The National AYUSH Mission under the Ministry of AYUSH has adopted the Institute of Dermatology (IAD), Kasargod in Kerala treatment as the public health program for treating Lymphatic Filariasis.
To benefit thousands of patients: This measure of the AYUSH Mission under the Ministry of AYUSH, Government of India is a feather in the cap of IAD, known for its contributions and accomplishments in the field of Dermatology and more so concerning treating Lymphatic Filariasis (LF) also known as Lymphoedema. Dr SR Narahari, Founder-Director IAD has expressed his happiness over the recognition, saying-"We are honoured by the Union Government's decision to implement our treatment protocol for the benefit of thousands of patients".
A neglected disease of the poor: Lymphatic Filariasis (LF) also known as Lymphoedema or Shleepada in Ayurveda and Daul feel in Unani is a neglected disease of the poor endemic in over 16 States and 5 Union Territories (257 endemic districts).
Global Programme for the Elimination: The Global Programme for the Elimination of Lymphatic Filariasis (GPELF) was set up by WHO to address two major objectives to achieve global elimination of LF through mass drug administration and morbidity control of Lymphoedema. In addition, there is a need to develop a nationwide public health programme of proven effectiveness to manage Lymphoedema caused by LF or other causes.
Community-level morbidity control: The Central Council for Research in Ayurvedic Sciences, Ministry of Ayush (then Department of AYUSH) conducted community-level morbidity control of Lymphoedema using self-care and integrative treatment in two Lymphatic Filariasis endemic districts of South India; Gulbarga and Alappuzha, based on integrative treatment protocol for morbidity reduction of LF by including Ayurveda and yoga developed by Institute of Applied Dermatology (IAD), Kasaragod.
Appeal to adapt national MMDP program: These AYUSH-based protocols could be followed up in the natural habitat of most LF patients. The study showed that the locally available and trained workers may be trained and deployed to deliver the technical aspects of integrative treatment. The outcomes are published in the Transactions of the Royal Society of Tropical Medicine & Hygiene. ‘Lympology’ official Journal of the International Society of Lymphology, Arizona wrote an editorial appealing to developing nations to adapt the treatment to their national MMDP program.
Objectives:
Managing morbidity and preventing disability among people who have already been affected by Lymphatic Filariasis.
Target Population:
People living in endemic districts and suffering from Lymphatic Filariasis.
Strategies & Implementation:
The community outreach to the patient from the line list provided by the National Filaria Elimination Programme. AYUSH intervention and regular follow-up till the patients are re-habilitated may be undertaken under the supervision of nearby AYUSH teaching hospitals.
AYUSH colleges as regional training centres: The AYUSH Health Wellness Centres/AYUSH dispensaries in the endemic region may undertake the screening at AYUSH wellness centres and later it may be linked to patient support at referral to AYUSH hospital. The medicines and other logistics for this program may be supported through the existing AYUSH hospitals including teaching hospitals. AYUSH hospitals and AYUSH medical colleges could be developed as regional training centres.
Key steps of the programme: The key steps of the Ayush Public Health Programme for Lymphatic Filariasis will be:
Health Promotion Including the Use of IEC for Behaviour Change Communication 61
AYUSH Intervention for Morbidity Management and Disability Prevention
Implementation & Monitoring
Outcome Assessment of AYUSH Intervention
Health Promotion Including the use of IEC for Behavior Change communication:
The promotion of healthy behaviours including the need for adopting appropriate hygienic measures amongst vulnerable communities is a crucial step in the prevention of LF and related clinical manifestations.
Regional Health Care Workers (HCWs)/ ASHA workers shall be trained to verbally spread awareness about the disease in the allotted communities. They shall also be provided with necessary IEC material/ brochures displaying the need for eliminating mosquito breeding sites, avoidance of mosquito bites, appropriate way of limb washing, wound care, foot care, suitable footwear, the need for regular exercise and limb elevation whenever possible, measures to be taken at home when suffering from acute attacks etc.
Stigmatization associated with the disease is another important area that needs redressal at the community level in local gatherings, panchayats, religious events etc. Social stigma often leads to hesitation in people and stops them from seeking timely medical advice. The target population shall be encouraged to pay routine visits to the designated medical facility and share their concerns with the treating AYUSH doctor.
AYUSH Intervention for Morbidity Management and Disability Prevention:
Ayurveda & Yoga:
In Ayurveda (a widely used traditional Indian system of Medicine), manifestations resembling elephantiasis are described as Shleepada, from the Sanskrit terms Shlee = elephant skin and Paada =foot. Lower limb filarial lymphedema is proposed to be supportively managed by using yoga exercises, skin care measures using Ayurveda medicines etc. The lymphedema is graded according to the International Society of Lymphology Consensus Statement 2003.
Skincare measures: meticulous soap and water wash every day. Following the wash, the affected limb will be immersed in an ayurvedic skin care “phanta” solution for 20 minutes. The Phanta may be prepared by selected drugs containing Manjistha, Sariva, Yestimadhu, and Triphala based on the ayurvedic principles of treatment.
Unhealthy granulation tissues and slough on the floor of the ulcer will be treated with Jatyadithaila of Ayurveda for chemical debridement to increase the rate of wound healing. Skin care also will be included for regular cleaning and cutting of nails and hair. Patients will be strictly advised to use good, well-fitting, cobbler-made footwear.
Swedana, ekanga swedana, udwartana and external lepana are indicated in these conditions. In addition, they may be advised to take oral Ayurvedic preparations based on patients-related clinical signs and symptoms. 62 National AYUSH Mission Operational Guidelines.
Patients will be advised to avoid weight gain and to observe restrictions in diet. A list of restricted and allowed dietary constituents will be provided. In general, eating a balanced with low fat, low carbohydrate, low salt and low on meat products and curd may be followed.
-Manohar Yadavatti
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