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Burmese have many traditions, including Thanaka; women and children have yellow paste over their faces, creating streaks along the cheekbone to the entire face. These are made from 'thanaka' powder (Abrahms, 2020). It's believed to protect the skin from the sun and prevent wrinkles (Abrahms, 2020). Chinlone is a game where participants pass a woven cane ball to each other using their feet, not letting it hit the ground while pulling off fancy moves (Abrahms, 2020). Teak Palaces form vast forests in the region's foothills; Teak is the building material for the Burmese because of its durability (Abrahms, 2020). The wood is resistant to monsoons and termites (Abrahms, 2020).

Transidus. (2020, April 15). Unique Traditions in Myanmar

https://www.transindus.co.uk/inspiration/blog/unique-traditions-in-myanmar/

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Unique Traditions in Myanmar | TransIndus

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Thanks to its geography, Myanmar has some of the most unique traditions and ranks among the most culturally distinctive countries in Asia. Find out more

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Burma is known for its different team and individual sports, the most popular being football, followed by golf (Wood, 2016). Burma has been waiting for football since the change of the government in the early 90s (Wood, 2016). Watching football is their way of bonding (Wood 2016). Golf is another popular sport nationwide in Burma(Wood, 2016). Burma also practices other sports, such as martial arts(Wood, 2016). Different types of martial arts are known in Burma, but the most popular is Lethwei (Wood, 2016). Lethwei is a form of kickboxing (Wood, 2016). Another popular local sport is Chinlone, a ball-centric game that is very popular in the country and played by many people (Wood, 2016).

Topend Sports. (2016, November). Sports in Myanmar

https://www.topendsports.com/world/countries/myanmar.htm#google_vignette

Stephen. (2017). Myanmar Traditional Sport: A Combination of Sports and Dance. [Photograph]. Go Myanmar Tours.

https://www.gomyanmartours.com/chinlon-myanmar-traditional-sport-combination-sports-dance/

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The Burmese believe that health is caused by supernatural factors such as spirit possession by an ancestor, spiritual factors including bad karma or non-observance of religious ethics, traditional belief such as culture-bound illness and is referred to as Koro which is the fear that the genitalia moves into the body and if done thoroughly, death will occur (Queensland, 2011). Amongst women, menstrual flow is considered critical to health, indicating excellent or poor physical and mental health. The Burmese use traditional plant-based medicine, which has become part of their heritage, treating Anemia, Arthritis, Eczema, Headaches, Diabetes, Common colds, Measles, Tuberculosis, and much more.

State of Queensland. (2011). Burmese Australians. Community Profiles for Health Care Providers - Burmese profile.

https://www.health.qld.gov.au/__data/assets/pdf_file/0027/155835/burmese2011.pdf

Alison, K. (2024). In Myanmar, Health Care has become a battleground [Photograph]. Governance.

https://www.thinkglobalhealth.org/article/myanmar-health-care-has-become-battleground

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Burmese have many traditional foods, such as Tea leaf salad (Cruises, 2021). Tea leaf salad in fermented tea leaves, and Burma is one of the few countries where the tea is eaten and drunk; this is also a peace offering as it was traditionally consumed to seal a court verdict (Cruises, 2021). Mohinga dish is Burma's unofficial national dish, traditionally served for breakfast (Cruises, 2021). Burmese Tofu is a dish made from chickpeas, and this dish comes in fritters, too, crisp outside and fluffy inside (Cruises, 2021). Samosa Thoke is a traditional Burmese street food that also resembles Indian samosa (Cruises, 2021). They are filled with potatoes and chickpea powder (Cruises, 2021).

Rainforest Cruises. (2021, April 28). Myanmar Food: 15 Traditional Dishes You Should Eat. Rainforest Cruises

https://www.rainforestcruises.com/guides/myanmar-food

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Myanmar food is an integral part of the Burmese way of life. The people of Myanmar love to indulge in food and spend a great many hours preparing and eating a meal, emphasizing on the cooking procedure rather than ingredients, and therefore paving a way for a variety of dishes with constant improvisation.

