TELEMEDICINE
कुष्ठरोगको जटिलता र हाम्रो समाज
शिवमन्दिरका ती अनगिन्ती खुड्किलाहरु अनि हजारौंका भिडमा पनि हराउन नसकेका केही व्यक्तिहरुमा मेरा आँखा एकाएक अडिन्छन् । पेशाले म चिकित्सक, त्यसैले पनि होला, मानिसका शरीरका स्वास्थ्य अंगहरुमा भन्दा अस्वस्थ अंगहरुमा आँखाहरु रोकिन पुग्छन् । लस्करै बसेका मुहारहरुमा धेरै असमानता भए तापनि उनीहरूमा केही कुराको समानता भने पक्कै थियो। केहिका हातका औलाहरु साना,झरेका जस्ता थिए भने केहीका खुट्टाका औंलाहरु झरेका जस्ता थिए । कसैका हातका औंलाहरु सबै झरी सकेका थिए भने कसैका खुट्टाका औंलाहरु बाँकी थिएनन् । कसैका नाक भिन्न थिए भने कसैका आँखीभौ बाँकी नै थिएनन् । उहाँहरु मध्ये कतिले कालो चस्मा, काठको लट्ठी र एउटा थाल आफैसँग राखेका थिए । यी दृश्यहरू थुप्रै धार्मिक तीर्थस्थलहरुमा देख्न सकिन्छ । यस्ता जटिलताहरु थुप्रै रोगले निम्त्याउन सक्ने भएपनि मलाई भने मुख्यतः कुष्ठरोगका जटिलता तर्फ सोच्न बाध्य बनाउँछन् ।
विश्वका विभिन्न देशहरुमा कुष्ठरोग उन्मूलन भइसकेका छन् भने ब्राजिल,भारत र इन्डोनेसिया जस्ता एसियाली एवं अफ्रिकी देशहरूमा कुष्ठरोगका बिरामीहरू मुख्यतः भेटिन्छन् ।विश्वमा वर्षेनी लगभग दुई लाख व्यक्तिहरुमा कुष्ठरोग देखिने कुरा विभिन्न तथ्यांकहरुले पुष्टि गर्दछ।कुष्ठरोगका विरामीहरु भेटिने एसियाली मुलुक मध्ये नेपालमा पनि वर्षमा लगभग तीन हजार नयाँ विरामीहरु फेला पर्ने आङ्कलन छ ।यद्यपि कोरोना सङ्क्रमणका कारण गत तीन वर्षहरुमा यो संख्या भन्दा थोरै विरामीहरु देखिए तापनि आउने वर्षहरुमा कुष्ठरोगका विरामीहरु नबढ्लान् भन्न सकिने स्थिति छैन।
कुष्ठरोग एक संक्रमक रोग हो। कुष्ठरोग Mycobacterium leprae भन्ने किटाणु(ब्याक्टेरिया) को संक्रमणले हुने गर्दछ। यो ब्याक्टेरिया एक संक्रमित व्यक्तिबाट अर्को व्यक्तिमा नाक र मुखबाट निस्किने पदार्थहरु (खोक्दा, थुक्दा, हाछिउ गर्दा)बाट सर्ने गर्दछ। संक्रमण हुन लामो समयसम्म संक्रमित व्यक्तिसँग नजिक रहेको हुनु पर्दछ र त्यस्ता व्यक्तिहरूमा ब्याक्टेरियाको मात्रा धेरै भएको खण्डमा छालामा देखिएका फुस्रो छोएको थाहा नहुने दाग बाट पनि अन्य व्यक्तिमा सर्न सक्ने सम्भावना हुन्छ। कुष्ठरोगले मुख्यतः छाला,नसा, माथिल्लो श्वास नली र आँखामा असर गर्दछ।
छालामा फुस्रो छोएको थाहा नहुने दाग वा रातो दाग/धब्बा देखिनु, छाला छोएको थाहा नहुनु, शरीरका विभिन्न भागमा डल्लो गिर्खा आउनु,आखिभौ हराउनु,शरीर हातगोडाहरु छोएको थाहा नहुनुर कमजोर हुनु नसा दुख्नु झमझम गर्नु वा मोटो हुनु,नाक बन्द हुनु वा नाकबाट रगत आउनु,आँखाको हेर्ने शक्तिमा कमी आउनु जस्ता विभिन्न लक्षणहरू कुष्ठरोगका हुन सक्छन्। यस्ता लक्षणहरु देखिएमा नजिकैको स्वास्थ्य चौकीमा गएर उपचार गर्नु पर्दछ। चिकित्सकले बिरामीको छाला,नसा,मासु,आँखा एवं सम्पूर्ण शरीर जाँच गरी Mycobacterium leprae किटाणु भएको पुष्टि भएमा औषधि-उपचार सुरु गरेमा यो रोग निको हुने गर्दछ। धेरै जस्तो परिवारमा नै यो रोग देखिने भएकाले अन्य परिवारजनमा यी लक्षणहरु भए-नभएको आवश्यक जाँचका लागि चिकित्सकले सल्लाह दिने गर्दछन्। उपचार सुरु भएको केही समयमा नै कुष्ठरोग संक्रमित व्यक्तिले अरूलाई कुष्ठरोग सार्न सक्दैनन्।
