*Medicine monk

Deprived of vital health services and ravaged by years of civil war, one devoted abbot is providing forgotten rural communities with much-needed relief By Phil Thornton

The muscular arm of a saffron-clad monk, propped against the wall of a bamboo hut, draws air pictures to illustrate why his community is in desperate need of an ambulance.

The arm belongs to abbot Sayardaw Baddhanta Warthithta, also known as Sayardaw, who is revered by the people of Karen state.

Abbot Sayardaw’s energy is seemingly endless. He runs a free health service from three monasteries and 14 mobile clinics, offers education scholarships to poor children, operates a boarding house for 168 students and orphans, visits prisons, finds jobs for the unemployed and delivered boatloads of supplies to displaced communities in the recent floods that devastated most of the country.

If the abbot’s team of volunteer doctors, nurses, midwives and pharmacists cannot solve a patient’s problem, Sayardaw is prepared to drive them eight hours to a hospital in the country’s largest city, Yangon — hence his need for an ambulance.

Sayardaw flicks through a bundle of photographs to show bloodied people, hurt in traffic accidents, and bed-ridden elderly being loaded into the back of a family car.

“We need a proper stretcher that we can strap badly injured people into. This will stop them suffering additional trauma.”

Abbot Sayardaw’s many good deeds have won plaudits from those he helps with his large group of volunteers, but have also galvanised his critics, whose professional egos have been bruised by the monk’s unorthodox methods.

“I face a lot of difficulties, not only raising funding, but from those who resent what we are trying to do,” he said. “Maybe they see us an opposition to the authorities or the institutions they work for?”

DO GOOD, GET GOOD
Sayardaw explains that his philosophy is simple: “If we wait for the right moment, reforms or changes that suit us, we waste valuable time. People in need can’t afford to wait.”

A constant motivation are the Buddhist scriptures he lives by and the hard lessons he learned as a child.

“My father died when I was seven. His family was wealthy, but rejected us. I had to stop school and work to support my mother and sister.”

Sayardaw took on a series of jobs to help his mother — selling ice-cream and vegetables, and collecting garbage. This forced him to stop his formal schooling at the age of seven.

“I was lucky, my old teacher, Naw Kwa wa Nu, used to come to my house after I finished work to give me lessons. She also gave me pocket money. I had help from good people. Dr Aung Naing helped me for free when I was sick. He was an inspiration and still helps me.

“Lord Buddha teaches what we do has equal effect — do good, get good; do bad, get bad. Jealousy is a waste of energy and time. If these people who resent what we are doing want to help, I accept it, if they want to kill me for this work, I accept that too. If you do bad, it stays bad, you can’t erase it by buying merit later, the bad deed is still bad.”

After a series of oppressive military regimes, more than 60 years of civil war in ethnic states and pitiful government investment, Myanmar’s broken health system became so threadbare and corrupt that in 2000 the World Health Organisation ranked it second-last out of 191 countries.

While conflict in Karen state has eased, it still rages in the north of the country, as the Myanmar military seeks to take control of Shan and Kachin states. Estimates suggest as many as 500,000 people have been displaced from all three states.

Between Yangon and Karen’s state capital, Hpa-an, military propaganda posters fade and are being replaced by billboards advertising shampoo, tractors, mobile phones and televisions. Travel short distances outside the state’s larger towns and single lane roads crumble and turn to dust. Small boys herd buffalo and farmers amble along by bullock and cart. Thin poles topped with household bulbs provide lighting in villages lucky enough to have the use of a generator. Temples dominate the skyline; mountain tops are capped with golden pagodas linked by small tracks walked by pilgrims.

In rural areas where government infrastructure is non-existent, ethnic community groups and people like Abbot Sayardaw have stepped in to make up for the void.

FILLING THE GAPS
Bill Davis, a Johns Hopkins University researcher based in Yangon, specialises in the delivery of health care in conflict areas. He says there is currently no reliable data on where health services are located in Karen state or any way of measuring the quality of provision.

For a long time the military government delivered few services and “community groups, cross-border organisations, free funeral providers and others engaged in community work filled the gap the best they could”, he said.

Mr Davis said the challenge will now be to bring all sides together to deliver effective services, suggesting a comprehensive mapping of existing provision as a good starting point.

