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The Rotary Club of Sunshine
3H Project 84-8
Alleviation of T.B. Amongst Refugee Tibetans
The biggest venture undertaken by the Rotary Club of Sunshine was a project in northern India.
This project provided tuberculosis treatment for Tibetan refugees living in the foothills of the Himalayas, as well as providing for outlying villages.
Brief History of Involvement
Application for a 3H Grant
T.B. Control Project
Development of the Program and Program Implementation
Delek Hospital Dharamsala
Treatment Strategy
Educational Strategy
Rotary Club of Sunshine
Conclusion
Brief History of Involvement
During the 1981/82 Rotary Year the Rotary International President Stan McCaffrey called for Rotary Clubs to be outgoing, and be involved in new projects of need, to highlight World Understanding and Peace.
This challenge was accepted when confronted with the possibility of assisting Tibetan children with T.B. in Dharamsala, India. Detailed information was presented to the club about the difficulties and concern experienced by an Australian volunteer, Dr. John Urie, and his wife Mendy, in providing essential treatment and hospitalisation for Tibetans. This was confirmed by Dr. Urie's father, Mr. Ralph Urie, and the club agreed to support this project as an additional responsibility in promoting world understanding and peace.
The project was then prepared in a suitable duplicated form for distribution to members, industry and the community - seeking donations for the 1981/82 Rotary Year. The resulting cheque for $660.00 was personally delivered to the Administrator, Mrs. Takla, Dr. John Urie and Matron Mendy Urie by Mr. Ralph Urie on behalf of the R.C. of Sunshine. In the 1982/83 Rotary Year a further $1,500.00 was forwarded in support of this project.
The T.B. problem among Tibetans was highlighted at District 9800 Conferences in Adelaide and Albury, also the District 9820 Conference in Morwell, and in I.P.A.C. segment presentations.
Application for a 3H Grant
The T.B. problem among Tibetans was researched and recorded, with the assistance of Dr. John Urie, detailing the project requirements, the Doctor's T.B. manual and costing for a five year funding program, supported by Tibetan Delek Hospital authorities and the Rotary Club of Dharamsala. The initial presentation on 13th September 1983 was unsuccessful, but re-submission on 20th February 1984 was successful due to efforts by P.P. R.I. Royce Abbey.
Acceptance of full funding by the R.C. of Sunshine was given on 15th June 1984 for US$240,000 or approx A$370,000. Strict planning and careful control of finances enabled the program to be extended for a further four years until 28th February 1994.
T.B. Control Project
The stated aim of the project was "to remove T.B. in the Tibetan community as soon as possible, to a level where it ceases to be a public health problem."
The funding provided a comprehensive program for T.B. Control and allowed expansion of the project to provide active case finding and treatment programs for T.B. to cover 19 separate Tibetan settlements in Himachel Pradesh -- some 500 kms distant -- with the Tibetan Delek Hospital, Dharamsala, as the base. All 3H funding was audited by Indian Government auditors.
The prime concern was for the provision of drugs, to ensure cure, control, and health education within the Tibetan community; leading to the provision of salaries for: 1 Tibetan doctor, 3 nurses, 20 community health workers, 1 laboratory assistant, and 1 Jeep ambulance driver; ambulance maintenance; educational material; X-ray films; slides and chemicals; and running costs for an 18-bed T.B. ward.
This project (3H 84-8) was published in the August 1985 edition of R.D.U. under the heading "A Ray of Sunshine in India."
Development of the Program and Program Implementation
Delek Hospital Dharamsala
In July 1985 when the program began, 277 patients were registered for the year ending June 1986, and Delek had completed a final phase of extension of its community health and T.B. Control program to all remote settlements.
The project was managed by the Chief Medical Officer, Dr. Sadutshang, and assisted by T.B. health workers, laboratory staff and community health workers in the settlements. Three visits a year by a health team from Delek were conducted to each settlement for case finding, diagnosis and monitoring the program.
An average of 300 new cases of T.B. were detected each year and a BCG vaccination coverage exceeding 90% was achieved, reducing dramatically the number of miliary and meningococcal T.B. cases.