Burmese cuisine is an exotic blend of noodles, seafood, and rice, spiced up and enhanced by condiments and salads. Fruits, a feature of the tropical climate, are also an important part of this cuisine. The food has been influenced by the techniques, ingredients and flavors of Myanmar's neighbors: Thailand, India and China.

Dishes are characterized by the extensive use of fish products, while pork, beef and poultry are more commonly used in landlocked cities like Mandalay. The great Irrawaddy river flows through the country, which means freshwater fish is a mainstay everywhere, and a primary source of protein, used in a variety of ways; fresh, salted, whole or filleted, salted and dried, made into a salty paste, or fermented sour and pressed.

The Burmese enjoy a wide range of salads (thoke), usually dominated by one major ingredient which may include rice, wheat and rice noodles, glass noodles and vermicelli, to potato, ginger, tomato, kaffir lime, lahpet (pickled tea), and the pounded, fermented fish paste known as ngapi. These salads have always been popular as fast foods in Burmese cities.

Every dish has at least three of the five tastes of salty, sweet, sour, bitter and umami, and every meal has a host of accompaniments. Texture is just as important as flavor, even within the same dish - for example, a bowl of Mandalay Meeshay will contain tender rice noodles, crunchy-sour pickles, beansprouts that snap to the bite, and meltingly rich morsels of pork.

Myanmar traditional food is wholesome, nutritious, and filled with the right amount of carbs, proteins, and vitamins. See below for a selection of must-try dishes from the Burmese cuisine.

1. Nan Gyi Thoke

Also known as Mandalay Mont Di, this is a hearty, warm salad of fat rice noodles, chicken or beef curry, chili oil, toasted chickpea powder, coriander and sliced shallots.

2. Burmese Tofu

Burmese tofu is made from chickpeas, while Shan tofu is made from split peas - neither type is made from the more standard soya beans. You can enjoy Burmese tofu in the form of fritters, which are crisp outside and fluffy inside (tohu kyaw) and served with a tangy tamarind dip; or sliced up into a salad (tohu thoke) with a piquant dressing; or even served while still warm and molten (tohu nway) over a bowl of spicy noodles.

3. Mohinga

Mohinga is the national dish of Myanmar. This hearty, herb-based, lemongrass and rice noodle soup, often supplemented with the crunchy pith of the banana tree is usually eaten for breakfast. It is heaped with crispy split-pea fritters, sliced soft boiled duck eggs and bouncy fishcakes, scattered with roasted chili flakes and shredded coriander leaves.

Served with lime or lemon wedges to squeeze on top, this is a perfect, balanced breakfast dish which is now creeping in as a filling snack that can be relished at any time of the day. Few people actually make mohinga at home, as there are countless street vendors and cafés vying for business, and everyone has their favorite.

4. Samosa thoke

The samosa thoke is a traditional Burmese street food that resembles the Indian samosa chaat but not entirely because Burmese samosas are smaller than their Indian cousins. They are filled in with potatoes and chickpea powder. These deep-fried pastries are then dunked in a plain Burmese curry and garnished with mint leaves, sliced onions, tomatoes, cabbage, and brown chickpeas. The base dish is not spicy at all so you can choose to add more chili if you wish.

5. Kyaw − Fried snacks

Myanmar has many popular fried foods that are light, crunchy and grease-free, which you can find on the street. In addition to deep-fried samosas and pancakes, you will find gourd fritters, urad dal fritters, prawn fritters, onion fritters, whitebait fritters, tofu fritters, spring rolls, sweets, breads, and noodles topped with deep-fried crispy garnishes.

6. Myanmar Shrimp Curry

Different from Thai or Indian curries, high on flavors, medium on spices, and low on broth, a Burmese shrimp curry has its own characteristic flavor and taste. Paired with rice, it can make for a perfect lunch.

7. Khao Soi

Khao Soi is a noodle soup made with chicken broth, shallots, and bean sprouts.

8. Nan Gyi thoke

This mouth-watering dish takes the form of thick, round rice noodles with chicken, thin slices of fish cake, par-boiled bean sprouts and slices of hard-boiled egg.