उपचारमा ढिलाई गरिएमा यसले थुप्रै जटिलताहरु निम्त्याउने गर्दछ। हातगोडाका छालाले छोएको थाहा नभई घाउ चोटपटक लागेर हातगोडा डुडो हुने,नसाको जटिलताका कारण हात-गोडाका मासुहरु सुक्दै जाने र अति कमजोर हुने,नसाको दुखाई, आँखामा समस्या भई आँखाको शक्तिमा ह्रास आउने,शरीरमा विभिन्न भागहरुमा डल्लाहरु आएर ज्वरो आइ सिकिस्त बनाउने जस्ता अनेकौं जटिलताहरु सामना गर्नुपर्ने हुनसक्छ।
नेपालमा कुष्ठरोगको जनचेतना धेरै नै न्यून रहेको विभिन्न अध्ययनहरुले देखाएका छन्। यद्यपि कुष्ठरोगको बारेमा जानकारी भएका व्यक्तिहरु पनि उपचारमा ढिलाइ गर्ने गरेको पाइन्छ। अघिल्लो जन्ममा थुप्रै पापहरु गरेका कारणले गर्दा यो जन्ममा सजाय स्वरुप कुष्ठरोग लाग्ने गर्दछ भन्ने विभिन्न धार्मिक ग्रन्थहरुमा उल्लेख गरिएको कारणले गर्दा अझै पनि नेपाली मानसिकतामा कुष्ठरोग एक संक्रमण रोग नभैकन पछिल्लो जन्मको पापको रुपमा चित्रित छ । अझै पनि नेपालका थुप्रै जिल्लामा कुष्ठरोगीहरुले आफ्नै घर परिवारबाट पनि हेला र तिरस्कार सहनु पर्ने बाध्यता, समाजले हेर्ने दृष्टिकोणमा क्षुद्रता एवं उपचारका क्रममा छालामा देखिने परिवर्तनले गर्दा हजारौ व्यक्तिहरु उपचारबाट टाढा हुने गर्दछन्। उपचार समयमा नभएको खण्डमा देखिने जटिलताका कारण र घर परिवार समाजमा स्थान नपाइएका कारण हजारौ व्यक्तिहरु विचलित भएका छन् । जिविकोपार्जनको लागि उचित सीप र तालिम नभएका एवं राज्यले दिने सेवा सुविधाको बारेमा थाहा नभएकाले धेरै व्यक्तिहरु भौतारिएका छन् ।
सायद यो मन्दिरको खुड्किलाहरुमा एकजनामा पनि कुष्ठरोग नभएको हुन सक्छ । सायद केही व्यक्तिहरुमा कुष्ठरोग कै जटिलताले यस्तो भएको पनि हुनसक्छ। कहिकतै जनचेतनाको अभाव,रोगको प्रकृति, समाजको सोच, राज्यको कमजोरी वा हाम्रो हेर्ने दृष्टिकोण-मैले छोटा ती औलाहरु,नभरिएका घाउहरु, कमजोर आँखाहरू, लुला हातखुट्टाहरू,असह्य पिडाहरु र लाचार जिन्दगीमा देख्ने गर्दछु।
अन्तत: कुष्ठरोग एउटा रोग हो, यो पूर्व जन्मको पाप होइन ।
-Dr. Yagya Prasad Timalsina
Cervical Cancer- a story of Deepa
Deepa will be 42 this January. Her husband, Ramesh had returned to Nepal from his third visit to Qatar, just before the expiry of his working Visa. He immediately took a bus to Dhunche and walked hurriedly in excitement to reach his family, in the remote hill of Nepal- Cholangpati. His wife and five children were equally excited. The eldest daughter was born when she was 17 years old. The youngest was the only son-born three years back,after repeated attempts to continue the generation for the family.
