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HEALTH: Thai Touch in HIV Care Attracts Doctors from Asia, Africa

Marwaan Macan-Markar

BANGKOK, Oct 21 2010 (IPS) - Northern Thailand’s Chiang Rai province has many charms to draw foreign visitors, from hilltribe communities dressed in colourful ethnic clothes, trips to gentle hills close to the Burmese and Lao borders, excursions to once infamous opium trails and a journey along the Mekong River.

But foreign guests – from neighbouring countries like Vietnam to other nations like China, India, Pakistan, Bangladesh and Papua New Guinea – are also being drawn to the province by a very different attraction – its main provincial hospital.

These visitors, health workers for the most part, spend time at the Chiang Rai Prachanukroh Hospital to learn how Thai health workers have succeeded in reducing the spread of HIV among babies.

“We show them how our team effort, including doctors, nurses, pharmacists and people living with HIV, has been important to bring down the numbers,” said Dr Rawiwan Hansudewechakul, chief of the hospital’s paediatric department. “How we train staff in community hospitals to reach out to people in distant areas has been part of this information exchange.”

The Chiang Rai hospital’s rise as a learning centre for preventing mother-to-child transmission (PMTCT) of HIV goes back to 1997, when this health facility was chosen by the Thai government for a pilot programme to reduce the number of babies being infected.

It was a natural choice, admits Rawiwan, given that Chiang Rai, close to several of Thailand’s borders with other countries, was in a belt that was severely hit by HIV in the early stages. There were “funerals seen every day and people were feeling helpless,” she recalled.

By 2000, when the first foreign doctors started to arrive in Chiang Rai, the local staff had answers to questions how pregnant mothers should be cared for to reduce HIV transmission to their babies. The 55-year-old Rawiwan was among a team of researchers at the hospital who had been grappling with an equally daunting question – “understanding what is the natural transmission of HIV” – since 1991.

Such training courses are part of a broader programme that Thailand’s public health ministry has put into place on the back of its success in curbing the spread of HIV. These have included a 100 percent condom-use campaign and public education initiatives, including care for those living with the disease by offering access to cheaper antiretroviral (ARV) drugs to ensure longer life.

In February this year, the ministry hosted 20 health workers from Bangladesh, Bhutan, Indonesia, Mongolia, Nepal, Pakistan, Sri Lankan and Burma for a 10-day programme in Bangkok on how to manage PMTCT.

In March, health workers from Africa, including Kenya and Uganda, were among a group of 17 who spent a week in the Thai capital to gather insights about ARV therapy.

“These are all part of the South-South cooperation programme that is being promoted by the ministry of foreign affairs,” said Surasak Thanisawanyangkoon, head of the international collaboration development section, at the public health ministry. “Treatment and care for mothers and children with HIV is a key area.”

“Thai doctors are also sent to the developing countries with which we are cooperating,” he told IPS. “They offer knowledge on how to monitor children affected by HIV and how to develop a good surveillance system.”

Few Thai public health workers convey this spirit of Thai cooperation more than Dr Krisana Kraisintu. She led researchers in efforts against many odds at the Government Pharmaceutical Organisation (GPO) to locally produce a cheap, generic ARV tablet, replacing the cocktail of three drugs that people with HIV had to take previously.

Since 2002, the 58-year-old Krisana, whose struggles to produce the generic drug GPO-VIR even inspired a play, titled ‘Cocktail’, has been working in Africa to help her counterparts locally produce and distribute the cheaper generics.

Thailand’s efforts in combating the spread of HIV and caring for its citizens living with the disease are reflected in the declining numbers since the first case of the pandemic was reported in 1984. The country has recorded over 1.1 million cases of HIV since the beginning of the pandemic, and 300,000 people among these have died due to AIDS.

Over a third of those infected – close to 400,000 – are women, for whom PMTCT has been pivotal. The percentage of HIV transmission from mother-to-child cases has dropped from 14 percent in the early 1990s in some parts of the country to less than two percent.

In 1991, the number of new HIV cases recorded was 143,000. By 2003, it had 19,000 new cases in a country of nearly 66 million people.

“Thailand’s ability to share its knowledge is not only because it is a middle-income country and wants to be a new global player, but because it has also done a lot to respond to the spread of HIV,” said Sompong Chareonsuk, social mobilisation and partnership advisor at the Thai office of the Joint United Nations Programme on HIV/AIDS (UNAIDS). “Many African and Asian countries want to benefit from the knowledge and technical support that the Thais are offering.”

Rawiwan’s team of health workers in Chiang Rai is frequently singled out among these kinds of support due to their work in reducing HIV infection rates among children. “We have made the virus go down for 90 percent of children,” she pointed out.