9. Laphet Thoke −Tea leaf salad

Lahpet Thoke is one of Myanmar's most iconic dishes. The sour, slightly bitter, pickled tea leaves are mixed by hand with shredded white cabbage, sliced tomatoes, ginger and other fried spices, dried shrimp, crunchy peanuts, lima beans and peas to create a piquant and savory salad, bursting with flavor and textures. The dish can be a snack, an appetizer or coupled with a plate of rice. Lahpet Thoke is widely observed at traditional ceremonies.

10. Ohn No Khao Swè

This Burmese curried soup contains egg noodles accompanied by coconut cream, vermicelli, and chicken along with spices. Consume with tangy lemon pieces, eggs, and fish sauces.

11. Htamin Jin

This famous rice dish is cooked with potatoes, tamarind pulp, and shrimp paste. It is commonly served with fried garlic, while for a spicier taste, dried chilies can be incorporated.

12. Shan-style 'tofu' noodles

The dish does not include tofu, but a thick sticky yellow porridge made from chickpea flour and turmeric, and served over thin rice noodles, marinated chicken or pork, topped with chili oil and pickled veggies and broth.

13. Burmese Coconut Rice

Cooked rice with onions, coconut milk, sugar and salt, the taste of this wholesome dish is not at all spicy, but deliciously sweet.

14. Ngapi Ye dipping sauce

This dip for deep fried items contains mashed fish or ngapi, lemon juice, shrimp powder and garlic.

15. Shan-style noodles

The dish is a combination of thin, flat rice noodles in a clear, peppery broth with marinated chicken or pork, served with a side of pickled vegetables. Compared with other noodle dishes, it is relatively simple but delicious.

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Myanmar Food: 15 Traditional Dishes You Should Eat - Rainforest Cruises

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Myanmar food is an integral part of the Burmese way of life. The people of Myanmar love to indulge in food and spend a great many hours preparing and eating a

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Latent tuberculosis is a global disease that impacts low-income countries and vulnerable populations (Denholm, Bailes, Francis, n.d.). According to a study, 5.5/per 100,000 of the population is affected by Latent Tuberculosis per year; however, nearly 90% of cases occur in overseas-born Australians (Denholm, Bailes, Francis, n.d.). Symptoms of Latent Tuberculosis include constant coughing for over two weeks, shortness of breath, hemoptysis, chest pain, fevers, night sweats and dramatic weight loss (Ngugyen, n.d.). A study was conducted on Burmese refugees at an Australian teaching hospital, and 70% of the Burmese refugees had Latent Tuberculosis (Chaves, Gibney, Leder, O'Brien, Marshall, Biggs, n.d.). Treatment for Latent Tuberculosis includes three to four months of antibiotics to help fight and destroy the disease (Department of Health, 2022).

Justin, D. Marion, B. Josh, F. (n.d.) Tuberculosis (TB & LTBI). Australian Refugee Health Practice Guide.

https://refugeehealthguide.org.au/tuberculosis-tb/

Andrew D, N. (n.d.). Latent Tuberculosis. National Library of Medicine.

https://www.ncbi.nlm.nih.gov/books/NBK599527/

Nadia J, C. Katherine B, G. Karin, L. Daniel P, O. Caroline, M. Beverley-Ann, B. (n.d.) Screening Practices for Infectious Diseases among Burmese Refugees in Australia. National Library of Medicine.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2857247/#:~:text=We%20performed%20a%20retrospective%20study,can%20prevent%20long%2Dterm%20illness.

Department of Health. (2022, October 26). Treatment for Latent Tuberculosis (TB) Infection is Isoniazid and Rifapentine (INH-RPT). Department of Health.

https://www.health.state.mn.us/diseases/tb/basics/factsheets/inhrptltbi.html#:~:text=You%20can%20take%20medicine%20to,used%20together%20to%20treat%20LTBI.

Refugee Council of Australia. (2021). Key issues for refugees from Myanmar. [Photograph]. Refugee Council of Australia

https://www.refugeecouncil.org.au/myanmar-burma/2/

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Around 1 in 5 refugees report that they feel lonely, 16% of males and 19% of females aged 35 and over in 2021 (Australian Government, 2024). Refugees from Myanmar to Australia are excluded from national programs for health promotion, disease prevention, as well as treatment (World Health Organisation, 2022). Refugees face high user fees, low levels of health literacy, poor cultural competency among health providers and inadequate interpreting services, making it harder for them to understand (World Health Organisation, 2022). To improve health outcomes for Burmese refugees, culturally sensitive healthcare services, such as interpreters, outreach programs in the Burmese communities, and mental health services for the Burmese refugees' needs were implemented (World Health Organisation, 2022).

