Follow-ups

As I mentioned in the last post, we see our patients at 3 months and 6 months after they have been discharged from the hospital. If fever and splenomegaly are still present at the follow-up visit, the patient may have relapsed. These patients need to come into the hospital for a splenic aspirate. Most patients are symptom free; these patients have been cured.

Despite the cost and the hassle, approximately 80% of our patients come back to the hospital for follow-up visits. If they don’t come back, we go out and look for them.

I went out with our follow-up team last week. It turns out that finding each patient is more difficult than you might think. The process involves going to nearest town and asking directions to the village. When we find the village, we need to ask if the patient is known there. Half the time, this involves a long discussion of the father’s name, the grandfather’s name, etc. A child is sent off to the fields to bring back the patient. Sometimes the person found is not the person we are looking for (e.g. same name but different age, height, etc). It took, on average, an hour or two to find each patient from the nearest town.

I enjoyed the follow-up visits, particularly because it took me from urban India to rural India. At each village, everybody stopped what they were dong to watch; there’s not much privacy in village life. Within minutes there was always a big crowd around us. Our health educators took each opportunity to educate the people about kala-azar. There were many questions.