Learning from the past

I first set foot in Myanmar in 2012. It was a special assignment, I was part of a delegation, led by the General Manager of the Global Fund to Fight AIDS, Tuberculosis (TB) and malaria, on an official visit to the country.

We met the health minister, partners, the national health programs officials, civil society groups and the lady herself. At that time she was a Parliamentarian, based in Naypyidaw, the capital city. I recalled seating in the car heading towards the capital from Yangon; it was raining cats and dogs since morning, I was not sure if the driver could properly see the road. Flying was not logistically possible that day. Needless to say, during the entire 325km bumpy ride, I was wide alert.

At Naypyidaw, we faced another challenge – locating the residence of Daw Aung San Suu Kyi, the Rose Cottage. Telecommunications were very limited, let alone the use of any GPS. Myanmar only started to liberalise communications services in 2013. Thanks to our experienced drivers, we managed to find the Rose Cottage, a simple single storey house among a few similar looking houses. We had to wait for our turn, the group before us had apparently overshot their meeting time allocation.

After a few minutes, we were greeted by Daw Aung San Suu Kyi and her aide. We sat at a simple rectangular table and were served tea. Our head of delegation spoke about our programmes in Myanmar and the important role of parliamentarians in policy development, and how the Global Fund supports the work of civil society in Myanmar. She was very receptive and supportive of the initiatives but also emphasised on the rule of law. She was not the warmest person I have ever met I must say, but she exuded confidence. This type of visit continues each time a senior official visits Myanmar. In a way it is to maintain and strengthen relationship, in another way to exchange views on the health landscape, and in another subtle way to get a feel of the political situation in the country.

On the political front, I was often asked about the situation of Rakhine. I was also often asked about the ethnic minority controlled areas in the country. I will not go into details but suffice to point that it was not easy to work on a portfolio of grants in a country where situations were constantly evolving sometimes at a rapid pace and approaches on programmes needed to be adapted according to the situation while ensuring the targets or end results were not compromised.

Apart form navigating political sensitivities, the international development and humanitarian actors had to deal with Myanmar’s proneness to natural disasters; the largest being the Nargis. Myanmar, is also a country that bears high disease burden, for example it is one of the 30 high TB and multi drug resistant TB burden countries in the world. Despite it all, Myanmar made remarkable achievements in reducing the HIV, TB and malaria burden in the country. On fighting malaria, a decade ago Myanmar had more than 1 million malaria cases every year; as of 2019 this number dropped to 108,000, and a significant decline in malaria-related deaths from 1,707 in 2005 to only 30 at the end of 2017. Death related to TB saw a 78% reduction from 2000 to 2019. For HIV, a total of 184,544 people were on antiretroviral therapy compared to 40,128 in 2011. Further information can be found here and here.

Part of the success is attributed to the willingness and openness to dialogue between Myanmar and the international community. This was especially relevant to the Global Fund because of its “dark” history in Myanmar – it abruptly withdrew its support to the country in 2005. It took five years to persuade the government of Myanmar to re-engage with the Global Fund. In 2011, after much efforts on “reconciliation”, the Global Fund resumed activities in Myanmar. Even so there would still be occasional awkward encounters when a senior official would bring up the topic on the 2005 termination.

I cannot write about the tremendous progress of the Global Fund in Myanmar with the support of international partners without highlighting the dedication of its people. Those who have experience in large donor funding would know how burdensome it is – the amount of rigour, complexity and the demand required from grantees, from funding application to implementation, monitoring and closing of the programmes. Two observations I witnessed in my eight years working on Myanmar programmes – the Myanmarese are very organised and are never late for appointments. Perhaps it is to do with the long years under the military administration. Myanmarese are very proud people. They take pride in the achievements gained in the health front and want to sustain them, examples include the increasing domestic financing in health and the government taking over the handling of HIV treatment in the country in 2019.

Recent developments have been ugly in Myanmar. The international community have rightly condemned the military coup. The United States have imposed sanctions on the military. But it has also maintained support for healthcare, civil society groups and areas directly benefitting the people of Myanmar. This is a positive signal, from a health perspective; it was absolutely needed as the gains achieved since the country started its democratic path is enormous. Reversing these gains is not an option.

Lest we forget during the democratization process and when Daw Aung San Suu Kyi led the country, Myanmar was still under strong military influence. Throughout my career at the Global Fund, I have witnessed at least three health ministers, one being a former major general who was appointed as minister in 2015.

The world should consider that since the opening of the country to democratisation, many lessons have been learnt especially on navigating the country’s political labyrinth. Perhaps instead of looking deep and far for solutions to the current situation, if not already done. it might do good for the international community to take on the lessons over the past decade in dealing with the current Myanmar. For all is not lost.


Myanmar’s shadow government, the junta and soul searching

The coup d’état in Myanmar on 1 February 2021 have triggered hundreds of thousands of Myanmarese, including civil servants, teachers, bus drivers and bank clerks to protest against the junta. The protests have been the largest since the so-called Saffron Revolution in 2007, when thousands of monks rose up against the military regime.

