The indoor department of St. Thomas` Home functions as a hospital and has 42 beds. It accommodates women with tuberculosis who are seriously ill. Many of the patients accommodated there have a drug-resistant germ and need special attention. Many of them are severely malnourished. Some have rare variants of tuberculosis, such as tuberculosis of the spine or of the brain. Many of them cannot walk up to a toilet or are not allowed to stand up for several months. Patients with tuberculosis of the spine need to keep bedrest for months, otherwise there is a risk of deterioration due to a fracture of their spine, which can lead to paraparesis (paralysis of the legs). Many patients, especially those with drug-resistant tuberculosis, experience side effects of the antibiotics used for their treatment, which may be serious enough to demotivated them to continue their treatment. Many patients have tuberculosis treatments with six or even more antibiotics at the same time every day and for an overall duration of up to 18 months and more. Few patients have to take up to 10 different antibiotics at the same time every day for a long time. These patients usually have side effects that irritate them.
Other patients are co-infected with HIV or have other serious illnesses, additionally to tuberculosis, like Diabetes (“Sugar”) or psychiatric diseases. Many patients need surgical operations. We do not operate by ourselves. We are connected to good surgeons (Dr. A. Agarwal, Dr. A.K. Bowmick and others) who do necessary operations in nursing homes outside, and our patients return to the Home once they are fit. The Home organizes around 30 operations of tuberculosis patients every year. Costs vary between 20.000, - and 1,00.000, - Rs. per operation. If we think that their family can contribute something, we ask for a small contribution, otherwise patients are getting the operation done free of charge.
We have central oxygen unit, and some patients need oxygen around the clock. We give blood transfusions when necessary. We treat concomitant diseases like Diabetes and many others. We accompany patients to tertiary level medical Colleges in the specialized departments over there and get good advice for the treatment of these concomitant diseases. Sometimes, we get a bed in one of the Medical Colleges, which isn't easy.
We accommodate children with tuberculosis, too. We have a dedicated team and our doctors do their ward rounds every day, including Sundays and national holidays.
The indoor service is usually free of charge for our patients, who come from very poor socioeconomic background. Those families who are from lower middle socioeconomic class are asked to contribute something, while majority of costs stay with us.
Literacy and Educational Classes: All patients are given sufficient scope regarding literacy and educational inputs to develop confidence and self-image for self-reliance. A trained teacher focuses on individual education plan as per ability of patient and fixes target a goal.
Social Help Unit There is a bunch of programmes available to strengthen patients to overcome the crisis period and to complete the full course of treatment and to stabilize for coping with regular life. The help is:-
Patient Entertainment Programme: On regular basis patients are taken for outing and rejuvenate through socialization like picnic and encourage to participate in social programme.
Follow-Ups: For a certain period of time, communication are maintained with patients who have completed treatment successfully.
Out Patient Department
The St. Thomas Home has an outpatient department, where anyone who lives in the nearby urban slums of Howrah can attend and can get help free of charge. We have doctors between 9:00 a.m. and 5 p.m. on all working days between Monday and Friday. Many sick people from the surrounding urban slums come to our OPD to get help. They don't have to pay for the doctor`s consultation. We have some common drugs like basic antibiotics available, that are prescribed by the OPD doctors and that are handed out free of charge to patients after their doctors' consultation.
Basic blood tests are done free of charge for the patients, too. If advanced diagnostics is necessary, we ask the patient to contribute a small amount of money, while we still bear the bigger part of the costs for such an advanced diagnostic test.
We have an own sputum-laboratory in license of the National Tuberculosis Elimination Program (NTEP), where persons with cough for long time give sputum samples for the exclusion or verification of lung tuberculosis. Microscopy of sputum samples is of crucial importance in the urban slums, where the tuberculosis epidemic is out of control. Next to the microscopy of sputum samples, we have a machine with the name TrueNat, that has been given to us by the NTEP. This machine can diagnose patients with tuberculosis at a much higher speed and with much higher accuracy than sputum microscopy can do.
We have an own X-Ray machine, and this is an advantage for the patients with tuberculosis suspect and other patients, because we can get an X-Ray done on the spot when a patient turns up who needs one. Patients don't have to come twice or thrice to see the doctor, to do an X-Ray, and to attend the doctor again with the X-Ray. With our own X-Ray machine, all this is done on a single working day.
The focus of our OPD is to identify patients with tuberculosis who live in the surrounding urban slums of Howrah and who come to our OPD because they have cough for long time, or because they have swellings at the neck (tubercular lymph nodes). We diagnose new patients with tuberculosis every day. Some are not very sick while others are seriously ill. Female patients and children with life-threatening tuberculosis can be admitted to our indoor facility on the spot if they agree.
Tuberculosis is verified in many other patients of the OPD by sputum tests (microscopy and TrueNat) or chest X-Rays.
