Transcript Jan Swasthya Sahyog Leprosy Project

Jan Swasthya Sahyog
Leprosy Project
JSS Health Centre
Ganiyari, Bilaspur District
Chhattisgarh
Background on JSS
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Jan Swasthya Sahyog (JSS) is a long term partner of AID and has been
working on healthcare in the Bilaspur District, Chattisgarh
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Founded by AIIMS doctors
JSS caters to patients at 3 levels-Main Hospital at Ganiyari, via 3 mobile
clinics/subcenters and through the village health workers in 53 villages.
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Accessed by people from about 1500 villages in Bilaspur and the neighbouring districts of
Chhattisgarh, as well as some adjoining districts of Madhya Pradesh state
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They are also working on sharing their findings from rural India including
highlighting issues of access, chronic hunger levels, cost of drugs and the link
between poverty and disease.
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Dr Jonathan Fine recently visited their site and gave us an update at GBM
2010 (visiting again in Q3)
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Multiple AID chapters have supported several projects from JSS over the years
AID Portland had also funded JSS from 2006-2008.
http://www.youtube.com/watch?v=4yY_JSO-Dqg ( if time permits)
JSS: Focus Area
• Bilaspur district, state of Chattisgarh
(statehood in Nov’00)
• Area details:
– Mainly rural population
– Forest cover and mainly dominated by
Adivasis
– Literacy: 52%
– Health conditions:
• IMR (Infant Mortality Rate) = 99/1000
(1993) with rural being 110. Under 5 IMR
is 20/100
• 57% of children under 5 are
malnourished
• Malnutrition is twice as common as the
urban areas
• Other health problems: Leprosy,
falciparum malaria, water-borne
diseases, TB
– Average family size = 5.6
JSS Activities
• Community health care center in Ganiyari – outpatient,
clinical & research lab, low-cost pharmacy, imaging facilities,
OTs, training facilities for workers
– Coverage >1500 villages in surrounding areas
• Village health program covers 53 tribal villages
• Development, adaptation and validation of low-cost healthrelated technology
• Field-based research into public health problems
• Providing technical support to voluntary organisations in the
field of public health
Leprosy – Prevalence in India
Leprosy is endemic in the state of Chhattisgarh.
The current official prevalence level is about 2 per 10,000 population.
Leprosy was eliminated as a public health problem by WHO in 2000
( less than 1 case per 10,000 persons)
LEPROSY- KEY FACTS
CAUSE
Leprosy is a chronic disease caused by a bacillus, Mycobacterium leprae
(Mycobacterium leprae). M. leprae multiplies very slowly and the
incubation period of the disease is about 5 years.
TRANSMISSION
Leprosy is transmitted by air through droplets from the nose and mouth,
during close and frequent contacts with untreated cases. Leprosy is one
of the least infectious diseases, because:
• Over 99% of the population has adequate natural immunity;
• Over 85% of the clinical cases are non-infectious, and
• An infectious case is rendered non-infectious within one week, most
often after the very first dose of treatment.
SYMPTOMS
Leprosy mainly affects the skin and peripheral nerves.
If left untreated, it can lead to progressive and permanent damage of
nerves, leading to loss of sensation and sweating in the extremities and
paralysis of muscles in the hands, feet and face.
The disease is classified as paucibacillary (PB) or multibacillary (MB),
depending on the bacillary load.
Leprosy – Govt Attitude & Treatment
• Cases of leprosy report initially to both the Government public health
system and also to the private practitioners in the area.
• Public health system often unwilling to recognize and register new cases of
leprosy reported by field workers
– Artificial attempt to keep the prevalence of the disease at a low level.
– Early cases of leprosy with only one or two skin lesions are simply ignored. Oral
instructions to this effect are given to all Government doctors.
– The few cases that are registered are not followed up adequately for compliance, side
effects of drugs, lepra reactions and other complications.
• The private health care system charges are high for the examination,
diagnosis and treatment of leprosy patients.
– The leprosy patients are also often wrongly diagnosed as suffering from other skin
diseases. Their complications are often not recognized and treated in time.
Leprosy Care at JSS
Although the JSS Health Centre at Ganiyari is not a leprosy hospital or treatment centre,
it has attracted and continues to attract a large number of leprosy patients, most of them
completely new cases. Some of the other kinds of leprosy patients are:
• Referred (but new) cases from other doctors in Bilaspur and beyond.
• Cases who have taken treatment partially from other private doctors,
with or without complications.
• Cases who have taken partial or complete treatment from the
Government public health system, with or without complications and /
or side effects.
Number of new cases of leprosy seen at JSS for the last few years:
2007.........121 cases
2008.........149 cases
2009.........180 cases
Leprosy Care at JSS – Cont’d
• A leprosy patient typically requires treatment
for the disease for about one year.
• Some patients require additional treatment
for complications like lepra reactions, ulcers,
other co-existing diseases etc.
