Twice a month, Min Naing-oo visits emaciated patients at a Myanmar clinic, urging them through his face mask to keep taking their medicine no matter how sick it makes them.
Otherwise they will die — and fuel the spread of drug-resistant tuberculosis (TB) in a country that is already tallying an estimated 9,000 new infections of the hard-to-treat strain every year.
Only a tiny fraction of those have gotten proper treatment, all in the past few years, creating what health experts say is an “urgent” threat.
“I feel it’s important to share my story,” says Min Naing-oo, who beat the disease after a 12-year fight, enduring debilitating joint pain, hallucinations, hearing problems, nausea and piercing headaches due to the toxic cocktail of medications.
Myanmar’s health system was basically buried during a half century of neglect. While there are signs of improvement, in large part because of donor funding, it remains badly broken even as the new quasi-civilian government moves forward with political reforms.
Before military rulers handed over power two years ago, they were spending as little as US$1 per person on health every year, and there were few sufficiently trained personnel or supplies, resulting in spiraling rates of diseases such as HIV and TB, infant mortality and deaths linked to malaria.
In the past year, the Burmese Ministry of Health quadrupled its budget — though still far from the amount needed — and has worked to strengthen ties with the international health community.
Experts from across the globe were gathering in Yangon this week for a two-day symposium aimed at finding ways to speed up diagnosis of multi-drug-resistant TB, improve patient care and take advantage of new shortened and less toxic treatments.
“We are still in the early days, but the political willingness is there,” said Unni Karunakara, the international president of Doctors Without Borders, which hosted the event with the WHO and the health ministry.
HIV drugs are also lacking in the nation of 60 million and UNAIDS estimates 18,000 people die from the disease every year, many of them succumbing — when their immune systems are weak — to TB.
TB is an age-old scourge and one of the world’s most infectious killers affecting 12 million people, according to the WHO.
With 506 sufferers per 100,000 people, Myanmar’s rate of regular TB is three times the global average.
The normal strain of TB is easy to treat with a simple and cheap drug regimen. However, when those medications are misused or mismanaged — often when patients skip pills — the bacteria can fight back and outsmart the drugs, creating resistance. The result is a new, much harder to treat multi-drug-resistant strain.
Though there are an estimated 9,000 new infections of this drug-resistant TB every year in the country, according to WHO, as of last year only 800 patients have ever received treatment.
It is a worrying problem since this dangerous strain also can be spread via coughs and sneezes, usually infecting people in close contact.
Thar Tun Kyaw, director of the health ministry’s disease control program, worries that the real number of infections could be higher, saying the country has only two laboratories capable of testing patients for drug-resistant TB — one in Yangon and the other in Mandalay.
There may also be countless hidden cases in areas that have been long cut off by civil unrest and rough terrain.
Currently, the few patients in Myanmar lucky enough to get treatment for drug-resistant TB receive it free of charge.
However, with the numbers increasing, the government still needs to come up with US$41 million for its ambitious five-year US$53 million expansion plan. Most of the money contributed so far has come from international donors.
Eamonn Murphy, a UNAIDS country coordinator who works closely on TB, said while outside help is for the moment key to tackling drug-resistant TB, the ultimate goal should be to get the government to build up its share.