Fiona Fisher, a medical doctor working for MSF in Manipur, India tells Vanlalsiam's story.

© Fiona Fraser/MSF
Vanlalsiam in November 2009, pictured here with his grandmother.

Vanlalsiam is 11 yrs old. His parents and 2 siblings have all died, probably due to HIV/AIDS, and so he is cared for by his grandmother. He has been attending MSF's Singngat clinic here in Manipur since 2008, having started antiretroviral and anti-tuberculosis treatment with the Ministry of Health but not getting any better. MSF changed his treatment slightly, but he still didn't improve. He deteriorated and was admitted to Shalom, a Community Care Center in Churachandpur supported by MSF who provides drugs and materials and staff - one of our national staff doctors and our expat HIV/TB doctor do a ward-round with the doctor in Shalom 3 times a week. The first photo was taken in November 2009 in Shalom. He was very unwell, with chronic diarrhoea, poor appetite and severe pulmonary tuberculosis (he had an appalling chest x-ray). I honestly thought he wouldn’t survive. It was hard for MSF to decide whether it was multi-drug resistant TB or resistant HIV. He was so weak that it was difficult to get a sputum sample to test for mutli-drug-resistant TB, but when his HIV viral load came back as extremely high we hedged our bets and went with HIV resistance. This meant changing his regime to an unusual 2nd line regime (that needed extra tablets to overcome the interaction with other medication he was on for tuberculosis).

© Fiona Fraser / MSF
Vanlalsiam, five months later in April 2010.

The second photo was taken at a follow-up appointment at MSF's town clinic in Churachandpur in April 2010, and I could barely believe it was the same child. His grandmother is so grateful, and clearly spoils him rotten (he was eating a big bag of potato chips!). She now walks him several kilometres to school each day and waits there until after class to walk him home again. When I last saw him, he was happily playing with his classmates like an average healthy 11 year old boy. In the north-eastern state of Manipur, MSF runs four clinics providing basic healthcare, HIV and TB treatment and counselling as well as maternity services. In 2009, MSF provided over 31,000 basic health care consultations. Pregnant women living with HIV were provided with anti-retroviral therapy for their own health and to prevent transmission of HIV from mother to child. MSF is treating over 400 HIV patients with anti-retroviral drugs.

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