VZCZCXRO0605
RR RUEHCHI RUEHDT RUEHHM RUEHNH
DE RUEHGO #0577/01 2000729
ZNR UUUUU ZZH
R 180729Z JUL 08
FM AMEMBASSY RANGOON
TO RUEHC/SECSTATE WASHDC 7930
RUCNASE/ASEAN MEMBER COLLECTIVE
RUEHBJ/AMEMBASSY BEIJING 1942
RUEHBY/AMEMBASSY CANBERRA 1361
RUEHKA/AMEMBASSY DHAKA 4925
RUEHLO/AMEMBASSY LONDON 2041
RUEHNE/AMEMBASSY NEW DELHI 4883
RUEHUL/AMEMBASSY SEOUL 8449
RUEHTC/AMEMBASSY THE HAGUE 0688
RUEHKO/AMEMBASSY TOKYO 6011
RUEHRO/AMEMBASSY ROME 0175
RUEHFR/AMEMBASSY PARIS 0594
RUEHCN/AMCONSUL CHENGDU 1519
RUEHCHI/AMCONSUL CHIANG MAI 1714
RUEHCI/AMCONSUL KOLKATA 0370
RUEAUSA/DEPT OF HHS WASHDC
RHHMUNA/CDR USPACOM HONOLULU HI
RUEHPH/CDC ATLANTA GA
RUCLRFA/USDA WASHDC
RUEHRC/USDA FAS WASHDC
RHEHNSC/NSC WASHDC
RUCNDT/USMISSION USUN NEW YORK 1863
RUEKJCS/SECDEF WASHDC
RUEHBS/USEU BRUSSELS
RUEKJCS/JOINT STAFF WASHDC

UNCLAS SECTION 01 OF 04 RANGOON 000577 
 
SENSITIVE 
SIPDIS 
 
DEPT FOR EAP/EX; EAP/MLS; EAP/EP; EAP/PD 
DEPT FOR OES/STC/MGOLDBERG AND PBATES; OES/PCI/ASTEWART; 
OES/IHA/DSINGER AND NCOMELLA 
DEPT PASS TO USAID/ANE/CLEMENTS AND GH/CARROLL 
CDC ATLANTA FOR COGH SDOWELL and NCID/IB AMOEN 
USDA FOR OSEC AND APHIS 
USDA FOR FAS/DLP/HWETZEL AND FAS/ICD/LAIDIG 
USDA/FAS FOR FAA/YOUNG, MOLSTAD, ICD/PETTRIE, ROSENBLUM 
DOD FOR OSD/ISA/AP FOR LEW STERN 
PARIS FOR FAS/AG MINISTER COUNSELOR/OIE 
ROME FOR FAO 
BANGKOK FOR REO OFFICE, USAID/RDMA HEALTH OFFICE - JMACARTHUR, 
CBOWES 
TOKYO FOR HEALTH OFFICER 
PACOM FOR FPA 
 
E.O. 12958:N/A 
TAGS: ECON TBIO EAID SOCI PGOV BM
SUBJECT: BURMA: DELTA HEALTH CONDITIONS CONTINUE TO IMPROVE 
 
Ref:  Rangoon 531 
 
RANGOON 00000577  001.2 OF 004 
 
 
¶1.  (SBU) Summary.  According to UN and NGO officials working in the 
Irrawaddy Delta, the health situation in the delta after Cyclone 
Nargis continues to improve.  While there have been no disease 
epidemics, health NGOs report cases of dengue, diarrhea, and acute 
respiratory infection throughout the region.  The number of cases 
continues to decrease each week.  GOB and international 
organizations continue to work with affected villages to improve 
water sanitation, provide medical treatment through mobile clinics, 
and repair Ministry of Health clinics destroyed by the storm.  As 
relief efforts continue, health NGOs working in the delta have 
improved coordination, providing medical care to thousands of 
affected villages.  During a trip to the Irrawaddy Delta July 8-12, 
we observed that the ten villages we visited had received some 
health treatment from either the GOB or NGO mobile clinics.  Village 
leaders confirmed that their people were in good health and that 
from a health perspective, their greatest concern was securing 
access to potable water and improving sanitary conditions in the 
villages.  End Summary. 
 
