Churachandpur: In small rooms that look less like rooms and more like oversized cabinets, two counsellors at the ART (Antiretroviral Therapy/Treatment ) centre, Reuben Pauneilian and Chingnunhoih, were busy managing HIV/AIDS clients/ beneficiaries and other day-to-day affairs. The centre at the district hospital in Lamka is the only existing ART plus centre in the district of Churachandpur, Manipur, one of the worst impacted by the violence that has gripped the state since May 2023.
Since the violent conflict between Meitei and Kuki-Zo broke out, the centre has recorded 171 new cases of HIV Positive/AIDS patients. The conflict year also recorded 53 patient-beneficiary deaths, of which 19 were women.
The centre had halted its therapy treatment due to the absence of drugs and testing facilities for almost a year. Though things have slowly improved, they continue to face several challenges. The centre requires various drugs for the treatment of HIV-AID patients. “Presently, we have drugs like Dolutegravir only,” the counsellors told EastMojo, “the third line of treatment is not available,” they added.
Dolutegravir is used with other medicines for the treatment of the infection caused by human immunodeficiency virus (HIV) in patients who have not received anti-HIV medicines in the past or to replace their current anti-HIV medicines.
Dolutegravir tablets are used with rilpivirine in adults to replace their current anti-HIV medicines when their healthcare provider determines that they meet certain requirements.
Since last year, Churachandpur, which has the highest number of relief camps, has been catering to displaced populations from other Kuki-Zo districts, mostly from Chandel, Tengnoupal and Imphal Valley. This put additional pressure on the district’s health department. Add the issues of limited or zero medical supply, and the situation became dire pretty quickly.
The ART Plus centre catered to more than 2,500 beneficiaries before May 2023 and now has more than 3,000 beneficiaries. New cases emerged as HIV was detected among patients in the district hospital. The new detection comes mostly from patients who undergo tests for various ailments, say, for instance, Cancer.
Ethnic violence over public health
The Lamka ART Plus Centre, like every other centre in the state, comes under the Manipur State AIDS Control Society (MACS) and the National Aids Control Society (NACO). The department is directly controlled and managed by Imphal MACS. This meant when violence broke out, the centre in Churachandpur no longer had access and/or connectivity to the MACS.
It was only after six months that the ART Plus centre somehow managed to bring in drugs supplied by the NACO via Mizoram to the Lamka Hospital in Churachandpur. Department officials said the Mizoram government transported the drugs to the Mizoram-Manipur Border at Tuivai Bridge. “From there, supplies were transported by the Churachandpur Medical Department,” an official added.
Due to the paucity of funds, staff would offer their vehicles and drive to the border to receive the supplies. The internet shutdown has further severely hampered the functioning. Things became slightly easier in December following the restoration of internet connections. “Now we do teleconsultation and other communication through telephones and the internet,” said a medical staff.
But improved telecommunications does not translate into improved finances. The ART centre is struggling with no funds available for management such as transport or day-to-day expenditure”. They rely on donations of staff like vehicles for the transport of drugs, printing costs etc. The ART staff said they were advised to open their bank account, which they did in August 2023. “But we did not receive any funds,” they said.
The ART Plus centre has been functioning without funds for more than a year now. “Our Medical Officer ( MO) has retired and we do not have a new replacement,” said counsellors Reuben and Chingnunhoih.
Presently, there are two counsellors, one data manager, one pharmacist, a lab attendant, a community coordinator and a nurse.
“Drug supply is somehow managed,” said the two ART counsellors, though they do not get all the required supplies. “Due to lower quantity, we reduce the drugs we provide to beneficiaries,” they explained.
“For example, the drugs we normally provide for three months are now for one month,” the counsellors said. That is partly the reason why the centre for the high footfall. “We attend to over a hundred beneficiaries daily,” said the counsellors.
An official at the hospital pointed out that the initial months of the crisis were stressful. “We were in a fix as to what to do, especially after the arrival of several displaced populations,” said an official at the office of the district CMO (Chief Medical Officer).
The medical department is controlled and managed by the Imphal state head office. Due to the crisis, the overall “supply chain was disrupted,” said a medical official on the condition of anonymity.
“Things have improved a bit, but still challenges remain,” he said.
“We cannot go to Imphal, they cannot come to Lamka. This has severely disturbed not only the supply chain but the overall functioning as well. The internet shutdown for over eight months caused additional hardships. We are yet to submit our financial reports,” the official added.
Injected drug users and other users dependent on OST (Opioid Substitution Therapy) Centre for IDUs (Injecting Drug Users) also suffered. “The equipment is stuck in Imphal,” said medical officer Dr Lunmuanlal.
The violence, the lack of internet for months and intermittent medicine supply have also impacted data collection, which is one of the cornerstones of ensuring regular, timely medication.
Pitiable conditions in camps, doctors missing
“There aren’t sufficient medical supplies presently,” revealed Dr Lunmuanlal. “Beneficiaries relapsed during this period as there are no drugs available,” he added.
Explaining the process, Dr Lunmuanlal said when drug users are enrolled, they are screened for HIV and Hepatitis, “The viral load testing laboratory is available only in Imphal, so we had to halt the viral load test,” he added.
There are only 3 staff in the centre. The drug Buprenorphine is administered orally for harm reduction for the IDUs. The therapy is such that they can manage their withdrawal symptoms. Withdrawal symptoms, if not treated, can lead to relapse, the doctor explained.
There are 95 relief camps in Churachandpur district as of July 2024. These are run and managed by philanthropic organisations and their medical expenses are also borne thanks to donations from individuals and CSOs.
As of May 2024, around 68 people have succumbed to various illnesses across relief camps in Churachandpur. According to local media reports, those who died were under immense financial hardship and could not afford further medical care. Some were also brought to the hospital after serious illness and could no longer be saved. The local media has, time and again, highlighted that the situation in relief camps is severe and that these camps will witness more casualties.
Even though some displaced persons have found rented accommodation, the majority of the displaced populations are still accommodated in these camps. Many relief camps have also been clubbed together in some dilapidated unattended infrastructures as many of the schools, which were utilised for relief camps, have now resumed classes. With no access to Imphal, those who could afford medical care have left for Aizawl, Guwahati, Delhi or other metro cities.
According to medical experts, even if medicine was made available for HIV/AIDS patients, it may not suffice. In Manipur, there is only one laboratory for viral load tests for HIV and Hepatitis, currently located at the Jawaharlal Nehru Medical Institute of Medical Science in Imphal. Ideally, every six months, the patients must be tested. All these have been halted for a year now, due to the present crisis. For many of the patients- even if they would desire to go outside the state – either it is expensive or the case cannot be transferred with no internet available.
Other patients too are hardly faring any better. While the Churachandpur district hospital has a specialist doctor for departments like Gynae, Orthopaedics and General Medicine, the Cancer department has shut down with no specialist doctor available. It is learnt that the only cancer doctor, a Meitei from Imphal, could no longer return to attend to patients in Churachandpur district hospital. In 2024 Manipur, who gets treated, and who provides treatment, is decided on ethnic lines. For most people, this cannot be a good thing.
Also Read: Meghalaya: Family seeks protection, files complaint against rehab centre
You just read a story that took days to report. Help us keep our reporters on the ground in the Northeast.
Ad-free reading, support and keep important stories alive
Support once (any amount)
Scan to pay via UPI