The Referral Programme is the longest running programme at Mae Tao Clinic. Before we had the supplies and capacity to treat many of the patients that we saw, they were referred to Mae Sot Hospital. Currently, approximately 1-3% of patients that present at Mae Tao Clinic are referred.
The Referral Programme is the longest running programme at MTC. Before the clinic had the supplies and capacity to treat many of the patients that we saw, they were referred to Mae Sot Hospital (MSH). In 1988, student camps were established along the border, mainly by students who had come from central Burma, and were not from Karen State or border areas. In the beginning, the cases that couldn’t be treated in the student camps were referred to MSH through coordination at MTC. At this time, MTC was more like a patient house, sending 20-25 cases per month to Mae Sot Hospital. Today, the clinic is able to treat malaria cases, and deal with more severe injuries, but there are still patients that require services beyond the clinic’s capacity.
The Current Programme
Approximately 1–3% of patients that come to MTC for treatment are referred to Mae Sot Hospital, as we are unable to treat them for a variety of reasons. Patients referred by the clinic are case-managed by a team of medics. Due to the high cost of referrals, we recently carried out a review of the referral process, and a new referral policy is now in place. We also held advanced training for some senior medics which has reduced the need to refer many patients, which, in turn, saves MTC money in the long-term.
The majority of the patients that enter the Referral Programme have crossed the border from Burma for medical services. Some of the most common cases seen for referral are congenital heart disease and severe fractures in children, and myoma, uterine prolapse and ovarian cysts in adult cases.
Not all cases that go beyond the services of the clinic will actually enter the Referral Programme. MTC allocates a monthly budget that is used to pay for treatment at larger service providers such as Mae Sot Hospital. Emergency and the most severe cases are referred first, but non-emergency cases are not often referred. Most referred cases are surgical cases, as medical cases can be treated at the clinic, with exceptions being chronic diabetes cases, and HIV positive pregnant women.
The referral team consists of 10 staff members. The role of the staff is to be in regular contact with the clinic departments, coordinating the travel of referral patients to Mae Sot Hospital and then acting as translator and social support for patients during their visit to the hospital. For this reason, it is necessary that these staff members speak several languages each, including any combination of Burmese, Po Karen, Ska Karen, Thai, and English, and they must possess a Thai identification card allowing them to travel freely in Mae Sot without threat of arrest. Each morning, the referral patients are gathered at 8:00 a.m. for transfer. Each patient is assigned to a member of the referral staff. Along with the patients, blood samples are taken to the hospital for testing of renal function, liver function, thyroid function, and all blood donor samples are sent for screening and some biopsy for testing. MTC also supplies 40 baht per patient per day for food while at the Mae Sot Hospital. The referral team provides all transportation, as it offers security that helps patients avoid being arrested.
Unfortunately, the Referral Programme faces difficulties with staffing. Not many medically trained staff are interested in working with the referral team, as they do not actually practice medicine, but rather facilitate the opportunity for patients to receive medical care elsewhere. Moreover, even if a medic were interested, the likelihood that they also speak Burmese, Karen and Thai, and possess a Thai identification card is low. Individuals who have strong language skills and possess a Thai identification card are understood to be very valuable assets to any organisation, making them highly employable. Many of these skilled individuals are already employed by INGOs, and receive a salary much larger than most CBOs can offer, thereby depriving CBOs of a much needed resource.
Landmine and Gunshot Referrals
MTC does not handle all patient referrals alone. Since 2004, the International Committee of the Red Cross (ICRC) has been supporting all landmine and gunshot wound cases for the first visit to MSH. For follow-up visits, which most of these complicated cases require, the clinic covers the cost.
Since 2003, the Burma Children Medical Fund (BCMF) has supported complex cases for children under twenty, where the patient is considered likely to respond well to treatment. In all of these instances, the majority are surgical cases, with exceptions being heart conditions that will respond to medication instead of surgery.
Read more about BCMF here (link to BCMF page).
Médecins Sans Frontières and World Vision
For many years, MTC referred TB patients to a Médecins Sans Frontières (MSF) programme in Mae Sot for comprehensive treatment. However, with MSF discontinuing this programme, MTC is not able to refer most TB patients for treatment. Beginning in 2008, World Vision has established a less comprehensive TB treatment programme in Mae Sot, but unfortunately, it does not include cross-border patients.