¶2.  (U) Between July 8-12, a USAID/OFDA officer, USAID/RDMA Health 
officer, Econoff, Poloff, and local staff member traveled to Labutta 
and Ngapudaw Townships in the Irrawaddy Delta.  The team visited ten 
villages - Ye Wei, Zin Ywe Kyi, Sin Chay Yar, Ka Pyo, Gant Eik, Yin 
Dee Lay, and Sa Kyin in Labutta Township and Thaketa, Gwe Chaung, 
Kan Seik in Ngapudaw Township. 
 
Health Providers on the Ground 
------------------------------ 
 
¶3.  (SBU) Cyclone Nargis, which struck Burma May 2-3, destroyed much 
of the Irrawaddy Delta, including more than 250 large public and 
private health facilities (Reftel).  World Health Organization 
Health Cluster Coordinator Margareta Skold told us that the storm 
severely damaged 17 Ministry of Health Rural Health Centers (RHCs) 
and 120 Sub-Rural Health Centers (SRHCs); an additional 800 smaller 
MOH clinics (one or two person offices) needed renovation.  The MOH, 
working with private businesses and NGOs, have done substantial work 
to either repair health clinics or construct temporary clinics and 
restock them with medicines, she noted.  Dr. Saw Aung, Medical 
Coordinator for UNICEF's Labutta office told us that since July 1, 
70 percent of the RHCs and SRHCs in Labutta Township and 60 percent 
of the RHCs and SRHCs in Ngapudaw Township have resumed operations. 
Consequently, the health situation in the Irrawaddy Delta continued 
to improve daily as more villages gain access to medical treatment, 
he opined. 
 
¶4.  (SBU)  Despite the reopening of RHCs and SRHCs, health NGOs 
continue to provide much of the medical care in the delta.  Dr. May 
 
RANGOON 00000577  002.2 OF 004 
 
 
Win Thin, Project Coordinator for MSF-Holland Labutta told us that 
many of the RHCs and SRHCs lack trained medical staff or enough 
medicines.  MSF-Holland and other NGOs, such as Save the Children, 
Malteser, and Merlin, continue to use their mobile medical teams to 
provide treatment to the most vulnerable populations, often living 
in villages that lack either a RHC or SRHC.  MSF recently opened a 
total of eight fixed clinics in Labutta and Ngapudaw Townships, 
which the mobile teams use as a base, she noted.  Teams travel 
around to neighboring villages for up to two weeks at a time. 
According to Dr. May Win Thin, the MSF mobile teams treat mainly 
acute respiratory infections, minor injuries, and mild cases of 
diarrhea.  MSF and other NGOs are closely monitoring patients living 
in camps for signs of psychosocial trauma, which she opined will 
become more prevalent in the coming months. 
 
¶5.  (SBU) During our trip, we observed that the level of medical 
care varied greatly among the affected villages in the delta. 
Larger villages, with populations of 2,000 or more, had at least one 
public or private clinic, staffed by either a doctor or a health 
assistant.  Two villages had at least two doctors who provided care 
to the village and the surrounding area.  Kan Seik, the most 
vulnerable village we visited, had no clinic, so villagers had to 
make a trip by boat the closest village.  Villagers told us that 
immediately after the storm, they received free care; however, they 
now have to pay private doctors for treatment.  As a result, 
villagers were reluctant to seek treatment, they told us.  The Sin 
Chay Yar village leader told us that they also must seek care in a 
nearby village, but that the doctors still provided treatment free 
of charge.  How can doctors request payment when people have no 
money to buy food, he asked. 
 
¶6.  (SBU)  NGOs working in the delta have improved their 
coordination, to avoid duplication and overlap of activities.  Dr. 
Thant, leader of an MSF-Holland Mobile Clinic working in Gwe Chaung 
village, told us that the health NGOs working in Ngapudaw meet 
routinely to discuss activities and seek ways to improve villages' 
access to care.  The four health NGOs working on Middle Island in 
Ngapudaw Township - MSF-Holland, Save the Children, Merlin, and 
Malteser - have divided up the island, with each NGO taking 
responsibility for specific villages.  At the national level, the UN 
Health Cluster is working with NGOs to map out the affected 
villages, denoting which organization is providing what service to 
villages to prevent overlap and maximize services. 
 
