Tag Archives: health myanmar

Unravelling the benefits of yoga with one of Yangon’s best known yogis

Published in The Global New Light of Myanmar on 22 October 2015

Jojo Yang swapped a financially comfortable but unfulfilling corporate life in New York and London for a yoga-led existence in Yangon

American expat Jojo Yang doing what she does best. Photo supplied by Yangon Yoga House
American expat Jojo Yang doing what she does best. Photo supplied by Yangon Yoga House

Jojo Yang spent the first 20 years of her life avoiding all forms of exercise.

“I was never athletic – I was the last kid picked for sports teams at school because I was small, scrawny and uncoordinated,” she told The Global New Light of Myanmar.

She was so determined to skip high school gym class that she used the only loophole that enabled her to do: by managing the boys’ wrestling team.

Ms Yang took her first yoga class 10 years ago after a friend promised her that it wasn’t like other types of exercise in that she could ease her body into it.

Yangon Yoga House in Yankin Township. Photo supplied by Yangon Yoga House
Yangon Yoga House in Yankin Township. Photo supplied by Yangon Yoga House

Ms Yang soon found yoga a useful outlet to counterbalance the prolonged periods she spent sitting down as a frequent business traveller – and as a way to pass the time during long evenings spent in hotel rooms. It certainly wasn’t a case of immediate infatuation.

“For the first few years, I was like, ‘I’m not sure I get it.’ I was always asking myself if I was doing it right and I was always trying to match someone else’s pose. It wasn’t until I took a few private lessons that my practice completely transformed,” she said.

The 30-year-old started getting serious about yoga three years ago. She found that if she went a couple of weeks without doing it, she’d get the feeling that “something was missing.”

At around the same time, her disenchantment with life in the corporate fast lane, both in Manhattan and London, led her and her partner to give their careers a serious rethink.

“Every day felt like the worst day of my life. My job was draining and soul-sucking. No one ever came up to me at the end of the day to give me a hug and say, ‘Thanks for that power point presentation’ or whatever,” she said.

Jojo Yang at a recent retreat at Angkor Wat in Cambodia. Photo supplied by Yangon Yoga House
Jojo Yang at a recent retreat at Angkor Wat in Cambodia. Photo supplied by Yangon Yoga House

Ms Yang zipped off to Bali to complete a 200-hour yoga teachers’ course and she and her partner then settled in Myanmar last year, after friends insisted that Yangon is “where the action is.”

Within a month of teaching her first class, a student came up to Ms Yang and gave her a hug – she was grateful that Ms Yang’s cues had helped her master a certain yoga posture for the first time.

“It was the best career choice I ever made. What I do is fulfilling. I wake up every day and feel excited to teach,” she said with a grin.

And it’s not as though business in Yangon is grim: since starting off a little over a year ago teaching a free class once a week in a friend’s apartment, Ms Yang now has her own studio – Yangon’s first – and a client mailing list of around 750 people. As many as 200 students visit Yangon Yoga House every week for a lesson from Ms Yang or one of the eight other teachers. Different styles of yoga are taught, with classes that cater to the beginner to the more advanced, and there’s are also pilates, barre and circuit training classses. Yangon Yoga House has arranged a number of international yoga retreats, including one at Cambodia’s Angor Wat that took place in early October.

However not everyone has been converted.

“The first thing I hear is: ‘I can’t do it because I’m not flexible enough,’” Ms Yang said.

She said this is one of the most common misperceptions about yoga – and yet as Ms Yang explains, flexibility is one of yoga’s core benefits (pardon the pun). And this is not simply about being able to touch your toes or do the splits.

“As people start to get older, things start to contract. Mobility becomes limited. It commonly starts with lower back pain and that’s because the core is weak or the hips are tight.”

Impressive! Photo supplied by Yangon Yoga House
Impressive! Photo supplied by Yangon Yoga House

The more flexible a person becomes, the better able they are to sit or stand for long periods of time. It’s also an enormously effective way of preventing injuries among those who regularly do other forms of exercise, such as running.

Another common misperception is that yoga isn’t hard enough because it’s not a cardio-based work out.

“If the poses are done properly, it’s always an effort. And if you breathe properly you will sweat and feel the intensity,” Ms Yang said.

However Ms Yang is at pains to point out that yoga is more of a lifestyle than an exercise. Serious yogis rarely eat meat and one of the most common reasons people rave about yoga is its ability to soothe the soul and de-stress the mind.

