"If the health attendant is not here when it is time, I will have to go to Pyinsalu to give birth," Win Mar said.

"Because of difficult access and the need to travel so far, it is very difficult for these women to attain health services," Dan Baker, country representative for UNFPA, told IRIN in Yangon.

With doctors from the Myanmar Medical Association, UNFPA has set up mobile reproductive health teams to cover remote areas of the delta.

"We've been trying to cover remote areas with reproductive health teams, which set up a temporary clinic for a day or two where they can do pre-natal exams or address other health concerns," Baker said.

"Our idea is to get as close to people as possible. We've shown the donors that there is definitely a need and we can be effective in those areas … now we need the money to make that happen."

Birth plan

Thwe Thwe Win suggested mobile health teams help women draw up a birth plan. "The health team usually visits a village at a time and they do a follow up [consultation] if necessary. Antenatal care alone is not enough. About 15 percent of pregnant women are likely to face difficulty when giving birth," she said.

"It is important for pregnant mothers to have a birth plan about where they want to deliver and how," said Thwe Thwe Win.

But both Thein Thein and Win Mar could not prepare much for the birth. "What can we prepare while Nargis left us only hands?" Win Mar asked.

As many of them are Christian, most of the assistance has come from Christian associations and they are still highly dependent on donations.

Fortunately both have husbands and other relatives left in the village.

Win Mar said: "They will carry me for two hours' walk using a blanket as a cradle between two bamboo poles when the time comes to go to Pyinsalu town for giving birth."

The Burma Partnership, which represents 19 aid organisations, released an "alternative" report to provide what it said was a more accurate picture of the response to Cyclone Nargis, which left 138,000 people dead or missing in May.

"When we studied the Post-Nargis Joint Assessment report prepared by the UN, ASEAN and the Burmese regime, we realised that it failed to describe the obstruction of aid and human rights abuses committed by the military regime in the areas affected by the cyclone," Khin Ohmar of the Burma Partnership told a press conference.

"As independent civil society organisations, we felt the need to tell the other side of the post-Nargis story."

The generals ruling Myanmar, formerly known as Burma, drew international outrage by refusing to allow a foreign-led aid response in the immediate aftermath of the storm.

But they dropped their resistance after coaxing from Association of Southeast Asian Nations (ASEAN) chief Surin Pitsuwan.

The official joint report was released to much fanfare at an ASEAN conference in Singapore in July.

But Ohmar said it failed to highlight issues such as blocking and misappropriation of aid and substandard treatment of survivors at relief camps.

It omitted cases of human rights violations such as orphans turned into child soldiers, survivors forced to do reconstruction work and farm land confiscated by the military regime, she said.

The coalition's recommendations include an independent system to monitor aid distribution and for all relief agencies to make public their activities.

"We hope international governments will consider using the new report to ensure funding reaches people who need the most help and that the recovery process will be implemented with the most transparency and accountability," Ohmar said.

Thai MP and coalition member Kraisak Choonhavan criticised Surin for failing to meet the organisers to discuss the alternative report.

He said he felt "let down" by Surin's late cancellation of a meeting in Jakarta, home to the ASEAN secretariat.

"They did not give any reason for cancelling. I feel let down and it makes it necessary for us to be more vocal. I am very disappointed," he said.

“It is obvious that people with disabilities have been completely overlooked so far in all general and sectoral assessments,” Thomas Calvot, disability and emergency adviser for Handicap International France, who spent three weeks in Myanmar, told IRIN.

The Post Nargis Joint Assessment (PONJA), considered by many as the blueprint for the humanitarian response to the area, makes only brief mention of PwDs, saying they should be included.

An assessment of the number of PwDs and the challenges ahead in terms of helping them has yet to be carried out.

Challenges

The cyclone-affected area was inaccessible at the best of times, with no concrete paths, houses built on stilts and areas largely surrounded by water. For PwDs things are obviously more difficult.

The psychosocial impact of the cyclone on PwDs, documented in the PONJA, is also significant, with some left apart or behind when their families or caretakers fled the storm. Some are experiencing difficulties recovering a sense of inclusion in their communities.

