A step towards Elimination of Lymphatic Filariasis  View Video
  Sitapur Model for Morbidity Management  View Presentation
  Camps held on 19th – 22nd November, 2015 & 22nd January 2017  

Lymphatic Filariasis (LF) is endemic in 51 districts of Uttar Pradesh, including Sitapur district. Here an NGO Sangtin, along with its field organization Sangtin Kisan Mazdoor Sangathan (SKMS), took up this issue due to the suffering of patients and the lack of treatment options. Their search led them to Dr. S.B. Gogia and Mrs. Arun Rekha Gogia, who have been working on the issue for decades as well as attempting to start Filaria Care clinics across India through their NGO called SATHI (www.sathi.org). Mrs. Arun Rekha operates a voluntary clinic within AIIMS Department of Surgery, where patients suffering from lymphoedema are taught self management through hygiene, exercise and compression

Patient RegistrationSangtin representatives, on the advice of Dr. P. K. Srivastava at the National Vector Borne Disease Control Programme (NVBDCP), took up line-listing of LF patients. An informal survey in 13 villages yielded a list of 262 patients – 136 with hydrocele, 121 with lymphoedema and 5 with both conditions. With this list, Sangtin representatives met the UP Principal Secretary (Health), Shri Arwind Kumar, who promised full support from the Health Department. Next, a plan was developed for a camp on morbidity management with Dr. Satya Mitra, Director Communicable Diseases.

A preliminary meeting for arranging the camp was held on 3rd November between the above government officials and their team including, Dr Saxena DDG, Dr Mithilesh Supervisor Lucknow Division and attended by SATHI (Dr S B Gogia and Ms Arun Rekha) as well as Sangtin Representatives (Ms Richa Singh and Ms Surbala). On 4th November SATHI and Sangtin held a preliminary camp at CHC Pisawan with active help from its incharge Dr Bharati. 85 patients of all the 262 invited attended it and were examined as well as counselled on the next steps benefiting from the actual camp between 19th to 22nd November, 2016

While the Health Department agreed to make all the arrangements and provide medicines for the camp, officials said that they were unable to cover the cost of the compressive bandages, which came to about Rs. 2000 per patient. Sangtin representatives then approached the local MLA, Shri Anup Gupta, who expressed great interest in the camp and the broader goal of eliminating LF in his constituency. He supported the cost of bandages through the O.P. Gupta Foundation, set up in honour of his late father.

Report of workshop and camp

On 19th November, a workshop on Lymphatic Filariasis was organized at the CMO office, which was chaired by Dr. S Tripathi, Chief Medical Superintendent (CMS), Sitapur District Hospital (DH). Various aspects of the disease were presented by Dr. Rashmi Shukla, WHO Consultant, and Dr. Shaukat Kamal, Regional Director, Lucknow. Dr. Gogia then talked about surgical interventions and morbidity management of the disease. Mrs. Arun Rekha Gogia described her work at AIIMS and the transformation in the lives of lymphoedema patients after compression bandaging, administration of penicillin (to reduce ADLA and infections) and promotion of self-care.

While Sangtin had listed 136 patients with hydrocele, many were reluctant to come forward for surgery. The lack of facilities for surgeries at the Pisawan CHC led to the shifting of the surgical cases to DH. Currently being the sowing time for the rabi crop was another deterrent. Finally, 14 men got screened at DH and a few more at Pisawan. Of these, 3 decided to get operated (and were on 21st November) alongside another who came for opinion regarding hydrocele but was felt to be a testicular tumour and hence operated for the same. The positive outcome of these patients may encourage more to get operated.

Of the lymphoedema patients, 55 arrived in time at the Pisawan CHC on November 20th to get registered and complete the initial procedures. These included photography, examination and measurement of their limbs as well as administration of penicillin injections. All the patients were then classified according to disease status as follows

The 33 patients with Grade II and Grade III lymphoedema were shown how to self manage & bandage themselves. Follow-up with these patients was done on the 21st and 22nd and 3 of them received bandaging for their other leg as well.

The Complete procedure was repeated next day. Bandage of the patients were opened on the next day with remarkable visible as well as measurable outcomes in the form of reduction in circumference upto 4 cm at places, along with the feeling of light and smooth skin. That it occurred in a largely rural and relatively less educated population by self tying of bandages meant that such such outcomes are easily replicable in a large scale

Additional patients, including those not from the previously surveyed areas turned up on the afternoon of the 20th and on the 21st after hearing of the camp. Many of them had Grade II and Grade III lymphoedema. Due to the unavailability of penicillin injections and of Dr. Gogia (who was at the DH for the hydrocele camp), these patients could not be accommodated. However, they received counselling on exercise and hygiene and 62 of them were registered at the Pisawan CHC.

Leg WashingNext steps

In consultation with Dr. Bharti (MO, Pisawan CHC), the follow-up session for the 55 lymphoedema patients was scheduled for December 17th, 2015. On this day, all the patients would receive penicillin injections and Dr. Bharti agreed to file a requisition for the same. Follow-up is required to ensure this.

A crucial step for a Filaria-free Pisawan is compliance with the Mass Drug Administration (MDA) programme for LF, scheduled for December 14th-16th. In preparation for this, an accurate line listing must be conducted in Pisawan. Sangtin Kisan Mazdoor Sangathan is willing to work with the Health Department in planning and implementing activities to improve compliance.

How to BandageFinally, a plan must be developed for morbidity management of the many patients suffering from lymphoedema and hydrocele. This has been acknowledged as the weak link of the government's Elimination of Lymphatic Filariasis (ELF) programme. But, as has been demonstrated with the recent workshop and camp, collaboration of the Department with experts, local field organizations and elected representatives can take us closer to eliminating LF and alleviating the suffering of countless patients.

Follow up

Camps were done every month where patients were provided oral penicillin. These continued for 3 months and data sent to SATHI for evaluation. Comparing the size of both limbs there now seemed to be major improvement in volume of the side given the bandage. Average reduction in limb size which was 38% within the first or second day was 69.8% at the end of month 4. Results was published as a letter to NMJI

A repeat survey of incidence was conducted in May/June 2015 which showed there were around 11000 patients or 4.98% of the population suffering from ill effects of Filariasis.

A repeat camp was held in January 2017 only one day of presence of SATHI members was required as the local volunteers are now well trained. Monthly follow up camps by local volunteers along with monitoring by SATHI staff is showing excellent progress. 

We are in the process of compiling results and shall publish soon. 

Patients apply Moisturising creamPatient bandaged legsPenicillin injection

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