Thai-Burmese Border Research Articles

Prevalence of intestinal parasitic infections among the pregnant women in South and South East Asian countries: A systematic review and meta-analysis.

Intestinal parasitic infections (IPIs) are a major health concern in resource-limited countries of South/South-East Asian region. Despite posing a potential threat to maternal and fetal health, there is limited data available on the actual burden of IPI among pregnant women. Through this systemic review and meta-analysis, we sought to determine the pooled prevalence of IPI and species-specific prevalence among pregnant women in this region. Subgroup analysis was done by region, stool examination technique, and study settings. Among 220 retrieved studies, 21 studies from 8 countries across the region were found eligible and included in this study. The estimated overall pooled prevalence of IPIs among pregnant women was 43.15% (95% confidence interval: 30.66-56.10). The most prevalent IPI was Ascaris lumbricoides (25.14%) and predominant protozoa was Entamoeba histolytica/dispar (6.96%). In subgroup analysis, the estimated pooled prevalence of IPIs in Nepal, India, Thailand, and Thai-Burmese Border was 40.88%, 28.33%, 55.38%, and 23.78%, respectively. Studies using Kato-Katz technique for stool examination showed the highest estimated pooled IPI prevalence (62.70%). The prevalence of IPI was found to be lower in facility-based studies (38.12%) than that of studies done in the community (66.21%). Considering the high burden of IPI in pregnant women as estimated in our review and the already established impact of IPI infection on maternal health and fetal outcomes, we recommend implementation of the preventive chemotherapy during routine antenatal checkups.

Producing and Embodying the Humanitarian Border: The Gendered Geopolitics of Responding to (and Preventing) Gender-Based Violence Among Burmese Displaced in Thailand

ABSTRACT Recent scholarship on forced migration, geopolitics, and the aid industry has built on William Walter’s concept of ‘humanitarian borders’, which refers to the ways in which humanitarian aid delivery becomes entangled with the enforcement of Global South-Global North borders. In this article, I apply a feminist geopolitics lens to expand on this idea, looking at humanitarian action related to the prevention of and response to gender-based violence (GBV) among Burmese who are displaced in Thailand. I ask how humanitarian borders themselves are gendered, produced through gendered violence and implicated in the ways forced migrants navigate exile. Based on ethnographic research conducted on the Thai-Burmese border over a ten-year period, this article analyzes multiple levels of discourse related to GBV intervention, including the perspectives of Global North donors, international aid workers, Thai and Burmese women’s rights advocates, and Burmese forced migrants who work on farms and in the garment industry. Following the work of feminist geographers, I offer a lens that recognises the linkages between multiple forms of violence, especially those between intimate partner violence among Burmese forced migrants in Thailand and the violence of the exploitative living and working conditions faced by Burmese forced migrants outside refugee camps . Through this lens, I show that the humanitarian border operates not only to contain forced migrant mobilities vis-à-vis the Global North, but to affix the border and its insecurities to forced migrants in ways that reinforce gendered geopolitical hierarchies.

Schooling, Identity, and Nationhood: Karen Mother-Tongue-Based Education in the Thai–Burmese Border Region

Modern Karen education began in the early 1800s when introduced by British and American missionaries at roughly the time the British colonial powers arrived from India. After independence from Great Britain in 1948, Burma faced revolt from ethnic groups including the Karen, in large part, over issues of language and cultural self-rule. This led to the forcible closing of Karen-language schools by the military junta beginning in the 1960s and the re-establishment of Karen schooling by the Karen National Union (KNU) in independent self-rule territories, often near the Thai border. In this context, beginning in the 1980s, Karen-medium language spread into the highlands of Burma and into Thai refugee camps where Karen had been living for nearly four decades. Karen medium education is an important element establishing what Benedict Anderson called the “imagined community”. With mass Karen literacy, a national consciousness emerged, particularly in areas where schools were sustained. This separate consciousness is at the heart of the Karen of Kawthoolei. The Karen Education and Culture Department (KECD) was established in 1947 by the KNU. Karen schools provide mother-tongue-based education. Much of the development of the Karen medium curricula was undertaken by the KECD, and it is significantly different from that of the Burmese government’s curriculum, particularly in terms of language medium, literature, and history. Karen schooling reflects the Karen political consciousness, which will be at the heart of any peace agreements negotiated in the still-ongoing Burmese Civil War.

