Problem
WHO classified Elephantiasis as a ‘Neglected disease of the poor’ because there is so little research into this tropical disease and both allopathic pharmaceutical industry and Governments have ignored causation for too long. One third of the world’s LF patients live in India. Elephantiasis causes appalling disfigurement with estimated losses of $1 billion annually to rural economy5. Most patients are in villages disabled by their swollen legs and suffer repeated, additional fever episodes. Many were once their families’ bread winners.

Global
Global Alliance for Elimination of Lymphatic Filariasis (GAELF) is supporting LF elimination program through mass drug administration to over 470 million Indians who are at risk of infection. These drugs kill parasites circulating in blood and break disease transmission. But the drugs have little effect on the already swollen limbs. Morbidity control is not yet activated as a major part of the programme in GAELF & Drugs for neglected diseases initiative. Since disease affects poor private health care including the multinational pharmaceutical industry has little interest in managing these patients. Therefore elephantiasis patients are not offered effective treatments and are neglected.

Photo gallery of before and after treatment of Lymphatic Filariasis


Indian Scenario
An estimated 60 million people the world over suffer from this disease of which Asia alone accounts for 50 per cent. Out of 30 million filarial cases in Asia, there are 23 million in India accounting for 80 per cent of the Asian load. Out of the estimated 2.3 crore patients with disability due to LF, Bihar (17%), Kerala (15.7%), UP (14.6%) and Orissa are most endemic. The Indian states namely Andhra Pradesh, Bihar, Kerala, Karnataka, Orissa, Uttar Pradesh, Tamil Nadu, and West Bengal, contribute over 86% of MF carriers and 97% of disease cases in the country.

Background

• The Institute of Applied Dermatology (IAD)a non profit oriented charitable NGO working in the field of health systems research developed a self care, home based, patient led, ethical and evidence based therapy combining Ayurveda, yoga therapy and biomedicine on a pathophysiological basis derived from biomedicine. IAD treatment reduces disability and lost working days of elephantiasis patients, many of whom are poor, through ‘Treatment empowerment’ and training.
• IAD demonstrated to peers the efficacy & scientific basis of integrated self care treatment in the two previous national seminars, This research was mentored by Emeritus Professor T J Ryan (Department of Dermatology, Oxford Medical School) and was supported as an extramural project of Kerala State Council for Science, Technology & Environment, Thiruvananthapuram (KSCSTE), during 2004–05. Both the Indian Council for Medical Research, New Delhi, (ICMR) & KSCSTE supported the peer review of this treatment protocol (pilot study) during the first National seminar on Evidence Based and Integrated Medicine for Lymphatic Filariasis, other Chronic Dermatoses and HIV/AIDS on February 200510. Later the International Society of Lymphology awarded its president’s prize to this study during the 20th international congress of Lymphology held at Brazil (2005) and ICMR discussed this protocol in the medical development congress (2006). This approach is supported by editorials in American & European journals. The brief details of this AYUSH intervention also appears on WHO’s web–based platform, Tropical Disease Research to foster Innovation and Knowledge Application (http://www.tropika.net), created for the acquisition, review and sharing of current information and knowledge on potential innovations for interventions and control of infectious diseases of poverty.
• Another lead group involved in the development of treatments for lymphodema in East and West, the International Lymphodema Framework, the Thames Valley University, London, joined with IAD to organize the 3rd national seminar in February 2008 to discuss the future strategies for morbidity management of lymphoedema in high prevalent nations. The focal theme was the development of strategies for morbidity control of LF in the endemic states by patient empowerment through creation of Patient Support Peer Group cooperatives (PSPG) using locally available AYUSH interventions and linking them to local AYUSH practitioners. This proposal has incorporated the recommendations on the focus theme of the 3rd National seminar that was supported by Government departments: ICMR, DST, KSCSTE and AYUSH

Experience

• The team also gained experience in treating 567 cases with varied presentations from different part of the endemic states like Andrapradesh, Tamilnadu, Kerala, Karnataka, Chhattisgarh, and Maharashtra by 14 days inpatient care in Kasaragod with an overall result of 95 % .We have evidenced based experience in treating 72 patients on Out patient basis with 90 % success rate
• We propose to conduct a pilot project by implementing the same protocol through the Patient support peer group cooperatives through distance management methodology using telemedicine technology. So that the the patients in remote areas of the endemic states can obtain the treatment without really travelling to the cities in search of expensive tertiary care facility.
• The protocol is developed by IAD. We have trained and experienced mutually oriented multidisciplinary team of doctors from Ayurveda, Allopathy and Homoeopathy and yoga therapists, messier and physiotherapists. We have an KPO agreement with a local hospital to use the facility to admit, treat and train the patients in Kasaragod.
• Besides developing a new, integrative, home care model for the morbidity control of lymphatic filariasis, the team also gained experience in treating 470 cases from different part of the endemic states like Andrapradesh, Tamilnadu, Kerala, Karnataka, Chatisgadh, and Maharashtra with varied presentations. We have also trained equal number of filarial affected families to take care of the sick at home. Nurses, Yoga therapists, Physiotherapists, compression providers, Doctors from Allopathy, Ayurveda and Homoeopathy are also been trained to implement the protocol,
• Our filariasis patients come from low income groups living in poor hygienic conditions. They suffer severe disability due to chronic leg swelling and acute filarial fever. Our low–cost, integrative treatment aims to reduce their morbidity and dependency on others, and to make them self–reliant.