Mae Tao Clinic
Burma
Prosthetics, Landmines and Rehabilitation
http://maetaoclinic.org/health-services/health-support-services/prosthetics/
With an estimated 70% of the Burma – Thailand border landmined, and mines continuing to be laid with no humanitarian mine clearance programmes extant in Burma, our Prosthetics department is kept busy providing over 200 new and replacement limbs every year.
A Prosthetics Department staff member works on a new limb for a patient
The founder of the prosthetics workshop at MTC is himself survivor of a landmine injury, he has experienced the psychological wounds of this physical injury. He explains: “In our culture, the man is the leader of the family and is more responsible for taking care of the family”. Many landmine survivors suffer humiliation and shame when their injury makes them dependent on the loved ones they are supposed to provide for and protect. “I have seen that most [landmine survivor] patients have little confidence in themselves after they get their prosthetic, including me,” he says. “They got injured not only physically but mentally…some don’t even listen when they are told how to take care of themselves after their amputation. I understand how they feel, because I was also feeling the same way a long time ago.”
History and Services
The prosthetic workshop was started at the Clinic in 2000. The department has grown every year – from a simple workshop into a more sophisticated production facility. Initially, lamination was the primary method of making artificial limbs. By 2005, with the support of Clear Path International the monolimb was introduced. Light and partly vacuum formed, this technical improvement made faster production possible, and consequently easier delivery to IDP areas.
In 2004 the ICRC began supporting the referral programme of landmine triage cases to Mae Sot Hospital. After amputation, patients return to MTC to begin their long rehabilitation journey. Amputees receive food, housing, physical therapy to help them learn to walk again and psychological help from our counselling centre.
Since 2003 the local government of the Autonomous Province of Bolzano, Italy, has provided a significant portion of the funding needed for the materials, machines and buildings necessary to produce prosthetic limbs at the Clinic. Today the shop staff of produce over 200 new and replacement limbs annually, utilising both lamination and monolimb methods. Most of the prosthetics workshops’ clients came from inside Burma, with some even coming all the way from central Burma, from towns such as Myin Chan in the Mandalay Division. 80% of the beneficiaries are landmine survivors, although some are the victims of car accidents, congenital issues, gunshot wounds and so on. The majority of the prosthetics patients require lower limbs; when a patient needs an upper limb, a sponsor is sought to purchase and deliver the materials for an artificial arm.
A patient gets fitted with their prosthetic leg
In addition to the successes, the program faces hurdles that are beyond the Clinic’s control. The supply of artificial feet, ordered from Cambodia by Handicap International, often cannot keep up with the demand. It is difficult to find local people willing and able to give physical therapy and limb massage to patients, and, with such a small staff, the shop acutely feels the loss of experience and knowledge when a technician resettles overseas. Fortunately however, the programmes financial future seems secure, as an Italian community organisation has guaranteed the Clinic’s prosthetics programme long-term support. Eventually the clinic hopes to produce artificial feet in-house to reduce the reliance on supply from the outside.
The legacy of MTC’s programme will not only be the landmine survivors it has served, but the many technicians that have graduated from the programmes prosthetics workshop training. Some from ethnic minorities have returned to their communities inside Burma to apply what they learned in Mae Sot, bringing hope to landmine survivors who are unable to make the arduous trek to the border.
Though the prosthetic limbs are an imperfect replacement for what was physically lost, they are pivotal to recovering a wholeness of being.
Landmines in Burma
Burma is the only country where, in recent years, there has been confirmed, regular use of antipersonnel mines by government forces.[1] The number of casualties as a result of landmines now annually exceeds those of Burma’s mine-afflicted regional neighbour, Cambodia, which has been the subject of much greater world attention.[2]
There are no humanitarian landmine clearance programmes in place in Burma, and they continue to be laid regularly. Additionally, there are no mine-awareness campaigns to educate local villagers about the dangers of these weapons.[3] It is estimated that approximately 70% of the 2000km Burma – Thailand border is now mined.
The Ottawa Convention on the Prohibition of the Use, Stockpiling, Production and Transfer of Anti-Personnel Mines and on their Destruction 1997, states the desire of the signing nations to
…put an end to the suffering and casualties caused by anti-personnel mines, that kill or maim hundreds of people every week, mostly innocent and defenceless civilians and especially children, obstruct economic development and reconstruction, inhibit the repatriation of refugees and internally displaced persons, and have other severe consequences for years after emplacement.[4]
There are currently 156 States Parties to the Treaty, but Burma is not one of them. It has refused to sign the Convention stating that it was ‘not in a position to associate itself with those states’ who concluded the treaty.[5]
Landmines are used in Burma to persuade local villagers to either leave particular areas (often to go to ‘resettlement’ camps), or to stay away from villages which have already been cleared or destroyed by government military forces. Also, dams, pipelines and other elements of the local civil infrastructure are mined, and paddy fields in insurgent areas are sown with mines in order to prevent local villagers from using them, or harvesting their crops.[6]
There are reliable reports that the Burma Army has routinely used local villagers and forced labourers (including ‘porters’) to act as human minesweepers. These people, including women and children, have been forced to walk ahead of military units in insurgent areas, in order to detonate any landmines or booby traps which lie in their path.[7] Civilians forced to clear minefields in this way have usually been denied medical attention if injured.[8]
The mines that are laid are very poorly managed, which greatly exacerbates the problems they cause, as there are often inaccurate records surrounding their locations.[9] But even if accurate or improved recording techniques are utilised, the smaller plastic blast mines used by the Burma Army can be moved or even washed away during heavy rain falls, to new locations unknown to anyone until they are detonated.[10]
As the only country where mines have regularly been used by the formal military forces since the 1997 Convention came into force, Burma is a key challenge to global efforts to ban antipersonnel mines.[11]
To find out more about landmine use in Burma, please see the following references:
- Selth, A., Landmines in Burma: Forgotten Weapons in a Forgotten War, Small Wars & Insurgencies, 12:2 (2001): 19-50.
- Lee, Thomas J., Luke C. Mullany, Adam K. Richards, Heather K. Kuiper, Cynthia Maung and Chris Beyrer, Mortality rates in conflict zones in Karen, Karenni, and Mon states in eastern Burma, Tropical Medicine and International Health, 2:7(2006): 1119–1127.
- Full text of The Ottawa Convention on the Prohibition of the Use, Stockpiling, Production and Transfer of Anti-Personnel Mines and on their Destruction 1997
[1] http://www.icbl.org/index.php/icbl/Library/News-Articles/HaltMineUse_Burma accessed September 26, 2011.
[2] A. Selth (2001): Landmines in Burma: Forgotten Weapons in a Forgotten War, Small Wars & Insurgencies, 12:2, 19.
[3] A. Selth (2001): Landmines in Burma: Forgotten Weapons in a Forgotten War, Small Wars & Insurgencies, 12:2, 35.
[4] http://www.icrc.org/ihl.nsf/FULL/580?OpenDocument accessed September 27, 2011.
[5] Ibid., 40.
[6] A. Selth (2001): Landmines in Burma: Forgotten Weapons in a Forgotten War, Small Wars & Insurgencies, 12:2, 24.
[7] Ibid., 32-33
[8] Ibid., 37.
[9] Ibid.
[10] Ibid., 27.
[11] http://www.icbl.org/index.php/icbl/Library/News-Articles/HaltMineUse_Burma accessed September 26, 2011.