Storytelling in Research with Refugees: On the Promise and Politics of Audibility and Visibility in Participatory Research in Contexts of Forced Migration

AbstractResearchers' methodological decisions have an impact on who gets to hear a refugees' story, the meaning a story conveys, and, consequently, the implications a story might have for forced migrants. What we as researchers, or aid workers, do with the stories gathered from forced migrants can contribute to their social and political invisibility, or our scholarship can be a tool to amplify refugee voices as forms of knowledge that are valid not only as testimony but as expertise to design research, programmes and policies. What potential do such methods have to disrupt the “established regimes” of what is audible, visible, or legible in society (Rancière, 2010)? In response to what is now widespread recognition of the “dual imperative” in forced migration research (Jacobsen and Landau 2003), action research has emerged as a common way to do research that is useful to the communities with which we engage. In this article we reflect on our efforts as researchers to address power imbalances by placing forced migrant stories at the forefront of our methods. We rely on two case studies to provide insights into and learn from critical narratives from the displaced themselves: 1) at the Thai-Burmese border, 2) with Somali refugee returnees in Kismayo. The two case studies reveal different ways of working with stories and strategies that can help address the inaudibility of refugee stories. We recognize that such work is necessarily partial and ongoing. To identify space for continued growth and learning, we point to moments where collaboration faltered and moments where our research inadvertently reproduced power inequities.

ThitiwutBoonyawongwiwatThe ethno‐narcotic politics of the Shan people: Fighting with drugs, fighting for the nation on the Thai–Burmese border,Lexington Books2017, 186 pp., £60 (HBK), £60 (ebook).

ThitiwutBoonyawongwiwatThe ethno‐narcotic politics of the Shan people: Fighting with drugs, fighting for the nation on the Thai–Burmese border<i>,</i>Lexington Books2017, 186 pp., £60 (HBK), £60 (ebook).

Comparing alternative cholera vaccination strategies in Maela refugee camp: using a transmission model in public health practice

BackgroundCholera is a major public health concern in displaced-person camps, which often contend with overcrowding and scarcity of resources. Maela, the largest and longest-standing refugee camp in Thailand, located along the Thai-Burmese border, experienced four cholera outbreaks between 2005 and 2010. In 2013, a cholera vaccine campaign was implemented in the camp. To assist in the evaluation of the campaign and planning for subsequent campaigns, we developed a mathematical model of cholera in Maela.MethodsWe formulated a Susceptible-Infectious-Water-Recovered-based transmission model and estimated parameters using incidence data from 2010. We next evaluated the reduction in cases conferred by several immunization strategies, varying timing, effectiveness, and resources (i.e., vaccine availability). After the vaccine campaign, we generated case forecasts for the next year, to inform on-the-ground decision-making regarding whether a booster campaign was needed.ResultsWe found that preexposure vaccination can substantially reduce the risk of cholera even when <50% of the population is given the full two-dose series. Additionally, the preferred number of doses per person should be considered in the context of one vs. two dose effectiveness and vaccine availability. For reactive vaccination, a trade-off between timing and effectiveness was revealed, indicating that it may be beneficial to give one dose to more people rather than two doses to fewer people, given that a two-dose schedule would incur a delay in administration of the second dose. Forecasting using realistic coverage levels predicted that there was no need for a booster campaign in 2014 (consistent with our predictions, there was not a cholera epidemic in 2014).ConclusionsOur analyses suggest that vaccination in conjunction with ongoing water sanitation and hygiene efforts provides an effective strategy for controlling cholera outbreaks in refugee camps. Effective preexposure vaccination depends on timing and effectiveness. If a camp is facing an outbreak, delayed distribution of vaccines can substantially alter the effectiveness of reactive vaccination, suggesting that quick distribution of vaccines may be more important than ensuring every individual receives both vaccine doses. Overall, this analysis illustrates how mathematical models can be applied in public health practice, to assist in evaluating alternative intervention strategies and inform decision-making.

