Indoor Department

Indoor Patients' Ward

The St. Thomas Home is a charitable tuberculosis hospital in Howrah, West Bengal. It exists since 40 years and serves women affected by tuberculosis from the poorest section of the society free of charge. The hospital treats 45 women with complicated tuberculosis disease in its indoor department and serves more than 500 tuberculosis patients (male and female, adults and children) per year in its large tuberculosis outpatient department (OPD).

Indoor Ground Floor patients' ward of Bantra St. Thomas' Home Welfare Society (BSTHWS)

Indoor 1st Floor patients' ward of Bantra St.Thomas' Home Welfare Society	Dr. Tobias, talking with a patient and her guardian during his round in indoor ward

Indoor patients are taking handicraft and educational training

This picture shows the same tuberculosis patient at the time of her diagnosis (left side) and at the time of discharge from St. Thomas Home (right side).

The St. Thomas Home is in the ownership of the Church of North India. It`s work is free from any religious or political component. The St. Thomas Home doesn’t have any commercial interest. It was founded 40 years ago in response to the miserable situation of tuberculosis patients in Howrah. Still tuberculosis is the by far most important and dangerous plague of the urban slums of Howrah. Tuberculosis kills many human beings every year in Howrah district, most of them in their normally most productive life years, leaving behind a socially downtrodden family and children without chances for social improvement. Tuberculosis causes a wide spectrum of life long remaining physical handicap in survivors of the disease, for example destroyed lungs that limit the capacity of the patient to reuptake physical work after completion of his tuberculosis treatment.

Tuberculosis is caused by germs that spread in the lungs of affected persons and sometimes to other parts of the body. Other persons are infected when these germs are coughed up. The TB-germ spreads easily in congested living conditions with poor ventilation of households and with a malnourished population. The urban slums of Howrah are ideal areas for the tuberculosis-causing germ to spread. In these slums every day new infected persons can be found. Unfortunately, tuberculosis is more difficult to treat than other lung infections. The germ needs to be treated for a minimum time of six months with a combination of drugs to be extinguished completely.

This picture shows the same tuberculosis patient at the time of her diagnosis (left side) and at the time of discharge from St. Thomas Home (right side).

India counts nearly two million (20 lakh) new tuberculosis patients per year who all need to be treated for a minimum of six months (up to two years). The Revised National Tuberculosis Control Program is the national response to the tuberculosis plague and saves hundred thousands of lives every year that would have been lost otherwise due to unprofessional treatment by poorly qualified private practitioners of the slums. To reach out to every corner of the country, the National Tuberculosis Program joins hands with non-government organizations (NGOs) like St. Thomas Home and hands over the responsibility for certain slums to cooperating NGOs.

St. Thomas Home is situated between several large urban slums (bustees) of Howrah with an excessively high prevalence of tuberculosis. Its indoor department is traditionally reserved for women with complicated tuberculosis, while “usual” (uncomplicated) tuberculosis can be treated on an outpatient basis in up to 90 % of all tuberculosis patients. St. Thomas Home cooperates with other NGO-run tuberculosis hospitals in Howrah that serve male patients and children with tuberculosis, respectively.

This picture shows the same tuberculosis patient (mother of two children) at the time of her diagnosis (left side) and at the time of discharge from St. Thomas Home (right side).

Complicated tuberculosis means that the patient is not able any more to walk and to take part in a treatment on outpatient basis. Most patients with complicated tuberculosis feel extremely weak due to the critical weight loss that the disease has imposed on them when it was undiagnosed and untreated. At the time of diagnosis, many tuberculosis patients have body weights well below 30 kg. These patients cannot not eat at this time, even when good food would be available, because the disease disturbs the appetite.

A full blown tuberculosis of the lungs can generate shortness of breath and the need to take supplementary oxygen for some time. St. Thomas Home offers all indoor patients next to its medical services good food and oxygen around the clock whenever needed.

Patients with a new diagnosed tuberculosis often need blood transfusions as the disease compromises their blood level. Blood transfusions can be given easily in a hospital but hardly on outpatient basis.
Furthermore, an admission to an indoor department has, in comparison with an OPD treatment, the advantage for seriously ill women of getting relief from unmanageable family duties.

This picture shows the same tuberculosis patient at the time of her diagnosis (left side) and at the time of discharge from St. Thomas Home (right side).