With the sunset and an early dinner, all the children quickly fell asleep. A reunion of the departed husband and wife turned into intimacy where Ramesh discovered that Deepa was wincing in agony during sexual intercourse. A little later after the moment, Ramesh went to the bathroom to pee where he noticed some blood stains in his genitals.
Deepa had her first day of menstruation 20 days back, and told the same to her husband. She even mentioned that there had been some blood spotting between her menstruation since last eight months. Ramesh thought it was a normal response of women’s body. The following night, she requested her husband to avoid the sexual intercourse as she was feeling tired with backache, pelvic pain and foul smelling discharge. Ramesh’s stay for two months before his return wasn’t a pleasurable sexual experience for both of them-with Deepa’s denial, pelvic pain, tiredness and vaginal discharge.
Deepa was in agony from this dreadful experience and cursed herself, however she never visited a doctor for the painful sexual experience. She didn’t feel like eating and was subsequently losing weight. She increased her frequency of smoking, a habit she leant from her mother since childhood- while lighting cigarette for her in the firewood. Eight months after Ramesh’s return,on her birthday, on 5th of January, she noticed her left leg swollen while taking a shower in the cold morning.
This,now, alarmed her. She visited the nearby health post,which referred her to a doctor’s clinic in Dhunche. The doctor then referred her to Kathmandu, for further management.
With detailed history taking, examination and investigations, the doctors found out that she had Metastatic Cervical Cancer- Stage 4B.
Metastatic cervical cancer is an advanced stage cancer of the mouth of the uterus(cervix) where the cancer cells have spread to other parts of the body such as lungs, liver, bone or lymph nodes.
Deepa’s story could have ended differently if:
- She was aware that it wasn’t normal to have spotting,foul smelling vaginal discharge, painful sexual intercourse, pelvic pain, backache etc. and visited a doctor earlier.
- Her husband had known about Cervical Cancer being the reason for refusal of sex.
- She had known the risks for Cervical Cancer such as smoking, early pregnancy, giving birth to many children etc.
- She had screened herself for cervical cancer beginning at 30 years of age and repeated every 5 years.
- She was vaccinated against Human Papilloma Virus (HPV) with appropriate dosage at appropriate age.
January is celebrated as Cervical Cancer Awareness Month.
Hyuna Sung et.al estimated 604,000 new cases and 342,000 deaths in 2020 due to cervical cancer globally. About 90% of the new cases and deaths worldwide in 2020 occurred in low- and middle-income countries. Due to vigorous screening and effective vaccination against HPV, cervical cancers have decreased significantly in developed nations.The contrary is true for the developing nations.
Bruni L. et.al recently has stated cervical cancer as one of the leading cancers in women in Nepal with 2,244 new cases and 1,493 deaths every year.
Every year, thousands of Deepa suffer in the world and Nepal.
Has Nepal thought anything for our women to prevent the situation that Deepa is facing currently? A question to think for !
