Commitment and Passion for hhc
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Supporting LF Elimination Program in Indonesia

To support World Health Organization (WHO) in sustaining progress achieved as well as give a push to accelerate the control, elimination and eradication of Neglected Tropical Diseases (NTD) globally by 2020, Eisai is one of a signatory to the London Declaration, has committed under the declaration to produce 2.2 billion high-quality Diethylcarbamazine Citrate (DEC) tablets and work with WHO to supply the tablets at price zero to endemic countries. As announced on Eisai official corporate website which has been explained at News Release page on August 27, 2013, Eisai has received prequalification from WHO for the treatment of Lymphatic Filariasis (LF) as one of NTD. The approval is the first case worldwide in which a pharmaceutical company has received prequalification from WHO for a medicine used to treat NTD.

Lymphatic Filariasis (LF), commonly known as elephantiasis, is parasites disease which the infection occurs when filarial parasites are transmitted to human through mosquitoes. Summarized from WHO website, it is explained that when lymphatic filariasis develops into chronic conditions, it leads to lymphoederma (tissue swelling) or elephantiasis (skin/tissue thickening) of limbs and hydrocele (fluid accumulation), and the involvement of breast and genital organs is common. It is also explained that such body deformities lead to social stigma, as well as financial hardship from loss of income and increased medical expenses, not mentioning the socioeconomic burdens of isolation and poverty are immense.

As one of endemic country, LF is one of the major public health problems in Indonesia. In a book of World Health Organization & Ministry of Health Indonesia, Neglected Tropical Diseases in Indonesia: An Integrated Plan of Action (2011), it’s estimated 125 million people are at risk of filariasis infection, in 337 endemic districts, and total of 11,914 chronic cases have been reported nationally between 2000 and 2009. It is also stated clearly that the government of Indonesia has decreed filariasis elimination as one of national priorities to combat communicable diseases in line with Presidential Decree number 7, 2005, and agreed to participate in the international goal launched by World Health Organization (WHO) to eliminate LF as public health problem by 2020. The LF program’s objectives are to reduce and eliminate transmission of LF by Mass Drug Administration (MDA), and to reduce and prevent morbidity in affected persons.

In cooperation with WHO Indonesia, Bandung Trust Advisory Group (B-Trust), Research Triangle Institute (RTI) International, local and central Sub-directorate for Filariasis of Ministry of Health, PTEI employees took initiative to spend time together with elephantiasis patients in Kramat Jati, East Jakarta, and observe MDA for local residents at risk of filariasis infection in Subang, West Java. These initiatives were to implement hhc concept by emphasizing the importance of socialization.

Spending time together with LF patients in Kramat Jati was conducted on November 19, 2013. We empathized with patients how this elephantiasis hampers their daily activities. Even though Sub-directorate for Filariasis declared that they are free from filarial parasites now, the disease leaves permanent damage and painful in their life.

Observation of MDA in Subang was conducted on November 20 and 26, 2013. We observed MDA in 3 villages in Subang. Based on mapping throughout Indonesia by Ministry of Health, Subang is one of endemic area, and was conducting the third years of MDA. During these observations, we saw many challenges that faced by local volunteers to implement MDA. Therefore, committed volunteers are important to address many problems for the successful of MDA implementation in the village level.

MDA campaign follows the principle of directly observed treatment which each eligible person has to ingest the drug in front of the volunteer. We observed how volunteers informed and motivated the local residents to accept treatment, as well as compliance in accepting MDA treatment. Volunteers admitted that it was not easy to persuade local residents accepting MDA treatment and the compliance. Therefore, in a village, volunteers provided free blood pressure check for them who accepting the treatment. Also, in certain village, PTEI employees supported the compliance of MDA by rewarding children who ingested the drug in front of volunteer.

Despite of giving the treatment, volunteers played important role in giving information related to MDA. Although this MDA was the third years, there were still many questions asked by the people. Most of them asked about whether they may or may not take the drug if following conditions applied, for example diabetic, high blood pressure, dizziness, fever, etc.. Also, they asked about how the drug should be taken; after or before meal.

Promoting “Living a Clean and Healthy Life” is part of integrated program of the Government of Indonesia to control and eliminated NTDs. Therefore, applying clean and healthy MDA practice is also important, and volunteers plays important role in doing and engaging local residents in this practice.

Eisai’s original DEC tablets for use in MDA have been produced at Vizag Plant in India. In October 2013, Eisai began its free supply to WHO to help treatment and elimination of LF worldwide. The first destinations confirmed to receive Eisai’s initial DEC shipment are the Pacific nations of Papua New Guinea, Kiribati, Tuvalu and Fiji. PTEI hopes that in collaboration with WHO Indonesia, and Indonesia Ministry of Health, Eisai’s DEC can also bring value to 125 million people at risk LF in Indonesia and contribute to the achievement of Indonesia free from LF in 2020.

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PTEI employees listened with empathy when LF patient shared her chronic condition and the impact of elephantiasis that hamper her daily live

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PTEI Employee was in Subang Health Office before observing MDA

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The discussion between PTEI, RTI, and B-Trust after MDA opening ceremony in Subang

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PTEI employee rewarded children who ingested drug in front of volunteer