Fighting Hepatitis in Cambodia: Reminders

27 June 2017

Being cured of a disease like Hepatitis C isn't just a case of finding the right treatment. Patients must also stick to a long drug regimen, taking medication multiple times a day, at specific times. In this week's post, Theresa blogs from MSF's Hepatitis C clinic in Phnom Penh, about the dedication of patients determined to get well...
 
The other week I wrote about a man who was cured of hepatitis C by direct-acting anti-viral drugs (DAAs). MSF has seen a 97.6% cure rate among patients who have finished treatment so far, which aligns well with results reported in medical research on the subject.
 
One important factor in achieving a successful cure is ensuring patients take their DAAs regularly. When a patient embarks upon a course of DAAs at our clinic, our nurse counselors provide detailed education on when to take the medicines and what to do in case of missed doses.
 
What I find remarkable are the strategies the patients themselves have devised to remember to take their DAAs. One woman sets not one but three alarms for each day’s dose. The first alarm reminds her to take the pill out of the bottle, the second reminds her to pour a glass of water, and the third reminds her to swallow the pill with plenty of fluid:
 

A patient holds a pill at the MSF Hepatitis clinic in Phnom Penh, Cambodia
Waiting for alarm #3. Photo: Theresa Chan / MSF.

Another man created his own medicine-reminder spreadsheet--in Khmer:

The record sheet shows a grid with Khmer writing, neatly marked up

Why aren't my taxes as organized as this man's medication reminder sheet? Photo: Theresa Chan / MSF.

In fact, our patients are so disciplined about taking their DAAs that I almost never hear them report a missed dose. (Believe me, I ask at every clinic visit.) Sometimes I get the shocking confession that someone has taken one or two doses ten minutes later than the scheduled time!
 
Overall, the compliance rate among our patients is greater than 99%, which goes a long way towards explaining our current record of treatment success. No medicine is effective unless it is taken regularly.
 
 
 
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