Medical Action Myanmar

Medical services in a city of extremes


Medical Action Myanmar provide vital medical services to some of the poorest suburbs on the outskirts of Yangon. Services range from sexual and reproductive health, HIV testing and treatment, to treatment of malaria and tuberculosis (TB), all packed into four small but very efficient and effective clinics. The original and largest clinic in Hlaing Tha Yar township, which has been operational since 1994 and originally set up by Médecins Sans Frontières (MSF), serves a population of about 400,000 people and they typically see 300 clients a day.

What struck me most was the many pragmatic and common sense approaches they took to looking at the patient in the broadest sense. The efficacy of treating HIV is restricted if the patient is lacking in basic nutrition, as is so often the case in clients who discover they are HIV positive at the clinic. The clinic has a feeding centre which provides a balanced diet for a six month period for malnourished children. The centre is a fun place for the children to play and be monitored, thereby making feeding a more positive experience. MAM also provide what is called “Dry Rations” to patients on ART or TB medication that have dietary needs.

MAM provide assistance with transport fees for some HIV positive patients to ensure they can attend clinic regularly. The clinic has an outreach programme to encourage sex workers to attend the clinic for regular screenings for STIs including HIV. This includes a dedicated waiting area which is comfortably set up with coffee and noodles are served. This makes for a positive experience for anyone attending and provides a space to relax, chill out and share time with each other. The aim is to “make it their home” so they visit regularly, ideally every month. They have a trained peer educator who used to be a sex worker and she overseas the outreach programme. This also includes making a payment to women who recruit new patients and bring them to the clinic.

The clinic provides TB services, but unfortunately the government won’t allow patients to stay over night as it is not a hospital, so all patients have to go home. MAM now has a separate patient house for those that have to travel a long way to the clinic.

Each adherence team is made up of a doctor, a counsellor and an Outreach Adherence Supporter (OAS) who meet every two weeks. They consider sex workers, MSM, HIV positive and tuberculosis patients. The OAS regularly visits patients in their home to provide support and if there are any problems for the patient taking their regular medication.

I met many patients who were very open to be photographed and included in the work. It was a real privilege to hear their stories and see first hand how they are being helped by MAM, which they hold in very high esteem.

Thazin clinic, the first of Medical Action Myanmar’s clinics and operational since 1994, provides vital medical services to Hlaing Tha Yar township on the outskirts of Yangon

Services range from sexual and reproductive health, HIV testing and treatment, to treatment of malaria and tuberculosis (TB).


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Today Daw San Mya Khaing (29) and her son, Myo Thant Zin (3) are visiting the clinic to get their blood results. Myo’s blood results today are very good and another sample of blood is taken to test for haemoglobin, liver and kidney function. 

Last year she tested positive for HIV and for TB. She and her son are now both doing well on antiretroviral therapy (ARVs). Her husband was a manual labourer on construction sites and travelled a lot. He died of an AIDS related illness last year..She lives with her mother and five sisters in the local township and is open to a few people about her HIV status. She works as a manual worker with no regular or fixed daily wages, often at the fish factory where she can earn 1500K per day ($1.35).

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Win Thandar Htun, with her 1 month old, currently unnamed baby was born 2 months prematurely, weighing 2.1kg. She is being seen by Dr Kay Khine Zaw. The baby is the first child of her new marriage and she has a 6 year old child. Thandar is HIV positive but not on ART, the father has found out he is HIV positive today and the child's status is unknown.

For economic reasons they are moving back to their hometown, a 6 hour drive from the clinic. The doctor doesn't think the outlook for the baby is very good as they are unlikely to be able to find a new local clinic where they can get ART for everyone. Against advice, as Thandar is not on ART, she continues to breastfeed the baby. If they were to stay, the clinic would provide milk for the baby for 18 months. The baby currently has Candidiasis and an upper respiratory tract infection and has been prescribed a broad spectrum antibiotic (cotrimoxazole) for 4-8 weeks.

Win Thandar Htun is currently an unemployed labourer and the father, San Hlaing, is a carpenter. Their irregular daily income is 5000 Kyats ($4.5). Thandar's first husband died - he was an alcoholic with liver disease.

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A young monk first came to the clinic in February 2014 with a fever, cough, loss of weight, skin infection and TB. They discovered he had a CD4 count (a key measure of the state of a patients immune system, typically in the range of 460 to 1600 parts per ml) of just 4 and went on ART in March 2014.

