A clinic on Thailand's border with Burma is struggling to treat a rising flood of Burmese patients -- a reflection of the country's political repression and economic woes.
It is inoculation day at the Mae Tao Clinic in Mae Sot township on the Thai-Burma border. Mothers and fathers cradle their young as they wait to see a doctor or medic. The room is a simple one -- mats on a concrete floor for waiting patients to sit on and tables along the walls where the staff attends to the children.
Almost all of the patients came from Burma, some now live in Thailand as refugees or illegal workers. Others slipped across the border to reach the one place where they know they can get help.
Myint Myint Aye, with her nine-year-old son, Than Zin Htun, traveled two days by car from their Burmese village of Shwe Gion to visit the clinic.
Myint Myint says Burmese doctors told her that her son may need an operation. But with visits to a doctor in Burma draining her meager income, she traveled to Thailand.
Dr. Cynthia Muang, an ethnic Karen, set up the clinic in 1989, after she fled to the border area, like so many of her compatriots, after Burma's military crushed pro-democracy protests and calls for reform in 1988.
In the early days, Dr. Cynthia, as she is known, mostly treated young men who also had fled to the jungle after the crackdown. Then, for many years, the clinic treated the victims of the government's efforts to quash rebellions by ethnic groups along the border.
The fighting displaced more than half-a-million people within Burma, while two million Burmese fled to Thailand. But ceasefires in recent years between the rebels and Rangoon mean that fewer war wounded come to the clinic.
Dr. Cynthia says the caseload has changed markedly over the years and most patients now are poor workers.
"After 2000, we see more adolescent age groups [who] come to Thailand [to work] in the factories or the farms. We see teenage pregnancies, unsafe abortions. We see more accidents, occupational accidents, road accidents, injuries caused by violence."
Burma's military government is considered one of the most repressive in the world, jailing hundreds of opposition activists. Many countries, including the United States, have imposed economic sanctions on Burma, which is desperately poor.
In 1989, the clinic treated 17,00 patients. But as Burma's economy declined over the years and the government fought to contain rebel groups, the numbers grew to nearly 30 thousand patients in 1999.
Last year, the clinic, with four doctors and 150 trained medics and other employees, treated more than 100,000. Everyone is welcome at the clinic, but critically ill patients or those in need of emergency surgery are transferred to nearby Mae Sot hospital.
Muang Muang Tinn works in the clinic's administration. He says it is famous along the border because of its low fees -- just 25 cents -- and because it can be easily reached by Burmese who can not get help in their impoverished country's health-care system.
"Most of the patient are Burmese. Seventy percent are migrant workers. They live here [in Thailand]. Thirty percent are from Burma. [They] cross the border and get treatment, and then go back. In Burma, public hospitals are very slow. You need to buy everything except the needles, except the cotton, at least, (and pay) a lot of bribes."
In a workshop at the back of the clinic, six young men make prosthetic legs so that landmine victims can walk again. All the workers themselves wear prosthetics. Once they have completed their training, they will return to Burma and set up shops to carry on the work.
Kyaw Win, a former ethnic-Karen rebel, lost a leg above the knee in 2003 from a mine blast.
He says he was taken to a Karenni hospital and about a year later was brought to the Mae Sot clinic. The clinic also is the base for so-called "backpack teams" -- medical workers who travel into Burma's Karen state, often for weeks at a time. Teams of two-to-four workers visit villages that lack medical services.
Saw Roman, a Karen, is one of the senior members of the 70 teams that cross the border.
"We will visit village by village, treating the patients, especially for common diseases like malaria, acute respiratory tract infections, and diarrhea, dysentery. Some measles, cholera. Communicable disease is very common, and malnutrition, landmine [injuries], emergency obstetric care [are] very common, and mental health [problems]."
Saw Roman says the work has risks. Burma's military, he says, tries to hunt down the medics. Seven have died after being shot by the military.
With the increasing workload, Dr. Cynthia says that keeping the clinic going is a constant struggle, even with assistance from the Thai government. The government gives them access to Mae Sot hospital, and the Thai public health agency provides help.
The clinic also gets funds from the United States and Canada, as well as relief organizations.
"In the past few years, honestly, we are struggling for everyday. We need medicines, we need more people to be trained. But gradually we see that we haven't done much for children."
She says the clinic will remain busy as long as there is no political or economic progress in Burma. She is pessimistic. She thinks it could be years before there are significant changes in Burma that would improve life for those along the border.
Dr. Cynthia's clinic -- as it is affectionately known -- not only is famous along the Thai-Burma border, it has been recognized internationally for its work.
In 2002, she received the Ramon Magsaysay Award for Community Leadership, which honors Asians who work to protect human rights, for the help she has given to tens of thousands.