By Dr. Star Link

In the Shan State, Union of Myanmar, Tuberculosis (TB) is the 5th leading cause of death,and 22nd high burden in Myanmar as a whole.

(Others are injuries, coronary heart disease, influenza, preumonia and stroke.)

Shan State is one of the seven states and seven regions that form the Republic of the Union of Myanmar and is located on the eastern part of the country bordering Thailand, Laos and China. The population of Shan State is 10% of Myanmar’s population (59.13 million, 2010 est). Most people in the Shan State live in rural areas and are small scale farmers. For administrative purpose, Shan State is divided into three parts: North, South and East. Most parts of the Shan State are mountainous.

Health care system in Shan Sate

Health care and medical services in Shan State are provided by both the public and the private sectors. The public sector, which includes hospitals, diagnostic services, outpatient clinics and primary health care programs, is managed by the Ministry of Health.

Tuberculosis problems in Shan State

The National Tuberculosis Programme (NTP) of the Ministry carries out TB control activities through Township Health Departments (THD) that operate in all 330 townships in the country. The township is the unit of management for all disease control activities and is responsible for providing primary health care to an average population of 130,000.

The THD provides a laboratory service for sputum microscopy, registers and records TB cases, maintains drug storage and consistent supplies, and provides anti-TB drugs to patients according to a standardized regimen. THD staff also follow-up people with TB, provide health education to patients and to a lesser extent the community, according to NTP guidelines, and report to the NTP regularly.

In principle, microscopy services for sputum examination are available at the THD, but in many townships this is not the case, and patients may have to visit a District, State or Divisional TB Centre for a sputum examination. Although some midwives have been trained to collect sputum from patients and to send the sample to the district laboratory, patients often have to travel themselves to a district-level TB center for sputum examination for diagnosis, evaluation and monitoring.

The private sector includes various individuals and institutions, including international and local non-government organizations (NGOs), private general practitioners, private hospitals, private pharmacies, small stationery and basic provision stores stocking medicines, and traditional practitioners.

Private GPs (General Practitioners) have usually been trained as general physicians or family medical doctors, but they are a diverse group. They include physicians who are employed in government service but who take private patients outside office-hours, and GPs engaged only in private practice. They also include GPs working in private capacity but registered with an international non-governmental organization (INGO). Most private clinics are open in the evenings; in contrast, government clinics operate from 9 am to 4 pm. The Myanmar Medical Association (MMA) also trained GPs for TB control.

In general, patients prefer to seek care at a GP clinic first irrespective of their socioeconomic status because of their convenient opening hours and the time they are back from farm, their proximity to patients’ residences, and the ability of GPs to provide individualized care.

However, the people who live where the transportation is difficult and far away, they just rely on traditional practitioner. From this, the transmission of disease to others is beyond the expected value. And because of poor health education or improper treatment, the numbers of multi-drug resistant was increasing.

The TB patients of co-infected HIV are also the leading killer of Shan people. Due to misunderstanding, the patient who diagnosed with HIV will not get any care and will be barred from the care center.

Tuberculosis is treatable and curable disease with the use of DOTS and Stop TB strategy. In order to achieve the goal, it is recommended to implement through public and private actions at national and local levels.

Problem in Shan State

Given the lack of facilities in diagnosis and therefore effective preventative measures, it is not exactly known how people are particularly infected by TB in the Shan State. Therefore GPs in the Shan State have no data to rely on in their combat of TB.

Key facts of Tuberculosis:
Globally:

• One third of the world population is infected with TB;
• It is caused by single infectious agent but the greatest killer worldwide and second only to HIV/AIDS;
• In 2010, 8.8 million fell ill and 1.4 million died from TB, largest number of new cases occurred in Asia;
• More than 95% of death occurred in low and middle income countries ;
• It is a leading killer in people who living with HIV and causing one quarter of deaths;
• Multi-drug resistant TB is the problems in all countries surveyed and
• The TB death rate dropped by 40% between 1990 and 2010, although very slowly to achieve the MDG by 2015.

The author is a young general practitioner working in Burma – Editor