Tag Archives: Shobha Shukla

Health

After months of diagnostic delay, a migrant worker could access TB services only when a community health worker met him

MaraviPost

SHOBHA SHUKLA, BOBBY RAMAKANT – CNS

nor his treating doctor(s) thought of TB. And this did not happen in an area with low TB rates but in India’s national capital Delhi – a state with highest TB rates nationwide – and a country which is home to the largest TB burden in the world.

It was only when a frontline community health worker met him, that she thought of TB and he could access TB services, increase his health and treatment literacy, and successfully complete his treatment. One of his daughters too who was found positive for TB (of the lungs and abdomen) in the contact tracing done by the community health worker, is as of now currently on treatment. Both could access a range of social support to help them adhere to the therapy, thanks to the community health worker.

Manjit, who is a native of Bihar state of India, had migrated to Delhi many years back with his parents. He works in a pipe market and lives in New Seemapuri urban slum, East Delhi, in a rented accommodation with his wife and three daughters. The area he lives in, is home to many homeless people and rag pickers and is also a site for garbage processing. This area is about 2-3 kilometers away from Delhi’s famous Guru Teg Bahadur (GTB) Hospital – the only tertiary care government hospital in East Delhi.

Eliminate diagnostic delays

If we are to stop the spread of TB infection it is imperative to diagnose early and accurately, and put each person diagnosed on treatment with medicines that are effective on that person. It is equally vital to ensure that the person is fully supported – in every possible way – to complete the therapy successfully. As per a study done by Dr Susmita Chatterjee et al, average diagnostic delays in those at heightened risk of TB is 12 weeks. We must eliminate these diagnostic delays if we are to end TB.

In July 2023 Manjit started suffering from bouts of cough and fever. He went from one doctor to another, seeking medical help and advice, but neither could his illness get diagnosed nor did he get any relief. On the contrary, his condition kept worsening.

“I was very sick. My body had become very weak. I was unable to walk by myself. There was constant coughing and fever. I consulted many doctors and followed their advice. Many medicines were tried on me. I was even put on typhoid medication for more than 20 days. But with every new treatment, instead of improving, my condition worsened. I suffered like this for more than three months. I had no clue what was happening to me, and perhaps neither did the doctors. I underwent a battery of tests. But no doctor asked me to get my sputum tested [for TB],” said Manjit to CNS (Citizen News Service) in April 2024.

Then luckily, one day a neighbour suggested him to contact Shanti, a community health worker who works as a field officer for Humana People to People India (HPPI). The neighbour told him that Shanti had been regularly going around the community raising awareness on TB and actively reaching out to those who had similar symptoms as Manjit and helping them access healthcare services.

Thanks to Shanti, same day test and treat made possible for one of the most vulnerable

Shanti took Manjit to the nearby private x-ray clinic in Saboli area of East Delhi and with support from HPPI a free x-ray was done, which showed Manjit as presumptive for TB. Then, they went to Red Cross healthcare centre where sputum microscopy confirmed TB. His Ni-kshay ID was made, and he was put on treatment on the same day (Ni-kshay is a web-enabled real-time patient management system of government’s National TB Elimination Programme).

After this, they went to GTB Hospital for a free WHO recommended molecular test via CBNAAT (Cartridge-Based Nucleic Acid Amplification Test) and drug susceptibility test via Line Probe Assay (LPA). Drug susceptibility test is done to ensure that the TB bacteria that infects a person is not resistant to the medicines he or she is treated with.

Same day test and treat is important when it comes to TB – the deadliest of all infectious diseases – so that the person can become non-infectious soon after beginning the therapy and also reduce spread of TB, as well as lessen human suffering.

Counselling of Manjit was important. Shanti did daily follow-up of father and daughter during their entire course of treatment. Both received health education, treatment literacy, importance of treatment adherence, nutrition, infection control (like wearing of mask) and other support to tide through their treatment journey. For instance, Manjit wore a mask regularly, thanks to Shanti. Shanti also ensured that both got food ration supplements every month, courtesy an NGO operating in New Seemapuri dispensary.

