Background

Persons afflicted with Elephantiasis, one of the worst ill effects of Filariasis are commonly seen in East UP, Bihar as well as the coastal regions of our country. It was considered as untreatable till recently. A National Filaria Control Program has been functioning since 1956 but success in prevention let alone its control has been eluded so far. The mainstay of prevention is mosquito elimination and administration of DEC tablets. China has been able to decrease the incidence of fresh cases by salt fortification of DEC. In India only the state of Tamilnadu has been active so far in this regard - a salt fortification program has been started in Kanyakumari District. Also a program of mass administration of DEC tablets to the entire endemic district in one go has been working since the last two years - the theory being to kill the worm in the entire population, thus if the mosquito cannot acquire microfilaria, they cannot transmit it. However, some reactions are known to occur to DEC administration which rarely makes the patients with lymphoedema better. Tamilnadu is the first state to start treatment centers for lymphoedema. The need is basically to promote mass use of DEC.
 

Following up on the successful results of a Filaria Therapy Trial unit at Chengalpattu, which has been operational since 1996-97, the Department of Public Health & Preventive Medicine of Tamil Nadu (Malaria & Filaria) is in the process of setting up Filaria clinics in its' Filaria endemic districts from 1997-98 onwards. So far 60 units have been set up and over 20 more are planned for the current year. These units offer a variety of treatment modalities to the afflicted patients as therapeutic support to the administration of DEC, since it is well known that DEC does not stop progression of clinical disease beyond a certain point and may even worsen the clinical condition in the short term.

These clinics were provided Interferential Therapy Machines (IFT), Heat Therapy machines as well as Pneumatic Compression machines (VIPEL) along with supply of Lympedim tablets.

As a doctor, I have been involved in promoting the use of one of these machines (VIPEL) which is made under my guidance. I have regularly involved in training the health workers who use these machines.

Report
NAGERCOIL (18/9/2000) One could immediately notice the marked improvement present in the two patients undergoing treatment against those yet to start therapy.

One was impressed by the chart displayed in the District Filaria Office showing the marked decline in MF density over the last 6 years - from 4.93 to 0.08 - reflecting on the immense success of the salt fortification program with DEC.

KUMBAKONAM (19/9/2000 Morning) One could immediately notice the marked improvement was present in both the two patients seen as they were undergoing treatment. Dr Sivapunnian, DFO commented that they already had records of over 2500 satisfied patients.

VELLORE (20/9/2000)Dr Gopalarathinum, District Entomologist, commented on the current experience which they had gained as well as the positive outcome of the Filaria treatment center at the Govt. Pentland Hospital. There was an excellent feedback from the health workers operating the clinics. The questions were not as to whether therapy was effective but rather which of the three modes available was more effective.

Later, the existing Filaria clinic at Govt. Pentland Hospital was visited and the patients undergoing treatment were seen to be happy. I was informed that about the novel method of promotion of that clinic - VIPEL and IFT machines were carried twice a week to the villages, and shown to the patients and then they were told to come to the hospital to undergo therapy. This resulted in a large turnover with the unfortunate problem of a waiting list.

Dr Gopalarathinam showed me the registers demonstrating excellent record maintenance as well as clinical details which he plans to use for a detailed study comparing the results of various modes of therapy as well as provide recommendations as to which would be best suited for what stage of disease.

General Comments:

1. There is no doubt now that the program for morbidity control for Filaria afflicted patients initiated by Department of Public Health & Preventive Medicine (Malaria & Filaria) is remarkably successful. Over 10000 patients have been treated with remarkable results. This program should not only be extended to other affected districts but also demonstrated to other states
2. The individual efforts of Filaria Officers and Entomologists (notably Dr Gopalarathinam) in studying the various available therapy modes as well as choosing the most suited in their area should be promoted. They should be encouraged to present papers on their findings.
3. The cleaning regime being followed is largely satisfactory with a little more emphasis on anti fungal treatment
4. The remarkable innovation of inviting patients to the clinic by showing them the machines in their native village (Vellore) is really commendable.

Your program is successful. I have myself learnt a lot from this visit and plan to publicize the good results obtained by your clinics. All the workers currently running the clinics as well as their seniors deserve commendation for running an excellent innovative program which I am sure will work as a shining example for other states.
 

Dr S B Gogia                                     25 September 2000

Consultant Surgeon

Consultant to AMLA MEDIQUIP