Getting to Naga
Situated in the mountainous far north-west of Myanmar's Sagaing region, Naga Self-Administered Zone is one of the most remote parts of the country, and home to the Naga people, a community living on both sides of the India-Myanmar border.
The Naga people are comprised of many tribes and retain a strong sense of cultural identity. Many in Naga, particularly in the more rural communities, sustain themselves and their families through subsistence agriculture and hunting.
In the rainy season, journeys between the two towns can take far longer than four hours and may even prove impossible if there are landslides or floods.
Mountainous terrain and remote villages make it difficult for people in rural communities to access basic healthcare services, even more so during the rainy season, when some of the villages can be cut off for several months.
MSF has been working in the Naga Self-Administered Zone since 2016; providing primary healthcare, hospital referrals and health education for 15 different villages in Lahe Township and supporting the Ministry of Health and Sports' (MoHS) hospital in Lahe town. We also assist in tuberculosis testing and in organising vaccination campaigns in the communities.
Our teams visit each of the 15 villages around once or twice each month. The mobile clinic team always includes a doctor and a pharmacist.
The teams rely mostly on motorcycles to traverse challenging terrain, with some of the journeys lasting up to eight hours.
Given the challenges many people face in reaching healthcare facilities, MSF's mobile teams can be a lifeline in emergencies and for those with serious illnesses.
The most common reasons for patients seeking medical treatment are respiratory tract infections, musculoskeletal pain and diarrhoea.
Low vaccination coverage is also an issue in the remote communities in Naga, leaving people vulnerable to preventable diseases. MSF has therefore supported MoHS in carrying out several vaccination campaigns in the past years.
Staying warm in the mountains
Naga is approximately 1,800 metres above sea level. During the winter months, temperatures can drop below zero, becoming particularly cold at night.
Most people live in wooden houses with thatched roofs, indoor fireplaces provide warmth and a place to dry meat and cook. Fires tend to burn constantly, keeping the houses warm, but making coughs and upper respiratory infections common.
Kyun lives in Hay Khun village and has made her living through subsistence agriculture. She has had an eye condition for 10 years, and now receives treatment from the MSF mobile clinic team.
It’s so much easier to see the MSF doctors when they come here. It was different when I was young – when someone was sick, there just wasn’t anywhere to go.Kyun
“I’ve always lived here [in Hay Khun village - several hours' off-road driving from Lahe],” Kyun says. “I’ve made my living growing rice and corn in the mountains, but I don’t work anymore – now my husband and my daughter, Kyakin, grow food for us to eat. She also has three children.”
“I believe I am around 70 years old, but I’m not sure. There have been a lot of changes in Naga since our ancestors’ time – now we wear a lot more clothes! The traditional style is to wear a lot less. The nearest big towns for us are Lahe and Khamti, but it takes a long time to travel to either town, and you need a motorbike.
“I first went to see the MSF doctors because of my eye – it feels itchy and hot, and it’s been this way for ten years now. I only started seeing the doctors recently, and they’re working on my treatment.”
Kyakin is Kyun's daughter. She also visits the mobile clinic, along with her children.
I went to the MSF clinic for the first time yesterday for a pregnancy test. I already have three children – I delivered all of them at home by myself.Kyakin
“The most important thing for me is that they are educated, I would be sad if they had the same life I have – having to farm every day for food is exhausting,” Kyakin says. “It’s especially difficult to work without cows, to pull the ploughs, because we need to do everything manually.”
“If it weren’t for MSF, I wouldn’t be alive today,” Kamor says. “Before I had medicine, I was so sick that I couldn’t move from my bed. But now I feel healthy and fit again. Before being treated, my whole body hurt and especially my chest.”
“I’m not sure of my exact age, but I think I’m over 80. I’ve seen a lot of changes in my life. I remember the different tribes fighting when I was young, and the establishment of Lahe township.
“Before the Christians and Buddhists and then the doctors came, we used to rely on a shaman when we were sick – sometimes they would tell us to sacrifice an animal. I’ve always been a farmer, but I don’t work anymore, so now my family support me with food and I stay home and cook.”
The work of MSF staff
Many of MSF's staff working in Naga are from the region itself, and some describe working for an organisation like MSF as a way to support the community.
Ma May Sandi Aung, Nurse
I came to work in MSF’s Naga project because I wanted to be close to the patients, to work with them in their villages and to provide medical care directly.
My mother is a midwife and she used to work in Wa Self-Administered Division. She’s an inspiration to me – I’ve wanted to be a nurse since my childhood.
I read a lot about Naga and Lahe before I joined this project. I knew about the transportation challenges too, but I want people to receive medical care – even if they’re hard to reach. The challenges we face as a team bring us closer together.
Here in Naga, there is little health education and people don’t trust strangers easily. Not everyone realises that they can come to the MSF mobile clinics for treatment. Because of that, we work a lot with village administrators – they help to introduce us to communities, build trust, and explain our services.
Joshua Pakaw Hlaing Bu, Finance and HR Assistant
I wanted to work with MSF because I want to be able to help the community here, especially when it comes to healthcare – it’s something we need, and health education in particular.
I care about the development of this community. When my friends ask me who I work for, I explain that MSF is a humanitarian organisation, specialising in different kinds of medical care. In the future I hope to run a small hostel for students coming from the rural villages to study in Lahe town, to ensure they have a place to stay. My goal is to contribute to the development of Naga’s youth, either through healthcare as I’m doing now, or through education.
Moses Mawlan, Health Promotion Officer
I mainly focus on behavioural change, asking how I can encourage people to lead healthier lifestyles. Some people still stay at home even if they are sick, and that’s not good. Because there were no medical staff coming to the rural villages until recently, people have little health knowledge. For people who have lived most of their lives without medical care as a part of daily life, seeking healthcare isn’t a natural instinct.
For me, it’s important that we change people’s mindset when it comes to health, and the way to do that is through health education.
Travelling to the more rural villages is particularly difficult during the rainy season. The roads and paths become far more challenging, and small streams swell to the size of rivers – in some cases we need to use rafts to cross them. There are times when we have to carry our motorbikes – sometimes mountain paths collapse from landslides, creating sheer drops. Sometimes travel just isn’t possible, and we have to cancel some of our outreach activities.
I will never quit my job because of these challenges. I think that experiences like this are important. Many challenges can be found in life, but we can only find solutions if we confront the challenges.
All photos © MSF/Scott Hamilton, © MSF/Khine Nwe Zin