Daw Than Than Yee is a volunteer TB DOT (Directly Observed Treatment) provider who received training from the Myanmar Medical Association (MMA). She told of how she had been able to make effective use of the knowledge and skills she has gained in order to overcome obstacles in saving the life of a TB patient who had misconceptions about anti-TB medications.

“My name is Than Than Yee, a member of Myanmar Maternal and Child Welfare Association (MMCWA), and I am working as a DOT provider for the MMA TB project. Before I attended the training organized by MMA, I did not have much knowledge on TB prevention and did not know how I could disseminate TB health messages.”

From the training organized by MMA, Daw Than Than Yee learned how TB is transmitted, its symptoms, how to refer a patient for sputum testing, the importance of completing the full course of anti-TB medication to prevent drug resistance, directly observed treatment for TB, the duties of a DOT provider, proper recording of patient treatment history, educating patients on the side effects of medications, monitoring for those side-effects, and referral of complicated TB cases. With the knowledge and skills she gained, she has helped a neighbour get cured of his TB.

“After I completed the training from MMA, one of my neighbours, U Mya Maung (not his real name), became very ill. He had a cough with streaks of blood in his sputum. With the knowledge gained from the TB DOT training, I suspected his cough could be due to TB and promptly referred him to GP Dr Myo Zay Ya at the Myint Myat Private Clinic. The doctor sent U Mya Maung for a sputum test, which confirmed that he had TB.”

However, as U Mya Maung had previously taken anti-TB medications five years ago, Dr Myo Zay Ya started him on anti-TB Cat (II). Unfortunately, U Mya Maung moved away from the neighbourhood after taking only three months of treatment. Because of her MMA TB DOT provider training, Daw Than Than Yee felt it was her duty to ensure the patient complete a full course of treatment, and followed U Mya Maung to his new home.

“As an MMA TB DOT provider, I could not just turn my back on the patient. I made a commitment to offer my time and service for the better health of my community. I have been entrusted with duties to make sure the patients take the complete anti-TB treatment, and get their sputum tested until fully cured,” she said.

On arriving at U Mya Maung’s new home, she was met with another challenge, since he refused to continue TB treatment saying he was already feeling well. However, Daw Than Than Yee had decided that U Mya Maung must win his battle against TB and she continually explained to him with patience, “A general sense of wellbeing after three months on TB treatment does not mean that you are fully cured of TB. If the treatment is interrupted, current anti-TB treatment will not be efficacious for you anymore. You might have to be switched to another regimen, which could be a longer course of treatment.”

However, U Mya Maung was stubborn and persistently refused to continue taking anti-TB medication, eventually giving a specific reason, “I am very tired at the end of a day’s work as a porter, and I need to relax with alcohol in the evening. But I cannot take TB drugs with alcohol.”

This is the kind of problem that TB DOT providers have to solve on a daily basis. Ready to put her newly acquired counselling skills to use, she quickly thought of a solution and advised him, “It is not a big problem. You can take anti-TB drugs in the morning and alcohol at night time.” This reasoning ultimately led U Mya Maung to a full recovery from TB.

U Mya Maung agreed to have his sputum tested after three months of medication and to continue treatment. His month-3 sputum was negative (and he had gained weight to 43 kg), as was his month-5 sputum result, when he had reached 46 kg. He was completely cured of TB as confirmed by his month-8 sputum, by which time he weighed 50 kg.

Daw Than Than Yee was overjoyed that U Mya Maung’s treatment was successful.

“I am really satisfied that the patient I referred was completely cured of TB. His quality of life has improved and he is enjoying life once again with his family, without the fear of passing TB to them. It is worth all my efforts as a DOT provider.”

She concluded with satisfaction, “As MMA TB DOT providers, volunteering our service for the community, we have proved that we can save lives. This has also contributed to the overall national response led by the National TB Programme. I am sure that this joy – from helping TB patients recover to enjoy life once again with their families – cannot be bought with money.”

The Myanmar Medical Association (MMA) has been implementing the ‘Public-Private Mix TB Project’ with support from the Global Fund since 2011 in Myanmar, namely in Ayeyarwaddy, Bago, Kayin, Magway, Mandalay, Mon, Rakhine, Sagaing, Shan, Kachin and Yangon.