World Health Organisation. (2022, May 2). Refugee and migrant health. World Health Organisation.

https://www.who.int/news-room/fact-sheets/detail/refugee-and-migrant-health

Australian Institute of Health and Welfare. (2024, July 2). Social determinants of health. Australian Institute of Health and Welfare.

https://www.aihw.gov.au/reports/australias-health/social-determinants-of-health

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Overview

Refugees and migrants have a variety of different physical and mental health needs, shaped by experiences in their country of origin, their migration journey, their host country's entry and integration policies, and living and working conditions. These experiences can increase the vulnerability of refugees and migrants to chronic and infectious diseases.

The COVID-19 pandemic has disrupted health services, putting people already in vulnerable situations at heightened risk and hampering the ability of health systems to respond to their needs.

Key data and information on refugees and migrants

The term refugee is defined in Article 1 of the 1951 Convention Relating to the Status of Refugees (3). There is no universally accepted definition of the term migrant (4). However, the United Nations Department of Economic and Social Affairs defines an international migrant as "any person who changes his or her country of usual residence", and this definition includes people who are moving or have moved across an international border, regardless of legal status, duration of the stay abroad and causes for migration (5).

Migrants may be given a migration status that limits their entitlement and access to health care. However, international law guarantees universal access in line with the 2030 Agenda for Sustainable Development, in particular with Sustainable Development Goal 3 (ensure healthy lives and promote well-being for all at all ages) (6).

Although governed by separate legal frameworks, refugees and migrants are entitled to the same universal human rights and fundamental freedoms as other people (7).

In 2021, countries with the highest number of refugees fleeing were 1. Syrian Arab Republic, 2. Venezuela, 3. Afghanistan, 4. South Sudan and 5. Myanmar while countries hosting the highest number of refugees were 1. Turkey, 2. Colombia, 3. Uganda, 4. Pakistan, 5. Germany (8).

In the first 5 weeks since the escalation of conflict in Ukraine on 24 February 2022, more than 4 million refugees from Ukraine crossed borders into neighbouring countries, and many more have been forced to move inside the country (9).

In 2020, the top countries of origin for international migrants were 1. India, 2. Mexico, 3. Russian Federation, 4. Syrian Arab Republic, 5. China. The United States of America has been the main country of destination for international migrants since 1970, and Germany is the second top destination (10).

Common health needs and vulnerabilities of refugees and migrants

Refugees and migrants are a diverse group and have a variety of health needs, which may differ from those of the host populations.

Refugees and migrants often come from communities affected by war, conflict, natural disasters, environmental degradation or economic crisis. They undertake long, exhausting journeys with inadequate access to food and water, sanitation and other basic services, which increases their risk of communicable diseases, particularly measles, and food- and waterborne diseases. They may also be at risk of accidental injuries, hypothermia, burns, unwanted pregnancy and delivery-related complications, and various noncommunicable diseases due to the migration experience, restrictive entry and integration policies and exclusion.

Refugees and migrants may arrive in the country of destination with poorly controlled non-communicable diseases, as they did not have care on the journey. Maternity care is usually a first point of contact with health systems for female refugees and migrants.

Refugees and migrants may also be at risk of poor mental health because of traumatic or stressful experiences Many of them experience feelings of anxiety and sadness, hopelessness, difficulty sleeping, fatigue, irritability, anger or aches and pains but for most people these symptoms of distress improve over time They may be at more risk of such as depression, anxiety and post-traumatic stress disorder (PTSD) than the host populations.

Refugee and migrant health is also strongly related to the social determinants of health, such as employment, income, education and housing

Barriers to access to health services

Refugees and migrants remain among the most vulnerable members of society and are often faced with xenophobia; discrimination; substandard living, housing and working conditions; and inadequate or restricted access to mainstream health services.

Migrants, particularly in an irregular situation, are often excluded from national programmes for health promotion, disease prevention, treatment and care, as well as from financial protection in health. They can also face high user fees, low levels of health literacy, poor cultural competency among health providers, stigma and inadequate interpreting services.