However for some, yoga’s spiritual aspects (namely, chanting) are off-putting; for years yogis fought against the stigma of being associated with hippies. Yet it’s they who are having the last laugh as more and more become converted; perhaps in part out of sheer envy of practitioners’ beautifully toned and sculpted bodies. (For the record, when asked, Ms Yang put her total lack of body fat down to “luck in the genetics department.”)

Yoga’s meditative element

Interestingly, up until quite recently, yoga and meditation were one and the same. The sole purpose of a ‘vasana’ (posture) was to prepare the body to sit for extended periods of time during meditation. It wasn’t until 100 years ago that yoga became a separate discipline and a host of new postures were invented.

Everyone gets the yoga glow after a class at Yangon Yoga House. Photo supplied by Yangon Yoga House
Everyone gets the yoga glow after a class at Yangon Yoga House. Photo supplied by Yangon Yoga House

“Back then, being a yogi was like being a hermit – the original tradition was to retreat into the Himalayas and sit in a cave and eat very little,” Ms Yang explained.

It’s ironic that in today’s modern age, in which we stare at computer screens for hours on end – during both work and play – that yoga’s potential benefits have never been greater.

The West has in general been pretty slow to catch onto the benefits of the ancient practice, whose origins lie in India. Yoga was first mentioned in the texts of Hindu Upanishads and Buddhist Pāli Canon during the third century BC, but it took until the 1980s for yoga to be accepted as a legitimate form of exercise in the western world.

“In terms of general wellness, the exercise is just one element. If you really want to get healthy you need to bring it into your diet, how you approach life – stress plays a big part in how your physical being is. It’s all connected.”

As someone who never had the confidence to take on traditional sports, Ms Yang is keen to emphasise that everyone can enjoy the benefits of yoga.

As featured in The Global New Light of Myanmar - the first spread ever to grace its pages!
As featured in The Global New Light of Myanmar – the first spread ever to grace its pages!

“It’s about accepting where your body is now. Yoga is a journey and there is no destination or end point. It’s simply something you can do for the rest of your life.”

For more information about Yangon Yoga House, visit yangonyogahouse.com

Lifestyle changes linked to alarming rise in diabetes in Myanmar

Published in Mizzima Business Weekly on 11 September 2014

The Department of Endocrinology at North Okkalapa General Hospital, Yangon
The Department of Endocrinology at North Okkalapa General Hospital, Yangon

With the first nationwide survey on diabetes prevalence in Myanmar set to launch in September and a public awareness campaign already well under way, the country’s ability to effectively address one of the most common non-communicable diseases is gaining strength. However diabetes experts have expressed concern that prevalence rates will increase at an alarming pace as a result of changing lifestyles among urban populations and a widespread lack of knowledge about the disease.

“We’re seeing more and more cases of Type 1 diabetes among younger people – some are as young as 10. A decade or so ago, the vast majority of diabetes patients I treated were always over the age of 40. I’m also starting to see a lot of cases of Type 2 diabetes among pregnant women in their twenties,” said Professor Than Than Aye, who is head of the department of medicine and endocrinology at North Okkalapa General Hospital.

Professor Than Than Aye said that wealthy Yangonites are most at risk.

“People in Yangon are much less physically active than those in rural areas and their diets are rich in calories. The number of fast food chains opening really worries me, because most are unaware of the dangers of a bad diet. People are also spending more time on the internet or just using a computer and lead sedentary lifestyles,” she told Mizzima Business Weekly.

According to the World Health Organisation, diabetes is the leading cause of blindness in Myanmar. Its estimated prevalence is six percent nationwide and 12 percent among rural populations. The number of undiagnosed cases is estimated at over a million people.

However obtaining concrete data that is representative of the entire country is necessary to effectively address the public health risk, said Dr Ko Ko, a professor at Department of Medicine at North Okkala General Hospital.

“The results from the survey will show us the magnitude of the problem. At the moment all we know is that diabetes is a big problem.”

Dr Ko Ko
Dr Ko Ko

The survey is being funded by the International Diabetes Federation and will be carried out by the Ministry of Health, with WHO providing technical assistance. Preparations for the survey have been underway since last October and it will include random sampling of almost 10,000 people in 52 of Myanmar’s 350 townships.

