Hpa-an prosthetics centre gives landmine victims new start in life

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In 2001, U Soe Paing, an off-duty Tatmadaw soldier, was leading a group of friends on a honey selling expedition along a trail through the mountainous jungle terrain near Papun in northern Kayin State when he stood on a landmine.

“I knew the path, so I was going first; I was the only one affected,” he told Mizzima Business Weekly on April 3 at the Hpa-an Orthopaedic Rehabilitation Centre in the Kayin State capital during his yearly visit for a new prosthesis.

“I heard a sound like thunder and knew immediately I had lost my leg,” U Soe Paing said. “My friend carried me on his shoulder to the closest [military] compound.”

U Soe Paing retired from the Tatmadaw and is a barber in Papun.

There were 3,349 landmine casualties in Myanmar between 1999 and 2012, said the 2013 report of the Geneva-based Landmine and Cluster Munitions Monitor, which assesses international mine mapping and clearance efforts.

The LCM report said the number of landmine casualties fell in 2012 and 2013. The report said there were “credible allegations” of the Tatmadaw using anti-personnel mines in Kachin and Rakhine states in 2012 and 2013. It also said armed ethnic groups, including the Kachin Independence Army, the Karen National Liberation Army, the Democratic Karen Benevolent Army and the Shan State Progress Party, laid mines in 2013.

Explosive remnants of war (ERW), including mortars, grenades, artillery shells, and ordnance dating to World War II remain under Myanmar soil, said the LCM report, although the location and extent of unexploded ordnance is unknown.

“In Myanmar there has been very little activity to remove the risk of mines since the Japanese invasion during the Second World War,” said International Committee of the Red Cross spokesperson Michael O’Brien in an interview with Mizzima Business Weekly at the ICRC’s Yangon office.

“Step ahead to the conflicts after the Second World War, you have six decades of people leaving munitions on the ground without necessarily mapping where they are,” said Mr O'Brien.

The Hpa-an Orthopaedic Rehabilitation Centre – run by the Myanmar Red Cross with the support of the ICRC – has been providing orthopaedic appliances to people with disabilities from Kayin, Kayan and Mon states and Bago and Tanintharyi regions since 2003. Bago Region and Kayin State have the highest number of recorded victims and are believed to have the heaviest concentrations of mines, the LCM report said.

U Soe Paing is among thousands of landmine and ERW victims served by the centre since it opened in 2003. The centre provided 1,030 prostheses in 2013, of which 683 were for landmine and ERW victims.

“Approximately 300,000 people in Myanmar need a (prosthesis) device,” Didier Reck, head of the ICRC’s physical rehabilitation programme in Myanmar, told Mizzima Business Weekly. “We should service 100,000 devices each year and a technician can produce around 250 devices per year. In Myanmar there are ten technicians,” Mr Reck said.

Three of the technicians work at the Hpa-an centre. To meet the large demand for prostheses in Myanmar, the HORC runs an outreach programme to help people with disabilities in remote parts of the country.

“Our first priority is reaching women and children in mountainous areas who do not know how to access our centre or are afraid to come alone,” HORC’s head of prostheses and orthopaedics Ko Naing Naing Eh told Mizzima Business Weekly in an interview at the centre.

HORC manager Ma Kyawt Thida Aung said villagers in mountainous areas of Bago Region and Kayin State faced difficulties if they wanted to use the centre. “They live in the border area, they don't have ID cards and they may not even speak Burmese,” Ma Kyawt Thida Aung said. “We have a network with the UNHCR [United Nations refugee agency] and people who work close to the border; if they find someone who needs services they will refer them to us,” she said.

“We offer all services for free, including the orthopaedic device, training, lodging, transport, a hygiene kit and medical assistance if necessary.” There are no barriers to the free support provided by the centre, Ma Kyawt Thida Aung said.

Maung Kyaw Htoo Aung, 12, was born with a deformed, knee-length right leg. He is from Kawthaung, at the southern-most tip of Myanmar – a region the Hpa-an outreach team can visit every three years. Referred by a person from a neighbouring village who has had a prosthesis from the centre, Maung Kyaw Htoo Aung and his father took five days to travel to Hpa-an early last month.

“According to religion and beliefs in Myanmar, disabled people are seen as being punished for something they did in a past life; this is not true,” said Ko Naing Naing Eh. “When disabled people come here, they see a lot of other people in the same situation and they don't feel so alone.”

Head physiotherapist Ma Nan Kaw Kay has been working at the centre for more than ten years. Most of those who come to the centre to have a prosthesis fitted also have mental health issues, Ma Nan Kaw Kay.

“We can change their thinking by motivating and encouraging them,” she said.

The centre runs a summer child programme and offers services to about 60 children with disabilities. Ma Kyawt Thida Aung said it was motivating for children and those having a prosthesis provided for the first time – known as primary service users – to see how mobile are those who have returned for a replacement, who are known as secondary service users.

The centre has 52 beds but was accommodating only 19 adults and children in early April before it closed for the Thingyan holiday. Among them was Maung Kyaw Htoo Aung, who was testing his first prosthesis while playing football with Ko Than Tun, 35, a former Tatmadaw general who stood on a landmine near Papun in 2012.

Because he is growing, Maung Kyaw Htoo Aung should return for a replacement prosthetic every six months, though his father anticipates it may be difficult to travel to Hpa-an that often.

