module treat the child -...

$: Module Treat the Child - dohs.gov.npdohs.gov.np/wp-content/uploads/chd/IMCI/HF/IMCI_HF_7Days_Module...&=) kvfnf nfu]sfnfO{ yk emf]ns'/fx? lbg'xf];\ / vfgf v'jfO/xg'xf];\..... pkrf$

ljifo–;"rL kl/ro ........................................................................................................................! !=) pkrf/sf] klxrfg / k|]if0f ..................................................................................... @ !=! k|]if0f ug'{ cuf8L t'?Gt pkrf/ ug'{xf];\ .................................................... # !=@ jRrfnfO{ k|]if0f ug'{xf];\ ............................................................................. $ @=) pko'Qm vfg] cf}iflw sf] dfqf s;/L / slt lbg;Dd lbg] xf] lgwf{/0f

ug'{xf];\ ............................................................................................................... @=! pko'Qm vfg] PlG6afof]l6s lbg'xf];\ ....................................................... cEof; …sÚ ............................................................................................ ( @=@ cf}nf] lj?4sf] vfg] cf}iflw lbg'xf];\ ......................................................................... !) @=# a9L–Hj/f]df -#*=%°;]=u|]=_ jf sfg b'v]df Kof/fl;6fdf]n lbg'xf];\ ............................. !@ @=$ le6fldg …PÚ lbg'xf];\ ................................................................................................. !# @=% cfO/g lbg'xf];\ ......................................................................................................... !% @=^ cNa]08fhf]n lbg'xf];\ ................................................................................................. !% cEof; …vÚ ................................................................................................................ !^

#=) k|efjsf/L ;+rf/ ;Lksf] ¿kdf k|of]u ug'{xf];\ ...................................................................... !* #=! cfˆgf] aRrfsf] pkrf/ 3/}df s;/L ug]{ eGg]af/] cfdfnfO{ ;Nnfx lbg'xf];\ ....................................................................................................... !* #=@ cfdfn] a'em]–ga'em]sf] s'/f hfFRg'xf];\ ....................................................................... @)

$=) 3/}df cf}iflw s;/L v'jfpg] egL cfdfnfO{ l;sfpg'xf];\ .................................................... @@

cEof; …uÚ ............................................................................................................... @& %=) :yfgLo ;ª\qmd0fsf] pkrf/ 3/}df s;/L ug]{ egL cfdfnfO{ l;sfpg'xf];\ .......................... @(

%=! cfFvfsf] ;ª\qmd0fsf] pkrf/ 6]6«f;fOlSng dndn] ug'{xf];\ ................................... #) %=@ sfgsf] kLk ;f];]/ ;'Vvf kfg'{xf];\ ............................................................................ #@ %=# -y|;_ d'vleqsf] 3fpsf] pkrf/ h]G;g efon]6n] ug'{xf];\ ....................................... ## %=$ 3fF6Lsf] b'vfO lgsf] kfg'{xf];\ tyf vf]sLaf6 5'6sf/f lbnfpg'xf];\ .......................... #% cEof; …3Ú ................................................................................................................ #^

^=) pkrf/ s]Gb|df lgDg pkrf/x¿ dfq ug'{xf];\ ....................................................................... $!

^=! PlG6afof]l6ssf] ;'O{ lbg'xf];\ .................................................................................... $! ^=@ s8f cf}nf]]sf]] nflu pkrf/ ug'{xf]; ........................................................................... $@ ^=# /utdf rLgLsf] dfqf sd x'gaf6 hf]ufpg aRrfsf] pkrf/ ug'{xf];\ .................... $$ cEof; …ªÚ ............................................................................................................... $%

&=) kvfnf nfu]sfnfO{ yk emf]ns'/fx? lbg'xf];\ / vfgf v'jfO/xg'xf];\ ..................................... $* &=! pkrf/ k|0ffnL …sÚ M 3/}df ul/g] kvfnfsf] pkrf/ ............................................... $* &=@ emf8fkvfnf /f]usf] Joj:yfkg ................................................................................ %) &=# emf8fkvfnfdf lhÍ rSsLsf] k|of]u ......................................................................... %) &=#=! lhÍ s] xf] / o;sf >f]tx? s] s] x'g\ ....................................................... %) &=#=@ lhÍ rSsL s;nfO{ v'jfpg] ...................................................................... %) &=#=# lhÍ rSsL v'jfpg] t/Lsf ......................................................................... %) &=#=$ lhÍ rSsL v'jfpg] dfqf ........................................................................... %! &=#=% lhÍ rSsLsf] k|of]ujf6 x'g] kmfObfx? ........................................................ %! &=#=^ lhÍ rSsLsf] k|of]ujf6 x'g] c;/x? .......................................................... %!

&=$ lhÍ rSsLsf] cfk"lt{ Jo:yfkg .................................................................................. %@

cEof; …rÚ ............................................................................................................... %#

&=% pkrf/ k|0ffnL …vÚ M s]xL hnljof]hgsf] pkrf/ k'gh{nLo emf]naf6 ug'{xf];\ ....... %^

cEof; …5Ú ................................................................................................................ ! cEof; …hÚ ................................................................................................................ #

&=^ pkrf/ k|0ffnL …uÚM s8f hnljof]hgsf] t'?Gt} pkrf/ ug'{xf];\ .............................. $ &=& bL3{ kvfnfsf] pkrf/ ug'{xf];\ ................................................................................. & &=* cfpF /utsf] pkrf/ ug'{xf];\ ................................................................................... & cEof; …emÚ .............................................................................................................. &#

*=) cfjZostf cg';f/, x/]s la/fdL aRrfnfO{ vf]k lbg'xf];\ .................................................. &$ HIV/AIDs sf] nfuL pkrf/ Aoa:yfkg ....................................................................... &%

cEof; …`Ú .......................................................................................................................... &^

kl/lzi6x¿ ......................................................................................................................................&*

kl/lzi6 s M Gofhf]Uofl:6\s k'gh{nLo pkrf/ ..................................................................... &(

kl/lzi6 …vÚM cf]= cf/= l6= sg{/ ........................................................................................ *)

kl/lzi6 …uÚ–! M olb tkfO{ OG6«fleg; -cfO{= le=_ pkrf/ ug{ ;Sg'x'G5 eg] ..................... *@ cEof; M kl/lzi6 …uÚ – ! ....................................................................... *#

kl/lzi6 …uÚ–@ M olb ghLsdf OG6«fleg; pkrf/ pknAw 5 eg] .................................... *$ cEof; M kl/lzi6 …uÚ–@ ......................................................................... **

kl/lzi6 …uÚ–#M olb tkfO{ pkrf/ k|0ffnL …uÚ s]jn d'vaf6 vfg lbP/ dfq lbg ;Sg'x'G5 eg] ............................................................................................ (!

cEof; M kl/lzi6 …uÚ –# .........................................................................($

kl/lzi6 …3ÚM s8f hnljof]hgsf] nflu OG6«fleg; pkrf/ .......................................... (&

kl/lzi6 …ªÚM hxfF k|]if0f ;Dej 5}g ............................................................................... ((

1

kl/ro

o; k'l:tsfdf tkfO{n] x/]s pkrf/nfO{ s;/L lbg] eGg]af/] l;Sg tflnsfsf] pkof]u ug'{ x'g]5 . ;fy} o; k'l:tsfdf tkfO{n] cfdfx¿nfO{ 3/df aRrfsf] pkrf/ ug{ s;/L l;sfpg' k5{ eGg] s'/f klg l;Sg' x'g]5 .

l;Sg] p2]Zox¿ o; k'l:tsfn] lgDglnlvt ;Lkx¿sf] j0f{g ug]{ 5 / tkfO{nfO{ lgDg s'/fx¿ ug{] cEof;sf] cj;/ lbg]5 M

* la/fdL aRrfsf] nflu pko'Qm vfg] cf}iflw / ltgsf] dfqf lgwf{/0f ug{ . * vfg] cf}iflwx¿ -PlG6afof]l6sx¿, cf}nf]]sf cf}iflwx¿, Kof/fl;6fdf]n, le6fldg …PÚ,

cfO/g / cNa]08fhf]n_ lbg tyf 3/df cf}iflwx¿ s;/L, slxn] / slt v'jfpg] egL cfdfnfO{ l;sfpg .

* :yfgLo ;+qmd0fx¿ -h:t}M cfFvf kfs]sf], sfgaf6 kLk au]sf], d'vsf 3fpx¿, 3fF6L

b'Vg' tyf vf]sL_ sf] pkrf/ ug{ tyf cfdfnfO{ slxn] / s;/L 3/}df pkrf/ lbg] eGg]af/] l;sfpg .

* cfdfn] a'em]–ga'em]sf] hfFRg . * pkrf/ s]Gb|df dfq k|of]u ul/g] cf}iflwx¿ -OG6«fd:s'n/ PDkLl;lng tyf lSjgfOg_

lbg . * /utdf rLgLsf] dfqf sd x'gaf6 hf]ufpg . * ljleGg k|sf/sf hn–ljof]hgsf] pkrf/ ug{ tyf cfdfnfO{ 3/df yk emf]ns'/fx? lbg]

af/]df l;sfpg . * afn aflnsfx¿nfO{ vf]k lbnfpg .

2

!= pkrf/sf] klxrfg / k|]if0f aRrfsf] ;d:ofsf] juL{s/0fkl5 pkrf/sf] k|ls|of z'? x'G5 . pkrf/ z'? ug'{cl3 cfjZos pkrf/sf] klxrfg ug'{ kb{5 . pkrf/nfO{ d'VotM tLg efudf afF8\g ;lsG5 .

!= k|]|]if0f ug'{kg]{ lj/fdLsf] pkrf/ @= vfg] cf}ifwLaf6 pkrf/ #= :yflgo ;+s|d0fsf] 3/}df ul/g] pkrf/

lgDglnlvt ˆnf] rf6{n] pkrf/sf] klxrfg ug{ ckgfpg] ljleGg r/0fx¿ b]vfpF5 . x/]s r/0fn]

Ps Ps v08sf] k|ltlglwTj ub{5 . w]/}h;f] la/fdL aRrfx¿nfO{ t'?Gt k|]if0f ug'{kg]{ x'Fb}g . ltgLx¿n] bf];|f] -@=)_ r/0fdf hfg' kb{5 . t'?Gt k|]if0f ug'{kg]{ lj/fdL ePdf ;Lwf t];|f] -#=)_ r/0fdf hfg' k5{ .

kb}{g

k5{

!=) t'?Gt k|]if0f ug{ h¿/L 5 ls? lg0f{o ug'{xf];\

@=) k|]if0f h¿/L gePsf la/fdLx¿sf nflu pkrf/sf] klxrfg ug'{xf];\

#=) t'?Gt k|]if0f ug'{ cuf8L cfjZos kg]{ pkrf/sf] klxrfg ug'{xf];\

$=) t'?Gt k|]if0f ug'{ cuf8L pkrf/ ug'{xf];\

%=) aRrfnfO{ k|]if0f ug'{xf];\

k|]|]if0f ug'{kg]{ lj/fdLsf] pkrf/ o;nfO{ @ efudf afF8\g ;lsG5 .

s= h?/L k|]|]if0f v= d'Nof°sgsf] nfuL k|]|]if0f h?/L k|]|]if0f ug'{kg]{ cj:yfx?

æd"Nofª\sg / juL{s/0fÆ tflnsfsf] s8f juL{s/0fsf] efu x]g'{xf];\ . of] efusf] k'l:tsf u'nfaL /+usf] 5 . o;df lgDglnlvt /f]ux¿ k5{g\ M

;fdfGotof b]lvg] vt/fsf lrGxx? ePdf s8f Go'df]gLof jf w]/} s8f /f]u ePdf s8f hnljof]hg c? s8f juL+s/0fdf klg kb{5 eg] s8f bL3{ kvfnf c? s8f juL+s/0fdf klg kb{5 eg] w]/} s8f Hj/f]hGo /f]u s8f hl6n bfb'/f df:6f]O8fOl6; (Mastoiditis) / s8f s'kf]if0f jf s8f /QmcNktf

3

oL jlu{s/0fsf /f]unfO{ ug]{ pkrf/sf] ;"rLdf …tTsfn c:ktfndf k|]if0fÚ ug'{xf];\ eGg] zLif{ssf lgb]{zgx¿ k9\g'xf];\ . lgb]{zgdf lbOPcg';f/ k|]if0f ug'{ k"j{sf] pkrf/ cfjZostfg';f/ oyfzL3| lbP/ la/fdL aRrfnfO{ t'¿Gt k|]if0f ug'{xf];\ . cgfj:os pkrf/ ubf{ Joy{df ;do v]/ hfg ;S5 . t;y{ k|]if0f ug'{ cufl8 To:tf] pkrf/ gug'{xf];\ . ckjfbsf] ?kdf M æs8f bL3{ kvfnfÆ nfO{ æc:ktfndf k|]if0f ug]{Æ eg]/ dfq n]lvPsf] 5 . o;f] n]Vg'sf] cy{ k|]if0f rflxF ug'{k5{, t/ t'¿Gt} rflxF x}g eGg] x'G5 . o; k':tssf] v08 @=) df pNn]v ePcg';f/ pkrf/ ljlwsf] klxrfg ug{nfO{ k|z:t ;do x'G5 / k|]if0f ug'{ cl3 tL pkrf/x¿ ug'{xf];\ . csf]{ ckjfbsf] ?kdfM olb tkfO{+sf] pkrf/ s]Gb|df s8f hnljof]hgsf] pkrf/ ug]{ Ifdtf 5 eg] To:tf la/fdLnfO{ k|]if0f gu/L tkfO{+ cfkm\g} pkrf/ s]Gb|df ltgsf] pkrf/ ug{ ;Sg' x'G5 . -kl/lzi7 x]g'{xf];\_ la/fdL aRrfx¿df hnljof]hg cj:yfdf x'g] ;fdfGotof b]lvg] vt/fsf lrGxx¿ b]vf kg{ ;S5g\, h:t}M ;':t jf a]xf]; cyjf s8f hnljof]hgsf] sf/0fn] emf]nkbfy{ lkpg klg g;Sg' OToflb . d"Nof°gsf] nfuL k|]if0f #) lbgeGbf al9 ;dob]lv nuftf/ vf]sL 5 eg] Hj/f] k|To]s lbg nuftf/ & lbg;Dd cfO{/Xof] eg] /SQ cNktfsf] cg'udgsfnflu cfPsf] aRrfsf] olb @ dlxgf kl5 klg xTs]nfsf] ;]tf]kgf uPg

eg] w]/}sd tf}nsf] aRrf cg'udgdf cfpFbf olb tkfO{sf] ljrf/df aRrfsf] vfgfdf ;"wf/ x'g ;Sb}g

jf tf}ndf sdLx'Fb} uof] eg] Go"df]lgo / cfFp /ut ePsf] aRrf cg'udgdf cfpbf l:ytL p:t} /x]df-olb p;nfO{ ut #

dlxgfdf bfb'/fcfPsf] lyof] eg]

!=! k|]if0f ug'{ cuf8L t'?Gt pkrf/ ug'{xf];\ (Give urgent pre-referral treatment) k|]if0f k"j{ ul/g] ;a} h¿/L pkrf/x¿ tflnsfdf ;dfj]z ul/Psf 5g\ . aRrfnfO{ k|]if0f ug{ nfu]sf] a]nf, t'¿Gt} pkrf/ ug'{xf];\ . cfdfnfO{ l;sfpg] kl§ nfu]/ ;do glng'xf];\ . s8f /f]u nfu]sf w]/} la/fdLx¿nfO{ k|]if0fk"j{ Ps dfqf PlG6afof]l6s lbg' cfjZos x'G5 . h]xf];, olb aRrf lkpg g;Sg] 5, vfPsf] ;a} jfGtf u5{, p;df sDkg 5, jf p;nfO{ hufpg ;ls+b}g eg] To:tf aRrfn] vfg] PlG6jfof]l6s, cGo vfg] c}f}iflwx¿, emf]n s'/fx¿, h:t}M k'gh{lnoemf]n jf cfdfsf] b"w vfg ;Sb}gg\ . vt/fsf lrGxx¿ ePsf To:tf aRrfnfO{ vfg] PlG6jfof]l6ssf] ;§f PDkLl;lngsf] ;'O{sf] cfjZostf k5{ . aRrf vfg ;Sg] 5 eg] k'gh{lnoemf]n cyjf vfg] cf}iflwx¿ h:t}M kf/fl;6fdf]n c:ktfndf lbOg' kg]{ cfjZostf kg]{5 . olb aRrfnfO{ /utdf lrgLsf] dfqf sd x'gaf6 hf]ufpg pkrf/sf] cfjZostf k5{ / tkfO{+ Gofhf]Uofl:6«s -Pg=lh_ 6\o"j gfsdf 3';fpg ;Sg'x'G5 eg], k|]if0fk"j{ lrgL kfgL jf cfdfsf] b"wsf] ljsNkdf cGo b"w Pg=lh= 6\o'jåf/f lbg'xf];\ .

4

!=@ aRrfnfO{ k|]if0f ug'{xf];\ (Refer the child)

la/fdL aRrfnfO{ c:ktfn k|]if0f ubf{ rf/ cf]6f dxTjk'0f{ r/0fx¿ k"/f ug'{k5{ M != k|]if0f lsg ug'{ k/]sf] xf] eGg] s'/f af/] la/fdL aRrfsf] cfdfnfO{ /fd|/L ;+emfpg' k5{ . olb aRrfnfO{

c:ktfn n}hfg cfdf lxrlsrfOg\ eg] s] sf/0fn] o;f] ul/Psf] xf] sf/0f kQfnufpg'xf];\ . o;sf sf/0fx¿ lgDglnlvt x'g ;S5g\ M

c:ktfndfM la/fdL d/]sf] ;'lgg] ePsfn] pgsf] aRrf klg d5{ ls eGg] ;f]r]/ pgL 8/fpFl5g\ . c:ktfndf aRrfnfO{ pkrf/sf lgDtL d2t ul/G5 eGg] s'/f pgn] g;f]r]sf] klg x'g;S5 .

pgL 3/ 5f]8]/ hfg g;Sg] ePsfn] / c:ktfn hfg grfx]sf] klg x'g ;S5, lsgeg] M – pgsf c¿ aRrfx¿sf] x]/rfx ug]{ c¿ sf]xL x'Fb}g jf – pgn] v]taf/L, 3fF;bfp/f ug'{ k5{ – pgsf] hflu/ 5'6\g ;S5 pgL;Fu af6f vr{, c:ktfndf nfUg] /sd, cf}iflw / c:ktfndf a:bf pgL cfkm}+nfO{ vfg]

vr{sf nflu k};f gx'g ;Sb5 . @= cfdfsf] 8/nfO{ x6fpg ;Demfpg'xf];\ / cGo s'g} ;d:of eP ;dfwfg ug'{xf];\, h:t} M olb aRrfsL cfdfnfO{ pgsf] aRrf dnf{ eGg] 8/ 5 eg] c:ktfndf pkrf/ ug]{ 8fS6/, g;{,

cf}iflw / pks/0fx¿ pknAw x'G5 / h'g;'s} /f]u klg lgsf] kfg{ ;lsG5 eg]/ ljZj:t kfg'{xf];\ / pknAw x'g ;S5 eg] PDa'n]G;sf] Joj:yf ug{ ;xof]u ug{'xf];\ .

#= aRrfnfO{ c:ktfn k7fpg k|]if0f l6kf]6 'HMIS' * sf] kmf/ddf pNn]v ;a} a'bfx? g5'6\6fO{ eg{'xf];\ .

Tof] l6kf]6 c:ktfnsf :jf:Yo sfo{stf{sf] xftdf lbg' kg]{ s'/f cfdfnfO{ atfpg'xf];\ . $= la/fdL aRrfsL cfdfnfO{ c:ktfn hf“bf af6f]df aRrfnfO{ x]/ljrf/ ug{ cfjZos kg]{ cf}iflw /

lgb]{zgx¿ lbg'xf];\ M olb c:ktfn 6f9f 5 eg] aRrfsL cfdfnfO{ yk PlG6afof]l6s lbg'xf];\ / ofqf ub}{ /xFbf

af6fdf s'g s'g cf}iflw slt slt a]nf vfg lbg] eGg] af/] atfpg'xf];\ . tkfO{+sf] ljrf/df k|]if0f u/] klg cfdfn] aRrfnfO{ c:ktfn n}hfGgg\ h:tf] nfUof] eg] PlG6afof]l6s k"/} sf];{ lbg'xf];\ .

:tgkfgsf] ;fy} Gofgf] kfl//fVg eGg'xf];\ . olb aRrfnfO{ s]xL jf s8f hnljof]hg 5 eg] / aRrfn] lkpg ;S5 eg] af6f]df v'jfpgsf

nflu s]xL k'gh{lnoemf]n aRrfsL cfdfnfO{ lbg'xf];\ . cf}nf]]sf] nflu /utsf] :nfO8 agfOPsf] 5 eg] cfdfnfO{ c:ktfn lnP/ hfgsf nflu lbg'xf];\ .

5

@=) pko'Qm vfg] cf}iflwsf] dfqf lgwf{/0f ug'{xf];\ (Select the appropriate ORAL Drug and Determine

the Dose and Schedule)

e"ldsf gf6s M /fhLjsL cfdfnfO{ lgb]{zgx¿ /fhLj tkfO{+sf] bf];|f] ;Gtfg xf] . tkfO{+n] o; cl3sf] @ jif]{ 5f]/fnfO{ 3/df ;f;";Fu 5f]8]/ cfpg'ePsf] 5 . pkrf/ s]Gb|df cfpFbf tkfO{+n] s'g} k};f Nofpg' ePg5 / c:ktfn k'Ug] af6f] klg yfxf 5}g . tkfO{+sf] 3/df kmf]g 5}g, t/ tkfO{+sf >Ldfg\n] sfd ug]{ 7fpFdf eg] kmf]g 5 . tkfO{ /fhLjnfO{ /fd|f] x'g] sfd ug{ rfxg' x'G5, t/ c:ktfn s;/L k'Ug], s;/L tkfO{+sf] kl/jf/;Fu ;Dks{ /fVg] cflb jf/] tkfO{ lrlGtt x'g'x'G5 . ;fy} tkfO{+sf] ufpFsf] Pp6f aRrf c:ktfndf xfn;fn} d/]sf] klg lyof] . /fhLj klg dnf{ ls eGg] tkfO{+nfO{ c;fWo} lrGtf 5 .

6

pko'Qm cf}iflw 5fGgnfO{ tyf To;sf] dfqf / lbg] ;do lgwf{/0f ug{ …afn pkrf/Ú eGg] tflnsf k|of]u ug'{xf];\ . k|To]s vfg] cf}iflwsf] af/]df s]xL s'/fx¿ ;Demgsf] nflu hfGg' h?/L 5 .

@=! pko'Qm vfg] PlG6afof]l6s lbg'xf];\ lgDg juL{s/0fdf k/]sf aRrfx¿nfO{ PlG6afof]l6ssf] cfjZostf kb{5 M

s8f Go"df]lgof cyjf w]/} s8f /f]u Go"df]lgof x}hf -Cholera_ ePsf] If]qdf b]lvPsf] kvfnf cfpF /ut w]/} s8f Hj/f]hGo /f]u s8f hl6n bfb'/f df;6\jf]O8fOl6; -Mastoiditis_ sfgsf] PSo'6 ;ª\qmd0f

w]/} h;f] :jf:Yo ;+:yfx¿df Ps eGbf a9L PlG6afof]l6s pknAw x'g;S5 . tkfO{n] la/fdL aRrfsf] nflu pko'Qm PlG6afof]l6ssf] rog ug{ l;Sg' k5{ . olb aRrf lkpg ;Sg] 5 eg] vfg] PlG6afof]l6s lbg'xf];\ . jf]tndf ePsf] w"nf] PlG6afof]l6s cf}iflwnfO{ s;/L emf]n jgfpg] eGg] jf/] cfdfnfO{ l;sfpg'xf];\M

x/]s jf]tnsf] jflx/L efudf kfgL sfxfF;Dd /fVg] eGg] lrGx /flvPsf] x'G5 . k|foh;f] ;j} jf]tnx?df cf}iflwsf] dfqf gfKg] skdf -@=%, %, &=% / !) ld=ln_ n]lvPsf] x'G5

h;n] jRrfnfO{ lbg' kg]{ cf}iflwsf] dfqf gfKg ;lhnf] x'G5 . olb gfKg] sk gePdf lrof rDrf -% ld=ln=_ k|of]u ug{ ;lsG5 .

pdfn]/ ;]nfPsf] kfgL jf]tnsf] lrGx;Dd /fVg'xf];\ / ljsf]{ jGb u/L /fd|/L xNnfpg'xf];\ . s]lx ldg]6 kl5 emf]n cf}iflwsf] dfqf jf]tnsf] lrGx;Dd eP gePsf] lglZrt ug'{xf];\ /

cfjZos k/] km]l/ lrGx;Dd kfgL ykL xNnfpg'xf];\ . cj cf}iflwsf] emf]n v'jfpgsf] nflu tof/ eof] . tof/ u/]sf] cf}iflw & lbg leq k|of]u u/L ;Sg' kb{5 . To;nfO{ 3fd, tfk / jRrfx?jf6 6f9f

/fVg' kb{5 . b]zcg';f/, k|To]s /f]usf] nflu pko'Qm vfg] PlG6afof]l6s km/s kg{ ;S5 . tkfO{sf] b]zdf l;kmfl/z ul/Psf PlG6afof]l6sx¿ …afn pkrf/Ú eGg] rf6{df lbOPsf] 5 . o;kl5sf] kfgfdf ePsf] rf6{ x]g'{xf];\ .

7

pko'Qm vfg] PlG6afof]l6s lbg'xf];\

Go"df]lgof,sfgsf] PSo'6 ;ª\qmd0f jf s8f juL{s/0fsf] nflu klxnf]–k+lQmsf] PlG6afof]l6s M sf]l6«df]S;fhf]n * sfgsf] PSo'6 ;+qmd0fsf] nflu % lbg;Dd lbg] / bf];|f]–k+lQmsf] PlG6afof]l6s M Pdf]lS;l;lng * lgdf]lgofsf] nflu # lbg;Dd dfq

sf]l6«df]S;fhf]n

6«fOd]yf]lk|d ± ;Nkmfd]yf]S;fhf]n lbgsf] @ k6s lbg'xf];\

Pdf]lS;l;lng

lbgsf] @ k6s lbg'xf];\

pd]/ jf tf}n jo:ssf] rSsL

*) ld=u|f= 6«fOd]yf]lk|d ± $)) ld=u|f=

;Nkmfd]yf]S;fhf]n

aRrfsf] rSsL @) ld=u|f= 6«fOd]yf]lk|d ± !))

ld=u|f= ;Nkmfd]yf]S;fhf]n

rSsL @%) ld=u|f=

emf]n !@% ld=u|f= k|lt %

ld=ln=

@ b]lv !@ dlxgf -$–!) s]=lh_

!÷@

@

!÷@

% ld=ln=

!@ dlxgfb]lv % jif{ -!)–!( s]=lh=_

!

#

!

!) ld=ln=

cfp“ /ut PlG6afof]l6s M l;k|f]ˆnf]S;fl;g

pd]/ jf tf}n

l;k|f] nf]S;fl;g lbgsf] @ k6s # lbg

lbg'xf];\ rSsL @%) ld=u|f=

@ b]lv $ dlxgf -$–^ s]=lh=_ !÷$

$ b]lv !@ dlxgf -^–!) s]=lh=_ !÷@

!@ dlxgfb]lv % jif{;Dd -!)–!( s]=lh=_

!

x}hf klxnf] k+lQmsf] PlG6afof]l6s M l;k|f] nf]S;fl;g

bf];|f] k+lQmsf] PlG6afof]l6s M Pl/y|f]dfOl;g

pd]/ jf tf}n

l;k|f] nf]S;fl;g lbgsf] @ k6s # lbg lbg'xf];\

Pl/y|f]dfOl;g lbgsf] $ k6s # lbg lbg'xf];\

rSsL @%) ld=u|f= rSsL @%) ld=u|f @ b]lv $ dlxgf -$– ^ s]=lh=_ !÷$ !÷$ $ b]lv !@ dlxgf -^–!) s]=lh=_ !÷@ !÷@ !@ dlxgfb]lv % jif{;Dd -!)–!(

s]=lh=_ ! !

Pr= cfO{= le ;+qmldt÷;+;u{ ePsf PlG6afof]l6sM sf]l6|df]S;fhf]n k|f]kmfONoflS;;\ dfqfM k|f]kmfONoflS;;\sf] nflu lbgsf] ! k6s -cf}iflw csf]{ k6ssf] cg'udg ;Ddsf nflu k'Ug] u/L lbg]_

pd]/

sf]l6\ddf]S;fhf]n -;Nkmfldyf]cS;fhf]n + 6\fOldyf]lk|d_ rSsL !)) ld=u|f=÷@) ld=u|f=

rSsL $)) ld=u|f=÷*) ld=u|f= emf]n -@)) ld=u|f=÷$) ld=u|f=_

^ dlxgf d"lg ! rSsL !÷$ -Ps rf}yfO_ rSsL vfgf ;+u}

@=% ld=ln=

^ dlxgf b]lv % jif{ ;Dd

@ rSsL !÷@ -cfwf_ rSsL % ld=ln=

cfpF/ut eP/

l;k|f] nf]S;fl;g lbg'kg{]cj:yfdf olb Go"df]lgof jf sfgsf] PSo"6 ;+qmd0f klg ePdf sf]l6«d jf

8

…k|yd kª\lQmsf]Ú vfg] PlG6afof]l6s pknAw 5 eg] ;f] lbg'xf];\ . of] k|efjsf/L1, v'jfpg ;lhnf] x'g'sf]

;fy} ;:tf] ;d]t ePsfn] o;nfO{ /f]lhPsf] xf] . olb k|yd kª\lQm PlG6afof]l6s pknAw 5}g, cyjf o;af6 aRrfnfO{ s'g} nfe ePg eg] dfq} tkfO{n] …bf];|f] kª\lQmÚ PlG6afof]l6s lbg' kb{5 .

s]xL aRrfx¿df Ps eGbf a9L /f]ux¿ eP/ PlG6afof]l6s4f/f ul/g] pkrf/sf] cfjZostf kg{ ;S5 . ;Dej eP;Dd, o:tf] Pp6f PlG6afof]l6ssf] rog ug'{xf];\, h;n] aRrfdf ePsf ;a} /f]ux¿sf] pkrf/ ug{ ;sf];\ . * slxn] sfxL+ ;a} /f]ux¿sf] pkrf/ ug{ Pp6} PlG6afof]l6s lbg ;lsG5 . pbf/x0fsf] nflu, Go"df]lgof tyf sfgsf] PSo'6 ;ª\qmd0f ePsf] aRrfnfO{ Pp6} PlG6afof]l6såf/f

pkrf/ ug{ ;lsG5 . olb sfgsf] PSo'6 ;+qmd0fsf] nflu k|yd kª\lQmsf] PlG6afof]l6s sf]l6«df]Shfhf]n xf] / x}hfsf] nflu klg of] k|yd cyjf bf];|f] kª\lQmsf] PlG6afof]l6s xf] eg] cfpF /ut tyf sfgsf] PSo'6 ;+qmd0f ePsf] aRrfnfO{ sf]l6«df]S;fhf]naf6 pkrf/ ug{ ;lsG5 .

Pp6} PlG6afof]l6ssf] cfjZostf kg{] PseGbf a9L /f]ux¿ ePsf] aRrfsf] pkrf/ ubf{, x/]s

dfqfnfO{ bf]Aa/ gug'{xf]; / PlG6afof]l6s nfdf] ;dosf] nflu klg glbg'xf]; . * cfp“ /ut eP/ l;k|f]km\nf]S;f;Lg lbg'kg]{ cj:yf x'g'sf] ;fy} Go"df]lgof jf sfgsf] PSo"6 ;+qmd0f

;d]t ePdf sf]l6«d jf Pdf]S;Ll;lng lbg' gkg]{ . * slxn] sfxL /f]ux¿sf] pkrf/ ug{ PseGbf a9L PlG6afof]l6s lbg} k5{, h:t}M Go"df]lgofdf k|of]u x'g] PlG6afof]l6sx¿ cfpF /utsf] nflu s'g} 7fpFx¿df k|efasf/L gx'g

klg ;S5g\ . o; cj:yfdf, cfpF /ut tyf Go"df]lgofsf] pkrf/sf] cfjZostf k/]sf] aRrfnfO{ b'O{ j6f PlG6afof]l6s lbg} k5{ .

…afn–pkrf/Ú eGg] tflnsfdf aRrfnfO{ lbOg] PlG6afof]l6ssf] pko'Qm dfqf / slt lbg;Dd lbg] eGg] ljj/0f lbOPsf] 5 . o; ljj/0fn] PlG6afof]l6s k|lt lbg slt k6s lbg] tyf slt lbg;Dd lbg] eGg] af/] atfpF5 . w]/} h;f] PlG6afof]l6sx¿ nuftf/ % lbg;Dd g} lbg'kg{] x'G5g\ . s]jn x}hfsf la/fdLx¿nfO{ dfq} PlG6afof]l6s # lbg;Dd lbP k'U5 . lbgdf slt k6s PlG6afof]l6s lbg] eGg] s'/f PlG6afof]l6s x]/L km/s–km/s x'G5 . -k|lt lbg @, # cyjf $ k6s_ PlG6afof]6ssf] ;xL dfqf lgwf{/0f ug{M * tkfO{sf] :jf:Yo rf}sLdf pknAw rSsL cyjf f]n cf}iflw s'g Ifdtf

(Strength) sf 5g\ tkfO{nfO{ hfgsf/L x'g'k5{ . * aRrfsf] tf}n cyjf pd]/sf] cfwf/df cf}iflwsf] rog ug'{xf];\ . ;xL dfqf lglZrt ubf{ pd]/

eGbf tf}n a9L pkof]uL x'G5 . pko'Qm vfg] PlG6afof]l6s rog ug{ tyf To;sf] ljj/0f / dfqf lgwf{/0f ug{ tflnsfsf] k|of]u s;/L ug{] eGg] af/] cfˆgf k|lzIf0f ;xof]uLn] k'gM jtfpg' x'g]5 .

1 /]lh:6ofG; (Resistance) tYof°x¿sf] cfwf/df l;kmfl/z ul/Psf k|yd tyf bf];|f] kª\lQmsf PlG6afof]l6sx¿nfO{ a]nf

a]nfdf abNg' kg]{ x'g;S5 .

9

cEof; ‘s’ o; cEof;df tkfO{n] …pko'Qm vfg] PlG6afof]l6s lbg'xf];Ú eGg] tflnsfnfO{ k|of]u u/L cEof; ug'{ x'g]5 . afn–pkrf/ eGg] tflnsfnfO{ k|of]u ug'{xf];\ . pko'Qm vfg] PlG6afof]l6s 5fGg'xf];\ tyf lgDg lnlvt k|To]s la/fdLsf] nflu dfqf / ;do n]Vg'xf];\ . cg'dfg u/f}+ ls aRrfsf] /f]usf] pkrf/ eO/x]sf] of] k|yd k6s xf] . aRrfdf cGo /f]u;DaGwL juL{s/0f 5}g . vfnL 7fpFdf pQ/ n]Vg'xf];\ . != ^ dlxgf -& lsnf]_ sf] Pp6f aRrfnfO{ df:6\f]jfO8fOl6; (Mastoiditis) sf] nflu PlG6afof]l6s

rflxPsf] 5 . @= s8f Go"df]lgof jf w]/} s8f /f]u ePsf] Pp6f aRrf -!) lsnf]_ nfO{ klxnf] dfqf PlG6afof]l6s

rflxPsf] 5 . #= ! jif{ -!! lsnf]_ sf] Pp6f aRrfnfO{ Go"df]lgof tyf sfgsf] PSo'6 ;ª\qmd0fsf] nflu PlG6afof]l6s

rflxPsf] 5 . $= cfpF /ut k/]sf] Pp6f aRrf -!^ lsnf]_ nfO{ PlG6afof]l6s rflxPsf] 5 . %= cfpF /ut / sfgsf] PSo'6 ;ª\qmd0fsf] nflu Pp6f aRrf -% lsnf]_ nfO{ PlG6afof]l6s rflxPsf]

5 . ^= x}hf km}lnPsf] If]qsf] #^ dlxgf -!% lsnf]_ sf] Pp6f aRrfnfO{ Go"df]lgof nflu PlG6jfof]l6s /

s8f hnljof]hgsf] nflu IV rflxPsf] 5 .

of] cEof; l;WofPkl5 cfˆgf pQ/ cfˆgf k|lzIf0f ;xof]uL;Fu hFrfpg'xf];\ .

tkfO{sf] k|lzIf0f ;xof]uLn] pko'Qm PlG6afof]l6s 5fGg / o;sf] ;do / dfqf lgwf{/0f ug{ tkfO{nfO{ cem a9L cEof; u/fpg' x'g]5 .

10

@=@ cf}nf]] la?4sf vfg] cf}iflw lbg'xf];\ cf}nf]]sf vfg] cf}iflwx¿ b]z cg';f/ leGg leGg x'G5g\ . xfd|f] b]zdf l;kmfl/z ul/Psf cf}nf]]sf vfg] cf}iflwx¿ tflnsfdf b]vfOPsf 5g\ . tkfO{sf] :jf:Yo rf}sLdf pknAw cf}nf]]sf] vfg] cf}iflw k|of]u ul/ pkrf/ z'?ug{'xf];\ . cf}nf]]sf] vfg] cf}iflwsf] dfqf tyf ;do lgwf{/0f ug{ afn–pkrf/ eGg] tflnsfnfO{ x]g'{xf];\, h:tf] ls tkfO{n] vfg] PlG6afof]l6s sf nflu ug'{ ePsf] lyof] .