Barriers are even greater for people with disabilities. Women and girls may find difficulty in accessing sexual and gender-based violence protection and response services. Refugee and migrant children, especially unaccompanied minors, are more likely to experience traumatic events and stressful situations, such as exploitation and abuse, and may struggle to access health care.

The ability to access health services in humanitarian settings is usually compromised and complicated by shortages of medicines and lack of healthcare facilities.

COVID-19

The COVID-19 pandemic has brought an increased risk of infection and death for refugees and migrants. People on the move may have limited tools to protect themselves such as social distancing, hand hygiene and self-isolation are often not possible.

The pandemic has highlighted existing inequities in access to and utilization of health services. Refugees and migrants have also suffered the negative economic impact of lockdown and travel restrictions. Income loss and health care insecurity may have particularly affected labour migrants. They may have also experienced legal and social insecurity caused by the postponement of decisions on migration status or a reduction of employment, legal and administrative services.

WHO response

WHO believes that everyone, including refugees and migrants, should be able to enjoy the right to health and access to people-centred, high-quality health services without financial impediment, as expressed by our commitment to universal health coverage. Health systems should incorporate the needs of refugees and migrants in national and local health policies, financing, planning, implementation, monitoring and evaluation. In rapid and effective emergency responses, health care may sometimes need to be delivered in a parallel structure to the national health system, but in the long term, refugee and migrant health should be mainstreamed into existing services.

WHO works around the world to secure the health rights of refugees and migrants and achieve universal health coverage. Through the Health and Migration Programme, and in collaboration with regional and country offices, WHO provides global leadership, advocacy, coordination and policy on health and migration; sets norms and standards to support decision-making; monitors trends, strengthens health information systems and promotes tools and strategies; provides technical assistance, response and capacity-building support to address public health challenges; and promotes global multilateral action and collaboration by working with UN agencies and other international stakeholders, as well as by being part of the United Nations Network on Migration.

WHO works with countries to build strong health systems that are supported by a well trained, culturally sensitive and competent workforce, and are sensitive to the needs of refugees and migrants, their languages and their unique health problems.

Notes

1. https://www.iom.int/data-and-research

2. https://www.unhcr.org/refugee-statistics/

3. http://www.unhcr.org/3b66c2aa10.pdf

4. https://www.who.int/publications/i/item/promoting-the-health-of-refugees-and-migrants-draft-global-action-plan-2019-2023

5. Recommendations on Statistics of International Migration, Revision 1 (1998) para. 32). https://unstats.un.org/unsd/publication/seriesm/seriesm_58rev1e.pdf

6. https://documents-dds-ny.un.org/doc/UNDOC/GEN/N15/291/89/PDF/N1529189.pdf?OpenElement

7. United Nations General Assembly resolution 71/1 (2016). New York Declaration for Refugees and Migrants, paragraph 6 ( http://undocs.org/a/res/71/1)

8. https://www.unhcr.org/refugee-statistics/

9. https://data2.unhcr.org/en/situations/ukraine

10. Interactive World Migration Report 2022 (iom.int)

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Refugees, asylum seekers, internally displaced people (IDPs) and migrants often come from communities affected by war, conflict, climate change or economic crisis, with vulnerabilities related to the condition of their journeys such as inadequate access to food and water, sanitation and other basic services.

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Competency Standard 2 is for clinicians to understand and respond to the barriers to quality and safe care experienced by people from refugees (Migrant and Refugee, 2019. For me, useful learning happened when completing this assignment. I have improved my knowledge of barriers to quality and safe care. Having learned this, I now understand how difficult as a refugee it is to come to Australia and adapt. Initially, I thought most families came over together, but I now know not all families do. Equally, I feel that implementing interpreters, a culturally sensitive healthcare system, and mental health services are important.

Australian Library and Information Association. (2021, August 28). Reflective practice writing guide. Australian Library and Information Association.

https://moodleprod.murdoch.edu.au/pluginfile.php/4119641/mod_resource/content/1/reflective%20writing%20phrases.pdf

https://www.britannica.com/topic/flag-of-Myanmar