The aforementioned advantages of admission to a hospital and of services over there are only basic helps for patients with complicated tuberculosis. Certain variants of tuberculosis, for example a tuberculosis of the spine or of the brain, need full medical attention and often quick qualified services to avoid the worst for these patients. For example, patients with tuberculosis of the spine often have a paralysis of their legs due to compression of nerves (the spinal cord inside of the spine) and need an operation to recover from paralysis soon. Patients with tuberculosis of the brain can have continuous epileptic fits (seizure disorder) and can develop cognitive deficits, blindness or psychosis if not treated sufficiently immediately. Patients with tuber-culosis of the abdomen can have an obstruction of their gut and can become unable to swallow anything, including TB drugs. In this situation, only a timely big operation is the way out.

The doctors of St. Thomas Home do all have decades of clinical experience with the treatment of tuberculosis and its complications. Necessary operations are done free of charge for patients without delay. Specialists of other fields (e.g. psychiatry, neurology) are called to the patients whenever needed.

Patients with so-called multidrug-resistant tuberculosis are of special concern. They are affected by germs that don`t respond any more to normal “first-line” antitubercular drugs. The reason for the acquisition of drug resistance by germs is an uncompleted treatment of tuberculosis before in life. If germs come in contact with drugs, that aren’t used strictly or long time enough to kill them, they can survive and cause relapses. These relapse-causing germs cannot be controlled any more by applying the same drugs as before.

This picture shows a girl with tuberculosis at the time of her diagnosis (left side) and at the time of discharge from St. Thomas Home (right side).

Unfortunately it is quite usual that tuberculosis patients stop their treatment long before their stipulated overall treatment duration of 6 up to 24 months. Tuberculosis patients, who feel better, are usually not willing any more to continue treatment. Furthermore, there is a huge population of migrant workers in Howrah who leave the city and district whenever they find work elsewhere without bothering much about the running tuberculosis treatment. When they harbor multidrug-resistant germs in their relapse, they infect others, who may never had tuberculosis before in their life, with the non-responding germ.

An estimated 5 % of the tuberculosis patients of Howrah are infected with multidrug-resistant germs. These patients can be saved only with a 2 years-regimen of reserve antitubercular drugs that unfortunately create lot of side effects and troubles. This regimen is the last chance of the so called MDR (multidrug-resistant) patients – without a correct application of this treatment these patients will surely die within short time while infecting their near and dear ones before they die.

St. Thomas Home serves many women with multidrug-resistant tuberculosis in its indoor department and tries to save their life and to control the strong side effects of the applied reserve drugs.

This picture shows an adolescent with tuberculosis at the time of her diagnosis (left side) and at the time of discharge from St. Thomas Home (right side).

Since around five years, the interplay of the tuberculosis and HIV plagues is observed in an increasing frequency in Howrah. These both infectious germs help each other to exploit the body of a patient. HIV-infected patients acquire tuberculosis easily. HIV fuels the progress of the tuberculosis disease and tuberculosis fuels the progress of the HIV disease.

Female HIV-positive patients have usually got infected by their husbands, and a diagnosis of HIV and tuberculosis in a female patient usually prompts the search for more of these diseases in her family, even among her children. A whole family can end to exist by the effect of these both diseases, or due to the long-term treatment of the family members in different institutions for sick women, men and children, resp. The treatment of HIV- and TB-double infected patients is medically complicated and is better done, at least in the first weeks, in a hospital and not on an outpatient basis.

This picture shows an adolescent with tuberculosis at the time of her diagnosis (left side) and at the time of discharge from St. Thomas Home (right side).

The state hospitals of Howrah are not equipped with beds to treat patients with complicated tuberculosis for long time, although this is a disease of the common man and very frequent in Howrah. But the State and District Health system supports St. Thomas Home by supplying TB drugs free of charge to most of the patients. However, St. Thomas Home depends in all its infrastructure, staff salaries, food for patients, much medicine, oxygen and consumables on donations. Up to now, resources have come from Germany only through a connection to a German-based NGO, the German Doctors. The patients of the indoor department of St. Thomas Home are so poor that they can`t contribute to their treatment. 

Indoor tuberculosis patients of St. Thomas home enjoy their relief from their former life threatening condition

The accountancy of St. Thomas Home is strictly supervised by external auditors. All audit reports are shown in detail publically on the internet site of St. Thomas Home. St. Thomas` Home is tax-exempted under West Bengal law. The long-time secretary of the hospital, Mrs. Monika Naik, has received the order of the cross of merit from the president of Germany recently for her outstanding help for thousands of tuberculosis patients.