For 15 years, the St. Thomas Home forms and guides a network of around 100 qualified doctors and local practitioners of the local urban slums who all have the same target: to stop the endless deaths of tuberculosis in the local area. Within this network, all participating doctors and local practitioners refer their patients with tuberculosis suspect and patients with verified tuberculosis to St. Thomas Home. In St. Thomas Home, our medical director and renowned specialist on lung diseases, Dr. Mita Roy Sengupta, excludes or verifies tuberculosis and gets patients started on an antitubercular treatment under NTEP, if tuberculosis is verified. If further diagnostic is done, patients get it done for free or with small own contributions.
St. Thomas Home runs four local tuberculosis medicine distribution centers (they are called DOT centers) in four different locations in the urban slums of Howrah. Patients who have been newly diagnosed as having tuberculosis can immediately start their treatment in one of our local centers which are usually nearer to their house than St. Thomas Home is. These centers hold a license under NTEP and care for more than 200 tuberculosis patients at any given day.
Through the network with other practitioners in Howrah, typical sequences of tuberculosis patients, this is treatment start in the private medical sector and loss of follow up once the patient feels better or has no money anymore, are avoided. On the long hand, this may help to get the level of drug-resistance of the local TB germ down, which is a major obstacle for a successful elimination of tuberculosis from the local urban slums.
Surgical Unit: Stich removing and dressing of wounds and any cuts are managed by our doctors and nurses.
Social Help: Mainly economically weaker section people are availing treatment and patients are encouraged to complete the full course of treatment with the support of foods, conveyance charges, educational fees, availing government benefit schemes like enrolling online for TB patients with important treatment related data and provide 500/- money to their own bank account for food support purpose and for 6 months duration of treatment.
Patients' Meetings: Patents interaction programme regular basis organized to build up their confidence and taking regular drugs without fail. Lots of discussions help them to clear their understanding level and share their issues related not only treatment but also personal and family related. The individual person may get chance to realize that he or she is not alone to have TB disease. The positive perspective developed and a mutual trust built up.
Public and Private Mix programme: To achieve the universal standardized treatment of the TB-patients regular basis contacts are with MBBS doctors, extra medical private practitioners or quack doctors, diagnostic centers, medical shop owners through seminars, meetings and up-date about the evolution of current TB treatment i.e. introduction of new medicines or schemes. Field and DOT providers meet them request to refer TB suspected cases. Private health care providers are encouraged to join in different trainings, seminars and workshops and follow thethe national guidelines outlined by the RNTCP of India.
Oxygen support: Some patents are helped at their home atmosphere the Oxygen concentrator along the portable oxygen cylinder for 24 hours. This is totally free of cost and depends upon the condition of patients and their economical situation.
Active Case Finding: This is government programme maneuvered with a team of six people comprising with staff and community volunteers for minimum 15 days and visits door to door and collecting the sample sputum for finding suspected patients.
Awareness Programme: On world tuberculosis day special programme is organized and share the information through stage programme, display posters, distribute leaflets, public speech of successful patent and eminent people participate and many community people are invited.
Staff Training: On regular basis staff are given exposures to up-date their skills and send them to attend sessions facilitated by Govt. professions like Senior Training Supervisors, District and State Tuberculosis Officers. In addition to this time-to-time staffs are given inhouse training on TB treatment issues and comorbidity factors like Diabetes.
St. Thomas Home runs four DOT-centers in Howrah, three of whom are located in large urban slums, and one near to a big urban slum. Over there, at any given day, around 250 tuberculosis patients get their treatment. Our largest center takes care for 127 patients, among them 27 patients with drug-resistant tuberculosis. This is a high responsibility, and St. Thomas Home is always alerted to maintain the quality of the work in the centers and to organize enough qualified staff, who deal with the patients. There must be sufficient equipment, too, for example a weight machine, a blood sugar machine, and, of course, uninterrupted supply of antitubercular drugs. We arrange for oxygen-cylinders for patients who are short of breath, or alternatively for oxygen-concentrators (which need an electric line in the house). We arrange for wheelchairs, walkers, nebulizer machines, callipers, and other items to enable patients to take their treatments at home and to improve themselves.
The challenge is to keep every patient on treatment. Some patients stop their tuberculosis treatment by themselves once they feel better. Other patients stop their treatment because they are not feeling better. There are migrant workers among our patients, who suddenly move house anywhere else. Some patients have serious side effects of medicine, mostly on treatment of a drug-resistant tuberculosis. Some patients are too weak to come to the center personally, and a relative comes to a center under St. Thomas Home to collect the medicine. We have dedicated staff who follow up the patients who stop their medicine, and who visit those patients who are too sick to come personally to the center. This latter group of patients has the highest risk to die from tuberculosis, and they must be brought to the doctors of St. Thomas Home by stretcher and car regularly.
Sudden emergencies can happen. Patients may start to cough up blood or to vomit endlessly on treatment. A collapse of a lung or a collapse of a spinal vertebra (in patients with spine tuberculosis) can happen and can bring patient in a difficult situation. At the time of such an emergency, there is sometimes a problem to arrange a hospital treatment. St. Thomas Home admits women and children with tuberculosis only but does not have beds for male tuberculosis patients. But there are contacts to Government institutions in Howrah, and St. Thomas Home can ask for a bed over there.
