“In Myanmar, The Union works with tens of thousands of patients whose lives depend on the treatment services we provide.” Nick Southern, Country Director, Myanmar

“In Myanmar, The Union works with tens of thousands of patients whose lives depend on the treatment services we provide.” Nick Southern, Country Director, Myanmar

Ian Nicholas ‘Nick’ Southern has been Country Director for The Union’s office in Myanmar since January 2016. Originally from Manchester in the UK, his has been a global journey spanning 30 years of international development experience for organisations including Oxfam, Save the Children UK, Save the Children International, CARE USA and CARE International.

“Wonderful though Manchester is, I always knew I wanted to work outside the United Kingdom,” explains Nick. “At the beginning of my career, my roles focused on public health water supply and humanitarian action during man-made emergencies and natural disasters. Gradually, the focus of my work leaned towards longer term socio-economic developmental work”. 

Now based in Mandalay, he oversees The Union office that, since his arrival, has grown from 200 to 400 staff, working in five regions and states throughout the country, reaching approximately 12 percent of the districts and 15 percent of the total 55 million people based in Myanmar. These are huge numbers, requiring a dedicated and consistently evolving team to meet, head-on, the challenges of working in a country that, until recently, was closed to any kind of international context and communication.

“I have a team of seven senior multidisciplinary management members who direct all of The Union’s work. My job is to guide the technically demanding and logistically challenging work in the context of Myanmar’s international isolation. We’re a close-knit team and I’m proud that these are not people who are just ‘getting the job done’, but whose increasing confidence, application and initiative is raising the overall standards of our operation and transforming the roles and responsibilities of those engaged in delivering the quality and impact of lifesaving health services.”

Myanmar is one of the most challenging global environments in which The Union operates. As well as being in the World Health Organization’s (WHO) top 20 high-burden countries for tuberculosis (TB), the country struggles with HIV co-infection and a high incidence of multidrug-resistant TB (MDR-TB).  This scenario puts Myanmar in a special category with only 14 other countries worldwide that are impacted by all three communicable diseases - TB, HIV and MDR-TB*. In contrast, the country has one of the lowest global percentages of GDP monies spent on health care; currently at just 2 percent.

“A vital element of The Union’s approach has been engaging with local communities and connecting the Ministry of Health and Sports (MoHS) with the wider society through an active network of over 3,000 volunteers focusing on TB and HIV, which connect the community with the central government system. In the Myanmar context, this has meant a considerable breakthrough in delivering health services to those living in poverty and underserved.”

This approach and other techniques by The Union has, at time of writing, led to the enrollment of 47,000 people in antiretroviral therapy (ART), the referral of 13,000 presumptive cases of TB, and support for 350 people who are on drug resistant TB care and treatment.

The impact of Myanmar’s isolation for almost 50 years can be seen in a lack of basic infrastructure and an educated and skilled human resource base in almost all fields. Nick says, in practice, this means The Union has had to take on a more operational hands-on role inside the country, that continues to be a learning experience:

“Myanmar has just gained global connectivity over the last four years. Most of the country still has limited electricity so communication services are only now becoming accessible and affordable for the majority of people.

“The banking system remains isolated from the international system and the country still operates on US$ cash being exchanged for the local currency, Kyat. Uniquely, only pristine unused US$ are accepted for exchange. To overcome this cash exchange challenge The Union has been able to maintain a US$ account.”  

And the challenges extend beyond the everyday practical concerns of running a business and service operation. An intricate political situation also needs careful negotiation and consideration.

Nick says, “Myanmar is a complex and diverse country of over 130 ethnic groups, with a history of conflict. The main issue, above any kind of political instability, is that The Union continues to work with tens of thousands of patients in Myanmar whose lives depend on the treatment services we provide. Our direct responsibility lies with those patients now and in the future.”

That future will continue to demand that The Union is always focused on sustainable effective and efficient models for development. “In the longer term there is an enormous need for overall Health Systems Strengthening (HSS) - the transformation of the business model and organisation of the country’s health service. In October 2017, I am happy to report that The Union conducted its first successful HSS training programme.” 

He adds, “I have been privileged to have worked in many different and challenging environments and cultures around the world but my roots are in working class Manchester. Before I was born my grandmother died of TB, or consumption, as it was then known. Over the years of working around the world with disadvantaged and marginalised people living in poverty, I have been aware of the scourge of TB and its dramatic increase with the onset of the global HIV epidemic starting in the 1980s.

“I believe that heath care is a universal human right and I identify with The Union’s commitment to find solutions for the world’s under-served. As a public health professional, The Union’s commitment to ‘Know’ ‘Share’ ‘Act’ is a powerful call to action – and I see it in action every single day.”

*Source – WHO Global TB Report 2017

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