The Road to Ending Tuberculosis – World Tuberculosis Day 2023: voices from Thailand

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Lee Leh, 77, left his hometown two decades ago.

After fleeing persecution in Myanmar in 2003, he rebuilt his life in Mae La – a temporary shelter in north-western Thailand which hosts over 34,000 refugees, predominantly from the bordering Kayin State.

Despite emerging from the COVID-19 pandemic relatively unscathed, Lee Leh knows first-hand that life as an elderly individual has its risks, especially in often challenging environmental and living conditions.

So, when he started to feel unwell, he was extremely concerned. “I was coughing a lot and had stomach pain. I could not walk properly,” he recalls.

Fortunately, Lee Leh’s daughter had heard of tuberculosis (TB) and that coughing is a common symptom, having been tested herself, a few years ago. 

Though it is a preventable and curable disease, TB remains the deadliest infectious disease in the world, with over 10 million people infected and 1.5 million people dying from it each year.

Although TB incidence is gradually declining in Thailand, it continues to be an important public health concern. In 2021, Thailand remained on the World Health Organization’s list of 30 high-burden countries for TB. As of 2021, TB incidence in the country was 143 cases per 100,000 people, down from 150 in 2020.

Delays in or lack of access to treatment can lead to transmission in communities – a challenge magnified among mobile and migrant populations who are already commonly at a disadvantage when it comes to health-care access.

Through the Global Fund’s Tuberculosis Elimination Among Migrants (TEAM2) programme, the International Organization for Migration (IOM) carries out TB screenings and health education in Cambodia, Thailand and Viet Nam. The Mae La temporary shelter is the primary target location in Thailand.

With encouragement from his daughter, Lee Leh underwent a screening and, as initially suspected, the results were positive for TB. Without hesitation, he opted for treatment and was isolated in a hospital for two weeks.

“I was very happy when I recovered. It’s better to be cured than to live without knowing what disease you have,” Lee Leh says.

Notwithstanding Lee Leh’s success story, stigma around the disease is still very high in Mae La. “It’s sometimes difficult to encourage residents to get screened; and for those who test positive, to ultimately receive treatment,” says IOM’s Apaporn Tana, who has been working in Mae La since August 2022.

“My neighbours are afraid to do the chest X-ray. They don’t want to test positive,” says Kyaw Moo, who had never heard about TB until last year but decided to get screened once he understood the stakes.

Though he tested negative, he maintains the importance of knowing if one is healthy or not. “If you know what diseases you have in your body, you can treat them early. I want to reassure others it is safe to get screened.”

A huge challenge faced for those who need treatment is the hesitation to isolate for an extended period, Apaporn adds. “For many, their main priority are their basic needs. They need to earn income or take care of their families. When some test positive for TB despite not having any symptoms, they are even more hesitant.”

In response, IOM is working with partners to ensure that the families of those who undergo isolation receive the support they need.

Language barriers and cultural differences add another layer of difficulty to the programme. “We do not speak their language, so why would they trust us?” explains Pimpika Janthawong, an IOM nurse.

To effectively educate residents and mobilize them to get screened, IOM works with an extensive network of volunteers and community leaders.

David is one of seven Migrant Health Volunteers supporting the programme. Having learned English seven years ago, he provides critical interpretation support in Karen, the most commonly spoken language in Mae La. “Since you can’t see TB visually, people sometimes ignore what we are trying to tell them. We need to continue working with shelter authorities to raise awareness,” he explains.

Kyi Lwe, an elected leader in a section of some 2,200 residents, is one such champion of the programme. “I try to remind people that TB can be fatal. Like COVID-19, it can be a risk to the community if left untreated. More importantly, to have the chance to receive treatment for free is a privilege.”

Between September 2022 and February 2023, IOM through the TEAM2 programme screened 4,786 individuals, identified 31 positive cases and supported an additional 8 who were referred. This incidence rate is over four times higher than the national average.

Despite the challenges in successfully engaging residents, the team of IOM staff, volunteers and community leaders persists with its work.

Since the programme commenced, the team has diligently reflected on the areas they need to improve on – for example, strengthening coordination with shelter authorities or mixing up the formats of health education activities.

Reflecting on the goals of the programme this year, Pimpika reminds herself of the bigger picture.

“As a nurse, I am in a position where I can help others. Little by little, my work is contributing to the ultimate goal – ending TB.”

IOM's Work on TB

The fight against TB is one of IOM's key areas of intervention on Migration Health. The Organization offered from its very inception in 1951 to this day TB prevention, diagnosis and treatment services among migrant and other mobile populations.

Across the world, annually, IOM carries out over 1 million TB radiological investigations for migrants, displaced persons and other key vulnerable groups.

This piece was originally published by IOM Migration Health.