Continuing care for tuberculosis, diabetes and heart patients in earthquake hit Nepal

May 2015

TB patient in Jhor Makankal, central Nepal
WHO/A. Bhatiasevi

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.

“If these centres become non-functional, then District TB officers trace the patients and enable their care at another treatment centre,” he said . A rapid assessment of TB needs is currently underway, which will outline how TB patients will be reached and provided with ongoing treatment - especially those in remote districts.

Once traced, patients will be tested and provided the appropriate treatment and counseling in order to prevent further incidence of the disease.

Continuing treatment of patients with noncommunicable diseases

Pre-planning has also helped ensure that other people who rely on medicines daily for noncommunicable diseases, such as diabetes and high blood pressure, can continue to receive them.

Dr Frank Paulin, WHO’s medical officer and public health and health systems administrator, says Nepal’s earthquake increases risks for patients suffering from a range of diseases.

"Nepal’s earthquake increases risks for patients suffering from a range of diseases. The disruption of medication, especially for major diseases such as diabetes and hypertension, can be very dangerous and even life-threatening".

Dr F. Paulin, WHO

“The disruption of medication, especially for major diseases such as diabetes and hypertension, can be very dangerous and even life-threatening. Similarly, disrupting medicines for people with chronic respiratory diseases like asthma can put them at increased risk of diseases such as the seasonal flu,” he said.

Hospitals within the Lalitpur district have reported a spike in patients with an increase in blood pressure, reportedly linked to the earthquake. While oral medication and insulin supplies to treat diabetes are reported as being adequate at the government-run Patan Hospital, in areas outside of the Kathmandu valley the difficulties are more acute.

“Drug availability at district level is constantly monitored by WHO staff and this information is provided on a daily basis to the government’s Health Emergency Operations Centre,” said Dr Paulin. “This information will be used to dispatch drugs to the districts as well as to prompt logistics groups to take action to ensure stock levels.”

Foreign medical teams are also on notice to treat people with chronic diseases, along with the steady flow of trauma patients.

In the early afternoon heat outside Alka’s TB treatment centre, a community medical assistant explained the reward she feels as her regular patients continue to come and receive their medication. “I am so happy, because they understand the TB disease,” she said. “The patients, they take my counseling seriously.”