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Kala-azar: Poverty stricken population in the Terai belt face the killer disease
JANAKPUR, NOV 28 - The environment inside the Kala-azar units in Janakpur Zonal Hospital is solemn. In a room lit with dim light lie 12 patients, with their lives hanging by thread.
All these patients are on second line medicine. To begin with, a patient of Kala-azar is treated with first line drugs for 30 days. If that fails to work, or if the disease develops resistance, the patient must be admitted to hospital for the second line medication. At this stage, the patients need a rigorous treatment.
Unfortunately, the hospital is facing a severe financial and human resource constraint to attend its patients well.
Dr Hukum Dev Shah, Medical Superintendent at Janakpur Zonal Hospital, said that the hospital’s service is severely affected by limited resources. "There is no nursing care for the patients, only the doctors go on rounds for check up," he said.
There are only two staffs working on a 12-hour shift to take care of the sick. And they, too, are employed by the Environmental Health Project (EHP), which will phase out soon. No one knows what happens after that.
Despite its financial gloom, the hospital provides medicines, living and eating expenses and free treatment to the Kala-azar patients. The patients, however, have to buy saline water themselves.
The tragedy is that for most of these patients, even buying saline water, which costs around Rs 25 per bottle, is beyond their means.
In fact, Kala-azar is one among a multitude of problems facing these poor. For instance, 24 years old Purni Devi is the only income earner in her family. She has left her two small children and come with her grandmother to the hospital for treatment.
"My husband left for Arab nine months ago but I haven’t heard from him till now," she said. Thin and frail Purni lives in her house, along with her children, which lacks basic amenities of life.
Besides Kala-azar, she also suffers from anaemia. She is already very weak and worries on how she will return to sustain her family.
"I have taken loans for my treatment. But, I do not know how I will feed my family now," she said.
The poverty stricken population in the Terai region is the most vulnerable to the disease. Kala-azar is a disease contacted through the bite of the sand fly, which breeds in small dark places. Once bitten, a patient is subjected to high fever. According to doctors, the maximum number of Kala-azar cases fall between the productive age of 15 years old to 34 years old.
Secondary infection from the disease includes anaemic problems, chest infection and liver damage.
At the peak season, during the summertime, the 22-bedded unit in the hospital is filled with patients. Last year alone, 383 cases of Kala-azar were recorded in the Hospital. Dhanusha district is known as the ‘capital’ of Kala-azar in Nepal and the hospital has a heavy flow of patients.
On the other hand, the hospital is also flooded with patients coming from neighbouring India. Since, the border area is just nearby, several people come to the hospital for the free treatment.
Incidentally, Dhanusha borders Bihar State of India, which is dubbed epicentre for Kala-azar in the world. This has further added to the burden of the Hospital.
"Since, the cultures and social structures is similar in India we cannot tell if a person is from the other side of the border," said Dr Shah. But, it is also inhumane to say no to the patients just on the ground of his/her nationality," he added.Posted on: 2003-11-27 10:29
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