He visits the clinic each month whilst his CD4 count is increasing. In August 2014 it was 49 when he cleared TB. He was 12 when he became a monk and didn’t know his mother, father or siblings. When he first arrived at the monastery, 30 minutes away, he took care of an HIV positive monk. He was in very close contact with the monk. He had a skin infection and thinks he contracted HIV through his skin. Others at the monastery and friends do not know about his status. He feels sad and depressed, but the support he has had from MAM has helped him to become more positive.

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A young monk leaves the Tun Clinic in Shure Pyi That township heading back to his monastery with a smile on his face. The clinic was operational in 2011 and serves a local population of 200-250 thousand.
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Myint Myint Khaing, TB Lab Technician at the Tun Clinic in Halaing That Yar township.
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Thi da Aye (31) visits the Tun clinic in Shwe Pyi Thar township for her regular check up, today including an eye examination with Dr Yee.

She is HIV positive and on ART and is also on treatment for TB.

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An afternoon of fun for all the children who use the HIV services at the Tun clinic (Shwe Pyi Thar township) to meet and play.
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An ingenious time saving system to send bloods to the lab from the consulting room at the Tun Clinic in Halaing That Yar township. There are many monitoring and control systems in place at MAM to ensure the best use of scarce resources and to enable effective reporting back to donors.
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The reception at Thazin clinic, the first of Medical Action Myanmar’s clinics and operational since 1994, provides vital medical services to Hlaing Tha Yar township on the outskirts of Yangon. Services range from sexual and reproductive health, HIV testing and treatment, to treatment of malaria and tuberculosis (TB).
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A typical house in the townships surrounding Yangon served by the MAM clinics where there is severe economic hardship.

Yangon is growing at a rapid rate and despite much building work, accommodation in downtown Yangon is some of the most expensive in SE Asia. This is partly as a result of supply not meeting the demand from foreigners working for NGO’s and large companies with the resulting knock on effect to locals. Land in and near the townships is becoming more valuable and is increasingly being taken by large corporations to develop.

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Peing Peing, a Peer Educator, talks to women visiting the Thazin clinic.

The clinic has an outreach programme to encourage sex workers to attend the clinic for regular screenings for STIs including HIV. This includes a dedicated waiting area which is comfortably set up with coffee and noodles are served. This makes for a positive experience for anyone attending and provides a space to relax, chill out and share time with each other. The aim is to “make it their home” so they visit regularly, ideally every month. They have a trained peer educator who used to be a sex worker and she overseas the outreach programme. This programme includes making a payment to women who recruit new patients and bring them to the clinic.

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Tin Tin Kaing (28) visits the Thazin clinic.She has been a sex worker for a year after previously working as a tailor in a garment factor. The family has financial problems and needs money for her eight 8 year old child who has leukaemia and needs a blood transfusion every 3 months at Chai Hospital.

She earns about 300,000 Kyat ($270) per month on average in a massage parlour. She is HIV negative, most of her clients use condoms but 1 in 10 she turns away when they ask not to use one. She is hoping that her son will soon recover so she can stop sex work..She pays her friend, a waiter in the massage parlour to drive her to the clinic for 4000/5000 Kyat ($3.5 / $4.5). Her husband is a bus driver, but doesn’t get regular work. Previously her auntie looked after her son, but she died and is now helped by her grandmother who knows she is a sex worker.

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Pearl (18) visits the Thazin clinic for the first time to find out she is HIV negative. She works with her sister Thandar (23) for the previous 6 months in a massage pallor for daily wages, about 3000 Kyat ($3) per session.

On a good day, they can earn 20-30,000 Kyat ($18 - $27), sometimes it is nothing. 8000 Kyat ($4.5) goes as commission to the owner. She tries to convince clients to use a condom and if they try not to she calls the waiter. Most of the time they use a condom..She lives with her mother, her older and younger sisters and two brothers. Her father divorced eight years ago. She and her older sister looks forward to the end of her family’s financial problems and they would like to be fruit and vegetable sellers.

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Ma Khaing (27) visits the Thazin clinic for the first time and came with a friend. She previously worked in a brothel, but it was low paid with long hours so she now earns more money on the streets in Yangon or North Okkala, but it is more dangerous. She has been arrested and spent a week in jail. 

She tries to use condoms with customers, but if a customer says no she accepts it. She then feels anxious after. It’s getting easier to convince clients..Her husband took another wife and her four year old child lives with the grand parents back in her home town. She hopes to get enough money to invest in a fruit, veg and betel stall..She has a new husband in Dagon whose a painter, but his work is not regular.