Numerous countries have condemned the military takeover and subsequent crackdown. The US, UK and European Union have all responded with sanctions on military officials.

In April 2021, the Association of Southeast Asian Nations (ASEAN) leaders and Myanmar’s junta leader Min Aung Hlaing on agreed on five issues or five-point concensus, including ending violence and holding constructive talks.

Six months have gone by since the coup and despite the promise to end violence, there has not been much progress on this front. Since the coup, more than 700 people including children have been killed and more than 3,000 detained.

“Neither party to the conflict is able to mobilise a combined political and military force to overcome the other party. We need to move forward, and this may require a reevaluation of strategy, ” said Marzuki Darusman, the chair of the UN Independent International Fact-Finding Mission on Myanmar.

Marzuki was speaking as a panelist at the the 1st Regional Dialogue with the theme of Beyond the Five-Point Consensus: Looking at other options available to discuss the best possible ways to move forward, with a view to contribute towards restoring democracy in Myanmar.

The event was co-organised by the Human Rights Commission of Malaysia (SUHAKAM), thé Commission on Human Rights of the Philippines (CHRP), the National Commission on Human Rights of Indonesia (KOMNAS HAM), Provedor for Human Rights and Justice (PDHJ) Timor-Leste, The ASEAN Intergovernmental Commission on Human Rights (AICHR) Indonesia, AICHR Thailand and AICHR Malaysia.

Marzuki added it is more productive to explore possible solutions within the dynamics caused by the standoff between the two sides.

“We are all looking at the big game of seeking recognition from the international community. At the end of the day the recognised government must find ways of working with each other, there may be soul-searching process for both sides,” Marzuki said.

He was referring to the upcoming event in September when at the next UN General Assembly session both the National Unity Government (NUG) and the junta will submit rival petitions to the Credentials Committee, which will decide on which it considers Myanmar’s legitimate government.

In May 2021, the NUG was formed by a group of ousted National League for Democracy (NLD) politicians, activists, and representatives from several ethnic minority groups to oppose the military regime.

“We don’t know what is going to happen,” Marzuki said adding that the the parties involved may have to look at their prospects between now and September and to come out publicly on its readiness to engage with each other.

The proposed “show all cards” effort should be Myanmar-led, he opined.

Analysts say given the historical affiliation between the junta and Russia and China, recognizing the NUG by the international community at the September UN General Assembly would certainly earn ire of the two countries. The September decision will also have implications on ASEAN whose members are split on their position regarding the crisis.

On the issue of NUG’s recognition, Marzuki opined that ASEAN’s recognition of the shadow government is so much more important than the recognition or non- recognition by international community. “The junta is more concerned about how ASEAN looks at Myanmar than what anybody in New York or Geneva say. Forget about that, this is real politics, and therefore this is an area that NUG needs to play an effective role,” Marzuki said.

He suggested the NUG to have a blanket policy of designating envoys in ASEAN to replace envoys that have been there so far and thus pushing ASEAN to make a decision on which party to recognise. “This could be done almost immediately, it just needs a decision by the NUG, ” he added.

So far NUG has designated 10 new envoys to ASEAN to represent Myanmar. Marzuki suggested the national human rights commission of each ASEAN country to support the NUG efforts to persuade ASEAN members to recognise its legitimacy. “Little things can add up to a significant change in the way ASEAN looks at the NUG,” he added.

Several panelists also spoke at the regional event. They include Tom Andrews the UN Special Rapporteur on the situation of human rights in Myanmar who said the people in Myanmar desperately needed the support of the international community before it was too late. He recommended an Emergency Coalition of those who were willing to exert economic pressure on the military authorities and prevent them from accessing weapons.

Razia Sultana who is a Rohingya and human rights activist and the founder of the RW Welfare Society spoke about the atrocities and hardships faced by the Rohingya community, saying the NUG has pledged to support the cause of the Rohingya including at the International Court of Justice (ICJ) where Myanmar is accused of committing genocide against the Rohingya. “This is a reversed position to the past NLD’s stand in the ICJ,” she said, adding that it was a positive development.

Razia urged neighbouring countries and ASEAN to increase maximum pressure on the junta by applying measures such as halting economic revenue, arms sales and development aid to Myanmar and supporting the ICJ case against Myanmar.

The issue of ASEAN non-interference tradition was highlighted as a stumbling block to the crisis. “The notion is a divisive concept. The demon of non-interference has to be exorcised from ASEAN. That is the way forward as we confront the 21st century challenges,” Marzuki said.

The implications of the pandemic which saw cases more than doubled every week in recent weeks were also discussed. A humanitarian corridor was recommended to bring all parties together to address the Covid challenges, an initiative similar to the mechanism that was used in bringing independent movements and government to collaborate during the aftermath of the 2004 Aceh tsunami.

Similar dialogues will be held in the coming months.


The Rohingya refugees in Malaysia: prejudice, challenges and hope

There are 102,960 Rohingya refugees and asylum seekers registered with the United Nations High Commissioner for Refugees (UNHCR) in Malaysia. The country hosts the largest number of Rohingya refugees in the Association of Southeast Asian Nations (ASEAN).

