Deep into a deadly outbreak partly fueled by the Delta variant, the targeting of healthcare workers by the country’s military junta has forced them into the shadows, just when they are needed most. Almost 200 doctors have been arrested and hundreds of others have been issued arrest warrants for defying the junta, according to an analysis released Tuesday by Physicians for Human Rights. Others have gone into hiding, afraid they will be next.
Many are now treating patients on their own, in secret.
Dr. Wai Phyo Kyaw, a 33-year-old surgeon in the central Myanmar city of Mandalay, is one of the country’s rogue doctors. He sleeps at safe houses, moving to a new hiding place about every two weeks. He has more than 20 patients who consult with him through phone or video calls, and his clandestine house visits. He has little protective equipment—sometimes he doesn’t even wear gloves—and had only one vaccine dose in January. If caught, he could be jailed.
“I don’t worry about getting caught or infected,” he said in an interview. “I made up my mind to help people.”
Myanmar’s response to rising Covid-19 cases has been hobbled by the country’s political crisis, with many doctors at the forefront of efforts to resist military rule. Doctors were among the first to go on strike after the military seized power on Feb. 1, refusing to staff government-run hospitals because they viewed it as legitimizing the regime. Highly revered in Myanmar society, their strike sent a powerful message to ordinary citizens to take a stand against the coup. Within days, millions took to the streets in protest.
Authorities responded with a violent campaign to crush the protests, in which thousands of civilians were arrested and hundreds killed. As the Covid-19 crisis worsened, the junta mounted pressure on medical workers to return to work. Few of them did, leaving hospitals short on personnel. Informal healthcare services then became the main lifeline for thousands of new Covid-19 patients each day. The military has tried to fill vacancies with army medics, and in some cases deployed armed soldiers to occupy hospitals, but that only reinforced public distrust of the formal healthcare sector.
Consequently, the country’s Covid-19 crisis is largely invisible. Signs of a spiraling outbreak emerged in early July, when photos spread widely on social media showing long lines of people waiting to refill oxygen tanks. Volunteer ambulance drivers said that around that time, they began receiving dozens of calls a day to help families transport bodies of people who died at home. Crematoriums were soon overflowing with corpses, prompting the military to announce on state-controlled television in late July that it would build at least 10 new ones.
According to official figures, Myanmar has recorded 12,000 deaths from the disease. While government data clearly shows a surge of infections beginning in early July—the total number of cases has doubled since then to more than 333,000—health experts say it captures only a fraction of the true scale of transmission. Testing is limited and the test positivity rate is high, over 29% as of Aug. 7, according to the World Health Organization. Only those tested at formal health facilities are counted. Covid-19-related deaths are also likely undercounted by a large margin, health experts said, because many people are dying at home or without being tested.
Only about 2.8% of the country’s 54 million people are fully vaccinated, according to the latest figures published by Our World in Data, dated June 5. A nationwide vaccination campaign began under the civilian government in late January, but stalled just days later in the wake of the coup. Delivery of 3.6 million doses under the Covax initiative, a multibillion-dollar program to immunize the world against Covid-19, was canceled due to political instability, and a new allocation of more than 4 million doses has yet to arrive. The junta says it has purchased millions of doses from China and Russia, and will try to fill any remaining shortfall with orders from India.
Gauging the scale of transmission is difficult in part because many people rely on informal healthcare services carried out in secret. Dr. Wai Phyo, who volunteers and hasn’t been paid since he went on strike on Feb. 3, said he doesn’t advertise and isn’t affiliated with any organization. Patients find him through word-of-mouth. At first he received a few phone calls a week from friends whose wives and relatives were sick with fever and respiratory symptoms. Then the calls became more frequent, as friends of friends sought his help after being turned away from hospitals.
Dr. Wai Phyo answers only calls that he is expecting. Acquaintances who refer patients will let him know in advance so that he can look out for their numbers. He does a phone consultation with each new patient first, asking about the family’s medical history and whether any household members suffer from comorbidities. If he suspects Covid-19, he will send them a shopping list of medicine and supplies, along with the names of trusted sellers, and set up a treatment tutorial over a video messaging app. He instructs them to buy antigen rapid tests online to confirm their diagnosis.
For the most severe cases, Dr. Wai Phyo makes house visits at least once a day. He said he currently has 15 patients he can treat remotely and six who require regular in-person care.
One patient, a 70-year-old woman, has been on oxygen in her home for more than four weeks, he said. He visits her every day to administer injections of enoxaparin, an anticoagulant that prevents blood clots, and dexamethasone, to treat inflammation of the lungs. When he isn’t there, her relatives, themselves unvaccinated and protected only by disposable surgical masks, take turns switching her from an oxygen concentrator to the refillable tanks they use at night to avoid disruptions to her air supply during frequent electrical outages.
“She’s improved a little, but I’d say her chances are 50/50,” Dr. Wai Phyo said. “There’s only so much I can do.”
Physicians like Dr. Wai Phyo work at great risk to their personal safety and freedom. Many, like him, operate on their own, while others are affiliated with established medical associations or smaller civil society groups that emerged in the wake of the crisis. Working with such organizations has become increasingly dangerous, as their higher public profile makes them vulnerable to retribution.
In late July, five doctors were arrested in Yangon, Myanmar’s largest city, after authorities allegedly lured responders to a residence on the pretense of a sick patient. Three doctors were detained immediately at the site and two others were detained during a subsequent raid on their office, according to a representative of the organization, the Covid-19 Prevention and People’s Benefit Group, which has since suspended operations.
Dr. Wai Phyo hasn’t been issued an arrest warrant, but he thinks it’s a matter of time. Many doctors like him have been charged with incitement, punishable by up to three years of imprisonment.
Myanmar’s junta leader, Gen. Min Aung Hlaing, said in a televised speech on Aug. 1 that the Covid-19 crisis was being exacerbated by extremist members of the National League for Democracy, the political party of the ousted civilian government led by a now imprisoned Aung San Suu Kyi, claiming they incited health workers to strike. “We are making our utmost efforts in carrying out the prevention, control and treatment activities in collaboration with the people,” he said.
But human rights advocates say the junta has targeted doctors and at times obstructed efforts to combat the virus. In the analysis published on Tuesday, Physicians for Human Rights and its partners Insecurity Insight and Johns Hopkins University Center for Public Health and Human Rights, said they had documented 252 incidents of violence against healthcare workers or obstruction of health services over the past six months. Since the coup, at least 190 healthcare workers have been arrested and 25 were killed, the group said. Other incidents included 86 raids on hospitals, 55 military occupations of health facilities and several instances of supplies and ambulances being seized or destroyed.
“It’s an incredibly dangerous time for doctors right now, they’re facing multiple threats while they’re in the middle of a very dangerous epidemic that’s ravaging the country,” said Jennifer Leigh, the lead Myanmar researcher at Physicians for Human Rights. “The fact that they continue to serve their community is a testament to their commitment to their calling.”
This story has been published from a wire agency feed without modifications to the text
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