3/}df cf}iflw s;/L v'jfpg] egL cfdfnfO{ l;sfpg'xf];\ 3/}df v'jfpg] k|To]s cf}iflwsf] af/]df lgDg lgb]{zgx¿sf] cg';/0f ug'{xf];\ . ;fy}, x/]s cf}iflwsf] dfqf–6]j'ndf lbOPsf

lgb]{zgx¿sf] kfngf ug'{xf];\ . ofb ug{'xf];\ aRrfx?df dn]l/of la?4sf] cf}iflw /utdf lrgLsf] dfqf sd u/fpg] Hypoglycemia u/fpg ;S5 . :tgkfg / rLgL kfgL vfglbg'xf];\ .

v= Un complicated Falciparum Malaria ePdf —Drug of choice Artemisinin - based Combination Therapy (ACT) sf] ?kdf 5 . o;df Artemether 20 mg /

Limefantrine 120 mg 5 . o; (AL Coartem R) nfO{ klxnf] klQ+msf] cf}ifwLsf] ?kdf lbg ;lsG5 . bf;|f]] klQ+msf] cf}ifwL M Quinine Sulphate xf] . The doses of AI (CoartemR) by kg. body weight

Body Weight (Kg.)

Day-1 Day-2 Day-3 First Dose (0

hour) 12 hours later Twice daily-12 hours apart

5-14 1 tablet 1 tablet 1 tablet 1 tablet 15-24 2 tablets 2 tablets 2 tablets 2 tablets

Notes: AL is administered to patients of uncomplicated, confirmed (by microscopy or

RDT) P. Falciparum Malaria. of] cf}ifwL -AL cf}ifwL_ ! aif{ eGbf sd pd]/sf jf % s]=hL eGbf sd tf}nsf

jRrfnfO{ lbg' x'“b}g . o:tf] cj:yfdf l;kmfl/; u/]sf] dfqf Quinine Sulphate 10 mg per kg body wt lbgdf # k6s & lbg ;Dd lbg' k5{ .

klxnf] klQ+msf] cf}ifwLaf6 pkrf/ ubf{ Failure ePsf] !$ lbg eLq Quinine Sulphate 10 mg per kg body wt x 3 times a day x 7 days lbg ;lsG5 .

of] cf}ifwL vfgf kl5 lbg'k5{ .

cf}nf] la?4sf] vfg] cf}iflw lbg'xf];\

s= Falciparum Complicated Severe Malaria ePdf Artemisinin Suppositories (Artisurate Single dose lgDg cg';f/sf] Rectal df lbO{

pkrf/ s]Gb|df k|]if0f ug'{xf];\ .

Wt . in K.g. Age (Years) Artemisinin Suppositories 5-8.9 0-12 months 50 mg 9-19 13-42 months 100 mg 20 + 43-59 months 200 mg

olb Artemisinin Suppositories (Artisurate Single dose gkfPdf Quinine Dehydrocholoride Intramuscular 10 mg/kg body weight n] lbO{ k|]if0f ug'{xf];\ .

o;sf] c;/M sfg s/fpg], l/Ë6f nfUg], k]6 u8a8x'g] / al9dfqf x'g uPdf d'6' / /Qm glnx?df c;/ x'g ;S5 . ue{jtL / aRrfdf Quinine Sulphate af6 pkrf/ ubf{ /utdf lrgLsf] dfqf sd x'g ;Sb5 .

11

u= aRrfnfO{ Non Faciparum Malaria jf P. Vivex Malaria ePdf lgDg cg';f/ Chloroquine / Premaquine klg pd]/ ;d"x cg';f/ lgDg cg';f/ lbg ;lsG5 t/ Premaquine cf}ifwL k|of]uzfnfdf G6PD sf] hfFr gu/L lbg ldNb}g . Dose of Chloroquine and Premaquine by age group

Days

Drug

Age in years

Wt. 4-10 Kg. Wt. 10-19 Kg

<1 year 1-4 Years 4-5 years

1 Chloroquine Tablet (150 mg) ½ 1 2

Premaquine Tablet (7.5 mg) NIL ½ 1

2 Chloroquine Tablet (150 mg) ½ 1 2


3 Chloroquine Tablet (150 mg) ½ ½ 1


4-14* Premaquine Tablet (7.5 mg) NIL ½ 1

*Each Tablet of Chloroquine is 150 mg. base. :ffgf gfgLx?nfO{ 6ofjn]6\sf] ;§fdf lgDg cg';f/sf] emf]n cf}ifwL klg lbg ;lsG5 . Chloroquine syrup for young children One teaspoonful = 5ml. of Chloroquine syrup = 50 mg. Chloroquine base

Day Age in years

Less than 1 year 1-4 years

Wt. 4-10 Kg. Wt. 10-19 Kg

1 One and half tea spoonful (75 mg) 1 & ½ (7.5 ml)

Three tea spoonful (150 mg) 3 (15 ml.)





olb Chloroquin lbg' 5 eg] M lj/fdL jRrfnfO{ sDtLdf cfwf 306f;Dd ;fjwfgL k"j{s x]/ ljrf/ ug'k5{ elg

cfdfnfO{ jtfpg'xf];\ . olb jRrfn] cfwf 306f leq afGtf u/]df cf}ifwL bf]xf]¥ofP/ v'jfpg' kb{5 / yk cf}ifwLsf] nfuL pkrf/ s]Gb|df cfpg' kb{5 .

cf}ifwL v'jfPkl5 hLp lrnfpg] x'g ;Sb5 t/ Tof] Toltsf] vt/fk"0f{ rf“xL+ x'“b}g . Chloroquine cf}ifwL vfln k]6df lbg' x'“b}g . Premaquine cf}ifwL Ps aif{ d'lgsf] pd]/sf aRrfnfO{ lbg' x'“b}g . olb al9 dfqf lbof] eg] d'6' / /QmgnLx?df Toxic effect x'G5 . tkfO{n] pkrf/ ubf{ ub}{ lgDg ;d:ofx?dWo] s'g} klg b]lvPdf t'?Gt k|]if0f ug{'xf];\ .

;':t÷a]xf]; s8f /QmcNktf

12

lk;fj sd ePdf jf /f]lsPdf, w]/} /ftf] lk;fa crfgs /Qm >fj ePdf /utdf lrgLsf] dfqf sd x'g] . /Qm ;+rf/ ;DalGw ;d:of (Low BP, weak pulse)

cf}nf]]sf] vfg] cf}iflwx¿ lbg] ;DaGwdf oxfF ;+l g' kg{] s]xL cfjZos s'/fx¿ o; k|sf/ 5g\M

* s'g} aRrfnfO{ Snf]/f]lSjgsf] pkrf/ lb+bf aRrfnfO{ o; eGbf klxn] Snf]/f]lSjgaf6 pkrf/ ul/Psf] lyOPg eGg] dfGg' k5{ . of] s'/fnfO{ cfdfaf6 kQf nufpg'xf];\ . o; lsl;dsf] Hj/f]sf] nflu cfˆgf] aRrfnfO{ klxn] klg Snf]/f]lSjgsf] dfqf k"/f lbOPsf] lyof] ls egL cfdfnfO{ ;f]Wg'xf];\ . lbPsf] /x]5 t/ aRrfnfO{ c } Hj/f] cfO/x]sf] /x]5 eg], o;nfO{ cg'udg e]63f6 egL ;f]Rg'xf];\ . afn–pkrf/ eGg] tflnsfdf ePsf] cf}nf]sf] cg'udg pkrf/ cg';f/ ug'{xf];\ .

* Snf]/f]SjLg cf}ifwL Epilepsy / Psoriasis ePsf] cj:yfdf lbg ldNb}g .

* olb aRrfnfO{ lk|dfSjLg lbPsf] 5 eg] pzsf] lk;fasf] /Ë w]/} /ftf] ePdf t'?Gt} cf}ifwL /f]sL k|]if0f ug{' k5{ .

* lk|dfSjLgsf] c;/n] Anemia x'g ;S5 .

* sf]l6«df]S;fhf]n Pp6f PlG6afof]l6s x'g'sf] ;fy} cf}nf]]df vfg] cf}iflw klg xf] . of cf}ifwL cf}nf]]sf] nflu % jif{ d'lgsf afn aflnafx¿nfO{ # lbg;Dd lbOof] eg] of] k|efjsf/L x'G5 .

pbfx/0fsf] nflu, olb Pp6f aRrfnfO{ Go"df]lgof / km]lN;k]/d jf hl6ntf ePsf] cf}nf]] nfu]sf] egL juL{s/0f ul/Psf] v08df tkfO{ To; aRrfnfO{ lgDg cg';f/sf] pkrf/ lbg' x'g]5 M

– lgdf]lgof eO{ sf]l6«df]S;fhf]n lbPsf] aRrfnfO{ cf}nf]sf] cf}iflw cfjZos kb}{g .

sf]l6«df]S;fhf]nn] lgdf]lgof tyf cf}nf]] b'a}df kmfObf u5{ . – Go"df]lgofsf] nflu bf]>f] klQmsf] cf}ifwL Pdf]lS;l;lng lbPdf To;kl5 cf}nf]]2 sf] klg

lbg' kg{] x'G5 . olb of] cf}ifwL pknAw gePdf pkrf/ s]Gb|df k]|if0f ug{'xf];\ . * Snf]/f]lSjgn] z/L/ lrnfpg ;S5 egL cfdfnfO{ atfpg'xf];\ . o;df 8/fpg' kb}{g . cfdfn]

cf}iflw lbg hf/L /fVg' k5{ . aRrfsf] z/L/ lrnfO/x]sf] 5 eg] p;nfO{ :jf:Yo rf}sLdf Nofpg' kb}{g .

@=# a9L Hj/f]df jf sfg b'v]df ->#*=%° ;]=u|]=_ Kof/fl;6fdf]n lbg'xf];\ Kof/fl;6fdf]nn] Hj/f]nfO{ 36fFp5 tyf b'vfOnfO{ sd u5{ .

a9L Hj/f] ->#*=%° ;]_ jf sfg b'v]df kf/fl;6fdf]n lbg'xf];\

Hj/f] / sfg b'v]sf] lgsf] geP;Dd ^÷^ 306fdf kf/fl;6df]n lbg'xf];\

2 Pdf]lS;l;lng, l;k|f]km\nf]S;f;Lg / PDkLl;lngn] cf}nf]]df sfd ub}{gg\ . w]/} h;f] b]zx¿df, sf]l6«df]S;fhf]nn] sfd u5{

lsg eg], ;Nkmf8f]lS;g–kfOl/d]yfldg h:t} of] klg b'O{ j6f PlG6kmf]n]6 cf}iflwx¿ -;Nkmf / 6«fOd]yf]lk|d_ af6 ag]sf] x'G5 h'g kmlN;Kof/d cf}nf]] lj?4 k|efjsf/L x'G5 .

13

aRrfnfO{ a9L Hj/f] cfPsf] eP, :jf:Yo rf}sLdf g} Ps dfqf Kof/fl;6fdf]n lbg'xf];\ . olb aRrfsf] sfg b'v]sf] 5 eg] jf Hj/f] 5 eg], cfdfnfO{ ! lbgsf] nflu kof{Kt cyf{t\ $ dfqf Kof/fl;6fdf]n lbg'xf];\ . pgnfO{ ^÷^ 306fdf ! dfqf kf/fl;6fdf]n sfgsf] b'vfO 7Ls geP;Dd jf Hj/f] 7Ls geP;Dd VjfO/xg eGg'xf];\ .

@=$ le6fldg ‘P’ lbg'xf];\

le6fldg …PÚ, /f]usf] pkrf/ tyf /f]syfd b'j}df lbOG5 . le6fldg …PÚ bfb'/f cyjf s8f s'kf]if0f ePsf aRrfsf] pkrf/ ug{ lbOG5 . o;n] cfFvfsf] ;fy} kmf]S;f], cfGb|f, d'v / 3fF6Lsf] ;txdf /x]sf hLjsf]ifx¿df bfb'/f efO/;sf] ;ª\qmd0fx¿nfO{ /f]syfd ug]{ k|lt/f]wfTds k|0ffnLdf d2t k'¥ofpg ;S5 . slg{of wldnf] x'g' le6fldg …PÚ sf] sdLn] x'g] Pp6f lrGx xf] . le6fldg …PÚ glbPsf] v08df of] a9]/ cGwf]kgdf k'Ug ;S5 .

kf/fl;6fdf]n

pd]/ / tf}n rSsL -%)) ld=u|f=_ emf]n -!@% ld=u|f= k|lt % ld=ln_

@ dlxgfb]lv # jif{ -$– !$ s]=lh=_

1÷4 % ld=ln=

# jif{b]lv % jif{ -!$–!( s]=lh=_

1÷2 &=% ld=ln

14

/f]usf] /f]syfdsf] nflu klg le6fldg …PÚ lbOG5 . g]kfndf w]/} afn–aflnsfx¿df le6fldg …PÚ sf] sdL 5 . ^ dlxgfb]lv % jif{sf ;a} afn–aflnsfx¿nfO{ x/]s ^ dlxgfdf le6fldg …PÚ lbg] u/]df o;n] le6fldg …PÚ sf] sdLsf] /f]syfd ug{]5 .

le6fldg ‘P’ lbg'xf];\, ^ dlxgf jf ;f] eGbf dflysf nflu

bfb'/fsf] nflu @ dfqf lbg'xf];\ klxnf] dfqf pkrf/ s]Gb|df g} lbg'xf];\ . bf];|f] dfqf ef]lnkN6 3/df v'jfpgsf] nflu cfdfnfO{ lbg'xf];\ .

s8f s'kf]if0f jf s8f hl6n bfb'/f ePsf]nfO{ k|]if0f ug'{ k"j{ Ps dfqf lbg'xf];\ . ^ dlxgf eGbf dflysf] pd]/sf] aRrfnfO{ pkrf/ s]Gb|df g} Ps dfq v'jfpg'xf];\ . bL3{ kvfnf ePsf] aRrfnfO{ pkrf/ s]Gb|df g} Ps dfq v'jfpg'xf];\ .

le6fldg …PÚ SofK;"n @)),))) o'lg6df pknAw 5 . dfqf lgwf{/0f ug{ aRrfsf] pd]/nfO{ cfwf/ dfGg'xf];\ . * bfb'/f ePsf] aRrfn] le6fldg …PÚ sf] @ dfqf kfpg' k5{ . aRrfnfO{ :jf:Yo rf}sLdf klxnf] dfqf

lbg'xf];\ . csf{] lbg 3/df cfdfnfO{ lbgsf] nflu ! dfqf lbg'xf];\ . * aRrfnfO{ ^ dlxgf cufl8 le6fldg …PÚ lbOPsf] ePtfklg bfb'/f ePsf] aRrfnfO{ le6fldg …PÚ

lbg'xf];\ . * s8f hl6n bfb'/f tyf s'kf]if0f ePsf] aRrfnfO{ k|]if0f ug'{ eGbf klxn] ! dfqf lbg'xf];\ . * afn–aflnsfx¿sf] lgoldt le6fldg …PÚ sf] cfk"lt{sf] nfluM olb aRrfn] cl3Nnf] ^ dlxgfdf

le6fldg …PÚ kfPsf] 5}g eg] ! dfqf :jf:Yo rf}sLdf lbg'xf];\ . olb le6fldg …PÚ sf] cfk"lt{ ;Lldt 5 eg], le6fldg …PÚ sf] sdLsf] /f]syfdsf] nflu k|of]u ug'{ eGbf bfb'/f tyf s8f s'kf]if0fsf] pkrf/df le6fldg …PÚ sf] k|of]unfO{ k|fyldstf lbg'xf];\ .

pd]/ le6fldg ‘P’ SofK;"n @)),))) cfO{=o"=

^ dlxgf;Dd ×–

^ b]lv !@ dlxgf;Dd À SofK;"n

!@ dlxgfb]lv % jif{;Dd ! SofK;"n

15

@=% cfO/g lbg'xf];\ xTs]nf s]xL ;]tf] ePsf] aRrfdf /QmcNktf ePsf] x'g;S5 . /QmcNktf ePsf] aRrfnfO{ cfO/gsf] cfjZostf kb{5 .

cfO/g lbg'xf];\ k|ltlbg ! dfqfsf] b/n] !$ lbg;Dd lbg'xf];\

pd]/ / tf}n

ao:ssf] rSsL cfO/g÷kmf]n]6 rSsL

km]/; ;Nkm]6 @)) ld=u|f=± @%) dfOqmf]u|fd kmf]n]6

-^) ld=u|f= tflTjs cfO/g_

cfO/g÷kmf]n]6 l;/k km]/; ˆo"df]/]6 / kmf]lns Pl;8 )=% ld=u|f k|lt %

ld=ln -@) ld=u|f tflTjs cfO/g k|lt ld=ln_

@ dlxgfb]lv $ dlxgf -$–^ s]=lh_ ½ 1 $ dlxgfb]lv !@ dlxgf -^–!)

s]=lh_ ½ 1=25

!@ dlxgfb]lv # jif{ -!)–!$ s]=lh_ ½ 2 # jif{b]lv % jif{ -!$–!( s]=lh_ ½ 2=5

!$ lbg;Ddsf] nflu cfdfnfO{ kof{Kt cfO/g lbg'xf];\ . !$ lbg;Dd cfˆgf] aRrfnfO{ b}lgs Ps dfqf vfgfkl5 lbgsf] nflu cfdfnfO{ eGg'xf];\ . !$ lbgdf c¿ cfO/gsf] nflu kms]{/ cfpg eGg'xf];\ . cfO/gn] aRrfsf] lb;fnfO{ sfnf] agfpg ;S5 eg]/ klg cfdfnfO{ eGg'xf];\ .

cfdfnfO{ aRrfn] cfO/g e]6\ofpg g;Sg] 7fpFdf /fVg eGg'xf];\ . cfO/gsf] j9L dfqf vt/gfs x'g;S5 cyjf To;n] aRrfnfO{ l;ls:t la/fdL agfpg ;S5 .

olb aRrfn] cf}nf]sf] cf}iflw kfO/x]sf] 5 eg], s]xL ;]tf]kg eP klg @ xKtfdf -cg'udg e]63f6_ geP;Dd cfO/g÷kmf]n]6 rSsLx¿ glbg'xf];\ . cfO/g÷kmf]n]6n]] sfo{df afwf pTkGg ug{ ;S5 .

@=^ cNa]08fhf]n lbg'xf];\

cª\s';] h'sf cyjf sf]/]{ h'sfsf] ;ª\qmd0f g]kfndf k|foM b]lvO/xg] ;d:of xf] . cNj]08fhf]nn] cª\s';] h'sf tyf sf]/]{ h'sfsf] ;ª\qmd0fnfO{ lgsf] kfb{5 . oL ;ª\qmd0fx¿n] ubf{ cfGb|faf6 /ut aUbf x'g] cfO/gsf] Ifltn] /QmcNktf pTkGg x'G5 . h'sfsf] ;+qmd0fn] s'kf]if0f x'g ;Sb5 . log} sf/0fx¿n] ubf{ ! jif{ / Tof]eGbf dflysf aRrfx¿nfO{ k|To]s ^ dlxgfdf h'sfsf] cf}iflw lbOG5 .

cNj]G8fhf]n lbg'xf];\

pkrf/ s]Gb|df $)) ld=u|f= sf] cNj]G8fhf]n rSsLsf] Ps} dfqfdf v'jfpg'xf];\Ù olb M aRrfsf] pd]/ ! jif{b]lv @ jif{ ;Ddsf] 5 eg] cfwf rSsL / @ jif{ dflysf 5 eg] ! rSsL lbg'xf];\ . aRrfn] ut ^ dlxgfb]lv otf cNa]G8fhf]n vfPsf] 5}g eg]

:jf:Yo rf}sLdf cNa]08fhf]nsf] Ps dfqf lbg'xf];\ . Pp6f $)) ld=u|f= rSsL cyjf ;fgf] jf]tnsf] ;j} emf]n lbg'xf];\ . ^ dlxgf leq aRrfnfO{ of] cf}iflw lbOPsf] 5 ls 5}g egL hfFr ug'{xf];\ . lbOPsf] /x]5 eg] km]l/ lbg] cfjZostf kb}{g .

16

olb cNa]08fhf]nsf] cfk"lt{ :jf:Yo rf}sLdf sd 5 eg], /QmcNktf ePsf aRrfx¿sf] pkrf/nfO{ k|fyldstf lbg'xf];\ . pgLx¿nfO{ cNa]08fhf]nsf] a9L cfjZostf k/]sf] x'G5 .

cEof; ‘v’ o; cEof;df tkfO{x¿n] …afn pkrf/Ú eGg] tflnsfsf] k|of]u u/L pko'Qm vfg] cf}iflw, ;xL dfqf tyf ;xL ;do tflnsfdf lbg] cEof; ug'{ x'g]5 . afn pkrf/ eGg] tflnsf x]g'{xf];\ . tkfO{sf] :jf:Yo rf}sLdf pknAw cf}iflwx¿sf] Ifdtf cg';f/sf] cf}iflw 5fGg'xf];\ . cGoyf ;"lrt gu/];Dd, k|To]s aRrfn] klxnf] k6s /f]usf] nflu pkrf/ kfO/x]sf] 5 eGg] dfGg'xf];\ . vfnL 7fpFdf tkfO{sf] pQ/ n]Vg'xf];\ . != ^ lsnf]sf] aRrfnfO{ (Vivex Malaria) cf}nf]]sf] vfg] cf}iflw rflxPsf] 5 . @= $ dlxgfsf] aRrfnfO{ sfgsf] PSo'6 ;ª\qmd0f tyf cf}nf]]sf] nflu cf}iflw rflxPsf] 5 . #= !@ lsnf] tf}n ePsf] aRrfnfO{ cf}nf]]sf] vfg] cf}iflw tyf pRr Hj/f]sf] nflu Kof/fl;6fdf]n

rflxPsf] 5 . $= ( dlxgfsf] aRrfnfO{ bfb'/fsf] nflu le6fldg …PÚ rflxPsf] 5 . %= $ jif{sf] aRrfnfO{ bfb'/fsf] nflu le6fldg …PÚ rflxPsf] 5 .

17

^= @ jif{sf] aRrf -!! lsnf]_ nfO{ xTs]nfdf s]xL ;]tf]kgf ;lxt /QmcNktf ePsf] 5 tyf p;nfO{ cfO/g / cNa]08fhf]n rflxPsf] 5 . aRrfsf] sf8{n] cNa]08fhf]n tyf le6fldg …PÚ # dlxgf cl3 lbOPsf] s'/f b]vfpF5 .

&= # jif{sf] aRrf -!$ lsnf]_ nfO{ xTs]nfdf s]xL ;]tf]kg ;lxt /QmcNktf ePsf] 5 / p;nfO{ cfO/g

clg cNa]08fhf]n rflxPsf] 5 . aRrfsf] sf8{df cNa]08fhf]n cyjf le6fldg …PÚ klxn] lbOPsf] s'/f pNn]v 5}g .

*= ^ dlxgfsf] aRrf -& lsnf]_ nfO{ xTs]nfdf s]xL ;]tf]kg ;lxt /QmcNktf ePsf] 5 tyf p;nfO{

cfO/g rflxPsf] 5 . p;nfO{ le6fldg …PÚ lbg klg cfjZos 5 . (= !^ lsnf] tf}nsf] aRrfnfO{ cf}nf]sf] vfg] cf}iflw tyf xTs]nfdf s]xL ;]tf]kgf ;lxt /QmcNktf

ePsf] x'gfn] cfO/g rflxPsf] 5 . p;n] le6fldg …PÚ tyf cNa]08fhf]n @ dlxgf cl3 kfO;s]sf] 5 .

tkfO{x¿n] of] cEof; ;s]kl5 cfˆgf pkrf/x¿ k|lzIf0f ;xof]uL;Fu hFrfpg'xf];\ .

tkfO{sf k|lzIf0f ;xof]uLn] pko'Qm vfg] cf}iflw 5fGg / o;sf] ;do / dfqf lgwf{/0f ug{ yk cEof; u/fpg' x'g]5 .

18

#=) k|efjsf/L ;+rf/ ;Lksf] pkof]u ug'{xf];\ (Use Good Communication Skills)

:jf:Yo rf}sLdf pkrf/ kfPsf] aRrfsf] nflu 3/df pkrf/ hf/L /fVg' kg]{ cfjZostf kb{5 . tkfO{n] aRrfsf] cfdfl;t slQsf] /fd|f] s'/fsfgL ug'{x'G5, 3/df ul/g] pkrf/ To;}df lge{/ ub{5 . pkrf/ s;/L lbOG5 eGg] s'/fsf] hfgsf/L pgsf] nflu cfjZos kb{5 . pkrf/sf] dxTjsf af/]df klg pgn] hfGg' cfjZos 5 . 3/df lbg] pkrf/af/] cfdfnfO{ l;sfpFbf k|efjsf/L ;+rf/ ;Lk -APAC_sf] pkof]u ug'{ dxTjk"0f{ x'G5 . ;f]Wg] / Wofgk"j{s ;'Gg] (Ask And Listen)

aRrfsf] nflu pgL s] ub}{l5g\ eGg] af/] kQf nufpg cfdfnfO{ k|Zgx¿ ug'{xf];\ .

k|z+;f ug]{ (Praise) pgn] h'g s'/f /fd|f] u/]sL l5g\, To;sf] nflu cfdfsf] k|z+;f ug'{xf];\ .

;Nnfx lbg] (Advice) aRrfsf] pkrf/ 3/df s;/L ug]{ eGg] af/] pgnfO{ ;Nnfx lbg'xf];\ .

a'em]–ga'em]sf] hfFr ug]{ (Check)

cfdfn] a'em]–ga'em]sf] hfFr ug'{xf];\ .

#=! cfgf] aRrfsf] pkrf/ 3/df s;/L ug]{ eGg] af/] cfdfnfO{ ;Nnfx

lbg'xf];\ . s'g} s'g} ;Nnfx ;lhnf] x'G5, pbfx/0fsf] nflu, @ lbgdf aRrf;lxt cg'udgsf] nflu cfpg tkfO{n] cfdfnfO{ eg] dfq k'U5 . s'g} ;Nnfx lb+bf s'g sfd s;/L ug]{ eGg]af/] tkfO{n] cfdfnfO{ l;sfpg] cfjZostf kb{5 . o;sf] nflu y'k|} r/0fx¿sf] cfjZostf kb{5 . aRrfsf] pkrf/ s;/L ug]{ eGg] af/] tkfO{n] cfdfnfO{ l;sfpFbf, oL # j6f cfwf/e"t r/0fx¿sf] k|of]u ug'{xf];\ M != hfgsf/L lbg'xf];\ . @= u/]/ b]vfpg'xf];\ . #= pgnfO{ u/fpg'xf];\ . hfgsf/L lbg'xf];\ M s'g} sfd s;/L ug]{ eGg]af/] cfdfnfO{ atfpg'xf];\ . pbfx/0fsf] nflu, cfdfnfO{ lgDg s'/f atfpg'xf];\ M * s;/L cfFvfdf dnd nufpg] * s;/L k'gh{nLo emf]n tof/ kfg]{ * s;/L 3fF6Lsf] b'vfOnfO{ lgsf] kfg]{ .

oL ;Lkx¿sf] j0f{g tn ul/Psf] 5 .

19

u/]/ b]vfpg'xf];\ M s'g} sfd s;/L ug]{, cfdfnfO{ b]vfpg'xf];\ . h:tf] M * xft w'g] r/0fx? . * cfFvfdf dnd nufpg s;/L aRrfnfO{ zfGt kf/]/ ;dfpg] . * Ps k'l/of k'gh{nLo emf]ndf ldnfpg' kg]{ kfgLsf] ;xL kl/df0f s;/L 7Ls kfg]{, * pgn] 3/}df v'jfpg ;Sg] 3fF6Lsf] b'vfOnfO{ lgsf] kfg]{ Pp6f cf}iflw s;/L tof/ kfg]{ . pgnfO{ cEof; u/fpg'xf];\ M cfdfnfO{ ug{ lbg'xf];\ / tkfO{ x]l//xg'xf];\ . h:tf] M * cfˆgf] aRrfsf] cfFvfdf dnd nufpg eGg'xf];\ * k'gh{nLo emf]n agfpg jf * 3fF6Lsf] b'vfO sd kfg]{ Pp6f ;'/lIft cf}iflw v'jfpgsf] nflu tof/ kfg{ eGg'xf];\ 3/df cf}iflw s;/L agfpg' x'G5 egL cfdfnfO{ ;f]Wg' g} kof{Kt x'g;S5 . cfdfnfO{ cEof; ug{ lbg' g} l;sfOg] sfo{sf] dxTjk"0f{ c+z xf] . cfdfn] ub}{ u/]sf] a]nf tkfO{n] x]g'{ eof] eg] pgn] s] a'lemg\ tyf pgnfO{ s] sl7gfO k/]sf] 5 eGg] s'/f a'‰g' x'g]5 . Tof] s'/f a'em]kl5 tkfO{n] pgnfO{ cem /fd|/L ug{df d2t ug{ ;Sg'x'g]5 . cfdfn] ;'g]sf] s'/f eGbf pgn] cEof; u/]sf] s'/fnfO{ a9L ;lDemg] ;Defjgf x'G5 . cfdfnfO{ l;sfp“bf M * pgn] a'‰g] zAbx¿ k|of]u ug'{xf];\ * kl/lrt lzIf0f–;fdu|Lx¿ k|of]u ug'{xf];\, h:t}M k'gh{nLo emf]n agfpg] ;fwf/0f efF8fx¿ . * pgn] cEof; ubf{ ;/–;Nnfx lbg'xf];\ . /fd|f] u/]sf] s'/fsf] k|z+;f ug'{xf];\ tyf ;'wf/

ul/lbg'xf];\ . cfjZos eP, c¿ cEof; ug{ lbg'xf];\ . * k|Zgx¿ ;f]Wg cfdfnfO{ k|f]T;flxt ug'{xf];\ . ;a} k|Zgx¿sf] pQ/ lbg'xf];\ .

20

#=@ cfdfn] a'em]–ga'em]sf] s'/f hf“Rg'xf];\

cfˆgf] aRrfsf] pkrf/ s;/L ug]{ eGg]af/] cfdfnfO{ l;sfPkl5 cfdfn] a'lemg\ eGg] s'/fdf tkfO{ 9'Ss x'g' kb{5 . cfdfn] s] l;Sg' eof] eGg] jf/] hfGg k|Zgx¿ ;f]w]/ kQf nufpg'xf];\ . kQf nufpg] /fd|f k|Zgx¿ s;/L ;f]Wg] eGg]af/] hfGg', s'/fsfgL ug]{ sfo{sf] Pp6f dxTjk"0f{ ;Lk xf] . ;f]lwg] k|Zg ;xL zAbx¿df JoQm x'g' kb{5 tfls cfdfn] æxf]Æ jf æxf]OgÆ dfq eGg'sf] ;f6f] a9L dfqfdf pQ/x¿ lbg ;s"g\ . o:tf k|Zgx¿n] cfdfn] aRrfsf] pkrf/ lsg, s;/L cyjf slxn] ug]{ eGg] s'/fx¿ a'em] ga'em]sf] kQf nfUb5 .

pkrf/ af/]df tkfO{n] pgnfO{ h] l;sfpg' ePsf] lyof] Tof] l;lsg\ ls l;lsgg\ tyf a'lemg\ ls a'lemgg\ eGg]af/] tkfO{ pgsf] hjfkmaf6 eGg ;Sg'x'g]5 . olb pgn] ;xL pQ/ lbg ;lsgg\ eg], cem a9L hfgsf/L lbg'xf];\ cyjf cfˆgf lgb]{zgx¿nfO{ :ki6 kf/L hfgsf/L lbg'xf];\ . pbfx/0fsf] nflu, tkfO{n] cfdfnfO{ PlG6afof]l6s s;/L lbg] eGg]af/] l;sfpg' eof] . To;kl5 tkfO{ ;f]Wg'xf];\ M …tkfO{sf] aRrfnfO{ cf}iflw s;/L lbg] eGg] s'/f s] tkfO{nfO{ yfxf 5 <Ú cfdfn] a'em] klg ga'em] klg ;fob …5Ú df pQ/ lbg]l5g\ . a'em]sf] 5}g egL pQ/ lbgdf pgL lxrlsrfpg ;lS5g\ . ;fRr} a'em] ga'em]sf] kQf nufpg] yk s]xL k|Zgx¿ ;f]Wg'xf];\, h:tf] ls M …cfˆgf] aRrfnfO{ tkfO{ slxn] cf}iflw lbg'x'g]5 <Ú …k|To]s k6s tkfO{ slt j6f rSsL lbg'x'g]5 <Ú …slt lbg;Dd tkfO{n] rSsLx¿ lbg'x'g]5 <Ú tkfO{n] pgnfO{ l;sfPsf lgb]{zgx¿nfO{ bf]x¥ofpg egL cfdfnfO{ elg/xg' ePsf] 5 . ;xL k|Zgx¿ ;f]w]df cfˆgf] aRrfsf] pkrf/ s;/L ug]{ eGg] s'/f cfdfnfO{ l;Sg / ofb /fVgdf d2t k'U5 .

tkfO{n] jRrfnfO{ cf}iflw slxn] / slt lbg lbg' x'G5 .

d}n] p;nfO{ ljxfg / j]n'sL % lbg;Dd cf}iflw lbG5' .

21

lgDglnvt k|Zgx¿n] cfdfn] a'em] ga'em]sf] s'/f hfFRg]5g\ . …/fd|f hfFRg] k|Zgx¿Ú o:tf x'g'k5{ ls logn] cfdfn] cfˆgf] aRrfsf] pkrf/ s;/L ug]{l5g\ eGg] s'/f JofVof ug{ ;s"g\ . tL k|Zgx¿ lsg, s], s;/L, slxn], slt k6s tyf slt h:tf zAbx¿af6 z'¿ x'G5g\ . …sdhf]/ k|Zgx¿Ú h;nfO{ …5Ú cyjf …5}gÚ n] hjfkm lbg ;lsG5 . tkfO{nfO{ cfdfnfO{ slQsf] a'em]sL l5g\ eGg] af/] hfgsf/L lbb}+g .

/fd|f hf“Rg] k|Zgx¿ sdhf]/ k|Zgx¿ tkfO{ k'gh{nLo emf]n s;/L agfpg' x'G5 < k'gh{nLo emf]n kfgLdf s;/L

ld;fpg] tkfO{nfO{ yfxf 5 < tkfO{ aRrfnfO{ slt k6s :tgkfg u/fpg' x'G5 < aRrfnfO{ tkfO{n] :tgkfg u/fpg'

k5{< cfFvfsf] s'g efudf tkfO{ dnd nufpg' x'G5 < aRrfnfO{ klxn] klg tkfO{n] dnd

nufpg' ePsf] lyof] < kftnf] lb;f ePkl5 k|To]s k6s tkfO{ slt yk emf]ns'/fx? lbg'x'G5 <

s] tkfO{nfO{ yfxf 5 emf]ns'/fx? s;/L lbg] <

cfˆgf xftx¿ w'g' tkfO{sf] nflu lsg dxTjk"0f{ 5 < s] cfˆgf xftx¿ w'g] s'/f tkfO{n] ;lDemg'x'G5 <

k|Zg u/]kl5 tkfO{ Psl5g /f]lsg'xf];\ . cfdfnfO{ ;f]Rg] clg To;kl5 pQ/ lbg] cj;/ lbg'xf];\ . pgsf] k|Zgsf] pQ/ glbg'xf];\ . t'?Gt} a]Un} k|sf/sf] k|Zg g;f]Wg'xf];\ .

hfFRg] k|Zgx¿ ;f]Wg w}o{ rflxG5 . cfdfnfO{ pQ/ yfxf x'g;S5, t/ pgnfO{ af]Ng ;do nfUg

;S5 . tkfO{n] pgLaf6 pQ/sf] cfzf /fVg' x'G5 eGg] yfxf kfP/ pgL crlDet x'g ;lS5g\ . cfˆgf] hjfkm unt x'G5 ls eg]/ pgL 8/fpg ;lS5g\ . cfkm" eGbf 7"nf] dflg;l;t s'/fsfgL ug{ pgL nhfpg ;lS5g\ . pgsf] pQ/sf] k|ltIff ug'{xf];\ . pgnfO{ k|f]T;flxt ug'{xf];\ .

olb cfdfn] unt pQ/ lblG5g\ cyjf pgL yfxf 5}g elG5g\ eg], pgnfO{ c;lhnf]kgsf] cg'ej

x'g glbg ;ts{ x'g'xf];\ . pgnfO{ pkrf/ lbg km]l/ l;sfpg'xf];\ . pgn] a'lemg\ eGg]af/] lglZrt x'g cem a9L hfgsf/L, pbfx/0fx¿ cyjf cEof;x¿ lbg'xf];\ . To;kl5 km]l/ pgnfO{ /fd|f hfFRg] k|Zgx¿ ;f]Wg'xf];\ .

cfdfn] a'‰g ;lSng\, t/ tkfO{n] ;f]Wbf ug{ ;lSbg eGg ;lS5g\ . pgnfO{ s]xL cK7\of/f] k/]sf] jf

pgn] la/f]w u/]sf] x'g;S5 . ;fwf/0f ;d:ofx¿df, pkrf/ lbgsf] nflu ;do cyjf ;fwgsf] cefj x'g;S5 . pgsf] la/fdL aRrfnfO{ ;'O{sf] ;§f vfg] cf}iflw cyjf cf}iflwsf] ;§f 3/]n' pkrf/ lbOPsf] s'/f cfdfnfO{ lrQ ga'em]sf] x'g;S5 .

pgsf ;d:ofx¿sf ;DefJo ;dfwfgx¿ ;f]Rg cfdfnfO{ ;xof]u ug'{xf];\ tyf pgsf]

c;lhnf]kgfnfO{ ;lhnf] kfg{'xf];\ . pbfx/0fsf] nflu M tkfO{ ;f]Wg ;Sg'x'G5 M

…cfˆgf] aRrfsf] cfFvfdf dnd slxn] nufpg' x'G5 <Ú cfdfn] pQ/ lbg ;lS5g\ ls pgL lbgel/ 3/df x'g] 5}gg\ . pgn] eGg ;lS5g\ ls cfˆgf]

aRrfnfO{ s]jn laxfg / /ftL dfq} pgL pkrf/ ug{ ;lS5g\ . s;}sf] -xh'/ af÷xh'/ cfdf cyjf bfh'÷lbbL_ nfO{ ug{ nufpg ;Sg'x'G5 ls eg]/ pgnfO{

;f]Wg'xf];\ . hf] JolQm lbgel/ 3/df x'g]5 tyf lbpF;f] pkrf/ lbg;S5 . To:tf] JolQmnfO{ ;xL t/Lsfn] pkrf/ s;/L lbg] egL l;sfpg pgnfO{ d2t ug'{xf];\ .