In 2003 a survey of 5,000 people was carried out in Yangon – a sample set that Dr Ko Ko said is too small and socio-economically selective to be reliable. Although in 2009 a nationwide survey on non-communicable diseases was undertaken, diabetes was excluded because the budget allocated by the government was insufficient to cover the cost of blood tests, which is the only means of providing an accurate diagnosis of diabetes.

Fortunately, care standards have been improving since 2012, when Myanmar’s first Department of Endocrinology opened at North Okkalapa General Hospital. The specialist department adheres to guidelines set by the American Diabetes Association and is able to provide the comprehensive care package that other general hospitals lack.

“The benefit of having a separate department dedicated to the treatment and prevention of diabetes is huge. Staff at general hospitals have so many duties to carry out and they’re overburdened. Here we’re able to provide specialist treatment, particularly for life-threatening complications that occur as a result of not managing the condition properly,” said Professor Than Than Aye, who has more than three decades of experience in treating diabetes, including two years at a hospital in the United Kingdom.

A young monk receives treatment at North Okkala General Hospital in Yangon
A young monk receives treatment at North Okkala General Hospital in Yangon

The department treats around 100 patients every week and as many as a third have never been diagnosed with diabetes. Professor Than Than Aye said that her patients fit broadly within two groups: the first are those who arrive with acute complications, such as dangerously high blood sugar levels, urinary tract infections, ulcers, hypertension and fevers.

Others require treatment for minor associated illnesses, or have been recently referred by their GP after being diagnosed with diabetes.

“When a patient arrives for treatment for the first time, we carry out a comprehensive medical checkup that reveals any complications, such as numbness in the feet – which can lead to a permanent disability. We also provide education about how to manage diabetes, such as changing their diet to avoid a lot of carbohydrates such as rice, as well as leading a more active lifestyle. Patients also need to understand that even if they feel healthy, regular check-ups to test glucose levels are vital to delaying complications setting in for as long as possible,” Professor Than Than Aye said.

However the costs of managing this lifetime disease are too high for many of the general hospital’s patients, and although the government began providing free medicines to in-patients in 2011, this has not yet been extended to outpatients.

“In the past, Myanmar’s health budget was just o.4% of the GDP [gross domestic product], while now it’s 4 percent – and the ministry has promised us it will be increase in the future. It’s given us some breathing room,” said Dr Ko Ko.

However donations from private individuals remain the lifeblood of the entire hospital’s ability to care for its patients – who consistently outnumber the number of beds available.

Up until two years ago, North Okkalapa General Hospital lacked an elevator: patients were carried up flights of stairs on stretchers – and were then required to pay for the labour involved. Continue reading Lifestyle changes linked to alarming rise in diabetes in Myanmar

Public enemy number one: Drug resistant malaria

Published in Mizzima Business Weekly on 13 April 2014

Global health organisation Population Services International plays a leading role in preventing and treating malaria in Myanmar – treating about 250,000 people every year with the parasitic disease. PSI’s senior malaria adviser (Asia-Pacific) Chris White told Mizzima Business Weekly about  the critical effort to prevent drug resistant malaria spreading from Myanmar to the Indian Subcontinent, from where it could spread to sub-Saharan Africa.

What is drug resistant malaria?

PSI’s senior malaria adviser in the Asia-Pacific, Chris White
PSI’s senior malaria adviser in the Asia-Pacific, Chris White

Think of drug resistance as an arms war between the parasites and whatever drugs we have available. This is not a new war – it’s a decades long war. Every time scientists find a new drug to kill malaria parasites, those parasites become exposed to the drugs over time and eventually, at some point, they develop a genetic mutation that confers some advantage to them. It’s widely acknowledged as a serious threat to global efforts to eliminate the disease.

The malaria-causing parasite that’s resistant to the most effective medicine available, artemisinin, is a subset of populations of Plasmodium falciparum. The type of malaria that is drug resistant is known as “severe malaria.” It kills more people around the world than any other.

When was drug resistant malaria discovered in Myanmar?

Drug resistant malaria was found during the last five years. That doesn’t mean resistance here is new, but that we’ve only become aware of it recently. Pockets of resistance have been found along south-eastern Tanantharyi Region near the Thai-Myanmar border, neighbouring Kayin State and in the highlands of eastern Shan State. The reason why it’s commonly found in border areas is because malaria is often transmitted by human movement. In the past, there were people moving from Myanmar to Thailand to the Cambodia border to work on gem mines and a lot of those people were Burmese. Then when they moved back, the parasites moved over the border. It’s human migration that moves the parasites around – obviously mosquitoes themselves can only travel a few kilometres. So what we are trying to do is put a wall up to stop resistant forms from reaching India, Bangladesh – and eventually, Sub-Saharan Africa. We have to stop the westward spread.