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Counsellor San Sun Aye talks to a group of women visiting the Thazin clinic. The clinic has an outreach programme to encourage sex workers to attend the clinic for regular screenings for STIs including HIV. This includes a dedicated waiting area which is comfortably set up with coffee and noodles are served. This makes for a positive experience for anyone attending and provides a space to relax, chill out and share time with each other. The aim is to “make it their home” so they visit regularly, ideally every month. They have a trained peer educator who used to be a sex worker and she overseas the outreach programme. This programme includes making a payment to women who recruit new patients and bring them to the clinic. About 50 women visit the clinic a month and they recruited 4 new women in September 2014.

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Yangon is growing at a rapid rate and despite much building work, accommodation in downtown Yangon is some of the most expensive in SE Asia. This is partly as a result of supply not meeting the demand from foreigners working for NGO’s and large companies with the resulting knock on effect to locals. There is severe economic hardship in the suburbs surrounding Yangon that the clinics serve.
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Ni Ni Win (23) is visiting the Children's Centre with her 2 of her children. She’s feeding Min Khant Zaw (1) and Eidone (3) who can’t walk properly due to malnutrition. She’s been attending the Feeding Centre since September when she couldn’t walk and weighed 6.8kg a month later she weighed 8.3kg and eats well. 

A fieldworker found the child and referred her to the clinic which is 30 minutes away on a trishaw from her village, Karsin near Hlaing That Yar on a trishaw which the clinic covers the cost of. She is now over her target weight and as long as the weight does not start to go down, will be discharged and come back once a month for check ups. Her husband is a freelance electrician but has no regular job for the last 4-5 months.

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The Childrens Centre at Thazin Clinic, the first of Medical Action Myanmar’s clinics and operational since 1994, provides vital medical services to Hlaing Tha Yar township on the outskirts of Yangon. Services range from sexual and reproductive health, HIV testing and treatment, to treatment of malaria and tuberculosis (TB).
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Ma Mya Than (39) prepares water melon to go and sell and earns 5000 Kyat ($4.5) a day whilst her neighbour looks after her children. Kosan Aungr is her Adherence Outreach Support worker (AOS) and helps her take her ART correctly and gives her support and when needed refers to her to the doctor. They appear at the clients house as a friend and visit every 3 months.

Her husband died of TB and HIV whilst on treatment, but she was only knew about his TB treatment. The neighbours helped out with free funeral services and helped with money. She first came to the clinic as she had severe diarrhoea and tested positive to HIV and started ART in May 2013. She hasn’t had any side effects..Aye Myat Mon is nearly 3 and is HIV positive on ART since February 2014, Aye Than Tar San is 6 and HIV positive, in good health but not on ART and plans to be a doctor. That That Mon is 9 years old and in 3rd grade. She is has won many prizes at school, including distinction in 4 subject and is top of her class. She is planning to be a teacher. Her youngest child attended the feeding centre for 6 months due to her malnutrition. She will join her sisters at school when she is 5.


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Zin Lay (24) sits in her corner of the single room house which she shares with her mother, step father and two elder brothers in Hlaing That Yar on the outskirts of Yangon in Myanmar.

She moved from the delta region of Myanmar and has been coming to the local clinic since 2011. She is very open about her HIV status which causes issues of stigma. Her Antiretrovial therapy started in 2012 and is working well. Although her family have no issues with her being transgendered, the same can not be said about her being HIV positive. She has a boyfriend who is often away travelling. She works in a beauty salon, washing and cutting hair and as a beautician.

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Zin Lay (24) with her mother outside their single room house which they shares with her step father and two elder brothers in Hlaing That Yar on the outskirts of Yangon in Myanmar.

She moved from the delta region of Myanmar and has been coming to the local clinic since 2011. She is very open about her HIV status which causes issues of stigma. Her Antiretrovial therapy started in 2012 and is working well. Although her family have no issues with her being transgendered, the same can not be said about her being HIV positive. She has a boyfriend who is often away travelling. She works in a beauty salon, washing and cutting hair and as a beautician.

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Ma Pyone Yee (41) sits at home with her 4 year old daughter Key Sin Pho whilst talking to her Adherence Outreach Support worker (AOS) from Thazin Clinic, Kosan Aungr who helps her take her ART correctly and gives her support and when needed refers to her to the doctor.

They appear at the clients house as a friend and visit every 3 months.

She first started attending the clinic in January 2013 when she couldn’t walk or eat. She was referred to hospital and after 45 days she started to recover. Her Antiretroviral Therapy started in March 2013 and is working very well.
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Ma Pyone Yee (41) stands outside her home with her 4 year old daughter Key Sin Pho. She first started attending the clinic in January 2013 when she couldn’t walk or eat.

She was referred to hospital and after 45 days she started to recover. Her Antiretroviral Therapy started in March 2013 and is working very well.

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