World TB Day: Bringing TB Treatment to Myanmar’s Remote Naga Communities

Tuberculosis (TB) remains a significant challenge to public health in Myanmar (Burma). On World TB Day, we talk to TB patients and health workers in remote communities of the Naga Self-Administered Zone to discover how USAID’s HIV/TB Agency, Information and Services Activity, led by Community Partners International, is helping to ensure access to testing and treatment.

Myanmar is one of 30 countries identified by the World Health Organization as having a high burden of TB and one of just ten that also face a high burden of HIV-associated TB and TB drug resistance. TB is a bacterial infection spread through inhaling tiny droplets from an infected person’s coughs or sneezes. It generally affects the lungs but can affect other parts of the body. It is a serious disease but is curable with proper treatment.

Reaching remote and marginalized communities in Myanmar with TB services has always been challenging, but rising turmoil and conflict since the February 2021 coup have made this even more difficult. With support from Community Partners International (CPI) under the USAID’s Agency, Information, and Services (AIS) Activity, the organization Medical Action Myanmar (MAM) provides TB prevention and treatment services to about 120,000 people in 100 villages in the Naga Self-Administered Zone (SAZ).

Situated in the northern tip of Myanmar’s Sagaing Region, bordering the Indian State of Nagaland, this mountainous frontier tract is one of Myanmar’s most isolated areas. The majority of the population is ethnic Naga, a group of more than 40 tribes who inhabit India’s Nagaland State and northwestern Myanmar. Shan, Kachin, and Bamar ethnic populations also live in the Naga SAZ.

“Now I can see a way to overcome this disease.”

Ko Sai Lann, 28, farms the hills around his village in Lahe Township in the Naga SAZ. “I suspected I had TB because I had been coughing and in pain for a long time,” he explains. “To reach the hospital, we have to go to India, which takes two days on foot, or to Lahe town, which takes three days on foot. But we have some MAM volunteers in our village, and I asked them for help.”

A MAM volunteer helped Ko Sai Lann get tested for TB at the township TB center, and he was diagnosed as positive. “I was sad and depressed, but the doctor encouraged me that I could be cured if I took medicine regularly. MAM supported me with a travel allowance to be examined and get treatment. They also provided me with a basket of nutritious food.”

“I’m thankful for their help as it’s tough to get treatment in this remote region,” Ko Sai Lann continues. “Before I was diagnosed, I suffered pain and felt very sick. But now I can see a way to overcome this disease.”

Kway, 26, is a field worker for MAM’s TB project in Lahe Township. “My job is to help screen people for TB in remote communities,” he explains. “People here face many health care barriers, including transport and financial problems. MAM provides referral services and TB testing facilities at the township TB center.”

“I was depressed and cried from the pain.”

​When Kway identifies a possible TB case, he refers the patient to the township TB center in Lahe town. “They can test sputum and conduct X-rays,” he confirms. “MAM supports their travel allowance and meal costs if they need hospitalization. We also give them a basket of nutritious food to help boost their immune system, and we follow up to ensure they take their medicines regularly.”

​Daw Ah Lar, 40, was also affected by TB. “I suspected I had TB in 2022 when I experienced stomach pain,” she explains. “I then had other symptoms like fatigue, appetite loss, and difficulty sleeping. I was depressed and cried from the pain. Sometimes, I didn’t want to talk with anyone. I stayed alone at home and lost weight.”

She also received help from MAM. “Kway helped to arrange transportation for me to get tested and then referred me to the hospital,” she confirms. “MAM provided a travel allowance, and I also received a nutritious food basket.”

“If I hadn’t chosen to get treatment, I think I would be dead now.”

Kway and his fellow health workers at MAM have to navigate many obstacles in their quest to reach TB patients. “The main challenge is transportation, particularly in the rainy season,” he explains. “There are also language barriers between different communities. There’s not much health education here, so talking to people about TB can be difficult. Sometimes, people get diagnosed late because they’re unaware they have TB.”

Kway urges fellow community members to be vigilant about TB. “If in doubt, get tested for TB. It can be cured if you take medicine regularly till the end of the treatment course.”
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Daw Ah Lar agrees. “If I hadn’t chosen to get treatment, I think I would be dead now,” she says. “I received a lot of help from MAM. I was in terrible pain, but now I feel better after taking the medicines regularly. TB medicines can save many lives. I am the best example of this. I encourage everyone to believe that they can beat this disease. With proper medicine, we can all return to a normal life.”

The USAID HIV/TB Agency, Information and Services (AIS) Activity aims to achieve HIV epidemic control by ensuring 95 percent of people living with HIV in Burma are aware of their status, 95 percent of those identified as positive are on antiretroviral treatment, and 95 percent of those on treatment are virally suppressed. It also aims to achieve a Burma free from TB by reaching every person with TB, curing those in need of treatment, and preventing the spread of disease and new infections. It is funded by PEPFAR and the Global Accelerator to End TB through USAID.