Nyaya Health

Posted by Tanya Shah

Eight months ago, a 74-year old man who lives near the Nyaya Health clinic came to our out-patient department because he was feeling ill. Upon performing a physical exam, he was diagnosed with high blood pressure. Through a series of lab tests using the I-Stat machine, the patient was found to also have non-insulin-dependent diabetes and poor kidney function (creatinine: 3.1). Without immediate and proper treatment, the patient would likely have suffered kidney failure in the near future as dialysis is not an option in this remote resource-denied area of Nepal.

Based on the diagnoses, the patient was given medication that would help control his blood pressure while being protective for the kidneys. He was also given medicine to control his diabetes.

Today, the patient returned to our clinic for a regular follow-up. We found that his kidney function has returned to nearly normal levels (creatinine: 1.2) and both his sugar and blood pressure levels are under control. We gave him another month of medication. When he returns for more medication the following month, we will perform another checkup and do repeat blood tests at that time.

Our lab technician, Santosh Shrestha, uses the I-Stat machine for lab tests.

This case highlights the challenges we face regarding treatment of chronic illnesses. These diseases often have no obvious symptoms – without regular checkups and lab tests at the clinic, patients with illnesses such as diabetes and high blood pressure are unlikely to be diagnosed until it is too late.

Another challenge we face is finding a way to provide this continuity of care for patients who, unlike the man in this case, live far from our clinic. Such patients are more likely to miss regular follow-up appointments. We aim to begin addressing the need for chronic care management in the community through the expansion of our community health worker program.

But this case does demonstrate the treatment success we can attain with proper management of chronic illnesses. This patient, who was quite ill less than a year ago, was able to walk out of our clinic today with a big smile on his face and jokes about how some of the staff members can best find a wife!

Lal Kunwar, one of our health assistants, checks the patient during a follow-up visit.