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A villager from east India, all Ramesh knew was that this illness meant certain death. He had a wife and a little girl. His monthly income was just INR 3,000 (approx. US$70). He had an idea that treatment for this illness would cost thousands of rupees every month, which he would never be able to afford. His family would shun him forever once they learned of his medical condition. There seemed to be no way out -- so he consumed eight cakes of rat poison to end his misery.
Ramesh was lucky. He survived the suicide attempt and was referred to a unique non-governmental organization called Samvedan. The organization was formed in 1999 at the initiative of Dr. Geeta Bhave, former head of the department of microbiology at the prestigious KEM hospital in Mumbai.
Bhave had been involved with treating HIV patients since 1989. A dedicated doctor, she had no intention of discontinuing her work after her retirement in 1999. Instead, she established this organization and began working with HIV patients with renewed vigor and gusto.
Samvedan (a Sanskrit word meaning 'I feel your pain') adopts an integrated approach toward treating HIV patients, an extraordinary blend of alternative and modern medicine. It offers personalized counseling and treatment at an affordable cost, with quite satisfying results, both for the patient and for Samvedan.
The human immunodeficiency virus, or HIV, attacks certain cells in the blood known as CD4 lymphocytes, which are responsible for the body's defense system. The normal count of these cells is about 800-1,000 per cubic millimeter of blood. As these cells die, the body loses its ability to fight infections.
When the CD4 count drops to below 200, the patient becomes very susceptible to infections called opportunistic infections. They can be fatal in HIV positive patients. These can be tuberculosis, herpes, pneumonias and even some cancers. Once this happens, the patient is said to have developed acquired immune deficiency syndrome, or AIDS. A patient with AIDS will hardly ever live longer than a year.
To date, there is no vaccine to prevent HIV infection, nor is there a drug to cure the infection. The patient's immunity drops slowly, over a period of 5-6 years. So the mainstay of treatment for HIV infection is prevention of the development of AIDS by using medicines to boost the patient's immunity. Conventionally, this is done with the help of anti-retroviral drugs. They prevent damage to CD4 cells and thus protect the body's defense system from damage. The cost of anti-retroviral drugs is about INR 1500 (approx. US$37) per month. This is half the monthly income of an average Indian.
Keeping this challenge in mind, at Samvedan Bhave has devised a "four strengths" program to strengthen the immunity. The first two strengths are willpower and controlling emotions like fear, stress and depression. A practitioner of yoga and meditation herself, Bhave believes that any illness can be conquered by an individual's will.
"Negative emotions have an unfavorable impact on every cell of the body. We explain this to our patients and urge them to think positive," she says. Samvedan teaches its patients techniques to improve their willpower and reduce fear.
The next strength is appropriate nutrition. "I have observed that people from all strata have a very poor sense of nutrition. A balanced protein-rich diet is most essential in HIV patients to promote the immunity," she says. The counselors at Samvedan go to great lengths to design diets for patients that suit their lifestyles and their incomes.
The last strength is the use of alternative therapy, in the form of homeopathy and Ayurveda, the traditional Indian system of herbal medicine. Bhave's in-depth knowledge of these two medical sciences allows her to select Indian herbs that improve the immune system. With help from experts in these fields, she has devised therapies that augment the immunity of HIV patients at the cost of just INR 300 (US$7.40) per month. Most patients can afford this.
This is an unconventional method of treatment, but it has shown very encouraging results. The patients are monitored by a CD4 count every year. Ninety percent of Bhave's patients have a good count, above 500. Only if the count falls below 200 are they started on conventional anti-retroviral therapy. "I prefer to postpone that therapy as long as possible. It is expensive and so most patients discontinue it. That gives rise to drug resistance. Patients stop responding to them."
Samvedan has centers in several cities in India including Mumbai, Pune, Nasik, Aurangabad and Yavatmal. There are about 1,500 registered patients. I spoke with Ramesh at the Pune center. Located in the densely populated residential area of Kothrud, the unassuming 500-square-foot clinic caters to some 500 registered patients. Patients come from nearby villages and suburbs for follow-up every one or two months.
Bhave, looking much younger than her 67 years, sits patiently and talks with her patients with great empathy. The patients speak openly with her. After receiving treatment from her for many years, they feel she is like family. "Some of my patients have been coming to me for the past 10 years. And they are still AIDS-free and doing well," she says.
Today, eight years since being diagnosed with HIV, Ramesh is a healthy adult weighing 80 kilograms (176 pounds). He is employed and can support his family. He does not suffer from any opportunistic infections. He is happy and optimistic, and looks forward to tomorrow. His family is still in the dark about his HIV status. His wife and daughter are HIV negative. His last CD4 count, which was done in 2003, was 600. He needs to repeat the test now, but the cost of the test at INR 1,800 (US$44.70) is too steep for him. Bhave has referred him to the Nana Palkar Trust and Counseling Center in Mumbai, a charitable organization that charges just INR 250 (US$6.20) for a CD4 count.
According to the Center for Disease Control and Prevention, India houses the second largest number of people living with HIV and AIDS in the world. There are almost 5 million HIV positive people in the country. Most are concentrated among the poor, marginalized groups. Ninety percent of the cases are seen among the sexually active and economically productive individuals aged 15-44 years. Health funds are low and patient ignorance is high among this group.
However, there is hope amid the despair. Even in such daunting circumstances, small low-profile organizations like Samvedan are making a commendable contribution toward lessening society's burden of AIDS, and making a good job of it.
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(Dr. Pradnya Kulkarni is a former clinical pathologist for a private laboratory in Pune, India. She now devotes her time to writing medical articles.)