-Dr. Yagya Prasad Timalsina
A BURNING ISSUE- CHINA’S DECEMBER 2022 COVID WAVE
Recent media (as in Reuters on Dec 25,2022) speak a lot about the new type of Omicron viruses spreading massively with10 lakhs new cases per day in China’s Zhejiang.
THIS PARTICULAR CORONAVIRUS:
SARS-CoV-2 is the name of the virus causing COVID-19.
SARS-CoV-2,like any other viruses, change with time, a property called as mutation.
Among many variants through mutation, Omicron is leading the infection in the world in the current scenario.
Omicron sub-variant BA.5 is causing a massive rate of infection in China.
This current sub-variant in news media is BF .7 (BA.5.2.1.7),which is creating havoc in the lives of people in China.
The signs and symptoms of the disease are similar to other sub-variants of Omicron.
The rates of infections of this sub-variant are found to be higher than the other variants.
Prevention includes the same principles of physical distancing, masking, avoiding crowded areas, complete vaccination with booster doses, and washing hands/use of sanitizers frequently.
Nepal has no reported case of this particular sub-variant of Omicron virus as of today, but a strict monitoring and regular genomic analysis of the positive cases found in Nepal is required.
(This is subject to change with new information through research, but holds true until the day it was drafted on December 26,2022).
-Dr.Yagya Prasad Timalsina
Dream
It was a real difficult night… I couldn’t fall asleep for long before I saw this peculiar dream!
This particular dream…
Midnight….I lay down sleeping in the room 105 in the south west corner of Hotel Planet Bhaktapur. Suddenly,I am awaken to check if the doors were locked or not. Unfortunately, it was wide open…
I see a woman, plain white dressed around 70 meters away from the main gate. She was rapidly proceeding towards me. A cold shiver ran down my spine.Yet, I succeded in closing the main gate. Strangely, she could see me through the gate and she could pass through the main gate as if the wall was transparent door for her….A mini heart attack..Luckily, I could close the secondary door. Suddenly,
She disappeared…
Well, whatever!
The dream goes on…
Then, in the morning, there were 6-7 guests, European in appearance,in the inner courtyard of Hotel Planet Bhaktapur. They were talking to each other. Among them, Francesco was in blue t-shirt and a blue geans. Yam, my brother,was in the centre with 4-5 guests encircling him. He was explaining things with love, passion and dedication, because he was born to add happiness to people’s life.
This was a gem for me, not replaced by any gold or any materialistic possessions. I watched him closely.
I then went to the next room,106. A staff appeared and asked for a working day off. I said, “My brother is back.I was just managing his paradise, when he was not here. Please take permission from him,he is the only one entrusted by all of us.”
No words would explain that joy when I could say that Yam was here. He was there…the aroma of his presence gave a devine feeling….I didn’t question his presence even though my mind in this dream was ready to accept that he was in a trip away from Planet Bhaktapur.
Oh dear, Only if this was true!
Only if he was here, even physically!
Only if he could smile with all of us like in this and other dreams of mine….
I fell asleep for some moments peacefully then….
A little later, I found myself awake with a real bad sore throat,in the room 106,of the Hotel Kaushi,at lakeside in Pokhara.
Some dreams are real charm…
A huge ask for my subcobscious to accept the fact that my brother have left your mortal self…
I embrace your presence in every form…pictures…dreams…blog posts…
Everything reminds me of you.
Yam’s Naresh!
Is there anything that is permanent?
Loud…Even louder…A moving bus and the ongoing music..I look towards the infinite depth of the Trisuli river…And the clouds caressing the trees of the neighboring hills…
“Where are we heading?”, the wind softly whispered to the ever changing cloud.
The cloud answered, “Our final destination is always towards the unison of ourselves to the higher self, and we disappear once our roles are accomplished”…
I simply smiled, thinking about this journey of the mortal self and everything around me that is replaceable and perishable.
Dinosaurs perished…The high hill that praised itself too have slid down as landslide… The glaciers have melted…. Even the temples, monasteries and churches have been hit by the lightening and shaken by earthquakes .
I keep thinking with the moving clouds around me….