Limited Cases, But No Disease Outbreaks 
--------------------------------------- 
 
¶7.  (SBU)  Both Dr. Saw Aung and Dr. May Win Thin emphasized that 
neither UN agencies nor NGOs have observed any widespread outbreaks 
of disease in the delta, beyond what is normal this time of year. 
 
RANGOON 00000577  003.2 OF 004 
 
 
Immediately after the storm, there were many cases of diarrhea and 
dysentery, but once villages received clean water, the number of 
cases substantially dropped.  Mobile teams reported that in the 
first month after the storm, they primarily treated patients for 
injuries sustained by the storm.  Health cluster officials described 
scattered cases of dengue and malaria, as well as isolated cases of 
tetanus and measles. 
 
¶8.  (SBU) Village leaders told us that there were no major medical 
issues in any of their villages.  The health assistant from Gant Eik 
(village population 2,860) explained that immediately after the 
storm, she treated up to 100 patients a day, primarily injuries, 
acute respiratory infections, and mild diarrhea cases.  Currently, 
clinic staff treat 30-40 patients a day.  Like other villages in 
Labutta and Ngapudaw, Gant Eik received medical and hygiene kits 
from NGOs such as Merlin, Save the Children, and MSF. 
 
¶9.  (SBU)  Despite reports that dengue and dengue hemorrhagic fever 
were on the rise in the delta, we found only a few villages that had 
any dengue cases.  According to WHO Vector-Bourne Disease Expert Dr. 
Leonard Ortega, the MOH, working with NGO partners, began 
larvaciding operations and educational outreach on the dangers of 
dengue and malaria in Labutta and Ngapudaw in early July.  None of 
the villages we visited had seen any of the MOH activities, although 
some, on their own initiative, were conducting dengue and malaria 
educational outreach. 
 
Water and Sanitation Desperately Needed 
--------------------------------------- 
 
¶10.  (SBU) According to village leaders, access to water and 
sanitation ranked third among their concerns, after food and 
permanent shelter.  Many villages in Labutta and Ngapudaw were in 
the process of working with NGOs to clean their water ponds, pumping 
water out and using lime and other chemicals to sanitize the area. 
However, this process can take up to several weeks, and most of the 
villages lacked the diesel to power the water pumps.  Consequently, 
the villagers were using pots and tarps to collect rain water. 
While this system allowed them to store potable water, it also 
provided a breeding ground for dengue-carrying mosquitoes.  Several 
villages had UNDP-provided water tanks for water collection systems, 
which were built more than ten years ago.  The villages with UNDP 
water tanks reported far fewer cases of diarrhea and dysentery, 
probably due to the provision of clean water quickly after the 
storm. 
 
¶11.  (SBU) During our tours of the villages, we noticed that most 
villages had very few latrines, with up to 25 people using one 
latrine in some villages.  In Kan Seik, the village had a total of 
60 latrines before the storm; currently there are five remaining. 
 
RANGOON 00000577  004.2 OF 004 
 
 
Village leaders informed us of their plans to repair latrines, but 
they lacked the funds to purchase new commodes.  Health assistants 
agreed on the urgency for improved sanitation.  In Gant Eik, the RHC 
sent one medical assistant to surrounding villages to explain the 
importance of clean water and sanitary conditions. 
 
Comment 
------- 
 
¶12.  (SBU)  Health conditions in the delta continue to improve, not 
because of the efforts put forth by the Burmese Government but 
rather because residents took the initiative to improve their own 
situations.  NGOs remain committed to providing medical supplies and 
treatment to affected villages.  Before the storm, the Rural and 
Sub-rural Health Centers provided minimal service at best. 
Currently, due to lack of medicines and medical equipment, 
government health workers provide even less care.  Until Burma 
develops an improved health care system, villagers in the delta will 
remain dependent on private clinics and mobile medical teams, as 
long as they remain operational, for treatment.  Because of the 
regime's paltry funding of the health system, the Nargis disaster 
relief assistance has brought improved health care to the delta. 
How long this continues depends on UN and INGO continued access to 
the delta.