I have been offered a position with Medecins Sans Frontieres working in Sittwe, Rakhine Province, Western Myanmar. The job will be working with patients suffering from HIV/AIDS as well as doing general medical work. One of the doctors at SMRU offered to show me how she does a similar role (more tuberculosis, less primary care) in the clinics along the Thai/Myanmar border. So I visited WanPha (sorry for the pun).
Tuberculosis is more common in people who are infected with HIV. It is extremely important that patients take their anti-TB drugs properly to prevent further transmission of TB and to avoid drug resistance. Patients on the border are strongly encouraged to move, with their families, to a sanatorium where their treatment can be directly observed. The usual course of treatment lasts nine months in total, but usually only the first part of treatment takes place in the sanatorium. Food and pocket money are provided, to encourage patients to stay and comply with treatment.
Multi-drug resistant TB is becoming more common. Treatment is difficult, unpleasant and lasts two years. There are no “wonder drugs”; some patients are never cured using the current regimens. Counselling and support from mental health workers improves compliance. I am not sure the facilities will be as good in Rakhine.
My contract with MSF runs for 9 months from 1st April. Unfortunately, the political situation in Rakhine is so delicate that MSF does not allow its staff to blog or take photographs. I hope this changes soon, for obvious reasons.