22

tkfO{ ;f]Wg ;Sg'x'G5 M

…k'gh{nLo emf]n agfpgsf] nflu ! ln6/ kfgL gfKg tkfO{ s'g efF8fsf] k|of]u ug'{x'G5 <Ú cfdfn] 3/df ! ln6/sf] efF8f 5}g egL pQ/ lbg ;lS5g\ .

3/df s:tf efF8fx¿ 5g\ egL cfdfnfO{ ;f]Wg'xf];\ . pgsf] efF8fdf ! ln6/ kfgL s;/L gfKg] eGg] s'/f pgnfO{ b]vfpg'xf];\ . s'g} pks/0fn] pgsf] efF8fdf ! ln6/sf] lrGx s;/L nufpg] eGg]af/] cyjf s]xL ;fgf efF8fx¿ k|of]u u/L ! ln6/ s;/L gfKg] eGg] af/]df pgnfO{ ;Demfpg'xf];\ . tkfO{ ;f]Wg ;Sg'x'G5 M …aRrfsf] 3fF6Lsf] b'vfOnfO{ 3/df s;/L lgsf]] kfg'{ x'G5 <Ú

tkfO{n] lbPsf] cf}iflw pgnfO{ dg kb}{g egL pgn] pQ/ lbg ;lS5g\ . To;sf] ;§f ;'O{+ cyjf c¿ rSsLx¿ lbP /fd|f] x'GYof] eGg] pgnfO{ nfu]sf] x'g;S5 .

cf}iflw eGbf ;'/lIft pkrf/sf] dxTjaf/] pgnfO{ ljZj:t kfg'{xf];\ . tkfO{sf] egfOnfO{ :ki6

kfg'{xf];\ . pgn] ;'/lIft pkrf/sf sf/0fx¿af/] cfˆgf] kl/jf/sf ;b:ox¿nfO{, h;n] aRrfsf] pkrf/ a]Un} lsl;daf6 x'g'k5{ egL cfzf u/]sf lyP, ;Demfpg' kg]{ klg x'g;S5 . cfdfn] a'em]–ga'em]sf] s'/f hf“r ubf{ * To:tf k|Zgx¿ ;f]Wg'xf];\, h;n] cfdfnfO{ s], s;/L, slt, slt k6s cyjf lsg egL JofVof

ug]{ cfjZostf k/f];\ . To:tf k|Zgx¿ g;f]Wg'xf];\ h;sf] pQ/ dfq …5Ú jf …5}gÚ df lbg ;lsG5 .

* cfdfnfO{ ;f]Rg] clg To;kl5 pQ/ lbg] ;do lbg'xf];\ . * ;xL pQ/x¿sf] nflu cfdfsf] k|z+;f ug'{xf];\ . * olb cfjZos k/] pgnfO{ cem a9L hfgsf/L, pbfx/0f jf cEof;x¿ lbg'xf];\ .

$=) 3/}df cf}iflw s;/L v'jfpg] egL cfdfnfO{ l;sfpg'xf];\ (Teach the Mother to give Oral Drugs at Home) tflnsfdf n]lvPsf vfg] cf}iflwx¿ ljleGg /f]ux¿df km/s km/s dfqfdf tyf ljleGg lsl;dn] lbOP tfklg k|To]s cf}iflw lbg] t/Lsf Pp6} x'G5 . o; kl/R5]bn] tkfO{nfO{ vfg] cf}iflwx¿ lbgsf] nflu cfdfnfO{ l;sfpFbf ckgfpg' kg]{ cfwf/e"t r/0fx¿ l;sfpg] 5 . cfdfn] vfg] cf}iflw s;/L ;xL t/Lsfn] lbg] eGg] af/] l;Sg ;s] dfq aRrfn] plrt pkrf/ kfpg]5 . cfdfnfO{ lbg] k|To]s vfg] cf}iflwsf] nflu lgDg lnlvt lgb]{zgx¿sf] kfng ug'{k5{ . aRrfsf] pd]/ / tf}nsf] cfwf/df pko'Qm cf}iflw / To;sf] dfqf lgwf{/0f ug'{xf];\ . lgDg s'/fx¿ ;dfj]z u/L aRrfnfO{ cf}iflw vfg'kg]{ sf/0f cfdfnfO{ /fd|/L atfpg'xf];\ M

* pgsf] aRrfnfO{ vfg] cf}iflw tkfO{n] lsg lb+b} x'g'x'G5, / * s'g ;d:ofsf] pkrf/ o;n] ug]{5 .

23

cf}iflwsf] dfqf s;/L gfKg] egL /fd|/L b]vfpg'xf];\ . cf}iflwx¿sf a§fx¿df x]/]/ / tL cf}iflwx¿ slxn];Dd k|of]u ug{ ;lsG5, Tof] ldlt hfFr ug'{xf];\ .

Dofb gf3]sf cf}iflwx¿ k|of]u gug'{xf];\ . aRrfnfO{ rflxg] kl/df0fsf] lx;fa ug'{xf];\ / cf}iflwsf rSsLx¿ ug]/ lgsfNg'xf];\ . To;kl5 cf}iflwsf] j6[fnfO{ aGb ug'{xf];\ .

olb tkfO{n] cfdfnfO{ rSsLx¿ lb+b} x'g'x'G5 eg] M

k|lt dfqf lbg] kl/df0f cfdfnfO{ b]vfpg'xf];\ . cfjZos k/]df, rSsLnfO{ s;/L 6'qm\ofpg]

eGg] s'/f b]vfpg'xf];\ . aRrfnfO{ lbg' eGbf klxn] rSsLnfO{ w"nf] kfg'{ 5 eg], kfgLsf s]xL yf]kfx¿n] cf}iflw

lehfpg'xf];\ / ! ldg]6 hlt klv{g'xf];\ . kfgLn] rSsLnfO{ g/d kfg]{5 tyf w"nf] kfg{df ;lhnf] agfpg] 5 . olb tkfO{ cfdfnfO{ emf]n lb+b} x'g'x'G5 eg] M

3/df Ps dfqfsf] nflu s;/L ;xL ldlnln6/ -ld=ln=_ lx;fa ug]{ eGg] s'/f b]vfpg'xf];\ .

af]tnsf] lasf]{ cyjf rng–rNtLsf] rDrf k|of]u ug'{xf];\ . h:tf] ls lrof cyjf skmLdf rLgL 3f]Ng k|of]u ug]{ rDrf . rDrfn] ;xL dfqf s;/L gfKg] xf] pgnfO{ b]vfpg'xf];\ .

Ps lrof rDrf a/fa/ s/Lj % ld=ln= x'G5 -tn x]g'{xf];\.

ldlnln6/ -ld=ln=_ lrof rDrf

!=@% ld=ln= !$ lrof rDrf

@=% ld=ln= !@ lrof rDrf

%=) ld=ln= ! lrof rDrf

&=% ld=ln= !!@ lrof rDrf

!)=) ld=ln= @ lrof rDrf !%=) dL=ln= # lrof rDrf

tkfO{sf] 3/ l5d]sdf rng–rNtLdf /x]sf rDrfx¿df slt ld=ln= c6fpF5, ;f] ljrf/ u/L plNnlvt kl/df0fsf] th'{df ug'{xf];\ . olb tkfO{ cfdfnfO{ SofK;"nx¿ lb+b} x'g'x'G5 eg] M

k|lt dfqf lbg] kl/df0f cfdfnfO{ b]vfpg'xf];\ . olb aRrfnfO{ Pp6f le6fldg …PÚ SofK;"n eGbf sd dfqf rflxG5 eg] -cyjf k"/f SofK;"n lgNg ;Sb}g eg]_ SofK;"n s;/L vf]Ng] tyf aRrfsf] d'vdf slt yf]kf xfNg] xf] cfdfnfO{ b]vfpg'xf];\ .

cfdfn] cf}iflwsf] dfqf gfKg] cEof; u/]sf] Wofgk"j{s x]g'{xf];\ .

cfdfnfO{ cfkm} dfqf ldnfpgsf] nflu eGg'xf];\ . olb dfqf rSsLsf] ¿kdf 5 / aRrfn] rSsL lgNg ;Sb}g eg], rSsLnfO{ w"nf] kfg{sf] nflu cfdfnfO{ eGg'xf];\ . pgn] w"nf] kfg]{ cEof; ub}{ u/]sf] x]g'{xf];\ . pgn] s'g s'/f ;xL t/Lsfn] ul/g\ pgnfO{ atfpg'xf];\ . olb pgn] unt t/Lsfn] dfqf gflkg eg], s;/L gfKg] xf] km]l/ b]vfpg'xf];\ .

24

aRrfnfO{ cf}iflwsf] klxnf] dfqf cfdfnfO{ g} v'jfpg nufpg'xf];\ .

aRrfn] afGtf ub}{5 eg] cf}iflw lbPdf km]l/ afGtf ug{ ;S5, tfklg p;nfO{ cf}iflw lbg'k5{ egL ;Demfpg] ug'{xf];\ . cf}iflw vfPsf] #) ldg]6;Dd aRrfnfO{ x]/L /fVgsf] nflu cfdfnfO{ eGg'xf];\ . olb aRrfn] #) ldg]6leq afGtf u¥of] eg] -rSsL jf emf]n jfGtfdf b]Vg ;lsG5_ csf]{ dfqf lbg'xf];\ . olb aRrfdf hnljof]hg 5 / afGtf ul//x]sf] 5 eg], cf}iflwsf] dfqf lbg'cl3 hnljof]hg 7Ls geP;Dd klv{g'xf];\ .

cf}iflw s;/L lbg] eGg] s'/fsf] ;a} j[QfGt ;fjwfgLk"j{s lbg'k5{ / cf}iflwnfO{ Kofs]6df /fv]/ n]an

ug'{xf];\ . aRrfnfO{ cf}iflwsf] dfqf lbgdf slt k6s, slxn] -h:t} ;a]/}, lbpF;f]sf] vfgfkl5, /ftLsf]

vfgfkl5, ;'Tg' cl3_ tyf slt lbg;Dd lbg] xf] pgnfO{ atfpg'xf];\ .

cf}iflwsf] n]j'ndf hfgsf/Lx¿ n]Vg'xf];\ . of] Pp6f pbfx/0f xf] M

cf}iflwsf] n]j'ndf hfgsf/L n]Vg M

s= pkrf/sf] cjlw k"/f ug{ vfg] cf}iflwsf] k"/f gfd tyf rSsL, SofK;"n cyjf emf]nsf] dfqf k"/f kl/df0f n]Vg'xf];\ .

v= la/fdLn] lng'kg]{ ;xL dfqf -rSsL SofK;"n, yf]kf jf rDrf cyf{t\ !@ , !, !

!@ == = = _

n]Vg'xf];\ . dfqf slxn] lbg] xf] -;a]/}, lbpF;f]sf] vfgfkl5, /ftLsf] vfgfkl5, ;'Tg' cl3_ n]Vg'xf];\ .

u= b}lgs dfqf / ljj/0f n]Vg'xf];\, h:t} M

!@ rSsL lbgsf] @ k6s u/L % lbg;Dd

lgb]{zgx¿nfO{ :ki6 n]Vg'xf];\ tfls Pp6f lzlIft JolQmn] ltgLx¿nfO{ k9\g tyf a'‰g ;sf];\ . k|To]s cf}iflwsf] k"/f dfqfnfO{ To;sf] n]j'n ePsf] cf}iflwsf] efF8f -sfuh, cyjf af]tn_ df

/fVg'xf];\ . cf}iflwx¿nfO{ ;kmf /fVg'xf];\ . ;kmf efF8fx¿ k|of]u ug'{xf];\ . cf}iflwsf] n]j'n tyf k'l/of agfPkl5 cfdfnfO{ lbg'xf];\ . aRrfsf] pkrf/ s;/L ug]{ eGg]

af/] pgn] a'lemg\ jf a'em]sL 5}gg\ eGg] s'/f lglZrt ug{sf] nflu hfFRg] k|Zgx¿ ;f]Wg'xf];\ .

25

ljleGg pkrf/x¿sf] nflu cf}iflwsf] dfqfsf pbfx/0fx¿

olb PseGbf a9L cf}iflw lbOPsf] 5 eg], k|To]s cf}iflwnfO{ ug]/, hDdf u/]/ leGbfleGb} k'l/of

kfg'{xf];\ . ! k6sdf Pp6f cf}iflw hDdf ug'{xf];\ . n]a'ndf lgb]{zgx¿ n]Vg'xf];\ . rflxPsf] kl/df0fsf]

lx;fa ug'{xf];\ . kof{Kt dfqfdf cf}iflwnfO{ Pp6} Kofs]6df /fVg'xf];\ . cf}iflwsf] csf]{ efF8f vf]Ng' cl3 Tof] cf}iflwsf] k'l/of aGbug'{'xf];\ .

pgsf] aRrfnfO{ ! eGbf a9L /f]u nfu]sf]n] pgsf] aRrfn] ! eGbf a9L cf}iflw kfO/x]sf] 5

egL cfdfnfO{ eGg'xf];\ . cfdfnfO{ cnu cnu cf}iflwx¿ b]vfpg'xf];\ . k|To]s cf}iflw s;/L lbg] xf] b]vfpg'xf];\ . olb cfjZos eP, cf}iflwx¿sf] hfgsf/L x/]s cf}iflw lbgdf slt k6s lbg' kg]{ xf], n]v]/ lbg'xf];\ .

ljgf !&=@=)^(

sff]l6«df]S;fhf] !@ rSsL

@ rSsL lbgsf] @ k6s # lbg;Dd

cho !&=@=)^(

le6fldg ‘P’ ! SofK;"n

@ @ !

lnnf !&=@=)^(

!÷@

cfO{/g !% rSsL

!÷@ rSsL lbgsf] ! k6s lbg'xf];\

le6fldg ‘P’ SofK;"n ef]nL lbg'xf];\ .

26

la/fdL lgsf] ePklg, vfg] cf}iflw emf]n jf rSsL h] xf];\ hlt lbgsf] nflu lbOPsf] 5 ;a} ;Sg'k5{

eGg] s'/f atfpg'xf];\ . aRrf 7Ls ePsf] h:tf] b]lvG5 eg] klg aRrfsf] pkrf/ hf/L /fVgsf] nflu cfdfnfO{

atfpg'xf];\ . of] dxTjk"0f{ 5, /f]usf lrGxx¿ x/fP tfklg hLjf0f' cyf{t\ cf}nf]sf sL6f0f'x¿ cem} hLljt x'g;S5g\ .

;a} cf}iflwx¿ aRrfx¿n] ge]§fpg] 7fpFdf /fVgsf] nflu cfdfnfO{ ;Nnfx lbg'xf];\ .

cf}iflwx¿ s'g} ;'Vvf tyf cFWof/f] 7fpFdf /fVg tyf d';f / sL/f–km6\ofª\u|fx¿af6 d'Qm xf];\ elg cfdfnfO{ eGg'xf];\ .

:jf:Yo rf}sL -pkrf/ s]Gb|_ 5f]8\g' cufl8 aRrfsf] cfdfn] slt s'/f a'em]sL l5g\ hf“Rg'xf];\ . cfdfnfO{ hfFRg] k|Zgx¿ ;f]Wg'xf];\, h:t} M …k|To]s k6s slt cf}iflw lbg' x'G5 <Ú …of] slxn] lbg' x'G5 <Ú …slt lbg;Dd lbg' x'G5 <Ú …of] rSsL tkfO{ s;/L agfpg' x'G5 <Ú …s'g cf}iflw lbgdf # k6s lbg' x'G5 <Ú

27

cEof; ‘u’ o; cEof;df tkfO{ Pp6f e"ldsf gf6sdf efu lng' x'g]5 h;n] 3/df vfg] cf}iflw s;/L v'jfpg] eGg] af/] cfdfx¿nfO{ l;sfpg] 5 . l:ylt — clxn];Dd s] ePsf] 5 M * dlxgfsf] % lsnf] tf}nsf] bof/fd gfds afns a:g] If]qdf cf}nf]sf] ;Defjgf pRr 5, t/ ToxfF c+s';] / sf]/]{ h'sf eg] 5}gg\ . Hj/f] cfPsf] x'gfn] cfdfn] p;nfO{ :jf:Yo rf}sLdf NofPsL lyOg\ . p;nfO{ $ lbgb]lv Hj/f] cfPsf] 5 . :jf:Yo sfo{stf{n] bof/fddf ;fdfGo vt/fsf lrGxx¿, vf]sL, kvfnf tyf sfgsf ;d:ofx¿ gePsf] kfpF5g\ . bof/fdnfO{ #*° ;]= Hj/f] 5, t/ 3fF6L c/l/g], l;+ufg aUg] / bfb'/f 5}g . pd]/ cg';f/ w]/} sd tf}n x'g'sf ;fy} p;sf] xTs]nfdf s]xL ;]tf]kgf 5 . :jf:Yo sfo{stf{n] bof/fdnfO{ Vivex cf}nf]] tyf /QmcNktf cyjf w]/} sd tf}n ePsf] juL{s/0fdf /fV5g\ .

cf}nf]]sf] pkrf/ ug{, :jf:Yo sfo{stf{n] Snf]/f]lSjgsf] rSsL lbg] lg0f{o u5{g\ . bof/fdnfO{ À rSsL # lbg;Dd lbg'k5{ egL :jf:Yo sfo{stf{ n]V5g\ . /QmcNktf cyjf w]/} sd tf}nsf] pkrf/ ug{ bof/fdnfO{ cfO/g jo:s rSsL cfwf rflxG5 egL :jf:Yo sfo{stf{ n]V5g\ . 1/2 tab × 14 days gf]6 M :jf:Yo sfo{stf{n] bof/fdsL cfdfnfO{ vfgf v'jfpg]af/] ;Nnfx lbg' k5{Ù t/ Tof] s'/f o; e"ldsf

gf6sdf ;dfj]z ul/Psf] 5}g . tkfO{n] cfdfnfO{ k/fdz{ eGg] csf]{ k'l:tsfdf s;/L vfgf v'jfpg] eGg] af/] l;Sg' x'g]5 .

:jf:Yo sfo{stf{ M bof/fdsf] nflu Snf]/f]lSjg tyf cfO/g rSsL rflxG5 egL p;sL cfdfnfO{ eGg'xf];\ / vfg] cf}iflwx¿ 3/df s;/L lbg] eGg] s'/f cfdfnfO{ l;sfpg'xf];\ . cfdfnfO{ ;a} cfjZos hfgsf/L lbg'xf];\, cf}iflwx¿ s;/L lbg] xf] cfdfnfO{ b]vfpg'xf];\ tyf cfˆgf] aRrfnfO{ cf}iflwsf] klxnf] dfqf pgn] lb+b} u/]sf] x]g'{xf];\ . To;kl5, :jf:Yo rf}sLdf -pkrf/ s]Gb|df_ slxn] t'?Gt} kmls{g] tyf cg'udg pkrf/sf] nflu slxn] cfpg] eGg] af/] cfdfnfO{ ;Nnfx lbg'xf];\ . cfdfn] a'em]–ga'em]sf] hfFRg'xf];\ . cfdf M :jf:Yo sfo{stf{n] lbPsf lgb]{zgx¿nfO{ tkfO{ ;fjwfgLk"j{s ;'Gg'xf];\ . tkfO{n] s]xL s'/f ga'em] k|Zgx¿ ;f]Wg'xf];\ / :jf:Yo sfo{stf{åf/f ;f]lwPsf] s'g} klg k|Zgsf] pQ/ lbg'xf];\ . bz{sx¿ M e"ldsf gf6s x]g'{xf];\ . jLrdf x:tIf]k gug'{xf];\ . lgDglnlvt k|Zgx¿ k9\g'xf];\ tyf tkfO{n] x]bf{ h] b]Vg' eof] ;f]sf] pQ/ lbg'xf];\ .

28

s= vfg] cf}iflwx¿ lsg dxTjk"0f{ 5g\, tyf ltgsf] k|of]u s;/L÷slxn] ug]{ eGg] af/] s] :jf:Yo sfo{stf{n] cfdfnfO{ hfgsf/L u/fpg' eof] <

v= s] :jf:Yo sfo{stf{n] k|To]s cf}iflwsf] dfqf s;/L gfKg] eGg] af/] pbfx/0fx¿ lb+b} cfdfnfO{

b]vfpg' eof] < u= s] :jf:Yo sfo{stf{n] cfdfnfO{ tn n]lvPsf s'/fx¿ ub}{ u/]sf] x]g'{ eof] < k|To]s cf}iflwsf] dfqf gfKg] cEof; u/]sf], tyf cfˆgf] aRrfnfO{ cf}iflw lbg] cEof; u/]sf] < 3= s] :jf:Yo sfo{stf{n] ;xL t/Lsfn] cf}iflwx¿nfO{ n]a'n u/]/ k'l/of kfg'{ eof] < ª= s] :jf:Yo sfo{stf{n] cfdfnfO{ slxn] t'?Gt} kms{g] eGg' eof] < s] :jf:Yo sfo{stf{n] cfdfnfO{ cg'udg pkrf/sf] nflu slxn] kmls{g] eGg]af/] atfpg' eof] < r= s] :jf:Yo sfo{stf{n] cfdfn] a'em]–ga'em]sf] s'/f hfFr ug'{ eof] < pxfFn] s:tf hfFRg] k|Zgx¿ ;f]Wg' eof] < cGo hfFRg] k|Zgx¿ tkfO{ s] ;f]Wg' x'G5 <

e"ldsf gf6s kl5, dflysf k|Zgx¿ tyf tkfO{sf pQ/x¿ cGo ;xefuL tyf k|lzIf0f ;xof]uLl;t 5nkmn ug'{xf];\ .

29

%=) :yfgLo ;ª\qmd0fsf] pkrf/ 3/}df s;/L ug]{ egL cfdfnfO{ l;sfpg'xf];\ (Teach the Mother to Treat Local Infections at Home)

k'l:tsfsf] o; v08n] tkfO{nfO{ :yfgLo ;ª\qmd0fsf] pkrf/ s;/L ug]{ eGg]af/] l;sfpg] 5 . :yfgLo ;ª\qmd0fx¿ eGgfn] vf]sL, 3fF6Lsf] b'vfO, cfFvfsf] ;ª\qmd0f, d'vleqsf] 3fpx¿ tyf sfgsf] ;ª\qmd0fnfO{ a'emfpF5 .

:yfgLo ;ª\qmd0fsf] pkrf/ 3/df ug{sf] nflu cfdfnfO{ s;/L l;sfpg] eGg]af/] klg tkfO{x¿n] l;Sg' x'g]5 M cfdfnfO{ l;sfp“bf M

pkrf/ ljlw s] xf], / of] lsg ug'{k5{ eGg] s'/f cfdfnfO{ atfpg'xf];\ .

pko'Qm sf]7df ePsf pkrf/sf ;"rLa4 r/0fx¿af/] atfpg'xf];\ .

cfdfn] cfˆgf] aRrfnfO{ pkrf/ s]Gb|df cf}iflw v'jfPsf] /fd|/L x]g'{k5{ -3fF6Lsf] b'vfO / vf]sLaf6

5'6sf/f lbnfpg] ljlw afx]s_ .

lbgdf slt k6s pkrf/ ug]{ eGg] s'/f atfpg'xf];\ .

cfjZostf k/]sf] v08df 3/df klg cf}iflw nufpg 6]6«f;fOlSng dndsf] 6\o"a / ;fgf] af]tndf

h]G;g efof]n]6 klg lbg'xf];\ .

pkrf/ s]Gb| 5f]8\g' cufl8, aRrfsL cfdfn] /fd|/L a'em]sL 5g\ ls 5}gg\ hfFRg'xf];\ .

:yfgLo ;ª\qmd0fx¿sf] nflu lbOg]

s]xL pkrf/x¿ aRrfnfO{ cK7\of/f] nfUg ;S5 . aRrfx¿n] k|foM cfˆgf] cfFvf, sfg cyjf d'vsf] pkrf/df lj/f]w ug{ ;S5g\ . To;sf/0f, aRrfnfO{ rNg glbg] u/L ;dfpg' dxTjk"0f{ x'G5 . o;n] aRrfnfO{ pkrf/df afwf pTkGg ug{af6 /f]Sg]5 . bfFofkl§sf] lrqn] aRrfnfO{ ;dfpg] Pp6f /fd|f] t/Lsf b]vfpFb5 . cfFvfdf dnd nufpFbf cyjf d'vsf] 3fpx¿sf] pkrf/ ubf{ aRrfsf] 6fpsf]nfO{ kl5lNt/ 9Nsfpg'xf];\ .

pkrf/ ug'{eGbf Ps} l5g cl3 dfq

aRrfnfO{ rNg g;Sg] u/L ;dfTg'xf];\ .

30

%=! cf“vfsf] ;+qmd0fsf] pkrf/ 6]6«f;fOlSng dndn] ug'{xf];\ .

cf“vfsf] ;ª\qmd0fsf] pkrf/ 6]6«f;fOlSng dndn] ug'{xf];\

lbgsf] # k6s cfFvf ;kmf ug'{xf];\ . xft /fd|/L w'g'xf];\ . aRrfnfO{ cfFvf aGb ug{ nufpg'xf];\ . ;kmf sk8fsf] 6'qmf lng] / xn'sf t/Lsfaf6 b'a} cfFvfsf] kLk k'5\g'xf];\ .

6]6«f;fOlSng dnd lbgsf] # k6s b'a} cfFvfdf xfNg'xf];\ . aRrfnfO{ dfly x]g{ nufpg'xf];\ . cfFvfsf] tNnf] 9sgLleq yf]/} dnd lgrf]/]/ xfNg'xf];\ . km]l/ xft w'g'xf];\ .

cfFvfsf] /ftf]kgf guP;Dd pkrf/ ul//xg'xf];\ .

cfFvfdf of] dnd afx]s cGo s'g} cf}iflw k|of]u gug'{xf];\ .

olb aRrfnO{ k|]if0f ug]{ xf] eg], cfFvfnfO{ xn'sf lsl;dn] ;kmf ug'{xf];\ . cfFvfsf] tNnf] 9sgLnfO{ tn tfGg'xf];\ . klxnf] dfqf 6]6«f;fOlSng dndnfO{ cfFvfsf] tNnf] 9sgLdf /fVg'xf];\ . Tof] cf}iflwsf dfqfsf] cfsf/ rfdnsf] u]8f hqf] x'G5 . aRrfnfO{ k|]if0f ug{ kb}{g eg], 6]6«f;fOlSng dnd cfFvfdf nufpg] t/Lsf cfdfnfO{ l;sfpg'xf];\ . cfdfnfO{ lgDg hfgsf/L lbg'xf];\ . cfFvfx¿nfO{ xflg x'g glbg, b'a} cfFvfx¿sf] pkrf/ ug{ cfdfnfO{ eGg'xf];\ . dndn] aRrfsf] cfFvfdf cln cln ljemfpg ;S5 eGg] s'/f klg aRrfsf] cfdfnfO{ eGg gla;{g'xf];\ . cfdfnfO{ eGg'xf];\ M * cfFvfsf] pkrf/ ug'{ eGbf klxn] tyf pkrf/kl5 cfˆgf xftx¿ w'g] . * 6]6«f;fOlSng dnd nufpg' 7Ls cl3 aRrfsf cfFvfx¿nfO{ ;kmf ug{] . cfFvf k'5\gsf] nflu Pp6f

;kmf sk8f k|of]u ug{]{ . * o; k|lqmofnfO{ -cfFvfsf] ;kmfO tyf dnd nufpg'_ laxfg, lbpF;f] / ;fFem u/L lbgdf # k6s

bf]x¥ofpg] .

31

To;kl5 cfFvfsf] pkrf/ s;/L ug]{ xf] cfdfnfO{ b]vfpg'xf];\ . cfˆgf xftx¿ w'g gla;{g'xf];\ . * tkfO{n] cfFvfsf] tNnf] 9sgLnfO{ tn tfGg'xf];\ . tNnf] 9sgL lt/ cf}+Nofpg'xf];\ . cfdfnfO{ pgn]

dnd nufpg' kg]{ 7fpF oxL xf] egL atfpg'xf];\ . 6\o'an] cfFvf cyjf 9sgLnfO{ g5f]cf];\ eGg] s'/fdf ;ts{ /xg cfdfnfO{ eGg'xf];\ .

* aRrfnfO{ rNg g;Sg] u/L ;dfpg Ps hgfnfO{ nufpg'xf];\ . * aRrfsf] Pp6f cfFvfnfO{ sk8fn] k'5\g'xf];\ . dndnfO{ tNnf] 9sgLdf lgrf]g'{xf];\ . cfdfn] 7Ls

7fpFdf dnd /fv]sf] / dnd sxfF nufpg] tyf To;sf] kl/df0fnfO{ b]lV5g\ eGg] af/] lglZrt ug'{xf];\ .

aRrfsf] csf]{ cfFvf ;kmf ug]{ tyf dnd /fVg] cEof; ug{sf] nflu cfdfnfO{ eGg'xf];\ . pgn] cEof; u/]sf] x]g'{xf];\ tyf k|ltlqmof lbg'xf];\ . pgn] ;s]kl5 lgDglnlvt cltl/Qm hfgsf/L pgnfO{ lbg'xf];\ .

* ;+qmldt cfFvfaf6 /ftf]kg guP;Dd b'a} cfFvfsf] pkrf/ ug'{xf];\ . olb cfFvfdf kLk 5}g cyjf cfFvfx¿ laxfg p7\bf 6fFl;b}gg\ eg] cfFvf 7Ls e}/x]sf] 5 eGg] yfxf x'G5 .

* aRrfsf cfFvfx¿df cfFvfsf cGo dnd yf]kf cyjf ljsNkx¿ g/fVg'xf];\ . ltgLx¿ xflgsf/s

x'g ;S5g\ tyf aRrfsf] cfFvfnfO{ gf]S;fg k'¥ofpg ;S5g\ . xflgsf/s tTjx¿ cfFvfdf /fVbf cGwf]kg pTkGg x'g ;S5 .

* @ lbgkl5, cfFvfdf olb cem} klg kLk 5 eg], aRrfnfO{ :jf:Yo rf}sLdf lnP/ cfpg

eGg'xf];\ .

32

To;kl5 3/ n}hfg cfdfnfO{ Ps 6\o'a dnd lbP/ k7fpg'xf];\ . tkfO{n] :jf:Yo rf}sLdf pkrf/ ubf{ k|of]u u/]sf] 6\o'a g} lbg'xf];\ . cfdf hfg'eGbf cl3, hfFRg] k|Zgx¿ pgnfO{ ;f]Wg'xf];\ . cfFvfsf] pkrf/ s;/L ug]{ eGg]af/] pgn] a'lemg\ ls a'em]sL 5|}gg\ hfFRg'xf];\ . pbfx/0fsf] nflu, ;f]Wg'xf];\ M …tkfO{ Pp6f cfFvfsf] pkrf/ ug'{x'G5 cyjf b'a} cfFvfsf] ug'{x'G5 <Ú …tkfO{n] cfFvfdf slt dnd /fVg'x'G5 < dnfO{ b]vfpg'xf];\ .Ú …tkfO{n] cfFvfx¿sf] pkrf/ slt k6s ug'{x'G5 <Ú …tkfO{n] cfˆgf xftx¿ slxn] w'g' x'G5 <Ú

%=@ sfgsf] kLk ;f];]/ ;'Vvf kfg'{xf];\

sfgsf] kLk ;f];]/ ;'Vvf s;/L agfpg] eGg]af/] cfdfnfO{ l;sfpg, sfg ;Grf] kfg{ ;j{k|yd ;+qmldt sfgnfO{ ;'Vvf kf/L /fVg' Hofb} dxTjk"0f{ x'G5 egL cfdfnfO{ atfpg'xf];\ . To;kl5 aRrfsf] sfg ;kmf s;/L ug]{ xf] cfdfnfO{ b]vfpg'xf];\ . tkfO{n] aRrfsf] sfg ;f]:b} u/]sf] a]nf, cfdfnfO{ eGb} ug'{xf];\ M * n'F8f] agfpgsf] nflu ;kmf ;"tL sk8f k|of]u ug{] .

;"tL sk8fsf] 6's|f, l;Gsf cyjf sdhf]/ sfuh -h'g sfgleq c8\lsg ;S5_ k|of]u gug{] .

* n'F8f] gleh];Dd aRrfsf] sfgleq /fVg] . * kLkn] leh]sf] n'F8f]nfO{ ˆofFs]/ ;kmf n'F8f]n] sfg

;kmf ug]{ .

sfgleq xfn]sf] n'F8f] ;'Vvf geP;Dd oL r/0fx¿nfO{ bf]xf]¥ofpg] . To;kl5 sfg ;'Vvf x'G5 .

aRrfsf] sfgdf @ yf]kf cf}ifwLx? xfNbf lgDg pkfo ckgfpg'xf];\ M sfg ;'Vvf kf/L;s]kl5 @–@ yf]kf l;k|f]ˆnf]S;fl;g cf}ifwL lbgdf $ k6s !$ lbg;Dd /fVg l;sfpg'xf];\ .

sfgsf] kLk ;f];]/ ;'Vvf kfg'{xf];\ / l;k|f]ˆnf]S;fl;g yf]kf sfgdf /fVg'xf];\ .

!= lbgsf] $ k6s sfgsf] kLk ;f]:g'xf];\ .

;f]:g] g/d sk8fsf] ;fgf] n'F8f] agfpg'xf];\ .

aRrfsf] kfs]sf] sfgleq lj:tf/} k;fpg'xf];\ / Tof] leh]kl5 aflx/ lgsfNg'xf];\ . csf]{ ;kmf n'F8f] km]l/ kLk ;f]:g leq k;fpg'xf];\ . ;'Vvf gx'~h]n;Dd o;f] ug{ hf/L

/fVg'xf];\ .

@= l;k|f]ˆnf]S;fl;g sfgdf /fVg] yf]kf cf}ifwL, @ yf]kf lbgdf $ k6s @ xKtf;Dd /fVg'xf];\ .

33

cfdfn] sfg ;'Vvf kfg]{ cEof; u/]sf] x]g'{xf];\ . ;/–;Nnfx lbg'xf];\ . pgn] ;s]kl5, lgDg hfgsf/L lbg'xf];\ .

* lbgsf] # k6s sfg ;kmf ug'{xf];\ .

* sfgdf n'F8f] /fVbf n'F8f] leHg g5f]8];Dd tyf sfgaf6 kLk aUg g5f]8];Dd hlt lbg nfu] klg of] pkrf/ hf/L /fVg'xf];\ .

* sfg ;kmf ug]{ pkrf/ u/]s]f a]nf sfgdf s'g} klg j:t' -t]n, emf]ns'/fx? cyjf emf]n cf}iflw g/fVg'xf];\ . aRrfnfO{ kf}8L v]Ng hfg glbg'xf];\ . sfgleq kfgL k:g' x'Fb}g .

hf“Rg] k|Zgx¿ ;f]Wg'xf];\, h:t} M …3/df sfg ;kmf ug]{ n'F8f] agfpg s:tf ;fdfgx¿sf] tkfO{ k|of]u ug'{ x'G5 <Ú …tkfO{ n'F8f]åf/f lbgdf slt k6s sfg ;'Vvf agfpg' x'G5 <Ú …cfˆgf] aRrfsf] sfgdf tkfO{n] c¿ s] /fVg' x'G5 <Ú olb cfdfnfO{ sfg ;kmf ubf{ s]xL ;d:of knf{ eGg] nfU5 eg], To:tf s'/fx¿sf] ;dfwfg ug{ pgnfO{ d2t ug'{xf];\ .

%=# d'vleqsf] 3fp -y|;_ sf] pkrf/ h]G;]g efof]n]6n] ug'{xf];\ d'vleqsf] 3fpx¿sf] pkrf/ ugf{n] ;ª\qmd0fsf] lgoGq0f x'G5 / aRrfnfO{ vfgdf ;lhnf] k5{.

d'vleqsf] 3fpsf] pkrf/ h]G;g efof]n]6n] ug'{xf];\

d'vleqsf] 3fpsf] pkrf/ lbgsf] @ k6s ug'{xf];\ . xft w'g'xf];\ .

dgtftf] g"g kfgLdf ;kmf sk8f lehfP/, cf}+nfsf] 6'Kkfdf a]/]/ aRrfsf] d'vsf]

3fp ;kmf ug'{xf];\ .

cfwf zlQm )=@%Ü sf] emf]n h]G;g efof]n]6 tL 3fpdf nufpg'xf];\ .

km]l/ xft w'g'xf];\ .

h]G;]g efof]n]6 -)=@%Ü_ sf] emf]n_ n] d'vleqsf] 3fpx¿sf] pkrf/ ug{ cfdfnfO{ l;sfpg'xf];\3 . pgnfO{ lgDglnlvt hfgsf/Lsf] af/]df eGg'xf];\ .