But the solidarity act had turned hostile especially in the past year when, as in other parts of the world, the pandemic has turned sentiment against foreigners. Anti-refugee sentiments and hate speech calling for violence against Rohingya refugees and other undocumented migrants have spread like wild fire, both on online and offline media.

Mahi Ramakrishnan a refugee rights activist who runs a non-profit organisation Beyond Borders said Rohingya prejudice in Malaysia had emerged long ago. “Initially we thought paid trolls have created the backlash but actually it was coming from a larger community. It has taken a pandemic to bring the deep-seated hostility which was already prevalent amongst Malaysian,” she added referring to netizens attacks on the Rohingya refugees.

She was speaking as one of the panelists at the Walk the Talk: Rohingyas at Peril: From Home to Malaysia, a forum organised by the Community Action Network.

Not a religious branding

“A lady walked seven nights across to Cox Bazaar from Rakhine. She fell in front of me, her legs bleeding, I saw a baby between her legs. I took the child with blood and all, I asked where the father was, the answer was he was killed. Ten minutes later, the lady died. There was this whole feeling of guilt in me asking what sin has this child done to deserve this,”

Azmi Abdul Hamid president of the Malaysian Consultative Council of Islamic Organization.

“They are human beings, they are like us, they have dreams, they have hope, we are in the same situation – Covid is attacking everybody. Yes we have our differences but they are in a much dire situation. Even when this whole thing ends, they will not be like us. We have a sense of being a nation, there is nothing wrong with that but there is also a sense of being human, and that process goes beyond ethnic, creed, religion,” he told the forum.

Azmi who is known for his work locally and internationally on the Palestinians, Syrians and Rohingya issues said this when asked on advice to Malaysians who could be afraid of sharing what they themselves are not getting.

Another panelist Father Bernard Hyacinth, a former Regional Director of the Jesuit Refugee Service who has worked with refugees in the Middle East and Asia, concurred with Aziz, saying. “The question we should ask is not who is my neighbour, but who am I a neighbour to? Anyone in need is my neighbour. We know they (the refugees) exist in Malaysian; they have been around for a long time. What have we understood about them? I am not saying Malaysians are not suffering, we will continue to help the locals but they are others worse off”, he added.

In multi-racial and multi-religion Malaysia, it is commonly perceived that issues face by the Rohingyas who are primarily Muslims “belong” to the Malaysian Muslim community.

“It is strange that people of other faiths do not think that it is an issue that belongs to all. It is not a religious branding, and so any refugee cause is a cause for all of us. A refugee did not choose to become a refugee,” said the panel’s moderator Jerald Joseph. Joseph is also a Commissioner of the Malaysian Human Rights Council.

Clearing up misconceptions

During the wide-ranging discussion, the panelists took various questions, including clarifying some of the misconceptions about the Rohingya refugees in Malaysia.

Syedah Nur Husen of the Rohingya Women Development Network (RWDN) said, “People are not the same. Some are helpful. Some are angry because they do not understand the Rohingya issues”.

Syedah, a Rohingya refugee who has been living in Malaysia for 23 years, also refuted claims that the Rohingya refugees receive financial aid through their UNHCR registration card. “It is not true that those with the UNHCR card receive financial aid. Only when we work we get money,” she said.

“Even when we have the UNHCR card, we still cannot buy the phone sim card. We cannot send our children to schools and if we managed to we cannot send them to college or university,” Syedah said adding that paying for medical fees is also a big challenge for the Rohingya refugees.

Joseph agreed stating the UNHCR confirmed that Rohingya refugees registered with the agency receive only registration cards.

Five main challenges

1. Documentation

Malaysia is not party to the 1951 Refugee Convention or its Protocol. Rights contained in the Convention includes: the right not to be expelled, except under certain, strictly defined conditions; the right not to be punished for illegal entry into the territory of a contracting State; the right to work; the right to housing and the right to education.

There is currently no legislative or administrative framework for dealing with refugees in Malaysia. By law, in Malaysia, refugees are not differentiated from undocumented migrants. They, including their children, are thus vulnerable to arrest for immigration offences and may be subject to detention, prosecution and deportation.

2. Welfare and livelihood

The UNHCR registration card does not allow refugees to work in Malaysia legally.

Around a quarter of the Rohingyas in Malaysia are children. The Rohingya children are denied formal education. There are about 150 schools run by non-governmental organisations that provide education to refugees in the country but many struggle with limited funding, overcrowded classrooms and few resources.

The constant fear of arrest, detention and even deportation pushes refugees underground. Many are forced to take on jobs in the informal sector, risking being exploited, blackmailed and underpaid.

3. Health

Healthcare costs in Malaysia are generally affordable for Malaysians. But foreigners pay thrice the amount.

For the Rohingyas whose monthly wages are less than RM900 (USD215) a month, healthcare cost is simply beyond their means. This forces many of them to avoid healthcare altogether, thus potentially worsening the associated risks.

The situation is worse if they had to face complicated cases which require complicated interventions.

4. Shelter

Many people think refugees live in camps. In Malaysia there are no more refugee camps.