Malaria drugs for sale. Photo credit: Chris James White
Malaria drugs for sale. Photo credit: Chris James White

What has PSI been doing to stop drug resistant malaria from spreading?

Well, the first thing is just to try to bring down malaria as a whole. That means preventative steps, such as sleeping under mosquito nets. But the most important thing is taking good quality medicine instead of medicines that can drive the problem up. So we’ve been working with our donor agencies to distribute a drug that’s more effective, and importantly also, cheaper. Many people in rural communities buy medicines from the informal private sector – that is a kiosk style pharmacy – and most can only afford a partial dose of a mono-therapy drug, for about 500 kyat. From a curative standpoint, the mono-therapy drugs were effective. The problem is that they have one active ingredient. The way around this is to protect the miracle drug artemisen by combining it with another drug. The two anti-malaria drugs work in very different ways on the parasite, so the chances of a parasite developing a mutation are minimised, because the probability of two mutations is minuscule compared to having one active ingredient.

The really powerful part about this project is that we recognised that AA Medical in particular and another company dominate the anti-malarial market with about an 80% market share. So we persuaded them to work with us and we’ve had legally binding contracts in place for two years. Donor money subsidises the price of the more expensive combination therapies, which means we can outcompete them.

How do you measure tangible success?

A survey carried out by PSI in June 2013 at 3,500 outlets in the priority resistance containment region of eastern Myanmar found that the volumes of combination therapy being sold relative to monotherapy increased from 3 percent in mid 2012 to 73 percent in mid 2013. Our target had been ambitious at 50 percent, but we exceeded it. This was in just one year after we implemented it – it was a remarkable change.

We also have people coming in from the Chinese border and they are all saying the same thing – that they aren’t seeing the “bad” medicine. I challenge anyone to find it in the market nowadays.

Has the government been cooperative?

Yes, the Ministry of Health has been very supportive and the minister himself takes a personal interest in it. The fact that the Food and Drug Administration banned the previous monotherapy medicines was very important to our success. A few years ago, things weren’t so straightforward – it was much more difficult. There’s been dramatic improvement over the last few years and decentralisation is more common, which means that township officials have more control over what is going on, which is helpful.

Photo credit: Chris James White
Photo credit: Chris James White

Does regional cooperation also exist?

It used to be fairly fragmented but in recent years there’s been a tremendous push –  and there’s a global plan for fighting resistance malaria, along with a regional plan. Within the Greater Mekong Region there are country-specific plans, though each with a similar language, identifying consistent themes and approaches. In any given month I’ll go to one or two donor coordination meetings. Could things be better though? Yes. There are different agendas for combating malaria. What I’d say is that there’s always room for improvement, but there is an enormous effort on right now.

How is Myanmar succeeding as compared with other countries facing this threat?

In the past in Myanmar, we used to talk about drug resistance containment – but increasingly we don’t use the word “containment.” We talk about limitation. There’s a big drive in the Asia-Pacific region as a whole to move to elimination, such as in Cambodia, Nepal and Laos.

Myanmar remains in the containment phase, that is, bringing down the transmission to a level where it’s the pre-elimination stage. Pretty soon Myanmar will be recognised as being in the pre-elimination stage. That’s the goal we’re focused on for the next few years. But it’s not straightforward – there are lots of technical, epidemiological challenges. But we need to move in that direction.

Is there a risk the parasites will eventually become resistant to these new drugs? What happens then?

It’s increasingly recognised that the only long term solution isn’t new drugs – it’s wiping out the parasite population entirely (this is not to be confused with wiping out mosquitoes, which would be impractical). So while we’ve solved one particular piece of the puzzle, we are buying time until we have new alternatives. It’s an arms war remember, so at some point, we will need to change medicines. In the past we had the luxury of having an alternative drug in the pipeline. The reason why everyone is so worried is because there isn’t a new drug ready. It gets harder and harder to develop a new drug because it requires finding new compounds. That  said, thanks to the Bill and Melinda Gates Foundation, there’s more spending on scientific research than ever before. So we at least have potential options, but they aren’t ready for deployment.