Myanmar’s health care is extremely underfunded at less than $1 per person annually, but even those who can find the money to buy medicine often end up with expired or ineffective medication, owing to the country’s frequent electricity outages that leave medical treatments that should be kept at certain refrigerated temperatures impotent.

Blackouts in Myanmar are so common that locals carry on with their lives without a pause, due to an old and neglected energy network that still only reach a quarter of the population of 60 million, according to CNN. Even in Yangon, the country’s commercial center, only two-thirds of the residents iare connected to the grid.

The power shortage has drastic ramifications for the health professionals and their patients in Myanmar, where health care is already expensive and in short supply.

Liquid medications used in injections are more affected than oral medicines by the frequent outages, as they need to be kept at strictly controlled temperatures, said Paing Soe Kyaw, a senior Myanmar doctor, according to the Democratic Voice of Burma, a non-profit Burmese media organization.  

“If medicines cannot be stored at fixed refrigerated temperatures they will lose their potency and effectiveness,” Paing Soe Kyaw said. “Medication for cancer is especially vulnerable, as are vaccines for tetanus and rabies.”

The doctor, based in Myanmar’s second largest city of Mandalay, related cases of diabetic patients dying due to the ineffectiveness of insulin that had not been properly refrigerated.

Many families and businesses rely on generators for power. While some hospitals in Yangon have generators, hospitals in other parts of the country often do not. Pharmacies across the nation also often suffer from power outages.

“I would advise people to buy medicine only from stores which keep materials refrigerated systematically,” Paing Soe Kyaw said.

The most recent survey by the World Health Organization ranked Myanmar as the worst nation for health care of  the 194 surveyed nations. Only 3.9 percent of the nation’s GDP is spent on health care, a figure that is low even compared to the poorest nations in Southeast Asia – Laos spends 4.5 percent while Cambodia spends 5.6 percent of its GDP on health care, the Democratic Voice of Burma reported.