A usual working week in Kachin

Since February the 11th that I am back here in Kachin things are getting well organizing work wise. My main objective is to train the staff in order to start HAART = highly active antiretroviral therapy, treatment for HIV. Our scope is to give access to HAART in a non-discriminative way, thus targeting in Kachin drug user’s population. As a matter of fact drug users have usually poor access to HAART all around the world because of misperception of the health care givers. DUs are thought to be a difficult population to treat because of their “chaotic lives” and poor adherence due to drug use. However it has been shown that when adequately supported in a good environment, they can achieve same levels of adherence and same HAART-induced responses as non-DUs. WHO stated as far as in 2004 that HAART should be accessed in a non-discriminative way and especially IDUs should not be an exclusion criteria. Now it’s “time to deliver”, as it has been said in the Toronto AIDS conference last August.
Our team is already specialized in DUs’ care. Our clinic are not usual clinics but DIC = drop-in centers. The patient or client come in when he/she likes to get what he needs: general health care, voluntary counseling and testing, support group, relax and TV or painting sessions.
I am now giving several theoretical trainings on HAART and AZG (dutch branch of MSF = Médecins sans Frontières) will take care of the on-job trainings of our doctors and nurses. AZG has already a large program of HAART in Myanlar, 6000 persons on treatment, since 4 years.
So my usual schedule is: two visits per week to Moegaung, one in Ubyit and the rest of the time I am working in our head office in Myitkyina. Moegaung is about é hours away from where I live, so I leave early in the morning, spend the day there and come back in the evening. 4 hours of car (hopefully with a car driver) on one of the “highways” of Kachin…a large 1 and half road with a “few” holes. Really not bad! I will post a picture as soon as I will be in Yangon, you will see. One hour or so of training and discussion; then a bit of management with the project officer in charge of the DIC or with the senior nurse, and a check at the data collection. Whenever possible I spend a couple of hours in the clinic to check the practices and see what we can improve in clinical care. Once a month TB control with the TB nurse…Tuberculosis is of course a big problem which is increasing with HIV epidemic.
In Myitkyina I have to sort out protocols and procurement/forecast of the HAART drugs with the help of our Program Advisor, Solene, and our team in Yangon. So these days are usually full of computer work and emails…that’s why I don’t write to often on the blog; when I am back home I usually don’t want to turn the computer on again!
I am training not only doctors and nurses but also health educators which are on the first line of care as they are the closest persons to our target population.
WEs are not spared. On Saturday I organize a training with the three teams (Ubyit, Moegaung and Myitkyina, about 30 people overall)….Article discussions by the doctors and seminar on HAART. We have now a new psychiatrist which for sure will help a lot in the care taking of DUs. Looking forward starting the first patient on HAART…