3 h]G;]g efof]n]6 k"/f zlQm -)=%Ü_ sf] x'G5 / d'vdf k|of]u ug'{ kg]{ rflx+ cfwf zlQm -)=@%Ü_ sf] x'g'k5{ . % u|fd w"nf]

G.V. nfO{ ! ln6/ kfgLdf ld;fP/ 3f]n agfPdf )=%Ü zlQmsf] G.V. aG5 . ca of] G.V. d'vdf k|of]u ubf{ a/fa/ dfqf kfgL ld;fpg'k5{ .

34

* cfˆgf aRrfsf] d'vleqsf] 3fpx¿df cf}iflw nufP l5§} pgsf] aRrfn] ;fdfGo ¿kdf vfgf

vfg z'? ug]{5 . aRrfn] vfgf vfg' dxTjk"0f{ x'G5 .

* aRrfsf] d'v ;kmf ug'{xf];\ . cfˆgf cf}+nfdf Pp6f ;kmf g/d sk8f a]g'{xf];\ . o;nfO{ g'g–

kfgLdf rf]Ag'xf];\ . d'v leq k'5\g'xf];\ .

* d'vleqsf] 3fpx¿df h]G;]g efof]n]6 nufpg Pp6f ;kmf g/d sk8f k|of]u ug'{xf];\ /

h]G;]g efof]n]6df rf]Kg'xf];\ . 3fp pTkGg ug]{ sL6f0f'x¿nfO{ h]G;]g efof]n]6n] dfg]{5 .

aRrfnfO{ h]G;]g efof]n]6 lkpg glbg'xf];\ .

* d'vleqsf] 3fpx¿sf] laxfg / ;fFem – lbgdf @ k6s pkrf/ ug'{xf];\ .

* d'vleqsf] 3fpx¿sf] pkrf/ % lbg;Dd ug'{xf];\ clg To;kl5 aGb ug'{xf];\ .

Pp6f ;kmf sk8fnfO{ cfˆgf] cf}+nfdf a]/]/ o;nfO{ g"g kfgLdf rf]Kg'xf];\ . klxn] aRrfsf] d'vnfO{ s;/L ;kmf u/L k'5\g] cfdfnfO{ b]vfpg'xf];\ . To;kl5 cfwf zlQmsf] -)=@%Ü_ h]G;]g efof]n]6nfO{ aRrfsf] d'vsf] 3fpdf nufpg'xf];\ . cfdfnfO{ cEof; ug{ eGg'xf];\ . pgn] aRrfsf] d'vnfO{ ;kmf u/L k'5]sf] tyf 3fp ePsf] afFsL efudf h]G;]g efof]n]6 nufPsf] lg/LIf0f ug'{xf];\ . pgn] /fd|/L u/]sf s'/fx¿ tyf ;'wfg'{ kg]{ s'/fx¿ eP ;f] atfpg'xf];\ . cfdfnfO{ 3/ n}hfg Ps ;fgf] af]tn cfwf zlQmsf] h]G;]g efof]n]6 lbg'xf];\ . cg'udgsf] nflu @ lbgdf af]nfpg'xf];\ . olb d'vleqsf 3fpx¿ emg a9L eP eg] cyjf aRrfn] lkpg jf vfg ;s]g eg] Tof] eGbf klxNo} :jf:Yo rf}sLdf kmls{g' k5{ eg]/ klg pgnfO{ atfpg'xf];\ . hfg' eGbf klxn], cfdfnfO{ hfFRg] k|Zgx¿ ;f]Wg'xf];\ . pbfx/0fsf] nfluÙ …aRrfsf] d'v ;kmfug{ tkfO{ s] k|of]u ug'{x'G5 <Ú …tkfO{ cfˆgf xftx¿ slxn] w'g' x'G5 <Ú …aRrfsf] d'vdf tkfO{ slt k6s cf}iflw nufpg' x'G5 <Ú …slt lbg;Dd ug'{x'G5 <Ú pkrf/ ubf{ pgnfO{ s]xL ;d:of knf{ ls ;f]Wg'xf];\ . ltgLx¿sf] ;dfwfgdf ;xof]u ug'{xf];\ .

35

%=$ 3f“6Lsf] b'vfO lgsf] kfg'{xf];\ tyf vf]sLaf6 5'6\sf/f lbnfpg'xf];\ 3fF6Lsf] b'vfO lgsf] kfg{ cyjf vf]sLaf6 5'6\sf/f lbnfpg, ;'/lIft cf}iflw k|of]u ug'{xf];\ . To:tf] cf}iflwx¿ 3/}df ag]sf, :jf:Yo rf}sLdf lbOPsf jf cf}iflw k;naf6 lslgPsf x'g ;S5g\ . dxTjk"0f{ s'/f s] 5 eg] ltgLx¿ ;'/lIft x'g' kb{5 . 3/}df ag]sf cf}iflwx¿, aflx/ lslgg] cf}iflwx¿ hlQ s} k|efjsf/L x'G5g\ .

;'/lIft cf}iflwåf/f 3f“6Lsf] b'vfO lgsf] kfg'{xf];\ tyf vf]sLaf6 5'6sf/f lbnfpg'xf];\

l;kmfl/z ul/Psf] pkrf/ ljlw M cfdfsf] b"w dfq vfg] aRrfnfO{ :tgkfg u/fO /xg'xf];\ . dx÷t'n;Lsf] kft÷cb'jfsf] /;÷sfutLsf] /; cflb tftf] kfgLdf ldnfO v'jfpg'xf];\ .

xflgsf/s pkrf/ ug{ glbg'xf];\ M

sf]l8g, P6«f]kLg, PlG6lx:6fldgo'Qm emf]n

afn–pkrf/ eGg] tflnsfdf 3fF6Lsf] b'vfO cyjf vf]sL nfu]sf aRrfx¿sf] nflu ;'/lIft, cf/fdbfoL cf}iflwx¿sf] l;kmfl/z ul/Psf] 5 . olb aRrfn] s]jn cfdfsf] b"w dfq} vfFb}5 eg] p;nfO{ cGo k]okbfy{ cyjf cf}iflw glbg'xf];\ . cfdfsf] b"w g} o:tf aRrfsf] nflu ;a} eGbf pQd cf/fdbfoL cf}iflw xf] . tkfO{sf] If]qdf xflgsf/s cf}iflwx¿sf] k|of]u x'g;S5 . To;f] 5 eg], ltgLx¿nfO{ aS;df clen]v ul/Psf] 5 . xflgsf/s tTj ePsf lgDglnlvt cf}iflwx¿sf] k|of]u slxNo} gug'{xf];\ h:t} M P6«f]lkg, sf]l8g cyjf sf]l8g ldl>t cf}iflw jf cNsf]xn . oL j:t'x¿n] aRrfnfO{ n6\7 kfg{ ;S5g\ . ltgLx¿n] aRrfsf] vfgfdf afwf pTkGg ug{ ;S5g\ . oL cf}iflwx¿n] aRrfnfO{ vf]s]/ kmf]S;f]af6 skm lgsfNg] sfddf klg afwf k'¥ofpg ;S5g\ . gfsdf /fVg] cf}iflw yf]kfx¿ g"g dfq ePsf] k|of]u ug{ x'G5 . ;'/lIft cf}iflw s;/L lbg] eGg] s'/fsf] JofVof ubf{, aRrfnfO{ cf}iflw lbg] cEof; cfdfn] u/]sf] x]g'{ cfjZos 5}g . o; pkrf/df jf:tljs dfqf ldnfpg' Hofb} h?/L 5}g . pkrf/ tflnsf k'l:tsfsf] k]h g+ @) df slxn] t'?Gt kms{g] eGg] ljifo x]g'{xf]; .

;Nnfxsf] k|fyldstf lgwf{/0f ug'{xf];\ aRrfdf pkrf/ ug'{kg]{ Pp6f dfq} ;d:of 5 eg] tflnsfx¿df n]lvPsf ;a} k|f;+lus pkrf/ lgb]{zgx¿ tyf ;Nnfx lbg'xf];\ . aRrfdf y'k|} ;d:ofx¿ 5g\ eg] cfdfnfO{ lbOg] lgb]{zgx¿ lgs} hl6n x'g ;S5g\ . o; cj:yfdf, tkfO{n] lgb]{zgx¿nfO{ clt dxTjk"0f{ s'/fx¿df dfq ;Lldt /fVg' k5{ . o:tf] cj:yfdf tkfO{n] s] a'emg' kb{5 eg] M cfdfn] slt;Dd a'‰g tyf ;lDemg ;lS5g\ < s] cg'udg pkrf/sf] nflu kms]{/ cfpg] ;Defjgf 5 < olb To;f] xf] eg], s]xL ;Nnfx

cg'udgdf cfPsf] a]nf klg lbg ;lsG5 . aRrfnfO{ ;Grf] kfg{ s'g rflx+ ;Nnfx a9L dxTjk"0f{ 5 <

36

olb cfdf cndNn k/] h:tf] b]lvlG5g\ cyjf ;a} pkrf/ lgb]{zgx¿nfO{ pgL l;Sg jf ofb ug{ ;lSbgg\ eGg] tkfO{nfO{ nfU5 eg], tkfO{ tL lgb]{zgx¿nfO{ dfq} r'Gg'xf];\, h'g aRrfnfO{ arfpgsf] nflu clt h?/L 5g\ . h?/L pkrf/x¿df PlG6afof]l6s jf cf}nf]sf] cf}iflw lbg' tyf kvfnf ePsf] aRrfnfO{ emf]ns'/fx? lbg' kb{5 . s]xL pkrf/x¿nfO{ /fd|/L l;sfpg'xf];\ tyf cfdfn] ltgLx¿nfO{ ;Demg ;lS5g\ ls ;lSbgg\ hfFRg'xf];\ . cfjZos k/] lgDglnlvt s'/fx¿nfO{ kl5sf] nflu 5f]8\g'xf];\ M – vfg]s'/f ;DaGwL d"Nof+sg tyf vfg]s'/f ;DaGwL ;Nnfx . – vf]sL jf ?3fsf] nflu cf/fdbfoL cf}iflw . – Kof/fl;6fdf]n* – le6fldg …PÚ* sf] bf];|f] dfqf – cfO/g pkrf/ – sfgsf] ;f];fO cfdf cg'udgsf] nflu kms]{/ cfpFbf tkfO{ c? pkrf/ lgb]{zgx¿ lbg ;Sg'x'G5 .

* Kof/fl;6fdf]n cyjf le6fldg …PÚ sf] klxnf] dfqf lbg'xf];\ . c¿ dfqfx¿ glbg'xf];\ . kl5sf dfqfx¿sf nflu lgb]{zgx¿ lbP/ cfdfnfO{ cndNn gkfg'{xf];\ .

cEof; ‘3’

o; cEof;df 3/}df :yfgLo ;ª\qmd0fsf] pkrf/ ug{ cfdfnfO{ s;/L l;sfpg] eGg]af/]sf k|Zgx¿sf] pQ/ tkfO{n] lbg' x'g]5 . tkfO{n] ;Nnfxsf] k|fyldstf lgwf{/0f ug]{ cEof; klg ug'{x'g]5 . efu ! M :yfgLo ;+qmd0fx¿sf] pkrf/ 3/df ug{ cfdfnfO{ l;sfpg] != cfFvfsf] ;ª\qmd0fsf] pkrf/ ug'{xf];\ . s= cfFvfsf] ;ª\qmd0fsf] pkrf/ ug{ lsg dxTjk"0f{ 5 eGg] af/] tkfO{ cfdfnfO{ s] atfpg'

x'G5 < v= lgDglnlvt ;"rLdf cfFvfsf] ;ª\qmd0fsf] pkrf/ ug{ cfdfnfO{ s;/L l;sfpg] eGg]

s'/fx¿af6 s'g d'Vo r/0f 5'6]sf] 5 < * s;/L clg slxn] cfFvfsf] pkrf/ ug]{ xf] atfpg'xf];\ * cfFvfsf] ;kmfO s;/L ug]{ tyf 6]6«f;fOlSng dnd cfFvfdf s;/L nufpg] k|bz{g u/]/

b]vfpg'xf];\ .

37

* slt k6s tyf slt lbg;Dd cfFvfsf] pkrf/ ug]{ eGg] s'/fsf] ;fy} aRrfsf] cfFvfdf

c¿ s]xL g/fVg egL pgnfO{ eGg'xf];\ . * pgnfO{ dndsf] Ps 6\o'a lbg'xf];\ . * lgb]{zgx¿nfO{ cfdfn] a'lemg\ egL lglZrt x'gnfO{ hfFRg] k|Zgx¿ ;f]Wg'xf];\ . u= oL k|Zgx¿nfO{ hfFRg] k|Zgx¿df kl/0ft ug'{xf];\ . != cfˆgf] aRrfsf] cfFvfsf] pkrf/ s;/L ug]{ eGg] s'/f s] tkfO{nfO{ yfxf 5 < @= tkfO{ cfˆgf] aRrfnfO{ cfFvfdf dnd nufpg] a]nf rNg g;Sg] u/L ;dfpg ;Sg' x'G5

< @= d'vleqsf] 3fpx¿sf] pkrf/ ug'{xf];\ . s= d'vleqsf] 3fpx¿sf] pkrf/ ug{ lsg dxTjk"0f{ 5 eGg] af/] tkfO{ cfdfnfO{ s] eGg'x'G5 < v= d'vleqsf] 3fpx¿sf] 3/df pkrf/ ug{ cfdfnfO{ l;sfpFbf tkfO{ s'g d'Vo r/0fx¿sf]

cg';/0f ug'{ x'G5 < u= d'vleqsf] 3fpx¿sf] pkrf/ 3/df s;/L ug]{ eGg] s'/f cfdfn] a'em]sL 5g\ egL lglZrt

x'gnfO{ ;f]Wg] # j6f hfFRg] k|Zgx¿ n]Vg'xf];\ . #= 3fF6Lsf] b'vfO lgsf] kfg'{xf];\ tyf ;'/lIft cf}iflwåf/f vf]sLaf6 5'6\sf/f lbnfpg'xf];\ . s= …;'/lIftÚ cf}iflw eGgfn] s] a'lemG5 < pbfx/0f lbg'xf];\ .

38

v= ;'/lIft gePsf sDtLdf @ j6f cf}iflwx¿sf] pbfx/0f lbg'xf];\ . u= …Go"df]lgof gePsf] M ¿3f jf vf]sLÚ egL juL{s/0f ul/Psf] aRrf pkrf/sf] nflu slxn]

t'¿Gt} Nofpg] <

efu ! ;s]kl5, k|lzIf0f ;xof]uLl;t cfˆgf pQ/x¿sf af/]df 5nkmn ug'{xf];\ .

efu @ M ;Nnfxsf] k|fyldstf lgwf{/0f ug]{ cEof; k|lzIf0f ;xof]uLn] dw' eGg] aRrfsf] nflu 7"nf] cfjfhdf la/fdLsf] ljj/0f k9\g' x'g]5 . != dw'sf] la/fdL ljj/0f ;'Gg'xf];\ . csf{] kfgfdf ePsf] clen]v kmf/ddf dw'sf] d"Nof+sg tyf

juL{s/0fsf glthfx¿ n]Vg'xf];\ . @= k|lzIf0f ;xof]uLn] la/fdLsf] ljj/0f k9\g hf/L /fVg]5g\ . #= dw'sf] lglDt tkfO{n] agfPsf] pkrf/, lgb{]zg tyf ;Nnfxdfly k'glj{rf/ ug'{xf];\ . :jf:Yo

sfo{stf{sf] nflu s'g s'/fx¿ xh'/cfdfnfO{ l;sfpg ;a} eGbf a9L dxTjk"0f{ 5g\ < $= olb xh'/cfdf cndNn k/]sf] :ki6} b]lvlG5g\ eg], s'g pkrf/, lgb{]zg cyjf ;Nnfx kl5 lbg

;lsG5 <

;a} hgf tof/ ePkl5 ;fd"lxs 5nkmn x'g]5 .

39

@ dlxgfb]lv % jif{;Ddsf] lj/fdL jRrfsf] Joj:yfkg jRrfsf] gfdM============================= pd]/M =============== tf}nM ======== s]=hL= tfks|dM ========;]= ;f]Wg'xf];\ M jRrfnfO{ s] s] ;d:ofx? 5g\ < ===================== klxnf] e]6 ======== cg'udg e]6====== d"Nof+sg -e]l6Psf ;j} lrGxx?df uf]nf] nufpg'xf];\_ juL{{s/0f

;fdfGotof b]lvg] vt/fsf lrGxx? hfFRg'xf];\ lkpg g;Sg] jf b"w r':g g;Sg] ;':t jf j]xf]; 5 < vfPsf] hlt ;j} jfGtf ug]{ sDkg 5 <

vt/fsf lrGxx? 5g\ === 5}gg===

juL{s/0f ubf{ vt/fsf lrGxx? 5g\ eg] lrgf] nufpg ge'Ng'xf];\

jRrfnfO{ vf]sL nfu]sf] jf ;f; km]g{ sl7gfO 5 < 5 === 5}g=== slt lbg eof]< ======== lbg

Ps ldg]6df ;f; b/ uGg'xf];\ === l56f]l56f] ;f; km]5{ < sf]vf xfg]sf] 5 ls x]g'{xf];\ :6«fO8/ x]g'{xf];\ / ;'Gg'xf];\

jRrfnfO{ emf8fkvfnf nfu]sf] 5< 5 == 5}g== slt lbg eof]< ____lbg lb;fdf /ut b]lvPsf] 5 <

jRrfsf] cj:yf x]g'{{xf];\ s] jRrf ;':t jf j]xf]; 5< 56\kl6g] jf lem+lhg] u5{ < cfFvf u8]sf] 5 ls x]g'{'xf];\ jRrfnfO{ emf]ns'/f vfg lbg'xf];\M s] jRrf lkpg g;Sg] jf w]/} lj:tf/} lkpF5 < v"j ltvf{P em}+ u/L lkpF5 < k]6sf] 5fnf cf}Fnfn] tfg]/ 5f]8\bf w]/} lj:tf/} kmls{G5 < -@ ;]s]G8 eGbf j9L ;do nufP/_ lj:tf/} kmls{G5<

jRrfnfO{ Hj/f] cfPsf] 5< -;f]w]/÷5fd]/÷gfk]/ tfks|d #&=%) ;]= jf j9L_ 5 == 5}g== jRrfnfO{{ slt lbgb]lv Hj/f] 5 < === lbg & lbg eGbf j9L ePdf, s] k|To]s lbg Hj/f] cfpF5 < cf}nf]sf] If]q lgwf{/0f ug{'xf];\M pRr/dWod/ Go"g jf gePsf] 5

eg], ;f]Wg'xf];\ s] tkfO{ xfn;fn} of] 7fpF 5f]8]/ st} hfg'ePsf] lyof]< lyof] eg] ljut #) lbgleq cf}nf] nfUg ;Sg] If]qdf k'Ug'ePsf] lyof] <

s] jRrfnfO{ ut # dlxgfleq bfb'/f cfPsf] lyof] <

uw{g c//f] 5 ls x]g'{xf];\ / 5fDg'xf];\ Microscopic/ RDT +ve - ve kmfN;Lk]/d +ve - ve gfsjf6 l;+ufg ju]sf] 5 ls x]g'{{{xf];\ bfb'/fsf] lrGx x]g'{{xf];\ bfb'/f h:t} hLpel/ 8fj/ cfPsf] x]g'{{xf];\ / vf]sL jf gfsjf6 l;+ufg jUg] jf cfFvf /ftf] dWo] s'g} Ps ePsf] x]g'{xf];\

olb # dlxgfleq jf clxn] jRrfnfO{ bfb'/f h:t} /f]u cfPsf] 5 eg]

d'v leq 3fpx? 5g\ ls x]g'{xf];\ . olb 5g\ eg] ulx/f / j9L km}lnPsf 5g\ ls < cfFvfjf6 kLk ju]sf] 5 5}g x]g'{{xf];\ . slg{of wldnf] 5 5}g x]g'{'xf];\ .

jRrfnfO{{{ sfgsf] ;d:of 5< sfg b'v]sf] 5 < sfgjf6 kLk ju]sf] 5 <

5 eg] slxn]b]lv ___ lbg

5 == 5}g== sfgjf6 kLk jlu/xsf] 5 ls x]g'{xf];\ sfgsf] k5fl8kl6[ b'Vg]u/L ;'lGgPsf] 5 ls 5fDg'xf];\

To;kl5 s'kf]if0f / /Qm cNktf prfO{ / sdtf}n hfFRg'xf];\ b]lvg] u/L z/L/sf] df;' s8f lsl;dn] ;'s]sf] 5 ls x]g'{xf];\

b'j} uf]8f ;'lGgPsf] 5 ls x]g'{xf];\ xTs]nfdf ;]tf]kgf x]g'{{{xf];\ w]/} ;]tf]kgf 5 ==== s]xL ;]tf]kgf 5 =====

kfv"/fsf] gfk ug'{ xf]; /ftf]/ kx]nf]/ xl/of] pd]/ cg';f/ tf}n x]g'{xf];\ w]/} sd tf}n === sd tf}n=== ;fdfGo tf}n ====

jRrfsf] vf]ksf] l:ylt, le6fldg ‘P’ / h'sfsf] cf}iflw v'jfP gv'jfPsf] hfFRg'xf];\ lj=l;=lh=== l8=lk=l6, x]k= aL, lxa==== l8=lk=l6, x]k= aL, lxa === l8=lk=l6, x]k= aL, lxa === le6fldg …PÚ === cNj]G8fhf]n ==== cf]=lk=le ! ==== cf]=lk=le=@ ==== cf]=lk=le=# === bfb'/f / ?j]nf === h]= O{= ======

csf]{ vf]ksf] nflu cfpg' kg]{

=========== ldlt

olb jRrfnfO{ /Qm–cNktf ePsf]5, k'8\sf] 5 jf jRrf @ jif{eGbf sd pd]/sf] 5 eg] vfgf ;DjGwL d"Nof°g ug'{xf];\ tkfO{ jRrfnfO{ :tgkfg u/fpg' x'G5< u/fpF5' ==== u/fpFlbg====

u/fpg'x'G5 eg] @$ 306fdf slt k6s < ===/ /ftL klg :tgkfg u/fpg' x'G5 < u/fpF5' ==== u/fpFlbg==== jRrfnfO{ s'g} vfgf jf emf]ns'/f v'jfpg] ug'{ ePsf] 5 < 5 == 5}g=== 5 eg], s:tf] emf]ns'/f jf vfgf v'jfpg' x'G5 <===== lbgsf] slt k6s v'jfpg' x'G5 < ====k6s . jRrfnfO{{ vfgf s]df v'jfpg' x'G5 < af]6n, srf}/f =========================== olb pd]/ cg';f/ w]/} sd tf}n 5 eg] M jRrfn] vfgf vfP/ s]xL 5f]8\5 < ==================================== jRrfn] cfˆgf] 5'6} efu vfG5<===== jRrfnfO{ s;n] v'jfpF5 / s;/L < ===============================

lj/fdL kbf{ jRrfsf] vfgfdf s]xL kl/jt{g ug'{ ePsf] 5 ls < 5 === 5}g====

vfgf ;DjGwL ;d:of

cGo ;d:ofx? eP d"Nof+sg ug'{{xf];\

olb af/Daf/ lgdf]lgof, s8f lgdf]lgof Hj/f], lb3{ kvfnf, d'vdf n]p cfpg] / lgsf] gx'g] ;d:of 5 / jfa' jf cfdf dWo] s';}nfO{ HIV ;+s|ldt 5g eg] HIV/AIDS dxndf x]g{'xf];\ .

40

pkrf/

s'g} klg vt/fsf] lrGx ePsf lj/fdL aRrf s8f juL{s/0f leq gk/] klg ltgnfO{ k|]if0f ug{ ge'Ng' xf]nf . ======================================================================================================================================== ======================================================================================================================================== ======================================================================================================================================== ======================================================================================================================================== ======================================================================================================================================== ======================================================================================================================================== ======================================================================================================================================== ======================================================================================================================================== ======================================================================================================================================== ======================================================================================================================================== ======================================================================================================================================== ======================================================================================================================================== ======================================================================================================================================== ======================================================================================================================================== ======================================================================================================================================== ======================================================================================================================================== ======================================================================================================================================== ======================================================================================================================================== ======================================================================================================================================== ===================================================================================================

41

^=) pkrf/ s]Gb|df lgDg pkrf/x¿ dfq ug'{xf];\ (Give these treatment in clinic only) …pkrf/sf] klxrfgÚ eGg] dxndf tkfO{n] s8f /f]u nfu]sf]÷ juL{s/0fdf k/]sf] aRrfnfO{ t'¿Gt} c:ktfn k|]if0f ug{ l;Sg' eof] . aRrfnfO{ c:ktfn k7fpg' eGbf cl3 tkfO{n] :jf:Yo rf}sLdf tn lbOPcg';f/sf pkrf/x¿ lbg' kg{] x'g ;Sb5 . * olb aRrfn] vfg] PlG6jfof]l6s vfg ;Sb}g eg] PlG6afof]l6ssf] ;'O{ . * cf}nf]sf] ;Defjgf pRr ePsf] If]qdf s8f hl6n cf}nf]]sf] nflu Rectal Artisunate jf

lSjgfOg ;'O{ . * /utdf rLgLsf] dfqf sd x'gaf6 hf]ufpg cfdfsf] b"w cyjf rLgL kfgL .

PlG6afof]l6ssf] ;'O{ jf lSjgfOg lb+bf M

of] cf}iflw lsg lbOPsf] eg]/ cfdfnfO{ /fd|/L atfpg'xf];\ . PlDkl;lng tyf lSjgfOgsf] kl/df0f cg';f/ dfqf lgwf{/0f ug{'xf];\ . lgd{nLs[t l;of] tyf l;l/Gh k|of]u ug'{xf];\ . cf}iflwsf] dfqf 7Ls;“u gfKg'xf];\ . cf}iflwnfO{ df;'df lbg] ;'O{sf] dfWodn] lbg'xf];\ . olb aRrfnfO{ k|]if0f ug{ ;lsPg eg], lbOPsf] lgb{]zg cg';f/ ug'{xf];\ .

^=! PlG6afof]l6ssf] ;'O{ lbg'xf];\

c:ktfn k7fpg' cl3 aRrfnfO{ PlG6afof]l6ssf] Ps dfqfsf] cfjZostf kg{ ;S5 olb aRrf

* lkpg jf :tgkfg ug{ ;Sb}g eg], jf * sDkg 5, jf * vfP hlt ;a} afGtf u5{, jf * ;':t jf a]xf]; 5,

d'vaf6 vfg g;Sg] aRrfnfO{ Ps dfqf PlDkl;lngsf] ;'O{ lbg'xf];\ . To;kl5 t'?Gt} c:ktfndf k|]if0f ug'{xf];\ .

dfqf lgwf{/0f ug{ lgDglnlvt 6]a'n k|of]u ug'{xf];\ M PlG6afof]l6s ;'O{ (IM) lbg'xf];\ -PDkLl;lng_

rSsL lgNg g;Sg] / t'?Gt} k|]if0f ug'{ kg]{ la/fdL aRrfsf] nflu M PlDkl;lng ;'O (IM) lbP/ t'?Gt aRrfnfO{ pkrf/ s]Gb|df k|]if0f ug'{xf];\ . k|]if0f ug{ ;Dej geP PlDkl;lngsf] ;'O{ k|To]s !@ 306fdf % lbg;Dd lbg'xf];\ . To;kl5 !) lbgsf] pkrf/ k"/f ug{ vfg] pko'Qm PlG6afof]l6s lbg'xf];\ .

pd]/ / tf}n

PlDkl;lng dfqf M %) ld=u|f= k|ltlsnf]

cf}iflwsf] efF8f]df @=! ld=nL= l8l:6n jf6/ xfNg'xf];\ %)) ld=u|f= Ö @=% ld=ln= @)) ld=u|f=÷k|lt ld=ln df

@ dlxgfb]lv $ dlxgf -$–^_ s]=lh !=) ld=ln= Ö @)) ld=u|f=

$ dlxgfb]lv ( dlxgf -^–*_ s]=lh !=% ld=ln= Ö #)) ld=u|f=

( dlxgfb]lv !@ dlxgf -*–!)_ s]=lh @=) ld=ln= Ö $)) ld=u|f=

!@ dlxgfb]lv # jif{ -!)–!$_ s]=lh @=% ld=ln= Ö %)) ld=u|f=

# jif{b]lv % jif{ -!$–!(_ s]=lh #=% ld=ln= Ö &)) ld=u|f=

42

PlDkl;lng ;fdfGotM w"nf]sf] ¿kdf %)) ld=u|f= efon l;;Ldf cfpF5 . %)) ld=u|f= PlDkl;lng efondf @=! ld=ln= lgd{nLs[t kfgL yKg'xf];\ . o;/L cf}iflw agfpFbf ! ld=ln= df @)) ld= u|f PlDkl;lng aGb5 . 6]a'nsf] Tof] efuaf6 cf}iflwsf] dfqf r'Gg'xf];\, h'g aRrfsf] tf}n -pd]/ cg';f/ olb tf}n yfxf 5}g eg]_ ;+u ldNbf] 5 .

^=@ s8f hl6n cf}nf]sf] nflu pkrf/ ug'{xf];\ w]/} s8f Hj/f]hGo /f]u ePsf] aRrfnfO{ s8f hl6n cf}nf]] x'g;S5 . cf}nf]]sf sL6f0f'x¿nfO{ l56f] eGbf l56f] dfg{sf nflu k|]if0f ug'{ eGbf cl3 Rectal Artesunate lbg'xf];\ . olb Rectal Artesunate 5}g eg] lSjgfOg ;'O{ bf];|f] k+lQmsf] cf}nf]sf] dxTjk"0f{ cf}iflw xf], lsgeg] ljZjsf w]/} h;f] 7fpFx¿df of] k|efjsf/L 5, tyf o;n] t'¿Gt} sfd ub{5 . df;'df Snf]/f]lSjgsf] ;'O{ eGbf lSjgfOgsf] ;'O{ ;'/lIft klg a9L x'G5 . crfgs /Qmrfk 36\g', l/ª6f nfUg', sfg s/fpg' tyf sL6f0f'/lxt kLnf] aGg' cflb lSjgfOg ;'O{sf] ;Defljt k|lts"n c;/x¿ x'g\ . aRrfsf] /Qmrfk crfgs 36]5 eg] !%–@) ldg]6df To;sf] c;/ /f]lsG5 . Pp6f w]/} s8f /f]usf] pkrf/ ubf{, l/ª6f nfUg', sfg s/fpg', kLnf] cfpg' cflb x'g' ;fwf/0f s'/f x'g\ . dfqf lgwf{/0f ug{sf] nflu lgDglnlvt 6]a'nnfO{ k|of]udf Nofpg'xf];\ . s8f cf}nf]sf] nflu lSjgfOgsf] ;'O{ lbg'xf];\ (High Risk)

xfd|f] /fli6«o lgtL cg';f/ of] ;'ljwf ;a} pRr If]qdf kg]{ lhNnf c:ktfn / ;f] eGbf dflysf c:ktfnx?df lrlsT;ssf] lgu/fgLdf dfq pknAw x'g]5 . w]/} s8f Hj/f]hGo /f]u ePsf] k|]if0f ul/Psf] aRrfsf] nflu M Ps dfqf Rectual Artisunate lbP/, /utsf] :nfO8 ;lxt k|]if0f ug]{ . k|]if0f ug{ ;Dej geP M lSjgfOgsf] klxnf] dfqf IM ;'O{ lbg'xf];\ . aRrfnfO{ Ps 306f;Dd ;'tfP/ /fVg'xf];\ .

klxnf] dfqf lbPsf] $ / * 306fsf] ;dodf km]l/ ;f]xL dfqf lSjgfOg ;'O{ lbg] . clg ha;Dd aRrf cf}iflw vfg ;Ifd x'Fb}g ta;Dd k|To]s !@ 306fdf ;'O{ lbg'xf];\ . lSjgfOgsf] ;'O{ ! xKtfeGbf a9L lbg' x'Fb}g .

df}lvs lSjgfOgsf] dfqf M -@) ld=u|f=÷s]=lh=÷lbg, lbgdf # k6s & lbg;Dd_

lSjgfOgsf] ;'O{ IM lbg'xf];\

pd]/ / tf}n !%) ld=u|f=÷k|lt ld=ln= -@ ld=ln= sf] PDk'ndf_

#)) ld=u|f=÷ld=ln= -@ ld=ln= sf] PDk'ndf_

@ dlxgfb]lv $ dlxgf;Dd -$–<^_ s]=lh )=$ ld=ln )=@ ld=ln=

$ dlxgfb]lv !@ dlxgf;Dd -^–<!)_ s]=lh )=^ ld=ln= )=# ld=ln=

!@ dlxgfb]lv @ jif{ -!)–<!@_ s]=lh )=* ld=ln= )=$ ld=ln=

@ jif{ b]lv # jif{ -!@–<!$_ s]=lh !=) ld=ln= )=% ld=ln=

# jif{ b]lv % jif{ -!$–!(_ s]=lh !=@ ld=ln= )=^ ld=ln=

6]a'ndf b'O{ Ifdtfsf] lSjgfOg lbOPsf 5g\ . aRrfnfO{ ;lsG5 eg] tf}n cg';f/ dfqf lgwf{/0f ug'{xf];\ .

olb tkfO{ sfo{/t ;+:yfdf SjLgfOg ;'O{ jf Rectual Artesunate klg 5}g eg] SjLgfOg ;Nkm]6 rSsL !) ld= u|f=÷s]= hL=÷lbgdf # k6ssf] b/n] lbO{ k|]if0f ug]{ .

43

PlDkl;lng ;'O{ lbg] k|s[ofx¿ olb tkfO{ df;'df ;'O{ lbgdf bIf x'g' x'G5 eg], lSjgfOg cyjf PlDkl;lng ;'O{ lb+bf oL r/0fx¿sf] kfngf ug'{xf];\ . olb x'g' x'Gg eg] c¿ s'g} bIf JolQmnfO{ ;'O{ lbgsf] nflu eGg'xf];\ -kl5 s;}n] tkfO{nfO{ ;'O{ s;/L lbg] eGg]af/] l;sfpg ;Sg' x'G5 ._ != ;xL dfqf lgwf{/0f ug{sf] nflu afn–pkrf/ eGg] tflnsfsf] k|of]u ug'{xf];\ . tkfO{sf] :jf:Yo

rf}sLdf pknAw cf}iflw s'g Ifdtfsf] cf}iflw 5 hfFRg'xf];\ . tkfO{n] k|of]u ub}{ u/]sf] tflnsfdf tkfO{n] ;xL t/Lsfn] k9\g' ePsf] 5 egL kSsf x'g'xf];\ .

@= PlDkl;lng M PlDkl;lngdf lgd{nLs[t kfgL ldnfP/ emf]n agfpg'xf];\ . PlDkl;lng ;fwf/0ftof

%)) ld=u|f=sf] /a/sf] lasf]{ ePsf] efondf w"nf]sf] ¿kdf x'G5 . @=! ld=ln= lgd{nLs[t kfgL PlDkl;lngsf] efondf /fVg'xf];\ . ld>0f ;kmf gb]lvP;Dd efonnfO{ xNnfpg'xf];\ .

lSjgfOg M ld>0f agfpg' kb}{g . #= ;'O{ lbgnfO{ lgd{nLs[t ;'O{ -l;of]_ tyf l;l/Gh k|of]u ug'{xf];\ . PlDkl;lng ;'O{ M tnsf] lrq PlDkl;lng ;'O{sf] nflu k|of]u x'g] l;l/Ghsf] gd"gf xf] . ;xL t/Lsfn]

dfqf gfKg'xf];\ .

lSjgfOgsf] ;'O{ M 6\o'a/s'lng l;l/Gh h:tf] yf]/} dfqf klg lng ldNg] l;l/Ghsf] k|of]u ug'{xf];\ .

;xL t/Lsfn] dfqf gfKg'xf];\ .

$= lSjgfOgsf] ;'O{ lbg' cl3 aRrfnfO{ ;'tfpg'xf];\ . lSjgfOgn] crfgs /QmrfknfO{ 36fpg ;S5 . %= aRrfsf] rfsdf xf]Og lt3|fsf] cufl8kl§ df;'leq ;'O{ lbg'xf];\ . lSjgfOgnfO{ l56f] ultdf g;fdf glbg'xf];\ . of] Psbd} vt/gfs x'G5 . s]xL c:ktfnx¿df,

lSjgfOgnfO{ ljz]if lsl;dn] lgu/fgL u/L $ b]lv * 306fleq la:tf/} OG6«fleg; OGˆo'hgn] lbg ;lsG5 . :jf:Yo rf}sLx¿ tyf w]/} c:ktfnx¿df OG6«fleg; OGˆo'hgeGbf OG6«fd:s'n/ lSjgfOg a9L plrt tyf ;'/lIft x'G5 .

^= aRrfnfO{ t'?Gt} k|]if0f ug'{xf];\ . lSjgfOgsf] ;'O{ lbg'kg]{ ePdf ! 306f;Dd aRrfnfO{ ;'tfP/

/fVg'xf];\ . To;kl5 aRrfnfO{ af]s]/ c:ktfn n}hfg' k5{ .

44

^=# /utdf rLgLsf] dfqf sd x'gaf6 hf]ufpg pkrf/ ug'{xf];\ w]/} s8f Hj/f]hGo /f]u jf s8f hl6n cf}nf] ePsf] aRrfdf /utdf rLgLsf] dfqf sd x'gaf6 hf]ufpgsf] nflu ul/g] Pp6f h¿/L k|]if0f cufl8sf] pkrf/ xf] . s8f hl6n cf}nf]] cyjf d]lgghfOl6; h:tf uDeL/ ;ª\qmd0fx¿df /utdf rLgLsf] dfqfdf sdL x'g] u5{ . of] w]/} lbgb]lv vfg g;s]sf] aRrfdf klg b]lvG5 . of] vt/gfs x'G5 lsg ls o;n] dl:tisnfO{ xflg ug{ ;S5 . cfdfsf] b"w, c¿ b"w cyjf rLgL kfgL lbPdf o;n] /utdf rLgLsf] dfqf sd x'gaf6 hf]ufpg / pkrf/sf] ;fy} /f]syfdsf] nflu s]xL Un'sf]h /utdf pknAw u/fpFb5 . aRrfnfO{ c:ktfn k|]if0f ug'{ cl3 of] pkrf/ Ps k6s lbOG5 .

