Outreach TB Services in Urban Areas of Myanmar

Aye Aye’s native region is the Ayeyrewady Delta in southern Myanmar, where she used to work as a rice paddy field labourer together with her husband. However, the family (they had two children) had no paddy field of their own. These factors, combined with the ongoing economic impacts of the disastrous Cyclone Nargis in 2008, meant Aye Aye and her family were getting further and further into debt.

They didn’t have that many options for making money, either. Migration, particularly to urban areas, is increasingly being seen across the country as a strategy to improve one’s livelihood. So the family decided to move to Yangon to get better job opportunities in whatever way they could. 

Her husband and eldest son found employment as daily labourers in a worksite that produced construction materials, including concrete foundation casts and concrete cases for toilets.

The family lived next to the worksite in a makeshift accommodation. There was a constant presence of cement powder and dust particles. Eventually, the family was able to move to a 48 square foot room in a hostel on the outskirts of Yangon, where the now six members of the family (plus one daughter in law and one month old grandson) all live together.

Although the family does not have a regular income, frequent work as daily labourers enable them to meet their living costs. They are earning on average more than they could make in their native village, so they have chosen to stay in Yangon where at least there is work. 

Aye Aye takes care of her family as best as she can, and sometimes also gets work as a day labourer. Ever since they started living in a shanty next to the concrete works, she has had trouble with her lungs. Living in cramped and crowded conditions like those in the hostel, where 11 of the 12 rooms are full with families, can make transmission of TB easier.

For several months, Aye Aye experienced subtle symptoms such as mild fever, loss of appetite, occasional coughing and weight loss. Although she didn’t feel well, she did not have enough money to go to a local health centre and pay a doctor for diagnosis and medicine. 

The hostel where Aye Aye and her family live. There are 11 migrant families staying in 12 rooms.

In early December 2015, IOM’s TB Active Case Finding Team (known as MORE HEALTHY - Migrant OutREach with Health Education and Access to Lab diagnosis for TB and HIV in Yangon) conducted a mobile clinic session near to Aye Aye’s home on the outskirts of Yangon where many migrants live. She heard about it from the local authorities and was very relieved to learn that the service was free of charge and would be coming to her and thus would be easy to access.

At the mobile clinic, Aye Aye listened to health education from IOM’s outreach workers. She was seen by an IOM doctor together with local health staff of the Ministry of Health, and had a Digital X-Ray done on the spot, which showed signs consistent with TB. IOM referred her for sputum testing.

They then accompanied her to go to the National TB Program clinic to get medicines and provided counselling and HIV testing as well. With a diagnosis of Pulmonary TB, she now needs to take medicines every day for at least 6 months.

IOM staff have been helping her along the way by providing initial counselling, daily observation of her taking her treatment, regularly checking for any side effects or problems, and encouraging her to attend outpatient appointments as well as other necessary tests. 

IOM’s Mobile Active Case Funding Team provides on the spot TB screening including Digital X-Ray 

IOM’s Mobile TB Active Case Finding Bus (MORE HEALTHY BUS– Migrant OutREach with Health Education and Access to Lab diagnosis for TB and HIV in Yangon) conducts mobile activities in areas in and around Yangon with high numbers of migrants

Within a few weeks, her fever had gone and she began feeling better.  Her appetite returned also, and she has been able to get some much needed sleep. It has now been 3 months since she was diagnosed, but she feels like a much younger person. She has been encouraging her family and neighbours to also attend the IOM clinic for screening. Aye Aye has also been providing health education among her friends and family.

IOM Outreach Health Worker visits Aye Aye daily to observe her taking her treatment, check for any side effects, arrange support for follow up appointments and provide support.

IOM works together with National TB Program and local Minsitry of Health Staff to mobilize community for Active Case Funding.