As there is always a likelihood of TB infection in the lungs to spread to others, Shanti went with Manjit to his home and counselled his wife to get herself and their three daughters screened for TB. His wife was initially reluctant to go for a TB test as none of them had any TB symptoms. But upon Shanti’s insistence she got convinced to take a free TB test. All tested negative except for one of the daughters who was found positive for TB of the lungs.

When she was taken to GTB Hospital for CBNAAT molecular test and LPA drug susceptibility test, her condition became so serious that she had to be admitted in the hospital for over two weeks. A CT scan later confirmed that she had abdominal TB too (in addition to TB of the lungs). Her treatment had also begun on the same day that she got diagnosed with TB.

It was only through Shanti’s untiring efforts, that Manjit and his 10-year-old daughter could get diagnosed with TB and receive treatment, care, and support all through their therapy.

Both got their medicines from the nearest dispensary in New Seemapuri.

“I defeated TB” says Manjit

Manjit successfully completed his 6 months long TB treatment on 1st of April 2024, and has tested TB free. “I defeated TB,” he said. His daughter is on the path of recovery and her treatment is hopefully about to complete later this month – subject to her test reports.

Shanti has been a pillar of support to Manjit during his entire treatment regimen. “Shanti didi (didi is a Hindi word for sister) helped me access all the available medical facilities, like diagnosis and timely treatment, and helped me get food ration supplements. I too followed the doctor’s instructions as I was determined to defeat this enemy called TB. I religiously ate my medicines (3 pills a day) on time. I had no prior knowledge about this disease when it struck me. But thanks to Shanti didi and thanks to my doctors, I have learned a lot about TB and have also become treatment literate” said Manjit.

Unlike many other TB patients, Manjit was fortunate enough to not have faced any stigma or discrimination from his friends, co-workers, or his employer. He received their support and solidarity all through his treatment.

Community health workers are critical link between vulnerable people and TB services

Shanti helped Manjit and his daughter to access social support provided by the government of India as well as by other NGOs. For instance, she helped them complete the formalities so that each of them could get direct benefit transfer under Indian government’s Ni-kshay Poshan Yojna and receive INR 500 every month during their treatment in their bank accounts.

She gave them moral support to bear with the side effects of TB medication. They too responded in a very positive manner and did not miss any dose of medicine.

The likes of Shanti are engaged in the daunting task of finding TB in the unreached populations –referred to as the key and vulnerable populations, such as, homeless, migrants, slum dwellers, daily wage earners- and connecting them with the healthcare system. As per the India TB Report 2024, key and vulnerable populations are those with heightened exposure to TB bacilli, constrained access to health services on account of socio-economic determinants of health, or an elevated risk of TB due to compromised immune function.

Shanti’s work at Humana People to People India is part of LEAD (Leveraging, Engaging and Advocating to Disrupt TB Transmission) project, supported by United States Agency for International Development (USAID) and JSI Research & Training Institute, Inc. (JSI), in close coordination with Indian government’s National TB Elimination Programme (NTEP).

“I work for an NGO. But this is not just a job for me. It gives me a lot of happiness and satisfaction for being able to do something for our fellow human beings who may be living in dehumanising conditions. Manjit was finding it difficult to walk when I had first met him and now, he can comfortably walk and go around his daily livelihood and support his family. This gives me a lot of strength to keep doing what we do. This is the driving force why we try our best to make the area we are allotted to work in, becomes TB free,” said Shanti.

Manjit’s mantra is Never Say Die. “One must have self confidence that he/ she/ they can fight TB (or for that matter any other disease). If I had become nervous and dejected and lost confidence about getting cured, it would have become difficult. I gave the disease a good fight – ate my medicines on time and kept my morale and confidence high – that I will get cured. And I won the battle. I defeated TB,” said Manjit.

Manjit is not only a TB survivor but also a TB champion who proactively goes to health awareness camps to encourage those with symptoms to get screened for TB, and those with TB disease to stay strong, seek support and finish the therapy.

The indomitable spirit of Manjit and the unstinted support of Shanti bear testimony to the fact that “Yes, we can end TB.”

Shobha Shukla, Bobby Ramakant – CNS (Citizen News Service)

(Shobha Shukla and Bobby Ramakant co-lead the editorial of CNS (Citizen News Service) and on the governing board of Global Antimicrobial Resistance Media Alliance (GAMA) and Asia Pacific Media Alliance for Health and Development (APCAT Media). Follow them on Twitter @shobha1shukla and @bobbyramakant)

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Health

Think twice: Can we deliver on #HealthForAll without saving lives from viral hepatitis?