/utdf rLgLsf] dfq sd x'gaf6 hf]ufpg pkrf/ ug'{xf];\

olb aRrf cfdfsf] :tgkfg ug{ ;S5 eg] M aRrfnfO{ :tgkfg u/fpg eGg'xf];\ .

olb aRrf :tgkfg ug{ ;Qm}g, t/ lgNg;Dd ;S5 eg] M – cfdfsf] b"w lgrf]/]/ lbg] jf cGo b"w vfg lbg'xf];\ . – o:tf] s'g} klg lrh kfOFb}g eg] rLgL–kfgL vfg lbg'xf];\ . – pkrf/ s]Gb|af6 hfg cl3 #)–%) ld=ln= b"w jf rLgL–kfgL vfg lbg'xf];\ .

rLgL kfgL agfpg M @)) ld=ln= ;kmf kfgLdf $ lrof rDrf -@) u|fd_ rLgL 3f]Ng'xf];\ .

olb aRrfn] lgNg klg ;Sb}g eg] M

olb tkfO{ tflndk|fKt x'g'x'G5 eg] %) ld=ln= b"w jf rLgL kfgL g]hf]Uofl:6«s 6\o'aåf/f lbg'xf];\ -lzz'sf] nflu $–% ld=ln=÷s]=lh=_

olb aRrfn] lgNg ;Sb}g tyf tkfO{ Gofhf]Uofl:6«s 6\o'a4 k|of]u ug{ ;Sg' x'G5 eg], %) ld=ln= b"w -lgrf]/LPsf] cfdfsf] b"w cyjf b"wsf] ljsNk_ jf rLgL kfgL Gofhf]Uofl:6«s 6\o'aåf/f lbg'xf];\ .

4 olb tkfO{ Gofhf]Uofl:6«s 6\o'a k|of]u ug{ tflnd k|fKt x'g'x'G5 eg], kl/lzi6 s–r/0f ! b]lv * s;/L Gofhf]Uofl:6«s 6\o'a /fVg] eGg]af/] k'glj{rf/ ug'{xf];\ .

45

cEof; ‘ª’

o; cEof;df, tkfO{x¿n] ;xL dfqfsf] lgwf{/0f tyf cf}iflwx¿sf] ljleGg dfqfx¿ gfKg] cEof; ug'{x'g]5 . efu ! M ;xL dfqfx¿sf] lgwf{/0f ug]{ cEof; ug'{xf];\ . != lgDgadf]lhd tf}n ePsf aRrfx¿nfO{ tkfO{ s'g lsl;dsf] dfqf lbg' x'G5 < PlDkl;lngsf] lSjgfOg aRrfsf] cfjZostf eP cfjZostf eP tf}n -@)) ld=u|f=÷ld=ln=_ -!%) dL=u|f=÷ld=ln=_ % lsnf] _______________ _______________ & lsnf] _______________ _______________ !# lsnf] _______________ _______________ !* lsnf] _______________ _______________ @= lSjgfOgsf] ;'O{sf ;Defljt k|lts"n c;/x¿ s] x'g\ < #= @ lbgb]lv Hj/f] cfO/x]sf] tyf lxhf]b]lv ;'lt/x]sf] x'gfn] pHHjn eGg] Pp6f !@ dlxgf -!) lsnf]_

sf] jRrfnfO{ cfh laxfg :jf:Yo rf}sLdf NofOPsf] lyof] . Ps hgf :jf:Yo sfo{stf{n] pHHjnsf] d"Nof+sg ubf{ p;nfO{ a]xf]; ePsf] kfP .

pHHjnnfO{ w]/} s8f Hj/f]hGo /f]u ePsf] t/ /QmcNktf gePsf] / w]/} sd tf}n gePsf] egL juL{s/0f u/] .

:jf:Yo sfo{stf{n] pHjnnfO{ df;'df PlG6afof]l6ssf] / lSjgfOgsf] ;'O{ lbP . pgn] p;sf]

/utdf rLgLsf] dfqf sd x'gaf6 hf]ufpg Gofhf]Uofl:6«s 6\o'aåf/f rLgL kfgL klg lbP . To;kl5 :jf:Yo sfo{stf{n] pHjnnfO{ ghLs}sf] c:ktfndf k|]if0f u/] .

46

pHjnn] kfpg] k|To]s pkrf/sf] dfqfsf] j0f{g Ps Ps u/]/ u/] . PlDkl;lng _____________________________________________________ lSjgfOg _________________________________________________________ Gofhf]Uofl:6«s 6\o'aåf/f rLgL kfgL _______________________________________

efu ! ;dfKt u/]kl5 cfˆgf pQ/x¿ tkfO{sf] ;d"xsf cGo ;b:ox¿l;t 5nkmn ug'{xf];\ .

efu @ M vfg] tyf ;'O{af6 lbOg] cf}iflwsf dfqfx¿ tof/ kfg]{ cEof; ug'{xf];\ . != tkfO{x¿sf k|lzIf0f ;xof]uLn] cnu cnu cf}iflwx¿sf] Pp6f ls:tL tof/ kf/]sf 5g\ .

Wofg lbg'xf];\ ls s'g rSsLx¿ Ps} lsl;dsf b]lvG5g\ tyf PseGbf a9L cf}iflw lb+bf cGof]ndf kfg{ ;S5g\ . k|lzIf0f ;xof]uLl;t tL cf}iflwx¿sf] af/]df 5nkmn ug'{xf];\ .

@= SofK;"n lgNg g;Sg] * dlxgf pd]/sf] Pp6f aRrfnfO{ le6fldg …PÚ SofK;"n tkfO{n] s;/L

lbg' x'G5 cfˆgf] k|lzIf0f ;xof]uL cyjf csf]{ ;xefuLnfO{ b]vfpg'xf];\ . Pp6f SofK;"n aRrfnfO{ v'jfpgsf] nflu k|of]u ug{ ;lsg]5 .

#= csf]{ kfgfdf n]lvPsf cf}iflwx¿sf] dfqf tof/ ug'{xf];\ . ;'O{af6 lbOg] cf}iflwx¿sf] dfqf

tof/ ug'{xf];\ . ;'O{af6 lbOg] cf}iflwx¿sf] nflu w"nf]nfO{ lgd{nLs[t kfgLdf ldnfpg'xf];\ tyf ;xL l;l/Ghdf ;xL kl/df0f tfGg'xf];\ .

k|To]s dfqfnfO{ kfgfdf lbOPsf] 7fpFdf /fVg'xf];\ . k|To]s dfqfnfO{ hfFRgsf] nflu k|lzIf0f ;xof]uLnfO{ eGg'xf];\ .

47

tnsf sf]7fx¿df jf:tljs dfqf /fVg'xf];\

s= ^ lsnf] jhg ePsf] aRrfsf] nflu sf]l6«df]S;fhf]n

v= ( lsnf] jhgsf] efOe]S;

ePsf] aRrfsf] nflu Snf]/f]lSjg

u= !@ lsnf] jhgsf] aRrfsf]

nflu cfO/g rSsL

3= ^ lsnf] jhgsf] aRrfsf]

nflu PlDkl;lng OGh]S;g

ª= # jif{sf] aRrfsf] nflu

cNa]08fhf]n

r= !$ lsnf] jhgsf] aRrfsf]

nflu Kof/fl;6fdf]n

5= !) lsnf] jhgsf] aRrfsf]

nflu Pdf]lS;l;lng emf]n

h= !) lsnf] tf}n ePsf] !$ dlxgf aRrfsf] dfOqmf]:sf]kLs÷cf/=l8=6L= hfFr ubf{ kmfN;Lk]/d kf]h]l6e ePsf]nfO{ cf}ifwLsf] dfqf

48

&=) kvfnf nfu]sfnfO{ yk emf]ns'/fx?, lh° rSsL lbg'xf];\ / vfgf v'jfO/xg'xf];\

(Give extra fluid and Zinc tablet for diarrhoea and continue feeding)

kvfnf nfu]sf] aRrfsf] d"Nofª\sg, hnljof]hgsf] cj:yfsf] juL{s/0f ug{ tyf lgDglnlvt pkrf/ k|0ffnLdWo]af6 s'g} Pp6f /f]Hg tkfO{n] l;Sg' ePsf] 5 . pkrf/ k|0ffnL …sÚ – 3/}df ul/g] kvfnfsf] pkrf/ . pkrf/ k|0ffnL …vÚ – s]xL hnljof]hgsf] pkrf/ k'gh{nLo emf]naf6 ug'{xf];\ . pkrf/ k|0ffnL …uÚ – s8f hnljof]hgsf] rfF8} pkrf/ ug'{xf];\ . oL tLg} j6f pkrf/ k|0ffnLx¿n] kvfnfdf v]/ hfg] g"g / kfgLsf] nflu Ifltk"lt{ ug{ emf]ns'/fx? pknAw u/fpF5g\ . aRrfdf k'gh{nLo pkrf/ tyf hnljof]hgsf] /f]syfd b'a}sf] nflu k'gh{nLo emf]n agfP/ kvfnf nfu]sf] aRrfnfO{ vfg lbg' g} pQd pkfo xf] . kvfnfsf] PlG6afof]l6såf/f ug'{ kg]{ pkrf/, x}hf km}lnPsf] If]qdf kvfnf;lxt s8f hnljof]hg tyf cfpF /ut5 dfq} x'g\ . x}hf tyf cfpF /utsf] nflu rflxg] PlG6afof]l6sx¿af/] v08 !=! / ^=% df 5nkmn ul/Psf] 5 . ca tkfO{x¿n] pkrf/ k|0ffnL …sÚ, …vÚ / …uÚ nfO{ s;/L ug]{ eGg] af/] l;Sg' x'g]5 .

&=! pkrf/ k|0ffnL s M 3/}df ul/g] kvfnfsf] pkrf/ o; v08n], kvfnf nfu]sf] t/ hnljof]hg gePsf] aRrfsf] pkrf/ k|0ffnL …sÚ sf] j0f{g ub{5 . 3/]n' pkrf/sf # j6f lgodx¿ 5g\ M != yk emf]ns'/fx? lbg'xf];\ -aRrfn] vfg vf]h];Dd lbg'xf];\_ @= lhÍ rSsLåf/f pkrf/ ug'{xf];\ . #= vfgf v'jfpg hf/L /fVg'xf];\ . $= pkrf/ s]Gb|df slxn] kmls{g] .

5 w]/}h;f] kvfnfx¿df PlG6afof]l6sx¿ k|efjsf/L x'Fb}gg\ . ltgLx¿n] la/n} d2t u5{g\ / logn] s]xL aRrfx¿nfO{ t a9L

la/fdL kf5{g\ . PlG6afof]l6sx¿sf] cgfjZos k|of]un] s]xL sL6f0f'x¿sf] k|lt/f]wfTds zlQmnfO{ a9fpg ;S5 . o; afx]s PlG6afof]l6sx¿ dxFuf x'G5g\ . k|foM cgfjZos pkrf/df k};f vr{ ul/G5 . To;sf/0f hyfefjL PlG6afof]l6s glbg'xf];\ . s]jn x}hf k|efljt If]qdf kvfnf;lxt s8f hnljof]hg 5 eg] / cfpF /utdf dfq PlG6afof]l6sx¿ lbg'xf];\ .

aRrf tyf lzz'x¿nfO{ slxNo} klg kvfnf /f]Sg] tyf afGtf /f]Sg] cf}iflwx¿ glbg'xf];\ . ltgn] kvfnfsf] pkrf/df la/n} d2t u5{g\ tyf s]xL t xflgsf/s x'G5g\ . sf]l8g, cf]lkod l6Gr/, 8fOkm]glS;n]6, nf]k]/fdfO8 h:tf cfGb|fsf] ult/f]ws cf}iflwx¿ cyjf afGtfsf] pkrf/df lbOg] cf}iflwx¿Ù h:t}M Snf]/k|f]dflhg cflb a9L g} xflgsf/s x'g ;S5g\ . s]xLn] cfGb|fsf] Kof/fnfOl;; u/fpg ;S5g\ cyjf ltgn] aRrfnfO{ c:jfefljs ¿kdf ;'tfpg ;S5g\ . ljz]if u/L lzz'df k|of]u ul/of] eg] s'g} s'g} t 3fts klg x'g ;S5g\ . kvfnfsf c¿ cf}iflw vt/gfs geP klg k|efjsf/L eg] x'Fb}gg\ . P8ha]{G6\;, -s]cf]lng, P6\6fk'lNu6, :d]lS6fO6 tyf PlS6e]6]8

49

pkrf/ k|0ffnL …sÚ Pp6f dxTjk"0f{ pkrf/ k|0ffnL xf] . :jf:Yo sfo{stf{sxfF cfpg] kvfnfsf] hnljof]hg gePsf aRrfx¿ pkrf/ k|0ffnL …sÚ df /flvg]5 . hnljof]hg ePsf aRrfx¿nfO{ k|0ffnL …vÚ cyjf k|0ffnL …uÚ sf] k'gh{nLo pkrf/sf] cfjZostf kb{5 . cGttf]uTjf, kvfnf nfu]sf ;a} aRrfx¿nfO{ pkrf/ k|0ffnL …sÚ df k'gh{nLo pkrf/ u/L NofOg]5 .

k|0ffnL …sÚ n] aRrfsf] cfdfnfO{ 3/]n' pkrf/sf $ j6f lgodx¿af/] hfgsf/L ;+nUg u/fpFb5 . To;sf/0f, tkfO{sf] lzIff tyf ;Nnfx lbg] ;Lkx¿ k|0ffnL …sÚ sf nflu w]/} dxTjk"0f{ 5g\ . ca k|0ffnL …sÚ sf] cWoog ug'{xf];\ .

pkrf/ k|0ffnL ‘s’M 3/}df kvfnfsf] pkrf/ ug'{xf];\ 3/}df ug]{ kvfnfsf] pkrf/ af/] $ j6f lgodx¿sf] hfgsf/L cfdfnfO{ lbg'xf];\ M yk emf]ns'/f lbg], vfgf v'jfO/xg], lh° rSsL / pkrf/ s]Gb|df slxn] kmls{g] eGg] af/]df k/fdz{ lbg'xf];\ . != yk emf]ns'/f lbg'xf];\ -aRrfn] vfg vf]h];Dd lbg'xf];\_

cfdfnfO{ ;Demfpg'xf];\ M — w]/}kN6 / x/]skN6 nfdf] ;do;Dd :tgkfg u/fpg'xf];\ . — olb aRrfnfO{ :tgkfg dfq u/fOPsf] 5 eg] :tgkfgsf] cltl/Qm k'gh{nLo emf]n jf ;kmf

kfgL lkpg klg lbg'xf];\ . — olb aRrfnfO{ :tgkfg dfq u/fOPsf] 5}g eg] lgDgdWo]jf6 Ps jf j9L emf]n lbg'xf];\M

k'gh{nLo emf]n, eftsf] df8, bfnsf] emf]n, u]8fu'8Lsf] emf]n, bxL jf ;kmf kfgL .

tnsf cj:yfx¿df ljz]if u/L k'gh{nLo emf]n lbg' clt h¿/L x'G5 — aRrfnfO{ k|0ffnL …vÚ jf k|0ffnL …uÚ cg';f/ o; e]6df pkrf/ ul/Pkl5 . — kvfnf a9L ePdf aRrfnfO{ pkrf/ s]Gb|df Nofpg g;lsg] .

k'gh{nLo emf]n s;/L agfpg] / v'jfpg]af/] cfdfnfO{ l;sfpg'xf];\ / @ k'l/of k'gh{nLo emf]n 3/df

k|of]u ug{sf] nflu lbg'xf];\ . ;bfsf] hlt emf]ns'/fsf] cltl/Qm yk emf]ns'/f jf k'gh{nLo emf]n slt v'jfpg' k5{ ;f] af/]

cfdfnfO{ b]vfpg'xf];\ .

k|To]skN6 kftnf] lb;f u/]kl5 @ jif{ ;DdsfnfO{ %) b]lv !)) ld=ln= / @ jf @ jif{eGbf 7"nf]nfO{ !)) b]lv @)) ld=ln= k'gh{nLo emf]n

cfdfnfO{ atfpg'xf];\ M

– skaf6 af/Daf/ cln cln lkpg lbg] . – afGtf u/]df !) ldg]6 kv{g] / km]l/ lj:tf/} lkpg lbg] . – kvfnf gyfldP;Dd cltl/Qm emf]ns'/f lbg hf/L g} /fVg] .

@= lh° rSsL lbg'xf];\M s'g dfqfdf lhÍ rSsL lbg] eGg]af/] cfdfnfO{ atfpg'xf];\ M – @ b]lv ^ dlxgf;Ddsf aRrfx?nfO{ – cfwf rSsL lhÍ !) ld=u|f= k|To]s lbg !) lbg;Dd – ^ dlxgfb]lv % jif{ ;Ddsf aRrfx?nfO{ – Ps rSsL lhÍ @) ld=u|f= k|To]s lbg !) lbg;Dd lhÍ rSsL v'jfpg]af/] cfdfnfO{ l;sfpg'xf];\ .

– ! jif{ d'lgsf lzz' – Pp6f ;kmf rDrfdf lhÍ rSsL /fVg'xf];\, To;df s]xL yf]kf ;kmf kfgL cyjf cfdfsf] b"w cyjf k'gh{nLo emf]n /fv]/ s]xLa]/ 3f]lng lbg'xf];\, 3f]lnPsf] rSsL k"/} aRrfnfO{ v'jfpg'xf];\ .

– ! jif{ b]lv % jif{;Ddsf aRrfx? – dfly pNn]v u/]sf] tl/sf g} ckgfpg l;sfpg'xf];\ cyjf aRrfn] rkfP/ vfg ;S5 eg] rkfP/ v'jfpg l;sfpg'xf];\ .

#= vfgf v'jfpg hf/L /fVg] .

$ slxn] t'?Gt pkrf/ s]Gb|df kmls{g] eGg]af/] ;Nnfx lbg] .=

50

&=@ emf8fkvfnf /f]usf] Aoa:yfkg

d"Nof+sg, juL{s/0f / pkrf/ ljlw jf/] kl/lzi7x?df x]g'{xf];\ . gof“ k'gh{nLo emf]n s] xf] / lsg< -kl/lzi7x?df x]g'{xf];\_

&=# emf8fkvfnfdf lh° rSsLsf] k|of]uM &=#=! lh° s] xf] / o;sf >f]tx? s] s] x'g\ <

lhÍ xfd|f] z/L/nfO{ geO gx'g] Ps ;'Id kf]ifs tTj xf] / of] xfd|f] z/L/sf] k|To]s sf]ifx?df kfOG5 . xfd|f] z/L/sf] !)) eGbf a9L laz]if O{GhfOdx?df klg of] tTj /x]sf] x'G5 . lhÍ ag:klt / kz'hGo b'a} ;|f]tx?af6 k|fKt ug{ ;lsG5 . ag:ktL ;|f]t dWo] lhÍ laz]if ul/ u]8fu'8Lx?df a9L kfOG5 / o; afx]s cGg, bfn, km;L{sf] lapm, abfd cflbdf kfOG5 . kz'hGo ;|f]tdf /ftf] df;'df lhÍ tTj w]/} x'G5 . o; afx]s df5faf6 klg s]xL dfqfdf lhÍ tTj k|fKt ug{ ;lsG5 .

lh°sf] b}lgs zf/Ll/s cfjZostf k|ltlbg $ b]lv @% ld=u|f= xf] .

z/L/df w]/} dfqfdf -bL3{sflng_ lhÍsf] sld ePdf zf/Ll/s a[l4df sld cfpg], emf8f kvfnf nfUg], vfgfdf ?lr sd x'g] jf :jfb yfxf gkfpg], cfFvfdf jf 5fnfdf 3fpx? cfpg] jf 3fp l56f] lgsf] gx'g] h:tf ;d:ofx? b]vf kb{5g\ . lhÍn] zf/Ll/s a[l4df, k|hgg c+ux?sf] lasfzdf, sf]if laefhgdf / /f]u k|lt/f]wfTds Ifdtf j9fpgdf / emf8f kvfnf h:tf ;+s|fds /f]ux? x'g glbgdf k|efjsf/L e"ldsf v]Ng] tYo kQf nfu]sf] 5 .

oxL tYox?nfO{ dWogh/ u/]/ xfn lhÍ rSsLsf] pTkfbg ePsf] 5 . lhÍ rSsL Ps lsl;dsf] 3'ngzLn rSsL xf] h'g :jfb /lxt x'G5 . emf8f kvfnf x'Fbf lb;faf6 w]/} dfqfdf -!%Ü—@)Ü_ lhÍ tTj v]/ hfg] x'Fbf tTsfn o;sf] k"lt{ ePg eg] z/L/df gsf/fTds c;/x? kb{5g\ . emf8f kvfnf x'Fbf lhÍ rSsLsf] k|of]un] o;sf] s8fkg, k6s / cjlwnfO{ sd u/fpg'sf] ;fy} k]6 / cfGb|fsf] sf]ifx¿nfO{ tGb'¿:t kf/L kfgLnfO{ a9L dfqfdf zf]if]/ lb;fsf] dfqf sd u/fpg'df klg dxTjk"0f{ e"ldsf v]Nb5 . ;fy} vfgfdf ¿lr hufpgdf klg dxTjk"0f{ e"ldsf v]Ng] s'/f ljleGg cWoogx¿af6 k|dfl0ft ePsf] 5 .

&=#=@ lh° rSsL s;nfO{ v'jfpg] <

cfFp /ut / emf8fkvfnf nfu]sf -hnljof]hg ePsf jf gePsf ;j}_ @ dxLgf b]lv % jif{ ;Ddsf jRrfx?nfO{ lhÍ rSsL v'jfpg ;lsG5 .

&=#=# lh° rSsL v'jfpg] t/LsfM

lhÍ rSsL cGo ;fwf/0f rSsLx¿ eGbf clnslt km/s x'G5 . lsg eg] of] kfgLdf 3'ngzLn x'G5 . lhÍ rSsL v'jfpgsf] nflu tn pNn]v eP adf]lhd ug'{xf];\ / cfdfnfO{ l;sfpg'xf];\ .

51

Pp6f rSsLnfO{ ;kmf rDrfdf /fVg'xf];\ To;df s]xL yf]kf ;kmf kfgL cyjf cfdfsf] b"w cyjf

k'gh{nLo emf]n /fVg'xf];\. s]xLa]/ 3'Ng lbg'xf];\ -$% ;]s]08 hlt_ k'/} 3'ln;s]sf] lhÍ cf}iflw emf8fkvfnf ePsf la/fdL

aRrfx¿nfO{ v'jfpg'xf];\ . kfgL, cfdfsf] b"w / k'gh{nLo emf]n afx]s of] rSsLdf cGo s'g} lsl;dsf] emf]n kbfy{ ld;fpg eg] l;kmfl/; ul/Psf] 5}g . t/ olb aRrfn] rkfpg ;S5 eg] rkfpg nufpg ;lsG5 . aRrfn] ;xL dfqf kfPsf] s'/fdf ;'lgZlrt x'g 3f]lnPsf] rSsL k'/} v'jfpg'xf];\ .

&=#=$ lh° rSsL v'jfpg] dfqf

WHO / UNICEF n] l;kmfl/; u/]sf] k|:tflat dfqf . x/]s k6s kvfnf nfUbf jRrfnfO{ lhÍ rSsL lgDg dfqfdf v'jfpg'xf];\ M

pd]/ Dffqf cjlw

@ dxLgfb]lv ^ dxLgf;Dd !) ld=uf|= rSsL !) lbg

^ dxLgfb]lv % jif{;Dd @) ld=uf|= rSsL !) lbg

gf]6 M olb rSsL vfPsf] ! 306f kl5 afGtf ePdf bf]xf]¥ofP/ v'jfpg' kb}{g t/ cfwf 306f leq jfGtf

u/]df bf]x/fP/ v'jfpg' k5{ . klxnf] dfqf cfdfnfO{ cfkm\gf] cuf8L v'jfpg nufpg'xf];\ / 3/}df s;/L v'jfpg] eGg] s'/f cfdfn] /fd|/L hflgg\ eGg] s'/f lglZrt ug'{xf];\ .

&=#=% lh° rSsLsf] k|of]uaf6 x'g] kmfObfx?

lhÍ rSsL x/]s lsl;dsf] emf8fkvfnfsf] pkrf/df plQs} k|efjsf/L ;flat e};s]sf] 5 . lhÍ rSsLsf] ;]jgaf6 x'g] k|d'v kmfObfx? /f]u k|lt/f]wfTds zlQm a[l4 ug{', lb;fsf] dfqf sd u/fO /f]u l56f] lgsf] kfg'{ / eljZodf k6s k6s emf8fkvfnf nfUgaf6 arfpg' xf] . o;sf] ;fy} vfgfdf ¿lr hufO /f]uaf6 l56f] lgsf] x'g / kf]if0f :t/nfO{ psf:g ;d]t o;n] dxTjk"0f{ e"ldsf v]Nb5 . cWoogx¿n] kQf nufP cg';f/ lhÍ rSsLsf] ;]jgn] cgfjZos cf}ifwLx¿sf] k|of]udf klg sld cfPsf] 5 kmn:j¿k cfly{s ef/ klg 36fpgdf d2t ub{5 .

&=#=^ lh° rSsLsf] k|of]uaf6 x'g] c;/x?

lhÍ rSsLsf] k|of]uaf6 gsf/fTds zf/Ll/s c;/x? geP tfklg o;sf] ;]jg kl5 s'g} s'g} aRrfx?nfO{ jfGtf x'g ;Sb5 . ;fdfGotof z'¿sf] cj:yfdf jfgL gk/]sf] sf/0fn] lhÍ tTjsf] :jfb gdL7f] x'g] x'gfn] jfGtf x'g ;S5 t/ w'ngzLn lhÍ rSsLnfO{ :jfb/lxt agfOPsf] 5 h:n] ubf{ of] c;/ w]/} dfqfdf sd ug]{ ljZjf; lnOPsf] 5 . jfsjfsL nfUg] jf jfGtf x'g ;Sg] cz/ c¿ cf}ifwLx¿df klg x'G5 .

52

&=$ lh° rSsLsf] cfk"lt{ Aoa:yfkg

lhÍ rSsLsf] cfk"lt{sf] nflu :jf:Yo ;]jf laefu cGt{ut cfk"lt{ Aoa:yfkg dxfzfvf d'Vo ?kdf lhDd]jf/ x'g]5 . lhÍ rSsLsf] cfk"lt{ klg k'gh{nLo emf]nsf] cfk"lt{ ul/g] dfWodx?af6} x'g]5 . g]kfn ;/sf/sf ;a} lgsfox?, h;n] :jf:Yo ;]jf k|bfg ub{5, df lhÍ rSsL lat/0f x'g]5 / o;sf] ;fy} ;a} ;fd'bflos :jf:Yo sfo{stf{x? ;dIf klg o;sf] cfk"lt{ lgoldt x'g]5 . lhÍ rSsLsf] cfk"lt{nfO{ ;'lglZrt / ;'rf? /fVgdf ;a} txsf :jf:Yo sfo{stf{x?sf] plQs} dxTjk"0f{ lhDd]jf/L /xg]5 . To;sf/0f tkfO{ cg'udg ug{ hfFbf :jf:Yo sfo{stf{x?n] ;fd'bflos :jf:Yo sfo{stf{x? / dlxnf :jf:Yo :jo+ ;]ljsfx?;+u lhÍ rSsL eP gePsf] hfFr ug'{ clgjfo{ 5 / gePdf cfk'lt{ klg ug{' kb{5 .

53

cEof; ‘r’ != ;f]d' Pp6f $ jif{sf] jRrf xf] h;nfO{ kvfnf nfu]sf] 5 . p;df ;fdfGotof b]lvg] vt/fsf

lrGxx¿ 5}gg\ . p;nfO{ kvfnf ePsf], t/ hnljof]hg gePsf] / /QmcNktf gePsf] tyf w]/} sd tf}n gePsf] eGg] juL{s/0fdf /flvof] . p;nfO{ pkrf/ k|0ffnL …sÚ cg';f/ pkrf/ ul/g]5 .

-s_ kvfnfsf] af/]df 3/]n' pkrf/sf $ j6f lgodx¿ s] s] x'g\ < ––– ––– ––– -v_ :jf:Yo sfo{stf{n] cfdfnfO{ s:tf emf]ns'/fx? jf/] ;Nnfx lbg' k5{ < @= s[i0f # dlxgfsf] jRrf xf] h;nfO{ kvfnf nfu]sf] 5 . p;df ;fdfGotof b]lvg] vt/fsf lrGxx¿

5}gg\ . p;nfO{ hnljof]hg gePsf] / /QmcNktf gePsf] tyf w]/} sd tf}n gePsf] egL juL{s/0f ul/of], p;n] :tgkfg dfq u5{ . p;nfO{ yk emf]ns'/fx? lbg] af/]df :jf:Yo sfo{stf{n] cfdfnfO{ s] eGg' k5{ <

#= hnljof]hg gePsf s:tf aRrfx¿nfO{ k'gh{nLo emf]n -ljz]if u/L 3/df_ lbg' dxTjk"0f{ x'G5 < ––– ––– $= tnsf aRrfx¿ kvfnf nfu]/ :jf:Yo rf}sLdf cfPsf lyP . pgLx¿nfO{ d"Nofª\sg ubf{

;fdfGotof b]lvg] vt/fsf lrGxx¿ gePsf] kfOof] . pgLx¿nfO{ hnljof]hg gePsf], /QmcNktf tyf w]/} sd tf}n gePsf] egL juL{s/0f ul/of]] . cfdfn] k|To]s k6s lb;f ePkl5 lbg'kg]{ yk emf]ns'/fsf] kl/df0f n]Vg'xf];\ .

k|To]s kftnf] lb;fkl5 lbg'kg]{ yk

gfd pd]/ emf]ns'/fx?sf] kl/df0f / lh° rSsL sf] dfqf -s_ snf ^ dlxgf -v_ Zofd @ jif{ -u_ s/0f !% dlxgf -3_ nlntf $ jif{

54

%= $ jif{sf] Pp6f jRrfnfO{ kvfnf nfu]sf] 5 . p;df ;fdfGotof b]lvg] vt/fsf lrGxx¿ 5}gg\ .

p;nfO{ hnljof]hg / /QmcNktf gePsf] tyf w]/} sd tf}n gePsf] egL juL{s/0f ul/of] . :jf:Yo sfo{stf{n] cfdfnfO{ pkrf/ k|0ffnL …sÚ sf] af/]df l;sfpg' ePsf] 5 tyf @ k'l/of k'gh{nLo emf]n 3/df k|of]u ug{sf] nflu lbg' ePsf] 5 .

kvfnf eP;Dd lj/fdL jRrfnfO{ lkpgsf] nflu cfdfn] k|f]T;flxt ug'{ kg]{ ;a} emf]ns'/fx?df lrgf]

nufpg'xf];\ . ____ -s_ ;fwf/0ftof vfg] lrof .

____ -v_ kmnkm"nsf] /; .

____ -u_ Kof; nfu]sf] aRrfn] hlxn] klg lunf; jf huaf6 kfgL lkpg x'G5 .

____ -3_ k|To]s kftnf] lb;fkl5 k'gh{nLo emf]n lbg] .

____ -ª_ kl/jf/sf] nflu agfPsf] df]xL .

^= cfdfn] !! dlxgfsL cfˆgL 5f]/L cldtfnfO{ kvfnf nfu]sf]n] :jf:Yo rf}sLdf lnP/ cfOg\ . cldtf

;fwf/0ftof cGg tyf df;'sf 6'qmfx¿, ;AhL / kmnkm"n vflG5g\ . cfdfn] pgnfO{ :tgkfg u/fpg klg hf/L /fv]sL5g\ . cfdf :jf:Yo rf}sLb]lv w]/} 6f9f al:5g\ tyf aRrf Psbd} la/fdL eP klg pgL s]xL lbg;Dd kms]{/ cfpg ;lSbgg\ xf]nL eGg] pgsf] egfO 5 .

:jf:Yo sfo{stf{n] cldtfsf] d"Nofª\sg ug'{ x'G5 tyf pgLdf ;fwf/0f vt/fsf lrGx tyf cGo

/f]usf] juL{s/0f gePsf] kfpg' x'G5 . :jf:Yo sfo{stf{n] pgnfO{ hnljof]hg gePsf] / /QmcNktf gePsf] tyf w]/} sd tf}n gePsf] egL juL{s/0f ug'{ x'G5 . :jf:Yo sfo{stf{n] cldtfnfO{ pkrf/ k|0ffnL …sÚ cg';f/sf] pkrf/ lbg] lg0f{o u5{g\ .

-s_ s] :jf:Yo sfo{stf{n] oL cfdfnfO{ k'gh{nLo emf]nsf k'l/ofx¿ / lhÍ rSsL 3/ n}hfgsf]

nflu lbg' k5{ < olb k5{ eg] jxfFn] sltj6f k'l/of / slt rSsL lbg' knf{ < -v_ cldtfsL cfdfn] k'gh{nLo emf]n s;/L agfpg] tyf s;/L lbg] eGg] s'/f /fd|/L a'em]sL

l5g\ egL lglZrt x'gsf] nflu pgnfO{ # j6f k|Zgx¿ ;f]Wg'xf];\ . –– –– –– -u_ olb k'gh{nLo emf]n v'jfpFbf aRrfn] afGtf u¥of] eg] cfdfn] s] ug'{ k5{ < -3_ cldtfsL cfdfn] yk emf]ns'/fx? slxn];Dd lbg hf/L /fVg] <

55

-ª_ :jf:Yo sfo{stf{n] cfdfnfO{ cldtfnfO{ vfg]s'/f v'jfpg hf/L /fVg eGg' x'g]5 . jxfFn]

t'¿Gt} kmls{g' kg]{ lrGxx¿sf] ljifodf klg pgnfO{ l;sfpg' x'g]5 . :jf:Yo sfo{stf{n] s:tf lrGxx¿ cldtfsL cfdfnfO{ l;sfpg' k5{ <

&= tkfO{sf] :jf:Yo rf}sLdf, hnljof]hg gePsf kvfnf nfu]sf aRrfx¿sf nflu l;kmfl/z ul/Psf

emf]ns'/fx? s] x'g\ < pkrf/ k|0fnL …sÚ df /flvPsf ;a} aRrfx¿sf] nflu s] k'gh{nLo emf]n l;kmfl/z ul/Psf]

emf]ns'/f xf] < olb xf]Og eg], pkrf/ k|0fnL …sÚ cg';f/ s:tf aRrfx¿n] k'gh{nLo emf]n kfpg' k5{ <

of] cEof; ;s]kl5, cfˆgf pQ/x¿af/] k|lzIf0f ;xof]uLl;t 5nkmn ug'{xf];\ .

56

&=% pkrf/ k|0ffnL ‘v’M s]xL hnljof]hgsf] pkrf/ k'gh{nLo emf]naf6 ug'{xf];\ o; v08n] kvfnf nfu]/ s]xL hnljof]hg ePsf] aRrfsf] pkrf/sf] nflu pkrf/ k|0ffnL …vÚ sf] j0f{g ub{5 . pkrf/ k|0ffnL …vÚ n] :jf:Yo rf}sLdf ;'?sf $ 306fleq ul/g] pkrf/nfO{ hgfpF5 . oL $ 306fdf, cfdfn] lj:tf/} aRrfnfO{ k'gh{nLo emf]n v'jfpFl5g\ . cfdfn] rDrfsf] d2tn] v'jfpFl5g\ . tkfO{sf] :jf:Yo rf}sLdf cf]= cf/= l6= sg{/ ePdf pkof]uL x'G5 . tkfO{ cf]= cf/= l6= sg{/ ;~rfng ug{ rfxg' x'G5 eg] kl/lzi6 …vÚ x]g'{xf];\ . s8f juL{s/0fdf k/]sf] ;fy} s]xL hnljof]hg ePsf] aRrfnfO{ t'¿Gt} c:ktfn6 k|]if0f ug'{kg]{ x'G5 . c:ktfn hfg'cl3 aRrfnfO{ k'gh{nLo pkrf/ lbg] k|of; gug'{xf];\ . cfdfnfO{ t'?Gt} s]xL k'gh{nLo emf]n lbg'xf];\ . c:ktfn n}hfFbf af6f]df s;/L Tof] k'gh{nLo emf]n cln cln u/]/ aRrfnfO{ lbg] xf] pgnfO{ b]vfpg'xf];\ . olb s]xL hnljof]hg ePsf] aRrfnfO{ cGo ;d:ofx¿ 5g\ eg], tkfO{n] hnljof]hgsf] nflu pkrf/ ;'? ug'{ k5{ . To;kl5 c¿ pkrf/x¿ lbg'xf];\ . $ 306fkl5, …d"Nofª\sg tyf juL{s/0fÚ ug'{xf];\ eGg] tflnsfnfO{ k|of]u u/L aRrfnfO{ hnljof]hgsf] nflu k'gd"{Nofª\sg tyf juL{s/0f ug'{xf];\ . hnljof]hgsf lrGxx¿ u};s]sf 5g\ eg], aRrfnfO{ pkrf/ k|0ffnL …sÚ df /fVg'xf];\ . olb s]xL hnljof]hg cem} klg afFsL 5 eg], aRrfn] pkrf/ k|0ffnL …vÚ bf]xf]¥ofpg' k5{ . olb aRrfdf s8f hnljof]hg 5 eg], aRrfnfO{ pkrf/ k|0ffnL …uÚ df /flvg]5 . ca pkrf/ k|0ffnL …vÚ cWoog ug'{xf];\ .

gof“ k'gh{nLo emf]nsf] ;ld>0f

Component New Low Osmolar ORS

Sodium Chloride (g/L) 2.6

Glucose, anhydrous (g/L) 13.5

Potassium chloride (g/L) 1.5

Trisodium citrate, dehydrate (g/L) 2.9

Total weight 20.5

6 s8f juL{s/0f ePsf] aRrfdf s8f bL3{ kvfnf dfq Pp6f ckjfb xf] . o:tf aRrfnfO{ k'gh{nLo pkrf/ u/]/ k|]if0f

ug'{k5{ .