“Due to the increased outbursts against the Rohingya refugees, they were kicked out of their homes. Thus shelter is a big issue. The landlords are afraid to rent their house because of the threat of immigration raids that could lead to charges not only against those who live in the house but the owner of the house too,” said Azmi.

5. Religious needs

Although Muslims, the Rohingyas are not recognised by the Malaysia Islamic Council. They thus had to take their religious matters in their own hands, which is also problematic. For example, a Rohingya imam will usually conduct a Rohingya wedding and the marriage certificate is not considered a legal document under the Malaysian law.

Prejudice can be reduced

Everyone has prejudices, but we are not born with them. Prejudice is a negative attitude and feeling toward an individual based solely on one’s membership in a particular social group (Allport, 1954; Brown, 2010). Prejudice often begins in the form of a stereotype and is common against people who are members of an unfamiliar cultural group.

According to Dominic Abrams, given that contact between different groups is linked to increased understanding, the development of relationships, particularly between individuals, offers one means of reducing prejudice.

Mahi’s organisation Beyond Borders has been organising Refugee Festivals which feature talents of the refugees as a way of connecting refugees with the Malaysian public. The festivals have helped change the perception of the refugees from being seen as people who are on the handout, to artists, poets and writers.

“In that moment we can see the empowerment because now you are looking at them beyond the experience they have experienced. I am not negating their experiences but it shows that they are much more than the experiences they had gone through,” Mahi added.

Beyond Borders also takes the festivals to the ground, for example the plantations, as an avenue for Malaysians to meet the refugees. “We believe that people are always afraid of something that they do not know in its entirety and we wanted Malaysians to have the first opportunity to just sit and chat so that they know that they are normal people, like you and me, who have aspirations for themselves and their children,” she said.

Mahi underlined the importance of sustained advocacy and pressure to engage political support. This includes working through lawmakers who are receptive to the cause of refugees in Malaysia and exercising one’s power as a citizen to convince Parliamentarians and State Assembly-women and men on supporting refugee issues.

Azmi offered another dimension to the discourse; emphasising the need to engage at the community level so that local communities are comfortable with the refugees. This includes engaging with local community leaders to create socialising processes where the local communities’ feeling of prejudice can be slowly erased. He cited 82 vicinities each with 20 to 50 families that could benefit from such engagements.

Some key take-aways

The nearly two-hour forum discussed various issues and answered many questions on topics ranging from socio-economic to politics. Here are some key messages that encapsulate the discussion.

  1. Refugees are humans. They are like you and I.
  2. The Rohingya cause is universal. It is not a “Muslim” issue. It goes beyond ethnic, creed and religion.
  3. The Rohingya refugees in Malaysia are stateless; they are not recognised by the Myanmar government as citizens. In Malaysia, the UNHCR registers them as refugees and asylum seekers. Their status differs from illegal economic migrants. But Malaysia law does not differentiate between refugees and illegal migrants.
  4. The pandemic has caused increased economic burden on Malaysians. But there are others (refugees) worst off (denied legal employment, unable to access affordable healthcare and denied education).

Reducing prejudice is possible. Here are some ways to manage prejudice feelings:

  • by being more aware about the cause of the Rohingya (and other refugees) and of their existence within our neighbourhood;
  • participate in discussions involving the Rohingya and other refugees. This is far better than relying on WhatsApp viral messages;
  • participate in events involving refugees;
  • lobby and advocate for the refugees’ plight to our community leaders and politicians;
  • always remind ourselves that the refugees cause is universal; it transcends religion and ethnicity.


My Christmas tree story

This Christmas tree does not stand straight, no matter how hard we tried to adjust its base that was secured by a ready-made tree stabiliser. We have even tried an ingenious idea of using tuna can as an added support the stabiliser. Last year we did not have this problem, the tree easily stood straight with the help of the stabiliser. The year before, it was also a straight-forward affair.

This tree, somehow, is stubborn. Not only that. My plan to decorate the tree the day after we got it was dashed – by food poisoning – due to my own silly determination of fighting food wastage, I had eaten some stale food in the afternoon. I was on the bus when I started feeling horrible – and only managed to escape throwing up on the bus by a few seconds!

After many trips to the bathroom and two days later, I recovered. When I was lying in bed fighting the constant twists in my gut, and the nauseousness, I thought of the many things I had planned. My calendar was full of this and that – to write, to work on my online shop, to decorate the tree, to get the presents, …the list was endless. I also thought of how fortunate I am that I have access to clean sanitation, and if things get worse medical help is available.

Looking at the tree, and my Christmas story thus far, I thank God or the power of the universe that the tree is not straight. Just as life is not straight, with its ups and downs. Life is not perfect but it can be as beautiful as you want it. Life is also not long, so savour every moment.

There are also many ways of looking at the tree – from a few angles it does look straight, actually, just like life, depending on how one looks at it, life can be torturous, on the other hand life can be an opportunity, it all depends on how one looks at it. And what one makes of it. Yes, this year has been tough for us on several fronts but there were also many high moments that we are proud of. Such is life.

