The magazine of the art-form of the photo-essay
“A free, really high quality photo-essay magazine. Fabulous!”
Stephen Fry. British actor, writer and film & documentary maker
Aug 2014 back issue
by Robert S Semeniuk
Fourteen million people die each year from treatable diseases like HIV/AIDS, malaria, tuberculosis, and diarrhea, while
another two billion are infected. In addition to these main killers are the numerous little known diseases like sleeping
sickness, river blindness, rotavirus, and trachoma, all of which shatter families, jolt economies and destabilize security
and food supplies. More than one billion people lack access to clean water, and 2.6-billion lack access to sanitation. Yet
the amount spent on world health is less than two percent of the global military budget. World health is a human right and
the most pressing development issue facing us today.
By living among, and forming intimate friendships with the diseased and disenfranchised people whose stories are
documented, this project aims to give a voice, hope and dignity to the victims, and humanize the crisis by putting faces
and personalities on the overwhelming statistics.
Malaria is pandemic in many places, especially in sub-Saharan Africa, but this story takes place where the fear
originates: along the Thai/Burmese border, in Karen refugee camps, where the world's most resistant parasites and fatal
strains of malaria thrive. No one knows why, even though the hospital and numerous malaria clinics in the Mae Sot
district treat hundreds of thousands of patients every year, and researchers come from all over the world to study the
problem. Malaria is the constant companion of everyone who lives here. Dr. Cynthia Maung has dedicated her clinic to
the cause for over thirty years. But the war involves educating people, who change slowly, and may not even associate
malaria with mosquitoes, and parasites that change too quickly for drugs to keep up. Mobile blood clinics make early
falciparum diagnoses so that treatment can be rushed to the infected migrant population.
This project illustrates the cultural politics and anthropology of malaria: how people experience it; how malaria shatters
families, stunts and destabilizes economies, security and food supplies; how malariologists, technologists, educators,
and a vast culture of malaria survivors fight what the WHO calls the "public health enemy number one."
Malaria cases, drug resistance, and mosquito persistence are worsening around the world. With the globe becoming
more traveled and warmer, deforestation, expanding mosquito habitat, and indiscriminate anti-malarial use, the fear is
that the world's most untreatable malaria will find its way to Africa and the temperate zones.
I’d like to read you something I wrote for a magazine article 20 years ago when I first experienced the relationship
between human rights and the spread of malaria, or just about any other infectious disease.
“Sweat runs off the faces of the two boys, 17 and 20 years old, who crouch in the front trench with us. After each shell
hits they strain their eyes to see through the dust, and over the logs piled in front of the trench to prevent grenades
from rolling inside of it, and shoot blindly down the hill, where the Burmese soldiers are. After the chaos and paralyzing
panic comes the eerie silence between artillery barrages and machine-gun fire. This morning five Karen soldiers were
killed and nine injured.”
I wrote this in 1988, after walking for days in the jungle, up and down steep hills, with a group of young Karen soldiers
heading to fight the repressive Burmese military, for democracy. We slept on the ground and ate only rice and fish paste.
The nights were freezing and the days humid and sweltering hot. It is the best place on earth for the deadliest strains
of malaria. We passed groups of people carrying small children and whatever little else they could, wrapped in little
bundles on their heads. They were heading to the relative security of the border, away from their destroyed village
which we walked through days later. Nothing was standing, everything was charred. Another day we met a group
carrying a boy swaddled in a bloody sling hanging from two bamboo poles. He had stepped on a landmine while
running from a village shelled by the Burmese military.
I saw the boy a few weeks later in a clinic near the border where a Karen doctor had successfully amputated his leg.
Now he was being treated for malaria. So was I. I had contracted it from sleeping too many nights in the jungle with no
net, and not enough smokey fires. It was grueling. I was exhausted and sick, and I had only been on the move in the
jungle for a few weeks. The Karen have been here either resisting the dictatorship, or running from them since 1948.
The young landmine victim died of malaria. I never knew his name, but I’ve never forgotten the young doctor who
treated us. Cynthia Maung was freshly out of medical school and on the run from a government in Rangoon that was
imprisoning and killing democracy activists. Her mission was to give emergency medical attention to fleeing students.
Not much has changed for the people of Burma in over 50 years.
When freedom is denied, the vulnerable become invisible and human rights are held with little respect. Burma spends
2 to 3% of its budget on health and 40% on its 400,000 strong armed forces. Only recently coming out of isolation, the
softening dictatorship remains as artificial as it’s capital, 460 km north of Rangoon, a fortress of boulevards, new
buildings, highways, and apartments, carved out of virgin jungle. And, in spite of a regime that continues it’s corrupt
ways, while millions of Burmese remain among the very poorest in the world, there is indeed hope on the horizon.
Burma’s doors are now open to the world and it will never be the same.
For 5 baht, about 15 cents, a boat ferries Internally Displaced people back and forth to Thailand across the Moi River. At
this border they come mostly for the malaria clinic. In the background is the SMRU clinic.
One of the gates to MaLae refugee camps where approximately 50,000, mostly, Karen ethnic refugees have lived for the
last 15 years. There are 9 other official refugee camps on the Thai side of the Burma's eastern frontier that support
150,000 refugees. These are people who are stuck with no means of livelihood, and dependent upon donors, ranging
from UNHCR, to help from the Canadian International Development Agency, which supports the Mae Tao Clinic, which is
the most important health provider along this border.