57

pkrf/ k|0ffnL ‘v’ M s]xL hnljof]hgsf] pkrf/ k'gh{nLo emf]naf6 ug'{xf];\

k|0ffnL ‘v’ M s]xL hnljof]hgsf] pkrf/ k'gh{nLo emf]naf6 ug'{xf];\

l;kmfl/z ul/Psf] k'gh{nLo emf]n pkrf/ s]Gb|df lgDg cg';f/sf] kl/df0fdf lbg'xf];\

klxnf] $ 306fleq lbOg] k'gh{nLo emf]nsf] kl/df0f lgwf{/0f ug'{xf];\ pd]/ $ dlxgf;Dd $ b]lv !@

dlxgf;Dd !@ dlxgfb]lv @ jif{;Dd

@ jif{b]lv % jif{;Dd

tf}n ^ s]=lh= eGbf sd ^–!) s]=lh= eGbf sd !)–!@ s]=lh= eGbf sd !@–!( s]lh=

ld=ln= df @))–$)) $))–&)) &))–()) ())–!$))

* aRrfsf] tf}n yfxf gkfPdf dfq pd]/ cg';f/ dfqf lgwf{/0f ug'{xf];\ . k'gh{nLo emf]nsf] kl/df0f lgsfNg k|lt s]=lh= &% ld=ln= sf] b/n] u'0fg ug'{xf];\ .

olb aRrfn] dfly tflnsfdf b]vfOP eGbf a9L vfg rfx]df a9L lbg'xf];\ . :tgkfg gug]{ ^ dlxgfeGbf sd pd]/sf lzz'nfO{ !))–@)) ld=ln= ;kmf kfgL klg o; cjlwdf

lkpg lbg'xf];\ .

k'gh{nLo emf]n s;/L lbg] egL cfdfnfO{ b]vfpg'xf];\ . skaf6 k6s k6s yf]/} lkpg lbg'xf];\ . aRrfn] afGtf u/]df !) ldg]6 kv{g'xf];\, clg la:tf/} km]l/ lkpg lbg'xf];\ . aRrfn] b"w vfg rfx]df :tgkfg klg u/fpg hf/L /fVg'xf];\ .

$ 306fkl5 M

aRrfsf] hnljof]hgsf] k'gd"{Nofª\sg / juL{s/0f ug'{xf];\ . pkrf/ hf/L /fVg pko'Qm pkrf/ k|0ffnL 5fGg'xf];\ . pkrf/ s]Gb|df g} aRrfnfO{ vfgf v'jfpg yfNg'xf];\ .

olb pkrf/ k"/f gx'“b} cfdf 3/ kms{g} k5{ eg]

3/}df k'gh{nLo emf]n s;/L agfpg] / lhÍ rSsL s;/L v'jfpg] egL b]vfpg'xf];\ . $ 306fsf] pkrf/ 3/df k"/f ug{ slt k'gh{nLo emf]n lbg'k5{ cfdfnfO{ b]vfpg'xf];\ . k'gh{nLo pkrf/ k"/f ug{ kof{Kt k'Ug] k'gh{nLo emf]nsf] k'l/of lbg'xf];\ / k|0ffnL …sÚ df

atfPcg';f/ yk @ k'l/of k'gh{nLo emf]n klg lbg'xf];\ .

3/}df pkrf/ ubf{ ckgfpg' kg]{ $ j6f lgod atfpg'xf];\ . != yk emf]ns'/fx¿ lbg'xf];\ . @== aRrfsf] pd]/ cg';f/ lhÍ rSsLåf/f pkrf/ ug'{xf];\ . #= vfgf v'jfpg hf/L /fVg'xf];\ . $= pkrf/ s]Gb|df slxn] t'?Gt kms{g] ;Nnfx lbg'xf];\ .

klxnf] $ 306fleq lbOg] k'gh{nLo emf]nsf] kl/df0f lgwf{/0f ug'{xf];\ . k'gh{nLo emf]n slt lbg] egL lgwf{/0f ug{sf] nflu pkrf/ k|0ffnL …vÚ sf] tflnsfnfO{ k|of]u ug'{xf];\ . lbOg] k'gh{nLo emf]nsf] tf]lsPsf] kl/df0f kQf nufpg aRrfsf] tf}n -cyjf tf}n yfxf 5}g eg] pd]/_ x]g'{xf];\ . pbfx/0fsf] nflu, % lsnf]sf] aRrfnfO{ klxnf] $ 306fdf ;fwf/0ftof @)) b]lv $)) ld=ln= k'gh{nLo emf]n rflxG5 .

58

;fwf/0ftof aRrfn] cfkm"nfO{ rflxP hlt lkpF5 . obL aRrfn] cg'dfg u/]sf] kl/df0f eGbf a9L cyjf sd lkpF5 eg], p;n] hlt rfxG5 Tolt lbg'xf];\ . cfjZos kg]{ k'gh{nLo emf]nsf] kl/df0f -ld=ln= df_ lgsfNg] csf]{ pkfo tn lbOPsf] 5 . aRrfsf] tf}nnfO{ -lsnf]u|fddf_ &% n] u'0ff ug'{xf];\ . pbfx/0fsf] nflu, * lsnf]sf] aRrfnfO{ klxnf] $ 306fdf slt rflxg]5M k'gh{nLo emf]n rflxG5 . * lsnf] × &% ld=ln= = $ 306fdf ^)) ld=ln= k'gh{nLo emf]n k'gh{nLo emf]n v'jfpFbf, :tgkfg ug]{ aRrfsf] ;fdfGo vfg]s'/fdf afwf kg'{ x'Fb}g . aRrfn] rfx]sf] a]nf p;nfO{ :tgkfg u/fpg' k5{, To;kl5 km]l/ k'gh{nLo emf]n lbg bf]xf]¥ofpg' k5{ . :tgkfg gug]{ ^ dlxgf eGbf sd pd]/sf] lzz'nfO{ cfdfn] klxnf] $ 306fdf k'gh{nLo emf]n afx]s !))–@)) ld=ln= ;kmf kfgL lbg' k5{ . cfdfsf] b"w tyf kfgLn] lzz'x¿df xfOk/g]l6«ldof7 x'gaf6 hf]ufpF5 . k'gh{nLo emf]n / lh° rSsL s;/L lbg] egL cfdfnfO{ b]vfpg'xf];\ aRrf ;lxt cfdfnfO{ a:gsf] nflu :jf:Yo rf}sLdf Pp6f cf/fdbfoL 7fpF vf]Hg'xf];\ . klxnf]] $ 306fdf slt k'gh{nLo emf]n lbg] xf] Tof] pgnfO{ b]vfpg'xf];\ . olb aRrf @ jif{eGbf sd pd]/sf] 5 eg], af/Daf/ rDrfn] s;/L lbg] xf] pgnfO{ b]vfpg'xf];\ . olb aRrf 7"nf] 5 eg], skaf6 k6s k6s cln cln u/]/ s;/L lbg] xf] b]vfpg'xf];\ olb aRrfn] afGtf u¥of] eg], c¿ k'gh{nLo emf]n lbg' cl3 cfdfn] s/La !) ldg]6 klv{g' k5{ . To;kl5 km]l/ lj:tf/} lj:tf/} To;nfO{ lkpg lbg'xf];\ . $ 306fsf] cjlwdf cfdfn] :jf:Yo rf}sLdf k'gh{nLo emf]n v'jfO/x]sf] a]nf, cfˆgf] aRrfsf] x]/rfx s;/L ug]{ eGg] s'/f l;sfpg' xf];\ . aRrf /fd|f] x'Fb} hfg yfn]kl5 cfdfn] s]xL s'/f l;Sgkl§ Wofg lbg ;lS5g\ .

7 aRrfdf xfOk/g]l6«ldof eP, p;sf] /utdf a9L dfqfdf Na (;f]l8od) x'G5 .

59

$ 306fkl5 M

pkrf/ k|0ffnL …vÚ af6 pkrf/ u/]sf] $ 306fkl5, d"Nofª\sg tyf juL{s/0f ug'{xf];\ eGg]

tflnsfnfO{ k|of]u u/L aRrfsf] k'g{d"Nofª\sg ug'{xf];\ . hnljof]hgsf] juL{s/0f ug'{xf];\ . pkrf/ hf/L /fVg ;xL pkrf/ k|0ffnLsf] rog ug'{xf];\ .

gf]6 M olb aRrfn] k'gh{nLo emf]n vfO/x]sf] 5}g cyjf p emg la/fdL eP h:tf] b]lvG5 eg] aRrfnfO{

$ 306f laTg' cl3 g} k'gd"{Nofª\sg ug'{xf];\ .

olb aRrfsf] cj:yf ;'lw|Psf] 5 tyf p;df hnljof]hg 5}g eg], pkrf/ k|0ffnL …sÚ /f]Hg'xf];\ . olb tkfO{n] ljut $ 306fx¿df pkrf/ k|0ffnL …sÚ l;sfpg' ePsf] 5}g eg], cfdfnfO{ l;sfpg'xf];\ . cfdfn] :jf:Yo rf}sL 5f]8\g' cl3, /fd|f hfFRg] k|Zgx¿ ;f]Wg'xf];\ . 3/df yk emf]ns'/fx? lbFbf cfdfnfO{ x'g ;Sg] s'g} klg ;d:ofx¿sf] ;dfwfg ug{df pgnfO{ ;xof]u ug'{xf];\ .

gf]6 M olb aRrfsf cfFvfx¿ ;'lGgPsf 5g\ eg], of] k'gh{nLo pkrf/ a9L ePsf] Pp6f lrGx xf] . of]

vt/fsf] cyjf xfOk/g]l6«ldofsf] lrGx x}g . aRrfsf] k'gh{nLo pkrf/ e};s]sf] 5 eg] of] Pp6f lrGx dfq xf] tyf ca aRrfnfO{ c¿ k'gh{nLo emf]n rflxFb}g . aRrfnfO{ ;kmf kfgL cyjf cfdfsf] b"w lbg' k5{ . cfFvf ;'lGgPsf] x/fPkl5, cfdfn] aRrfnfO{ pkrf/ k|0ffnL …sÚ cg';f/ k'gh{nLo emf]n / lhÍ rSsL lbg' k5{ .

olb aRrfdf cem} s]xL hnljof]hg afFsL 5 eg], pkrf/ k|0ffnL …vÚ km]l/ 5fGg'xf];\ . pkrf/

s]Gb|df aRrfnfO{ vfgf v'jfpg ;'? ug'{xf];\ . vfgf, b"w cyjf kmnkm"nsf] /; lbg'xf];\ . aRrfnfO{ vfgf v'jfPkl5 $ 306fsf] pkrf/ k|0ffnL …vÚ nfO{ bf]xf¥ofpg'xf];\ . k|To]s # jf $ 306fdf vfgf, b"w cyjf kmnk"mnsf] /; lbg'xf];\ . :tgkfg ul//x]sf aRrfx¿nfO{ af/Daf/ :tgkfg u/fpg hf/L /fVg' k5{ . pkrf/ l;l4g' cl3 :jf:Yo rf}sL -pkrf/ s]Gb|_ aGb x'g nfu]sf] 5 eg], cfdfnfO{ 3/df pkrf/ hf/L /fVg eGg'xf];\ .

olb aRrf a9L la/fdL x'Fb} uO/x]sf] 5 / p;df s8f hnljof]hg 5 eg], tkfO{n] pkrf/ k|0ffnL …uÚ -o; k'l:tsfdf k5fl8 5nkmn ul/Psf] 5_ ;'? ug'{kg]{ x'G5 .

60

olb pkrf/ k'/f gx'“b} 3/ kms{g' k¥of] eg] M slxn] sfxL+ cfdfnfO{ cfˆgf] aRrfsf], pkrf/ k|0ffnL …vÚ af6 pkrf/ x'Fbf x'Fb} cyf{t\ aRrfsf] hnljof]hg /fd|/L 7Ls x'g' cufj} :jf:Yo rf}sL 5f]8\g' kg]{ x'G5 . o:tf cj:yfx¿df tkfO{n] oL s'/fx¿ ug'{kg]{ x'G5 M * cfdfnfO{ 3/df k'gh{nLo emf]n s;/L agfpg] egL b]vfpg'xf];\ / lhÍ rSsL s;/L / slt v'jfpg]

jtfpg'xf];\ . 3/ hfg'cl3 pgnfO{ of] cEof; ug{ nufpg'xf];\ . * 3/df pkrf/ ubf{ $ 306fsf] pkrf/ ug{ slt k'gh{nLo emf]n nfU5 egL pgnfO{ b]vfpg'xf];\ . * k'gh{nLo pkrf/sf] nflu k'Ug] k'gh{nLo emf]nsf k'l/ofx¿ lbg'xf];\ / pkrf/ k|0ffnL …sÚ df

atfPcg';f/ pgnfO{ yk @ k'l/of k'gh{nLo emf]n lbg'xf];\ .

61

cEof; ‘5’

!= lgDglnlvt aRrfx¿ kvfnf nfu]/ :jf:Yo rf}sLdf cfP . pgLx¿sf] d"Nofª\sg ul/of] tyf s]xL

hnljof]hg ePsf] t/ /QmcNktf gePsf] tyf w]/} sd tf}n gePsf] e]l6of] . k|yd $ 306fsf] pkrf/df k|To]s aRrfsf] nflu cfjZos kg]{ k'gh{nLo emf]nsf] kl/df0f n]Vg'xf];\ M

gfd pd]/ jf tf}n k'gh{nLo emf]nsf] kl/df0f -s_ s'df/ # jif{ -v_ sdnf !) lsnf] u|fd -u_ sNkgf &=% lsnf] u|fd -3_ /fd !! dlxgf @= % dlxgfsL ljlgtfnfO{ kvfnf nfu]sf] 5 . pgnfO{ s]xL hnljof]hg ePsf] / /QmcNktf tyf w]/}

sd tf}n gePsf] egL juL{s/0f ul/Psf] 5 . :jf:Yo rf}sLdf ljlgtfsf] tf}n lng] d]l;g 5}g . ljlgtfsL cfdfsf] d[To' k|;"lt x'g] a]nfdf ePsf] lyof] . To;sf/0f ljlgtf a§fsf] b"w vfFb}l5g\ . xfn;fn} xh'/ cfdfn] pgnfO{ ksfPsf] cGg klg lbg yfn]sLl5g\ .

-s_ ljlgtfnfO{ pkrf/sf k|yd __________________ 306fx¿df __________________ ld=ln= _____________________ lbg'k5{ . pgnfO{ o; cjlwdf _______________ ld=ln= ______________ klg lbg'k5{ . -v_ pkrf/sf] bf}/fgdf ljlgtfn] afGtf ul/g eg] xh'/ cfdfn] s] ug'{k5{ < -u_ :jf:Yo sfo{stf{n] ljlgtfsf] k'gd"{Nofª\sg slxn] ug'{k5{ < -3_ lalgtfsf] k'gd{"Nofª\sg ubf{, pgdf hnljof]hg gePsf] kfOof] . ljlgtfnfO{ s'g pkrf/

k|0ffnLdf /fVg' k5{ < -ª_ :jf:Yo sfo{stf{n] xh'/cfdfnfO{ slt k'l/of k'gh{nLo emf]n / slt rSsL lhÍ lbg'k5{ . -r_ 3/df pkrf/ hf/L /fVg, xh'/ cfdfn] ljlgtfnfO{ k|To]s ____________________ kl5 ______________ ld=ln= ____________________________ lbg'k5{ .

62

#= ;l/tf ( dlxgfsL l5g\ / pgsf] tf}n * lsnf] 5 . kvfnf nfu]/ cfdfn] pgnfO{ :jf:Yo rf}sLdf lnP/ cfOg\ . :jf:Yo sfo{stf{n] ;l/tfnfO{ d"Nofª\sg ubf{ s]xL hnljof]hg ePsf] / /QmcNktf tyf w]/} sd tf}n gePsf] kfP . :jf:Yo sfo{stf{n] pkrf/ k|0ffnL …vÚ nfO{ /f]Hg' x'G5 . ;l/tf cem} :tgkfg ub}{l5g\ ls egL jxfF ;f]Wg' x'G5 . pgsL cfdfn] pgL x/]s lbg w]/} k6s :tfgkfg ul5{g\ eg]/ atfOg\ . x/]s lbg pgL # k6s eftl;t t/sf/L, tyf df;'sf s]xL 6'qmfx¿ klg vflG5g\ .

-s_ k|yd $ 306fdf cfdfn] ;l/tfnfO{ cGbfhL slt k'gh{nLo emf]n lbg' k5{ . -v_ pkrf/sf k|yd $ 306fx¿df, ;l/tfn] k'gh{nLo emf]nsf] cltl/Qm c¿ s'g} s'/f vfg'

cyjf lkpg' k5{ < vfg'k5{ eg], s] < -u_ $ 306fsf] pkrf/ kl5, :jf:Yo sfo{stf{n] ;l/tfnfO{ k'gd"{Nofª\sg ug'{ eof] . pgnfO{ cem}

klg s]xL hnljof]hg ePsf] egL juL{s/0f ul/G5 . pkrf/ hf/L /fVgsf] nflu s'g pko'Qm pkrf/ k|0ffnL xf] <

-3_ ;l/tfnfO{ ca lbg] pkrf/sf] j0f{g ug'{xf];\ . -;+s]tM tkfO{sf] pQ/n] k'gh{nLo emf]n afx]s

cGo s'/fx¿nfO{ ;dfj]z ug'{k5{ ._ $= aRrfsf] k"0f{ ¿kdf k'gh{nLo pkrf/ x'g'cl3 cfdf tyf aRrfn] :jf:Yo rf}sL 5f]8\g} k5{ . :jf:Yo

sfo{stf{n] cfdf hfg'cl3 s] ug'{ k5{ < tnsf] ;"rLnfO{ k"/f ug'{xf];\ M * 3/df k'gh{nLo emf]n s;/L agfpg] egL pgnfO{ b]vfpg'xf];\ . *

* * 3/df pkrf/ ubf{ ckgfpg' kg]{ $ j6f lgod atfpg'xf];\ M != @= #= $=

tkfO{n] cEof; ;s]kl5, k|lzIf0f ;xof]uLl;t cfˆgf pQ/x¿af/] 5nkmn ug'{xf];\ .

pkrf/ k|0ffnL …vÚ cg';f/ aRrfnfO{ lbg] k'gh{nLo emf]nsf] kl/df0f lgwf{/0f ug]{ cEof; ug{sf] nflu tkfO{sf k|lzIf0f ;xof]uLn] yk cEof; u/fpg'x'g]5 .

63

cEof; ‘h’

o; e"ldsf gf6sdf Ps hgf :jf:Yo sfo{stf{n] cfdfnfO{ hnljof]hg ePsf] aRrfsf] x]/rfx s;/L ug]{ eGg] af/] l;sfpg' x'g]5 . klxnf] c+zdf, aRrfnfO{ pkrf/ k|0ffnL …vÚ sf] cfjZostf k5{ . bf];|f] efudf, aRrf pkrf/ k|0ffnL …sÚ sf] nflu tof/ 5 . kl/l:ylt – clxn];Dd e};]sf]s'/f M cfdfn] @ jif{sL nLgfnfO{ !!÷@ lbgb]lv kvfnf nfu]sf] x'gfn] :jf:Yo rf}sLdf lnP/ cfOg\ . :jf:Yo sfo{stf{n] ;fdfGotof b]lvg] vt/fsf lrGxx¿ kfpg' ePg . lb;fdf /ut klg lyPg . nLgf lem+lhg] uly{g\ . pgsf cfFvfx¿ u8]sf b]lvGy] . nLgfsf] k]6sf] 5fnf cf}+nfn] tfg]/ 5f]8\bf t'¿Gt} kmls{GYof] . pgL v"a ltvf{P em} u/L lkpFlyg\ . pgdf cGo ;d:ofx¿ lyPgg\ . :jf:Yo sfo{stf{n] nLgfnfO{ s]xL hnljof]hg ePsf] egL juL{s/0f u/] . pgdf cGo /f]usf juL{s/0fx¿ lyPgg\ . pgdf /QmcNktf gePsf] / w]/} sd tf}n gePsf] kfOof] . :jf:Yo sfo{stf{n] k'gh{nLo emf]nåf/f pkrf/ ug{ pkrf/ k|0ffnL …vÚ nfO{ 5fGg' eof] . :jf:Yo sfo{stf{ M e"ldsf gf6s ;'? ubf{ nLgfnfO{ k'gh{nLo emf]nåf/f pkrf/ ug'{k5{ egL pgsL cfdfnfO{ eGg'xf];\ . nLgfnfO{ k'gh{nLo emf]n lbgsf] nflu :jf:Yo rf}sLdf a:g' k5{ egL cfdfnfO{ ;Demfpg'xf];\ . To;kl5, k'gh{nLo emf]n v'jfpg ;'? ug{sf nflu pkrf/ k|0ffnL …vÚ sf] cg';/0f ug'{xf];\ . slt k'gh{nLo emf]n lbg] xf] Tof] cfdfnfO{ b]vfpg'xf];\ . s;/L lbg] egL pgnfO{ b]vfpg'xf];\ . pgsf k|Zgx¿sf] pQ/ lbg'xf];\ clg s]xL ;d:ofx¿ eP d2t ug'{xf];\ . cfdf M :jf:Yo sfo{stf{sf] s'/f ;'Gg'xf];\ tyf jxfFn] h] eGg' x'G5 To; cg';f/ ug]{ k|of; ug'{xf];\ . k|i6 gePsf s'g} klg s'/fx¿af/] ;f]Wg'xf];\ . s]xL ldg]6;Dd k'gh{nLo emf]n lbPkl5, nLgfn] ev{/} jfGtf ul/g\ eg]/ :jf:Yo sfo{stf{nfO{ eGg'xf];\ . bz{sx¿ M pkrf/ k|0ffnL …vÚ nfO{ x]b}{ e"ldsf gf6s x]g'{xf];\ . s'g s'/fnfO{ :jf:Yo sfo{stf{n] /fd|/L JofVof u/] / s'g s'/fnfO{ cem} s;/L /fd|f] ug{ ;lsG5, Wofg lbg'xf];\ .

k|lzIf0f ;xof]uLn] e"ldsf gf6s ;'? ug'{x'g]5 tyf s]xL ldg]6kl5 pkrf/ k|0ffnL …vÚ af/] 5nkmn ug{sf] nflu o; e"ldsf gf6snfO{ aGb ug'{ x'g]5 .

64

&=^ pkrf/ k|0ffnL ‘u’ M s8f hnljof]hgsf] t'?Gt} pkrf/ ug'{xf];\ s8f hnljof]hg ePsf aRrfx¿df kfgL / g"gx¿sf] cfk"lt{ t'¿Gt} x'g'kg]{ x'G5 . o; p2]Zosf] nflu ;fwf/0ftof OG6«fleg; ˆn'O8\;sf] k|of]u ul/G5 .

cfO= le= ˆn'O8\;8 cyjf Gofhf]Uofl:6«s -Pg= lh=_ 6\o'a k|of]u u/L lbOg] k'gh{nLo pkrf/ s]jn s8f hnljof]hg ePsf aRrfx¿sf] nflu l;kmfl/z ul/G5 . s8f hnljof]hg ePsf aRrfsf] pkrf/ lgDg s'/fx¿df lge{/ ub{5 M * cfˆgf] :jf:Yo rf}sL cyjf ghLssf] pkrf/ s]Gb| cyjf c:ktfndf pknAw ;fwgsf] lsl;d * tkfO{n] k|fKt ug'{ ePsf] tflnd, tyf * aRrfn] lkpg ;S5 jf ;Sb}g .

8 pko'Qm cfO=le= ˆn'O8\;sf] nflu kl/lzi6 …3Ú x]g'{xf];\ .

65

s8f hnljof]hg ePsf] aRrfnfO{ k|0ffnL …uÚ cg';f/ cfˆgf] :jf:Yo ;+:yfdf tkfO{n] s;/L pkrf/ ug'{ x'G5 egL l;Sgsf] nflu kl/lzi6 k9]/ jRrfsf] cj:yf cg';f/ pkrf/ ug{ ;Sg'x'g]5 . !=kl/lzi6 u–! n] tkfO{nfO{ pkrf/ k|0ffnL …uÚ cg';f/ s;/L pkrf/ ug]{ eGg] af/] l;sfpF5 olb M * cfˆgf] :jf:Yo ;+:yfdf tkfO{ cfO=le= ˆn'O8\ lbg ;Sg' x'Gg, / * #) ldg]6leq k'Ug ;lsg] :jf:Yo ;+:yf jf c:ktfn -pkrf/ s]Gb|_df cfO= le= pkrf/

pknAw 5 eg] . @=kl/lzi6 u–@ n] tkfO{nfO{ pkrf/ k|0ffnL …uÚ cg';f/ s;/L pkrf/ ug]{ eGg] af/] l;sfpF5 olb M * cfˆgf] :jf:Yo ;+:yfdf tkfO{ cfO=le= ˆn"O8 lbg ;Sg' x'Gg eg] . * cfO=le= pkrf/ lbg ;lsg] :jf:Yo ;+:yf cyjf c:ktfn ghLsdf 5}g eg] . * tkfO{sf] :jf:Yo ;+:yfdf Gofhf]Uofl:6«s 6\o'a 5 eg], tyf * tkfO{n] Gofhf]Uofl:6\s -Pg=lh=_ 6\o'a k|of]u ug]{ tflnd lng' ePsf] 5 eg] . #=kl/lzi6 u–# n] tkfO{nfO{ pkrf/ k|0ffnL …uÚ cg';f/ s;/L pkrf/ ug]{ eGg] af/] l;sfpF5 olb M * cfˆgf] :jf:Yo ;+:yfdf tkfO{ cfO=le= ˆn'O8 lbg ;Sg' x'Gg eg] . * cfO=le= pkrf/ lbg] :jf:Yo ;+:yf jf c:ktfn ghLs 5}g eg] . * tkfO{ Gofhf]Uofl:6«s pkrf/ lbg ;Sg' x'Gg eg], tyf * aRrfn] lkpg ;S5 eg] . olb tkfO{ cfO=le= cyjf Pg=lh= 6o'j4f/f lbg ;Sg' x'Gg / aRrfn] lkpg klg ;Sb}g eg], aRrfnfO{ t'¿Gt} ghLssf] :jf:Yo ;+:yf cyjf pkrf/ s]Gb| -c:ktfn_df k|]if0f ug'{xf];\ hxf“ cfO=le= cyjf Pg=lh= 6o"j4f/f pkrf/ lbg ;lsG5 .

66

k|0ffnL ‘u’M s8f hnljof]hgsf] rf“8} pkrf/ ug'{xf];\ k|0ffnL ‘u‘ sf] pko'Qm pkrf/ af/] lgwf{/0f ug{sf nflu k|Zgx¿ k9\g'xf];\ . olb pQ/ ;S5' eGg] 5 eg] cufl8 bfof“lt/ hfg'xf];\ . olb ;Sg' x'Gg eGg] 5 eg] tNnf] sf]7fdf x]g'{xf];\ . oxf“jf6 ;'? ug'{xf];\

kl/lzi6 u–! x]g'{xf];\M olb tkfO{n] cfO=le= ˆn'O8 lbg ;Sg'x'G5 eg] k9\g'xf];\ . kl/lzi6sf] cGTodf lbOPsf] cEof; ug'{xf];\ .

kl/lzi6 u–@ x]g'{xf];\M olb cfO=le= pkrf/ ghLs} pknAw 5 eg] k9\g'xf];\ . kl/lzi6sf] cGTodf lbOPsf] cEof; ug'{xf];\ .

kl/lzi6 u–# x]g'{xf];\M olb tkfO{n] Pg=lh= 6\o'a k|of]u ug]{ tflnd lng' ePsf] 5 eg] k9\g'xf];\ . kl/lzi6sf] cGTodf lbOPsf] cEof; ug'{xf];\ .

kl/lzi6 u–$ x]g'{xf];\M olb tkfO{n] k|0ffnL …uÚ pkrf/ s]jn d'vaf6 lbg ;Sg'x'G5 eg] k9\g'xf];\ . kl/lzi6sf] cGTodf lbOPsf] cEof; ug'{xf];\ .

5}g

s] jRrfn] emf]ns'/f lkpg ;S5 <

;Sb}g

cfO{= le= l8«k jf gfsjf6 Pg=lh 6o'j k;fO ul/g] pkrf/sf] nflu t'?Gt pkrf/ s]Gb|df k]|if0f ug'{xf];\ .

s] tkfO{ cfO{=le ;'O{ lbg ;Sg'x'G5 < ;S5'

;lSbg

#) ldg]6leq k'Ug] 7fpFdf st} cfO{=le pkrf/ pknJw x'G5 <

x'G5

x'Fb}g

tkfO{n] k'gh{nLo pkrf/sf] nflu Pg=lh 6o'j xfNg] tflnd lng' ePsf] 5 .

5

;S5

pkrf/ k|0ffnL …uÚ rflxg] aRrfnfO{ tkfO{n] s;/L pkrf/ ug]{ egL lgwf{/0f ug{nfO{ tnsf] k|jfx tflnsf -Flow Chart_ x]g'{xf];\ . k|Zgx¿nfO{ dflyb]lv qmd}l;t k9\g'xf];\ tyf cfˆgf] :jf:Yo ;+:yfsf] l:yltcg';f/ pQ/ lbg'xf];\ . tkfO{sf] pQ/;Fu ldNbf] kl/lzi6 kN6fpg'xf];\ / k9\g hf/L /fVg'xf];\ .

67

&=& bL3{ kvfnfsf] pkrf/ ug'{xf];\ bL3{ kvfnfsf] pkrf/sf] nflu ljz]if lsl;dsf] vfg]s'/f rflxG5 . bL3{ kvfnf nfu]sf] aRrfsL cfdfnfO{ cfˆgf] aRrfnfO{ vfg]s'/f v'jfpg] ;Nnfx lbOg] 5 . bL3{ kvfnf nfu]sf] aRrfsf] nflu vfg]s'/f ;DaGwL l;kmfl/zx¿ …cfdfnfO{ k/fdz{Ú tflnsfdf lbOPsf] 5\ . …cfdfnfO{ k/fdz{Ú eGg] k'l:tsfdf logsf] JofVof ul/Psf] 5 .

&=* cfp“ /utsf] pkrf/ ug'{xf];\ cfpF /utsf] pkrf/ ug{sf] nflu tkfO{sf] If]qdf l;u]nfsf] nflu l;kmfl/z ul/Psf] vfg] PlG6afof]l6s lbg'xf];\ . aRrfsf] cj:yf ;'lw|Fb}5 jf 5}g egL hfGgsf] nflu cfdfnfO{ @ lbgdf cg'udgsf] nflu kms]{/ cfpg eGg'xf];\ . afn–pkrf/ eGg] tflnsfdf …pko'Qm vfg] PlG6afof]l6s lbg'xf];\Ú eGg] sf]7fn] cfpF /utdf lbOg] PlG6afof]l6sx¿ atfpF5 . PlG6afof]l6s s;/L lbg] eGg] af/] o; k'l:tsfsf] v08 !=) df lbOPsf] 5 .

68

olb tkfO{ OG6«fe]g; -cfO=le=_ pkrf/ ug{ ;Sg'x'G5 eg]

olb tkfO{ cfO= le= pkrf/ lbg ;Sg' x'G5 / tkfO{l;t cfjZos ˆn'O8Ù h:t}M l/Ë;{ n]S6]6 jf gd{n ;nfOg cfˆgf] :jf:Yo ;+:yfdf 5g\ eg], s8f hnljof]hg ePsf] aRrfnfO{9 cfO= le= ˆn'O8 lbg'xf];\ . pkrf/ k|0ffnL …uÚ sf lgDg v08x¿n] aRrfnfO{ cfO =le= l8«kaf6 k'gh{nLo pkrf/ ug]{ r/0fx¿sf] j0f{g ub{5g\ . aRrfsf] pd]/ tyf tf}n cg';f/ lbg' kg]{ cfO= le= ˆn'O8sf] kl/df0fnfO{ o;df ;dfj]z ul/Psf] 5 . oL v08x¿nfO{ Wofgk"j{s cWoog ug'{xf];\ .

9 o; kl/lzi6n] cfO= le= pkrf/ s;/L lbg] eGg] af/] l;sfpFb}g . kl/lzi6 …3Ú n] 5f]6s/Ldf s;/L cfO= le= lbg], k|of]u

ug]{ / cfO= le= ˆn'O8 s'g b/df lbg] eGg] s'/f ;dfj]z u/]sf] 5 .

cfO{=le= 8«Lk t'?Gt} lbg] . olb aRrfn] lkpg ;S5 eg] l8«ksf] tof/Lsf] ;do cjlwdf k'gh{nLo emf]n lkpg lbg'xf];\ . l/+u;{ n]S6]6 -olb gePdf gd{n :nfO{g_ !)) ld=ln= k|lt s]=lh= lgDgfg';f/ lbg'xf];\ .

pd]/ klxnf]kN6df #) ld=ln= k|lt s]=lh=

To;kl5 &) ld=ln= k|lt s]=lh

lzz' -!@ dlxgf d'lgsf]_ ! 306f* % 306f

aRrf -!@ dlxgf b]lv % jif{;Ddsf]_ #) ldg]6* @ !÷@ 306f

k|To]s !–@ 306fdf hnljof]hgsf] k'gd"{Nofª\sg ub}{ ug]{ . olb hnljof]hgsf] l:yltdf

;'wf/ ePg eg] cfO{=le= l8«ksf] rfn l56f] ug'{xf];\ .

emf]ns'/f lkpg ;Sg] eP M lzz' eP #–$ 306fleq jf afns eP !–@ 306fleq % ld=ln=

k|lt s]=lh= k|lt 306fsf b/n] k'gh{nLo emf]n klg v'jfpg'xf];\ .

lzz' eP ^ 306f / afns eP # 306fdf k'gd"{Nofª\g ug]{ clg k|0ffnL s, v, jf u h'g

rflx+ pko'Qm x'G5 ;f] cg';f/ pkrf/ k'gM yfNg'xf];\ .

l6kf]6 M ;Dej eP, k'gh{nLo pkrf/ yfn]sf] ^ 306f;Dd aRrfsL cfdfn] d'vaf6 k'gh{nLo emf]n

lbP/ aRrfsf] k'gh{nLo cj:yfnfO{ oyf :yfgdf /fVg ;lS5g\ ls ;lSbgg\ cjnf]sg jf k/LIf0f ug'{xf];\ .

69

pkrf/ k|0ffnL …uÚ sf] o; efudf s]xL zAbx¿ tkfO{sf] nflu gofF x'g ;S5g\ . pkrf/ k|0ffnL …uÚ df oL zAbx¿nfO{ s;/L k|of]u ul/G5 egL a'‰gnfO{ tnsf] JofVof k9\g'xf];\ M * l8«kn] (Drip) cfO= le= cf}hf/ tyf cfO= le= ;f]No';gl;t (Solution) ;DaGw /fV5 . …8«Lk b/Ú

n] cfO= le= ˆn'O8 lb+bf k|ltldg]6 yf]kfx¿sf] ;+VofnfO{ hgfpF5 . …h'ga]nf l8«k tof/ ul/G5Ú eGgfn] cfO= le= ;fdfgx¿ cfO= le= ˆn'O8 tof/ ug'{ tyf aRrfsf] g;fdf ;'O{ k;fpg'nfO{ a'emfpF5 .

* xfO8«];g l:yltn] aRrfnfO{ :jfefljs ¿kn] k'gh{nLo pkrf/ u/] gu/]sf] jf hnljof]hg eP

gePsf] / hnljof]hgsf] cj:yfnfO{ hgfpF5 . hnljof]hg gePsf] egL juL{s/0f ul/Psf] aRrfdf hnljof]hgsf lrGxx¿ b]lvgsf] nflu kof{Kt dfqfdf kfgL v]/ uPsf] 5}g . s]xL hnljof]hg cyjf s8f hnljof]hg ePsf] aRrfsf] z/L/df :jfefljs ¿kdf /xg'kg]{ eGbf sd kfgL x'G5 .

aRrfsf] xfO8«];g l:yltsf] d"Nofª\sg ug{ …d"Nofª\sg / juL{s/0fÚ eGg] tflnsfdf ePsf

lrGxx¿nfO{ x]g'{xf];\ . * /]l8on kN;n] (Radial pulse) /]l8on cf6{/Ldf cg'ej ul/g] gf8LnfO{ hgfpF5 . /]l8on cf6{/L

a"9L cf}+nfsf] 5]pdf gf8Llg/ cjl:yt d'Vo wdgL xf] .

s8f hnljof]hgsf] nflu cfO=le= pkrf/sf] Joj:yf ug'{xf];\ tkfO{ s8f hnljof]hgsf] nflu cfO= le= pkrf/sf] Joj:yf ubf{ aRrfnfO{ 7"nf] kl/df0fdf ˆn'O8;\ l56f]l56f] lbg'xf];\ . o;/L lbOg] ˆn'O8n] z/L/af6 7"nf] kl/df0fdf v]/ uPsf] ˆn'O8;sf] cfk"lt{ u5{ .

pkrf/ k|0ffnL …uÚ df vf; u/L pNn]v ePsf] kl/df0fcg';f/ cfO= le= pkrf/ t'¿Gt} ug'{xf];\ . olb aRrfn] lkpg ;S5 eg], l8«k grn];Dd k'gh{nLo emf]n v'jfpg'xf];\ . To;kl5 cfO= le= ˆn'O8sf] klxnf] c+z -#) ld=ln= k|lt lsnf]_ Psbd l56f] lbg'xf];\ -lzz'x¿nfO{ ^) ldg]6leq, 7"nf] aRrfx¿nfO{ #) ldg]6leq_ o;n] /utsf] kl/df0fnfO{ ;'wfg]{5 / ;s (Shock) af6 x'g] d[To'nfO{ /f]Sg]5 . To;kl5, k'gh{nLo pkrf/ k"/f ug{ &) ld= ln= k|lt lsnf] lj:tf/} lbg'xf];\ . -lzz'x?nfO{ % 306fleq / 7"nf] jRrfx?nfO{ @½ 306f leq_ . cfO= le= pkrf/sf] a]nf k|To]s !–@ 306fdf aRrfsf] k"g{d"Nof+sg ug'{xf];\ . aRrfn] cfO= le= ˆn'O8 kof{Kt dfqfdf kfO/x]sf] 5 ls 5}g egL lgwf{/0f ug'{xf];\ . pbfx/0f tnsf pbfx/0fn] tkfO{ cfO= le= pkrf/ ug{ ;Sg' x'G5 eg] s8f hnljof]hg ePsf aRrfx?sf] pkrf/ s;/L ug]{ eGg] af/] j0f{g u5{ .

