I spent my second week at the MTC in the medical in-patient department (IPD) which is split into three separate rooms. There's one big room with more serious patients placed closer to what is essentially a nurses station and two smaller rooms for TB and suspected TB patients, and malaria patients. The thing about TB treatment is that it is basically a minimum of 6 months of 4 or 5 different medications and lost to follow up at the MTC is a major issue, so only a very select group of patients are able to receive TB treatment as it is costly to supply and monitor. The remainder are put in contact with hospitals inside Burma or other NGOs which can supply the 6 months worth of treatment.
I think the week in IPD really highlighted the differences in healthcare between a place like the MTC and Australia. I remember my first clinical rotation in third year was in the renal department for two weeks where I met a woman who was grateful to have kidney disease over something like heart disease, because there was still hope for her with dialysis and transplantation. However, here at the MTC access to such treatments is out of the reach of most patient's finances. I met a young woman, only 30 years old with a young son who has chronic renal failure. When she was admitted she passed 10mL of urine over 2 days, and had such significant facial oedema (swelling) that when she rolled over from her side to her back, the two sides of her face were different shapes due to the compression of the pillow. For those first two days every time we walked passed to assess another patient I always had a quick look at her urine bag to see if there was anything in there. Luckily on her third day she managed to pass ~1 litre of urine. I've never been happier to see urine because it means she still has more time and her kidneys haven't completely abandoned her.
You know how blood groups are divided into + and - groups? Well most Asians have a + blood group. In western countries pregnant women are screened for their blood group specifically to determine if they are + or - because if their fetus is not in the same group as them it can cause issues in the future. In Asia it's not such big issue since - blood groups are rare. But I met a patient, another young woman who had an A- blood group and had a haemoglobin of 5.9, low enough to warrant a transfusion, probably two, but given that the donor blood is from the local area there was no - blood to give. She also had a difficult to determine illness, but TB treatment seems to have resulted in a significant improvement.
Not all the stories from the clinic are this extreme. Most patient recover and go home in better shape then they came in. The clinic provides two meals a day, and it's substantial enough that most share with their family. One of the best things about the MTC is the family's involvement in the treatment of the patient. On one of the days, a patient a few beds down from where we were got up to turn on the switch for the fan when he suddenly fell backwards hitting his head on the corner of another bed. Instantly about four men, three of them some other patient's family members and another was actually a patient helped to clear the area, and managed to lift the convulsing patient onto the bed between seizures. They also helped to secure his limbs whilst an anti-convulsant was administered.
Another major difference is between theory and practical application. At university we participated in an online health economics course which outlined the basics of the costs of healthcare and cost efficiency and basically how every dollar counts, but I don't think you can truly understand what is meant by health economics until you visit a clinic like the MTC. The lab at the MTC does the more common blood tests such as haemoglobin levels, white cell counts and malaria testing but the more extensive ones are sent to the Mae Sot Hospital which costs money. And for every single blood test and x-ray that is ordered you really need to question whether or not it is necessary and if it would change the treatment outcome. There are actually charts on the wall which tell you how much each test will cost, which helps you narrow down which one test is going to be most cost effective to order. Whereas in Australia most patients will have had a blood test just because.
One of the Mae Tao Clinic slogans is 'Health as Human Rights' and that just the thing that we all probably need to think about. Access to medical treatment for health should be equal regardless of financial status. Women should not have to worry about the increased mortality rate that comes with being pregnant and giving birthing in a developing country. And the saddest thing here is that a baby is not named for the first 7 days in case it doesn't make it through their first week of life. So spare a thought for those who don't have the easy access to healthcare that we do the next time you pop into the doctor's office.