Re: Manipur on fire

[Guest guest]

Dear forum,

Recent days there are many reports on the non availability of drugs

from various parts of India. And everybody is worried about the non

availably -erratic procurement /supply of one or two drugs . There

was no response even on this forum about the viability of this

program in a health care system like what we have in India.

Just " airdropping " of medicine is not an answer for managing AIDS

Epidemic. Unless we accept this challenge as a crisis and make use

of this crisis to streamline health care delivery ARV/ HIV care is

not going to improve. Even in Kerala where we have the best health

care delivery system, we are struggling to continue regular

supply.And this was expected and anticipated by many of us. Unless

we start a proper program and streamline ARV program it is unlikely

to be a success. Just demanding Efavirenz/ Trimmune 30 supply is not

going to solve the problem.

The program should be well structured, planned and regularly updated

and upgraded. Do we have any idea about the numbers of patients died

of Stavudine induced lactic acidosis? Do we have any data on

patients started on ARV without any real indication and died of

IRIS and suffering irreversible neuropathy? Are we planning any

long term cost effective analysis on ZDV against Stavudine?Do we

have any program for those who are on 2 drug ARV? What about HIV 2?

Is there any real criteria to select ARV centers? Are we selecting

the high profile influential centers is the state capitals or

selecting centers with a good track record?

Does our ARV centers having medicine and infrastructure to manage

OIs ( look at our Namakkal andPune stories posted). Why should our

patients chronic diarrhea who came for ARV wait in streets? Why

don't we have IV fluids, antibiotics and atleast bowel binding

agents - even if he is HIV negative he should be able to get them.

Why nobody is worried about the lack of these drugs?

why our PHCs/thaluk hospitals are not diagnosing and treating TB,

and PCP and candidiasis which need only ATT, co trimoxazole and

steroids and fluconazole which should be available in every

hospitals?

Why our Private hospitals which claim to provide quality health care

not interested in HIV care? Is it possible to equip our system to

meet this challenge?I am not sure!

But we those who are working with " Trichur modal HIV care facility "

could do that in our Government set up without any extra funding. In

the last 3 years if we could provide all components of HIV care for

about 800 patients registered in our facility, regularly provide OP

and IP care ( with a mortality rate of less than 15 % admitting

every sick patient who needs admission) initiate ARV for about 200

patients using Government ARV program, provide most of the IP and OP

care free of cost, provide elective and emergency surgical care,

eliminate stigma and discrimination to a minimum, provide counseling

(not only pre and post test but ongoing supportive life long

counseling for those who need),train every staffmember atleast once

a year, provide PEP and PMTCT. with out appointing any new staff

member and getting any extra funding either from government or

funding agencies.

We feel it can be replicated in other parts of the country as well

if there is a will. Only thing we should do is to be vigilant,

educated and make the system work.

Dr Ajith

Medical College Chest Hospital Trichur

E-mail <trc_ajisudha@...>