Voices close to home: Combating MDR-TB with trust and reason

25 November, 2013

Daw is a 55-year-old widow from Myanmar whose husband passed away 4 years ago from tuberculosis.  Her 32-year-old son has also been treated twice for TB since his father’s death, and he was finally diagnosed with MDR-TB in April, 2013.  But, because he was concerned about the family losing its sole source of income -- he works in a factory making iron doors -- he did not start MDR-TB treatment.
Like her son, Daw developed signs and symptoms of TB, and was treated with Category I and II drugs without success.  She, also, was diagnosed with MDR-TB and began treatment in June, 2013.  But after 2 months on MDR-TB medication, Daw experienced severe joint pain and stopped her treatment. This impacted her son, reinforcing his resistance to treatment and finally resulting in his treatment discontinuation. Basic health staff from their township health center counseled Daw and her son to restart treatment, but they could not be convinced.
After about 3 weeks of missed doses, a community supporter from Myanmar Medical Association, trained through CAP-TB’s initiative for community-based DOT for MDR-TB, reached out to these patients.  Crucially, this community supporter was also a familiar neighbor from within Daw’s township. With this rapport, the community supporter succeeded in overcoming Daw’s resistance.  Daw agreed to restart TB treatment after an interruption of 45 days.  And just as a familiar neighbor was able to regain Daw’s trust, her son was swayed by this voice of reason close to home. Seeing the kind support of the MMA CAP-TB community supporter, he agreed to restart his medications. Experiences like this remind us that a “community-based” focus is not just a buzzword, but a strategy that can lend greater influence than instructions alone-- even those from a medical authority.  Using the community-based support for DOT to increase and strengthen the capacity of the TB network may be a critical strategy for building a team to eliminate MDR-TB in Myanmar.

Pictured: Daw and her son at their home in Myanmar.