What is permanent here?
Nothing….
~~Dr. Yagya Pd. Timalsina
THE UNIQUE ANALYSIS
Learning should be continuous,constant yet dynamic. In a group of 37 students, I place myself mostly in the third row.Mostly, because-when I feel like having fun and enjoy a boring subject(personal perception)-you will find me in the last seat of the class-true for most of my older high school days.
A middle aged teacher enters the class,where students vary in age from early 20s till late 40s or beyond, yet act like mere teenagers. This diversity in tourism classes -the craving to learn or say,earn a license to keep as an armor when and where required. Geography-the subject to be learnt that very day.
Never judge a book by its cover-the teacher with the very simple attire,was struggling to open the slides to be projected for the lecture.Not to blame the teacher,as none of us could open it either-None of us…Though not all volunteered to try the technological aspect as we were busy gossiping with our diversified colleagues.
I had expected the class to be a boring one,first due to the simple appearance of the teacher and secondly because we were unable to move ahead in the content despite 15 minutes of vigorous efforts from the teacher and the colleagues. Then the teacher began. Oh my goodness-he was such a gem-simple, soft,always smiling,humble and knew perfectly how the content had to be delivered.The first word-COORDINATES, then followed latitude,longitude and topography of Nepal.
One Interesting incident….which he shared with all of us…
He had once been in a cultural event where people from all three geographical delineation of Nepal i.e. The Himalayas, The Hills and The Terai had participated performing their cultural dances. He watched them carefully and later came up with a conclusion-People in Himalayan region danced staying close together with soft songs, then followed people in the hills, with some gaps amongst the performers and slightly higher pitched songs,then finally staged by the people from the Terai- where performers danced with wide gap between them,high energy and very high pitched songs. He, as a geographer, could see the gaps,energy and pitch in different areas of Nepal and their culture.
Being snow clad in the high mountains, closeness among people keeps them warm.If you are in the hills, the temperature is moderate enough to allow some space between people,whereas in the plains of the terai, you would want people to be with some space to let the breeze flow around them. There could be various explanations and dimensions to this observation-scientifically or culturally.But, being born in Nepal and watching a lot of cultural dances live or recorded, me-at least would have never analyzed the dance and the song in this way i.e. through the eyes of a geographer.
Cultures are mostly endemic, sometimes exotic. Sky burial-a new term for a huge mass of us – is practiced in some rural high altitude areas of Nepal (Upper Dolpo) where, a deceased family member is offered to the vultures in the sky. Literally, you will chop them into pieces and with specific Buddhist religious chants,offer them to the vultures.It is a very pious ritual for them-inspired by the Buddha’s offering to the hungry tigress in one of his lives. Yet, as a born Hindu, it is still very difficult for me to open up with this thought. I shall consider myself a narrow minded person,in this regard. But, look into a different perspective-You are an offering even after your death-the highest form of giving….Offering the self.…
I can go on writing about unique analysis about so many things-from history,culture,architecture,religion to a vast dimension of arenas.Yet, that is not what I intend to do. But, I wish the readers of this blog to take some time to analyze, share and smile at your thought processes. One day, that analysis might really turn into a decade changing concept that can help, heal and lead our society to a better world.Who knows we might be the next Newton, who saw the apple falling like all of us-yet never thought about the reason for it to fall down(Only Newton analyzed immensely and fruitfully about the subject). I don’t want those analyses to harm humankind for sure,leading to the devastating chemical inventions dismantling the peace of the world and creating a havoc in the universe.
Let us simply open up ourselves to explore,learn and motivate.
Let us analyze,share and smile….
Dr. Yagya Prasad Timalsina
See You Again!
Dreams…..
Like everyday, a lot of things drag me closer to you. If you were here, how things would have changed!
I know you can feel me,I feel your presence too.
I have always remembered you on a good note,like every one of us do. You have left a strong imprint of love in the hearts of many people. You have kept me and everyone of us closer to a lot of people around the world. Despite that, your physical absence creates a void that never gets fulfilled.
