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Myanmar has a yearly water festival called Thingyan, celebrating the New Year, as described by Einspruch (2007). The celebration occurs for three or four days during the hottest month in Myanmar, April, with the dates varying between April 10 and April 20th. Water is thrown on everyone except pregnant women or older adults, symbolising the washing away of one's problems, and has the added benefit of cooling people from the relentless heat. Einspruch (2007) further describes other activities, including cleaning monasteries and homes and preparing traditional foods such as mont-lone-ye-paw, a ball of dough floating on water. Many years ago, the hair of the Burmese King would be washed in public view as part of the celebration.

Einspruch, A. (2007). Myanmar. Heinemann Library.

One of the most popular festival in Myanmar, Thingyan | MingalaGO -Myanmar travel guide- – Useful and valuable travel information in Myanmar. (2018). MingalaGO. https://mingalago.com/en/interest/detail/thingyan

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Myanmar is renowned for its large variety of flora and fauna, as described by Hinchley (2019). Further, there are about 300 species of mammals in Myanmar, some of which are classified as being close to extinction. Additionally, the newly discovered Myanmar snub-nosed monkey was found in the Gaoligong Mountains in the north of Myanmar in 2010. Shortly after, the primate was also found living in China. Hinchley (2019) describes Myanmar's coastlines as some of the most undisturbed in southeast Asia, resulting in preserved mangroves, coral reefs and beds of seagrass housing more than 800 species of marine life.

A New National Park for the Myanmar Snub-nosed Monkey. (n.d.). Rainforest Trust. https://www.rainforesttrust.org/urgent-projects/a-new-national-park-for-the-myanmar-snub-nosed-monkey/

Hinchey, J. (2019). Myanmar (Burma) : discover the country, culture and people. Redback Publishing.

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According to Khin Zaw (1981), the Burmese marionette show as we know it today originated in the second half of the 18th Century.  The puppets are lovingly handcrafted from wood and adorned with traditional and colourful costumes. Strings attached to the puppets allow them to move and dance in a life-like fashion. Khin Zaw (1981) further describes the Marionette show as being directed towards an adult audience, consisting of an introduction, middle and end section and taking a whole evening to complete. The Burmese marionette show goes beyond entertainment, depicting Buddhist mythology and Myanmar culture and traditions.

(2015). Insightguides.com. https://www.insightguides.com/trip/myanmar-dreams

Khin Zaw. (1981). Burmese culture : general and particular. Daw Ohn Kyi.

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Social inclusion and non-discrimination are vital WHO social determinants of health for Burmese refugees in Australia. Refugees experiencing inclusion and equality are more likely to access healthcare services and integrate successfully into society. Borwick et al. (2013) noted how essential relationships are within communities. A welcoming and inclusive environment contributes to a sense of belonging and fosters mental well-being. Wong et al. (2019) describe having a "peaceful heart" and "not overthinking" as being linked to good mental health. Discrimination can lead to social isolation, limiting access to essential services, exacerbating health disparities and poor mental health outcomes. According to Schweitzer et al. (2011), anxiety, depression, and somatisation symptoms were explicitly influenced by postmigration living challenges.

Australia Map. (2017, June 28). Guide of the World. https://www.guideoftheworld.com/australia-map.html

Borwick, S., Schweitzer, R. D., Brough, M., Vromans, L., & Shakespeare-Finch, J. (2013). Well-Being of Refugees from Burma: A Salutogenic Perspective. International Migration, 51(5), 91–105. https://doi.org/10.1111/imig.12051

Schweitzer, R. D., Brough, M., Vromans, L., & Asic-Kobe, M. (2011). Mental health of newly arrived Burmese refugees in Australia: contributions of pre-migration and post-migration experience. Australian and New Zealand Journal of Psychiatry, 45(4), 299–307. https://doi.org/10.3109/00048674.2010.543412

World Health Organisation. (2024). Social determinants of health. World Health Organization. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1

Wong, C. K., White, C., Thay, B., & Lassemillante, A.-C. M. (2019). Living a Healthy Life in Australia: Exploring Influences on Health for Refugees from Myanmar. International Journal of Environmental Research and Public Health, 17(1), 121-. https://doi.org/10.3390/ijerph17010121

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Health challenges facing refugees from Burma

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Health challenges facing refugees from Burma

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It has been reported that roughly 220,000, or 1% of Australia’s population, have been diagnosed with chronic Hepatitis B Virus (HBV), with the majority of cases born outside of Australia (Australian Refugee Health Practice Guide, 2024). Further, studies show that Burmese refugees have a high incidence of HBV. Up to 25% of these people may develop severe liver disease or liver cancer if the condition is not detected and treated. According to the WHO (2020), the increase in recent vaccination programs is significantly reducing the occurrence of HBV in Burma. Research conducted by Gao et al. (2020), Hosaka et al. (2013), and Papatheodoridis et al. (2015) described the potential benefit of antiviral therapy in reducing hepatocellular carcinoma (HCC) and cirrhosis of the liver.

