Kala azar or black fever (visceral leishmaniasis) is a tropical, parasitic disease caused by the bite of the sandfly. It is almost always fatal if left untreated. Below is the firsthand account of a doctor who is part of the kala azar ward run by Doctors Without Borders/Médecins Sans Frontières (MSF) in Sadar District Hospital, Vaishali in Bihar.
In the past four years, Dr Deepak Kumar has been through both – days of disappointment and triumph – in the daily battle against kala azar. The experiences of some patients are therefore etched in his mind.
One such is of a 50-year-old man who had HIV, uncontrolled diabetes and fell ill with kala azar six times, leading to a complicated situation that endangered his life.
“We questioned ourselves on why there was multiple relapse in him. Both kala azar and HIV lower immunity. But we found out that his diabetes was the problem,” says Kumar. The respite that this realisation gave to the medical team was, however, shortlived as a pressing concern loomed – how do you monitor the patient’s condition, much less restrain it in a rural setting?
The team set its target in tackling parameters including fasting, blood sugar and his CD4 count (through which the strength of a person’s immune system can be gauged).
“Now, with vigorous monitoring, we have almost controlled his diabetes. He’s feeling better,” says Kumar.
MSF and kala azar
A kala azar patient can be swamped by weakness, troubled by persistent fever, lose appetite and have an enlarged liver and spleen. While it is curable, kala azar still snatches away many lives due to reasons which include insufficient awareness and late treatment. It is endemic in 76 countries with Bihar having one of the highest incidences of the disease in the world.
Apart from the ward, MSF staff in Bihar have been taking care of patients with kala azar, and who have co-infections like HIV or added illnesses, at five Primary Health Centres. Suspected or complicated kala azar cases are referred to the hospital by them and by private doctors at times. The ward receives patients from outside the state as well.
Kala azar is the second biggest parasitic killer after malaria in the world and for Kumar, every life saved gives him the motivation to go on.
Dr Deepak Kumar was interviewed by Avantika Shrivastava.
This photograph is for representative purpose only.