And when I think about you and your absence, too much with a pang of pain , you appear in my dream on the same night. Thanks to our connection and brain.
Even in my dream, I always realize that you have left physically. Yet, you assure me that you had never left me, with a smile.
You were very happy tonight, that smile is what I wish to stay with you forever. Your long coat and smile, in front of Planet’s gate, in a way can be said that, you have never left Planet and us.
The way you looked at me-that love can never be described.
‘How could you leave us?’- always stays with me.
You always see me crying in my dream, asking the same question, ‘Why did you go too early?’ You remain calm and smile and say, ‘I am all here,like always.I have not gone anywhere.’
I love this part of the dream, but I know that I shall wake up soon.The wakening is too painful…I wish I could continue the dream…and I wish I could live with it forever.
The hard reality of accepting the truth always stays with me, with the bright sunlight. I embrace our dreams, carry some tears, and move on. I go on, for you and me, for the life that you have created, to live and love.
The principle that you embraced-Do it with love. Be calm. Managing things in every part of our life is the most important thing-this being some last words you said still resonate louder.
Some drops of tears- and immense love, You are forever alive.
I love you,dear brother.
Stay smiling,forever.
-Yam’s Naresh
ACUTE HEPATITIS IN CHILDREN-CAUSE UNKNOWN
In late December 2019, our world witnessed the first cluster of cases of COVID-19 which is still creating a massive havoc for the entire human population of the world. We have been skeptical since then because the first few cases of Wuhan,China engulfed the entire world in no time.
Now, the first few cases causing acute hepatitis have been notified to WHO on April 5 2022. Acute hepatitis– a medical terminology to describe the period of inflammation( local response to cellular injury marked by swelling, redness,heat,pain and loss of function) in the liver lasting less than six months of duration.
10 cases were reported from Central Scotland- the cause for severe acute hepatitis is unknown till date.
What do we know as of today?
74 cases had been reported in the UK till April 8,2022 with similar symptoms. All the cases are reported among children less than 16 years of age.
Hepatitis viruses(A,B,C,D,E) were excluded in the laboratory.However,viruses causing COVID-19 i.e. SARS-CoV-2 and/ or Adenovirus have been found in many cases.
Less than 5 cases from Ireland and 3 cases from Spain are on the investigation with similar symptoms.
So, what is the working case definition?
A confirmed case is a person presenting with an acute hepatitis (non-hepatitis Virus A,B,C,D,E) with AST or ALT over 500 U/L who is 10 years and under, since 1 Jan, 2022.
AST and ALT are enzymes found mostly in liver which increases during liver injury( Normal value varies based on laboratory-ALT 7-55 U/L, AST 8-48 U/L).
Signs and Symptoms :
A child can present with any one or more of the following:
Discoloration of Urine (dark) and/or Stool(pale)
Jaundice (yellowish discoloration of skin, sclera etc)
Pruritis (Itching)
Arthralgia/Myalgia( joint pain/Muscle pain)
Pyrexia(fever)
Nausea,Vomiting or Abdominal Pain
Lethargy and/or loss of appetite
Diarrhea
How severe is it?
All the first 10 cases were detected during hospitalization. All of them were healthy, prior to illness.As of April 11,2022, no deaths had occurred amongst reported cases.However, six children required liver transplantation.
What next?
WHO is monitoring the situation with other member states and the UK along with partners for cases with similar profiles.
Many questions are left unanswered. With time,we hope to find the cause(etiology) of acute hepatitis of this unknown etiology because we are all exhausted to have another outbreak in any form.Hence, it is our duty to stick with the basics to contribute to the better health of everyone.
For more,click on the link below:
https://www.who.int/emergencies/disease-outbreak-news/item/acute-hepatitis-of-unknown- aetiology—the-united-kingdom-of-great-britain-and-northern-ireland https://www.gov.uk/government/publications/hepatitis-increase-in-acute-cases-of-unknown- aetiology-in-children/increase-in-acute-hepatitis-cases-of-unknown-aetiology-in-children
Dr.Yagya Prasad Timalsina 