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(Caused by a parasite transmitted by sand flies which thrive in some parts of rural Bihar, kala azar (black fever) or visceral leishmaniasis is almost fatal if left untreated. The 2012 national data reveals that Bihar is host to nearly 80 per cent of the kala-azar patients in India. Post kala azar dermal leishmaniasis or PKDL is a neglected complication of kala azar.)
Raghubir Kumar
“I had skin rashes for about eight years. People in my village said these would go away with time. I believed them. But my condition didn’t improve,” recollected 18-year-old Raghubir Kumar, who had undergone treatment for PKDL at the MSF-supported kala azar ward in Sadar Hospital, Vaishali district.
Kumar had been cured of kala azar at a Primary Health Centre but developed the rashes a year later. He lived with the complications associated with PKDL while facing social exclusion and stigma.
PKDL affects 5 to 10 per cent patients cured of kala azar causing disfiguration and patchy skin in some cases. This disease is not life threatening but it does make life rather difficult for the patients because of the social stigma that is attached to it. People often exclude PKDL patients from social gatherings and relationships because of the visible boils and rashes that may appear threatening.
“Before my treatment for PKDL began, I was very weak. Every 2-3 months, I would feel feverish. With some tablets and injections the fever would subside,” said Kumar, conscious of not moving too much to keep the intravenous drip intact.
Apparently the medication Kumar took, expecting to be cured, was prescribed by a “local doctor” who visited his village, Ganga Harpur. The ‘doctor’ made rounds of other villages as well, but was unable to diagnose PKDL in Kumar. While he isn’t certain on the number, Kumar recalls meeting many known people afflicted by kala-azar during the time he was sick.
“I did not know I had PKDL till an MSF team came to our village and informed us about the symptoms of the disease. Information accompanied by pictures of what PKDL might look like were shared which helped me understand my condition. Some of the symptoms that I saw in the pictures were identical to what I had, so I asked them for help. They referred me to an MSF-supported ‘kala azar ward’ at the Hajipur Sadar Hospital,” said Kumar who was admitted to the ward in January 2014.
“Since I’ve sought treatment, I feel a lot better. MSF staff attends to me properly. I feel really good seeing this,” he added.
PKDL manifests itself as skin lesions in the form of rashes and boils, usually six months to one year after the completion of kala azar treatment. PKDL patients provide easy access for the sand fly to pick up the parasites and transmit it to a healthy person. PKDL is therefore seen as a reservoir of kala azar.
Raghubir Kumar was interviewed by Avantika Shrivastava
