The financial burden of healthcare has been foisted on patients since the coup, including time-sensitive, live-saving treatment for rabies, which is seeing a minor resurgence in recent years.
By ANT PWEH AUNG | FRONTIER
Shwemawdaw Pagoda’s Buddha Pujaniya festival draws so many visitors that hundreds of temporary guesthouses and shops are set up to cater to the influx of pilgrims coming to make offerings of rice, flowers and other goods to the temple’s Buddha statues.
Festival-goers also chant religious mantras, seek blessings and merit, and browse for local crafts and snacks. But this charming scene turned into a nightmare on April 27 when an aggressive dog tore through the crowded marketplace, biting 29 people, including four children under the age of 10, during its rampage.
Unbeknownst to trishaw driver Ko Win Zaw, this chaos was unfolding blocks away as he was finishing up a long day of work. As he was about to make his final trip – to pedal himself home – he felt a sharp pain in the back of his right thigh. By the time he turned around, the mud-covered dog was already a blur sprinting down the street.
Four other people in his neighbourhood were also bit, bringing the total to 34 victims. A single dog biting over 30 people is, in and of itself, one of the most telling signs that it has rabies, and this dog was also drooling uncontrollably.
“There are many dogs in almost every neighbourhood. We are too poor and we can’t afford the vaccines, so we need to prevent this from happening again,” the 40-year-old trishaw driver told Frontier.
Since the military seized power in a 2021 coup, the public healthcare system has collapsed, pushing much of the financial burden onto the patients, many of whom are suffering from a parallel economic collapse.
Because of his precarious economic situation, Win Zaw made a series of poor decisions after being bit. Rather than going to the hospital right away, he waited until the next morning, after he had secured K30,000 from his sister, around US$7 at the market rate.
He bought his first dose of a rabies intradermal vaccine at a local pharmacy and brought it to the Bago General Hospital to have it administered. A single vaccine can be administered to two dog bite victims, so he was able to save half his sister’s donation. Given the severity of his bite wound, the nurse there told him he should also take a rabies immunoglobulin injection, but he declined because it would have cost another K60,000.
Rabies is nearly always fatal when contracted, and there is a limited amount of time to administer treatment after being exposed.
“When I took my dose, I felt sick and my whole body ached for two days. But I had to work anyway if I wanted to feed my family,” Win Zaw said.
“It would be good if government hospitals could vaccinate everyone who’s been bitten by a dog for free, as happened before. It’d be a lot easier for poor people like us who can’t afford it.”
Tens of thousands of public healthcare workers walked off their jobs to protest the coup, and the regime has been unable to stabilise the economy or provide basic public services.
“Government hospitals are not capable of administering rabies vaccines to all dog bite patients,” said a general practitioner in Yangon. “People have to buy anti-rabies vaccines from private pharmacies.”
According to the World Health Organization, the typical rabies incubation period is two to three months, so while Win Zaw and the other patients bitten in April are all reportedly healthy for now, they aren’t out of the woods yet.
Ko Phyo Wai, a charity worker who helped transport dog bite victims from the Shwemawdaw Pagoda to the Bago General Hospital, said all 29 received their first injection for free but had to pay for their next three doses, and all remain in good health as of June 19.
The story is much the same in Yangon, Myanmar’s commercial capital where one might expect better public services and more readily available supplies. A resident of North Okkalapa Township told Frontier that there were no vaccines available at the public hospital she visited after being bitten in April, so she had to purchase a vaccine for K35,000 at a private clinic.
It wasn’t always this way. Dr Myint Htwe, former health minister in the National League for Democracy administration, toppled by the coup, said in 2019 that his government had spent K15 billion on rabies vaccines starting in 2016.
A poisoned chalice
Data on the dog population in Myanmar, the frequency of dog bites and the number of rabies deaths is limited, but all available information points to an increase since the coup.
According to the 2019 inter-censal survey, there were between 6 and 7 million dogs in Myanmar, with just 1.9 million of them having an owner. While the regime’s health ministry has not disclosed any data on dog bites since the takeover, the World Organisation for Animal Health estimated that the total animal bite occurrence was around 150,000 in 2022, with only 135,000 people receiving post-exposure prophylaxis. Meanwhile, the WHO reports human rabies deaths starting to creep up after cratering during the now-aborted democratic transition. Recorded annual deaths peaked at 242 in 2011, hitting their lowest point at just six in 2017, but climbing back up to 55 in 2022, an increase of 35 from the year before.
