As per the latest national data from the National Vector Borne Disease Control Programme (NVBDCP), Bihar recorded nearly 3,529 cases of kala azar in the state, highest in India. Dr Gaurab Mitra has been working in the kala azar programme of Doctors Without Borders/Médecins Sans Frontières (MSF) in Vaishali district of Bihar for the last seven years. He recounts two of his most challenging cases.
There was a 30-year-old man who was suffering from kala azar, abdominal tuberculosis and severe malnutrition. He was frail and needed dedicated medical attention and nursing. As his doctors, we knew that it was going to be a hard fought battle to win his survival, but we had to try. My team took the decision to start treating him for kala azar and, side by side, for malnutrition.
One of our most difficult days was when he left the hospital on his own to return home. He was not cured and did not have the necessary discharge papers. What he did have were incomplete medical records and an uncertain future. My team went to his home and tried to convince him to continue the treatment. He agreed and came back to the hospital.
He stayed with us in the kala azar ward for two months in total. This time was marked by intensive nursing and constant monitoring of his health. It was an extraordinary team effort. His condition slowly started improving. After his body gained a measure of strength, we also referred him to the government’s TB programme.
He not only bounced back from three threatening diseases, he resumed going to work. It was satisfying for me to see this.
‘You treated my son’
In my experience, patients often don’t know they have kala azar because the symptoms are faint at first and it’s easy to confuse them with malaria. The disease progression is slow which means that a person starts feeling sick only later. Usually, their condition has deteriorated by the time they finally go to a doctor. The more the delay, the more the chances that they’ve also become anemic.
There was an 8-year-old boy whom we treated a few years ago. At the time he was admitted, his hemoglobin level was very low and he had kala azar. We had to arrange for blood transfusion for this boy, but getting a donor was proving to be difficult. The father was a potential donor yet he refused at first because he thought that he would grow weaker if he gave blood. I’ve seen similar instances when family members have declined to donate, fearing adverse consequences to their own health.
We started the boy on kala azar medication and blood transfusions were done after his father agreed to donate. The boy recuperated soon.
I met the father while on a personal visit to a resort a few months later. He used to work at the place and he recognised me. He refused to take money from me by saying “you’ve treated my son”.
His gesture really touched me.
‘Some of my best years have been at MSF’
MSF has given me some of the best years of my life. I worked as a doctor before, but I learnt something very important here- that a doctor should have empathy towards his patients. Even saying namastey can go a long way in taking care of them.
I am able to treat those most in need with the best of medicines and facilities. This is what I want to do.