A feature article from WHO: Continuing care for tuberculosis, diabetes and heart patients in earthquake hit Nepal. Excerpt:
Less than 24 hours after the earthquake shook Nepal, outpatient assistant Ganga KC assumed her regular post at Alka hospital’s tuberculosis (TB) treatment centre, south of Kathmandu.
At 8 a.m. sharp on 26 April, Ganga opened the doors to the Lalitpur-based facility ready to receive patients. It was a new day, and despite Saturday’s disaster, she knew a lapse in TB care for her patients could result in their medicines becoming less effective.
According to Ganga, the number of patients coming to the facility has not fallen since the earthquake hit, reflecting the Ministry of Health and Population’s (MoHP) long-term emphasis on the provision of continuous, supervised care.
“When the patients come, we tell them that if even one day is dropped, it won’t work, so you need to come every day – we counsel them that way,” she said, adding, “The patients think, ‘oh yes, we have to come here otherwise the medication we have taken till now will not work,’ so they come.”
Reaching TB patients
The treatment centre ensures direct observation of therapy for those requiring TB medication, in line with the WHO’s globally-disseminated Stop TB Strategy. This approach allows patients to receive free daily medicine and ensures that they are given adequate care and support to complete their treatment course.
Alka’s treatment centre sustained only minor damage as a result of the earthquake, but many others were damaged beyond repair, with patients being forced to travel further to receive care. The biggest challenge for the control of TB post-disaster is not generally a lack of drugs, but that of reaching patients who have not come to the health centre or don’t know where to go for treatment when their usual centre is no longer functioning.
TB patients whose treatment has been disrupted risk developing drug resistant strains of the disease, a growing public health threat, which is a further burden on Nepal’s health care system. According to Dr Bikash Lamichhane, Director of Nepal’s National Tuberculosis Centre, a contact tracing mechanism developed in collaboration with the WHO will be critical to reaching TB patients that have not arrived for treatment.