Community-driven patient support: CAP-TB in Mandalay

Dr. Anh Innes is Chief of Party of the CAP-TB project.

The vast upper regions of Myanmar are mostly rural, with some areas being especially difficult to access.  These variables introduce significant challenges to TB and MDR-TB control, which are distinct from the unique issues facing the crowded urban areas of Yangon. 

This week, I’ve had the pleasure of spending time with CAP-TB’s partners in Mandalay -- Myanmar Health Assistant Association and Myanmar Medical Association.  Visiting the MHAA office in Mandalay was one of the highlights of my visit -- getting the opportunity to sit with U Ba Maung and his team was inspiring and reminded me of the great work being done daily by each member of the CAP-TB team. 

Every day, Nway Mya Tun, MHAA community facilitator, rides her motorbike along Mandalay’s dusty roads to visit MDR-TB patients in one of the 7 townships covered by MHAA.  She and U Ba Maung divide the 74 MDR-TB patients under MHAA’s care in Mandalay -- these 74 comprise all of the MDR-TB patients currently registered and on treatment by the NTP in this region.  The MHAA office has detailed maps on its walls for each of these 7 townships, with every one of the 74 patients represented on the maps.  U Ba Maung keeps the logistics organized, with a system for tracking the patients through their treatment.  His many years of experience as a health assistant have clearly given him invaluable perspective in supporting these patients.  Even more importantly, he is doing so in a way that can be used to train others and expanded to other regions of upper Myanmar.  The rural model for MDR-TB patient support may therefore be of value to the NTP as Programmatic Management of Drug-Resistant Tuberculosis (PMDT) is expanded throughout the country.

The question of how to maximize treatment success for MDR-TB is critical in a health system with limited human resources, which is particularly relevant with PMDT quickly expanding throughout Myanmar.  Leveraging the untapped resources of the community may help the NTP to support patients through this expansion, by mobilizing previously untrained workers to provide DOT for MDR-TB.  CAP-TB’s community supporters, trained by our partner, Myanmar Medical Association (MMA), may be one strategic, creative solution to this problem of limited resources.  They are the first such community supporters providing DOT for MDR-TB in the country, and we believe that effectively training these supporters is worth the investment. Although they may not come to the task with formal medical education, the supporters are committed to their communities and to helping those with MDR-TB.  I was able to meet some of these community supporters at the MMA-organized World TB Day 2014 Commemoration in Mandalay, and I was touched by their dedication and their enthusiasm.  Spending time this week with MMA’s community supporters and MHAA’s Mandalay team was memorable and motivating—I am glad that CAP-TB is partnered with a committed team that is applying innovative and strategic solutions toward the goal of TB and MDR-TB elimination in Myanmar.

Posted by: Dr. Anh Innes