In this post I want to share a bit about my assignment with the Clinton Foundation. We are focused on helping improve access to care for patients with TB (tuberculosis). TB the second leading infectious disease cause of death in Vietnam. TB is an airborne disease caused by a bacterium called Mycobacterium tuberculosis and can be caught by breathing in the air that an infected person has contaminated through: Breathing. Coughing. Not everyone infected with TB bacteria become sick but those with a weak immune system are most at risk, this includes HIV patients, substance abusers, Organ transplant patients. TB is highly contagious and can quickly spread if not caught, isolated, and treated early. Good news is that TB can be treated by taking several drugs for 6 to 9 months, treatment is free through the government and there are well established national treatment guidelines.
“So why is management of TB an issue?” For starters a treatment regimen of 6-9 months for any disease presents a problem. Patient compliance is not a unique challenge to Vietnam. So what is different here….for starters there are a lack of government controls and oversight. Interesting thing to say about a communist country so let me explain. In Vietnam unlike the US you do not need a prescription to purchase drugs. There are thousands of pharmacies and you can just walk up and ask for virtually any drug you want. As it relates to TB management clinical studies have found that 40-60% of TB patients will go to a private pharmacy before a medical provider. This is understandable as the common symptoms of TB are persistent cough, fever, night sweats. So the path of least resistance is self medication by buying some antibiotics and cough medicine from the local pharmacy. WRONG THING TO DO ! Problem is most of the pharmacy staff does not have the proper education to diagnosis and treat TB in addition pharmacies are in business to sell medications and many are hesitant to refer patients to a physician or government treatment facilities for fear of losing a sale….
For a frame of reference above are pictures of the typical pharmacy in Vietnam. They are small walk up stores with a counter. Businesses in Vietnam tend to be clustered together and our office is on what they call pharmacy street so with-in 2 short blocks there are about 20 different pharmacies most next to each other.
Back to our work at the Clinton foundation we are currently working with the Ministry of Health and pharmacies in Ho Chi Minh City to developing ways to educate pharmacies on TB, national treatment guidelines and available resources so they are better equipped to identify TB patients and direct them to appropriate resources.
This past weekend I had the opportunity to join a group from our office on a training meeting they had with some staff from the Ministry of Health, CDC (Communicable Disease Center).
I will leave you with a few pictures of the beautiful landscape and people of the Yen Bai province. Yen Bai is located about 3 hours north of Hanoi and famous for the terraced rice fields and tea plantations.