Le Per Her IDP camp. A young man tends communal cooking fires for the student hostel that looks after the 60 students,
many orphans, who are here, because there is a teacher and basic school, as opposed to no education where they came
from - living in the jungle, on the run, further inside rural Burma. Recent studies show that people dislocated from their
homes have three times the malaria infection rate.
Young Karen soldiers in their barracks at Manerplaw, and
in trenches on Pagoda Hill. After each shell hits they
strain their eyes to see through the dust, and over the logs
piled in front of the trench to prevent grenades from rolling
inside of it, and shoot blindly down the hill, where the
Burmese soldiers are. After the chaos and paralyzing
panic comes the eerie silence between artillery barrages
and machine-gun fire. This morning five Karen soldiers
were killed and nine injured.”
Le Per Her IDP (Internally Displaced People) camp about
one kilometer inside Burma. Five hours drive north of Mae
Sot, over at least two mountain ranges, and down a
washed out road between expansive fields of the young
corn. The people here had to flee their village when the
Burmese attached and burned them out three years ago.
A clinic funded by the estate of Austrian women is where
families bring their babies to get weighed and have their
blood tested for malaria parasites.
Once a month babies are brought to the clinic where they
are weighed and a blood sample analyzed to detect any
plasmodium parasites. Out of 26 children seen by the
medics, 14 had malaria.
Held close by her father, this young girl was one of the few showing any symptoms of maleria.
Mae Tao Clinic: The Child Health Out Patient Dept.
Today it is crowded with women and children who have
come for checkups, and malaria tests. Along with many
other donors, the Canadian International Development
Agency contributes to the operations of the Mae Tao
Clinic, founded by Dr. Cynthia Maung. When I walked
into Dr. Cynthia Maung’s Mae Tao Clinic on the outskirts
of Mae Sot, (less than 5 kilometers to the “Friendship
Bridge” over the Moi River to Burma), I was surprized by
the number of patients crowded in front of all the depts,
and how everything seemed to be so calm and organized.
If it weren’t for a few children, out of scores, screaming in
the Children’s Out Patient Department, near the entrance
to the clinic, the chirping and whistling of tropical birds in
the trees would have captivated me.
SMRU Mawker Tai clinic on the bank of the Moi River,
and the border between Burma and Thailand, about one
hour drive south of Mae Sot. A boat brings people across
the river to the clinic for 5 Baht (15 cents). There is no
visible security here. This border, like the hundreds of
"unofficial" border crossing is porus for those seeking
medical help, or who pay and understand the local power
struggles that pervade this remote and war torn territory.
Today mothers and expectant mothers receive ultra sound
and blood tests for "on the spot" malaria diagnosis. Some
are participating in long-term studies of cardiac and other
problems associated with repeated bouts of malaria.
Sterilizing mosquitos is simply not practical says Prof.
Francois, the Director of SMRU and an expert on malaria,
especially here at the epicenter of the world’s most
resistance plasmodium parasites. "One very practical
solution is to detect and treat it before symptoms show."
We are traveling along a rough and remote side road that crosses into Burma. The Karen army controls this area of the
border. Just inside Burma is an IDP camp (Internally Displaced People), where about 100 families live with nothing after
having their food stolen and crops burned, fearing from landmines, or forced into carrying supplies for the Burmese
military, or worse. We came here with two medics that work at the malaria clinic in Le Per Her IDP camp.
Mae Tao Clinic: A women arrives from Burma with her husband. She is nearly unconscious. She has servere faciparum
malaria and a team of medics tries to find a vein for the IV.
Mae Tao Clinic, Mae Sot. The woman in the foreground is from Mae La camp, one of 10 official refugee camps on the
Thai side of the border. A young medic asks her some questions for me. She has had malaria many times. Now she also
has tuberculosis. She has no money. Fortunately Dr. Cynthia’s clinic feeds the patients and their families twice a day.
The Mae Tao clinic treats over 100, patients every year; the vast majority of them are illegal migrants. Most come from
far away inside rural Burma.
Mae Tao Clinic. Malaria victim battles with malaria, falling in and out of consciousness for last three days. He was one of
four people admitted that day, to the Clinic. His wife and brother carried him here. They had walked four days from
inside Burma. This was the closest place to get help. By the time they reached here, the father of three had falcipurum
malaria so severe that he required a blood transfusion. He was unconscious for nearly three days. His wife was by his
side the whole time.
Mae Tao Clinic. Last year the Mae Tao Clinic employed 200 workers maintained 120 inpatient beds, and treated over
100,000 patients. Over the years the clinic has trained hundreds of health care workers, often through the work of
international volunteers.
Young Karen soldiers in their barracks at Manerplaw, and in trenches on Pagoda Hill.
It is the rainy season, and the incidence of malaria soars among difficult to count refugees, migrants, undocumented, and
internally displaced: all people condemned to foreign food rations, crowded camps, slavery wages in sweatshops, and
garbage. This market is situated outside the Mawker Thei malaria clinic run by SMRU (Shokalo Malaria Research) on the
Moi River, which is the border between Thailand and Burma.