Jhabua District HIV/AIDS Care and Prevention Program Update

February 28, 2009

Honorary Country Director Fabian Toegel, M.D.

HIV Program

The year 2009 started for our RMF project in Central India with the arrival of two 4th year Harvard Medical Students, which marked the second time that the Harvard Office of Enrichment Programs supported this exchange. Similar to the summer of 2008, the students helped caring for the increasing number of patients living with HIV which had been identified through RMF’s prevention and care program in Jhabua district. Out of close to 1700 clients who had undergone voluntary confidential counseling and testing since the inception of the program, over 140 patients had been found to be HIV positive and were given access to free care and treatment. While 2 thirds of the patients are male, and a third are female (and one transgender), 20 children below the age of 16 receive special attention. Thirty percent each fall into the age categories 16-30, and 30 to 40 years of age.


Figure 1: Cumulative number of clients tested for HIV over the course of RMF’s India program, of which 8% or over 140 patients living with HIV/AIDS have so far been identified.


RMF’s CEO Dr. Martina Fuchs and RMF’s honorary country director in India Dr. Fabian Toegel visited the project in early January to attend the inauguration of the Jhabua Network for People living with HIV/AIDS, which RMF helped to form in August 2008. The network’s office was inaugurated at Jeevan Jyoti Hospital, the partner hospital of RMF in Meghnagar, which was recently selected as a ‘Link ART Center’ by India’s National AIDS Control Organization and the Government of Madhya Pradesh. All of RMF’s patients will now be able to access life-saving anti-retroviral treatment closer to their home without making the monthly 4-hour ride in RMF-rented vehicles to the Government’s only drug-distribution center in Western Madhya Pradesh.

During the course of the stay of the volunteers, RMF’s partner hospital was also selected as a Government HIV Counseling and Testing Center, which will now receive free testing kits and report directly to the National AIDS Control Program. In addition, Jeevan Jyoti Hospital was selected as a ‘DOTS’ Center, which will receive free TB medicines from the Government to provide “Directly Observed Treatment –Short course (DOTS)". By making the project sustainable in less than two years (through free test kits, HIV and TB medicines and the creation of the Jhabua Network for People Living with HIV/AIDS), RMF’s plan for Quarter 2 of 2009 is a separate care facility, the so-called Community Care Center or 10-bedded HIV care home, which would be established under the Global Fund to Fight AIDS, Tuberculosis and Malaria. In order to prevent new infections, RMF also plans a large Prevention of Parent-to-Child Transmission program as well as Targeted Interventions among Migrants, both of which have the prospect of receiving large Government Support.

Rural Health Program

2009 also marks the year in which RMF plans to expand into rural healthcare. More than 90% of Jhabua district’s populations lives in villages, and RMF is teaming up with the Bhil Health Initiative & Literacy Society, which runs a boarding school and a rural community health center (both of which were founded ten years ago by our country director). The community health center now caters to over 27,000 villagers in 20 villages providing health awareness, vaccination and nutrition programs, caring for and referring to pregnant women and children below 5 years of age. By expanding their work of the nurses and health workers to more villages, an additional 10,000 villagers could be added to the list of beneficiaries since 2006.


Figure 2: Total population cared for by the staff of the Bhil Rural Community Health Center, RMF’s latest project in Jhabua district


With the help of the Harvard Medical Students, RMF is planning the expansion of these services further, by constructing a rural clinic in a village and building a mobile health van. Similar to the RMF’s HIV program in Jhabua district, this model has the potential to rapidly expand and achieve sustainability through linking to the Indian Government’s National Rural Health Mission, the world’s largest public health program.

Free education and boarding for poor tribal children

The Harvard Medical Students, similar to their predecessor in 2008 spent much of their time teaching the students of Bhil Academy, a residential school founded by RMF’s country director in 1999, which is located in the town of Jhabua. These children are selected from the poorest families in the surrounding villages (identified through health workers) and receive their education in English, live on campus and engage in a variety of extracurricular activities including sports, performing arts and competitions with other schools. Learning science and having day-to-day conversations in English poses an initial challenge for these children, because they come from very poor households, and may have suffered from malnutrition as children. In order to monitor their nutrition status, each student was assessed for weight, height and anemia. While most girls and boys fared well in the nutritional assessment, those with signs of malnutrition and anemia received appropriate medical care and special attention while taking their meals.

Figure 3: Nutrition status of 81 girls and 141 boys from age 4 – 14 years of age, who study at Bhil Academy, a residential school for poor tribal children in Jhabua.


In addition, several students suffered from minor medical problems, such as infected wounds, cysts, ENT problems, as well as more serious conditions, such as extra pulmonary tuberculosis, which is non-infectious. All these students were frequently referred to RMF’s partner hospital to receive appropriate care and treatment. In addition, two adult cases received special attention. The father of one of the students fractured his femur, which was complicated by underlying diabetes and hepatitis. After almost 3 weeks in hospital, he was operated successfully and is ready to be discharged. A more serious case of a 21-year-old kidney transplant patient also received care from the Harvard Medical Students and RMF’s Country Director. This young man had come from his village showing signs of graft rejection and kidney failure, for which he is receiving dialysis and immunosuppressive treatment at a specialty hospital. It is too early to know the outcome of this case, but RMF is continuing to provide free care and treatment to its people of Jhabua to make a difference in the lives of children and adults in a holistic and sustainable way.

Read Matt Oertli and Tyler Chernin, two 4th year students of Harvard Medical School’s RMF blog about their experience in Jhabua, here.


Country Page: India Initiative Page: HIV/AIDS Prevention & Care Program