Re: My experience at Government ART Centre in Hospital in Bangalore.

[Guest guest]

Dear FORUM,

Re: /message/10699

Many of my patients had similar experiences and I wrote them earlier

too

Since it has come from proverbial horse's mouth, may be the

attitudes will change for the better and autorities who matter will

look into it.

Otherwise also Dr.Rewari is a great listener--do not loose heart Margadarshini

and do justify your name by showing the

direction (Margdarshini means one who shows the path---am I right)

Cheer up

Dr.Bharti

--

Rakesh Bharti

MD,AAHIVS,

BDC Research center,

27-D,Sant Avenue,The Mall,Amritsar.

Punjab,INDIA143001.

TEl-91-183-2277822;91-183-2278522

e-mail: <rakesh.bharti1@...>

[Guest guest]

Dear All Forum Members

Re: /message/10699

I have gone through the case. Though it is not correct to comment on the

treatment given without seeing patient and his records, it appears that starting

ART at 259 CD4 was correct.

It is not clear what was the time gap between starting ART and repeat CD4 done

at Hospital. The CD4 count could have been increased to 500 as patient

was started on it ART.

Any way the ART should not have been stopped by MO at

hospital and he must know the latest guidelines by NACO are 250 and not 200.

I request to concerned person to send me a confidential email at my email id so

that we can ask the concerned doctor that why treatment was stopped & correct

advice was not given.

I am also taking up the issue with the nodal officer of ART at

hospital.

Thanks

Dr B.B.Rewari MD,FICP,FIACM,FIMSA,FGSI

Sr.Physician,Dr RML Hospital & National Programme Officer (ART)

National AIDS Control Organistion, 6th Floor, Chandralok Building, 36,

Janpath, New Delhi-110001

Tel; 011-23731954, 43509999(O) Mobile ; 91-9811267610

Fax : 011-23731954,23731746

e-mail: <drbbrewari@...>

[Guest guest]

Dear Forum,

Re: /message/10699

I have noticed that there are many ART centers like the one at Tumkur, Indira

Gandhi Institute of Child  health etc where the ART officers do call up and

discuss the condition of their patient before they make a decision on treatment.

They are also accessible to others by phone.

However there is the other extreme where ART medical officers and all the others

at the ART unit just refuse to cooperate with NGOs.

They fail to realize that the ART program is just one of the many government run

public health programs. So instead of treating everybody else in the field as

competitors, the ART officers should start looking at net-working and

associating with others in the field.

If they do this, they will also realize that there is a lot more that can be

achieved towards actually helping the PLHA. It would also be wise for doctors to

remember that every public health program finally caters to " the individual " .

We also need to remember that  in a democratic country, people have the right

to choose where they want to seek treatment 

 

These are my views.

Dr. Nirmala Rajagopalan

Freedom Foundation

e-mail: <drnirmala@...>

[Guest guest]

Dear All,

Re: /message/10699

Let us see this issue it in different perspectives not see it as reason to blame

each other (which is the easiest response possible):

It is unfortunate that a patient get an advice to stop ART from a government ART

center.It should not happen at all.

But an ART MO who had training in ART guidelines -- thinks s/he does not have

the mandate to initiate ART for an individual who is started with ART outside

the guideline given to him.--initial CD4 was done outside NACO, and current

one is 500.

A typical response will be to follow the guideline and be safe.

As a program it is important to have some strict guidelines and

regulations in a public health program and any practitioners and managers

consider guidelines as inflexible rules. Same time too much flexibility in

guidelines can lead to anarchy.

(Probably) except for ART program all public health programs aim at the

community and not on individuals. Hence many guidelines applied in public health

programs are suboptimal for individual patient care. There are examples for this

in leprosy and HIV programs.

But the care delivery in these programs -especially HIV-program is highly

individualized and personalised. There exists a conflict between community

oriented program management and individualized health care delivery.

I personally see this kind of problems as a result of this conflict and we

should take this as an opportunity to develop an optimal health care delivery

modal for the future. (HIV is not just a crisis but an opportunity too)

I agree partially with Ms Nirmala Rajagopalan that there is lack of

understanding between various stake holders. This happens even inside the same

organization. It is important to sensitize the roles , duties and limitations of

each component of HIV response to the rest.

The lack communication happens not only between ART MOs and NGOs , between

managers and patients, between different NGOs,different arms of same

organization.

what is the solution?

Vigilance and regular feed back , respect to the rest of the partners in

response, devolving comradeship between the stake holders, updating of training

modules, developing mechanism to clear the practical issues from the field,

frequent updating of guidelines ....

Let us continue to do these.

I hope NACO will soon include a section which can be a quick reference to

usual practical problems encountered by ART team during their work especially on

real life situations which are not easy to be solved by an young and new team

member as part of the guidelines.

I am sure ART team of NACO will teak it up.

I thank Margadarsi team for raising this issue, we should have a system where

such problems are problems of both program managers, doctors, patients and NGOs.

It is unfortunate that patients feel doctor can be potential

threat to patient and doctors see patients as potential threats!

With best wishes

Dr Ajithkumar.K

--

Dr Ajithkumar.K

Asst Professor In Dermatology and Veneriology

Medical college Chest Hospital

MG Kav,Trichur, Kerala ,India

Ph 04872333322 (res)

9447226012