^ dlxgf -( lsnf]u|fd_ sL ;'GtnLnfO{ s8f hnljof]hg ePsf] t/ /QmcNktf gePsf] tyf w]/} sd tf}n gePsf] egL juL{s/0f ul/of] . pgL lkpg ;lSbg lyOg t/ cGo /f]usf juL{s/0fx¿ pgdf lyPgg\ . :jf:Yo rf}sLdf cfO= le= pkrf/ pknAw lyof] . To;sf/0f, :jf:Yo sfo{stf{n] pgnfO{ pkrf/ k|0ffnL …uÚ cg';f/ cfO= le= ˆn'O8af6 pkrf/ ug]{ lg0f{o ug'{eof] .

:jf:Yo sfo{stf{n] ;'GtnLnfO{ klxnf] 306fdf @&) ld=ln= -#) ld=ln= x ( lsnf]u|fd_ l/Ë;{ n]S6]6 cfO= le= åf/f lbg'eof] . csf]{ % 306fdf, jxfFn] pgnfO{ ^#) ld=ln= cfO= le= ˆn'O8 -&) ld=ln= x ( lsnf]u|fd_, s/La !@% ld=ln= k|lt 306fsf] lx;fan] lbg'eof] .

70

:jf:Yo sfo{stf{n] ;'GtnLsf] xfO8«];g l:ylt x/]s !–@ 306fdf d"Nof+sg ug'{eof] -cyf{t\, jxfFn] hnljof]hgsf] d"Nofª\sg ug'{eof]_ pgsf] xfO8«];g l:ylt ;'lw|/x]sf] lyof], o;sf/0f :jf:Yo sfo{stf{n] ;'GtnLnfO{ Pp6f l:y/ b/df ˆn'O8 lbg' eof] .

$ 306fsf] cfO= le= pkrf/kl5, ;'GtnL lkpg ;Sg] eOg\ . :jf:Yo sfo{stf{n] pgnfO{ cfO= le=

lbg hf/L/fVg' eof] tyf pgnfO{ s/La $% ld=ln= k'gh{nLo emf]n k|lt 306fsf] lx;fan] lkpg lbg'eof] .

^ 306f;Dd ;'GtnLnfO{ cfO= le= ˆn'O8 lbPkl5 :jf:Yo sfo{stf{n] pgsf] hnljof]hgsf]

k'gd"{Nofª\sg ug'{eof] . pgL /fd|L eOg\\ tyf pgnfO{ s]xL hnljof]hg ePsf] egL k"gjuL{s/0f ul/of] . :jf:Yo sfo{stf{n] pkrf/ hf/L/fVgnfO{ pkrf/ k|0ffnL …vÚ 5fGg' eof] . :jf:Yo sfo{stf{n] cfO= le= ˆn'O8 aGb ug'{eof] . jxfFn] pkrf/ k|0ffnL …vÚ n] atfP cg';f/ ;'GtnLnfO{ k'gh{nLo emf]n lbg ;'? ug'{ eof] .

aRrfsf] xfO8«];g l:ylt tyf cfO= le= n'O8sf] kl/df0fsf] cg'udg ug'{xf];\ . s8f hnljof]hg ePsf] aRrfsf] k'gh{nLo pkrf/ ubf{ tkfO{n] lbg] cfO= le= ˆn'O8sf] kl/df0fnfO{ cg'udg ug'{xf];\ . tkfO{ lgDgadf]lhdsf] gd"gf kmf/d k|of]u ug{ ;Sg' x'G5 .

kmf/ddf la/fdLnfO{ s]xL ;do lbOPsf ˆn'O8;sf] kl/df0f clen]v ug{sf] nflu $ j6f dxnx¿ 5g\ . != ;do M tkfO{n] cfO= le= ˆn'O8 hfFr]kl5 ;do clen]v ug'{xf];\ . slt slt a]nf cfO= le= ˆn'O8

hfFRg'kg]{ xf] ;f] ;do clen]v ug'{xf];\ . lzz'sf] nflu -!@ dlxgf d'lg_ M 7"nf aRrfsf] nflu -!@ dlxgfb]lv % jif{;Dd_ * klxnf] Ps 306fdf * klxnf] cfwf 306f -#) ldg]6_ df * csf]{ % 306fdf * csf]{ @½ 306fdf @= lbg'kg]{ dfqfsf] Joj:yf M tkfO{n] cfO= le= ˆn'O8 ;'? ubf{ k|To]s af]tn jf Kofsdf ˆn'O8sf]

kl/df0f clen]v ug'{xf];\ . kl/df0fnfO{ efF8fdf n]Vg'xf];\ . x/]s k6s tkfO{ csf]{ efF8faf6 ˆn'O8 ha cfk"lt{ ug'{ x'G5, kmf/dsf] ;xL /]vfdf kl/df0fnfO{ abNg] a]nfdf clen]v ug{ lglZrt x'g'xf];\ .

71

#= cg'dflgt dfqf afFsL M efF8fdf afFsL /x]sf] cfO= le= ˆn'O8nfO{ n]lvPsf ;dox¿df hfFRg'xf];\ . afFsL /x]sf] dfqfnfO{ lglZrt ¿kdf k9\g ;ls+b}g . o;nfO{ ghLssf] !) ld=ln= df lx;fa /fVg'xf];\ . -pbfx/0fsf] nflu – @@) ld=ln= @#) ld=ln= @$) ld=ln= cflb_ kmf/ddf cg'dflgt dfqfnfO{ clen]v ug'{xf];\ .

$= k|fKt dfqfM aRrfn] k|fKt u/]sf] cfO= le= ˆn'O8sf] kl/df0fnfO{ n]lvPsf ;dox¿df lx;fa

ug'{xf];\ . lx;fa ug{sf] nflu, …dfqfsf] lx;faÚ af6 …dfqf afFsLÚ nfO{ 36fpg'xf];\ . o;sf] pQ/, tkfO{+n] hfFRbfv]l/ aRrfn] k|fKt u/]sf] cfO= le= ˆn'O8sf] kl/df0f xf] . Tof] kl/df0fnfO{ kmf/ddf clen]v ug'{xf];\ .

Pp6f lglZrt ;dodf k'Ug' kg]{ n]an b]vfpgsf] nflu cfO= le= ˆn'O8sf] efF8fdf Pp6f k]g cyjf 6]kn] lrgf] nufpg' pkof]uL x'G5 . pbfx/0fsf] nflu, klxnf] #) jf ^) ldg]6kl5 k|To]s 306f, cyjf # 306f jf ^ 306fsf] cGtdf k'Ug' kg]{ dfqfdf lrgf] nufpg'xf];\ . o;n] tkfO{nfO{ l8«ksf] b/ ;xL eP gePsf] yfxf kfpg d2t ug]{5 . ˆn'O8sf] ;xL kl/df0f k|lt306f lbgsf] nflu k|ltldg]6 lbg] yf]kfx¿sf] ;+VofnfO{ lgoldt kfg'{xf];\ . tnsf] gd"gf kmf/fdn] !^ dlxgf -!) lsnf]u|fd_ sf] Pp6f aRrfnfO{ lbOPsf] cfO= le= ˆn'O8sf] kl/df0fnfO{ b]vfpF5, h;nfO{ s8f hnljof]hg ePsf] egL juL{s/0f ul/Psf] 5 . :jf:Yo sfo{stf{n] pkrf/ k|0ffnL …uÚ nfO{ cg';/0f ug'{eof] . jxfFn] aRrfnfO{ klxnf] #) ldg]6df #)) ld=ln= -#) ld=ln=×

!) lsnf]u|fd_ lbg'eof] . jxfFn] csf]{ @ ½ 306fdf &)) ld=ln= -&) ld=ln= × !) lsnf]u|fd lbg'eof] -s/La #)) ld=ln= k|lt 306f_ .

n'O8sf] gd"gf kmf/fd

;do -306f_ lbg'kg]{ dfqf -ld=ln=_ sf] Joj:yf*

cg'dflgt dfqf -ld=ln=_ afFsL

k|fKt dfqf

!@= )) ah] !))) ld=ln= !@=#) ah] _________

&)) ld=ln= #)) ld=ln= !=#) ah] _________ $)) ld=ln= ^)) ld=ln= @=#) ah] _________ !)) ld=ln= ()) ld=ln= #=)) ah] _________ ) ld= ln= !))) ld=ln=

_________ _________ _________ _________

_________ _________ _________ * x/]s gofF af]tn Kofssf] nflu, ;'?sf] jf yk]sf]

cfO= le= ˆn'O8 ;xL t/Lsfn] / kof{Kt kl/df0fdf lbOPsf] 5 eGg] s'/fdf kSsf x'g'xf];\ . ˆn'O8 b/ kof{Kt 5 ls 5}g egL cg'udg ug{sf] nflu k|To]s !–@ 306fdf aRrfdf hnljof]hgsf] k'g{d"Nof+sg ug'{xf];\ . olb kvfnf tyf hnljof]hgsf lrGxx¿ cem lau|]sf] / g;'w|]sf] kfP ˆn'O8sf] b/ tyf kl/df0f b'a}nfO{ a9fpg'xf];\ . olb aRrfn] afGtf ul//x]sf] 5 eg] klg ˆn'O8sf] b/nfO{ a9fpg'xf];\ . olb lrGxx¿ ;'lw|+b}5g\ eg] ToxL b/df cfO= le= ˆn'O8 lbg hf/L /fVg'xf];\ . cfO= le= ˆn'O8 lbO/x]sf] a]nf, klg aRrf lkpg ;Sg] ePkl5 p;nfO{ cln cln k'gh{nLo emf]n vfg lbg' k5{ eGg] s'/f ofb /fVg'xf];\ . aRrfnfO{ s/La % ld=ln= k'gh{nLo emf]n k|lt lsnf]u|fd k|ltlbgsf] lx;fan] lbg'xf];\ .

72

hnljof]hgsf] k'g{d"Nofª\sg ug'{xf];\ tyf pko'Qm pkrf/ k|0ffnL 5fGg'xf];\ lzz'df ^ 306fkl5 tyf 7"nf] aRrfdf # 306fkl5 hnljof]hgsf lrGxx¿sf] d"Nofª\sg ug'{xf];\ . hnljof]hgsf] juL{s/0f ug'{xf];\, pkrf/ hf/L/fVgnfO{ pko'Qm pkrf/ k|0ffnL -pkrf/ k|0ffnL s, v jf u_ 5fGg'xf];\ . aRrfsf] hnljof]hg k"0f{¿kdf 7Ls u/]kl5 tyf hnljof]hg gePsf] egL juL{s/0f u/]kl5, klg ;Dej eP aRrfnfO{ c¿ ^ 306fsf] nflu :jf:Yo ;+:yfdf /fVg'xf];\ . o; cjlwdf, cfdfn] pkrf/ k|0ffnL …sÚ cg';f/ aRrfnfO{ yk emf]ns'/fx? lbg' k5{ . kvfnf hf/L/xFbf /xFb} klg v]/ uPsf] ;a} ˆn'O8sf] k"0f{¿kn] k"lt{ ug{ cfdfn] kof{Kt emf]ns'/fx? lbO/x]sL l5g\\ eGg] s'/fdf lglZrGt x'g a/fa/ hfRg] ug'{xf];\ . aRrfnfO{ vfgf klg v'jfpg' k5{ . hnljof]hgsf lrGxx¿ gkmls{of];\ egL 9'Ss x'gnfO{ ;do ;dodf aRrfsf] hfFr ug'{xf];\ .

pkrf/ k|0ffnL …uÚ df /flvPsf aRrfx¿sf] nflu cfO= le= ˆn'O8sf] kl/df0f lgwf{/0f ug]{ cEof;sf nflu tkfO{sf] k|lzIf0f ;xof]uLn] tkfO{nfO{ yk cEof; u/fpg' x'g]5 .

73

cEof; ‘em’ != # jif{ pd]/sf] j;Gt !% lsnf]u|fd tf}nsf] 5 . lxhf]b]lv p;nfO{ kvfnf nfu]sf] lyof] egL p;sL

cfdfn] :jf:Yo sfo{stf{nfO{ elgg\ . :jf:Yo sfo{stf{n] j;Gtsf] d"Nof+sg u/] / pgn] kfP, p lkpg ;Sb}g tyf k]6sf] 5fnf cf}+nfn] tfg]/ 5f]8\bf w]/} la:tf/} kmls{G5 . j;GtnfO{ s8f hnljof]hg ePsf] / /QmcNktf tyf w]/} sd tf}n gePsf] egL juL{s/0f ul/of] . :jf:Yo sfo{stf{ cfO= le= pkrf/ lbg ;S5g\ .

s= j;Gtdf ePsf] hnljof]hgsf] pkrf/ :jf:Yo sfo{stf{n] s;/L ug'{k5{ < v= j;GtnfO{ slt kl/df0fdf emf]ns'/fx? lbg'k5{ < u= cfkm"n] lx;fa u/]sf] b/df cfO= le= ˆn'O8 uO/x]sf] 5 egL lglZrt x'gnfO{ :jf:Yo

sfo{stf{n] k|To]s cfwf 306fdf To;sf] cg'udg ug]{5g\ . pgL j;Gtsf] hnljof]hgsf] d"Nof+sg klg x/]s 306fdf u5{g\ . s/Lj @ 306fkl5, j;Gt rgfvf] x'G5 / p lkpg ;S5 . ca s] ug{ plrt x'G5 <

3= j;Gtn] # 306fsf] cfO= le= pkrf/ k"/f u/]kl5, :jf:Yo sfo{stf{n] s] u5{g\ <

@= cd/ @ jif{ k'u]sf] 5 / p;sf] tf}n * lsnf]u|fd 5 . p;nfO{ kvfnf nfu]sf] 5 . Ps hgf :jf:Yo sfo{stf{n] cd/ ;':t 5Ù t/ p lkpg ;S5 eGg] lgwf{/0f u/]sf 5g\ . p;sf cfFvfx¿ u8]sf 5g\ tyf k]6sf] 5fnf cf}+nfn] tfg]/ 5f]8\bf w]/} la:tf/} kmls{G5 . :jf:Yo sfo{stf{n] cd/nfO{ kvfnf e} s8f hnljof]hg ePsf] egL juL{s/0f u/]sf5g\ . p;nfO{ #*=%° ;]= Hj/f] 5 / p;sf] gfsaf6 l;+ufg au]sf] 5 . p j;]sf] 7fpFdf cf}nf]]sf] ;Defjgf pRr 5 . :jf:Yo sfo{stf{n] p;nfO{ w]/} s8f Hj/f]hGo /f]u nfu]sf] 5 eg]/ klg juL{s/0f u/]sf 5g\ . p;df /QmcNktf / w]/} sd tf}n klg 5 .

:jf:Yo sfo{stf{n] pkrf/ k|0ffnL …uÚ cg';f/ cfO= le= ˆn'O8 lbg ;S5g\ . s] cd/nfO{ t'?Gt} c:ktfn k|]if0f ug'{k5{ < k5{ eg] lsg / kb}{g eg] lsg <

74

*=) cfjZostf cg';f/ x/]s la/fdL aRrfnfO{ vf]k lbg'xf];\ (Immunize Every Sick Child As Needed) o; k'l:tsfn] vf]kx¿ lbg tkfO{ klxNo} tflnd k|fKt x'g'x'G5 eGg] 7fg]sf] 5 . tkfO{ vf]kx¿ s;/L lbg] eGg] af/]sf] lj:t[t ljj/0f lj:tfl/t vf]k sfo{qmdaf6 kfpg ;Sg' x'G5 . …vf]k sfo{s|dsf] cEof;M vf]k lbg] :jf:Yo sfo{stf{x¿sf] nflu Pp6f dfu{ lgb]{zgÚ eGg] kf7\oqmdn] :jf:Yo sfo{stf{x¿nfO{ vf]kx¿ lbg] af/]sf] tflnd lbg ;3fpF5 . olb tkfO{n] aRrfx¿nfO{ pko'Qm ;dodf pko'Qm vf]k lbnfpg' eof] eg], bfb'/f, kf]lnof], Eofu't] /f]u, nx/] vf]sL, wg'i6+sf/ tyf Ifo/f]ux¿nfO{ /f]Sg ;Sg'x'g]5 . cfˆgf] :jf:Yo ;+:yfdf tkfO{n] pkrf/ ug]{ x/]s aRrfsf] vf]ksf] l:ylt hfFRg'xf];\ . cfjZostf cg';f/sf] vf]k lbg'xf];\ . tof/ ug]{ tyf vf]kx¿ lbg]af/] lgDglnlvt a'Fbfx¿af/] k'glj{rf/ ug'{xf];\ .

* aRrf lans'n 7Ls 5 / 3/ hfg ;S5 eGg] nfU5 eg] :jf:Yo ;+:yf 5f]8\g'cl3 p;nfO{ rflxg] vf]kx¿ lbg'xf];\ .

* k|To]s ;'O{sf] nflu lgd{nLs[t ;'O{ / l;l/Ghsf] k|of]u ug'{xf];\ . o;n] Pr= cfO= le= tyf x]kf6fOl6; aL efO/;nfO{ ;g{af6 /f]S5 .

* olb :jf:Yo ;+:yfdf s]jn Pp6f aRrfnfO{ dfq} vf]kfpg] cfjZostf k/]sf] 5 eg] klg p;nfO{ rflxPsf] vf]k lbg'xf];\ .

* k|To]s vf]k ;qsf] cGtdf bfb'/f tyf la= l;= lh= EoflS;gsf vf]lnPsf efonx¿nfO{ ˆofFSg'xf];\ . tkfO{n] kf]lnof] tyf l8= lk= l6=, Hep. B, lxa, sf vf]lnPsf efonx¿nfO{ kl5 k|of]u ug{sf] nflu /fVg ;Sg' x'G5, olb

– logLx¿ /a/ :6f]k/x¿l;t 7LSs u/L ldn]sf 5g\ . – cGt x'g] ldlt ;lsPsf] 5}g, tyf – EoflS;gx¿ :ki6 ¿kdf n]a'n ul/Psf 5g\ tyf ;xL tfk;Gt'lnt cj:yfx¿df e08f/

ul/Psf 5g\ eg] . kf]lnof] tyf l8= lk= l6= efonx¿nfO{ k5fl8sf vf]k ;qx¿df vfnL geP;Dd k|of]u ug{ ;lsG5 . * aRrfsf] vf]k sf8{df aRrfnfO{ lbOPsf ;a} vf]kx¿nfO{ clen]v ug'{xf];\ . k|To]s dfqf lbPsf]

ldltnfO{ clen]v ug'{xf];\ . aRrfsf] vf]kx¿nfO{ vf]k /lh:6/ / aRrfsf] vf]k ;+ks{ sf8{df klg clen]v /fVg'xf];\ .

* olb aRrfnfO{ kvfnf nfu]sf] 5 / cf]= lk= le= -kf]lnof]_ rflxG5 eg], aRrfnfO{ Tof] lbg'xf];\ .

vf]k clen]vdf dfqfnfO{ clen]v gug'{xf];\ . kf]lnof]sf] yk dfqfsf] nflu cfdfnfO{ $ xKtfdf kmls{g eGg'xf];\ .

* tkfOsf] :jf:Yo ;+:yfdf k|To]s lbg vf]k lbg ;+ej 5}g eg] ghLssf] vf]k s]Gb|df t'?Gt hfg

;Nnfx lbg'xf];\ . bf]xf]¥ofpg] dfqf k"/f ug{sf] nflu aRrf kmls{P kl5 lbOPsf] cf]=lk=le=nfO{ cl3Nnf] k6s cfPsf]

a]nf lbg' kg]{ dfqf egL ljrf/ ug'{xf];\ . bf]xf]¥ofP/ lbg] dfqf lbPkl5 vf]k sf8{ tyf tkfO{sf] :jf:Yo ;+:yfsf] vf]k /lh:6/df vf]k lbPsf] ldltnfO{ clen]v ug'{xf];\ .

75

pgsf] aRrfn] cfh s'g s'g vf]kx¿ kfpg] xf] ;f] s'/fsf] hfgsf/L cfdfnfO{ lbg'xf];\ / ;Defljt k|lts"n c;/x¿af/] atfpg'xf];\ . k|To]s EoflS;gaf6 x'g] k|lts"n c;/x¿sf] j0f{g 5f]6s/Ldf tn lbOPsf] 5 . * la= l;= lh= M @ xKtfkl5 vf]k nufPsf] 7fpFdf ;fgf] ;'lGgPsf] vl6/f cfpF5 / vl6/f cfkm}+ 7Ls

e} Pp6f ;fgf] vt a:5 . vf]k nufPsf] 7fpFdf Pp6f vl6/f cfpg]5 tyf To;nfO{ 5f]Kg x'Fb}g egL cfdfnfO{ eGg'xf];\ .

olb cfjZos k5{ eg], Pp6f ;'Vvf k§Ln] dfq} 5f]Kg'k5{ egL eGg'xf];\ . * cf]= lk= le= -kf]lnof]_M k|lts"n c;/x¿ x'Fb}gg\ . * Hep B, lxa: k|lts'n c;/x¿ x'Fb}gg\ . * l8= lk= l6= M Hj/f] cfpg', lemlhg' tyf b'Vg' l8= lk= l6= sf ;Defljt k|lts"n c;/x¿ x'g\ .

ltgLx¿ ;fdfGotof uDeL/ vfnsf x'Fb}gg\ tyf s'g} pkrf/sf] cfjZostf kb}{g . Hj/f]sf] cy{ xf] EoflS;gn] sfd ub}{5 .

Kof/fl;6fdf]n lbg cfdfnfO{ l;sfpg'xf];\ . ;fdfGoeGbf a9L sk8fx¿df pgn] aRrfnfO{

u'D:ofpg' x'Fb}g . * bfb'/f÷?j]nfM bfb'/fsf ;Defljt k|lts"n c;/x¿, Hj/f] tyf bfb'/fsf ;fdfGo lald/fx¿ x'g\ .

tkfO{n] vf]k lbPsf] ! xKtfkl5 aRrfnfO{ ! b]lv # lbg;Dd Hj/f] cfpg ;S5 . Hj/f]sf] cy{ xf] EoflS;gn] sfd ub}{5 .

olb Hj/f] a9L 5 eg] Kof/fl;6fdf]n lbg cfdfnfO{ eGg'xf];\ .

* h]= O{=

HIV/AIDS sf] nflu pkrf/ Joj:yfkgM

lj/fdLsf] uf]klgotf / :jfledfgnfO{ Vofn ug{'xf];\ .

olb tkfO{ sfo{/t :jf:Yo ;+:yfdf /ut kl/If0f ul/ /f]u kQf nufO{ pkrf/ ug]{ ;'lawf pknAw 5 eg] lrlsT;sn] l;kmf/L;\ u/]sf] dfqf cg';f/ ART (Anti Retroviral Therapy, lh8'e'l8g, nflde'l8g, Okmfe]l/Gh) sf] Regimen pkrf/ tyf k/fdz{ ug{'xf];\ .

olb of] ;'lawf pknAw gePdf t'?Gt k/fdz{ tyf pkrf/ ;]jf pknAw x'g] :jf:Yo ;+:yfdf

k|]if0f ug{'xf];\ .

76

cEof; ‘`’ o; cEof;df tkfO{x¿n] s]xL aRrfx¿sf] vf]ksf] l:yltaf/] k'glj{rf/ ug'{x'g]5 . tn lbOPsf 7fpFdf pQ/x¿ n]Vg'xf];\ . != dfof ^ dlxgfsL 5] . p;nfO{ xh'/cfdfn] :jf:Yo rf}sLdf Nofpg' eof] . :jf:Yo sfo{stf{n]

p;nfO{ Go"df]lgof, cf}nf]] / /QmcNktf gePsf] tyf w]/} sd tf}n klg gePsf] egL juL{s/0f u5{g\ . p;sf] vf]k sf8{n] cfh dfofnfO{ l8= lk= l6= klxnf] / cf]= lk= le= klxnf] dfqf lbg] lbg xf] eGg] b]vfpF5 . s] cfh dfofnfO{ vf]kx¿ lbg' x'G5 <

@= :jf:Yo sfo{stf{ kl08t, z/0ffyL{ SofDk ghLs Pp6f Jo:t :jf:Yo rf}sLdf sfd u5{g\ . o;

If]qdf vfgfsf] cefj 5 . :jf:Yo rf}sLdf NofOg] w]/}h;f] aRrfx¿nfO{ /QmcNktf cyjf w]/} sd tf}n ePsf] egL juL{s/0f ul/G5 . s] kl08t /QmcNktf cyjf w]/} sd tf}n ePsf aRrfx¿nfO{ vf]k lbG5g\ <

#= Pp6L cfdfn] cfˆgL % dlxgfsL 5f]/L h'g]nLnfO{ kvfnf nfu]sf]n] :jf:Yo rf}sLdf NofpFl5g\ .

h'g]nLsf] lb;fdf /ut b]lvPsf]n] :jf:Yo sfo{stf{n] h'g]nLnfO{ hnljof]hg gePsf], cfpF /ut k/]sf] t/ /QmcNktf gePsf] tyf w]/} sd tf}n gePsf] egL juL{s/0f u5{g\ . h'g]nLsf] vf]k sf8{n] klg pgn] cf]= lk= le= bf];|f] tyf l8= lk= l6= bf];|f] kfFr xKtfcl3 lnPsL lyOg\ eGg] b]vfpF5 .

-s_ s] :jf:Yo sfo{stf{n] cfh h'g]nLnfO{ cf]= lk= le= t];|f] tyf l8= lk= l6= t];|f] lbg'k5{ <

77

h'g]nLnfO{ km]l/ vf]k nufpg pgL rfxGgg\ egL cfdf elG5g\ . kl5Nnf] rf]l6 vf]k lbFbf h'g]nLnfO{ Hj/f] cfPsf] lyof] / pgL lem+lhg] uly{g\ egL :jf:Yo sfo{stf{nfO{ pgL elG5g\ .

-v_ cf]= lk= le= tyf l8= lk= l6= sf ;Defljt k|lts"n c;/x¿ af/] :jf:Yo sfo{stf{n]

cfdfnfO{ s] eGg' k5{ < h'g]nLnfO{ vf]k lbnfpg cfdf dflG5g\ . :jf:Yo sfo{stf{n] h'g]nLnfO{ vf]kx¿ lbg' x'G5 . -u_ :jf:Yo sfo{stf{n] vf]kx¿sf] clen]v s;/L /fVg' k5{ < $= :jf:Yo sfo{stf{ /d]z ! jif{sf] aRrfnfO{ bfb'/fsf] vf]k nufpg rfxG5g\ . aRrfnfO{ Go"df]lgof /

/QmcNktf gePsf] tyf w]/} sd tf}n klg gePsf] egL juL{s/0f ul/Psf] 5 . aRrfsL cfdf cfˆgf aRrfnfO{ vf]k lbnfpg rfxGgg\ . aRrf 7Ls ePkl5 vf]k nufpg kmls{g]5' eg]/ pgL elG5g\ .

cfˆgf] aRrfnfO{ cfh} bfb'/fsf] vf]k lbnfpg pgnfO{ ljZj:t agfpgsf] nflu k|of; ug{ aRrfsL

cfdfnfO{ tkfO{n] s] eGg' x'g]5 j0f{g ug'{xf];\ .

o; cEof;nfO{ ;s]kl5, cfˆgf pQ/x¿sf af/]df k|lzIf0f ;xof]uLl;t 5nkmn ug'{xf];\ .

78

kl/lzi6x¿

kl/lzi6 ‘s’M Gofhf]Uofl:6«s k'gh{nLo pkrf/ kl/lzi6 ‘v’M cf]= cf/= l6= sg{/ kl/lzi6 ‘u’–!M olb ghLsdf OG6«fleg; pkrf/ pknAw 5 eg] kl/lzi6 ‘u’–@M olb tkfO{n] Gofhf]Dofl:6«s 6\o'a -Pg=lh=_ k|of]u ug]{ tflnd k|fKt

ug'{ePsf] 5 eg] kl/lzi6 ‘u’–#M olb tkfO{ pkrf/ k|0ffnL ‘u’ s]jn d'vaf6 -k"gh{lnoemf]n_ dfq

lbg ;Sg' x'G5 eg] kl/lzi6 ‘3’M s8f hnljof]hgsf] nflu OG6«fleg; pkrf/ kl/lzi6 ‘ª’M hxf“ k|]if0f ;Dej 5}g M

79

kl/lzi6 ‘s’

Gofhf]Uofl:6«s k'gh{nLo pkrf/ != Pp6f ;kmf /a/ cyjf Knfl:6ssf] Gofhf]Uofl:6«s -Pg= lh=_ 6\o'a k|of]u ug'{xf];\ . aRrfsf] nflu

@=) ld= ld= b]lv @=& ld= ld= jf $=)–^=( ld=ld -jo:ssf] nflu_ ;Dd Jof; ePsf] Pp6f 6\o'a k|of]u ug'{xf];\ .

@= la/fdLnfO{ pQfgf] kf/L lz/nfO{ clnslt dfly p7fP/ ;'tfpg'xf];\ . 7"nf aRrf tyf o'jfx¿ a:g

dg k/fpg ;S5g\ . #= 6'Kkf]nfO{ 7Ls gfeLdfly /fv]/ d'v;Ddsf] lgNg' kg]{ 6\o'jsf] nDafO gfKg'xf];\ . To;kl5 6\o'anfO{

sfgsf] k5fl8 tyf cufl8 gfssf] 6'Kkf];Dd tGsfpg'xf];\ . 6\o'jn] hxfF gfssf] 5]pnfO{ 5'G5 ToxfF 6]ksf] 6'qmfn] lrgf] nufpg'xf];\ . o; lrgf]n] gfssf] 6'Kkf]b]lv e'F8L;Dd k'UgnfO{ rflxg] 6\o'asf] nDafOnfO{ b]vfpF5 .

$= 6\o'jnfO{ kfgLdf ldNg] lrNnf] kbfy{ cyjf ;fbf kfgLdf lehfpg'xf];\Ù t]nsf] k|of]u gug'{xf];\ . %= 6\o'jnfO{ gfssf] ;a}eGbf 7"nf] Kjfnkl§af6 l5/fpg'xf];\ . o;nfO{ g/dk"j{s, 3fF6Lsf] k5fl8 6'Kkf]

gk'u];Dd cufl8 a9fpg'xf];\ . la/fdLn] lgNbf x/]s k6s, 6\o'jnfO{ #=% ;]=ld= cufl8 a9fpg'xf];\ . la/fdL xf];df 5 eg] pgnfO{ clnslt kfgL lkpg eGg'xf];\ .

^= olb la/fdL lg;fl;G5, af/Daf/ vf]S5 cyjf p;nfO{ ;f; km]g{ sl7gfO x'G5 eg], ;Dejt ;f;–

gnLdf 6\o'a k;]sf] x'g;S5 . vf]sL sd geP;Dd tyf la/fdLnfO{ cf/fd geP;Dd o;nfO{ @ – $ ;]=ld= k5fl8 tfGg'xf];\ . Ps ldg]6 klv{g'xf];\ clg To;kl5 6\o'jnfO{ km]l/ leq k;fpg'xf];\ .

&= 6o"jsf] lrgf] gfsdf gk'u];Dd, x/]s k6s la/fdLn] lgNbf 6\o'anfO{ cufl8 a9fpFb} hfg'xf];\ . olb

la/fdLnfO{ cf/fd 5 tyf vf]ls/x]sf] 5}g eg], 6\o'a e'F8Ldf k'u]sf] x'g'k5{ . *= 3fF6Lsf] k5fl8 6\o'a u'8'lNsP/ a;]sf] 5}g egL lglZrGt x'gsf] nflu la/fdLsf] d'vleq x]g'{xf];\ .

Pp6f l;l/Gh 6\o'al;t hf]8]/ tyf e'F8Laf6 clnstf emf]ns'/fx? tfg]/ kSsf ug'{xf];\ ls 6\o'a e'F8Ldf g} 5 . tkfO{n] :6]y]:sf]knfO{ 7Ls gfeL dfly /fv]/ klg hfFr ug{ ;Sg'x'G5 . of] hfFr ubf{ :6]y]:sf]knfO{ 7Ls gfeLdfly /fv]/ Pp6f vfnL l;l/Ghn] 6\o'aleq xfjf eg'{xf];\ . xfjf e'F8Lleq k:b} u/]sf] :6]y]:sf]kåf/f ;'Gg'xf];\ .

(= 6\o'jnfO{ 6]kn] cg'xf/df 6fF:g'xf];\ tyf k'gh{nLo emf]n ePsf] Pp6f ;kmf cfO= le= af]tn;Fu

hf]l8Psf] cfO= le= 6\o"jl;t o;nfO{ ufF:g'xf];\ . k'gh{nLo emf]nnfO{ @) ld=ln= k|lt 306f cyjf sdsf] b/df ldnfpg'xf];\ .

!)= olb cfO= le= af]tn pknAw 5}g eg], Pp6f l;l/GhnfO{ 6\o'al;t hf]8\g ;lsG5 / Pp6f ;f]nL

h:t} u/L k|of]u ug{ ;lsG5 . l;l/GhnfO{ la/fdLsf] lz/eGbf dfly /xg] u/L ;dfpg'xf];\ tyf lgoldt cGt/df k'gh{nLo emf]n vGofpg'xf];\ .

80

kl/lzi6 ‘v’

cf]= cf/= l6= sg{/ cf]= cf/= l6= sg{/, df}lvs k'gh{nLo pkrf/sf] nflu :jf:Yo ;+:yfsf] Pp6f If]q xf] . o:tf] 7fpF cfjZos 5 lsg eg] k'gh{nLo emf]nsf] cfjZostf kg]{ aRrfx¿ / ltgsf cfdfx¿nfO{ s]xL 306f :jf:Yo ;+:yfdf a:g' kg]{ x'G5 . kvfnfsf la/fdLsf] cefjdf cf]= cf/= l6= sg{/sf] k|of]u e}/x]sf] 5}g eg], o; 7fpFnfO{ cGo ;d:ofx¿sf] pkrf/sf] nflu pkof]u ug{ ;lsG5 . o;/L Tof] 7fpF v]/ hfFb}g . To; If]qdf hnljof]hg ePsf la/fdLx¿ x'g] eP ;'ljwfo'Qm tyf k"0f{¿kn] ;lHht cf]= cf/= l6= sg{/n] ;lhn}l;t la/fdLx¿sf] Joj:yfkg ug{ :jf:Yo sdL{x¿nfO{ ;xof]u k'¥ofpg]5 . cf]= cf/= l6= sg{/ x'g' kg]{ 7fpF M * o:tf] 7fpFdf :yflkt x'g'k5{ hxfF sd{rf/Lx¿ af/Daf/ cfpg] hfg] u5{g\, t/ ;fj{hlgs 7fpFdf x'g'

x'Fb}g . sd{rf/Lx¿n] aRrfsf] k|ult x]g{ ;S5g\ / cfdfnfO{ k'gh{nLo emf]n v'jfpg k|f]T;flxt

u5{g\ .

* kfgLsf] ;|f]tsf] ghLs .

* rkL{ tyf w'g] ;'ljwfx¿ 7fpFsf] ghLs .

* :jR5 tyf /fd|/L xfjf rNg] 7fpF .

cf]= cf/= l6= sg{/df lgDglnlvt dfn;fdfgx¿ x'g'k5{ M

* k'gh{nLo emf]n agfpg tyf ;fdfgx¿ /fVgsf] nflu Pp6f 6]an .

* dfn;fdfgx¿ /fVgnfO{ Pp6f b/fh .

* a]Gr cyjf c8]; nfUg] d]r, hxfF cfdf aRrfnfO{ ;dft]/ cf/fdl;t a:g ;s"g\ .

* Pp6f ;fgf] 6]a'n, hxfF cfdfn] ;'ljwfk"j{s k'gh{nLo emf]nsf] sknfO{ /fVg ;lS5g\ .

cf]= cf/= l6= sg{/df lgDglnlvt ;fdfgx¿ x'g'k5{ . oL ;fdfgx¿ To:tf] :jf:Yo ;+:yfsf] nflu x'g\ , hxfF k|lt xKtf @%–#) hgf kvfnfsf la/fdLx¿ cfpF5g\ . * k'gh{nLo emf]n k'l/ofx¿ -Ps dlxgfsf] nflu rflxg] sDtLdf #)) k'l/ofsf] cfk"lt{_

* 6'F6L ePsf] lasf]{ ;lxtsf] Pp6f Knfl:6s afN6L .

