The health challenges are constantly evolving because the team is working with such a marginalised and vulnerable group in a setting that not only has limited resources but is subject to economic, political and military vagaries. The Covid pandemic and the military coup in Myanmar in February 2021 have only added to those challenges.
The team is always working to find other ways to ensure crucial health care still reaches the most vulnerable and, in fact, expanded services in conflict zones and communities in lockdown. For example, with Rose and the rest of her team’s support and guidance, staff marooned in Myanmar by a sudden border closure created a delivery room where they continued to offer safe care to women who could no longer travel to the clinics. When women from migrant communities in Thailand could no longer travel to the clinics because of lockdowns, Rose rallied her team to travel to the women and provide antenatal care in schools, temples, churches, mosques and other public places.
The medical challenges, however, are significant and ongoing, with the team focused on several key areas.
Reducing the maternal death rate
The maternal death rate on the Thai/Myanmar border is more than 30 times higher than Australia’s.
Maternal and neonatal mortality rates remain unacceptably high despite the significant gains Rose and her team have already achieved.
The maternal death rate has stagnated without reaching the United Nations’ Millennium Development Goals and with few prospects of reaching the Sustainable Development Goals.
Women often present too late due to barriers in accessing health care, which remains one of the biggest contributing factors to maternal and neonatal death.
Reducing rates further will be the team’s toughest challenge but they remain committed to achieving this goal with new and existing local and international partners.
Current efforts are focused on meeting the women in their own communities to provide early pregnancy care.
Reducing the number of babies born too small
Babies born too small is a significant health concern among this vulnerable group. Their growth is impaired in-utero by disease or malnutrition, which has lifelong negative implications for the children’s development, resulting in cyclical poverty.
They are also at higher risk of developing chronic diseases such as diabetes and hypertension in adulthood. One in five babies is born too small compared with one in 20 born prematurely.
SMRU was one of eight sites around the world to participate in the Interbio-21 study to examine how babies grow in utero. Of all the participating sites, SMRU had the highest proportion of babies born too small.
The research and health care teams have developed a multi-faceted strategy to tackle this problem. Vivax malaria is a major cause but growing awareness of other factors, such as nutrition and lack of nutritional support for pregnant women, has prompted this multidisciplinary approach.
Eradicating the recurrent form of malaria
Vivax malaria is a strain that resides in the liver (for part of its life cycle) and is far less deadly to a pregnant mother than falciparum malaria, but it is harder to cure.
Rose’s team have published evidence showing it is a major cause of babies born too small, as well as too early. This strain can reoccur multiple times during the same pregnancy and can be passed onto babies in utero. The harmful effects of the disease increase in proportion to recurrences.
No safe treatment exists for pregnant mothers to eliminate the parasite from their liver, because the only drug available cannot be used during pregnancy.
Rose’s team is involved in a study funded by the Thrasher Foundation of a single use drug in lactating mothers, so women can be treated early and prevent recurrences of fever and illness as they care for their young babies.