How science and shamanism are go hand in hand to fight malaria and TB in tribal lands of Myanmar

With malaria and tuberculosis (TB) screening out front and sacrifices to jungle gods out back, health worker Htan Pi and her shaman mother are an unlikely double act in their isolated Myanmar village. Their family have been the local healers for generations in the northern community of Satpalaw Shaung near the Indian border. This is Naga territory, a tribal region of former headhunters with myriad languages and customs still largely based on animist beliefs. But trainee Htan Pi, 24, is helping usher in modern medicine thanks to a band of health mentors on motorbikes. Sitting on the porch of her family’s bamboo house that doubles as a clinic, Htan Pi, who can administer basic health care, insists she is not in competition with her mother – the village shaman. “People come to me first and only go to my mum if they don’t get better,” she says. Her mother, Jang Ngon, picks up the story, describing the case of a man suffering from severe swelling all over his body which did not respond to treatment at the hospital, a day’s walk away. “We needed to call his soul back from the jungle, so we sacrificed a chicken and the patient got better,” said Jang Ngon – who believes she is around 50 years old. Retreating British colonialists left Naga tribes divided between India and Myanmar. Those on the Myanmar side of the border remain largely cut off from the rest of the country in an area still desperately underdeveloped. In Lahe, one of three Naga townships, it can be a gruelling walk of several days to reach the nearest developed town, negotiating precipitous, muddy paths over sharp mountain ridges. Picking up a phone signal is a rare triumph, two in five villages have electricity, and only one in five boasts a government-run health clinic. “The needs are so huge … the government cannot do it alone,” says regional MP Kail, who goes by just one name. To bridge the gap, intrepid health workers from Medical Action Myanmar (MAM) head to the remote communities by motorbike, foot and even boat. Lines of patients await their arrival for the monthly mobile clinics that often run late into the evening by firelight. Alongside more common ailments, TB is a constant threat, and the hunting traditions of local tribes add risk. “Their lifestyle is quite injury-prone,” says the NGO’s regional head, Dr Zaw Min Lay, wiping the mud from his glasses after undertaking a ride of steep hairpin bends, ramshackle bridges and a river crossing by rowing boat. The NGO’s success lies primarily in its network of health volunteers. One person in each of the area’s 275 villages has been trained to distribute basic medicines, from painkillers to rehydration salts, screen for TB, and – crucially – conduct malaria tests. Patients give a drop of blood and receive a result in just 15 minutes, flagging cases of the often fatal sickness early. The organisation provides transport to the nearest hospital for anyone needing emergency help, saving excruciating journeys by foot. “We have no motorbikes and no money to pay for a motorbike taxi,” says farmer Mon, 30, visibly relieved after testing negative for malaria in Toe Lawt village. Improved rural health services are largely credited for driving down malaria across Myanmar by more than 90 per cent between 2010 and 2017, World Health Organisation (WHO) figures show. But Naga is particularly problematic. “Language, transportation and zero telecommunications are the major challenges,” explains Zaw Min Lay. The trainees offer a lifeline – however basic – for communities, especially in the rainy season when mud and landslides can leave villages completely marooned. But the NGO’s army of volunteers has also uncovered a medical anomaly – a high concentration of rickets. The bone disease, which can result in irreversible limb deformities and stunted growth, is often caused by a lack of vitamin D, obtained in part from sunlight and hardly an expected problem in tropical Myanmar. Mon’s six-year-old son, Mg Taing Khite, is one of about 300 such cases in the area, his legs so bowed and painful, he was unable to walk just a few months ago. Thanks to a course of vitamin D and calcium supplements, Mg Taing Khite now cavorts around with the village’s other kids. MAM is conducting research into the conundrum. Zaw Min Lay thinks it could be caused by a combination of a poor diet, genetic predisposition and lack of sunlight in the thick jungle. As the health workers pack up their bikes to leave Satpalaw Shaung village, Jang Ngon says she accepts modern medicine is easing out the family tradition of shamanism. She says it’s not easy to take up the shaman trade, reeling off a list of costly sacrifices of chickens, pigs and oxen. Besides, she adds, she is getting older and her eyesight is going. “I tell educated people to go to the clinic instead.”