Others suffer from sensorial or mental impairments and are often not properly informed about what is happening around them.

Calvot would like to see more attention given to such groups: Their participation in interagency coordination mechanisms is nearly nonexistent.

Saw Kay Htoo

You could be forgiven for thinking that Saw Kay Htoo is just like any other 11-year-old boy. Walking home from school with a beaming smile and chatting with his classmates, there are no obvious signs of the tragedy he has lived through.

Home, however, is the child protection centre in Labutta, where seven orphans live together. They all lost their parents during the cyclone almost five months ago. Three of the smaller children are from the same family, but Saw Kay Htoo is alone.

Htoo lost his parents and ten siblings when Cyclone Nargis ravaged the Ayeyarwaddy Delta that fateful night in May. His family tried to escape the cyclone in their boat, but the boat was dashed to pieces by the waves. He saw his parents and siblings disappear one by one during the night. Htoo managed to survive by holding on to some wreckage until he landed on higher ground.

Sitting on a chair in the child protection centre, you can sense the sadness in Htoo's eyes, but it will take a psychologist to treat the underlying trauma. Fortunately, Htoo has been surrounded by committed and caring volunteers from the Myanmar Red Cross Society, who run the centre with support from UNICEF.

Volunteers

Since the cyclone struck, the volunteers have taken turns looking after the children, preparing their meals, helping them with homework and organizing plays when possible. Now a more systematic psychosocial support programme is being implemented as the whole operation gradually moves from relief to recovery.

So far, 25 volunteers from the Myanmar Red Cross Society have been trained in psychosocial counselling, and they in turn will train their peers. The training will target community leaders, teachers, monks and other groups, and it is designed to help the healing process as the children deal with their trauma and loss. Htoo and the other children from the centre, together with 443 orphans from the area around Labutta, are all in need of this psychosocial support.

Pont Pont

Children like Pont Pont are simply happy to be alive. Pont Pont is 15 years old and she wears purple grips in her hair, and her face is decorated and protected with thanaka (a traditional cosmetic paste). The wind blew away her family's home and her parents were swept away by the floodwater. Pont Pont was rescued by a group of people who managed to take refuge on higher ground. Using a map pinned to the wall of the Red Cross office in Labutta, Pont Pont was able to point out the location of her parents' house.

Eleven days later, Red Cross volunteers were able to locate her parents, who amazingly were alive, and they arranged a family reunion. Pont Pont's family had survived the disaster. Pont Pont's gratitude for the help she received from the Red Cross led her to enrol as a volunteer, so that she too can help other vulnerable people.

Fertiliser in the cyclone-affected rice farming areas of Myanmar costs around $21 per 50kg bag, but $15 in Yangon. Damaged roads have driven up transport costs.

In addition, local fertiliser dealers refuse to sell on credit, unconvinced they will be repaid.

Most paddy farmers apply fertiliser in two stages. Triple Super Phosphate (TSP) is normally applied in full as basal application during the final tillage operation at a rate of some 25kg per acre, while Urea and Muriate of Potash (MOP) applications are typically split. Fifty percent of Urea and MOP is usually made as basal application with the remainder applied as top dressing.

In an effort to help cyclone-affected farmers, the UN Food and Agricultural Organization (FAO) has distributed close to 2 million kg of fertiliser to cyclone-affected farmers through their implementing partners, including Welthungerhilfe (German Agro Action), Cooperation e Sviluppo (CESVI), the UN Development Programme (UNDP) and International Development Enterprise.

Each beneficiary household was to receive a fertiliser kit consisting of 100kg of Urea, 50kg of TSP and 25kg of MOP.

FAO says that more than 10,000 households have been helped with its fertiliser and seed programmes but that donor funding is low.

"The agriculture sector continues to be the least funded among all sectors that are part of the overall response to Cyclone Nargis," Rene Suter, the FAO's head of the emergency and rehabilitation coordination unit in Yangon, told IRIN.

"In order to rapidly restore food security and rebuild shattered livelihoods, much greater donor support is urgently required," the official said.

