Yangon: Myanmar is largely unprepared for an outbreak of Zika, experts say, with the health ministry slashing anti-virus measures due to lack of funds, overworked doctors skipping check-ups and pregnant women saying they are in the dark about the dangers.
Zika has spread to some 60 countries and territories since the current outbreak was identified last year in Brazil, raising alarm over the rare birth defect microcephaly, as well as other neurological disorders it can cause in infants and adults.
The World Health Organization's (WHO) Myanmar country head Dr Jorge M. Luna, warned Myanmar was likely to experience more cases of the mosquito-borne virus that has spread quickly in the region, with the number of infections doubling in Vietnam and 33 fresh cases confirmed in Thailand this week.
Myanmar detected its first Zika-infected patient more than two weeks ago, prompting pledges of increased monitoring and stepped up mosquito-prevention measures.
But more than a dozen interviews with pregnant women, doctors in public hospitals and government officials show the country of 51.5 million is struggling to inform the public about the virus or prevent it from spreading.
On a recent afternoon more than 100 pregnant women waited - some standing for more than three hours - in noisy, crowded corridors of the Yangon Central Women's Hospital, the largest such institution in the country.
"I wanted to ask doctors some questions about Zika, but they are very busy because they have to see many pregnant women at the same time," said San San Aye, 42. She had heard about Zika from a friend, but was unsure how it could affect her pregnancy.
Myanmar is struggling to shed the legacy of nearly 50 years of junta rule that has left its economy and public services - especially healthcare and education - in tatters.
It has only 0.6 physicians per 1,000 people, according to the WHO, six times fewer than Kazakhstan. Total expenditure on health stands at $20.3 per person, about 18 times less than Thailand, and dilapidated and overcrowded hospitals often lack basic supplies.
A Reuters reporter visiting the Yangon hospital did not see any stickers or signs posted alerting or explaining Zika to the women. Healthcare workers said they did not know how to educate patients about the virus.
At smaller public hospitals nurses often carry out check-ups instead of specialist doctors, who sometimes do not turn up for scheduled appointments, Reuters reporters found when visiting two township-level hospitals on Yangon's outskirts.
Dr Than Htun Aung, in charge of Zika emergency response and international relations at the Ministry of Health, said a shortage of doctors meant they could not always attend appointments. He said nurses were qualified to examine the women.
At hastily called news conference after the first case of Zika in Myanmar was confirmed, Dr Soe Lwin Nyein, who heads public health department at the Ministry of Health, has urged women to avoid pregnancies in the next six months.
The statement has confused some Myanmar healthcare specialists, who said they did not understand the reasoning behind the recommendation, and whether it meant no more Zika cases were expected after the six-month period.
That made them reluctant to discuss the risks with patients, doctors and nurses told Reuters.
The WHO's Luna said the organization's guidelines were to give couples full information about potential risks and impact on newborns, but the decision on whether to have children was up to the couple.
"You have to give them information, good information, what is going on, and it's the couple's choice," said Luna.
Than Htun Aung, at the health ministry, said medical specialists were trained about Zika guidelines last week.
"During the training, we told them how to give instructions to patients on how to avoid transmitting Zika," he said.
But in Yangon, Dr Tun Lwin, who heads the regional public health authority, said Zika was not the priority, compared with sometimes fatal dengue fever and other mosquito-borne diseases. He said the regional government did not provide funds to local staff to carry out public health campaigns about the virus, but some staff members campaigned spending their own money.
The Ministry of Health's Than Htun Aung said measures to control mosquitoes in cities were progressing slowly because of a lack of staff and funding.
He added the government wanted to test all pregnant women, travellers, and foreigners, but "we do not have the budget to test them because the tests are expensive".