And sometimes we just have to listen to our body. As in my case, I have worked way too much (not complaining because I enjoyed it) and perhaps it was karma telling me to slow down, and reflect on what life has been to me. I am grateful I could breathe, think, smell, move, touch and talk. In the end that’s all I need – plus the love of friends and family.

The last two weeks, as work had slowed down a little, I called an old friend whom I have not spoken with in ages. I had found out he was discharged from the hospital and was recovering. Instead of writing on his facebook to wish him well, I picked up the phone and voila we spoke on a video call. I was unsure if he would answer the call because my number was certainly not on his contact list. But the minute we saw each other, I could see his eyes lit up, and he was full of smiles. We chatted about his health and other things. He asked how I was, and I told him I was not that well, but nothing to compare with what he had gone through – I had applied the positive dimensional perspective from my Christmas tree experience.

Wishing you a wonderful and magical holiday!


Talking about suicide prevention

In November 2020, a friend exited. I cannot say I was close to him, we have met several times – he had dinner with us when he came to town, and once he joined us to watch my son at a karate lesson. I was introduced to him through my good friend. They have been close friends for many years.

When my friend broke the news about Laurent, I was sad; I was shocked. Only two months prior to his departure I was looking forward to see him; he had planned to come to Geneva to spend some time here. But that trip did not materialise. He was also supposed to meet my friend in another city in October, alas, that too did not happen.

Many questions came to mind upon hearing the news, and each time I kept asking “why”.

It was very devastating for my friend who had known Laurent for more than 20 years. It was really difficult he said. They had been in touch several days before Laurent’s passing, but only through WhatsApp. Had he spoken to Laurent, maybe he could have sensed what was going on, he confided saying the toughest time was when was he was alone.

According to WHO’s report, Suicide worldwide in 2019, every year, more people die as a result of suicide than HIV, malaria or breast cancer or war and homicide. In 2019, more than 700,000 people died by suicide: one in every 100 deaths.

“We can be speaking to a close friend and not be aware that they are struggling, that could be depression with suicidal thoughts or some other kinds of mental health. And sometimes it needs a little bit of time and thought and follow up conversation in order to find out when somebody is really feeling very low. It is hard to have these kinds of conversations,”

the World Health Organisation (WHO) Communications Officer Alison Brunier.

Brunier was moderating the panel discussion at the launch WHO’s LIVE LIFE guide on suicide prevention.

DJ Nash, one of the panellists, concurred with Brunier adding that asking someone about hurting themselves does not make them more likely to hurt themselves.

“I think we are sometimes afraid to have that conversation because what if they say yes, but as that incredible video demonstrates someone stopping and saying what’s going on, are you ok, sometimes feeling cared about and have someone think about you is enough to get you out of the nosedive ” he said referring to the video that was played at the beginning of the panel discussion.

Nash is a creator and producer of A Million Little Things a family drama series about a group of friends who became motivated to living fuller lives after the unexpected death of a close friend.

Nash’s involvement in suicide prevention originated from losing an old friend a few years ago. He had ran into his friend on the street and making plans to have lunch the next week. But before they could meet up again, he learned that his friend had killed himself. “I don’t feel for a second like my lunch, our lunch, could’ve saved him. But I do feel a lot of seconds, like, we could have had one more lunch,” he said.

Talking helps

Panellist Jonny Benjamin, author and founder of youth mental health charity Beyond, who is a suicide survivor, underlined the importance of having conversations about suicide, saying it does not get any easier for him but the difference when comparing now and the time when he was growing up is that he could talk about it.

Benjamin began having mental health problems at a young age and his parents first took him to see a psychologist at the age of five. He later developed depression at 16 and was eventually diagnosed with schizoaffective disorder, a combination of schizophrenia and bipolar disorder, in his early 20s. He intended to exit by jumping off a bridge but a passerby found him and talked him out of it, which lasted long enough for the emergency services to arrive.

“When you are a person that’s experiencing suicidal thoughts and feeling, or you are a person who supports them, the most important thing to remember is those suicidal thoughts and feelings will pass. They do pass. It does not feel like it will when you are in the moment, it is so intense. But it does pass. It passes through things like distractions or talking it through with someone. The most important thing to remember is it is just a thought, it’s just feelings and you don’t have to act on them. It is really, really key to remember”.

JONNY BENJAMIN, Author and founder of youth mental health charity Beyond, excerpt from video on preventing suicide and coping with loss

Benjamin, 34, said when growing up, mental health was not talked about at all and he wished someone would come to his school and talk about it, and say it is ok not to be ok.

His work through Beyond promotes mental health among young people including in schools in the United Kingdom. At schools, his organisation has a 30-minute slot to speak about mental health. Benjamin though wished more time should be allotted.

“We have to give proper time to this. This really needs to come from the top, the head teachers, senior leaders and government. We have to put real valuable time into the curriculum for this, otherwise things are not going to change,” he opined.

Benjamin’s argument makes sense as global statistics show that half of all mental health conditions start by 14 years of age but most cases are undetected and untreated. Suicide is the fourth leading cause of death in 15-19-year-olds.

When to talk about suicide?

