- Name: Ma Ni Mar
- Age: 41
- Condition: Rheumatic Heart Disease
- Program: Adults: BAMF
Ma Ni Mar’s Story:
Ma Ni Mar is 41 years old but has felt tired and has experienced difficulty breathing since her first pregnancy 18 years ago. She never sought a diagnosis for her condition until her symptoms exacerbated 10 months ago (late 2010). She was now having severe difficulty breathing, chest pain, palpitations and was coughing persistently. In October 2010 she was informed that she had cardiac disease that requires corrective surgery (rheumatic heart disease).
Ma Ni Mar and her husband own some land in Burma. They grow rice once a year in the wet season and the money they make from selling their produce must last them for the next 12 months. On average, they are able to make around 200,000 Kyat (US$200) which needs to cover all the family’s costs including the schooling of their four children (aged between 7 and 18 years old). Over the last 10 months the family has had to pay 1,000,000 Kyat (US$1,000) alone on Ma Ni Mar’s frequent admissions to their district hospital. This has meant that the family has had to borrow money to make ends meet and to pay the bills. The doctor at the district hospital was only able to treat Ma Ni Mar’s symptoms. She was informed that she must go to a hospital in Rangoon and pay over 4,000,000 Kyat (US$4,000) to have corrective cardiac surgery to survive her heart failure.
A neighbour of Ma Ni Mar’s moved to Myawaddy on the Thai-Burma border (Burma side) to seek better economic prospects. The ex-neighbour soon contacted Ma Ni Mar’s family to let them know that there was a free clinic just over the border in Thailand that might be able to help her (the Mae Tao Clinic). At first Ma Ni Mar and her husband thought that travelling through Karen State was too dangerous due to civil conflict but as Ma Ni Mar grew more gravely ill they thought it was worth a chance as it was her only means of survival.
They left their eldest daughter in charge of the three younger children and they commenced their journey to Thailand. Ma Ni Mar had an episode of severe difficulty in breathing before reaching the border. Her husband thought that she was going to die and they had to stay in Karen State’s capital for one night for Ma Ni Mar to rest. Ma Ni Mar was able to resume her journey and she arrived at the Mae Tao Clinic on 7 June 2011. She was admitted to the medical inpatient department and referred to the Burma Adult Medical Fund (BAMF) as the Mae Tao Clinic only has the resources to treat her symptoms. Major heart surgery is not available in Mae Sot so patients requiring such surgery must go to Chiang Mai or Bangkok. While she was waiting for transfer to Chiang Mai, her husband travelled home to check their children’s welfare and to explain the situation. On her husband’s return he gave Ma Ni Mar a letter written by her seven year old son. Her son explained that he understood why she was away and that she needs to stay in Thailand until she was better and to not worry about him.
Ma Ni Mar’s believes her situation is very difficult. There is not enough money to support all their needs and she is sad that she is separated from her children. Her hope is to be reunited with her children after her life-saving surgery. Her greatest wish is for her eldest daughter to return to school since she has had to drop out of school to take charge and look after the younger children while Ma Ni Mar is away.
Rheumatic fever (scarlet fever)
Rheumatic fever can develop if a child (or adult) catches a very common bacterial strep throat infection and does not receive proper antibiotic treatment. The infection is highly transmissible and spreads rapidly amongst families and within communities. Rheumatic fever can cause inflammation of the heart valves (Rheumatic heart disease), which can lead to permanent scarring and a lifetime of heart problems (including heat failure).
The development of penicillin in the 1950s greatly reduced the number of cases of rheumatic heart disease.
Tragically, rheumatic heart disease is still the leading cause of heart-related premature death and disability amongst children and adults in developing countries.
Symptoms of rheumatic heart disease depend on the type and severity of the damage, though children and adults presenting at the Mae Tao Clinic often have severe signs of heart failure. Symptoms include chest pain, lightheadedness and lethargy, and shortness of breath especially on exertion or lying flat to sleep.
Surgical valve replacement is usually the only corrective procedure at this point; this involves complicated and costly open heart surgery.