Paper short abstract:

Drawing on ethnographic research in Yangon, Myanmar, we explore how 'nar lel hmu' (mutual understanding) formulates between medicine retailers; providers; patients; and regulators, enabling public secrets, which in turn are integral to the provision and regulation of medicines in this context.

Paper long abstract:

This paper explores how the Myanmar state practices the regulation of 'illegal' and 'legal' transactions of medicines, and the potential implications such practices have for global and national implementation plans to regulate and restrict medicines in Myanmar. Drawing on ethnographic research in Yangon and documentary and media analysis, our findings demonstrate how wider social, political, and structural factors in Myanmar such as the militarisation of healthcare; regulations around taxes; and the onset of neoliberal reforms influence and determine the ways in which medicines move between retailers; providers; patients; and regulators, beyond the narrative of medicine overuse. We show how the Burmese notion of 'nar lel hmu' (mutual understanding) formulates between regulatory bodies; medicine vendors; and their wider networks, permitting so called 'illegal' practices to become accepted public secrets that are integral to the healthcare provision in this context. These findings suggest that the currently growing action against the 'illegal' - such as jail sentences for vendors selling so called 'illegal' medicines, or confiscation and burning of locally unregistered medicines - combined with the global call to reduce medicine use, may exacerbate pressures on such people. These people include individual health providers; patient/ clients; and street-level administrators, who are often already struggling to cope under a precarious healthcare system. 'Nar lel hmu' acts as one coping mechanism, a means to mutually care for one another while enabling each actor to continue performing one's duties whether this involves selling medicines or on the contrary, regulating the sales of such medicines.