What are the causes of suicide? Panellist, the WHO suicide prevention expert, Dr Alexandra Fleischmann outlined several risk factors associated with the topic. These includes mental health issues, depression and alcohol use.

But there are other issues to be considered too, she added. These include experiences of loss of a loved one, breakup of a relationship, experience of violence or trauma, loneliness and lost of employment especially as the economy plummets due to Covid-19.

“Different risk factors should be taken into consideration and the important thing is if there is one risk factor at play, one should already ask about suicidal thoughts and follow up with that, and if there are many or several risks factors together, of course the risk increases,” she said.

Benjamin highlighted the importance of listening when talking about suicide prevention. “Listening is so key, we don’t learn to listen very much, we learn to quickly respond especially now with meetings being online, everything is going at a fast pace, we don’t take the time to pause. We don’t talk to each other,” he stressed.

He cited some examples of good practices. One example is at work places where before going right into meetings, the people involved would they take a pause, and they actually ask each other how they are doing. Another example was starting a meeting by going for a walk with a colleague and asking about how the other person was doing; this can be a good technique when it is hard to look into someone in the eyes and open up.

When a nation talks about mental health

Jazz Thornton, mental health activist and co-founder of Voices of Hope, also a suicide survivor spoke about her work in advocacy and mental health activism in her country New Zealand where youth suicide rate is one of the highest in the developed countries.

“We made noise, we keep talking about it, and eventually made it to the front page, and the radio and TV stations in the country talked about it so much, and when the elections came everyone was looking at how much attention was given to mental health,” she said.

Thorton and fellow activists’ work paid off as eventually the government listened, and allocated an overwhelming budget to mental health. “It started from the ground and still continues. We need to get them to listen,” Thornton added.

The WHO’s comprehensive guidance for implementing its LIVE LIFE approach to suicide prevention outlines four strategies of this approach to support countries in their efforts:

  • limiting access to the means of suicide, such as highly hazardous pesticides and firearms;
  • educating the media on responsible reporting of suicide;
  • fostering socio-emotional life skills in adolescents; and
  • early identification, assessment, management and follow-up of anyone affected by suicidal thoughts and behaviour.

Dr Fleischmann said the strategies are applicable to all countries but some adaptation to country context should be applied. “For example with access to means of suicide, a country would need to know what are the main means used and then intervene and restrict of possible access to the means. With pesticides, these are found in lower and middle income countries in agricultural areas where in the households they are right there readily accessible, in other countries maybe different means are more important,” she said.

Do no harm approach

Thornton when responding to a question about how advocates can post in social media without triggering somebody from attempting suicide, said she is always very careful when posting on social media as it can be very dangerous and one must always be careful in one’s messaging.

“Especially on advocacy point, at all times no matter what the story is that you are telling you always have to add hope into it, that you can be raw, you can be real, but you must provide hope, you must be able to say that change is possible, even if the thing you are directly talking about is very raw,” Thornton said.

She added she would often made sure that she was not impulsively posting, and she was actually thinking things through before she put it out because, “as soon it is out in the world people are seeing it, and we are responsible for what we put online,” she emphasised.

“I don’t even put anything out without checking over it and making sure that I am thinking of everyone who was vulnerable and thinking – would this have been something that would have caused more damage than good? If you don’t know the answer to that (if it could have caused more harm than good), don’t post it,”.

Jazz Thornton, mental health activist and co-founder of Voices of Hope

The role of the media

Media reports of suicide can lead to a rise in suicide due to imitation, especially if the report is about a celebrity or describes the method of suicide. The WHO LIVE LIFE guide highlights the role the media play in relation to suicide and how national media (including social media) bodies at local level can work with local media outlets. Below is an extract from the guide outlining tips for implementation at country level.

55 StigmaWatch, Sane Australia (https://www.sane.org/get-involved/stigmawatch, accessed 28 January 2021).

  1. Change is possible
  2. There is hope
  3. If you are struggling, reach out for help, that’s so important

To those interested in resources of this article, please refer to the following links:
https://bit.ly/3zZxaWn (panel discussion)
https://bit.ly/3ttlGbb (video on preventing suicide and coping with loss)

For me personally, I was especially moved and encouraged by the testimonies by the suicide survivors. I have also gained valuable insights into a topic which I have always been afraid to approach. Now, I understand a little better.


To sing or not to sing?

What is your memory of your national anthem? Mine is singing my national anthem Negaraku (My Country) every morning with my schoolmates at the school hall before the first lesson starts. This was a daily routine I did throughout my primary and secondary school years.

When I moved to and settled in Switzerland, I was surprised to find that national anthem of the country is not sung at schools. In Geneva where I live, there is this song called the Cé qu’è lainô introduced in schools from as early as the first year of school. It is Geneva’s anthem, sung to commemorate its victory over the Duke of Savoy’s army in 1602. I remember, one day, my son sang this song and then said to me , “the Genevoises are very brave because they defeated the Savoyards”. My son born in Geneva, is German and in 2019 became a naturalised Swiss, which makes him German-Swiss. He does not know the national anthem of both countries. But a proud Genevois he is.