“Adult service users need to have their prosthesis replaced at least every three years,” said Ma Kyawt Thida Aung. “But some services users are never able return.”

Ma Kyawt Thida Aung says those needing their first or a replacement prosthesis need to come to the centre, but a mobile team operates in southern Myanmar to serve secondary service users needing simple repairs.

Creating the right prosthesis is a long process. “After registration we do assessment or evaluation here with a physiotherapist,” said Ko Naing Naing. “We check if their residual limb is ready to fit the prosthesis. If their stem needs to be re-amputated we refer them to Hpa-an General Hospital. If they are ready they stay in our dorms and begin the process.”

While trying a prosthesis for the first time, Ko Naing Naing Eh says the physiotherapist and technician need to check the 'stem' – the limb needing the prosthesis – every ten to fifteen minutes for bruising.

“If there is an issue, we modify the device; when we are satisfied we drape hot plastic over the mould,” he said. “Then the service user trains to use the device.”

Ko Niang Naing Eh, who has been working at the centre for more than ten years, has collected many home-made prostheses, made from materials such as wood, bamboo and metal pipes.

The HORC develops Myanmar-specific prostheses, says Ko Naing Naing Eh. “In the past we imported rubber for feet prostheses from Geneva,” he said. “But they would crack and become destroyed in this heat; now we use Myanmar rubber.”

The rehabilitation centre, only 50 metres from the workshop, was developed to simulate the conditions in southern Myanmar villages.

“When service users go back to their villages, they won't have concrete,” said Ko Naing Naing Eh. “We have a sand area, rock area, a ladder and a bridge so they (service users) can prepare to go home.”

U Chit Hla, who was at the centre for a replacement prosthesis, tidied the library and watched other service users training – some trying a professionally-made prosthesis for the first time. When he is wearing pants, it is difficult to tell he is using a prosthesis.

U Chit Hla stood on a landmine while logging in Mon State in 1988. His right leg was amputated from below the knee in a rural clinic and he used a home-made prosthesis for nearly 20 years. He came to the centre for the first time in 1995.

“After the amputation I was depressed and I couldn't work,” he told Mizzima Business Weekly at the centre. “But to my wife, I did not change. She took care of me the same as before.”

U Chit Hla, who has a small rubber plantation in Kayin State, believes the mine was planted by a Mon armed group, but says his anger over the incident has faded. “I feel satisfied now because I can do everything I could do before the amputation,” he said.

Ko Than Tun, the former general in the Tatmadaw who stood on a mine while overseeing a road building project near Papun in 2012, now works as a security guard.

While in the Tatmadaw he saw a device that can detect mines, but only once.

There were serving and former members of the Tatmadaw among the adults at the centre in early April, but no one from Myanmar’s armed ethnic minority groups. Three Karen National Union soldiers arrived at the centre in March, said Ma Kyawt Thida Aung.

“KNLA, BGF [Border Guard Force], DKBA, KNU and Tatmadaw soldiers have been here, sometimes at the same time,” she said. “There is never a problem. They are not soldiers while they are here, just service users; they leave their uniforms outside.”

The National Ceasefire Coordination Team, the group representing armed ethnic groups which is negotiating a national ceasefire with the government’s Peace-making Work Committee, has proposed a ban on the laying or transfer of mines by both sides.

Internationally, Myanmar has shown a reluctance to take action against landmines.

Myanmar abstained from acceding to the United Nations Mine Ban Treaty in 2013. More than 160 countries have ratified the treaty, agreeing to cease the production of anti-personnel mines and clear all mined areas within ten years. The Myanmar government has also abstained from joining the Convention on Custer Munitions, which has been ratified by more than 80 nations.

Action targeting unexploded ordnance – including minimal surveying of mined areas and removal of mines – has been conducted in Myanmar by 15 domestic NGOs since 2006, said a report prepared in 2011 by international NGOs Geneva Call and Dan Church Aid (DCA) on the humanitarian impact of landmines in the country.

Dan Church Aid Mine Action and other international NGOS involved in surveying and clearance in other parts of the world have not been able to operate in Myanmar, the report said.

“Surveying and mine removal are not being discussed by DCA, as parties to the peace process feel it is not yet time,” DCA spokesperson Christopher Bath told Mizzima Business Weekly in an email on March 24.

Mr O'Brien says the ICRC, among other international NGOs, hopes to conduct mine clearance in cooperation with the Tatmadaw.

ASEAN aims to create a mine action centre that would assist in activities such as surveying and clearance throughout Southeast Asia, said Mr O'Brien. “This problem is not restricted to Myanmar – but here in Myanmar there is a huge amount of work to do and a large amount of people who need assistance.”

While mine survey and clearance activities remain largely on hold in Myanmar, Ma Kyawt Thida Aung says villagers in affected areas such as east Bago Region and Kayin State rely on local knowledge to avoid mined areas.

“Where the villagers live, there are no mines but they have to go to the forest for their livelihood,” she said. “On the way there, there may be no mine but on the way home they may take a slightly different route and set one off.”

Ko Myint Win detonated a landmine on his way to work in the fields at his village in east Bago Region in 2011. He was 19 and lost most of his left leg. In March he returned to the centre for a replacement prosthesis.

Soon after his accident, another villager was injured by a landmine in a nearby area, he said. Ko Myint Win was married in 2012 and has a one-year-old son. He continues to work as a farm labourer and his dream is to one day farm his own land.