Sister Mary's car is all but held together with sticky tape and string, but she guides it over the bumpy roads of Mytkyina as lovingly and carefully as if it was one of her chronically ill patients in a wheelchair. She knows how important this old jalopy is. It's what enables her and Lucy, her local sidekick, to visit some of the people who would be totally cut off from help.
Mytkyina, situated in Kachin state in northern Myanmar, is on the frontline of HIV/AIDS in the country. This is where the disease first proliferated, moving from IV-drug use by those who came to work the jade and gold mines nearby, to sex workers who passed it onto men who brought it into their families, spreading it around the country. "Our clinic is like a GP practice back home," says an MSF doctor based in the region. "You see women, old men, children. AIDS is no longer an epidemic of high risk groups, but a general health problem."
Daily visits
Every day, Sister Mary, an Irish Catholic nun, and Lucy visit AIDS patients who are too sick, or too poor, or too ashamed to go to the clinic in town. To be seen in the clinic is to openly admit their HIV status. And that, in a country like Myanmar, is a grave step because it could mean social ostracism, even from family members.
Daw Suu Win was so ashamed that she refused to go to the local MSF clinic until a month ago, but there's a good chance it's already too late. She's wasted down to 35 kilos, and is too thin and too ill to move or eat. Her husband abandoned the family years ago, and her three children are not yet grown and clearly frightened of losing the one parent they have left.
Media ban
Myanmar, which has one of the worst HIV/AIDS problems in Asia, is also the country where prevention and treatment programs are at their lowest. Although the military-ruled government promised to make AIDS a priority, education campaigns about HIV/AIDS infection and treatment are still banned from the state controlled media. And people are still afraid to get themselves tested or visit treatment clinics because of the shame of being seen by their community. Sister Mary estimates that in Mytkyina alone at least 75 percent of the people who will die of AIDS will never even have been tested for it.
Sister Mary with a dying patient
By official estimates, there are 80,000 people in Myanmar who are in acute need of antiretroviral drugs - unofficial estimates put the number far higher. Yet, less than 15 percent of the people in severe need of the drugs that can save their lives actually receive them. This makes Myanmar one of the worst places in the world to be for people with AIDS. In most other parts of the world, 30-90 percent of people with AIDS have access to antiretroviral drugs, but in Myanmar, the government has turned a blind eye to the problem, and there are simply not enough international agencies in the country with the resources to tackle it properly.'
One agency shoulders most of burden
The agency shouldering the bulk of the burden is Medicins Sans Frontières (MSF), which provides drugs for about 11,000 patients. But aid agencies are reluctant to take on the yoke of providing antiretroviral drugs.
"They don't start, because they're afraid to stop,"
says Dr Frank Smithuis, MSF's Head of Mission. The problem is once a patient is on the drugs, they have to keep taking them for the rest of their lives or they'll die. It's a responsibility that scares organizations who are not sure how long their donor money or their mandate in a country will last. But Dr Smithuis believes this to be a false premise.
"You shouldn't be afraid to start - even treating people for 5-10 years is very helpful. You see mothers with young kids. What will happen to those kids if she doesn't get the drugs? Help her for a few years, and you don't know what will happen in the future."
He points to the example of Thailand where MSF started working with AIDS years ago. At first the government hardly intervened in the crisis. However, less than a decade later, the Thai government had taken over most of the country's AIDS treatment programmes, and now more than 90 percent of the people who need antiretroviral drugs receive them free from the government.
"All those people that we started helping then are still alive now, and now their own government helps them."
A hut in Kachin state where people living with AIDS remain largely cut off from treatment centres, or outside help
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