India

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Key medical figures:
• 93,100 outpatient consultations
• 1,500 patients on first-line ARV treatment
• 820 patients under treatment for TB

India

Healthcare remains difficult to access for India’s most isolated and marginalised populations.

Longstanding, low-intensity conflict in Chhattisgarh and Andhra Pradesh has led to population displacement and reduced access to healthcare. MédecinsSans Frontières (MSF) teams continued to bring basic healthcare to people in villages through weekly mobile clinics in southern Chhattisgarh, and those living in displacement camps on the Andhra Pradesh side of  the border. Patients suffered mainly from skin infections, general body pain, respiratory tract infections and malaria. A mother and child health programme offered antenatal care,  immunisations and nutritional support for pregnant women and children in Bijapur, Chhattisgarh. Screening, diagnosis and treatment for tuberculosis (TB) were also available. In  November, a clinic providing basic healthcare was opened in Mallampeta, a remote village on the border of Andhra Pradesh and Chhattisgarh. In 2013, MSF carried out nearly 52,600  consultations and treated approximately 8,465 people with malaria in the region.

Healthcare in Nagaland
Until recently there had been few health services available in remote Nagaland state, where the years of insurgency had stunted the area’s development. Since 2010, MSF has  supported Mon district hospital by refurbishing the buildings and upgrading key services including pharmacy and medical waste management, the laboratory, infection control  measures, and water and sanitation. MSF has also provided staff training to improve medical management, with special focus on sexual and reproductive health and TB. The team carried out 30,365 outpatient consultations, assisted more than 680 deliveries and treated 15 patients for drug-resistant TB (DR-TB) in 2013. The project has been recognised by the  government and local community for the significant impact it has had on people’s access to healthcare in Mon district.

Improving access to HIV and TB care
In Mumbai, MSF  continued to provide treatment for patients with HIV and co-infections who have been excluded from government health services. In 2013, however, the focus shifted to responding to the public health crisis posed by  DR-TB in the city. MSF treated patients with the most severe forms of DR-TB. The strategy is to treat a small but acute group of patients who cannot access the government healthcare  system, and to use evidence from operational research to encourage the government to find ways and means to provide treatment for these people. MSF runs a clinic offering outpatient  care that provides third-line antiretroviral (ARV) therapy for patients with second-line ARV failure and treats patients co-infected with HIV and hepatitis B or C, or DR-TB. In addition, MSF supports a government

TB hospital with infection control and counselling services. Approximately 300 patients received treatment in 2013, including nearly 160 patients on second-line and third-line HIV  regimens, approximately 50 patients with HIV and DR-TB co-infection, and about 80 patients with DR-TB. In the northeastern state of Manipur, where the prevalence of adult HIV  infections is the highest in the country, MSF offers HIV and TB care in three clinics in Churanchandpur and Chandel districts. One of the clinics is situated in the town of Moreh, right on the border with Myanmar. More than 560 patients started treatment for HIV this year (a total of 1,244 patients were receiving treatment by the end of 2013), 299 people began treatment  for TB and 30 for multidrug-resistant TB (MDR-TB).

Mental healthcare
Decades of conflict in Kashmir have taken a toll on people’s mental health, and needs persist for psychological support. A wellestablished MSF mental health programme continued at  five fixed locations in Srinagar and Baramulla districts. Teams also visited victims of violence in Srinagar hospitals and provided psychological first aid – ensuring basic psychological,  social and material needs were being met. Counselling services were launched in Pattan in June. A total of 2,530 individual mental health consultations were provided across the  programme. Heavy rains and landslides in Uttarakhand state in mid-June caused significant flash flooding in Uttarkashi, Chamoli, Rudraprayag and Pithogarh districts. The state is  home to many holy Hindu sites and the majority of the estimated 10,000 people who lost their lives were pilgrims from all over India and the local population working with them.  MSF set up a three-month programme to support those suffering from acute distress in Rudraprayag district. More than 440 individual sessions and 37 group sessions were provided.

Treating kala azar and malnutrition in Bihar
People in Vaishali district, Bihar, live in an area where kala azar (visceral leishmaniasis), a parasitic disease transmitted by the bite of an infected sandfly, is endemic. The infection is  almost always fatal if left untreated. MSF began responding to kala azar in 2007, introducing L-AmB 20mg/kg (liposomal amphotericin B) as a first-line treatment at Sadar district  hospital and five health clinics. More than 10,000 patients were treated, with an initial cure rate of 98 per cent. Since 2012, MSF has collaborated with the Drugs for Neglected Diseases initiative (DNDi), implementing a pilot project examining the safety and effectiveness of two combination therapies, as well as an alternative, single-shot dosage of L-AmB. Initial outcomes were encouraging and the pilot programme will expand to additional districts. If these new drug regimens are proven effective and safe, the research could potentially  change national treatment protocols for the disease. In the Darbhanga district of Bihar, child malnutrition is a chronic and under-reported health crisis. MSF teams  provide weekly treatment for children with severe acute malnutrition through a community-based programme in Biraul block. In 2013, the programme expanded to cover an additional four blocks. MSF also began building a malnutrition intensive care unit inside a teaching hospital in Darbhanga to treat the most severe cases. MSF continues to work with  health authorities to define a model of care for children with severe acute malnutrition that can be implemented within the public health system. Over 13,000 children under the age of  five have been treated in Darbhanga since 2009. 

No. staff end 2013: 672 | Year MSF first worked in the country: 1999

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