Indra’s Drishtikona (Viewpoint)

A Doctor Serves Rural Bihar

Posted : June 22, 2005 at 12:30 am [IST]

As usual as on every Monday, I was scanning through new magazines- Time, Businessweek, US Newsweek, Newsweek, Economist, Red Herring, and some more. I came across the Newsweek’s special edition of summer 2005. It is on ‘The Future of Medicine’. It has an article ‘Chasing Black Fever’ by Geoffrey Cowley. One of the photographs of the article was of name boards.

And

I went through the story that confirms my confidence in some individuals that carrying out mission selflessly for the benefits of the people in their own way. You yourself read this and judge.

“Seven hundred miles beyond Delhi, on the plains of India’s Bihar state, the 21st century is hard to distinguish from the 11th… In Rajwara, a community of 3000, whole families survive on $300 a year. The adults are illiterate, the children malnourished and the misery is compounded by a growing sense of dread. As a local crowd converges on Dr. Shyam Sundar, a soft-faced physician who has traveled from the district headquarters Muzaffarpur. What has every one so frightened is kala azar, or ‘black fever.’

As Shundar wanders Rajwara’s dusty lanes, villagers emerge from one hut after another begging him to examine a family member whose failing health has defied all local remedies… Local healers are largely powerless against kala azar, a parasitic infection spread by tiny, biting sand flies. The disease is always fatal, if left unattended…A sufferer’s best hope of survival is a month of intravenous infusions in a distant hospital, at a cost that can run to several hundred dollars. “People will sell their land, their homes, even their utensils to pay for the treatment.” Sundar explains as he presses villagers’ abdomens to check for telltale swelling of the spleen. Sundar runs a small charitable hospital in Muzaffarpur. Sundar saves about 600 lives a year this way. “This is a very drop in the ocean”, he says. In the area he serves, kala azar kills 1,00,000. Sundar has made it his mission to treat the unlucky. The son of a middle class textile merchant, he runs his 50-bed clinic as a trust, using family donations and his own research grants to cover his patients’ costs… As he walks through Rajwara, when a distraught mother admits that she lack 100rupees ($2.30) to bus her stricken child to his clinic, Sundar finds the fare in his pocket.
Victoria Hale heard Shyam Sundar speak at a conference in Belgium. She was mesmerized by Sundar’s talk. She visited his clinic a few weeks later. “I had never seen such helplessness in people’s faces.” She recalls.

Victoria Hale, herself a Ph.D in pharmaceutical chemistry has formed a company ‘Institute for OneWorld Health‘ to develop the drug paromomycin in this case for kala azar. Hale recruited 4 Indian physicians including Sundar to run the trial out of their clinics in Bihar. Trial has been successful. If all goes as planned, paromomysin will soon be available for $10 a cure-just one twentieth of what treatment now costs in Bihar.

But hurdle remains… The larger challenge is to change the conditions that make villages like Rajwara such hotbeds for kala azar. The needed measures are often staggeringly simple-clearing the cow dung that sand flies thrive on, providing people with insecticide-impregnated bed nets. But none of that is happening at the moment. Sundar moves from hut-to-hut feeling people’s spleen, and keeps on asking if they what causes kala azar.

I know, Dr. CP Thakur, the eminent doctor of Patna, coming from the same region of Bihar and the former cabinet minister also specialized in kala azar. He perhaps got number of international awards too. Why he could not get rid of this dreaded disease with all the resources available to him as the cabinet minister of India? Why couldn’t some of our pharmaceutical companies do what Hale is doing?

And at the end, two ideas, basically appeals started troubling me that I shall like to share.

1. Can some architects or civil engineers from the Regional Engineering Colleges such as one in Muzaffarpur itself design some rural dwellings or houses that separate effectively the cowsheds from the effective bedrooms for human beings? Can they market the cost effective designs to the rural folks for its functionality and contemporary standard? Can the scientists of Patna Science College, Patna University, or for that matter of any institutions come out with effective and affordable repellants or sprays to get rid of sand flies? Can some enterprises and NGOs get together and manufacture cheap insecticide-impregnated nets and distribute?

2. Will more or for that matter, all doctors with urban base adopt a village and give one day in a week or even in fortnight as Dr. Sundar does to visit that village and provide the advice at free or at discount? Can the practice be made mandatory by doctors’ associations such as IMA if it does come up voluntarily?

- Indra

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