Since the beginning of the project many T.B. patients have been treated successfully, and the project has served thousands of Tibetans as well as benefiting the local Indian population. The overall success rate has varied between 98% in 1988 and 85% in 1989, while maintaining an overall success rate of 91% over the nine year period of the T.B. project.
The Delek Hospital has earned a reputation as a centre of excellence in the treatment of T.B., and consequently patients are referred there, or present themselves for treatment on their own initiative.
A unique and rare facility that this program provided was the treatment for drug resistant cases. In India, despite the gigantic problems of T.B., very few centres treat this category of patient. Delek has emerged as the referral centre for Tibetan settlements all over India and Nepal, for patients with multiple-drug resistant and complicated disease.
Treatment Strategy
At the start of the project three different regimens were used:
- 1st Line Regime -- Streptomycine, Isoniazid, Thiacetazone
- 2nd Line Regime -- Rifampicin, Pyrazinamide, Isoniazid, Streptomycine
- 3rd Line Regime -- For multi-drug resistant cases -- Kanamycine, Ethionomide, Cycloserine (most expensive).
Following new guidelines from 1988, an 8-month short course of chemotherapy was started for all new smear positive cases. The trend today in the field of T.B. is for shorter periods of treatment despite the resultant increased costs.
Educational Strategy
The Doctor's T.B. manual has been revised five times since the beginning of the project and provides a most useful reference for the project team and volunteer doctors. It is also used by health staff throughout India, Nepal, Tibet and sought by developing countries.
Booklets on T.B. prevention for the public, available in English and Tibetan, are printed for use in the same areas.
A booklet to serve as a manual for health workers was also published.
Rotary Club of Sunshine
The Rotary Club of Sunshine through a 3H sub-committee was responsible for the administration of the project, forwarding all funds direct to Delek Hospital, and purchasing all drugs from overseas suppliers. All records of project finances and activities were reported half-yearly to the Rotary Foundation for evaluation. The project was conducted in full co-operation with Districts 309 and 980 and the Rotary Club of Dharamsala, and each District Governor was informed of all significant developments. All funds received from the Rotary Foundation and forwarded to Delek Hospital, were audited and administrated through a special 3H bank account established specifically for this project under the control of P.P. Neil Kemp and P.P. Geoff Gannoni.
Communication with Delek Hospital created considerable problems, alleviated by organised medical and financial visits by Rotarians -- Dr. Trevor Smith, P.P. Bob Hayes, Dr. John Urie (twice), P.P. Ken Follett and P.P. Fred Bergman. Their comprehensive reports created important specific budget adjustments and desirable T.B. controls.
The supply of all drugs for T.B. control, sourced from suppliers overseas, was managed initially by P.P. Neil Kemp, and for most of the period by the treasurer P.P. Geoff Gannoni. The purchase of drugs from overseas suppliers was eventually limited to Cycloserine, when all other T.B. drugs were purchased locally and funded from the 3H account.
It is important to record the assistance and support given to this 3H project, throughout the years of preparation and involvement, by all members of the Rotary Club of Sunshine.
We have been extremely careful in the stewardship of the allotted funds to3H 84-8. The total outlay of funds for this 3H project, including funds from the Rotary Foundation, bank interest and direct Rotary Club of Sunshine donations, amount to A$410,000 or US$274,000, excluding all administrative costs covered by the Rotary Club of Sunshine.
We record our deepest appreciation of the Rotary Foundation in providing funding for the 3H project "Alleviation of T.B. Amongst Refugee Tibetans." We are indeed honored to be of service in this area of International Service.
Conclusion
Dr. Tsetan Sadutshang, the Tibetan C.M.O./Administrator of Delek Hospital, reported:
"The support of the T.B. project by Rotary has helped achieve the success that Delek can be proud of. The beneficiaries have extended far beyond the intended project area, and hundreds remain ever grateful for service provided by the project. The program has served as a model for the T.B. Control Program being implemented by the Tibetan Government-in-exile Department of Health. we remain ever grateful to the Rotary Club of Sunshine for their unfailing support throughout the program period."
Last Updated: 6 August 2006