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Last Updated: Monday, 17 November, 2003, 15:00 GMT
Aids care by motorbike in India

By Charles Haviland
BBC correspondent in Bangalore

Three-year-old Vinod Kumar runs up to visiting 'Uncle' Nagaraj who tickles his chin. Vinod wriggles in delight as the room echoes in laughter.

It could be a typical Indian household scene. But it isn't.

The Nagaraj doctors
Travelling by motorbike makes the Nagaraj doctors less conspicuous
Vinod, his mother, Rama, and his eight-year-old sister, Jayashree, are all HIV-positive.

The visiting 'uncle' is, in fact, Doctor D Nagaraj, accompanied by his wife Deepa. Both are doctors specialising in HIV and Aids treatment.

The doctors used to care for Rama's husband at their clinic on the outskirts of the city of Bangalore. But he died from Aids last year.

Since then, they have found a new way to care for patients - they go on almost daily home visits.

The response from patients has been generally very good. The visits bring them personal contact that is not always easy to find.

Ostracised

The scene at Rama's home in a quiet village near Bangalore seems pleasant.

Birds chatter in the trees while chillies and lentils dry in the yard.

But, Rama tells me, the neighbours shun the family, including her mother-in-law who also lives with them. Even their own relatives have cut them off.

Rama (r) and her mother-in-law
Rama (r) and her mother-in-law - Rama's husband died last year

This is the reality of the stigma that HIV patients across India face. No wonder the doctors, who always visit as a couple, are welcomed as friends.

The two doctors travel by motorbike. It is an inconspicuous means of transport. And for families whose neighbours do not know they are infected, this is invaluable. And they bring medical care.

Today Rama is complaining of numb legs. Although antiretroviral drugs are too expensive, the doctors always carry other medicines and have some for her.

As a result of the home visits, patients have become much better at taking their medication properly.

From pre-test counselling and the taking of blood samples, through to drug courses and palliative care, everything can be brought to the doorstep.

The couple even complement each other as Dr D. Nagaraj is a general physician while Deepa is trained in alternative medicine.

Treating patients away from the clinic brings advantages.

"When we go to their houses, we know the family situation, family background, how they are living their life," Deepa says.

"Patients are more comfortable, they express all their family problems."

Mobilising funds

Home visits make it easier to tell uninfected family members how the HIV virus can and cannot be transmitted.

The visitors also try to help with financial and employment issues, for instance where there is a widow who was previously not earning a salary.

The Nagaraj doctors
The Nagaraj doctors back at their clinic

"We try to mobilise funds," Dr D. Nagaraj explains, "and looking at her capacity we try to elevate her, get her a job suitable to her educational status, so she is able to look after her family".

The Nagarajs have, for instance, found people jobs in tailoring and security. They have also helped place newly-orphaned children in homes.

Money remains the chief problem. Their clinic, the Good Shepherd Health Centre, is their only source of funds.

Many non-governmental organisations prefer to channel funds into Aids awareness programmes rather than care. The couple do not charge their Aids patients, most of whom are poor.

They try to raise money "through our own colleagues and friends who are able to give," says Dr D Nagaraj. "Even their resources are very poor."

He sees some hope. He believes that in Bangalore, perhaps because of its relatively highly-educated population, the stigma attached to HIV is gradually diminishing.

Some villages are now accepting patients back into the fold where before they would not even have offered them water.

But it is a slow process. Rama's daughter was asked to leave her school. She has since found a more accepting one.

Hostility and ignorance are still common. In one family in the area all the members decided to commit suicide because of the effect Aids was having on them.

They pulled back from the brink when they heard about the help the Nagaraj couple could provide. As for Rama's mother-in-law, she is already asking when the doctors' next visit will be.

"It makes us feel comfortable," she says, adding, on a practical note, that "there are no travel costs to and from the clinic".


