By Dinah Gardner in Yangon
Min Lwin U was 5-years-old when he found out he was HIV positive. That was three years ago. His doctors now say he has three months to live unless he gets anti-retro viral therapy (ART) soon.
Every day Lwin U is at a Medicins Sans Frontieres-run clinic in one of the poorest suburbs of Yangon. He comes to eat the three free meals of rice and curry the humanitarian organisation dishes out a day to malnourished and HIV positive children.
Even so his tiny arms are like sticks. His growth has been so stunted by the virus that he looks no more than four.
His dirty T-shirt and shorts hang loosely on his tiny, bony body. He scoops up the rice with his fingers and stares listlessly at some infants sprawled on bamboo mats being fed their meals.
Mismanagement
According to the World Health Organisation, 32 per cent of all children under five in Myanmar are seriously malnourished.
Decades of economic misrule by Myanmar's military government have made this resource-rich country one of the poorest in the world.
The ruling generals earned more than $2bn from natural gas exports last year, but the country's impoverished millions do not have free access to even basic healthcare.
And with the average daily income around $1 a day, many families cannot afford to pay doctor's fees – around $1-2 – when they get sick, much less the $35 price tag on a month's worth of ART.
The poverty here is crippling. In many ways it was the trigger that ignited September's protests.
Ten of thousands of people followed marching monks in the country's main cities and towns until the army moved in to crush the rallies on September 27.
While Western media stressed a public desire for democracy, for most in Myanmar, the demonstrations were about having enough food to eat and the right to basic healthcare.
"Most people here don't care about politics," says Su Hlaing Htwe, a doctor at the MSF clinic in Yangon's slum suburb of Hlang Thayar.
She waves her hand at the wooden and corrugated iron homes clustered behind the centre; an emaciated dog leaps over a ditch - a swill of filthy water cluttered with rotting debris.
Survival
"The people just want a chance to earn enough money to survive. Many of them can barely write. Mostly their education is very basic – just primary level."
Myanmar does not publish its budget but most experts agree that it probably spends less than a paltry dollar a person on health each year.
That's among the lowest level in the world.
It's left to a few UN agencies, MSF and a handful of other NGOs to do what they can, but their efforts are just a drop in the ocean.
Myanmar's poor suffer not just because their military government ignores them but also because the international community – citing discomfort over working with the generals – has been giving the country the cold shoulder for years.
And even among the few agencies that entered the country, some have pulled out.
Global Fund and MSF-France quit in the past two years citing excessive government interference in their humanitarian programmes.
According to 2005 World Bank figures, overseas development aid (ODA) per capita in Myanmar was about $2.90.
In nearby Cambodia, ODA per person in 2005 was about $38.50.
Double blow
"So now you have a people with a government that doesn't do anything for them, and an international community that also doesn't do anything for them," one long-term expatriate NGO worker in Yangon says.
"What little ODA you do have goes mostly on UN salaries anyway. So the people get nothing."
The four doctors at MSF-Holland's Hlang Thayar clinic see around 200 patients a day – mainly malnourished children and sufferers of HIV and TB.
Despite the surrounding slums and the plainness of the centre – basically a large wooden shed on stilts – the staff have made the place a comfortable escape from despair.
Doctors joke with their patients, local pop songs are piped over the speakers and there is a television in the waiting room.
But there is real suffering beneath the smiles.
Many of the women are widows – husbands already dead from Aids, their only legacy the virus in their wives' bodies.
Too sick to work, many of the women with HIV sport cropped hair, transforming them into teenage boys, because they can earn about $1.50 from selling their locks.
But their shaven heads act as a badge, alerting their neighbours to their likely HIV status.
Many are wholly reliant on the MSF's daily handout of rice and beans to its patients on ART.
Aids challenge
Min Min comes into the consulting room with a brilliant smile but within minutes her eyes begin to mist up and she crumples into her chair.
The 24-year-old mother is recovering from stage 4 HIV – the point at which a patient's immune system is so battered she is on the brink of being diagnosed with full-blown Aids.
Her soldier husband – dead now for four months – gave her the disease.
She is pleading with her doctor to let her have a month's worth of ART so she can leave Yangon for the southern city of Mawlamyine where her parents-in-law live with her five-year-old son.
But her doctor wants her to stay in Yangon. She is too sick and needs to stay close to the MSF clinic.
UNAIDS estimates there are around 360,000 people living with HIV/Aids in Myanmar and only a fraction of those can ever hope to get treated.
The bulk of the care is carried out by MSF. The group has committed to treating 16,000 sufferers but has reached the limit of its resources and announced a cap onnew patients in July.
But that still means "tens of thousands of people die from Aids every year and nobody does anything about it", says Frank Smithuis, MSF-Holland's country director.
In some ways Lwin U is one of the lucky ones. He is already on MSF's list.
The organisation put him on ART when he was first diagnosed with HIV. But two years later, his mother, who is also HIV positive, took him out of the city, cutting him off from the drug that was keeping him alive.
Now he's back and very sick. But the clinic cannot restart his treatment until it is sure his family will stay put in Yangon and properly administer the therapy to him.
Stopping and starting ART can render it ineffective as the virus may become resistant to the cocktail of drugs.
"This situation is very common," says Hlaing Htwe. "Many patients here are poorly educated; they don't understand how important the drug is, and how important it is to take it properly."
The international community may be focusing on UN envoy Ibrahim Gambari's visit and meeting with the generals to persuade them to start a dialogue with the opposition, but Hlaing Htwe is concentrating on getting Lwin U's family to oversee his treatment.
"We are trying to persuade Lwin U's parents to commit to giving him the drug. But it is very difficult."
She smiles as she watches him take his bowl into the kitchen to be washed.
"But we are trying our best."
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