Maravi Post Reporter
Can we deliver on #HealthForAll without saving lives from viral hepatitis?

Despite over 350 million people living with hepatitis B and C virus globally, and 3 persons dying every minute, much-needed efforts are yet to be on-track to end viral hepatitis in next 108 months (by 2030) as promised by heads of all countries in UN General Assembly (by adopting the Sustainable Development Goals). More importantly, during the Covid pandemic, efforts to prevent and save lives from viral hepatitis had taken a backseat – which is risking losing the gains made earlier in addressing viral hepatitis across the world.

“Elimination of viral hepatitis should be part of any sound public health agenda. With a strong political will and collective leadership we can achieve the regional goal of eliminating viral hepatitis by 2030” said Wangsheng Li, cofounder and founding President of The Hepatitis Fund (endHep2030.org).

He was speaking at the 6th Asia Pacific Summit of Mayors (APCAT Summit) which brought together subnational leaders of almost 80 cities across the region. Addressing viral hepatitis was an important part of the integrated health and development agenda of this summit. The Mayors and other subnational leaders and delegates of APCAT Summit adopted an APCAT Declaration 2021 which includes the promise for “addressing the challenge of viral hepatitis as a major public health threat in the Asia Pacific region through elimination of mother to child transmission by raising public awareness and strengthening health systems through public and private partnerships.”

The Declaration endorsed by 6th APCAT Summit further underlines: “We commit to doing everything to harness the power of our city governments to ensure that tobacco control, prevention of non-communicable diseases, TB control, elimination of viral hepatitis, routine immunization and scaling up Covid vaccination are effectively implemented and measured, along with other health and development initiatives, and the recovery from Covid is healthy, equitable and sustainable.”

“We are very excited on the recently formed partnership between EndHep2030 and APCAT” said Wangsheng Li. Rightly so, given how critical is political leadership to advancing ending hepatitis agenda.

“Health is a political choice that should ensure leadership, accountability and sustainability for the effective implementation of public health policies and programmes and prevent current and future pandemics. Viral hepatitis is an essential part of the #HealthForAll agenda”, said Dr Tara Singh Bam, Asia Pacific Director of the International Union Against Tuberculosis and Lung Disease (The Union), and Board Director of Asia Pacific Cities Alliance for Health and Development (APCAT) in Singapore.

How will we end hepatitis by 2030?

Dr Po-Lin Chan from Manila-based World Health Organization (WHO)’s Western Pacific regional office said that “Elimination of viral hepatitis as a public health threat by 2030 is a combination of existing interventions at scale. These include ensuring universal free childhood vaccinations of 3 doses of hepatitis B vaccines, prevention of mother to child transmission of hepatitis during antenatal care, ensuring safe blood and blood products (so that transfusions are safe), making sure universal precautions is the norm in healthcare settings, ensuring safer sex programmes are in place, ensuring harm reduction interventions and efforts to prevent new infections among people who inject drugs are in place and accessible, and making sure that tests and affordable drugs are available in healthcare facilities nearer to where people live.”

Along with Singapore, other countries like Bangladesh, Bhutan, Thailand, Malaysia, and Nepal have also successfully met the WHO target for 2020 of achieving 90% prevention of hepatitis B through vaccination (by providing birth dose of hepatitis B vaccine to newborn children).

“Vaccination is the foundation of prevention of hepatitis B virus (HBV)” said Dr Po-Lin Chan.

Asia Pacific is home to more than half of world’s people with hepatitis B and C

Asia and the Pacific has more than half of world’s total number of people with hepatitis B and C virus. About 200 million people are chronically infected with hepatitis (180 million with hepatitis B and 20 million with hepatitis C) and most people are not even aware that they are infected, said Dr Po-Lin Chan of WHO. These are the people who are also at high risk of developing liver cancer. Chronic infection of hepatitis B and C affects the liver overtime and causes cirrhosis and eventually liver cancer. All these premature deaths are untimely and so preventable, because we have prevention tools, as well as good tests and drugs that can treat hepatitis B and C, and hepatitis C can be cured.

