Tracking, Treatment, Investigation of a Left Against Medical Advice (LAMA) malaria positive case by MEDP Mandla.
I. FIRST NOTIFICATION: On May 26 2020, CMHO Mandla informed us that a 20 yrs old Plasmodium falciparum (Pf) positive patient named Pahal Singh from Lutiya village of Nakawal sub-center in Bichhiya block has Left Against Medical Advice (LAMA) from District Hospital on May 24 (same day of admission). MEDP was given the task of tracking and treating the patient. II. TRACKING: MEDP immediately mobilized its resources and Malaria Field Coordinator (MFC) Nandkumar Bajpai with his Village Malaria Worker (VMW) visited the village and interacted with the patient’s family members. They informed that patient had not returned home for the past two days. Following this, we made contact with patient’s brother, who informed us that they are staying with a relative in Bhurkhatola of Rasaiyyadouna village of the same block and is now undergoing treatment from Nirmala missionary hospital. III. PATIENT IS MALARIA NEGATIVE? INVESTIGATED FURTHER: The local VMW Nischal Shriwas tracked them, checked the private lab’s pathology report which showed the patient as malaria negative. He immediately informed us and re-tested him (Pahal Singh) using a RDT. Result was Pf malaria positive (Figure 1). IV. RE-TESTED. MALARIA POSITIVE AMIDST THE COVID-19 SITUATION: Meanwhile, the local ASHA came to the spot and handed over the ACT anti-malarial and warned the patient and his brother to return to their homes immediately and stay put amidst the COVID-19 pandemic. Both of them were scared and confused. V. PATIENT NOT COOPERATING. WHAT TO DO?: The VMW informed us that the patient is refusing to take the anti-malarial, is suffering from high-grade fever, and arguing because they have been asked to leave the village. VI. MEDP’s DISTRICT OFFICE STEPS IN: With the nearest MFC 40 Kms away and tense situation, the District Officer of MEDP Mr. Sekh Nisar visited at patient at 8 PM on the same day. After rigorous counselling and efforts, the patient was fed, and the first day treatment was administered under direct observation by us. The LLIN was installed and he was made to sleep inside it. The local ASHA was counselled and asked to cooperate with the patient. Both VMW and ASHA were also asked to follow-up on the radical treatment. Few packets of ORS were handed over to the patient. VII. REWIND. EVENTS LEADING TO LAMA.: On May 24, 2020, the patient experienced fever for the first time and underwent treatment from an un-registered medical practitioner, who administered the treatment. On May 25, 2020, he had a repeat episode of high-grade fever with severe headache. They contacted the local ASHA, but was advised to visit the District Hospital, as he was a COVID-19 suspect. The same day patient was admitted in the District Hospital, Mandla. The blood sample was collected and supportive treatment was started. The patient did not feel comfortable and left the premises (LAMA) before the lab results came in. After L.A.M.A., they went to the Nirmala Hospital, where the patient was administered I.V. saline with oral paracetamols. He was discharged in the evening citing malaria negative case. The hospital has only day-care-facility. VIII. COMPLETION OF RADICAL TREATMENT AND MOVING FORWARD: On May 29, 2020, the patient was administered his last dose of ACT anti-malarial by MEDP under direct observation. He is feeling much better and is on the road to full recovery. Moving forward, the patient has been advised to sleep under LLIN and will be followed-up closely by our active surveillance.