Many patients on treatment of a multidrug-resistant tuberculosis have side effects and it needs frequent and active follow up of these patients to alleviate their problems and to motivate them to continue their treatment.
Immunization is one of the most effective and cost-effective measures that medicine has ever achieved. Nowadays, people can be protected against many otherwise dangerous germs. Death and suffering of so many diseases belong to the past because people are vaccinated. Vaccines usually consist of attenuated germs, that cannot create harm anymore, or a part of a germ, for example a certain protein. When the human immune system learns to know this attenuated germ or protein, it prepares itself to fight against this germ. When the real germ infects vaccinated people, everything is prepared for a fast killing of the germs. Without the vaccine, the immune reaction of the human body would be slow, and the germ would have enough time to create many problems.
In India, there is a universal immunization program in the responsibility of the Government and pushed by the Government, through the public health system. Through this program, children, adolescents, and adults get protection against a variety of germs. At present, there is protection against the following diseases: tuberculosis, poliomyelitis, diphtheria, whooping cough, tetanus, hepatitis B, haemophiles influence, rotavirus, pneumococcus, and some more vaccines in certain areas of India, for example against Japan B encephalitis.
The herculean task of the Government health system to vaccinate all people several times against the Coronavirus is well remembered.
Most vaccines must be taken several times before the immune system of the human body is strong enough to fight against the real germ once it would come. Children must be brought usually at least five times to Government immunization centers, before they have optimum protection. Adolescents and adult people must attend for some vaccines for them, too.
Study: While in Howrah and South Twenty-Four Parganas, here are many Government health centers, the St. Thomas Home noticed that in certain trouble spots, children are not at all vaccinated. These social flashpoints are in brick fields of Howrah and Kolkata. Brick fields are big open area-factories in that bricks are produced from a mixture of wet ground of the riverbank of the Hooghly and silver sand. Producing bricks is seasonal work. In the rainy season, no bricks can be produced. This physically very hard job is done by migrant worker-families, who come to Howrah and South Twenty-Four Parganas in November and stay up to June. These families are recruited in very poor districts of India, mostly in Jharkhand and Bihar. These families live in great poverty and hardship in their villages, and they don't find work over there. These families migrate to Howrah for seasonal work and live in primitive shelters in the brick fields. They are not allowed to leave the field for the whole season. For the adult persons (husband and wife) there is lot of physically hard work, and the children - with the exemption of very small ones - usually help in this work the whole day, too.
On closer examination of these children, none of them has ever been vaccinated, no one of them has ever gone to school or intends to go to school, and many children and adolescents are malnourished and have severe vitamin deficiencies.
Interventions: Our immunization team works in brick fields of Howrah and South 24 Parganas in 21 brick fields and covers more than 2500 children. Because it is not allowed to disturb the work over there, our team can vaccinate the children and adolescents during the lunch break time only. Our team gives many vaccines to the brick field children, but not all the vaccines of the Government universal immunization program, due to financial constraints. All children and adolescents get, next to vaccines, a single dose of the medicine albendazole, a drug that kills all worms in the belly in a single time application. Next to vaccines and albendazole, all children and adolescents get high dose vitamins that protect them for a certain time against health threats due to vitamin deficiencies.
Further parents are alerted about health and hygiene. For protections from Dengue and Malaria mosquito nets are distributed along with biscuits and health drinks, toffy.
We hope that we can protect the children and adolescents from the poorest part of the population through our outreach. Because of this programme parents prefer to return to the same brick field after recession period of rainy seasons and complete the immunization course.
A certain eye disease is quite widespread in the population. Its name is cataract, and it affects the lens of the eyes, usually of both eyes at the same time. Cataract is probably a consequence of long-time UV-B ultraviolet radiation from the sun. The disease affects mostly the elder part of the population. When the eye lenses have become hazy, vision becomes cloudy. Cataract is a slowly progredient disease, and it is only after many years that patients complain to doctors about their hazy vision. There is no medicine for cataract, but it can be cured by a small eye operation. The hazy lens is taken out and a glass lens is introduced at the same position where the hazy lens was. It is a minor operation which takes 10 minutes and is done in local anesthesia. Usually, first one eye is operated on and the other one is operated later. The operation costs in the commercial sector are around 4.000, - Rs. per eye.
St. Thomas Home collects regularly patients who come for other matters to its outpatient department, but in whom additionally a diagnosis of cataract is made and gets them operation on a specific pre-planned day. On this day, an eye doctor is booked, and he or she operates on around 30 patients in the same “Eye-camp”, which is held every three months. The operation is done free of charge for the patients, and the follow-up of the eye doctor is done free of charge for them, too.
The St. Thomas Home and a former sister NGO, Howrah South Point, have got operated around one thousand patients with cataract in the last ten years. The work is going on and the staff of St. Thomas Home continues to diagnose cataract in the out-patients of the OPD and to collect their addresses for the next eye camp.
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