It’s hard to know how healthcare actually works (or fails to work) on the ground inside Myanmar – still harder of course in peripheral communities in the midst of, or close to, zones of conflict. From the BSC programme, Céline Coderey’s paper therefore looked really interesting. Well, maybe not from the title – “Implementation and appropriation of bio (traditional) medicine in contemporary Rakhine”. But certainly from the abstract, which promised a detailed grassroots study. In the event, the presentation was even better than advertised – a terrific analysis drawing on fieldwork conducted in 2005 and 2010 in Thandwe and five surrounding villages (with a total of 18,500 residents). I took fairly extensive notes, and hope that what I report here does not do injustice to the talk.

In Myanmar as a whole, the healthcare “system” is highly centralized and hierarchical, with distinct strands of western medicine and traditional Myanmar medicine – TMM. Government expenditure was below 2 percent of GDP until 2013, when it climbed to 3.9 percent. Most healthcare spending is therefore out of pocket: 99 percent in 2005, and 92 percent in 2010. Even when provision is funded by the state, “donations” are often requested by healthcare providers. Until recently, there was minimal INGO support.

Thandwe is nestled on the Bay of Bengal towards the southern end of Rakhine State. Here, as in the country as a whole, healthcare is better in the core than in the periphery. The downtown is served by one hospital, eight licensed modern medical shops, and a dispensary operated by the Association Médicale Franco Asiatique, a small INGO. Villages have small stores stocking medical products. Throughout the area, though, much is either missing or inadequate. Moreover, local people are deeply mistrustful of the state, public services, and the entire concept of modern medicine. Operations are thus avoided. Beyond dietary rules, preventive care is treated with suspicion. Self-medication is common, though products are not well understood and, especially in the villages, often past their sell-by date.

Alongside modern medicine, and wholly separate from it, stands a TMM sector that merges imperceptibly into folk custom and belief. In Mandalay, there is a University of Traditional Medicine (dominated, at the managerial level, by specialists in western medicine). Across Myanmar, UTM-trained practitioners operate through dispensaries prescribing mainly pre-manufactured pills and potions. In village Thandwe, however, they tend to be viewed as hybrid providers. True TMM practitioners typically remain old men operating from home and concocting potions in front of patients.

In most respects, then, healthcare in Thandwe, and especially its villages, looks like a survivor from an earlier age. Dominated by folk practice, it is only very haphazardly moving into the contemporary era. While there’s much to be said for making use of traditional medicines in modern societies, there are problems with a system with scarcely any knowledge of the best medical science has to offer.