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MSF in Cambodia, 2011
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Overcrowding, lack of ventilation and generally poor living conditions all contribute to the high risk of contracting tuberculosis (TB) in Cambodian prisons.
Cambodia is on the World Health Organization’s list of 22 countries with a high burden of TB. TB is spread through the air by an infected person coughing. It is an opportunistic infection that takes advantage of weakened immune systems, which are all too common among people living in poverty in Cambodia. Malnutrition, poor hygiene and living conditions and HIV infection are all key contributing factors to the spread of the disease.
Healthcare in the capital’s prisons
Doctors Without Borders/Médecins Sans Frontières (MSF) has been working in three prisons in Phnom Penh, where 25 percent of all Cambodia’s prisoners are held, since February 2010. Teams provide care and treatment for HIV and TB, and have introduced measures to improve infection control, such as a quarantine area in one of the prisons.
Staff carried out a comprehensive HIV and TB screening program for all prison inmates. Mobile teams then conducted daily visits, carrying out an average of 100 consultations per month. At the end of the year, 94 HIV patients were on antiretroviral treatment. More than 3,600 people had been screened for TB and 32 were receiving treatment for the disease, bringing the number treated since 2010 to approximately 200.
Being able to keep up with treatment is crucial if patients are to avoid developing drug resistance. So, when they are transferred or released, MSF staff provide follow-up. They help make sure patients have access to the drugs they need, as well as to medical services.
Inside the prisons, the teams are extending their activities to provide basic healthcare, including the treatment of skin diseases and sexually transmitted infections. Staff also engage in health promotion activities, such as improvements to sanitation.
Kampong Cham TB program
In Kampong Cham hospital, MSF offers treatment for TB and drug-resistant TB (DR-TB). In the pediatric ward, staff work with the hospital’s doctors to identify children who may have TB.
Follow-up is key to the strategy. If patients are unable to come to the hospital, staff make home visits. A telephone hotline has been set up for patients to call in case of emergencies. Over the year, MSF conducted over 6,000 consultations at the hospital and registered more than 600 new TB patients.
The team is working to get more people tested for TB earlier. Counselors have begun asking new patients whom they have been in contact with, so that people at risk can be invited to take a free TB test. Testing and detection have improved with the introduction of a new testing machine that reduces the time it takes for diagnosis.
Twice a month, an MSF doctor and counselor participate in a radio program about TB. Awareness-raising events are regularly held at pagodas, universities, high schools and mosques. The aim of such outreach activities is to increase understanding of the disease and reduce stigma. MSF also advocates at a national level for improvements to Cambodia’s national TB response.
At the end of 2011, MSF had 136 staff in Cambodia. MSF has been working in the country since 1979.