Essential skincare in peril for the displaced people of Myanmar

Myanmar (Burma), a country of 53 million people and 135 ethnic groups, transitioned to a civilian government in 2011 after five decades of military dictatorship. According to WHO figures, its healthcare is amongst the poorest in the world, a situation that has deteriorated significantly since the military coup on 1 February of this year. This article describes our establishment of the Burma Skincare Initiative (BSI), the health and skincare needs of the displaced peoples of the country, and the necessity for healthcare workers in Myanmar to be supported by their international colleagues during this critical time.

The First International Dermatology Meeting in Myanmar, attended by 200 delegates from across the country, including dermatology trainees, nurses and consultants, as well as general practitioners and other clinicians. International and Myanmar speakers included Dr Ruth Murphy (then-President, British Association of Dermatologist), Dr Claire Fuller (Chair, International Foundation for Dermatology), Mrs Rebecca Penzer-Hick (President, British Dermatological Nursing Group), Dr Russell Roberts (Royal College of Physicians) and Dr Tin Tun (Pre-coup Deputy Director General, Myanmar Ministry of Health and Sports), amongst others.

We founded the BSI (a UK-registered charity) following visits to Dermatology centres in Myanmar in 2018. The charity’s mission is to promote excellence in skincare for the people of Myanmar. With the support of the international dermatology community, including the International Foundation for Dermatology (IFD), the BSI has worked in close partnership with Myanmar dermatology colleagues and the pre-coup civilian government-led Myanmar Ministry of Health and Sports, to provide training, fellowships, funded research studies and the first international dermatology meeting in the country in February 2020.

Since independence from the British in 1948, Myanmar has suffered considerable instability and civil war has ravaged its people and the economy. Consequently, many people, particularly ethnic minorities, have resettled as refugees abroad (e.g. 800,000 Rohingya people in Bangladesh) but at least 600,000 have remained as internally displaced persons (IDPs). In December 2019, Chris, working with Dr Sidra Khan, Dr Valeska Padovese and Professor Toby Maurer, visited the refugee camp for more than 750,000 displaced Rohingya people at Cox’s Bazar, Bangladesh in order to establish dermatology clinics there. A wide-variety of dermatological conditions were seen but the majority were tinea corporis and other cutaneous infections and infestations. This work, in partnership with dermatologists from Chittagong and two NGOs (OBAT and Refugee Crisis Foundation), has continued via teledermatology and funding from the American Academy of Dermatology. The plight of the Rohingya people has received significant global publicity but the situation of the “forgotten” IDPs in Myanmar is equally precarious.

Professor Griffiths, Dr Sidra Khan, Dr Toby Maurer and Dr Valeska Padovese with dermatology colleagues from Bangladesh at Cox's Bazar refugee camp.

One of the largest refugee camps in Thailand for Karen ethnic groups is Mae La refugee camp on the Thailand-Myanmar border, hosting a population of approximately 60,000. In September 2007, just prior to the Myanmar Saffron Revolution, Su volunteered as a medical student during her elective in Mae La refugee camp and Dr Cynthia Maung’s Mae Tao Clinic in Mae Sot, Thailand. Mae Tao clinic serves the largest population of Burmese IDPs and migrant workers in Thailand, in both inpatient and outpatient settings. Landmine injuries, along with malaria and tropical skin infections comprised the majority of the daily caseload.

In February 2020, with the help of two local philanthropists, Su and Chris visited five orphanages, located in monasteries and nunneries, in central Myanmar, each catering for 100-200 children, most of whom were IDPs from ethnic minority groups. With permission from the heads of the orphanages, we performed impromptu dermatology clinics. Overall, and as expected, communicable skin diseases, such as tinea capitis were present in most of the children with severe scarring and disfigurement in some. Scabies was seen predominantly amongst the boys, along with infected eczema and allergic contact and irritant dermatitis. The BSI has the development of sustainable skincare services for the orphanages as one of its long-term objectives. This work was the subject of a presentation made by Su to the IFD’s Migrant Health Dermatology Working Group in April 2020.

Professor Griffiths and Dr Lwin delivering an ad hoc dermatology clinic to a nunnery orphanage in central Myanmar.

The military coup in Myanmar has thrown the already poor skincare provision to the rural population and the IDPs in the country into disarray. Consequently, most of the BSI’s activities have halted but we have restructured some of our projects to continue under the current circumstances with a view to full restoration as and when the country resumes stability. However, the gravity of the situation in Myanmar is devastating for the population and each day brings new developments and an escalation of the crisis. Healthcare workers have been targeted for arrest and violence by the military and the public hospitals have been asset-stripped and closed. In this dangerous, uncertain environment, healthcare and skincare, particularly for disadvantaged communities, are severely compromised. We are working closely with the global healthcare community via the Tropical Health and Education Trust (THET) to help support our colleagues on the ground in Myanmar. Essential emergency healthcare is more than the immediate care of the critically injured but is about preserving the fabric of comprehensive healthcare of which skincare is necessary component. It is our Myanmar colleagues’ wish that we, the global dermatology community, continue to provide educational and clinical support via online media and teledermatology and to develop skincare protocols for acute dermatoses to be used by non-dermatologists in the country. We unwaveringly support the brave healthcare workers of Myanmar and condemn any violence directed towards them and their families.

Professor Chris Griffiths, University of Manchester.Dr Su Lwin, Kings College London.