November 28, 2006
The Chiang Saen hospital is five miles from the center of the opium-producing Golden Triangle, where Laos, Myanmar and Thailand meet and where drug use and sex work are rife. The pioneering Thai clinic is famous for miles around for its treatment of HIV/AIDS patients regardless of their nationality.
While the majority of boats along the Mekong river carry tourists, every month from Myanmar and Laos, boats carry men, women and children to the only two clinics in Thailand that offer antiretroviral drugs.
"In Laos there are no facilities, no medicine, so I had to come here," said Arun Petchawong, a 43-year-old subsistence farmer with three children. In her country, HIV rates are increasing, and more than 18,000 people could have HIV by 2015, said UNAIDS. In Myanmar, some aid workers estimate the country has double the official figure of 333,000 infections.
In 2004, Doctors Without Borders (DWB) offered to finance two border clinics, including in Chiang Saen, to dispense ARVs to patients excluded from the public health system in Thailand. A Myanmar-Thai border clinic treats 56 mostly ethnic minorities, with transportation assistance from Norwegian Church Aid. Three to five patients, most Laotian, arrive each month, said A. Kace Keiluhu, head doctor at the clinic.
"In the long term, the Laotian hospitals should be able to manage their patients," said Paul Cawthorne, DWB's Thailand mission chief. He lauded Laos' Ministry of Health for its openness to building the knowledge and skills necessary for clinics to dispense ARVs. The program should be operable within months.
But "it is impossible to have any relationship with the central government in Myanmar," Cawthorne said. The clinic is advised not to over-enroll Myanmar patients, since it has no long-term strategy for funding. Cawthorne asked, "How do you say 'I'm sorry, you're Burmese, so we've not got a long-term strategy so we're not going to treat you'?"