Nearly two decades of treating Burmese migrants on the Thai border has taught Cynthia Maung, herself a political refugee from military-ruled Burma (Myanmar), to expect the unexpected. Every day brings more migrants to her private clinic – many of whom can't afford treatment.
On Monday, the unexpected came from an entirely different direction: a hastily arranged teleconference with the White House. At the other end of the link-up was first lady Laura Bush, flanked by her husband's senior advisers on Asian affairs. She praised Dr. Maung's work, calling her "an inspiration," and sent a typically firm message to the Burmese government.
"Members of the junta have promised to engage in a serious dialogue with democratic representatives of the Burmese people," Mrs. Bush said. "If [junta leader] Than Shwe and the generals cannot meet these very basic requirements, then it's time for them to move aside."
Bush has stepped up a personal campaign in recent months to keep Burma in the headlines, even as international outrage ebbs over the regime's suppression in September of peaceful protests led by Buddhist monks.
At that time, she urged UN Secretary-General Ban Ki Moon to act and stood beside President Bush when he announced further US sanctions on Burma at the UN General Assembly. Last month she added her voice to campaigners seeking a global boycott on gems from Burma.
It's a role that appears to be driven by personal conviction as much as politics, say US officials and Burmese analysts. But how effective it proves in swaying an isolated regime that has long resisted pressure for political change is uncertain.
Nearly three months after widespread protests, diplomatic momentum against the junta appears to be slowing. Bush's emphasis on regime change if Burma fails to make reforms puts the US at odds with Thailand and China, which fear political instability on their borders. For their part, US officials argue that the current standoff in Burma is brewing more trouble for its neighbors than appeasing the junta.
Last month, Southeast Asian nations held a summit that offered little in the way of criticism of Burma, reversing their earlier condemnation of the bloodshed during the UN General Assembly. An invitation for the UN Security Council's special envoy to Burma, Ibrahim Gambari, to speak was withdrawn at Burma's request.
Analysts say the US has only limited tools to shape political events in Burma, which has courted its energy-hungry neighbors with oil and gas deals. They warn that US sanctions aren't swaying Burma's generals, even if they win plaudits from democracy activists. Nor can it be a substitute, say analysts, for diplomatic pressure in Asia and on the UN Security Council, whose special envoy, Mr. Gambari, is due to visit again this month.
But to pro-democracy groups left despondent by the violent crackdown on the democracy movement, the first lady is a welcome voice in the darkness.
"I think her engagement will help keep the spotlight on Burma, since the regime has switched off the lights inside, so to speak," says Maureen Aung-Thwin, director of the Burma Program at the Open Society in New York.