• Some patients do not get completely cured
with one year's treatment and require a
longer course of drugs.
• Some patients also require corrective surgery,
protective footwear for deformed feet and so
on.
Proposed Budget
AID Bay Area approved– Rs 3,00,000 for JSS Leprosy Project
[AID-BA already funded $14K this year to JSS projects]
AID Pittsburgh approved– Rs 1,80,000
Proposal – Vote on funding Rs 4,60,000 for 1 year
Can we take a vote ?
Backup
JSS Leprosy Proposal – Q&A
• What is the long-term plan regarding the Leprosy project
We plan to continue treating leprosy patients with the following
objectives:
• Demonstrate that leprosy is still very much a problem that
needs the attention of the Government
• Provide good quality treatment to rapidly cure patients and
prevent complications and deformities.
• Demonstrate that general health services can handle leprosy
care successfully with few inputs.
• Leprosy will continue to be a problem for the foreseeable
future, till socio-economic conditions improve.
JSS Leprosy Proposal – Q&A
• What is the approximate population of the 50 villages that JSS caters to?
• JSS caters to patients at 3 levels-Main Hospital at Ganiyari, via 3 mobile
clinics/subcenters and through the village health workers in 53 villages.
• The health centre at Ganiyari is accessed by people from about 1500
villages in Bilaspur and the neighbouring districts of Chhattisgarh, as well
as some adjoining districts of Madhya Pradesh state.
• The population served by the health centre at Ganiyari is over 300,000
with 35% Dalits, 14% Tribals and 44% backward castes. The population
served by the subcentres is around 75000 and by the village health
workers (of 50 villages) around 26000, and over 72% are adivasis, 7%
dalits, and 19% backward castes.
SUPPORT FOR JSS
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Ministry of Health and Family Welfare, GOI
Dept. of Science and Technology, GOI
Sir Dorabji Tata Trust, Mumbai
Sir Ratan Tata Trust, Mumbai
AID-India and USA
NOVIB(Netherlands)
AIMMS, New Delhi
Hospital fÜr Indien, Emsdetten, Germany
Letzdream Foundation, Mumbai
Friends and Relatives
Referral Center/OPD
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Located in Ganiyari – 20 km to the north of Bilaspur
Leased by Govt. of Madhya Pradesh in Nov 2000
Servers about 150-250 patients on a clinic day
Health center has access to approx 500 villages
The old godown in the Water
Resources Department Colony
The same building converted
to the ward and operation
theatre
OPD (contd.)
• Public health problems like
tuberculosis, falciparum malaria,
leprosy, and childhood infections
• 650 patients of tuberculosis have
been identified
• Leprosy and malaria most common
• Equipments/lab: X-ray and
ultrasound machine, diagnostic
laboratory, an electrocardiograph,
two observation beds, oxygen
cylinders, a dressing room for minor
diagnostic procedures and a
nebuliser for rapid relief of patients
with asthma.
A child being positioned for
an X ray examination
OPD (contd.)
• Dispensary
– 100 essential drugs at
affordable cost
– Drugs mainly purchased from
LOCOST – known for 25 yrs to
produce low cost drugs at 200300% cheaper than open
market
– Drugs are dispensed in pouches
with pictorial prescription slips
The Dispensary
Counter
OPD (contd.)
• Inpatient Department
– 10 bedded wards and 2 OTs
– High quality surgical services have
been provided to more than 750
needy patients at 25-30% of market
rates
Inside the ward
The Operation Theatre: an elective and an
emergency operation in progress at the
same time
Outreach Clinic
• Outreach clinics at Shivtarai, a forestfringe village about 50 km to the
northwest of Bilaspur town, since
March 2000.
• One doctor visits the clinic every
Saturday along with laboratory
technician, pharmacy assistant, village
health coordinator and registration
clerk and attends to 30-50 patients,
depending on the season
• Serves up to villages in 15-20 km
radius
• Two clinics already open in Semariya
and Chappawara
Examining a patient at Semariya
Research
• Goal: To develop medical
technology, which is low-cost,
simple and accessible to the
peripheral health worker
• Developed a simple and
inexpensive reproductive health
test battery for diagnosing
– Anemia, urinary tract infections,
vaginal discharge etiology, diabetes,
pregnancy
• Produced a low-cost kit for the
detection of fecal contamination of
drinking water
• Other achievements:
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weighing scales for babies
stadiometers
electrophoresis equipment
breath counters
The kit for diagnosing
urinary tract infection
Treatment / Cure
MDT : Multi Drug Therapy- provided by WHO and Novartis for free to all patients in the world
(agreement uptill 2010)
Current recommendations :
Pauci-bacillary leprosy(1-5 skin lesions):
Treat with rifampicin and dapsone for 6 months
Multi-bacillary leprosy (>5 skin lesions):
Treat with rifampicin, clofazimine and dapsone for 12 months