Jalalpur is a small village of a thousand people, located in Bihar—one of India’s largest yet poorest states. It resembles the millions of other villages that dot Bihar’s largely rural landscape: a cluster of mud and straw houses with meandering buffalo and piles of cow dug that are used for fuel. A humming sound from a power-generator announces the arrival of evening.
On one of my field visits to Jalalpur, I met a small boy named Vivek who is unaware, that against all odds, he recently survived visceral leishmaniasis—known as kala azar or black fever in India.
Kala azar is an infectious disease spread between people through the bite of a sand fly. It disproportionately affects children and causes prolonged fever, an enlarged abdomen, anemia, and weight loss. It will eventually kill anyone who is infected unless it is treated.
In Vivek’s case, he first developed a fever. When the fever lasted more than 3 days, his family contacted Chintadevi, a local community health worker called an Accredited Social Health Activist (ASHA). Chintadeva believed Vivek was suffering from kala azar and urged the family to bring him immediately to the nearest primary health center (PHC).
At the PHC, the medical officer confirmed that Vivek had kala azar and started him on the standard course of treatment. Later however when Vivek’s fever returned, the doctors at the PHC thought the fever was a symptom of a different illness.
Vivek’s family took him two more times to the PHC, which meant more than 15 hours of travel and spending money on medications that weren’t working. But the boy wasn’t getting better, and Vivek’s father was ready to give up.
Finally, Vivek’s father approached Praveen, the owner of a local chemist shop across the street from the PHC. Parveen is a high school graduate and has been running a small pharmacy for over 20 years.
Parveen and his wife Manisha had recently joined World Health Partners’ Sky Health Franchise Network, and run a Sky Health Telemedicine Center out of a small room behind their shop.
With training from WHP, Praveen and Manisha had learned how to operate the telemedicine software and diagnostics including taking blood pressure and giving an ECG. They has also been trained to recognize kala azar and other common illnesses in their area and refer patients for more specialized care.
Praveen and his wife connected Vivek’s family with a tele-doctor in New Delhi. This doctor instructed Vivek’s family to take him to district hospital at Hajipur, where Medicines Sans Frontiers (MSF) operates a facility to treat kala azar.
This time, Viviek was treated with a new, safer therapy. The MSF center is one of just a handful of facilities offering this therapy, which uses a more expensive drug, free of cost. Following an uncomplicated treatment course, Vivek returned home. When I met Vivek again he was a healthy, vivacious child of 6 years old.
Vivek is blissfully unaware of the odds he overcame in his battle against kala azar because a lot of things went right in his case.
First, a community health worker was readily available in Vivek’s village, and knew how to refer him to the government facility. Second, the government facility was equipped to diagnose and treat kala azar, an advance that has only occurred within the last six years. Third, when Vivek needed help beyond what the local PHC could offer, the Sky Network was able to get him to the facility run by MSF, where he could get better but affordable treatment. Finally, Vivek’s family had the courage and the tenacity, to navigate rural India’s medical maze.
It’s a success story we hope to see repeated many times over, and it’s an example of how health networks really do save lives.