Caring Narratives in the Face of Perilous Situations: Voices of Karen Women in Communities in Thai-Burmese Border Zones

Caring Narratives in the Face of Perilous Situations: Voices of Karen Women in Communities in Thai-Burmese Border Zones

Ethnic Conflict and Economic Cooperation in the Borderlands: Burma, Thailand, and the Karen

Since 1949, the Karen ethnic minority has been engaged in an armed uprising against the Burmese government, and this uprising has defined Thai-Burmese border relations. Despite its length and impact, this conflict is easily overlooked, and has been willfully ignored by Thailand, Burma, and the international community in the optimism surrounding the start of the ASEAN Economic Community. Documentary research and interviews with participants in the conflict demonstrate that the Karen, and the armed nonstate groups which represent them, maintain the ability to end any sustained cross-border cooperation between Thailand and Burma. As such, a resolution to the conflict is necessary if the ASEAN Economic Community, and the various other projects that Thailand and Burma have envisioned for the border region, is to succeed.

The Politics of Aid to Burma: A Humanitarian Struggle on the Thai-Burmese Border

The Politics of Aid to Burma: A Humanitarian Struggle on the Thai-Burmese Border

Community Coping Strategies in Response to Hardship and Human Rights Abuses Among Burmese Refugees and Migrants at the Thai-Burmese Border

We conducted 10 focus groups (n = 49) with community members and key informant interviews (n = 28) to explore hardships and community coping strategies for sequelae of abuse among Burmese refugees/migrants in Thailand. Transcripts were coded and analyzed for major themes. In Burma, they universally experienced human rights violations and economic hardship. Hardships continued in Thailand through exploitation and threat of deportation. Coping was achieved through both personal and community-based mechanisms including self-reflection, sharing experiences, spirituality, and serving their community. Western psychosocial counseling, although available, was used infrequently. Effective psychosocial support often originates from the community and should be supported by international organizations.

The Constitutive Effects of Time: Understanding the Evolution and Innovation of Refugee Governance along the Thai-Burmese Border

The Constitutive Effects of Time: Understanding the Evolution and Innovation of Refugee Governance along the Thai-Burmese Border

A Political Ecology of Sovereignty in Practice and on the Map: The Technicalities of Law, Participatory Mapping, and Environmental Governance

AbstractThis article examines the relationships between representations and operations of sovereignty in natural resource governance. We advance a ‘political ecology of sovereignty’, examining the participation of non-state actors in resource governance processes. We particularly argue that processes of integrating subaltern populations through mapping local ecological knowledge can modify effective governance practices while nonetheless reproducing the legibility of state sovereign authority and its territorial boundaries. Exploring the Enbridge Northern Gateway pipeline in Canada, we suggest that state jurisdictional authority is secured through incorporating indigenous interests as a delimited geography of tradition. Examining the Hatgyi hydroelectric development along the Thai–Burmese border, we argue that the territorial boundaries of those nation-states are rearticulated through the governance of this transboundary development. Through these cases, we demonstrate how the insertion of local knowledge works not only to reconfigure effective governance processes but also to reinforce the effect of state sovereignty in new ways.

Clinical audit to enhance safe practice of skilled birth attendants for the fetus with nuchal cord: evidence from a refugee and migrant cohort

BackgroundCurrent evidence for optimal management of fetal nuchal cord detected after the head has birthed supports techniques that avoid ligation of the umbilical cord circulation. Routine audit found frequent unsafe management of nuchal cord by skilled birth attendants (SBAs) in migrant and refugee birth centres on the Thai-Burmese border.MethodThe audit cycle was used to enhance safe practice by SBA for the fetus with nuchal cord. In the three birth centres the action phase of the audit cycle was initially carried out by the doctor responsible for the site. Six months later a registered midwife, present six days per week for three months in one birth facility, encouraged SBAs to facilitate birth with an intact umbilical circulation for nuchal cord. Rates of cord ligation before birth were recorded over a 24 month period (1-July-2011 to 30-June-2013) and in-depth interviews and a knowledge survey of the SBAs took place three months after the registered midwife departure.ResultsThe proportion of births with nuchal cord ligation declined significantly over the four six monthly quarters from 15.9% (178/1123) before the action phase of the audit cycle; to 11.1% (107/966) during the action phase of the audit cycle with the doctors; to 2.4% (28/1182) with the registered midwife; to 0.9% (9/999) from three to nine months after the departure of the registered midwife, (p < 0.001, linear trend). Significant improvements in safe practice were observed at all three SMRU birth facilities. Knowledge of fetal nuchal cord amongst SBAs was sub-optimal and associated with fear and worry despite improved practice. The support of a registered midwife increased confidence of SBAs.ConclusionThe audit cycle and registered midwife interprofessional learning for SBAs led to a significant improvement in safe practice for the fetus with nuchal cord. The authors would encourage this type of learning in organizations with birth facilities on the Thai-Burmese border and in other similar resource limited settings with SBAs.

