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Myanmar :: Breaking down barriers to disease in remote areas In December, Jocelyn O’Neil, Financial Manager for Médecins Sans Frontières Australia completed a visit to the MSF-Holland project in Northern Rakhine State in Myanmar. The project has been partially funded by AUSAID for the past two years. Northern Rakine state is regarded as one of the most remote and underdeveloped regions of Myanmar. Some 80% of the population are Muslims, known locally as ‘Rohingyas ’, who are not legally recognised by the government. In 1992, over 250,000 of this Muslim population fled en masse to Bangladesh. While almost all of them have since been repatriated, their predicament is still tough with malaria the major killer in Rakhine topping a long list of diseases that Médecins Sans Frontières (MSF) currently treats, including: sexually transmitted infections, HIV/AIDS, diarrhoea, acute respiratory infections and tuberculosis. “The Rohingya Muslims are not granted citizenship. This means it is very difficult for them to move outside their villages, townships and the state - and to access health care and education,” says Jocelyn O’Neil, Financial manager for MSF Australia, recently returned from Myanmar. “Effectively they are locked into one of the poorest and most geographically isolated states in Myanmar.” Northern Rakhine State is also a poor region with little infrastructure.
Malaria Malaria is the one of the main causes of illness and death in Myanmar. In Northern Rakhine State the malaria transmission is seasonal (May–January) and peaks during the post monsoon (November – January) and sometimes in the early monsoon (May–June) periods as well. The malaria project in Rakhine is a system of ‘mobile clinics’ that travel to the most isolated areas and field microscopy sites. The mobile-malaria-clinics are staffed, coordinated and managed by Médecins Sans Frontières, and operated by expatriate and national staff doctors, microscopists, drug-dispensers and health educators, providing free access to malaria diagnosis and treatment. Alongside this, Médecins Sans Frontières supports around 25 static microscopy field sites located in high transmission areas which offer the same level of malaria diagnosis and treatment, but carried out by government staff, trained and supported by MSF. These field sites are constantly monitored to ensure drugs are used correctly and all patients have access. They charge people a nominal amount of USD$0.15 (waived where the patient cannot afford to pay). Working in this dual environment of governmental and independent operations provides Médecins Sans Frontières the opportunity to extend effective treatment to thousands of people suffering from malaria in the Rakhine State. “This year MSF treated over 160,000 patients in Rakhine. Since the beginning of the programme in 1996 more than 1.1 million have received a ‘finger prick’ to test for malaria and almost 600,000 have received treatment” says Jocelyn. MSF mobile clinics and the field sites register sick patients who will take a blood sample slide and approximately an hour later, if tests are returned positive, patients will be prescribed with Artemisinin-combination therapy (ACT). As well as treating malaria patients, the mobile clinics also offer care to those who arrive with fever or cough but do not have malaria. Patients suffering conditions such as diarrhoea or acute respiratory tract infection are treated immediately, while those suspected to have tuberculosis – another common and life-threatening condition – are referred to the national TB program, so there is a primary health care aspect to the field sites and mobile clinics, even though they are focussing on malaria treatment. In a separate component of the Northern Rakhine State project, MSF provides basic health care for a population of 70,000 in the township of South Maungdaw, working through 28 community health workers and three primary health care clinics. World AIDS Day Coincidentally, Ms O’Neil arrived in Buttidaung, one of the main towns of NRS at the same time as World AIDS Day on the 1st of December, witnessing the medical aid organisation’s contribution to latest efforts in breaking down barriers in the Rakhine state. Médecins Sans Frontières offers care and treatment for opportunistic infections to HIV positive patients, as well as preventive interventions such as treatment for STIs and condom distribution through three specialist clinics in NRS. It also has an active programme of education and awareness-raising which, in many cases is literally bringing people knowledge on the issue for the very first time. Health education materials have been designed in seven national languages including Bengali. The team pulled-up their cars in the middle of a major intersection attracting
an immediate and eager crowd for the medical aid organisation’s activities
in Buthidaung [Rakhine]. “First of all, the team set up a talk using flash
cards allowing a sophisticated interaction with the audience,” says Jocelyn.
Identifying high risk groups in the community was one of the most illuminating
facts for the crowd as they listened and learned and participated in the impromptu
discussion. In other project sites in Myanmar, MSF has also been able to start offering HIV/AIDS patients treatment with antiretroviral (ARV) therapy. As of end of December 2004, more than 500 HIV/AIDS patients (including 34 children) in Yangon, Shan and Kachin project sites have been provided with anti-retroviral (ARV) treatment in other parts of the country, and the organisation hopes to gain permission in the future to expand such activities in places like Rakhine. For the moment the medical aid organisation continues to be in contact with high-risk groups, such as male and female sex workers and IV drug-users, offering regular checks, group and 1:1 counselling for HIV and a supply of condoms. STI Clinics Another aspect of Médecins Sans Frontières multi-faceted health program throughout Myanmar is their Sexually Transmitted Infection (STI) clinics, which have become a recognisable part of many people’s lives in different regions, especially for sex workers. Médecins Sans Frontières has taken a novel approach to making visitors comfortable in the STIs by making the clinics as similar to each other as possible, although many of them come in different forms such as bamboo huts and different buildings – where it is possible they are provided in the same sense as a franchise. A majority of the STI clinics across the country are painted in the same colours and have the same set-up in terms of consultation rooms and parlours for groups of sex workers. These STI clinics, called ‘Thazin’ (the same name as a treasured orchid of Burma), offer a combination of services. These include treatment for malaria and tuberculosis as well to help remove the embarrassment of walking into an ‘STI/HIV’ clinic. One particular objective of the clinics is to be ‘sex worker friendly’ since sex work is a critical element in transmission of the HIV epidemic in Myanmar. “Part of the target group is the sex workers, and in the parlour they’ll do group counselling with commercial sex workers - there’s even a dressing table with a big mirror there! So they can be putting on their make-up while they’re chatting to each other and talking to the counsellor before they head out to work for the night,” says Jocelyn. James Nichols
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