“The best way of doing this is if ethnic groups and the government work together, and the international community helps by offering technical support,” he said.

“Ethnic groups need to get involved, to be included in the changes and recognised for their work, and the Ministry of Health needs to be more open and willing to listen to them at the township level. What’s important is that everyone gets health care of a decent standard.”

SERVING THE PEOPLE
The abbot’s living quarters at Naga Yong Temple are basic — paper-thin bamboo floors and walls and a leaf-tiled roof. A morning breeze finds its way through an unfinished wall and holes punched in the roof, cooling the room. A rusty, battered fan lies unused and unneeded, and the uneven bamboo floor heaves and sags when walked on. Photos of Sayardaw’s mother and the exiled humanitarian worker Dr Cynthia Maung take the centre space on one wall. A large oil painting given to him by a grateful patient leans against another.

Myanmar’s monks have a reputation for standing up for the people. For example, the Saffron Revolution in 2007 saw thousands of monks and nuns join political activists and civilians in demonstrating against the military regime’s decision to remove fuel subsidies, which sent petrol prices soaring. But not all Myanmar’s monks are known for their good deeds. Ashin Wirathu has become notorious as Myanmar’s most fanatical monk, targeting Muslim communities with his extreme nationalistic speeches and stoking religious intolerance that has fuelled deadly violence between Buddhist and ethnic Rohingya communities.

Abbot Sayardaw is quick to point out the importance of tolerance and giving, irrespective of people’s ethnicity or religious beliefs.

“I am working to protect the nation, the religion. This means everyone has the right to believe in their beliefs and their God. I don’t discriminate. If people need, I give. Different people have the right to believe in their own way. Giving creates happiness, resentment generates unhappiness.”

A look inside the Lawkardhipati Gararlone Temple clinic confirms his stance. Muslim, Hindu and Buddhist patients sit side-by-side chatting while waiting to see clinic staff. Outside, a motorcycle taxi driver, who identifies himself as a Muslim, says taking patients to the clinic keeps him busy.

“All people, regardless of religion are welcomed by the monk,” he said. “I was a patient here myself, I had crippling gastric problems that are now fixed. It’s good for all people, its reputation is good, and it’s now doing eye care screenings.”

Nan Than Than Htay, a qualified nurse with 10 years experience, works five days a week as a volunteer at the clinic: “I like the work. I like working for people. There’s not much free health care in our country. This way I can contribute to my community. My parents support what I do.”

Nan Than Than explains the clinic has 15 volunteer staff that include midwives, nurses, doctors and pharmacists.

“Some work five days, others when they have free time. We open at 10am and we are still going well into the afternoon. It’s mainly chronic illnesses — diabetes, hypertension. We also see serious cases, as we are the first stop for people. If we can’t handle them we refer them to hospitals, either locally or in Yangon. People come here first because all our services are free.”

WHEN FREE ISN’T FREE
A government worker, who asked not to be named, said “free health care” as offered by Myanmar government hospitals, is a complex matter.

“The doctor’s appointment is free, but there are many hidden costs. X-rays, CAT-scans, MRI’s, blood tests, medicine, medical dressings and other supplies have to be paid for by the patient. If you need blood during surgery, the donor’s transport and food for them afterwards also has to be paid for. The hospitals are under-resourced and don’t have the money for these costs, so the patient pays.”

The government worker claimed hidden costs also include patients paying cash to porters to use a wheelchair. If a nurse accompanies, it’s extra, and gatekeepers demand cash payments to open hospital gates after hours.
Nurse Nan Than Than shares a joke with her patients, leaving them all laughing. Daw Yan Sein says she comes to the clinic to have her diabetes monitored.

“I was worried, my legs felt heavy and I was dizzy. I had missed my follow-up appointment three times, but the nurses and doctor smiled, listened and took the time to explain to me what I needed to do,” she said. “It’s admirable what the monk does. He teaches the staff to take care of the elderly and treat us with respect.”

Daw Myint Myint San chips in: “My diabetes is under control, my blood pressure is down — if it was not for this clinic I would have died by now.”

A doctor working at the clinic, who asked not to be named, said he works two jobs — in the civil service and as a volunteer at the clinic.