These most recent figures, however, are far from conclusive, as the nationwide civil war sparked by the coup has made it even more difficult to accurately collect data. All healthcare workers that spoke to Frontier agreed that dog bites are up compared to previous years.
“The majority of victims are children who were running and playing on the street,” said a doctor, who added that his private clinic in Yangon’s Mingalar Taung Nyunt Township treats at least one patient bitten by a stray dog per day.
Measures to control stray dogs were always dismal in Yangon, even under the NLD. Municipal authorities largely engaged in sporadic mass culls that had little effect because they weren’t carried out consistently and because dog lover groups sought to protect street dogs from being poisoned. The civilian government started taking small steps towards reform, building a shelter in West Hlaing Tharyar Township and promising to replace cullings with sterilisation and vaccination campaigns, but locals complained it had made little progress.
“For many years, the Yangon City Development Council has been trying to kill stray dogs by poisoning them, but so far it hasn’t been successful,” said a veterinarian who volunteered to help vaccination and sterilisation programmes in Yangon before the coup.
Under military rule, even efforts by volunteers and civil society groups have been curbed due to draconian new restrictions on the activities of all non-government organisations.
“Vaccination and sterilisation programmes for stray dogs are halted for the moment,” said Dr Kyaw San Aung, secretary of the Myanmar Veterinary Association in Yangon Region. “Unfortunately, these efforts were suspended after the coup due to the political situation and now we are trying to start them again.”
One animal lover who feeds stray dogs said YCDC poisons them because of public pressure for action, but it accomplishes nothing.
“Right now, the YCDC is poisoning stray dogs almost every day. One of the excuses they use is that they have to clean up the streets because people are complaining,” he said. “But if they really wanted to control stray dogs, the best way to do it is to carry out mass sterilisation according to international standards.”
It seems to have been a similar story in Bago, where Win Zaw said municipal authorities embarked on a purge after the pagoda incident, poisoning street dogs in the town, but only “for a day or two”.
The resistance against rabies
Meanwhile, in areas controlled by armed groups opposed to military rule, dog bite victims aren’t freed from the financial burden of rabies treatment.
Resistance officials told Frontier there have been many dog bite incidents, particularly among people displaced by the conflict, reminiscent of the trouble with snake bites. One of the main problems with providing vaccines is that they have to be stored in cold chain systems to remain effective, something very difficult to achieve in the rugged borderlands or rural areas where insurgent groups rule.
“If a victim comes to our clinics after being bitten by a dog, we have vaccines available. But we can’t provide them free of charge because their price is too high,” said Padoh Saw Diamond Khin, head of the Karen Department of Health and Welfare, which has some cold storage facilities.
The KDHW is under the Karen National Union, Myanmar’s oldest ethnic armed group, which has been fighting for autonomy for Karen people for decades.
“Before the coup, dog bite patients were treated at government hospitals in the towns and they didn’t come to our centres very often. But after the coup they have come to our clinics due to vaccine shortages at government hospitals,” he added.
In Sagaing Region, where militias formed after the coup have carved out some rural territory, cold storage facilities aren’t available at all. Dr Joseph, leader of the People’s Healthcare Network-Kalay, which operates in resistance-controlled parts of Kalay Township, said the group treated 30 dog bite patients last year and 13 this year, as of May.
They must buy the vaccines from regime-controlled towns, but military checkpoints litter these routes, making the journey dangerous and slow.
“Some people are brave enough to help us, carrying the vaccine from the town to our patients on their motorbikes, but the patients have to pay for both the cost of the vaccines and the transportation,” he said.
He said the National Unity Government, a parallel administration set up by elected lawmakers deposed in the coup, provides some support for medical equipment, but nothing specifically for rabies vaccines.
“Our group doesn’t have contact with donor organisations for rabies vaccines either,” Dr Joseph added.
Back in Bago town, survivors of the dog bite attack continue to worry that they could still develop rabies. In Thayawady Township, also in Bago Region, a 25-year-old woman died in April, six months after she was bitten by a rabid puppy she had recently adopted off the street.
“This is a life that wouldn’t have been lost if she had the awareness to go to the hospital immediately after being bitten by a dog to get a rabies vaccine,” said U Aung Kyaw Linn, chair of the White Colour Parahita charity group in Thayawady.
But Win Zaw, the trishaw driver, said he worries more about his four children than his own health.
“I always warn my children not to go where stray dogs are,” he said. “If they have to go, I always ask them to bring a stick.”
