Nan Aye is a 28 year-old woman that came to BCMF with a large goiter resulting from thyroid dysfunction. She lives in Nyi Naung Village in Karen State, Burma. Her family is originally from Mon State, however when she was a child a typhoon flooded her family’s land and they were forced to relocate to Karen State. She now runs a small business selling vegetables, and through this she earns between 50,000 and 60,000 kyat ($50 and $60 USD) per month. She also occasionally raises and sells pigs for additional income. Her husband works as a carpenter and a day laborer and earns 3,500 kyat ($3.50 USD) per day, however, his work is not consistent and he must sometimes travel to other villages for work. They have a 4-year-old son in kindergarten. Currently they do not earn enough to cover their expenses and must occasionally borrow money from their neighbor with 10% interest. Other times Nan Aye will borrow money from her siblings (with no interest) and pays them back when she has the money. She says that in order to pay for health care, she must always borrow money.

Nan Aye first noticed her condition in August 2007. When she looked in the mirror, she could see a small mass on the right side of her neck. She says that when she saw this she cried. The mass soon got bigger, becoming as large as a chicken egg. She says she often feels tired as she cannot sleep well and has difficulty breathing. She also suffers from joint pain, tightness in her chest, low blood pressure, and tension in the back of her neck. She has difficulty swallowing when eating as she feels as though something is blocking her throat. Two or three times she has experienced episodes where she has become dizzy, her vision has gone blue, and she has fallen down.

She came to Mae Tao Clinic from her village for the first time in 2007. Medics gave her a blood test and medicine to treat the pain and swelling in her neck for one week as well as medication to treat her low blood pressure. They told her that she needed to return for a follow-up appointment in one week, at which time they did another blood test. The medic checked to see if her eyes were swollen (a symptom of thyroid problems) and tested her joints for pain. Following this exam they told her that she would need an operation to treat her neck. However, after discussing her prognosis with her husband, he stated that he would not allow her to have surgery as he was away working at the time.

In October 2008, she went to visit her husband while he was working in Mae Pa and the village head saw the condition of her neck. He contacted a foreigner working with an NGO who explained to her that a health organization in the area might be able to facilitate the surgery needed, however nothing ever came about and Nan Aye returned to Burma without receiving treatment.

She continued to return to Mae Tao Clinic because of her thyroid symptoms. During this time she also received prenatal care and eventually gave birth to her son at the clinic. After giving birth, the medics told her they could not afford to fund the thyroid surgery that she needed, but that if she could pay for it herself (over 10,000 baht or $333 USD) it would be best if she underwent surgery in Chiang Mai. She was not able to afford the surgery, but said that since she was first told she would need surgery she began trying to save money without telling her husband.

Nan Aye frequently experiences swelling in her lymph nodes and abscesses in her throat that are usually accompanied by a fever. This is very painful and when it happens she is unable to eat anything but porridge. When describing her symptoms to BCMF, she gets a little choked up. She says that sometimes hard pieces of mucus will come out of the abscesses in her throat. Once when this happened she went to the clinic in Nyi Naung. The clinic doctor recommended traditional medicine; he told her that as there’s a chance he could give her the wrong thyroid medication, which would make her condition worse, that she should use traditional medicine. She tried this, but it did not help. She says that now she cries frequently because she cannot afford the surgery that she needs and her husband would not allow her to have it anyway. Her thyroid continues to get bigger and bigger.

Nan Aye returned to MTC again in June 2013 after her husband finally decided that he would now allow her to undergo surgery. He saw that her thyroid was getting bigger and knew that she was in constant pain all the time so this changed his mind. She had an ultrasound that revealed two spots of fluid in the front and side of her neck. After speaking with the medic about the surgery, she was referred to BCMF.

Nan Aye cried when we asked her how her condition affects her daily life. She says it is very difficult for her and she is often upset. When she sells vegetables at her business, the customers see the mass on her neck and they do not want to buy goods from her. Some people come and want to touch it because they’ve never seen it before. She says that she feels like an outsider and sometimes people do not want to eat with her. She often feels very sad and upset and sometimes she wants to just sit by herself. It is very stressful.

She hopes that in the future she will be able to support her family and live in her native village in Burma with her family all together again. She wants to send her son to school and continue to sell vegetables and raise pigs.

Nan Aye is currently undergoing treatment in Chiang Mai.