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HIV/AIDS treatment in Laos at Savannakhet Hospital
Alouny is afraid, even though she hides it well. She’s afraid for her six year old daughter, Phimpha, who is suffering from AIDS. Her mother already knew that she was infected but now it’s been confirmed that her daughter has it too. She started treatment two weeks ago and the first secondary effects of itchiness and fever have begun. The little girl’s mother knows well what is to come. Alouny herself went through this ordeal two years ago when she fell sick. At the time, she couldn’t move her legs and MSF gave her a wheelchair. For a rice farmer who has to work on her feet all day, this was particularly difficult for her. But Alouny is strong. She refused to give up and after one year of training herself at home, her legs have again found their strength. Treatment of AIDS remains the exception rather than the rule Everything considered, Alouny and her daughter are lucky because they live close to Savannakhet. Those who live further take two days to get to the treatment centre. And the truth is that many who are sick do not even know that this place exists. The main reason is that currently in Laos, the treatment of HIV/AIDS remains the exception. In fact, Savannakhet Hospital is still the only treatment centre for HIV/AIDS in the country. If one is to ask why this is the case, one of the arguments still put forward by the authorities – financial reasons aside - is that there is a low HIV prevalence in Laos compared to other Asian countries. This is a notion that is being questioned. The president of the association of AIDS sufferers in Laos, Kinoy Phong, believes that the real number of infected people could well be higher. In order to avoid being stigmatised, a vast number of AIDS sufferers do not declare they are ill until they have received assurance that they can be treated. Moreover, if Laos’ capacity to treat the disease does not improve, this figure could quickly grow: only antiretroviral treatment for life, along with screening and prevention measures, can limit the spread of the disease. Savannakhet is a unique hospital. As it’s located on the edge of the Mekong, patients can look straight out at the other bank of the river from their window. On the other side is Thailand, quite symbolic as Thailand is viewed in Laos as the main origin of infection for Laotians. Many Laotians have worked in Thailand in the past and were infected over there, but again, exact figures and circumstances are not known. Many of the patients in the hospital are in an advanced state of the disease. They are incapacitated and do not really realise what is happening around them. Bounam is one of these patients. She is in pain as the hospital staff - under the management of Dr Ann Bosque from MSF and Dr Khampang, the head Laotian doctor - do their morning rounds. Sivilay, Bounam’s daughter, sits on her mother’s bed. Sivilay isn’t like other 11-year-olds. Her childhood stopped abruptly when her mother fell ill. Sivilay missed the last year of school because she was taking care of her mother, day and night. Now, she’s massaging her feet, keeping her busy and feeding her. At night – like other patients’ family members – she’s sleeping on the bare ground behind the hospital, between the Mekong and the HIV/AIDS unit. Still no tests suitable for babies Khanti, or Baby Khanti as this 8-month-old boy is known, is the youngest patient. Khanti is a gorgeous baby, but his development has been slowed and he can not sit up by himself nor can he see properly. The doctors cannot screen him because there are no tests suitable for babies under 15 months old. However, all the signs say that Khanti is truly suffering from this disease. In Laos, the limited capacity to detect AIDS doesn’t only concern babies – it’s a problem for all of the population. AIDS detection methods are insufficient in Laos. “Detection is the starting point for any program against AIDS and this is lacking at the national level,” explains Marie Deblaise, Head of Mission for MSF in Laos. “At the moment, there are not many screening centres – there are only 34 in the entire country, 17 of which were set up by MSF all in the Savannakhet district. The Ministry of Health must take responsibility to give access to screening and treatment on a much larger scale… People suffering from this disease will only go to health centres if they are offered screening and treatment.” Another treatment centre for HIV/AIDS will soon open in Laos, this time in the capital, Vientiane. Again, this is MSF’s instigation. “It’s about time that others finally take responsibility, especially at a government level, if not the pandemic will progress quickly,” concludes the MSF Head of Mission.
Treatment of HIV/AIDS in Laos: “The government must take over and assume its responsibility”. Interview with Kinoy Phong, president of the association of patients living with AIDS in Laos. A few days after the submission by the Ministry of Health authorities in Laos of a request of funding to treat AIDS patients from the “Global Fund”, the president of the association of patients living with AIDS in Laos, Mr Kinoy Phong explains the difficulties experienced by the sufferers of this disease. He also discusses the respective roles of NGOs and the government in the treatment of AIDS in the country. Mr Kinoy Phong is the first of 378 patients who was able to have access to treatments in Laos through MSF’s project undertaken in conjunction with the provincial hospital in Savannakhet. What are the main obstacles that face HIV/AIDS patients? The main problem for the patients is their poverty. They breed buffalo and cows and the majority of them have had to sell everything to buy drugs, or to go and see a healer or a traditional herbalist. Often, it’s only after exhausting all other solutions that they finally go to the hospital. By this time, they’re completely penniless, even poorer than before. Do you know a lot about the situation of these patients? Where do they mainly come from? They come from everywhere. However the majority come from the southern provinces. Some are from Savannakhet, others come from even further. It can take them two long days just to get to Savannakhet. The transport for them is very expensive and, if they’re really sick, they can’t even take the bus. So what is there to be done? The best way to allow access to treatment for the greatest number of these people is to decentralise the treatment centres, so that treatment is available for patients close to where they live. This is a government obligation and duty and should not be the responsibility of NGOs. What NGOs can do is to set an example in some places but in the end, it’s the government’s responsibility to increase the amount of treatment centres. In your opinion then, NGOs should play a pioneering role and the final responsibility must be taken by the authorities? Yes, totally. In this way, MSF has paved the way to encourage us to see and to learn how patients can be treated. Now that we have this knowledge, it’s time for the government to take action to increase the number of treatment centres in the country. Are you sure that the HIV/AIDS problem is considered important enough to justify, in the eyes of the government, an increase in treatment centres? In other words, is the prevalence of the disease high enough? We definitely do not know the exact amount of people suffering from the disease in the different provinces, so we don’t have an exact picture of its prevalence. Nevertheless, data from the National Committee for the Control of HIV/AIDS puts the current number of sufferers at higher than a thousand. It’s important to understand that these are the people who have decided to declare their illness. Without doubt, there are many who are still hiding the fact that they are HIV positive. If the number of treatment centres multiplies, the number of patients will immediately increase. Do you mean to say that there could be a significant number of HIV-positive people who could be hiding their situation and that because of this, the government statistics are not right? The reality is that the figure of 1000 sufferers is rough – it’s a result of official notification from each province to the national committee. Also, the figure is already a year old. In 2006, this figure, even the official one, has increased. Is increasing the number of treatment centres the only option? No, but it’s only by creating these centres that we can let those
who live in the most isolated areas know that treatment exists and that
they can benefit from it. Getting closer to treatment is one thing but
we must distribute information on a large scale so that patients can take
steps to get care before it’s too late. Is it your personal story which is pushing you to take on this challenge? My unhappiness in being infected with HIV was largely relieved the day that the treatment centre was opened here in Savannakhet. I’d tested positive in 2001 in Thailand and I even thought I’d go to live there for the rest of my days – but then MSF came here. I was so lucky because in some way, I’d been given a new life, like many others here. Other patients in Laos also have the right to this new life and it’s for this reason that I’m calling on the government to follow in MSF’s footsteps and take its full responsibility in treating all of us. Savannakhet July 2006 Read other articles on HIV/AIDS
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