Karen ethno-nationalism and the wrist-tying ceremony along the Thai–Burmese border

This article presents an ethnographic investigation of displaced Karen in a border area of northern Thailand, and in particular, the reasons for their enthusiasm for the wrist-tying ceremony. It examines the way in which Karen ethno-nationalists have both influenced this cultural practice and appropriated it. This study argues that Karen nationalist intellectuals invented and reinvented the tradition of wrist-tying by borrowing structure and content from the use of soul-calling for healing and other purposes. The invented tradition is persuasive and efficacious because of its continuities and ties with existing cultural practices. Ordinary Karen participants utilise vernacular elements of the wrist-tying rite — such as sensory experiences through the handling of ritual objects — to assure a well-balanced life and spiritual security.

Explosive border: Dwelling, fear and violence on the Thai–Burmese border along the Salween River

AbstractThe Salween borderlands can be conceptualised as spaces of exception where contradictory outcomes of state actions lead to state violence. The Burmese and Thai states have maintained their sovereign power and responded to economic regionalisation through violent practices in particular spaces. The political conflicts between the Burmese junta and ethnic minorities in the Salween borderlands have become war zones. The Burmese government in association with the Thai state and transnational dam investors has imposed the Salween dam projects on the Salween borderlands and people in the form of a terrorising state. The border people have experienced fear, danger and military violence, which has become part of the violence in everyday life. This paper provides an ethnographic study focused on specific events involving an explosion and death in a particular place and time on the Salween borderland. It shows the suffering of the border people in relation to sovereign power.

The open-air site of Huai Hin (Northwestern Thailand): Chronological perspectives for the Hoabinhian

The Hoabinhian is well known in Southeast Asian prehistoric studies, where it has been considered both a chronological period and a cultural entity. However, recent work suggests it should more appropriately be considered a functional technocomplex. Although most often described from sites in Vietnam and Thailand, it has also been recognized in northern Sumatra and Cambodia. Here, we present a series of Hoabinhian stone tools discovered during fieldwork carried out by the Thai-French Paleosurvey at the Huai Hin site found on the eastern bank of the Salaween River near the Thai-Burmese border. Although the technological analysis of this material supplies new evidence for Hoabinhian regional variability, new dates from this open-air site also provide a useful reference point for constructing a regional chrono-cultural sequence for Southeast Asian prehistory.

Microsatellite characterization of Plasmodium vivax in pregnant women on the Thai–Myanmar border

Background Plasmodium vivax infections in pregnant women are associated with low birth weight and anemia. Genotyping of P.vivax is useful to study P. vivax in pregnancy, though it is still remains challenging to distinguish between relapse from hypnozoite stage and recrudescence from blood stage following treatment. A genetic investigation of P.vivax in pregnancy on the Thai-Burmese border, comparing the genotype between at follow up with the day of admission for pregnant patients and non pregnant patients was undertaken in this study.

Quality of ultrasound biometry obtained by local health workers in a refugee camp on the Thai-Burmese border.

