The Lotus clinic opened in August 2014, following the increasing demand for healthcare services from the community of Hlaingthayar Township as well as geographical access to another part of this sprawling and populous township. The clinic provides professional care 7 days a week. The clinic delivers a wide range of outpatient services from acute medical consultations to more complex TB and HIV-related care and nutritional support to a township population of approximately 700,000.
Most patients attended the clinics for chronic health conditions like HIV, diabetes, high blood pressure and acute issues like the common cold. MAM also provides counselling sessions and management of long-term treatment regimens like HIV and TB. In total, 21,305 consultations took place at Lotus this period, along with 530 home visits by Lotus clinic staff.
MAM has a dedicated medical doctor assigned for the consultation of children. The management of children’s health is different from that of adult patients as we are dealing with immature organs and systems like the liver, the kidneys, the brain or the immune system. Our paediatric doctors acquired higher skills and knowledge specific to dealing with children.
Central to the paediatric support is MAM’s strengthening of the medical treatment provided to children with chronic conditions, by providing caregivers with advice and clinical guidance through one-to-one and group sessions. All acute complex medical cases are referred to the local public hospital. In these cases, all hospital- and treatment-related expenses, including transportation, were covered by MAM.
Malnutrition is a severely neglected disease in Myanmar and responsible for many deaths, especially so in poor townships such as Hlaingthayar. MAM started systematic screening of children and pregnant women to detect and treat malnutrition early. MAM has a dedicated team that provides therapeutic feeding to infants, young children and pregnant women as well as a rigorous follow-up process. Of the 4,117 patients screened for malnutrition with middle and upper arm circumference measurements, 20 patients were diagnosed with moderate malnutrition and 11 with severe malnutrition.
The screening and treatment of reproductive tract Infections (RTIs) and sexually transmitted infections (STIs) includes both a physical examination and laboratory screening for the most common diseases such as syphilis and gonorrhoea. Female Sex Workers (FSWs) are an important target group for STI management due to considerable risk behaviour and high laboratory positivity rates. STIs are also a potential risk to unborn babies and RTI management among pregnant women is therefore crucial.
Of those screened for STIs and RTIs 80 were diagnosed with syphilis while another 42 were diagnosed with a range of other conditions. In addition, MAM provides health treatment and support to vulnerable communities at higher risk of contracting HIV.
Up to June, 2,271 patients at Lotus Clinic had received family planning consultations. Family planning empowers women to make more informed decisions about their own body, the number of pregnancies they wish to have and the best suitable time to conceive. Poor planning can often lead to poor health outcomes for both mothers and children.
The use of male and female condoms continues to be limited and requires further advocacy by MAM and others through consultations and community education programming. Most women opted for a depo injection, while 15% chose the Pill and 2% an implant.
HIV+ mothers are enrolled into the program for up to 18 months after the birth of the baby. Without the use of ART in infants and their HIV-infected mothers, as well as close follow-up after pregnancy, the risk of HIV transmission from mother to child is 15-45%. There were 5 new HIV+ pregnant women enrolled into the PMTCT program at Lotus this reporting
period. All five have started lifelong antiretroviral therapy (ART), and a further 16 pregnant women continued their treatment from 2016; two women receiving ART delivered between January and June. One child had an HIV test at 18 months and the result was negative.
In total there were 563 ANC consultations at Lotus this reporting period. Complicated pregnancies were referred to the local public hospital for further treatment and management.
The Lotus clinic provides comprehensive HIV care, including testing (1,326 tested), counselling and treatment procured by the National AIDS program since 2014, as well as nutritional support and transport fee coverage. MAM offers a one-stop service to improve attendance, ease patient experiences and enable them to retain employment.
434 patients who have been stable on treatment returned to work, while 371 patients reported no symptoms this reporting period. MAM continues its central role in HIV programming in
Myanmar, giving clinical advice to other organisations with regards the treatment and management of HIV related opportunistic infections (OIs). In 2016, patients from Care Consortium, PSI, Alliance, MDM, PPPH, MSI, as well as private and public clinics from Asia Royal, Mingaladon, Pyay, and Thaketa hospitals all referred patients to the Lotus and Thazin Orchid clinics on a regular basis.