The Swiss national football team are often criticised for not singing the national anthem before the start of a match. Many of the players are second generation Swiss, or became Swiss through naturalisation. The Swiss team had one of the highest proportion of players who were born abroad (31%), comprising several members with Balkan roots.

Perhaps no national team sings their anthem before the game with such heart and soul than the Italian national team. Il Canto degli Italiani (The Song of the Italians).

Take Gianluigi Buffon, the iconic Italian national football goalkeeper. He sings the Italian national anthem on top of his lungs with such passion. He exuded pride and emotion that came along with the act of singing.

Most songs of national anthems are often mediocre with the least uplifting tune. But studies reveal that singing simultaneously have the ability to bring people together. Because singing and listening evoke feelings of pride and patriotism, of displaying a group’s identity. The New Zealand’s All Blacks though has taken their affiliation to their country to another level.

Instead of singing their national anthem, the All Blacks does the haka, a ceremonial Māori dance or challenge which involves movements, foot-stamping, tongue protrusions and rhythmic body slapping to accompany a loud chant before a match. “For me, the Haka is a symbol of who we are and where we come from,” former All Blacks captain Richie McCaw told CNN in 2015.

Auckland, New Zealand – August 15, 2015 – Kieran Read, Richie McCaw and Maa Nonu of the All Blacks (front row L-R) perform the Haka ahead of The Rugby Championship match between the New Zealand All Blacks and the Australia Wallabies at Eden Park on August 15, 2015 in Auckland, New Zealand.

A 2018 study that examined the passion displayed by teams during the singing of their national anthems at UEFA Euro 2016 highlighted:

  • Teams that displayed greater passion during national anthems conceded fewer goals.
  • In the knockout phase, but not the group phase, teams that displayed greater passion were more likely to win.
  • Identity-based expressions of passion are an important predictor of subsequent success.

Sports as we all know evoke emotions – joy, sadness, anger, fear, shame, guilt or pride, for both athletes and spectators. Listening to music and singing together has been shown to have direct impact on neuro-chemicals in the brain, many of which play a role in closeness and connection.

Why then some athletes don’t sing the national anthem?

The hesitance to sing is partly attributed to the fact that, many of the athletes were not born or did not even grow up in their adopted sporting nations. There are also those who possess more than one nationality.

Some just do not know the national anthem, and had never been introduced to it. A study says half of England’s young people don’t know their national anthem.

Some (like myself) were drilled into singing my national anthem since young. Whether this good or not I do know it by heart and would earnestly listen to it when I see a Malaysian athlete or team wins a competition. Would I sing it alone? Maybe not. But with a group to cheer a Malaysian team I certainly would. It is the only national anthem I know, and although I have been living in Switzerland close to 20 years now, I still feel strongly connected to Malaysia.

At the end of the day, it boils down to how connected one is with his or her country. By connection I mean the experiences one has when growing up and living in the country, and these usually developed over time. After all, it is the ties that bind.

But even strong connections can be displayed in many ways other than singing the national anthem.

For athletes there are other motivational tactics to boost performance whether they sing or not their national anthem. What counts is the team’s spirit in giving their best to the sport they love, be it by singing the national anthem from the top of their lungs, getting pumped with motivational words prior to a match or listening to heavy metal rock by AC/DC, a ritual of Germany’s national goalkeeper Manuel Neuer.


The old foe that still kills

Here’s something about tuberculosis (TB): it is widely (and mistakenly) considered as a disease of the past even though it kills about 1.5million people every year; 10million people fell sick with TB in 2019. This is partly because tuberculosis rates in the high-income world are low, helping to create an illusion that it has been beaten. Have you ever encountered someone who have contracted TB? Hardly, I guess. At least not in Geneva where I live.

But if you ask a person in India where the TB burden is highest in the world, you will get a different answer. India accounts for 26% TB cases globally. India and seven other countries: Indonesia, China, Philippines, Pakistan, Nigeria, Bangladesh and South Africa account for 2/3 of new TB cases.

Contrast to the COVID-19 response. The global response to COVID-19 had literally taken the world’s breath away. Probably because COVID-19 is also impacting heavily the rich countries. When respiratory Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) and Ebola emerged, the world did not budge much. This reality also mirrors the reason why TB is not getting the attention it deserves – because similar to SARS, MERS and Ebola it mostly affects poorer people in the developing world.

From my experience in working in HIV/AIDS, TB and malaria, the three diseases are usually characterized as follows: malaria is a disease that affects communities in the rural and hard to reach areas; it usually takes only a few days to cure. For HIV/AIDS, there is no cure exists but strict adherence to antiretroviral regimens (ARVs) can dramatically slow the disease’s progress, in terms of science and research, there are innovative tools (there is a home testing kit for example); and the disease has super strong civil society support. TB is seen as a disease associated with poor people; slow on innovation (the vaccine is 100 years old and it does not work in adults) and expensive for the patient and family as TB patients (in low- and middle-income countries often) face medical expenses, costs of seeking and staying in care, and income loss. Loss of income resulted in patients being less able to complete treatment, more likely to have repeat episodes, and more likely to develop drug resistance resulting in more expensive and arduous treatment).

