Multi-drug resistant tuberculosis is one of the most complex types of tuberculosis you can get. As opposed to drug-sensitive, which responds well to the medication, multi-drug resistant tuberculosis, by its very name, is resistant to some of the drugs used to treat the disease. This makes the response more complicated, often requiring the doctors to develop bespoke treatment plans depending on the patient.
The prevalence of TB in Myanmar
Myanmar still faces a significant health crisis in the form of tuberculosis. According to the latest report released by the World Health Organisation[1], Myanmar is one of the 30 countries globally with a high burden of TB and it bears a triple burden of drug-sensitive TB (DSTB), drug-resistant TB (DRTB) and HIV-associated TB; when HIV patients also suffer with TB because of their weakened immune system.
There was an estimated total of 257,000 TB cases in Myanmar in 2022[2].
In the last three years, MSF’s TB patient cohort in Myanmar has mostly been transferred to the National Tuberculosis Programme (NTP). However, the NTP is facing numerous challenges, ranging from a lack of staff to regular supply of drugs that impact the NTP’s ability to provide quality and readily available care for TB patients.
This means progress made in battling TB continues to be stalled and is making accessing public healthcare ever more difficult, especially for the long treatment times required for a complex disease such as TB.
Currently, in Yangon, MSF supports a 90-bed hospital specialised in the treatment of DRTB. This is one of the only specialised DRTB hospitals in the whole country. TB patients with particularly complicated cases of DRTB can spend upwards of six months in this hospital, following a carefully prescribed treatment plan. The hospital also carefully monitors out-patients who come to the hospital regularly for treatment as part of their long-term plan.
A long and difficult recovery
“I had to take seven pills every day. I would drink almost one litre of water just to take them.” remembers Zin Mar Lin. “It took me several minutes every day to encourage myself to take them. There was one medicine, I forget the name, but I had to take it every Monday, Wednesday and Friday. I felt nauseous whenever I took it.”
The treatment for DRTB is very difficult, often requiring a large concoction of pills to be taken every day, with severe side effects. Patients speak of dizziness, nausea and insomnia, among other things, stemming from their medication. In some cases, these side effects can prove too much, and patients stop taking their medication. To successfully recover from TB, it is crucial to fully adhere to the treatment plan, enduring everything that comes with that.
In recent years, progress has been made in the research and development of alternative treatments for tuberculosis. MSF has been instrumental in the research used to develop a new shorter regime called BPaLM. It takes six months of oral medication with very few side effects. Although too late for Zin Mar Lin’s recovery, the availability of this improved treatment regime for patients in Myanmar is a bright spot in the national TB response.
The importance of a support network
As well as the extreme side effects of the medication, the financial pressures can also prove too much for TB patients throughout their long treatment time.
The long recovery time involved with MDRTB can put immense pressure on patients, emotionally, physically and financially. At the TB hospital, a social welfare team also supports patients’ overall well-being and living conditions. Ensuring that a patient is well looked after, eating well and has a strong support network can improve the chances of a successful recovery.
Myanmar’s struggling public healthcare system
As well as the challenge of the treatment itself, TB patients in many parts of Myanmar face the additional barrier of lack of availability and accessibility of care. The last three years of conflict have drastically increased humanitarian needs across the country and created huge additional gaps in healthcare service provision.
Since the military takeover in 2021, the public healthcare system in Myanmar has been struggling to cope with the sudden loss of staff and funding. HR gaps remain, often filled by humanitarian organisations. In Kachin and Shan states, MSF works alongside the National Tuberculosis Programme to support these facilities in caring for patients and supporting their ability to keep up with necessary levels of testing and treatment.
On-going widespread fighting is further limiting healthcare services available for people in Myanmar and is making accessing these few facilities a dangerous journey. Authorities, health actors and donors must engage with each other to rapidly improve availability and quality of TB (including Drug Resistant-TB) care in Myanmar.