Globally, 296 million people are estimated to be infected with Hepatitis B Virus (HBV), and 58 million with Hepatitis C Virus (HCV).

African region has 82 million people with hepatitis B virus (HBV) and 9 million with hepatitis C virus (HCV). Pan-American region has 5 million people each with HBV and HCV. Southeast Asian region has 60 million people with HBV and 10 million with HCV, and accounts for around 15% of global HBV and HCV cases, as well as 30% deaths due to HBV and HCV. European region has 14 million people with HBV and 12 million with HCV. Eastern Mediterranean region has 18 million people with HBV and 12 million people with HCV. Western Pacific region has 116 million people with HBV and 10 million with HCV.

Dr Po-Lin Chan shared that latest scientific evidence shows that there is a group of pregnant women who are more at risk of passing the hepatitis B virus to their babies. These are pregnant women who are themselves hepatitis B infected. WHO guidelines provide recommendations that we can further prevent hepatitis B transmission from an infected pregnant woman to her baby. Universal testing during antenatal care for HIV, HBV and syphilis, is the entry point to get infected woman timely into the care she needs. WHO’s framework for triple elimination of mother to child transmission of HIV, syphilis and HBV brings together integrated mother to child care so that next new generation of babies can be free of infectious diseases such as HIV, syphilis and hepatitis B.

Act today to prevent liver cancer tomorrow

“If we take action today, we can prevent liver cancer tomorrow. To reduce liver cancer and to reduce advanced liver disease such as cirrhosis, an effective way is to provide testing services so that people can know their own hepatitis status, can get linked to health services and get drugs to treat hepatitis. Even during the pandemic we must intensify our efforts to prevent our babies from getting infected with viral hepatitis B. This means investing in childhood vaccination (against HBV), and prevention of mother to child transmission to get to elimination” said Dr Po-Lin Chan.

People living with hepatitis B and C are at high risk of developing liver cancer. Most are not aware. But liver cancer can be prevented by ensuring testing and treatment for those who need it. Because cancer once developed will cost all of us even more.

“Hepatitis C can be cured. Hepatitis B can be effectively treated. We need to work towards strengthening health systems, towards universal health coverage which includes hepatitis, optimising primary care service delivery nearer to places where people live, including public private partnership, equitable access including hard to reach groups and engaging communities, and data based decision making” said Dr Po-Lin Chan.

Almost all countries in southeast Asia have now developed and are implementing national strategic plans that provide key guidance on hepatitis testing and treatment and blood and injection safety. All southeast Asian countries have at least 3 doses of hepatitis B vaccine in their national immunization schedule with the region achieving more than 90% coverage rate in 8 countries.

We have to scale up genuine and effective hepatitis-interventions for supporting key populations through community outreach and by implementing opioid substitution therapy and safe injection programmes.

For eliminating mother to child transmission of hepatitis B, it is essential to ensure that all pregnant women are tested for the virus and where necessary treated and for every newborn to receive the hepatitis B birth dose.

Shobha Shukla, Bobby Ramakant – CNS (Citizen News Service)

(Shobha Shukla and Bobby Ramakant both are part of editorial team of CNS (Citizen News Service), and founding board members of Asia Pacific Media Alliance for Health and Development. Follow them on Twitter @Shobha1Shukla, @BobbyRamakant)

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Health, Lifestyle, Travel & Tourism

Turning sunset years into gold

Maravi Post Author

(Citizen News Service): As soon as I set foot inside Suansawan Care Resort for the elderly in northern Thailand, I was immediately struck by its spacious, sylvan and tranquil surroundings.

Set in Maerim valley, 20 km away from the Lanna province of Chiang Mai, this retirement facility is owned and managed by 66-year old British businessman Peter Brown and his Thai wife. Opened in 2013, it won the Most Outstanding Care Resort of the world award in 2016.

In an exclusive and candid interview with CNS (Citizen News Service), Peter narrated the incident that motivated him to open this care home for the elderly.

His mother, Joyce Brown, had been living in a nursing home in London for 5 years, where the care kept diminishing to the point when there were just 4 carers for 40 people. Once when Peter went to meet her, he found her very sick — almost dying— in her room, and without anyone of the care facility staff knowing about it.

