When Cynthia Maung stumbled across the Thai-Myanmar border into Mae Sot in 1988 after a 10-day jungle trek to flee a military crackdown in Yangon, she planned to stay a few months at most. Twenty-two years later, Dr Maung's Mae Tao clinic is a border institution, employing a staff of 634 who provide treatment to more than 2,000 patients a day suffering from malaria to amputated limbs.
Maung's pioneering health work for Burmese refugees and migrant workers has not gone unnoticed. She has won a dozen international awards, including the Ramon Magsaysay award in 2003, and a Nobel Peace Prize nomination in 2005. The clinic, founded by Maung in 1989, has grown from a makeshift shack where she sterilised thermometers in a rice cooker to a sprawling, albeit still makeshift, community hospital with 150 beds, a laboratory, pharmacy, prosthetics centre, first-aid training programmes and a school.
Nearly half the patients are migrant workers and their families living in around Mae Sot, where an estimated 200,000 Burmese survive in a semi-legal limbo.
The rest of her patients come from across the border. "Every day we see more and more people seeking help," Maung said. "Our most severe cases come from inside Burma." Not all are fleeing fighting and landmines. Some are simply escaping Myanmar's notoriously poor medical system.
War Yar Htuu, a 15-year-old from Myawadi, across the Moei River from Mae Sot, came to get treatment for a leg infection. "I had no money to go to a Myanmar hospital," said Htuu. "The hospitals in Myanmar are okay but they only accept you if you have money." After 48 years of military rule, Myanmar has gone from being one of the richest countries in South-East Asia to one of the poorest, with among the worst health and education systems in the region.
"The system itself does not work, not even in central Burma," Maung said. "Only people with money can use the health service." Because of Myanmar's pariah status as a brutally run military state, it ranks among the world's lowest recipients of foreign aid, receiving less than 2 dollars per person each year.
Operations such as Mae Tao clinic, on the other hand, survive on foreign largesse. Maung estimates that 95 per cent of her annual operating budget of about 3 million dollars comes from foreign donors, the rest is met by a token 1-dollar registration fee per patient.
With her patient load increasing 5-10 per cent annually, the clinic is facing a budget shortfall this year, which is managed by cutbacks on free food and postponing improvements. The long term, especially with an election promised by Myanmar's junta some time this year, is more worrying. Although few expect the polls to be free or fair, the outcome is likely to increase aid going into Myanmar, and less to cross-border operations.
"Definitely, most donors want to do more inside and less cross-border, and I think that trend will continue after the election," said one Bangkok-based European diplomat. Donations to political groups in exile, based along the border, are already drying up, and are expected to end after the polls as these groups look increasingly ineffective, sources said.
More worrisome is the potential impact on cross-border operations such as health services, the more than 60 schools catering to Burmese migrant children and labour protection groups. There are some 130 Myanmar-related non-governmental organisations in Mae Sot alone.
"That's the big concern," said David Mathieson, Myanmar expert for Human Rights Watch. "Because after the election it's not like the root problems are going to change. It's not as if all the Burmese refugees and migrant workers are going to go home after the polls, even if that's what the Thai government wants to happen." Thailand has yet to clarify its post-election policy towards the estimated 2 million Burmese refugees and migrant workers on its soil.
Like most governments, Bangkok is waiting to see what the polls bring, but most observers anticipate a sham election that will install a pro-military government. "After the election things will become clearer for the international community," said Mahn Mahn, executive director of the Back Pack Health Workers Team, that works with the Mae Tao clinic to train health workers inside Myanmar. "It will be clear what the election hasn't achieved."
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