.

AAI have succeeded in obtaining visas for Australian aid workers to be based in Yangoon. It is anticipated that this team will quickly grow as specialists are brought in to perform essential tasks. The World Food Program (WFP) is currently managing an air bridge and distribution service to help relief supplies to reach the worst affected areas. AAI are working closely with DRI, the WFP and WHO to ensure that small organisations and local NGOs within Myanmar (Burma) are able to access the relief supplies that are being donated. We are also in discussions with a shipping operator and hope to raise funds to provide a floating clinic, which can provide medical services on-board and is capable of reaching remote affected communities. Three weeks after Cyclone Nargis struck, many communities are still yet to receive adequate assistance.

Epidemiological models predict this period of time after a disaster to be the greatest risk for outbreaks of life threatening infectious diseases. Pathogens contracted due to the poor living conditions caused by the Cyclone have had the opportunity to incubate in infected persons. As these people become infectious the rate of transmission of disease to others will increase exponentially and without urgent aid major outbreaks are predicted which will rapidly multiple the number of initial deaths from the Cyclone.

Compiling Officer
Brad Chapman
Access Aid International
Information Officer - Cyclone Nargis Response

17 May 2008 - Access Aid International: Cyclone Nargis Response

Background

Cyclone Nargis struck Myanmar on 2 and 3 May 2008 , making landfall in Ayeyarwady Division and directly hitting the country's largest city, Yangon . 40 townships in Yangon Division and seven townships in Ayeyarwady Division remain on the Junta's list of disaster areas. International organisations assessment teams have reported major damage in affected areas, particularly the low-lying delta region, where Cyclone Nargis' impact was compounded by a storm surge. On 17 May Myanmar 's ruling junta increased its official count of dead and missing by over 100 percent to a combined total of 133,000 people. The UN now estimates that between 1.6 and 2.5 million people may be affected. The World Health Organisation has warned that unless safe water sources are established immediately, a widespread outbreak of water-borne disease is likely.

AAI Update

Access Aid International (AAI) has a regional assessment and coordination team in Thailand and a medical response team on standby for immediate deployment to the disaster-affected area when entry visas are granted.

Representatives from NGOs inside Myanmar who are in contact with AAI report that the situation in many townships is dire. Some affected villages are yet to receive any shipments of aid supplies and there are reports of people begging by the side of the road.

AAI's Program Manager is currently in Mae Sot near the border of Thailand and Myanmar meeting with local partners and developing strategies for the most effective deployment of aid. AAI also have an Information Officer posted in Bangkok where regional coordination meetings are undertaken. AAI are liaising with UN agencies and other NGOs to coordinate our response.

Brad Chapman - Access Aid International

4 May 2008 - Cyclone Nargis Update

As heavy rains continue to batter victims of the recent cyclone in Myanmar / Burma, the United Nations estimates that 1.5 million people remain in urgent need of humanitarian assistance. Up to 100,000 people are now dead or missing. Survivors in the Irrawaddy Delta now face a second humanitarian disaster in the form of disease and malnutrition.

Whilst the Junta has began accepting aid from the outside world, AAI’s Information and Security Manager has commented to media sources that, ‘the people of Burma now face an even greater threat to their human security. While the affected communities are desperately trying to recover from the impacts of Cyclone Nargis, they are now inundated by torrential rain and limited humanitarian assistance. We now risk facing a calamity of unimaginable proportions.” Cholera, dysentery and other water borne diseases are of great concern to humanitarian teams attempting to gain entry into affected areas.

As 90 percent of the victims still await food and shelter supplies, the United Nation’s Joint Typhoon Warning Centre has said that a storm currently located South-West of the port city of Rangoon was gaining intensity.

AAI has a disaster and assessment response team in neighboring Thailand that is now assessing the possibility of creating sea, air or land bridges in an attempt to provide desperately needed aid to those who need it most.

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2 May 2008 - Emergency Appeal for Cyclone Nargis in Myanmar

AAI is on standby to conduct a Rapid Emergency Assessment Response to the recent cyclone in Myanmar and is desperately appealing for donations for help. AAI have conducted a number of effective emergency responses in South East Asia and Pacific and is well equipped to help those desperately seeking medical aid immediately.

Tropical Cyclone Nargis struck south-western Myanmar at around 4pm Friday May 2 local time, with winds of up to 190 kph. Unofficially the death toll could be as high as 15,000 with hundreds of thousands of people left homeless and in desperate need of medical and shelter assistance. 

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