In April 2017 a 29 year old woman admitted herself to Lotus Clinic with pain in her suprapubic area. She tested positive for HIV and syphilis. On her first visit to the clinic she was visibly very ill and emaciated, weighing a mere 28k. Furthermore, her ability to consume foods and liquid was hampered by oral thrush. She began ART in May, and her first CD4 count was 52. The lady is illiterate, and as a cleaner she is the only breadwinner in her household. She is married to her second partner and he refused to come to the clinic. Our adherence staff are working to encourage him to be tested too.She is also a recipient of the supplementary nutrition program, and is provided with dry rations and plumpy nut supplements. By June her weight was up to 30kg, she was asymptomatic, and her CD4 was at 95.
This reporting period, 20% (86) of TB-screened patients tested positive, of whom 25 were also HIV positive. This incidence rate is exactly correspondent with data from Thazin Orchid Clinic this period. MAM continues to work closely with the National TB Program (NTP). HIV negative TB patients now start TB treatment at an NTP clinic and in some cases their follow-up may be provided by MAM. MAM referred 87 patients to the NTP and no HIV-negative TB patients were followed-up by the Lotus clinical team this reporting period.
A patient potentially suffering from TB has their blood pressure taken in the day care unit. All TB patients continue to receive food support provided by WFP to help improve and accelerate TB recovery. MAM outreach workers regularly visit TB patient houses to provide treatment management support, discuss drug side effects, and offer social counselling.
With continued support from the Elton John Aids Foundation MAM is able to run this small but essential element of programming. People with severe HIV infection have a high risk of becoming blind due to cytomegalovirus (CMV) infection that affects the retina. Early CMV treatment using ganciclovir injection directly to the eye ball can prevent disease progression and blindness. Dr Ni Ni Tun is specialised in this procedure.
139 patients were screened for eye pathologies during this reporting period. One patient was diagnosed with CMV retinitis and required treatment. Four patients had TB lesions or other eye pathologies that were managed per specific treatment protocols.
Patients requiring long-term treatment who are in relatively good health can attend our day-care unit daily for more intensive care, clinical observation, and administration of medicine under supervision. 83 patients were admitted to our day-care unit, accounting for 195 consultations between January and June 2017. Most common reasons for admission were severe dehydration, pneumonia and hepatitis. A further 530 home visits were made this reporting period, ensuring those less able to travel to the clinic, or those needing special support with adherence were given extra assistance.
Almost half of the 6,861 lab tests run at Lotus Clinic this reporting period related to syphilis and HIV testing. Advanced laboratory tests (e.g. CD4 test, kidney function test and liver function test) were done at MAM’s main laboratory and the results provided to the clinic on a daily basis.
Counselling is an important part of healthcare delivery, especially for patients with chronic diseases like HIV and TB where lifelong treatment can be challenging and treatment adherence is vital to prevent the development of drug resistance. Of the total counselling sessions run, 68% were HIV test related, 31% were supporting ART management and adherence while 1% were TB related. In addition to counselling MAM has a dedicated staff
member who visits communities to advocate for the clinic’s services, while also educating about common diseases like HIV, TB, sexually-transmitted infection, diarrhoea and the screening of malnourished children CMV retinitis treatment at Lotus Clinic 3,920 counselling sessions 6,861 lab tests (active case finding) in the communities. 5,837 caregivers attended MAM health education sessions during this reporting period.
Patients with serious chronic diseases and poor health are more likely to face unemployment, thus reduced incomes and poverty. Some may sell part of their medicines to support their family, leading to treatment failure and the development of drug resistance. MAM can supply families with food, thanks to the World Food Program (WFP) as well as covering for travel expenses to help patients attend their health appointment and build physical strength. This period 243 vulnerable patients received food ration support. Most commonly this goes to: chronic disease patients, orphans, and single-women households. 63 enrolled this reporting period, and the other 180 continue the support from 2016.
As mentioned in previous reports, MAM has been working towards increasing its uptake of HIV testing and counselling, improve its network and access key populations at higher risk of contracting HIV, including men who have sex with men (MSM) and female sex workers (FSW). MAM has also engaged in an ongoing and more effective collaboration with local government hospitals and other INGOs with regards to PMTCT, CMV retinitis and HIV/TB care management. In late 2016 MAM procured 2 ultrasound machines, which can improve the precision of diagnosis for various conditions. It is particularly helpful to prevent obstetric complications and to identify swellings in the abdomen (for example TB and hepatitis) which can be difficult to identify by routine physical exam. One of the machines is located in Lotus Clinic and is being used regularly by the newly trained staff.