Burma (Myanmar) - Traveler view / Travelers' Health / CDC. (n.d.). Wwwnc.cdc.gov. https://wwwnc.cdc.gov/travel/destinations/traveler/none/burma

Gao, X., Yang, H.-I., Trinh, H., Jeong, D., Li, J., Zhang, J., Le, A., Hoang, J., Nguyen, P., Henry, L., & Nguyen, M. H. (2020). Antiviral therapy and hepatocellular carcinoma risk in hepatitis B patients with cirrhosis. European Journal of Gastroenterology & Hepatology, 32(9), 1207–1211. https://doi.org/10.1097/MEG.0000000000001639

Hosaka, T., Suzuki, F., Kobayashi, M., Seko, Y., Kawamura, Y., Sezaki, H., Akuta, N., Suzuki, Y., Saitoh, S., Arase, Y., Ikeda, K., Kobayashi, M., & Kumada, H. (2013). Long‐term entecavir treatment reduces hepatocellular carcinoma incidence in patients with hepatitis B virus infection. Hepatology (Baltimore, Md.), 58(1), 98–107. https://doi.org/10.1002/hep.26180

Maclachlan, J., Cowie, B., Isaacs, D., & Davis, J. (2024, August 10). Hepatitis B Virus (HBV). Australian Refugee Health Practice Guide. Hepatitis B Virus (HBV) » Australian Refugee Health (refugeehealthguide.org.au)

Papatheodoridis, G. V., Chan, H. L.-Y., Hansen, B. E., Janssen, H. L. A., & Lampertico, P. (2015). Risk of hepatocellular carcinoma in chronic hepatitis B: Assessment and modification with current antiviral therapy. Journal of Hepatology, 62(4), 956–967.

https://doi.org/10.1016/j.jhep.2015.01.002

World Health Organization. (2020, July 28). Viral hepatitis. factsheet-viral-hepatitis-2020-v2.pdf (who.int)

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Culturally responsive clinical practice: Working with people from migrant and refugee backgrounds competency framework for clinicians.

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I have worked in healthcare for over 30 years and have cared for many people from diverse backgrounds. I thought I understood how to provide outstanding person-centered care to my culturally and linguistically diverse patients. However, standard 1.1 of Domain 1: Clinical Expert from the Culturally Responsive Clinical Practice: Working with People from Migrant and Refugee Backgrounds competency standards framework for clinicians (2019) highlights to me that although I slow down my speech, speak clearly and allow time for questions regarding patient care, in future, if appropriate, I need to involve the families of my patients in the decision-making process regarding care and treatment as not doing this may affect patient experience and be detrimental to mental health leading to poor health outcomes.

Migrant and Refugee Women's Health Partnership (2019). Culturally Responsive Clinical Practice: Working with People from Migrant and Refugee Backgrounds COMPETENCY STANDARDS FRAMEWORK FOR CLINICIANS. [online] Available at:

Murdoch.edu.au.https://moodleprod.murdoch.edu.au/pluginfile.php/4119639/mod_resource/content/3/Culturally-responsive-clinical-practice-Working-with-people-from-migrant-and-refugee-backgrounds-Jan2019.pdf

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People in developing countries frequently use traditional medicines as their primary source of healthcare. Research conducted by Awale et al. (2006) describes Myanmar, formerly Burma, as having a long history of using traditional knowledge to make medicines from plants. In addition, a preparation of Jaggery, an unrefined sugar product, mixed with Aloe Vera, sesame oil, and a decoction of Alstonia scholaris, an evergreen tropical tree, which is toxic in high doses, depending on the season it is harvested, is successful in treating both post-menopausal and menstrual symptoms and that the Department of Traditional Medicine issues formal licences for people to practice traditional medicine.

Alstonia scholaris (L.) R. Br. (2020). Nparks.gov.sg. https://www.nparks.gov.sg/florafaunaweb/flora/2/7/2705

AWALE, S., LINN, T. Z., THAN, M. M., SWE, T., SAIKI, I., & KADOTA, S. (2006). The healing art of traditional medicines in Myanmar. Journal of Traditional Medicines, 23(2), 47–68. https://doi.org/10.11339/jtm.23.47