"Before, we could not sit at the same table. We were enemies killing each other. Now, we cooperate... to help people."
TA GAY LAUNG, Myanmar, Dec 18 (Thomson Reuters Foundation) - In the middle of a bustling village hall in Myanmar's Kayin state, a government health worker pricks the finger of a child to extract a tiny drop of blood for a malaria test.
A scene unthinkable just a few years ago, it is now commonplace in an area that used to be blighted by armed conflict between the government and soldiers from ethnic groups fighting for greater autonomy.
The situation has changed since a January 2012 ceasefire with the Karen National Union (KNU) paved the way for government health workers to reach remote villages in southeast Myanmar such as Ta Gay Laung.
Their work is symbolic of the changes sweeping Myanmar, ruled for almost 50 years by a military regime until 2011 when the country installed a quasi-civilian government and emerged from international pariah status, experts say.
It is also one of the first fruits of the ceasefire and a fragile wider peace process that participants hope will bring stability to a country that is still grappling with inter-communal violence, human rights abuses and poverty.
"Before 2012, we could not talk, we could not sit at the same table. We were enemies fighting each other, killing each other," said Ed Marta, a doctor and official at the Karen Department of Health and Welfare (KDHW), the KNU's medical arm.
"Now, we're able to cooperate and coordinate our work, with one single objective: to help people," said Marta, speaking in Hpa-an, capital of Kayin state.
Before the ceasefire there were few government health services in the state. For decades people in the area have relied on KDHW and other community-based organisations to provide crucial, albeit limited, healthcare.
The need to collaborate is even more pressing now as progress in fighting malaria is threatened by parasite resistance to drugs used to treat the disease, which is spread by mosquitoes.
Doctors have discovered drug-resistance in Kayin state and other parts of eastern Myanmar, as well as Cambodia, Thailand, Laos and Vietnam.
Myanmar has the largest malaria burden in the region, with 333,871 malaria cases in 2013 and about 60 percent of people living in areas where it is endemic, many of them migrants and people in rural regions that are hard to reach.
Villages like Ta Gay Laung used to be malaria-ridden but better access to healthcare since the ceasefire, availability of powerful drugs and mass distribution of insecticide-treated bed nets led to a sharp drop in the number of cases.
Pho La Lone, 29, who has had malaria twice, said he felt reassured knowing there is a community health worker and malaria testing in his village, a hamlet of 1,300 people some 80 kms (50 miles) from the Thai border.
"Of course I worry that I will get malaria again but it's good to know that I can get help quickly," the rubber plantation worker said as he waited with Thun Thet, his three-year-old son, to get tested for the disease.
Mistrust of the government still runs deep in the remote villages of Kayin state, whose people endured more than 60 years of armed conflict and are still exposed to sporadic shelling, rocket attacks and fighting between government soldiers and rebels despite the ceasefire.
During a recent visit to a remote village close to the border with Thailand, KDHW's Marta said people told him they would not trust anything coming from the central government.
"Some people are still very suspicious," he said. "They are suspicious of drugs coming from the central government and are even concerned about the insecticide-treated mosquito nets."
Aung Kyaw Htwe, the government's health director of Kayin state, said that after decades of conflict all sides had to recognise that it would take time to build trust.
"Before the ceasefire, we had no systematic quality healthcare in this area," he said, speaking at his office in Hpa-an. "We're negotiating with the ethnic groups. They're very important stakeholders."
A crucial step in building trust was a September 2013 meeting in Myanmar's capital, Naypyidaw, between senior health ministry representatives and leaders of ethnic health groups.
The landmark meeting resulted in an agreement to collaborate to improve health services, establish joint training programmes and share health information.
Soon afterwards, the ministry of health provided a supply of much-needed medicines to ethnic health organisations, said Shane Scanlon of the Project for Local Empowerment (PLE), which facilitated the meeting.
"It seemed that this meeting helped all parties to ... believe in the potential for health to serve as a bridge for peace," said Scanlon.
The PLE, a programme led by the International Rescue Committee in Thailand, together with consortium partners Mae Tao Clinic, The Border Consortium and World Education, supports local aid groups providing social services to about 400,000 people with little or no access to state services in contested areas of southeast Myanmar.
"Communities in southeast Myanmar have told us that, seeing the government and ethnic service providers working together, for the first time they feel that there may be peace," said Scanlon.
CONCERN ABOUT "BURMANISATION"
While analysts agree that providing basic social services is a crucial part of building trust in conflict zones, they stress that it is only one part of a much larger reform process needed in Myanmar.
"Mistrust of the government is chronic, following decades of civilian-targeted military operations ... and (trust) will not be bought through token social services without genuine changes to the governance and security sectors," said Kim Jolliffe, author of a report on the issue for the Asia Foundation.
Reforms instituted by President Thein Sein, a general who left the military to lead the reformist government, have sparked an unprecedented rise in aid to $504 million in 2012 from $355 million in 2010.
It could prove a mixed blessing as more aid money is channelled through the central government rather than local groups amid fears that it could undermine trust in the peace process because it gives the state more power.
"A number of the ethnic organisations we support express concerns that the expansion of government services into contested areas may lead to 'Burmanisation' and the expansion of state control, and risk undermining movements towards peace," said Scanlon.
(Reporting By Astrid Zweynert; Editing by Alex Whiting)
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