Overcoming multidrug-resistant TB in displacement

FOR the first time since 2015, MSF’s clinic in Shan State has cured two patients of multidrug-resistant tuberculosis (MDR-TB). The couple contracted MDR-TB after being displaced by armed conflict, then had to leave their children and home for almost two years of treatment. Their story illustrates the difficulties that patients in conflict-affected communities in Myanmar face, as well as the scarcity in specialised treatment for patients in rural areas.

Shan State has long been dogged by conflict between the Myanmar armed forces (Tatmadaw) and non-state ethnic armed groups, as well as fighting between ethnic armed groups. Renewed fighting since mid-August 2019 has killed civilians and resulted in short-term displacement of approximately 8,000 people. In September MSF’s team in northern Shan were able to carry out a distribution of non-food items to hundreds of families in one new displacement camp, but many areas remain inaccessible to humanitarian organisations.

For patients needing specialized medical care, displacement disrupts treatment, which can have devastating consequences on their health. In 2017, Aik Jong and Aye Htwe were displaced from their home in Namhsan Township and detained in a crowded monastery for five days.

The couple had been receiving antiretroviral (ARV) medication from MSF since 2013 but weren’t allowed to take their medicine during their period of detention.

Difficult but necessary separation

After they were released, Aik Jong and Aye Htwe sought refuge elsewhere, and Aye Htwe noticed she was losing weight. They travelled to MSF’s clinic in Lashio where both tested positive for multidrug-resistant tuberculosis (MDR-TB). Due to a lack of locally available MDR-TB treatment, the couple were unable to return home.

Treatment for MDR-TB is essential and lifesaving. However it is grueling, causing many patients to drop out; curing patients is relatively rare. The treatment lasts almost two years and has considerable side effects including nausea, vomiting, dizziness, hearing damage and loss of renal function. Every day patients must take a cocktail of oral medication, and for the first six months, patients undergo painful injections six days a week.

To minimise the risk of spreading the infection, MSF patients with MDR-TB are encouraged to live apart from others, with limited visits from family and friends, during their treatment. While Aik Jong and Aye Htwe stayed in the MSF MDR-TB house in Lashio, where MSF also paid their living expenses, their three children stayed with relatives.  “At first the treatment was really hard but the medical staff supported us,” says Aye Htwe. “We didn’t need a lot of motivation, we knew the treatment would be hard, but we were determined – we had to do it for our kids.”

Although Aik Jong and Aye Htwe were cured, they are still struggling to reunite their family and to return to their village where they once worked as farmers. “I’m happy to be cured of MDR-TB. I just feel like a huge burden has been lifted,” said Aik Jong. Now he has other worries: “I don’t know when we’ll see our children again. It’s too expensive for us to make the journey to see them right now.”

The need for treatment closer to home

The social and emotional upheaval experienced by Aik Jong and Aye Htwe might have been reduced had there been treatment available closer to home. While Myanmar’s Ministry of Health and Sports has, in principle, committed to decentralizing treatment for MDR-TB to the district level, providing treatment along with primary healthcare, this has not yet been implemented.

“A lack of resources and diagnostic equipment continue to keep nearby care out of reach for many,” says Mitchell Sangma, MSF medical coordinator. “This means that those living in more remote areas do not have treatment options close by, and may be forced to leave their homes, their jobs and their families in search of treatment.”

Given the lack of decentralized MDR-TB care, MSF has been providing treatment in Kachin and Shan, as well as Yangon, and has cured 228 MDR-TB patients in Myanmar.


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