Where public sector is more reliable

A health assistant examining the blood smear.  

There is at least one person who is not a part of your kin, but is very keen on knowing whether you and your family members are keeping well. But you often turn him off with a curt `okay', thinking about him as another government servant who has come to scribble some data on the wall. He is none other than a health worker from the Malaria Department, which is silently doing the splendid job of controlling the disease. If you cooperate with him you are the beneficiary, otherwise... ..

There are quite a few cases in the city, where malaria patients had to shell out thousands of rupees on treatment at private hospitals. The worst part is that the treatment at many of the private clinics and nursing homes is incomplete often resulting in relapse of the disease.

The health workers take a blood smear of all persons suffering from fever. The blood samples are sent to the laboratories of the Malaria Department. The report is prepared by evening and treatment is started the same day. All this is done free of cost and at the doorstep of the patient.

There are several reasons for people, especially those living in urban areas not availing themselves of the services offered by the health assistants. Apprehensions regarding the safety of needles used for drawing the blood sample, lack of faith in the Government set- up and the false notion that only private hospitals, which charge exorbitant fee, could provide reliable treatment are some of the main causes.

The Malaria Department has a well-oiled network. The health assistants visit all the households in all the 50 wards in the city. They collect blood samples, if any member of a family suffers from fever. There is no need to be apprehensive about the safety of the needles as the health assistants use sterile pricks to draw the blood sample. They also provide drugs, which could be used without waiting for confirmation of the test report.

There are 13 malaria clinics in the city, where the patients suffering from fever can go and get their blood tested free of cost. The drugs being used are chloroquin and primaquin. Interestingly, the poor and lower middle class people are utilising the services of the health assistants and are reaping rich benefits.

Ratna Shilpa, a college student residing at Dwarakanagar, suffered from fever in June last. Her family members admitted her in a private nursing home in the same area. After conducting various tests and treating her for two days, the hospital referred the case to a private diagnostic centre. Shilpa's father, A.S. Bose Reddy, took her to the Malaria Department laboratory. The department staff took a blood smear and asked them to come the next day for the report.

The next evening, the private diagnostic laboratory gave a negative report saying the girl was not affected by malaria. A relieved Reddy did not feel the need to go to the department lab to get the report. Meanwhile, the department in its report found it to be a positive case of malaria.

The health assistants rushed to the house of Reddy and told him that the test had confirmed malaria infection. They started treatment instantly and within one day the fever was under control and there was no relapse.

A health worker collecting blood smear at a slum. --Photos: C.V. Subrahmanyam

A health worker collecting blood smear at a slum. --Photos: C.V. Subrahmanyam  

"They (the health assistants) located our house after several enquiries, as in our anxiety, we did not give them the full address the previous day. They only knew the name of our apartment complex. We are thankful to the Malaria Department people," says the girl's mother with gratitude in her eyes.

The family spent Rs.2,500 for the two-day stay at the private hospital. But for the timely intervention of the health assistants, the poor girl would have been made to suffer for the negligence of the private diagnostic laboratory.

In another case, V.V. Satyanarayana Murthy, a retired teacher residing at Shantipuram suffered from fever on March 20. The department identified it as a positive case of malaria and gave him drugs and he was cured. However, the fever relapsed again on April 30. Instead of giving this feed-back to the department, Murthy went to a private hospital in Seethammadhara. The case was diagnosed as falciparum malaria. He was hospitalised for five days and given drugs. The hospital charged him a whopping Rs.6,500!

S. Girija (13), residing at a slum at Resapuvanipalem, had to suffer from fever for about a month due to improper diagnosis. She was taken to a private practitioner at Seethammapeta junction. He gave some antibiotics, which brought down her temperature. However, there was a relapse. Finally, a health assistant who visited her house took the blood smear and the same evening, it was confirmed as malaria. She was treated for five days and completely cured.

Happily, most slum dwellers in the locality rely only on health workers for treatment of malaria. Only new comers, who are unaware of such an efficacious service, go to private doctors for treatment. "In view of the high incidence of malaria in the slum, the department has stocked the drugs in a local kirana shop for free distribution, in case of emergencies," says Kanaka Mahalakshmi, a social worker of the locality.

K. Satya Srinivas, a resident of Nakkavanipalem, was admitted to a private hospital at Dwarakanagar in June 2001. The weeklong treatment cost him Rs.8,000. He was happy that he had not gone to a corporate hospital for treatment, as it would have cost him twice or thrice that amount. In January last, there was a relapse. He came across the malaria health workers and took the drugs given by them. "Within two days, I felt better and in five days, the fever was completely under control. I overcame weakness and felt fully fit in 10 days," he recalls. This is not to say that there would be no relapse of the disease when treatment is given by the Malaria Department. However, such cases are few and far between.

The DMO, K. Prabhakara Reddy.

The DMO, K. Prabhakara Reddy.  

Cheepurapalli Babu Rao, a washerman residing at Santhipuram, says that he has been suffering from malaria on and off. He takes treatment at the clinic run by the department at Akkayyapalem. His wife had to suffer for a long time though she was treated by the health workers, one of whom explained that she was not given primaquin as she was pregnant at that time. Administration of the drug during pregnancy results in abortion. Primaquin was given to her some days after delivery and she was cured.

"There are chances of a relapse of the disease if primaquin is not given to patients along with chloroquin. Many of the private practitioners prescribe chloroquin but do not recommend primaquin," says the District Malaria Officer, K. Prabhakara Reddy.

"The main reason for private practitioners not recommending primaquin is that till last year, this drug was not available in the free market. Fortunately, the Government has removed the restrictions in the supply of the drug and it is available in the open market now. All malaria positive cases have to be invariably given primaquin."

The parasites - plasmodium vivax (PV) and plasmodium falciparum (PF) - which cause malaria are spread through the female anopheles mosquito. "The larvae of the mosquito thrive in stagnant fresh water (in open overhead tanks) and the accumulated water in discarded tyres, bottom of water coolers and water storage containers without lids," says the sub unit officer, A. Tatabbai.

In the rural areas, the mosquito thrives in stagnant water in paddy fields. While plasmodium vivax is more prevalent in urban areas, plasmodium falciparum is seen more in the rural areas.

So, next time a health worker visits your home don't turn him away saying that everyone in the family is well, concealing the fact that of one among you is down with fever. The fever could well turn out to be malaria, the treatment of which at a private hospital can burn a hole in your pocket.

The genesis

Malaria is caused by sporozoon parasites of the genus, Plasmodium. It is transmitted to man by certain species of infected female anopheline mosquitoes. The common symptoms are episodes of chills and fever with periods of latency, enlargement of spleen and secondary anaemia.

A typical malaria attack comprises three stages: The `cold stage', which is characterised by sudden onset of fever with a sensation of extreme cold. The patient desires to be covered with a blanket. This stage lasts between 15 minutes and one hour. This is followed by the `hot stage', during which the temperature may rise to 106 degrees Fahrenheit. This stage lasts for two to six hours.

At the third and final `sweating stage' the fever subsides with profuse sweating. This lasts for two to four hours. However, the three stages may not always be observed due to maturation of different species of the parasite at different times.