Do you know about multidrug-resistant TB (MDR-TB)? This is the most serious form of TB; it occurs when the drugs for TB do not work; treatment is nine to 12 months with combinations of drugs. The cure rate in persons with MDR-TB is 50-60%. Globally, new cases of MDR-TB is increasing with 206,030 reported in 2019, a 10% increase from 186,883 in 2018.

On global campaign and advocacy for the three diseases, HIV seems to be the most popular in celebrity advocacy; for example Elton John has his own foundation supporting HIV response and Bono is behind RED a consumer marketing initiative to finance HIV/AIDS programs in Africa. Star footballer David Beckham is active in ending malaria. Which world famous celebrity do you remember or know of that is a champion for TB response? If there was, the celebrity advocacy is most probably at regional or local levels.

From global funding perspective, the Global Fund to Fight AIDS, Tuberculosis and malaria (the Global Fund) the largest multilateral funder of the three diseases, TB received the smallest share. The Global Fund has, between 2002 and 2018, invested USD 19.6 billion for HIV (it currently provides 20% of all international funding), USD 8.2 billion on TB programmes (69% of all international funding but small compared to domestic funding for TB,) and USD 11.4 billion in malaria control programmes (57% of all international funding).

While HIV and malaria each receive dedicated additional donor funding apart from the Global Fund, with Presidential Emergency Plan for AIDS Relief (PEPFAR) for HIV, and U.S. President’s Malaria Initiative (PMI)  for malaria, it is not the the case for TB.

In terms of funding gap for TB programmes, the disequilibrium reached $3.5 billion per year. In 2019, US$ 10.1 billion was needed for diagnostic and care but only US$0.9billion came from international funding while US$ 5.9 billion was made available by domestic funding.

In 2018, for the first time, the United Nations (UN) held its first high-level meeting on TB, sparkling a ray of hope on how to end the TB epidemic and elevate the discussion on TB to the heads of state and government. It was a break-through for TB. The outcome was a political declaration agreed by all UN Member States. One of the outcome was governments pledged USD$15 billion a year for TB. Alas less than half have been delivered.

Is there hope to see the end of TB in our lifetime?

Let’s have a look at the UN Political Declaration on TB which also included four targets for the period 2018-2022 vis-a-vis results achieved thus far (2018 and 2019):

  • Treat 40 million people for TB disease. Only 14 million treated (35% of the target)
  • Reach at least 30 million people with TB preventive treatment for a latent TB infection. Only 6.6 million reached (21% of the target)
  • Mobilize at least US$13 billion annually for universal access to TB diagnosis, treatment and care. A total of US$6.5 billion raised (50% of the target)
  • Mobilize at least US$2 billion annually for TB research. US$.9billion raised (45% of the target)

This year’s World Tuberculosis (TB) Day‘s theme, The Clock is Ticking is a stark reminder to the world, including those in high-income countries, of the devastating health, social and economic implications of TB. As with the fight on Covid-19, so must the world step up its effort to end TB, long seen as a second tier disease. There is no excuse.


Did you write today?

That is a question my husband asks me. Every day.

I had given him the task to ask me, “Did you write today?”.

In January this year, I created this blog. The idea came up after I was struggling to follow the lessons on navigating WordPress. Struggling to understand the explanations given during the lesson, I thought, “instead of learning the theory, why not learn by doing?”

Then I got another idea – why not play around with twitter too?

On 1.1.21 I wrote my first post, a few lines of poem to greet the new year. I also posted the poem as my first tweet.

I was delighted to see my work on display; after many years hiatus from writing. But something bugged me. It had to do with my first attempt at blogging in 2014. The blog was also created on New Year’s day. But it died a few days later. I was afraid this blog would succumb to the same fate.

I decided to challenge myself to write more frequently, i.e. daily. By writing I mean jotting down ideas or drafting a post or finishing a post. I knew it cannot just be me telling myself to write. I wanted a more structural help.

This idea to assign my husband with the task came from something I learned from The Daily Questions, a list of questions around commitments set by ourselves. It is a technique used by executive coach Marshall Goldsmith whose talks and guidance I follow from time to time.

So my husband has been asking the question every evening since 2.1.2021. I soon realised the question is easy but it is hard to do, just as Goldsmith had warned (he hired a person to call him every day to ask him a set of questions), because it is easy to get off target.

Sometimes my answer is a “no”, another time a “yes”. Every time it is a “no”, I would get uneasy and upset at myself for not writing. Sometimes I would answer with a terse ‘no’ almost sounding annoyed by the question (and at the questioner!). Sometimes I would say “no” and come up with excuses.

Over time, I am better at managing it – instead of a barking “no” or finding excuses, I have come to accept that behaviour change is not easy, and that the aim of this exercise is making progress. I also realised there will always be areas where I can improve.

I am still not writing daily, but I am proud that after 71 days since my blog and tweeter went alive, I have a total of 66 tweets and 13 blog posts. I am thankful too to my husband for taking on the task which seem simple but actually requires some patience and understanding.