In July I had lots of opportunities to meet Government officials and NGO personnel at various meetings and field visits – went on a 2-week field trip in Bihar and West Bengal, about 1800km away from my Delhi apartment!
Regional Review Meeting of Kala-azar (KA) Elimination for Programme Officers, 11-12 July 2013
This regional meeting was for Govt. Programme Officers, Matt (my counterpart) and I had such a great opportunity to sit in on this meeting, held in Patna. I’ve learnt so much and had a much better understand of the regional perspectives (Bihar, Jharkhand, West Bengal & Upper Pradesh) in their fight against Kala Azar and the progress so far. Presentations were mostly in English, but at times there were heated discussions in Hindi or Bengali and I could just about work out what it was about through the occasional English words; and later translations from the CARE team (my NGO). CARE was piloting an on-line HMIS (Health Medical Information System) and plan to roll it out to all the regions. Collection of case information is so critical for tracking patients to ensure the Govt. and the development community can identify KA hotspots and measure progress against the elimination goal. I chatted with an MSF (Médecins Sans Frontières) program co-coordinator about my project at CARE and asked about the work they do, of particular interest is the combination drug trials they are conducting for KA patients in collaboration with DNDi (Drugs for Neglected Diseases initiative).
Field Trip to Gopalganj, 15-16 July 2013
Also organized a field trip to an endemic district in Bihar which had higher KA cases compared to the first field visit in Patna. Went to Gopalganj, northwest of Patna, about 4.5 hours by car on some stretches of rough roads and sometimes heavy traffic through villages with bikes, motorcycles, tuk tuks, animals, trucks, and buses competing for the road. Once we arrived, we met up with the local CARE Link Worker who escorted us around the villages in his territory within Gopalganj. Visited the Manjha Block PHC (Public Healthcare Centre), a facility which serves 104 villages with a population of about 200,000.
The PHC deals with maternal and child healthcare, they have two Auxiliary Nurse Midwives (ANMs), three doctors, a Block Health Manager and a Medical Office-in-charge whom we spoke with. We wanted to find out the number of KA patients, how they were diagnosed and treated; and what efforts have been used to reduce the incidence of KA in the district. Unfortunately Indoor Residual Spray (IRS, the most effective way to reduce sand fly population which helps to reduce the incidence of KA) has not yet happened in 2013 in this block, as the spray workers were on strike, wanting to become permanent government employees instead of contractors.
Meeting with the ASHAs (Accredited Social Health Activists)
Next we went to meet a group of ASHA workers who were getting together for a training discussion at a nearby high school. ASHAs are the front-line healthcare workers in rural India. One ASHA worker looks after around 1000 villagers, so there are about 200 ASHAs in Manjha Block. While the ASHAs’ primary function is to attend to the needs of mothers and young children in the villages, they receive training to help manage most public health issues, including infectious diseases like TB, malaria, and Kala Azar. For KA, they are trained to identify the early signs of the onset of the disease (2 weeks+ fever that doesn’t respond to medicine, tender abdomen with enlarged spleen) and get the patients quickly to the PHC for treatment. As well as finding KA patients, the ASHAs also spend time in dispelling some of the myths about the disease, and teaching villagers about how it is transmitted. They told us that it was inevitable that villagers would visit Rural Practitioners or Private Doctors and pay to get treated, as many had the attitude that “anything free can’t be good”. But the ASHAs were working to try to get people trust the government facilities.
RMRI – Rajendra Memorial Research Institute in Patna, 17 July 2013
After the field visits, my NGO Manager arranged for us to visit the RMRI in Patna. It is a well-known facility that specializes in Neglected Tropical Diseases, especially Kala Azar. RMRI is and has been conducting many of the research studies into different medicines to treat KA, different diagnostic tools and methods, the effectiveness of IRS, life cycles of sand flies and effective means to control KA transmission, and all the other aspects of KA management in India. They are also devoting a significant amount of effort to researching PKDL (post-kala-azar dermal leishmaniasis).
We met with the director as well as some of his key staff. They gave us a tour of the facility which includes a KA ward, where patients who are part of their clinical trials are treated, and a sand fly research wing where they breed the insects for study and we got to see some sand flies in an enclosed box. They also conduct training programmes for doctors and government field workers like ASHAs. We spent some time in the ward at RMRI speaking to a few patients to find out how and why they were there.
World Bank Pre-implementation visits, 23 July 2013
After a week of field trips in Bihar, we travelled to the neighbouring state of West Bengal, to a district called Malda (north of Kolkata) which is another endemic area for KA. Had the opportunity to travel with my NGO Manager and representatives from the World Bank, officials from the Gov’t of India and the Gov’t of West Bengal for the World Bank Pre-implementation Mission visits. The aim was to review the elimination efforts & progress made in this region. We visited several healthcare facilities, including PHCs, Health Sub-centres, a Medical College Hospital and spoke to some KA patients from a tola.
We concluded our action-packed trip after 2 weeks; the trip has enabled me to appreciate the regional perspectives, the social and economical factors affecting patients’ health-seeking behaviours, the KA elimination efforts & progress so far. These will certainly help me to design a study to better understand the private providers’ role in the management of the disease.