    Some 33.5 million U.S. dollars of fund for the extended project are being sought, the FAO resident representative was quoted as saying.

    The extended project is designed to benefit 50,000 lesser-land-owned and 100,000 landless storm-survived households, the sources said, adding that the fund will further help develop agriculture, livestock breeding and forestry undertakings locally until next summer.

    In July this year after May storm, the FAO agreed to provide emergency relief aid supplies for an initial six-month period to storm survivors in two cyclone-hard-hit regions of Ayeyawaddy and Yangon for the resumption of their agricultural and fishery production, according to earlier local report quoting the Myanmar Ministry of Agriculture and Irrigation.

    The FAO also donated 600 cattle for four cyclone-hit areas of Kungyankon, Mawlamyinegyun, Ngaputaw and Phyapon to help restart agricultural cultivation there, the Livestock Breeding Department said.

    The FAO-donated cattle were purchased from lesser-cyclone-hit region of Bago and cyclone-free northern region of Mandalay, it added.

    Deadly tropical cyclone Nargis, which occurred over the Bay of Bengal, hit five divisions and states -- Ayeyawaddy, Yangon, Bago,Mon and Kayin on May 2 and 3, of which Ayeyawaddy and Yangon inflicted the heaviest casualties and massive infrastructural damage.

    The storm has killed 84,537 people, leaving 53,836 missing and 19,359 injured according to official death toll.

    Altogether 300,000 cattle died in cyclone-hard-hit Ayeyawaddy and Yangon divisions.

The ruling junta of Myanmar was initially criticized for the slow relief work and for refusing the entry of international relief groups. Thanks to international pressure, the junta welcomed relief efforts from other countries. After several months, relief groups noted the improving situation inside Myanmar, with regards to the coordination of humanitarian assistance. A report from Refugees International:

“Aid agencies today report an unprecedented level of access and mobility in the Ayeyarwady Delta, which is a tribute to the successful fight by the United Nations, the Association of Southeast Asia Nations and the United States for humanitarian access. But the gains in delivering relief supplies, gathering information about needs and supporting local communities are at risk without continued commitment to food security, livelihood and early recovery activities.”

The report also highlighted the need to sustain relief operations:

“While a large majority of cyclone victims have received some sort of assistance, and most are receiving regular food aid, the process of transitioning from relief to self-sufficiency will require international help well through 2009 and perhaps beyond. The international community must continue funding humanitarian assistance and begin livelihood and other early recovery activities that will allow the gradual phasing-out of emergency aid.”

But “hardliner isolationists” continue to block foreign aid:

“Nonetheless, hardliner isolationists are still determined to prevent further international involvement in Burmese affairs. This obstructionism has raised hurdles for relief operations, such as the failed attempt to impose strict guidelines on international agencies.”

These “hardliner isolationists” could be the leaders who are wary of U.S. involvement in the humanitarian process since they fear the U.S. will topple the junta. A government document was uncovered which accused the U.S. of delivering only drinking water, instant noodles and medicine in refugee camps.

It is good to read news of recovery:

“The resilience of those who have been most affected is inspiring. A surprisingly high proportion of the Delta's paddy fields have been planted despite the destruction created by Cyclone Nargis. Still, close to a million people will rely on food assistance for many months to come. In areas such as agriculture, fishing, health and education, an enormous recovery and rebuilding task lies ahead for the affected population as well as for those seeking to assist them.”

Education officials are doubling efforts to help students. International artists are still raising money for victims.

Healthcare was provided to cyclone victims because of influx of donations and volunteer doctors. This was validated by the World Health Organisation which recognized the crucial role of government doctors, nurses and midwives in providing urgent medical treatment to cyclone survivors. An interesting suggestion from the WHO:

“One set of lessons from Nargis should be the introduction of swimming lessons for women, and family evacuation training designed to encourage men to look after older children – which requires greater strength – while women should care for babies.”