When a visibly upset Peter questioned them, they said that every morning they would call her and ask her how she was, and she would say she was fine. So they believed her, without ever checking if she was telling the truth or was just being polite. Even though her meals were being returned untouched for the past 5 days, no one seemed to be bothered.

The lame excuse given to Peter was that the person who delivered the meals was not a carer, only a delivery person.

“So basically there was no culture of care in that care home. Unfortunately what people need is care, and what care needs is carers. So if you do not have enough carers you cannot give care, if you do not give care you cannot improve people’s lives.” He said.

Peter then looked for other care homes for his mother but could not find anything better. At that time, he was already running a 4 star tourist resort on this property since 2007. So in 2013 he and his wife converted a part of that tourist resort into a care facility for the elderly (including those with dementia and Alzheimer) and brought his mother (now 94 years old) to live here with the other guests.

Joyce is now one of the residents with dementia at the facility. Unlike other places, they are not kept in locked wards but in a ‘memory care’ zone where they have the freedom to move around. Peter ensures that there is a carer for a guest with dementia, just a few metres away, 24 hours a day.

When the guest wants to go for a walking the resort’s garden, the carer goes alongside. Guests go shopping once a week – that means one carer goes with one guest. If there are not enough carers, one cannot give that sort of personalised service.

The other residents live in independent villas, each of which is fully alarmed to the central care station. Basic health checks, like measuring blood pressure, are done daily, with carers taking residents for periodical medical appointments to the city. Meal times are flexible. Says Peter: “They can eat when they want, what they want, in their room or outside. We believe that even in their old age people should be able to enjoy a quality life, and retain their independent freedom of choice, within physical and medical limitations. Guests here are not treated like a child, but like normal adult human beings”.

The facility currently houses 25 residents between ages 63 and 97 years: 70% of them being females. Most of them come from the USA, and the rest are from UK, Canada, Australia, France and Hong Kong. 12 of the guests are in some stage of dementia. Guests stay here on a one year renewable retirement visa which Peter helps to organise for them. The all-inclusive monthly cost runs from Thai Baht 47,000, depending upon the level of care required and the room-type chosen. But, as Peter says, it is not only about costs, it is also about care levels – while it is much cheaper here than in the US or UK, care level is also very high here.

“When I started this facility, neither did I have any experience of running such an enterprise, nor could I find any existing model that I could copy and replicate. So, I thought what would my mother like, and what would she not like. My mother had said to me – do not ever put me in a nursing home. People go to a nursing home to die miserably. Let me die happily in my own bed. I also felt that when I am old and infirm I would not want to live in boarding school-like environment where others dictate and force their will upon me. I would not like to be a child again.”

The biggest USP of this care home is the high staff-to-resident ratio. There are 29 Thai carers, including two degree-qualified nurses, for these 25 residents. Add to this, Peter’s philosophy regarding elderly-care, and you have a perfect recipe to add cheer to the twilight years.

“Providing sufficient ‘care’ whilst maintaining individual dignity is our key philosophy. My carers know that maintaining the dignity and personal freedom of the guests is very important. Our guests live their own lives as much as possible – they choose when to eat, what to eat, where to eat, when to go to sleep, what activities to do, what not to do, etc. In most nursing home type care places around the world the guests virtually live in a prison like atmosphere.”

People with dementia are often aggressive and depressed, perhaps due to frustration for being treated like children. “So here we try to take away that frustration from them, give them a dignified life, give them choices. I have guests in stage-6 of Alzheimer’s disease. But they still go shopping, they still make their own decisions – whether to buy something or not, whether to go out and have lunch or sit in a coffee shop.”

“People with dementia are not stupid – they just suffer from memory problems,” says Peter. “One has to learn how to adapt to the actions of a dementia patient. They might seem to act like a child, but should not be treated like a child. Adequate provision of care levels coupled with a healthy lifestyle and diet can improve their condition tremendously.”

