Emergency and humanitarian action

Nepal’s TB patients continue to seek care amid trying post-quake circumstances

The challenges Nepal’s recent earthquakes pose for Tuberculosis (TB) care and control are significant. In Nepal, TB remains an ongoing public health burden, with health officials keen to ensure that advances in recent years are not threatened.

In the wake of the disaster, Nepal’s National Tuberculosis Centre formed a rapid response team and with logistical support from WHO have started tracing TB patients in the 14 most affected districts, with a priority on reaching those with Multiple Drug Resistant (MDR) TB. On 21 May, NTC and WHO staff met with District TB and Leprosy Officers in Bhaktapur to explore issues surrounding post-quake TB care and control in the district. The team also met with MDR TB patients living in temporary camps in order to identify patients’ immediate needs and ensure their continued care and access to treatment. According to the NTC, addressing living conditions in camps, increasing patient access to infection control measures and minimizing stigma have been identified as key areas for action.

Tara Sharma, District Tuberculosis and Leprosy Officer for Bhaktapur
Tara Sharma, District Tuberculosis and Leprosy Officer for Bhaktapur says she and her colleagues have been working since the first earthquake hit to ensure that patients are traced and afforded access to the medicines they need to continue treatment. “There are 109 Tuberculosis patients whose houses are completely damaged, they are living in camps.”
Photo: WHO/Korver
Sharma updates WHO and National Tuberculosis Centre staff
Sharma updates WHO and National Tuberculosis Centre staff on the status of TB patients in the district.

“We take care of local residents and are linked to Kavre and Sindhupalchok districts. We know of six patients missing in Bhaktapur and three in Sindhupalchok. We are trying to track missing patients but mobilization of volunteers to visit their houses is difficult in this scenario.”
Photo: WHO/Korver
Krishna Sundar Bhaila, 37, an Extra Pulmonary TB (EPTB) patient
Krishna Sundar Bhaila, 37, an Extra Pulmonary TB (EPTB) patient is committed to continuing with his anti-TB medication after the earthquake.

“The hospital doctor and health worker told me I have to have daily medicine. My wife goes to get the drugs and I have one week of medication at a time – it’s difficult to go for daily DOTS, but weekly is easy.”
Photo: WHO/Korver
Krishna Sundar Bhaila and wife Nangal Maya
Krishna Sundar Bhaila and wife Nangal Maya, 35. As an EPTB patient Krishna has faced much discrimination since the earthquake.

“The home we were renting collapsed in the earthquake so we tried to go to a shelter. My wife told them about my TB – that it was the non-contagious kind – but I face much discrimination in the shelter. I think people fear transmission. The people in the shelter shouted to get away and my wife and my two daughters cried a lot. We now stay separately from each other. My wife can only visit one or two times a week.”
Photo: WHO/Korver
Binod Khotea, 37, who is a relapse case of TB and has multiple drug resistant-TB (MDR-TB).
Binod Khotea, 37, who is a relapse case of TB and has multiple drug resistant-TB (MDR-TB).

When the earthquake hit he only had a one day supply of anti-TB medicine. He had been sputum smear negative (meaning his TB is non-contagious) for four months so it was important for him to seek out medicine the day after the earthquake to keep it under control.
Photo: WHO/Korver
Khotea travelled of his own accord in search of anti-TB medication after the earthquake.
Khotea travelled of his own accord in search of anti-TB medication after the earthquake. He went to visit the house of a National Anti TB Association scout volunteer known to him.

“I found her, she had been trapped inside her demolished house. Once she got out, she went back inside the house to get me medicine for 5 days. It was important to the both of us.”
Photo: WHO/Korver
Sitaram Ghatuwa, 43, has sputum smear negative MDR-TB, and has been living in a temporary camp in Bhaktapur since the first earthquake demolished his home.
Sitaram Ghatuwa, 43, has sputum smear negative MDR-TB, and has been living in a temporary camp in Bhaktapur since the first earthquake demolished his home. He stays with eight members of his family including his wife Laxmi Ghatuwa, 35, and his 12-year-old nephew Sujan Ghatuwa. Twenty-five others also sleep under the same shelter in an adjoining tent.

“We belong to a farming group. We do not have much at this time. If they provide medicine close by it will be easier. The 30 rupees I spend on travel could buy me two eggs to eat.”
Photo: WHO/Korver
Ghatuwa had a six-day supply of anti-TB medicines from before the earthquake as he was attending the Deo Puja festival and did not want to be without his drugs in case clinics were closed for the festival.
Ghatuwa had a six-day supply of anti-TB medicines from before the earthquake as he was attending the Deo Puja festival and did not want to be without his drugs in case clinics were closed for the festival. After the earthquake he continued taking his drugs in the temporary camp. He keeps them safe in a Bhujia (snack) packet, “it is waterproof,” he says, “it protects them from the rain and sun.”
Photo: WHO/Korver
Nhuchhelal Ghatuwa, 70, Sitaram’s father
Nhuchhelal Ghatuwa, 70, Sitaram’s father, has Chronic Obstructive Pulmonary Disorder, and is vulnerable to contracting TB in this environment. The WHO and NTC arranged for his sputum to be tested for TB bacilli and will ensure he is provided with free treatment if needed. In the meantime he wears a mask to protect his family.
Photo: WHO/Korver
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