“I try to come here every day. My other job is early morning. If I am here and get an emergency call I go back, and if I can’t work here I get a friend to stand in for me. I admire what Sayardaw does and when I heard about his work I wanted to help.”

Abbot Sayardaw is quick to play down his growing reputation and dismisses any suggestion he is becoming famous.

“I don’t need fame, if you have fame, it means nothing. I need people to help me take action. Despite all the gold and money of the rich, they still seek something that is missing in their lives. If their money is not spent in the right way, it’s useless. Even the rich and the corrupt will die poor. They can collect it in this life, but can’t take it with them. In this life we can’t live alone, we belong to the community.”

RIDING THE STORM
Abbot Sayardaw points out that communities need constant support and everyone has a role to play, citing the recent floods that devastated Myanmar as an example. Heavy monsoon rains from July to September resulted in mass flooding that caused 103 deaths, displacing as many as a million people.

“Many hard-to-reach communities struggled. Burmese migrant workers in Bangkok got together to raise donations for us to be able to buy medicine, rice, pots, bottled water, clothing, tarpaulins, iodine, insect repellent and dried noodles.”

Abbot Sayardaw shows photographs of his drive and boat trips to the hard-to-reach communities. Four-wheeled vehicles are bogged down in deep mud and overloaded boats float dangerously low on flood-swollen rivers. Among the vast array of supplies, the abbot is sat. “It was dangerous, we had to wear safety vests all the time we were in the boat.”

Abbot Sayardaw moves awkwardly from a chair to the bamboo floor, and up to standing. He does a painful stretch and pulls apart his robe to reveal a thick scar along his spine and lower back.

“My back problem is a degenerative condition caused by carrying heavy loads like coffins, quarrying stones for building pagodas and doing temple repairs. I was in pain, I was helpless with no money, but I was operated on by two surgeons for free, and an anonymous person donated 1.5 million kyat. I wanted to pay back that kindness to the community.”

Abbot Sayardaw said he can no longer take part in a ritual that teaches monks about death and impermanence. “I used to mediate in a coffin for three to seven days twice a month without food — my back pain prevents me from doing that now.”

TENDER LOVING CARE
Naw Tender, who was for 13 years a medic at Dr Cythnia’s renowned Mae Tao Clinic on the Thai-Myanmar border, now runs a small clinic in a converted room of her house, about 60km from Hpa-an. The room is three by 10 metres, with enough space for a row of single beds. Surrounded by mountains, the clinic buzzes with villagers seeking medical assistance.

“I see about 900 patients a month. My treatment is cheaper than the hospital. I only charge for the medicine. I provide midwifery help, eye screenings and general health care. I treat urinary tract infections, measles, dengue, diabetes, respiratory infections and TB. This year I delivered 22 babies.”

Naw Tender said 2015 was a bad year for dengue fever. “We had 15 cases this month alone and treated 653 cases this year. We had an eight-year-old girl die — she had severe dengue, she got to hospital but it was too late.”

Despite the challenges, she is happy to be back working in her own country. “I miss the Mae Tao Clinic, but I never felt free working in another country. I was born in Myanmar. Even if our country is poor, I still love it and am proud of it. I came back to work directly with my community. I can improve the health of the people here.”

Naw Tender has just begun a working relationship with Abbot Sayardaw. “He’s energetic and trying to do his best,” she said. “We are working with him on eye screening. I act as support and adviser on complicated cases. There are many cases of glaucoma, trachoma and cataracts.”

She is optimistic that Aung San Suu Kyi’s National League for Democracy’s recent election victory will herald a new future for Myanmar. “It’s time for a change. I would love to see all our people — refugees, the displaced, migrant workers — come back to make our country a better place.”

Abbot Sayardaw points out that Myanmar must develop for the benefit of its entire population, regardless of ethnicity or religion. “If the poor don’t have work that pays them living wages, they will migrate. We need our people to stay and work here in our communities.”

He says life is not about the wealth you accumulate or the number of university degrees you earn, but the positive contribution you make to the community. “You can be highly educated, but have learned nothing about life. There are many kinds of education and many highly educated people go through life blind while only thinking of their own advancement. I’m filled with gratitude to the people who taught me to understand the power of giving.”

*This Article first appeared on Bangkok Post on 27/12/2015