High blood pressure and diabetes are two major health problems of the guests, which, in most cases, are controlled through proper diet and physical exercise- an important part of the guests’ routine here. But to make elderly people exercise is not easy. Recalls Peter, “We had a guest in her 80’s who came here from the USA in stage 6 of Alzheimer’s. She had not walked for 7 months, and had not talked for 2 months. Within 2 months of her stay here she could walk 200 metres. Once she started walking, she started talking. It just took 4 days’ efforts, sans any medication, to make her take the 1st step with the help of two carers. But then there was no looking back for her. She made continuous progress – walking to the bathroom, then till the front door, then past the terrace.

And now she enjoys walking and talking when she wants to. Her son says she is stubborn, but I say that she is free willed. When you reach 75, you do have the right to be free willed – you have the right to exercise your choice on what you want or do not want to do.”

Peter has many other success stories to share: “I have been pleasantly surprised to see what one can achieve by helping people with care. One gentleman, who came from USA, was on 24 hour care for one whole year in this place—one carer with him throughout day. But last year he moved to an independent living unit. He still needs care but he lives independently. And it is not because his health has got any better, but because he has learnt to live with his disease and also because we respect his decisions.

I have also dared to comply with his request to let him manage his shopping expenses, with astounding success. It is not about right or wrong decisions; it is about giving one the freedom to make choices. So elderly people can do much more than what others think.”

Peter still runs his tourist-resort alongside, but its size is diminishing and the care home size is increasing. He had earlier thought of closing the resort when he broke even in December 2016.

But then he decided against it because the resort is very popular with the care home guests. It creates a different ambience for them and they feel happy seeing and meeting younger people and children from different countries. It gives them the feel that they are not segregated.

“We do have a huge place here, but I do not want to increase the number of guests beyond a certain point. If the number is too big, care will not be that personalised.

As of now I know the minute by minute medical problem of each of my guests. It is the care and the philosophy within the care that is important.”

Peter candidly admits that he is not running this care home for altruistic reasons, but because it gives him pleasure to see people benefit from what he does.

“I am passionate about looking after the elderly and I believe in people. Elderly people can do a lot more if we just give them a little bit of support.”

Between 2015 and 2030, the number of older persons worldwide is set to increase by 56% – from 901 million to more than 1.4 billion – thus making care for the elderly is a huge problem which must not be neglected anymore.

Although there is a growing market for elderly care homes, but it may not be prudent to make it a business. A profit driven model cannot run a good caring facility that focuses to improve the quality of life of senior citizens, rightly believes Peter.

The elderly do need care, but they also want to live their own lives and do not want to be a burden. People’s independence, and their freedom of choices are important and must be respected, irrespective of their age. Only then can countries fulfill their pledge to step into a sustainable future leaving no one behind.

Shobha Shukla, is a regular contributor of the Maravi Post and is the Managing Editor of CNS (Citizen News Service)

The views expressed in this article are not necessarily the views of the Publisher or the Editor of Maravi Post.

Regional

Anger begets hope and drives constructive action for a better tomorrow

Patience Mandowa

By Shobha Shukla, CNS (Citizen News Service)

More than 300 feminist activists, women human rights defenders and global allies are gathered in Chiang Mai, Thailand under the banner of ‘(re)Sisters, (per)Sisters and Sisters’, for the 3rd Asia Pacific Feminist Forum (APFF 2017). This 3 days Forum (?7-9 September 2017?) has been organised around the framework of ‘Anger, Hope and Action.’

The first plenary of the forum saw Judy Taguiwalo, a human rights activist and former Minister for Social Welfare and Development, Philippines, arousing the anger of feminists, from different constituencies, against patriarchal, right-wing and authoritarian leadership in the Asia Pacific region, that is using women’s bodies as a site of power and is usurping their fundamental rights. Continue reading Anger begets hope and drives constructive action for a better tomorrow →

Health

Asthma: We can beat it but not kill it

MaraviPost

Shobha Shukla, Citizen News Service – CNS

Asthma is a common chronic non-communicable disease (NCD) that is usually characterised by inflammation of the bronchial tubes or airways of the lungs. 10,000 litres of air and blood pass through our lungs and, as a result, they deliver 350 litres of oxygen every day. If this delivery is hampered in any way it leads to respiratory distress or breathlessness. The episodic onset of respiratory symptoms is called an asthma attack. Continue reading Asthma: We can beat it but not kill it →