Dear Friends,

A Mouthful of Guava

I saw her sitting there on the bench, popping pills into her mouth like candy. Then, rummaging in the pocket of her tattered little dress, she pulled out a hard, green guava, obviously unripe. Digging her teeth into it she smiled and mumbled, "There! Now the bitter taste from my medicine is all gone." With that she toddled over to her mother, who swooped her up onto her hip and carried her off down the path. The scene I had just witnessed was so endearing that I had to find out more about this little girl. The health-post staff told me that her name was Sunita and that she was 4 years old. "What was she taking those pills for?" I asked. "Worms?" "Oh no," they answered. "She has tuberculosis. I was taken by surprise, not because it is unusual to see TB patients at the health post—after all, this is Nepal, where TB kills over 15,000 people a year. But I had never seen such a young child with TB before. And I had never seen any child take medicine so well!

Luckily for Sunita and her family, the United Mission to Nepal’s Community Development & Health Project (CDHP) runs a health post only three minutes’ walk from their house in the village of Ashrang, in South Lalitpur. When she showed symptoms of weight loss and a swollen belly, her mother brought her in for a check-up. "We first thought she was malnourished," said Sarada, the nutrition worker. "We fed her ‘super porridge’ and counseled her parents about good nutrition. Since they live so nearby, we could easily go and see how she was doing. But she just wouldn’t improve." The staff decided to refer her to the nearest hospital, a two-day’s journey across the Lalitpur hills. There, Sunita was diagnosed with abdominal TB. Although the news was bad news, the fact that she was diagnosed and started immediately on a treatment regimen was nothing to take for granted. In Nepal, many people suffer from TB without knowing the cause of their suffering or the means to treat it. Most live far from any health facility. Furthermore, many existing facilities lack basic drugs and skilled staff. Patients who are fortunate enough to receive both diagnosis and medication must commit to the rigorous long-term treatment plan, which is yet another challenge, given the conditions in rural Nepal.

In recent years the National Tuberculosis Center has begun implementing what is known as the "DOTS Program," which shortens the length of the treatment from twelve months to six months, but requires the patient to take the pills—daily—in the presence of a trained health worker. CDHP carries out DOTS in our health post located closer to the capital city. But given the long distances most patients would have to travel on a daily basis to Ashrang Health Post—which serves a population scattered up to a day’s walk in all directions—it was unrealistic to conduct the DOTS program there.

However, in Sunita’s case, the DOTS method works perfectly! Each morning she walks down the rocky trail with her mother, greets the health post workers, and takes her pills as they look on. She has been a "regular" for five months now. Her parents, pleased with her progress and with the encouragement given by the staff, are true believers in the health post services. "Some people might have taken their child to see a Jhankri (traditional healer) or worse," Sunita’s mother said. "But we are happy with the choice we made. We are happy our daughter is alive. What a blessing Ashrang Health Post and the good people here have been to us."

Sunita, her parents, and the CDHP staff are living witnesses to the value of community health in Nepal. Granted, things were a little easier because Sunita just happened to live "in the neighborhood." But, as her mother said, proximity is not the only factor. Without the concern, timely referral, and treatment provided by the health-post workers; without the commitment and discipline of these parents; and without the good-natured willfulness of the little patient herself, this story might have a bitter ending. To the contrary—Sunita now has hope for a future free from the dreaded disease that nearly took her life. Happily, I can say as Sunita did, with her mouthful of guava: "The bitter taste is gone!"

God bless you!

Ellen "Jyoti" Collins

The 2000 Mission Yearbook for Prayer & Study, p. 146