The optimism of the WHO was not shared by the Global Hope Network International:

“Most of the hardest hit places of the Ayeyarwaddy delta still refuse entry to foreigners. It is a dangerous place to work. Our teams of national workers continue to risk their freedom and lives by helping the desperately suffering. People are perpetually hungry and are not getting enough food to remain healthy. Months after cyclone Nargis devastated Myanmar, the situation remains grim and dangerous.”

Other disturbing news: Some local leaders are extorting money from villagers. Prices of commodities, like salt, are still high. Food and rice shortage could worsen because of illegal rice trade in Myanmar’s borders. About 5,000 refugees were forced out (relocated) of humanitarian camps a few weeks ago.

Only 112 orphans are officially registered in government-run orphanages. However, the initial UN estimate of children orphaned was about 2,000. Where are the other orphans? It is feared that many orphans have been recruited into the Tatmadaw, Burma’s armed forces.

New Mandala interviewed an aid worker who provided us with a believable and concrete situation inside Myanmar. The hardest part of the humanitarian work:

“Communication between agencies and the field was the most difficult problem faced. Communication infrastructure was minimal, highly regulated and controlled. It was very difficult to get a clear picture of the type and extent of damage suffered. On many occasions the only way to transfer information was to travel to other offices and collect hardcopy or transfer directly to computers. The lack of trust from aid agencies to the government and the government to the aid agencies created an environment of secrecy where many people were very hesitant to share information about their activities.”

An inspiring experience:

“I never felt unwelcome at anytime during the response. Generally the reception was positive although culturally the population is guarded about commenting or complaining openly about any ‘issues’. I think one of the most amazing things early in the response was the reaction and sharing between the affected population…The sharing of supplies between households to ensure everyone received adequate assistance was also heartening.”

Kyimaykaung ponders on the series of tragedies which struck Myanmar:

“I observe that Burmese crises are becoming closer together and more severe, which makes sense in the light, or rather darkness, of the junta's ratcheted up oppression and the accompanying systemic problems, from infrastructure to bureaucracy to an enormous army to environmental degradation.”

Magyi Bin village in Ngapudaw Township was hit hard.  The storm ripped through the village, leaving many buildings in tatters, including the station hospital which provides more than 20,000 people with essential medical services.

“The hospital’s ceiling was completely blown off, its walls, beds and equipment were severely damaged, and its small stock of medicine was mostly wiped out,” says Giorgio Faedo, the IRC’s Field Coordinator in Myanmar. “The crumbling facility is barely able to care for the 50 or more inpatients it receives at any given time.”

IRC teams have started work repairing the structural damage to the building and improving the hospital’s ability to address the needs of the community. IRC contractors and volunteers are delivering cement, ceiling tiles and tin roofing and supplying the hospital with medicines, surgical equipment and other materials.

In the coming weeks, the IRC hopes will begin training midwives, operating small boats to provide ambulance services to villagers along the waterways, and work with the Ministry of Health to launch an immunization campaign and improve maternal and infant health care. 

Meanwhile, in order to prevent the spread of disease, IRC aid workers are educating communities about safe health and hygiene practices.

“We are helping people understand what causes some of their health problems,” says So Pyay Win, an IRC hygiene promoter.  “Our messages concentrate on hand-washing with soap, drinking and cooking with safe water, using latrines and mosquito nets and education about common diseases. At the same time, we have also been distributing hygiene supplies, like soap, jerry cans and water purification tablets.”

A project to build more than 300 latrines, as well as sanitation facilities and washrooms at schools and health centers is well underway.

The IRC is also working to improve and safeguard the water supply in Ngapudaw Township.  Teams are treating water in seven rainwater collection ponds, fencing them in, linking them to public tap stands, and training community workers to maintain them.

“The villagers rely almost exclusively on rain water for drinking, bathing and domestic use,” says Bob Brox, the IRC environmental health coordinator. “To capture rain water for use in the dry season, communities built rainwater collection ponds generations ago. Our project focuses on improving the quality of the water so that it is safe to drink and keeping it clean by building fences around the ponds that block animals from coming in and contaminating the water.”

In total, IRC health services in the Ngapudaw area are benefiting some 45,000 people.