Having led Thailand's first medical mission last month to cyclone-ravaged Burma (Myanmar), Pichit Siriwan, a doctor, was on standby for another two-week tour. But last week he got word that Burmese authorities no longer needed the services of his 30-person team.
The notice came as part of a broad drawdown of Asian medics in the disaster zone – another entry, perhaps, in the ledger of international outrage against a junta whose deep suspicion of foreign influence has slowed aid efforts since a May 2-3 cyclone killed tens of thousands of people.
For weeks, aid agencies have warned of the threat of disease to survivors and called for greater international assistance in affected areas, which are under tight military control.
But another explanation for the exodus of Asian doctors, whose primary role was in temporary camps, may be the shifting nature of the disaster.
As more people return to their shattered communities, aid workers are trying to put in place village-level systems that can offer preventive primary care and screen the population for any epidemic outbreaks.
These rely more on local volunteers and mobile clinics than on hospitals and foreign doctors, who are usually primed to treat trauma patients.
Aid agencies say that cyclone-affected areas are reporting cases of various diseases, as well as mental trauma from the tragedy.
But aside from the emotional trauma, all these conditions were long prevalent in the Irrawaddy Delta and elsewhere in Burma, a grindingly poor and insurgent-racked country that spends a minuscule proportion of its income on healthcare.
In Laputta, a delta township of roughly 350,000 people, the main hospital is said to have only one fully qualified doctor.
Last week, the UN warned of a shortage of trained midwives and clean facilities for tens of thousands of pregnant women in the delta. William Ryan, a spokesperson for the UN Population Fund, told reporters that health kits designed for safe deliveries were being sent via Burma's Ministry of Health to affected areas.
Burma's maternal mortality rate of 380 per 100,000 live births is four times higher than that of neighboring Thailand.
Dispersed survivors hard to reach
Aid workers say the closure of displacement camps in the delta, which international human rights groups have criticized as forced relocation, has added to the urgency of rebuilding local health networks. The dispersal of survivors to remote areas where water and food supplies are uncertain is stretching local medical personnel, whose numbers were already depleted by the tragedy.
But aid workers haven't received reports of any major disease outbreaks, such as cholera and measles, as many had originally warned.
Infrastructure in the delta also took a hit. In a preliminary assessment, the World Health Organization said last month that about half of rural health centers and 20 percent of hospitals had suffered cyclone damage, with many losing their roofs to the storm and a tidal surge.
Aid agencies are hoping to get a clearer picture of short- and long-term needs, including the provision of health services, once a survey team of 250 UN and Association of Southeast Asian Nations experts currently working with Burmese counterparts returns from the delta next week. They are due to present their findings on June 24.
"If there are challenges, they will be in the villages," says John Sparrow, a spokesman for the International Federation of Red Cross and Red Crescent Societies (IFRC), which plans to set up 200 small health centers that can offer preventive care and basic first aid. Burma's Red Cross has about 10,000 volunteers in the delta, according to the IFRC.
Over the past two years, Merlin, a British medical charity, had trained and equipped more than 500 community health volunteers in the delta and had begun to scale down its program before the cyclone, says Jacqueline Koch, a spokesperson currently in Laputta.
At least 80 volunteers died in the disaster and hundreds more are still missing. Merlin is now helping to repair health facilities and is operating mobile clinics, including one on a specially equipped boat, that have treated about 10,000 patients.
Inured to government neglect
Such responses are common in international emergencies. But most ordinary Burmese expect virtually no public services and are reliant on their own families and communities for support, say aid workers and foreign observers.
The junta's piecemeal response fits a pattern of neglect that has inured many people to its shortcomings, while an outflow of private aid, at least until recently, has helped tide over some of those left destitute by the storm.
"Even before the cyclone, there were chronic shortages.... We're trying to fill the gap for medical care," says Osamu Kunii, head of health and nutrition in Burma for Unicef, which is supplying nutrition supplements, vaccines, water purification kits, and other health supplies in the delta.
"Most of the affected people are now returning to the villages. It's quite difficult for us to get access" to these far-flung areas, Mr. Osamu adds.
Burmese authorities have told aid agencies that doctors and nurses from other parts of the country are being sent to the delta, though it's unclear whether these are mobile teams or short-term replacements. Nor is there any national plan yet for rebuilding wrecked clinics and hospitals.
Given these acute shortages, the decision to send away Asian doctors seems perverse, even if their original deployment was in an emergency capacity, says a Western diplomat in Bangkok.
But it fits the junta's pattern of asserting that the crisis is over and that villagers must go back to rebuild their houses and farms, whatever the state of the health system.
Pichit, the doctor, says that his team was grateful for the opportunity to work in Burma, where they treated 3,700 patients during their two-week stay. "I think many of the doctors were willing to help more, especially with the children. But it's their country," he says.