So, my ‘go-to’ place where there is air-conditioning is the famous Myanmar Plaza. That’s where the internet access is and you can even get a flat-white. For a bit of ‘back-home’ if needed this is the place to be. Back to the clinic and an important topic, food! All the clinic staff eat enormous amounts of food and have a sugar-enriched diet but seem to have size 8 waists whereas for the rest of us we waddle about as we left UK.
But onto serious things and let me tell you about the HIV drugs that are available. These are fixed dose with few exceptions: EFV/TDF/3TC is now standard first line therapy and there is NVP/TDF/3TC as well. D4T happily is no longer stocked and ART is provided free. The level of primary drug resistance is not known. Other available drugs include abacavir, Combivir, Kivexa, and TDF/3TC. HBV and HCV are common. For second line, there is Kaletra and atazanavir-ritonavir making typical progression from EFV/TDF/3TC to LOP/r/AZT/3TC.
Viral load testing which we rely on so much in the UK is only available for those with falling CD4 counts: CD4 these are performed 6 monthly. Most patients have probably never had a VL test done. So, this week’s education topics are reading a CXR, dealing with TB-drug induced hepatitis, and a start on managing HIV without viral loads (tricky)! What about all the other clinic staff? Counselling here is fantastic with an outreach team for the LTFU patients. I’ve met with some members running drop-in clinics for IVDU (major problem) – Myanmar second only to Afghanistan for opium production – and tomorrow will meet with the MDRTB team.
But my first weekend away to Bagan was unforgettable and this weekend I’ll willingly undergo another nightmare 10-hour overnight journey by coach to Lake Ilne. Yes, you’re young and do this all the time but I’m touching 64 and I ache more!! The Burmese are a super friendly welcoming cheerful lot, the food is spicy and delicious (imagine Thai with a little Japanese and Indian thrown in), there is the usual minority extremely wealthy and the majority impoverished, and it’s only cool between 9pm and 6am. But it’s a wonderful place.
Am I doing anything? I don’t know but obviously, I hope so! Contacts are being made, protocols are being suggested, and trust being generated. We will see!! And to those of you who remember me swanning about in 5-star hotels, I share a flat with one air conditioning unit and two other volunteers under half my age.