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Jeevraj Adhikari, a TB educator in the Kathmandu slum, talks to people about the disease. Photo by Kiran Panday.
Chan. “Dr. Bam was constantly on the road, always out supervising people, meeting with private doctors, trying to motivate them. He was a stickler for information – he made sure people submitted the right information. From then on, there was a different picture. For the next four or five years, we had a period of rapid expansion to reach 100 percent of the country.” TB cure rates, which had hovered around 45 percent before DOTS began, soared to more than 80 percent, and would eventually reach 90 percent in 2009. The country achieved nationwide DOTS coverage in 2001, started to treat multiple-drug resistant TB in 2005, and wrote a new National Strategic Plan in 2010 that outlined strategies and goals for the next five years. The Global Fund to Fight AIDS, TB, and Malaria awarded Nepal a $56 million, five-year grant to help it meet those goals. Nepal, a rarely told story in the expansion of global TB efforts, now is being tested again. The small mountainous country of 27 million people, wedged between India and China, is intensifying its battle against TB strains resistant to drugs, which threaten to torpedo past efforts.
Dr. Kashi Kant Jha, a TB medical specialist who worked with Bam in those early days, now leads the country program. He is confident Nepal’s TB program can meet new difficulties. “If your home is strong and you are earnest, you will get support and get good results,” he said. Long List of New Challenges But Jha said the job wouldn’t be easy. Among the new challenges: health workers need more training; the lack of laboratory facilities in many parts of the country; the high number of MDR- and XDR-TB (extensively drug resistant) cases identified in the last five years; concerns of co-infection with the country’s estimated 60,000 HIV-positive patients; and the lack of a TB hospital in the entire country, which means that even people with infectious drug-resistant TB remained in the community, not in an isolated setting. The National Strategic Plan calls for 125 new microscopy centers in under-served areas; building Nepal’s first chest hospital that would have 150 beds;
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