In the mountains between Mindat and Madupi towns in Myanmar’s remote Chin State, 45-year-old Mo Reen is searching for orchids to sell during the cold season.
Her husband, meanwhile, works the land for their slash-and-burn farm in Mindat Township, about an hour away. Their children, aged six, eight and 11, are left alone at home.
"When we were young, we were left by our parents, the way we leave our children now," Mo Reen said. "The eldest of the siblings takes care of the younger ones, while the parents are away working. It's traditional here."
But without proper care, her barefoot children run around unwashed and unkempt.
Agencies say a lack of awareness about children’s health issues in Chin State, Myanmar’s poorest, is leaving them vulnerable to infectious diseases, some of them deadly.
"Most Chin parents, especially in the remote areas, lack knowledge, not only about personal hygiene, but also about the health of their children," said Syed Shah Miran, the project health coordinator for Chin State with Merlin, a medical NGO.
Poverty and low levels of literacy contribute to the lack of information, while there is a need for more health awareness-raising campaigns in the state’s isolated, hilly areas, he said.
“Because of this lack of knowledge among parents, their children are very vulnerable to … infectious diseases such as malaria,” said Syed Shah Miran.
According to the Canada-based Chin Human Rights Organization (CHRO) tuberculosis, typhoid, malaria, HIV, vitamin and mineral deficiencies, diarrhoea and stomach problems are common ailments in Chin State, home to some 500,000 people and nestled along the border with India.
A health worker from the Department of Health said most illiterate parents did not know how to protect their children against common diseases.
“It’s very clear that they don't know how to keep themselves clean and healthy, [nor] do they know how to care for their children and keep them from being infected with diseases that could kill them,” the health worker said on condition of anonymity.
There is no data available on the mortality rate and causes of death in under-fives in Chin State, according to the UN Children’s Fund (UNICEF).
However, it is assumed that causes of child mortality are similar to other states, UNICEF says, including infectious diseases, especially pneumonia, diarrhoea and malaria.
The most recent joint UNICEF and government Multiple Indicator Cluster Survey in 2003 showed a higher rate of malnutrition among under-five children in Chin State than the national average.
Chronic malnutrition-stunting among under-fives in Chin State is 36.5 percent, compared with the national average of 32.2 percent.
At the same time, acute malnutrition among under-fives in Chin State is 8.7 percent, against the national average of 8.6 percent.
Chin advocacy groups say malnutrition and chronic food insecurity have worsened since 2007 due to the destruction of crops by a rat infestation.
Challenges to raising awareness
To educate Chin people on the importance of healthcare, international agencies and the Ministry of Health are conducting awareness campaigns. However, there are challenges in Chin State such as accessibility, health experts say.
“One of the challenges is difficult access to its mountainous terrains, especially during the rainy season," Osamu Kunii, UNICEF Myanmar’s chief of health and nutrition, told IRIN.
Villagers have difficulty accessing health providers and facilities, while getting health providers to communities is a problem, he said.
There are only 12 hospitals and 56 doctors for the population, and just four viable roads in the state, according to a January 2009 Human Rights Watch (HRW) report.
In addition, there are restrictions in terms of data collection and sharing.
Officials also say they face difficulties in convincing parents of the importance of health education. “Persuading parents to come and join awareness-raising campaigns is quite challenging for us as they’re busy farming,” said the government health worker.
Most people in Chin State are subsistence farmers and live hand-to-mouth.
"I'm sorry that I cannot spend time with my children," said Lin Htan, 31, while she worked with her husband to prepare their farm in southern Mindat Township. "It’s because day in and day out, I'm busy finding food for them."
Her eldest child, aged seven, has been left at home to take care of his younger brother and sister. Lin Htan said she worried about her children being infected with malaria or other fatal diseases, but she had no time or opportunity to act on it.
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