Suu Kyi faces same issues that Mandela confronted

This is the third of three columns I’ve devoted to health care in Myanmar.

The previous two articles covered the dire state of health care in Myanmar and described one hospital that survives on donated resources. Under the current military regime, the country is finally beginning to open up, but what does that mean for the prospect of increased access to quality health care for the people of this impoverished nation?

Leading the charge for change is Aung San Suu Kyi, Myanmar’s Nobel Peace laureate and chairwoman of the National League for Democracy, the main opposition party. After being released from 17 years of house arrest in 2010 and winning a seat in parliament in 2012, for many she is the dream candidate for presidency in the 2015 elections. Although she embodies Myanmar’s democratic face and is capable of leading her country along the road of democracy, the question remains whether she will be given that chance. In 2008 the junta inserted Article 59 to the constitution, which disqualifies any person whose spouse or children hold foreign citizenship from running for president. Article 59 is believed to be designed specifically to stop Suu Kyi. Attempts to alter the constitution are underway, but it appears the generals will resist.

I had the opportunity to hear Suu Kyi speak at an intimate gathering recently and found her to be incredibly articulate, kind-hearted and wholly dedicated to the plight of her people. Her profound intelligence and first-rate education at Oxford came across as she shared her views on reconciliation and how best to navigate the road ahead.

She faces many challenges, not the least of which is the physical toll of her incarceration. Nelson Mandela also faced a long and arduous internment. Should Suu Kyi be elected once again to run the country, she, like Mandela, will also be faced with the challenge of reconciliation. Mandela modeled for the world how skillful and heartfelt dedication can bring cohesion to a country that had only known victims and victimizers. Suu Kyi will need to help heal the country of pain wrought upon the people of Myanmar from years of military dictatorship. She will also need to help the country move past its ongoing ethnic and religious strife.

Linked to Myanmar’s democratic fate are the living conditions and health care of its citizens similar to Nelson Mandela’s post-apartheid South Africa in 1994. Mandela inherited a country that was deeply divided by racial segregation and was in dire need of health care reforms. Whereas the white population had access to a well-organized medical system, for black South Africans health care was virtually nonexistent. In the new democratic South Africa, Mandela made access to health care a constitutional right and developed a comprehensive public health strategy, which benefited all ethnic groups. As a result, overall health equity and access improved tremendously. Doctor-to-patient ratios increased from 1-to-40,000 in the rural areas during apartheid to 1-to-4,000 in 1994; new health care facilities were provided, as well as free maternal and child care and programs for water, nutrition and welfare.

Unlike Mandela, however, Suu Kyi will not have the benefit of a highly developed government infrastructure built by years of apartheid. In Myanmar a culture of democracy and the institutions that ensure equity, a free flow of labor and the rule of law will need to be built almost from scratch.

Foreign direct investment has the potential to support this process, but it is a two-edged sword. Foreign investment now drives the development of five-star hotels, million-dollar condo buildings and golf courses in Myanmar’s capital, but two-thirds of the nation’s population does not have access to electricity, clean water or enough food. The key to a truly free Myanmar is to be found in quality health care and education combined with free and fair elections. Together with Lord Darzi, director of the Institute of Global Health Innovation, Suu Kyi is working on sustainable reforms of Myanmar’s health system. Equity in resource allocation is of crucial importance in this effort, especially with foreign, profit-driven players waiting for their chance to get a slice of the pie. Mandela showed it is possible to lay the foundation for such a system, as long as the government does not divert from the principle of equality. Suu Kyi understands the daunting challenge. Following her visit with President Obama, she said, "The most difficult time in any transition is when we think that success is in sight."

Note: Dr. Zunin recently returned from Myanmar where he evaluated strategies for humanitarian and medical service.

Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.