ObjectiveIn a refugee camp on the Thai–Burmese border, accurate dating of pregnancy relies on ultrasound measurements obtained by locally trained health workers. The aim of this study was to substantiate the accuracy of fetal biometry measurements performed by locally trained health workers by comparing derived reference equations with those published for Asian and European hospitals.MethodsThis prospective observational study included 1090 women who had a dating crown–rump length (CRL) scan and one study-appointed ultrasound biometry scan between 16 and 40 weeks of gestation. The average of two measurements of each of biparietal diameter, head circumference, abdominal circumference and femur length was used in a polynomial regression model for the mean and SD against gestational age (GA). The biometry equations obtained were compared with published equations of professional sonographers from Asian and European hospitals by evaluation of the SD and Z-scores of differences between models.ResultsReference equations of biometric parameters were found to fit cubic polynomial models. The observed SD values, for any given GA, of fetal biometric measurements obtained by locally trained health workers were lower than those previously reported by centers with professional sonographers. For nearly the entire GA range considered, the mean values of the Asian and European equations for all four biometric measurements were within the 90% expected range (mean ± 1.645 SD) of our equations.ConclusionLocally trained health workers in a refugee camp on the Thai–Burmese border can obtain measurements that are associated with low SD values and within the normal limits of published Asian and European equations. The fact that the SD values were lower than in other studies may be explained by the use of the average of two measurements, CRL dating or motivation of the locally trained sonographers. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

Population pharmacokinetics of halofantrine in healthy volunteers and patients with symptomatic falciparum malaria

To investigate the population pharmacokinetics of the antimalarial halofantrine (HF) in healthy volunteers and patients with symptomatic falciparum malaria. Healthy volunteer data were obtained from six volunteers who received three different doses of HF (250, 500 and 1000 mg) after an overnight fast with a washout period of at least 6 weeks between doses. Patient data (n = 188) were obtained from randomised controlled trials conducted on the Thai-Burmese border in the early 1990s. They were either assigned to receive a total HF dose of 24 mg/kg (8 mg/kg every 6 h for 24 h) or 72 mg/kg (8 mg/kg every 6 to 10 h for 3 days). The population pharmacokinetics of HF were evaluated using non-linear mixed effects modelling with a two-compartment model with first-order absorption. The population estimates of apparent clearance (CL), volume of compartment one (V1), distributional clearance (CLD) and volume of compartment two (V2) of HF in healthy volunteers were 2453 l/day (102 l/h), 2386 l, 716 l/day (29.8 l/h) and 2641 l, respectively. The population estimates of the PK parameters in patients were 429 l/day (17.9 l/h), 729 l, 178 l/day (7.42 l/h) and 1351 l, respectively. All PK parameters were significantly related to body weight and some were related to sex, sampling method, pre-treatment parasite density and whether patients vomited or not. When the two datasets were analysed jointly using a maximum likelihood method, the population estimates in patients were 196 l/day (8.17 l/h), 161 l, 65 l/day (2.71 l/h) and 89 l, respectively, and the parameters were significantly related to body weight and sex. Bayesian analysis of the patient data, with a diffuse prior based on the healthy volunteer data analysis results, yielded the population estimates 354 l/day (14.8 l/h), 728 l, 162 l/day (6.75 l/h) and 1939 l, respectively. The pharmacokinetic properties of HF in patients with malaria are affected by several demographic variables as well as other relevant covariates. Apparent differences between the healthy volunteer and the patient data analysis results are not entirely due to differences in bioavailability. For the patient data analysis, the Bayesian method was preferred, as the fitting procedure was more stable, allowing random effects to be estimated for all four dispositional parameters.

Harbouring the illicit: borderlands and human trafficking in South East Asia

The unique environment of borderlands in mainland and insular South East Asia has facilitated the growth of human trafficking for sexual and labour exploitation. Organised crime groups have seized upon opportunities offered in these geographic locales to develop this illicit industry. This article examines the dynamics of human trafficking in three diverse border areas in the region: the Cambodian-Thai border; Indonesia-Singapore-Malaysia border; and the Thai-Burmese border. An examination of the unique social and power dynamics of the borderlands and a comparative history of these areas will illustrate how organised crime groups have flourished and engaged in human trafficking to support local border sex industries. This trade preys upon the vulnerable and impoverished living on the fringes of border communities. Weak State institutions, entrenched patronage networks, and distance from central control have made these borderlands ideal for criminals to establish themselves and their illicit activities. These same conditions have made it easy for regional tourists to engage in illicit sex in neighbouring countries with little chance of recrimination.