The following comments reflect the balance of views we received:

A doctor in need is a doctor indeed!
Sheraab Phunkyi, Madison

A doctor in need is a doctor indeed! Keep up the good job.
Sheraab Phunkyi, Madison, WI, USA

When you first hear about HIV/Aids, it is the sheer case of the crisis that hits you and makes you feel helpless. Thank you Mr Haviland for showing us the human face of both the illness and the generous response made by these two doctors. May your report inspire us to work and hope for a better future for all who live with HIV.
Peter Benson, Leeds, United Kingdom

A very heartening and inspiring story, their courage and dedication is truly remarkable.
Sadaqat Khan, Sackets Harbor, New York, USA

Congratulations Dr Nagaraj. I am proud of both of you. This world only needs people like you. I am sure your dedication and hard work will inspire many more people around the globe. God bless you.
Hemant Biswal, Washington, DC, USA

I really appreciate the efforts that these doctors are making in order to reach the depressed HIV patients. It's the worst that could happen to anyone when he/she is segregated from his/her community. We all should be inspired by people like the Nagaraj doctors and step forward and increase the awareness among the masses before Aids can turn into an epidemic.
Praveen Tummala, East Lansing, USA

I hope it will be an inspiration to so many youngsters like me
Semeena, Kerala

I would like to congratulate both the doctors for their very good work. I hope it will be an inspiration to so many youngsters like me.
Semeena, Kerala, India

Thoughtful Gesture! My heartiest congrats for this big move. I hope that many other follow this path and make the suffered lot a better place to leave in. Great Going!
Sowmya Vasu, Detroit, USA

The service offered by these two definitely is exceptional.
Naveen Thota, Cambridge, MA, USA

I wish to congratulate both D Nagaraj and Deepa for their great humanitarian work. Wish the world had millions of wonderful people like them, who are willing to serve.
Abraham Thundathil, Toronto, Canada

Door to door care, not awareness, is something that has the potential to handle the social sensitiveness of the disease
Sahadev Shankarappa, Virginia, USA

I was moved by the efforts of the two good doctors. I think they may have come up with a unique system of treating HIV/Aids, a system which I feel can be adopted by more organized health care bodies. Door to door care, not awareness, is something that has the potential to handle the social sensitiveness of the disease. Considering the lack of Aids understanding and attached social stigmata in the majority of Indian society, this may well be the next stepping stone in the mode of treating Aids. I once again congratulate the doctors on their efforts for a selfless cause. I hope that government bodies look into the potential of this method of treatment approach and incorporate it in the national program.
Sahadev Shankarappa, Virginia, USA

Congratulations to this duo for undertaking an important medical and social mission when many of us are mired in the quest for personal glory be it in terms of money or fame. Aids is an important issue that continues to be denied by Indian society.
Dr. Murali Ramaswamy, Iowa City, USA

Stories like these make one feel better. Just to think that people care for others. Suddenly, the world is a better place. Keep up the good work and I hope you get all the encouragement and motivation you need.
Mithun, Kochi, India

I feel proud to see some grassroots activism from the people of India
Kartik, Austin

Very commendable work, indeed. I feel proud to see some grassroots activism from the people of India. It's high time, the politics and mere programs on paper culminate into actual actions on the ground. Great Work, Dr. Nagaraj!
Kartik, Austin, USA

I was really inspired by the example of the Nagarajs. May their tribe increase. It is only when dedicated professionals like them reach out to those afflicted by the deadly pandemic that there will be hope for a better future. They have found the ideal means to overcome the stigma and the pain.
Matthew, Rome

We need more Dr. Nagaraj's in our country to take care of those who were neglected by the society.
J David Raja, India

It is so heartening and touching to read about people who go out of their way (literally, in this case) to make a positive difference to the lives of the less fortunate.
Sujatha Rajanandam, Accra, Ghana

I wish to congratulate both the doctors for their humanitarian work. I wish the world had millions of wonderful people like them. Please keep up the good work.
Joe, Melbourne, Australia

The Nagaraj couple bring fresh hope to the HIV patients and also, a breath of fresh air to the often-maligned medical profession in India.
Ganadev Sinha, Mississauga, Canada

How wonderful to read these stories about people responding to the Aids crisis in other parts of the globe. Perhaps politicians were made to spend time with doctors such as the Nagaraj's, more funds (and effort) would be mobilised world-wide to fight the pandemic threatening this world of ours.
Seamus Fitzpatrick, Cape Town, South Africa

I belong to the Rotary Club Calgary North. Two months ago we supplied a motor cycle to the Mahenge Epilepsy Clinic in Tanzania for delivery of medication to remote areas. Preliminary feedback is that the delivery system is working very satisfactory.
Thomas D. Whittle, Calgary, Canada




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