* ^ j6f gLnf] Nkfl:6s sk jf ^ lrof lunf;

* Pp6f Knfl:6s hu

* ^ j6f rDrf .

* Knfl:6s af6f

81

* @ j6f 8«k/ -gjhft lzz'x¿sf] nflu rDrfeGbf of] ;lhnf] x'g;S5 ._

* sf8{ cyjf kDkmn]6 -h:tf] ls cfdfsf] sf8{_ h;n] cfdfx¿nfO{ kvfnf ePsf aRrfsf] x]/rfx

s;/L ug]{ eGg] af/] ofb lbnfpF5 . x/]s cfdfnfO{ 3/ n}hfg sf8{ lbOG5 .

* ;fa'g -xft w'gnfO{_

* kmf]x/ kmfNg] 6f]s/L -8fnf]_

hfgsf/L lbg] kf]:6/x¿ k|bz{g ug{sf] nflu cf]= cf/= l6= sg{/ Pp6f /fd|f] 7fpF xf] . cf]= cf/= l6= sg{/df cfdfx¿ nfdf] ;do;Dd a:g] x'gfn], kf]:6/x¿af6 /f]syfdsf pkfox¿af/] pgLx¿n] l;Sg] /fd|f] cj;/ kfpF5g\ . cfdfx¿ kvfnfsf] pkrf/, /f]syfd tyf hnljof]hg ePsf kf]:6/x¿k|lt rfv lnG5g\ . kf]:6x¿n] cf]= cf/= l6=, ;kmf kfgLsf] k|of]u, :tgkfg, kf:gLkl5sf] vfgf, xft w'g', rkL{sf] k|of]u tyf :jf:Yo ;+:yfdf aRrfnfO{ lnP/ slxn] kmls{g] cflb hfgsf/Lx¿ ;d]6]sf] x'g'k5{ . cGo ;"rgfx¿n] vf]kx¿ af/]sf] hfgsf/LnfO{ ;dfj]z u/]sf] x'g'k5{ . cfdfx¿nfO{ hfgsf/L lbgsf] nflu kf]:6/x¿ dfq} kof{Kt x'Fb}gg\ . :jf:Yo sfo{stf{x¿n] olb pknAw 5 eg]], cfdfsf] sf8{ k|of]u u/L cfdfx¿nfO{ JolQmut ¿kdf ;Nnfx lbg' kb{5 .

82

kl/lzi6 ‘u’ – ! olb ghLsdf OG6«fleg; pkrf/ pknAw 5 eg]

cfˆgf] :jf:Yo rf}sLdf tkfO{cfO= le= pkrf/ pknAw u/fpg ;Ifd x'g' x'Gg . t/\, ghLssf] pkrf/ s]Gb|cyjf c:ktfndf -! 306f leq k'Ug ;lsg]_ cfO= le= pkrf/ pknAw 5 . tnsf]

pkrf/k|0ffnL …uÚ v08nfO{ k9\g'xf];\, h;n] of] l:yltnfO{ j0f{g ub{5 .

s8f lsl;dn] hnljof]hg ePsf] aRrfnfO{ t'?Gt} ghLssf] :jf:Yo ;+:yfdf k|]if0f ug'{xf];\ . olb aRrfn] lkpg ;S5 eg], aRrfnfO{ k'gh{nLo emf]n s;/L lbg] xf], cfdfnfO{ b]vfpg'xf];\ . :jf:Yo ;+:yfdf hfFbf af6f]df cfˆgf] aRrfnfO{ lkpgsf] nflu pgn] k|f]T;flxt ug'{k5{ .

cfO{=le= pkrf/sf] nflu t'?Gt pkrf/ s]Gb| -c:ktfn_ df k|]if0f ug'{xf];\ . olb aRrfn] lkpg ;S5 eg] cfdfnfO{ k'gh{nLo emf]n lbg'xf];\ / af6f]el/ s;/L lkpg

lbg'k5{ eg]/ l;sfpg'xf];\ .

83

cEof; M kl/lzi6 ‘u’ – !

!= u0f]z ! jif{ k'u]sf] 5 / !) lsnf]u|fd tf}nsf] 5 . p;sL cfdfn] p;nfO{ kvfnf nfu]sf] x'gfn] :jf:Yo rf}sLdf NofpFl5g\ .

:jf:Yo sfo{stf{n] u0f]zdf ;fdfGotof b]lvg] vt/fsf lrGxx¿ 5}gg\ eGg] lgwf{/0f u5{g\ . pgn]

k|f]T;flxt ubf{ u0f]zn] cln cln k'gh{nLo emf]n lkpg ;S5, t/ ylst / sdhf]/ ePsf]n] /fd|/L lkpg ;Sb}g . u0f]zsf cfFvfx¿ u8]sf 5g\ / k]6sf] 5fnf cf}+nfn] tfg]/ 5f]8\bf w]/} la:tf/} kmls{G5 . :jf:Yo sfo{stf{n] u0f]zdf s8f hnljof]hg ePsf], /QmcNktf gePsf] / w]/} sd tf}n gePsf] kfpF5g\ . :jf:Yo sfo{stf{n] u0f]znfO{ pkrf/ k|0ffnL …uÚ sf] cfjZostf 5 eGg] lg0f{o u5{g\ . :jf:Yo rf}sLdf cfO=le= pks/0fx¿ 5}gg\ . !% ldg]6 6f9f Pp6f c:ktfn 5 hxfF cfO=le= pkrf/ pknAw 5 .

s= :jf:Yo sfo{stf{n] u0f]zsf] pkrf/ s;/L ug'{k5{ < v= :jf:Yo sfo{stf{n] cfdfnfO{ s:tf] ;Nnfx lbg'k5{ <

@= ( dlxgf pd]/sf] hLjg, vf]sL tyf kvfnf nfu]/ :jf:Yo rf}sLdf cfpF5 . p;n] lkpg ;Sb}g . p;sf] ;f;b/ k|lt ldg]6 %) k6s 5Ù t/ sf]vfxfg]sf] 5}g . ;fdfGotof b]lvg] vt/fsf lrGxsf] cfwf/df p;nfO{ s8f Go"df]lgof cyjf w]/} s8f /f]u ePsf] egL juL{s/0f ul/G5 . p;sf cfFvfx¿ u8]sf 5g\ tyf k]6sf] 5fnf cf}+nfn] tfg]/ 5f]8\bf w]/} la:tf/} kmls{G5 . p;nfO{ s8f hnljof]hg ePsf] eg]/ klg juL{s/0f ul/G5 . p;df cGo s'g} /f]usf juL{s/0fx¿ 5}gg\ / /QmcNktf gePsf] tyf w]/} sd tf}n gePsf] eGg] 5 . cfO= le= pkrf/ pknAw 5}g . hLjgsf] pkrf/ s;/L ul/g'k5{ <

…k|lzIf0f ;xof]uLnfO{ cfˆgf pQ/x¿ hfFRgsf] nflu eGg'xf];\ . To;kl5 v08 ^=$ — bL3{ kvfnfsf] pkrf/nfO{Ú x]g'{xf];\ tyf k9fO hf/L /fVg'xf];\ .

84

kl/lzi6 ‘u’ – @ olb tkfO{n] Gofhf]Uofl:6«s 6\o'a

-Pg=lh=_ k|of]u ug]{ tflnd k|fKt ug'{ePsf] 5 eg]

tkfO{ cfˆgf] :jf:Yo rf}sLdf cfO= le= pkrf/ lbg ;Sg' x'Gg tyf cfO= le= pkrf/ lbg ;Sg] pkrf/ s]Gb| jf c:ktfn ghLsdf 5}g, t/ olb tkfO{n] Pg= lh= 6\o'j k|of]u ug]{ tflnd k|fKt ug'{ePsf] 5 eg], Pg= lh= 6\o'aaf610 k'gh{nLo emf]n lbP/ aRrfnfO{ k'gh{nLo pkrf/ lbg ;Sg' x'G5 . tnsf] pkrf/ k|0ffnL …uÚ sf v08x¿ k9\g'xf];\ . o;df aRrfsf] k'gh{nLo pkrf/ Pg= lh= 6\o'aaf611 ug]{ r/0fx¿sf] j0f{g ul/Psf] 5 .

10 o; kl/lzi6n] tkfO{nfO{ ˆn'O8 lbgsf] nflu clxn] Pg= lh= 6\o'asf] k|of]u ug{ l;sfpFb}g . kl/lzi6 …sÚ n]

Gofhf]Uofl:6«s 6\o'a /fVg tyf k'gh{nLo pkrf/sf] 5f]6f] k'glj{rf/ pgLx¿sf] nflu ;dfj]z ub{5, h;n] klxn] tflnd lnPsf 5g\ .

11 pkrf/ k|0ffnL …uÚ cg';f/, aRrfsf] k'gh{nLo pkrf/ d'vaf6 u/] h:t} Pg= lh 6\o'aaf6 ubf{, tL g} r/0fx¿sf] kfng ul/G5 .

gfsaf6 Pg=lh= 6o'j k;fP/ k'gh{nLo emf]n lbO hnljof]hgsf] pkrf/ yfNg'xf];\ . @) ld=ln= k|lt s]=lh= k|lt 306fsf b/n] ^ 306fdf cyf{t\ s'n !@) ld=ln= k|lt s]=lh= k'gh{nLo emf]n lbg'xf];\ .

x/]s !–@ 306fleq k'gd"{Nofª\sg ub}{ /xg'xf];\ . – olb aRrfn] tf/Gtf/ afGtf u/]df jf k]6 km'Nb} uof] eg] emf]n s'/f lj:tf/} dfq lbg'xf];\ . – olb ^ 306fleq hnljof]hgsf] l:yltdf ;'wf/ cfPg eg] cfO{=le= l8«k lbg k|]if0f ug'{xf];\ .

^ 306fkl5 aRrfsf] k'gd"{Nofª\sg ug'{xf];\ . hnljof]hgsf] juL{s/0f ug'{xf];\ . To;kl5 k|0ffnL s, v, u h'g pko'Qm x'G5 To;sf] 5gf}6 ug'{xf];\ .

gf]6 M ;Dej eP, k'gh{nLo pkrf/ yfn]sf] ^ 306f;Dd aRrfsL cfdfn] d'vaf6 k'gh{nLo emf]n lbP/

aRrfsf] k'gh{nLo cj:yfnfO{ oyf :yfgdf /fVg ;lS5g\ ls ;lSbgg\ cjnf]sg ug'{xf];\ .

85

pkrf/ k|0ffnL …uÚ sf] o; c+zdf s]xL zAbx¿ tkfO{sf] nflu gofF x'g ;S5g\ . tL zAbx¿sf] cy{ oxfF lbOPsf] 5 M

* …PA8f]ldgn l8:6]G;gÚ eGgfn] k]6 km'Ng'nfO{ a'emfpF5, o;df k]6sf] 5fnf tlGsG5 . * …xfO8«];g l:yltÚ n] aRrfsf] hnljof]hgnfO{ :jfefljs ¿kdf 7Ls ul/Psf] 5 jf 5}g tyf

hnljof]hg eP To;sf] cj:yfnfO{ hgfpF5 . hnljof]hg gePsf] egL juL{s/0f ul/Psf] aRrfdf hnljof]hgsf lrGxx¿ b]lvgsf nflu kof{Kt dfqfdf z/L/af6 kfgL v]/ uPsf] x'Fb}g . s]xL hnljof]hg cyjf s8f hnljof]hg ePsf] egL juL{s/0f ul/Psf aRrfsf] z/L/df :jfefljs eGbf sd kfgL x'G5 .

aRrfsf] xfO8«];g l:yltsf] d"Nof+sg ug{, d"Nof+sg tyf juL{s/0f ug'{xf];\ eGg] tflnsfdf lbOPsf

lrGxx¿nfO{ x]g'{xf];\ . pbfx/0fM tnsf] pbfx/0fn], tkfO{n] Pg= lh= 6\o'jaf6 k'gh{nLo emf]n lbg ;Sg'x'G5 eg], s8f hnljof]hg ePsf] aRrfsf] pkrf/ s;/L ug]{ eGg] s'/fnfO{ :ki6 u5{ . $ jif{sf] -!) lsnf]u|fd_ ;dL/ eGg] Pp6f jRrfnfO{ kvfnf nfu]sf] x'Fbf :jf:Yo rf}sLdf NofOof] .

:jf:Yo rf}sLn] cfO= le= pkrf/ lbg] u/]sf] lyPg tyf ghLsdf cfO= le= pkrf/ lbg] ;+:yf lyPg . Pg= lh= pkrf/ pknAw lyof] . ;dL/ lkpg ;Sb}g lyof] . p;df cGo /f]usf lrGxx¿ lyPgg\ . p;nfO{ kvfnf eO s8f hnljof]hg ePsf] t/ /QmcNktf / w]/} sd tf}n gePsf] egL juL{s/0f ul/of] .

pkrf/ k|0ffnL …uÚ sf] cg';/0f u/L, :jf:Yo sfo{stf{n] Pg= lh= 6\o'aaf6 ;dL/nfO{ k'gh{nLo

emf]n lbg] lg0f{o u/] . :jf:Yo sfo{stf{n] Ps 306fdf @)) ld=ln= -@) ld=ln= x !) lsnf]u|fd_ k'gh{nLo emf]n p;nfO{ lbP . p;n] k|lt 306f @)) ld=ln= k'gh{nLo emf]n kfcf];\ egL lglZrt x'gsf] nflu :jf:Yo sfo{stf{n] ;dL/nfO{ x/]s 306fdf hfFr] . jRrfn] afGtf u/]sf] 5}g tyf p;sf] k]6 km'n]sf] 5}g egL 9'Ss x'gsf] nflu klg pgn] hfFr] .

^ 306fleq ;dL/n] Pg= lh= 6\o'aaf6 !@)) ld=ln= k'gh{nLo emf]n kfPsf] lyof] .

86

Pg=lh= n'O8sf] kl/df0f tyf aRrfsf] xfO8«];g l:yltsf] cg'udg ug'[xf];\ s8f hnljof]hg ePsf] aRrfsf] k'gh{nLo pkrf/ ubf{, tkfO{n] ^ 306fsf] ;dodf lbg] cfO{= le ˆn'O8sf] kl/df0fsf] cg'udg ug'{k5{ . tkfO{n] tnsf] gd"gf ˆn'O8 kmf/d h:t} kmf/d k|of]u ug{ ;Sg'x'G5 .

;do -306f_

lbg'kg]{ dfqf -ld=ln=_sf] Joj:yf


k|fKt dfqf

_______ _________ _______ _________ _________ _________ _______ _________ _________ _________ _______ _________ _________ _________ _______ _________ _________ _________ _______ _________ _________ _________ _______ _________ _________ _________

– x/]s gofF af]tn÷Kofssf nflu, ;'?sf] jf yk]sf] lbOPsf] Pg= lh= ˆn'O8sf] kl/df0fnfO{ clen]v ug{sf] nflu o; kmf/ddf $ j6f dxnx¿ 5g\ . != ;doM Pg=lh= ˆn'O8 hfFRg] ;donfO{ tkfO{ clen]v ug'{xf];\ . tkfO{ ^ 306fsf nflu x/]s 306f

ˆn'O8sf] cg'udg ug{ rfxg' x'g]5 . @= lbg'kg]{ dfqfsf] Joj:yfM ha tkfO{ Pg= lh= ˆn'O8 lbg z'? ug'{x'G5, efF8fdf ˆn'O8sf] kl/df0fnfO{

clen]v ug'{xf];\ . x/]s k6s Pg= lh= ˆn'O8sf] kl/df0fnfO{ clen]v ug'{xf];\ . x/]s k6s Pg= lh= ˆn'O8sf] efF8fnfO{ abNg] a]nfdf, kmf/dsf] ;xL 7fpFdf kl/df0fnfO{ clen]v ug'{xf];\ .

#= cg'dflgt dfqf af“sLM ;"rLa4 ul/Psf ;dox¿df efF8fdf afFsL /x]sf] Pg= lh= ˆn'O8nfO{

hfFRg'xf];\ . afFsL /x]sf] dfqfnfO{ ;xL lsl;dn] k9\g ;lsb}g . o;nfO{ !) ld=ln=sf] cf;kf; cg'dfg ug'{xf];\ -pbfx/0fsf] nflu — @@) ld=ln=, @#) ld=ln=, @$) ld=ln= cflb_ cg'dflgt kl/df0fnfO{ kmf/ddf clen]v ug'{xf];\ .

$= k|fKt dfqfM ;"rLa4 ul/Psf ;dox¿df aRrfn] k|fKt u/]sf] Pg= lh= ˆn'O8sf] kl/df0fsf] lx;fa

ug'{xf];\ . lx;fa ug{sf] nflu, kl/df0f …lbg'kg]{ dfqfsf] afFsLÚ nfO{ …dfqfsf] Joj:yfÚ af6 36fpg'xf];\ . o;sf] pQ/ tkfO{n] hfFr ul//x]sf] ;do;Dd aRrfn] k|fKt u/]sf] Pg= lh= ˆn'O8sf] kl/df0f xf] . Tof] kl/df0fnfO{ kmf/ddf clen]v ug'{xf];\ .

Pp6f lglZrt ;dodf k'Ug' kg]{ n]jnnfO{ b]vfpgsf nflu efF8fdf Pp6f k]g cyjf 6]kn] lrgf] nufpg pkof]uL x'G5 . pbfx/0fsf] nflu, klxnf] #) jf ^) ldg]6kl5, k|lt306f jf # cyjf ^ 306fsf] cGtdf k'Ugsf] nflu rflxg] n]jndf lrgf] nufpg'xf];\ . o;n] tkfO{nfO{ l8«ksf] b/nfO{ ;xL t/Lsfn] ldnfpgdf d2t ug]{5 . ˆn'O8sf] ;xL kl/df0f k|lt 306f lbgsf] nflu k|ltldg]6 yf]kfx¿sf] ;+VofnfO{ lgoldt ug'{xf];\ . pbfx/0fM

tnsf] gd"gf kmf/dn] Pg= lh= ˆn'O8sf] Tof] kl/df0fnfO{ b]vfpF5 h;nfO{ ;dL/n] :jf:Yo– rf}sLdf pkrf/ ul/+bf ^ 306fleq kfPsf] lyof] . :jf:Yo sfo{stf{n] p;nfO{ laxfg !! ah] ;'? u/L @)) ld=ln= -cyf{t\ @) ld=ln= x !) lsnf] u|fd_ k'gh{nLo emf]n Pg=lh= 6\o'aaf6 lbP .

87

n'O8 kmf/dsf] gd"gf ;do -306f_

lbg'kg]{ dfqf -ld=ln=_sf] Joj:yf


k|fKt dfqf

!!=)) ah] !))) ld=ln= !@=)) ah] _________ *)) ld=ln= @)) ld=ln= !=)) ah] _________ ^)) ld=ln= $)) ld=ln= @=)) ah] _________ $)) ld=ln= ^)) ld=ln= #=)) ah] _________ @)) ld=ln= *)) ld=ln= $=)) ah] !))) ld=ln= ) ld=ln= !))) ld=ln= %=)) ah] _________ *)) ld=ln= !@)) ld=ln=

– x/]s gofF af]tn÷Kofssf] nflu, ;'?sf] jf yk]sf]

x/]s !–@ 306fdf aRrfsf] k'gd"{Nof+sg ug'{xf];\ M

* olb aRrfn] af/Daf/ afGtf ul//x]sf] 5 cyjf p;sf] k]6 km'n]sf] 5 eg], Pg=lh= ˆn'O8 Psbd} la:tf/} lbg'xf];\ .

* olb aRrfsf] hnljof]hg # 306fkl5 klg ;'w|]g eg], aRrfnfO{ cfO= le= pkrf/sf] nflu

k|]if0f ug'{xf];\ . * olb aRrfdf ;'wf/ e}/x]sf] 5 eg], Pg=lh= ˆn'O8 hDdf ^ 306fsf] nflu lbg hf/L

/fVg'xf];\ .

hnljof]hgsf] k'gd"{Nof°g ug'{xf];\ tyf pko'Qm pkrf/ k|0ffnL 5fGg'xf];\

Pg= lh= ˆn'O8 lbPsf] ^ 306fkl5, aRrfsf] hnljof]hgsf] k'gd"{Nof+sg ug'{xf];\ . hnljof]hgsf] juL{s/0f ug'{xf];\ . pkrf/ hf/L /fVg pko'Qm pkrf/ k|0ffnL -pkrf/ k|0ffnL s, v jf u_ 5fGg'xf];\ . aRrfnfO{ k"0f{¿kdf k'gh{nLo pkrf/ lbPkl5 tyf hnljof]hg gePsf] egL juL{s/0f u/]kl5 klg, olb ;Dej 5 eg] aRrfnfO{ c¿ ^ 306fsf] nflu :jf:Yo rf}sLdf /fVg'xf];\ . o; cjlwdf, cfdfn] pkrf/ k|0ffnL …sÚ cg';f/ aRrfnfO{ yk emf]ns'/fx? lbg' k5{ . kvfnf nflu/x] z/L/af6 v]/ uPsf] ;a} emf]ns'/fx? cfk"lt{ ug{sf] nflu kof{Kt emf]ns'/fx? lbg cfdf ;Sbl5g\ ls eGg] s'/f kSsf ug'{xf];\ . aRrfnfO{ vfgf klg v'jfpg' k5{ . hnljof]hgsf lrGxx¿ km]l/ gkmls{pg\ egL lglZrt x'gsf] nflu aRrfnfO{ ;do ;dodf hfFRg'xf];\ .

88

cEof; M kl/lzi6 ‘u’ – @

!= !* dlxgfsf] -* lsnf]u|fd_ /f]lxt eGg] jRrfnfO{ kvfnf nfu]/ :jf:Yo rf}sLdf NofOof] . :jf:Yo sfo{stf{n] aRrfsf] k"0f{¿kdf d"Nof+sg u5{g\ . /f]lxt rgfvf] b]lvG5 . /f]lxt lkpg ;S5 t/ lj:tf/} lkpg ;s]sf] :jf:Yo sfo{stf{n] kfP . k]6sf] 5fnf cf}+nfn] tfg]/ 5f]8\bf w]/} la:tf/} kmls{G5 . :jf:Yo sfo{stf{n] p;nfO{ kvfnf nfu]/ s8f hnljof]hg ePsf], /QmcNktf tyf w]/} sd tf}n gePsf] egL juL{s/0f u5{g\ . s8f hnljof]hgsf] nflu aRrfnfO{ pkrf/ k|0ffnL …uÚ cg';f/ ˆn'O8 rflxG5 . cfO= le= pkrf/ pknAw u/fpg] ghLssf] c:ktfn @ 306fsf] af6f] hlt 6f9f 5 . :jf:Yo sfo{stf{n] Gofhf]Uofl:6«s pkrf/ lbg] tflnd kfpg' ePsf] 5 .

s= /f]lxtnfO{ k'gh{nLo pkrf/ s;/L lbg'knf{ < v= /f]lxtnfO{ k|lt306f slt k'gh{nLo emf]n lbg'knf{ < u= ! 306fkl5 x]bf{ /f]lxtn] af/Daf/ afGtf ul//x]sf] kfOof] . :jf:Yo sfo{stf{n] s] ug'{knf{ < 3= # 306fkl5, klg /f]lxtsf] hnljof]hgsf lrGxx¿df ;'w|f/ ePsf] 5}g . ca :jf:Yo

sfo{stf{n] s] ug'{knf{ <

89

@= ;l/tfsf] pd]/ ( dlxgf ePsf] 5 . pgL ^ lsnf]u|fdsL l5g\ . p;nfO{ ! xKtfb]lv kvfnf nfu]sf] x'gfn] cfdfn] :jf:Yo rf}sLdf lnP/ cfOg\ .

aRrLn] w]/}a]/ :tgkfg ulb{gg\ tyf pgL Psbd} un]sLn] skaf6 lkpg klg ;lSbgg\ . :jf:Yo

sfo{stf{ ;l/tfsf] d"Nof+sg u5{g\ . pgL ;':t l5g\, cfFvfx¿ u8]sf 5g\ tyf k]6sf] 5fnf cf}+nfn] tfg]/ 5f]8\bf w]/} la:tf/} kmls{G5 eGg] :jf:Yo sfo{stf{n] kfP . :jf:Yo sfo{stf{n] ;l/tfnfO{ kvfnf nfu]/ s8f hnljof]hg ePsf], /QmcNktf gePsf] / w]/} sd tf}n gePsf] egL juL{s/0f u5{g\ .

:jf:Yo sfo{stf{n] ;l/tfnfO{ pkrf/ k|0ffnL …uÚ cg';f/ Pg= lh= 6\o'aaf6 k'gh{nLo pkrf/ lbg]

lg0f{o u5{g\ . :jf:Yo sfo{stf{n] ( ah] !))) ld=ln= k'gh{nLo emf]n lbg] Joj:yf ldnfpF5g\ .

s= :jf:Yo sfo{stf{n] ;l/tfnfO{ slt Pg= lh= ˆn'O8 k|lt 306f lbg'knf{ < v= :jf:Yo sfo{stf{n] ;l/tfsf] nflu Pg= lh= ˆn'O8sf] Joj:yf ldnfpFbf tnsf] gd"gf kmf/d

s;/L eg'{knf{ < u= tkfO{ cfFkm}n] ;l/tfsf] nflu Pg= lh= ˆn'O8sf] Joj:yf ldnfpFbf tnsf] gd"gf kmf/d s;/L

eg'{x'G5 <

;do -306f_

lbg'kg]{ dfqfsf] -ld=ln=_ Joj:yf


k|fKt dfqf

(=)) !))) !)=)) _________ !!=)) _________ !@=)) _________ !=)) _________ @=)) _________ #=)) _________ – x/]s gofF af]tn÷Kofssf nflu, ;'?sf] jf yk]sf]

3= !) ah] :jf:Yo sfo{stf{n] ˆn'O8 KofsnfO{ hfFRb5g\ . *^) ld=ln= ˆn'O8 afFsL 5 . o;nfO{ kmf/fddf clen]v ug'{xf];\ tyf ;l/tfn] k|fKt u/]sf] dfqfsf] lx;fa ug'{xf];\ .

90

ª= :jf:Yo sfo{stf{n] x/]s !–@ 306fdf ;l/tfsf] cg'udg ub{5g\ . :jf:Yo sfo{stf{n] s] s] s'/f x]g'{ knf{ <

r= # 306f ;Dd Pg= lh= ˆn'O8 lbPkl5 ;l/tfsf] cj:yf ;'lw|b}+ hfG5 . :jf:Yo sfo{stf{n] Pg=

lh= pkrf/ hf/L /fV5g\ . ^ 306fkl5, :jf:Yo sfo{stf{n] ;l/tfsf] k"gd"{Nofsg u5{g\ . To;a]nf p rgfvf] b]lvG5] . ca cfFvfx¿ u8]sf 5}gg\ tyf k]6sf] 5fnf cf}+nfn] tfg]/ 5f]8\bf t'?Gt} kmls{G5 . Ps sk ;kmf lkpg] kfgL lb+bf ;l/tfn] To;nfO{ lkpF5] . ;l/tfnfO{ s;/L juL{s/0f ug]{ <

5= To;kl5 :jf:Yo sfo{stf{n] s] ug'{knf{ <

#= ( dlxgfsf] ho, vf]sL / kvfnf nfu]sf] x'gfn] :jf:Yo rf}sLdf cfpF5 . p;n] lkpg ;Sb}g . p;sf] ;f;b/ k|lt ldg]6 %) eGbf a9L 5Ù t/ sf]vf xfg]sf] 5}g . ;fdfGotof b]lvg] vt/fsf lrGxx?n] ubf{, p;nfO{ s8f Go"df]lgof jf w]/} s8f /f]u egL juL{s/0f ul/G5 . p;sf cfFvfx¿ u8]sf 5g\ tyf k]6sf] 5fnf cf}+nfn] tfg]/ 5f]8\bf w]/} la:tf/} kmls{G5 . p;nfO{ kvfnf eO s8f hnljof]hg ePsf] eg]/ klg juL{s/0f ul/G5 . p;df c¿ /f]usf juL{s/0fx¿ 5}gg\ / /QmcNktf tyf w]/} sd tf}n klg 5}g .

hosf] pkrf/ s;/L ul/g' k5{ <

cfˆgf pQ/x¿ hfFRgsf] nflu k|lzIf0f ;xof]uLnfO{ eGg'xf];\ . To;kl5 …bL3{ emf8fkvfnsf] pkrf/Ú eGg] v08 ^=$ nfO{ x]g'{xf];\ tyf k9\g hf/L/fVg'xf];\ .

91

kl/lzi6 ‘u’ – #

olb tkfO{ pkrf/ k|0ffnL ‘u’ s]jn d'vaf6 -lkpg lbP/_ dfq lbg ;Sg'x'G5 eg]

tkfO{ cfˆgf] :jf:Yo ;+:yfdf cfO= le= ˆn'O8 lbg ;Sg' x'Gg . ghLsdf cfO= le= pkrf/ lbg ;Sg] pkrf/ s]Gb| cyjf s'g} c:ktfn 5}g . k'gh{nLo pkrf/sf] nflu Pg= lh= 6\o"j k|of]u ug{df tkfO{ tflnd k|fKt x'g'x'Gg . d'vaf6 pkrf/ k|0ffnL …uÚ lbg l;Sgsf] nflu, tn pkrf/ k|0ffnL …uÚ sf v08x¿ k9\g'xf];\ . tL v08x¿nfO{ Wofgk"j{s k9\g'xf];\ .

gfsaf6 Pg=lh 6o'j k;fP/ k'gh{nLo emf]n lbO hnljof]hgsf] pkrf/ yfNg'xf];\ . @) ld=ln= k|lt s]=lh= k|lt 306fsf b/n] ^ 306fdf cyf{t\ s'n !@) ld=ln= k|lt s]=lh= k'gh{nLo emf]n lbg'xf];\ .

x/]s !–@ 306fleq k'gd"{Nofª\sg ub}{ /xg'xf];\ . – olb aRrfn] tf/Gtf/ afGtf u/]df jf k]6 km'Nb} uof] eg] emf]n s'/f lj:tf/} dfq lbg'xf];\

. – olb ^ 306fleq hnljof]hgsf] l:yltdf ;'wf/ cfPg eg] cfO{=le= l8«k lbg k|]if0f

ug'{xf];\ . ^ 306fkl5 aRrfsf] k'gd"{Nofª\sg ug'{xf];\ . hnljof]hgsf] juL{s/0f ug'{xf];\ . To;kl5 k|0ffnL s,

gf]6 M ;Dej eP, k'gh{nLo pkrf/ yfn]sf] ^ 306f;Dd aRrfsL cfdfn] d'vaf6 k'gh{nLo emf]n lbP/

aRrfsf] k'gh{nLo cj:yfnfO{ oyf :yfgdf /fVg ;lS5g\ ls ;lSbgg\ cjnf]sg ug'{xf];\ .

92

olb s8f hnljof]hg ePsf] aRrf tkfO{sf] :jf:Yo ;+:yfdf cfpF5 tyf tkfO{ cfO= le= cyjf Pg= lh= pkrf/ lbg ;Sg' x'Gg eg], aRrfn] lkpg ;S5 ls ;Sb}g egL kQf nufpg'xf];\ .

olb p lkpg ;S5 eg], tkfO{n] aRrfnfO{ d'vaf6 k'gh{nLo pkrf/ lbg] k|of; ug{ ;Sg'x'G5 .

olb aRrfn] lkpg ;Sb}g eg], tkfO{n] p;nfO{ t'¿Gt} ;a}eGbf ghLssf] cfO= le= cyjf

Pg lh= pkrf/ pknAw x'g;Sg] pkrf/ s]Gb| cyjf c:ktfndf k|]if0f ug'{k5{ . olb o:tf] aRrfn] ˆn'O8\; kfPg eg], dg]{5 .

pkrf/ k|0ffnL …uÚ sf] o; v08df ePsf s]xL zAbx¿ tkfO{+sf] nflu gofF x'g ;S5g\ . lgDglnlvt JofVofx¿n] ltgLx¿nfO{ a'‰gdf tkfO{nfO{ d2t ug]{5g\ . * …PA8f]ldgn l8:6]G;gÚ eGgfn] k]6 km'Ng] a'emfpF5 . o;df k]6sf] 5fnf tlGsG5 . * xfO8«];g l:yltn] aRrfsf] hnljof]hgnfO{ :jefljs ¿kdf 7Ls ul/Psf] 5 jf 5}g tyf

hnljof]hg eP To;sf] cj:yfnfO{ hgfpF5 . hnljof]hg gePsf] egL juL{s/0f ul/Psf] aRrfdf hnljof]hgsf lrGxx¿ b]lvgsf] nflu kof{Kt dfqfdf z/L/af6 kfgL v]/ uPsf] x'Fb}g . s]xL hnljof]hg cyjf s8f hnljof]hg ePsf] egL juL{s/0f ul/Psf] aRrfsf] z/L/df :jefljs eGbf sd kfgL x'G5 .

aRrfsf] xfO8«];g l:yltsf] d"Nof+sg ug{, …d"Nof+sg tyf juL{s/0f ug'{xf];\Ú eGg] tflnsfdf lbOPsf lrGxx¿nfO{ x]g'{xf];\ .

k'gh{nLo emf]nsf] kl/df0fsf] cg'udg ug'{xf];\ olb tkfO{n] aRrfnfO{ v'jfP/ k'gh{nLo pkrf/ ug{ nfUg' ePsf] 5 eg], tkfO{n] p;nfO{ lbg] k'gh{nLo emf]nsf] kl/df0fsf] cg'udg ug'{kg]{ x'G5 . z/L/sf] tf}nsf] k|lt lsnf]u|fd k|lt 306f @) ld=ln= sf lx;fan] ^ 306fsf] nflu lbg'xf];\ . ^ 306fkl5 tkfO{n] aRrfnfO{ hDdf !@) ld=ln= k'gh{nLo emf]n p;sf] z/L/sf] k|lt lsnf]u|fdsf] cg'kftdf lbg' kb{5 . x/]s !–@ 306fdf aRrfdf hnljof]hgsf] cj:yfsf] k'gd{"Nof+sg ug'{xf];\ . * olb aRrfn] af/Daf/ jfGtf ul//x]sf] 5 jf p;sf] k]6 km'n]sf] a9\b} 5 eg], k'gh{nLo emf]n

cln la:tf/} lbg'xf];\ . * aRrfsf] xfO8«];g l:ylt # 306fkl5 klg ;'lw|Pg eg], aRrfnfO{ cfO= le= pkrf/sf] nflu

k|]if0f ug'{xf];\ .

pbfx/0fM nf}sL :jf:Yo rf}sLdf cfO= le= jf Pg= lh= pkrf/ pknAw 5}g . cfO= le= jf Pg= lh= pkrf/

lbg ;Sg] ;a}eGbf ghLssf] c:ktfn hfg @ 306f nfU5 . !% dlxgfsf] -& lsnf]u|fd_ rGbf eGg] jRrLnfO{ nf}sL :jf:Yo rf}sLdf cfdfn] lnP/ cfOg\ . rGbf

lgbfP h:tL b]lvGyL t/ p7fP/ kfgL lkpg lb+bf eg] cln cln lkpg ;SyL . :jf:Yo sfo{stf{n] p;sf cfFvfx¿ u8]sf] kfP . k]6sf] 5fnf cf}+nfn] tfg]/ 5f]8\bf w]/} la:tf/} kmls{GYof] . p;nfO{ kvfnf nfu]/ s8f hnljof]hg ePsf], /QmcNktf tyf w]/} sd tf}n gePsf] egL juL{s/0f ul/of] .

93

:jf:Yo sfo{stf{n] rGbfnfO{ pkrf/ k|0ffnL …uÚ cg';f/sf] k'gh{nLo pkrf/ lbg] lg0f{o ug'{ eof] .

rGbfsf] tf}n & lsnf] ePsfn], :jf:Yo sfo{stf{n] lx;fj u/L yfxf kfP ls pgnfO{ k'gh{nLo emf]n !$) ld=ln= k|lt 306fsf] lx;fan] rflxGYof] . :jf:Yo sfo{stf{n] rGbfsL cfdfnfO{ Ps 306fdf slt k'gh{nLo emf]n lbg] egL b]vfpg' eof] .

306fsf] cjlwdf k|To]s ! 306fdf, :jf:Yo sfo{stf{n] p;n] jfGtf ul//x]sL 5}g tyf p;sf] k]6

km'n]sf] 5}g egL lglZrt x'gsf] nflu rGbfsf] hfFr u/] . :jf:Yo sfo{stf{n] p;sf] xfO8«];g l:ylt klg hfFr] . rGbfdf ;'wf/ cfpg yfn]kl5, :jf:Yo sfo{stf{n] cfdfnfO{ rGbfsf] k'gh{nLo pkrf/ hf/L /fVg k|f]T;flxt u/] .

hnljof]hgsf] k'gd"{Nof°g ug'{xf];\ tyf pko'Qm pkrf/ k|0ffnL 5fGg'xf];\ k'gh{nLo emf]n lkpg yfn]sf] ^ 306fkl5, aRrfdf hnljof]hgsf] k'gd"{Nof°g ug'{xf];\ . hn– ljof]hgsf] juL{s/0f ug'{xf];\ . pko'Qm pkrf/ k|0ffnL -k|0ffnL s, v, jf u_ 5fGg'xf];\ tyf pkrf/ hf/L /fVg'xf];\ . k'gh{nLo pkrf/ k"/f ePkl5 klg olb ;Dej eP c¿ ^ 306fsf] nflu aRrfnfO{ :jf:Yo rf}sLdf /fVg'xf];\ . o; cjlwdf, pkrf/ k|0ffnL …sÚ cg';f/ aRrfnfO{ yk emf]ns'/fx? lbgsf] nflu cfdfnfO{ k|f]T;flxt ug'{xf];\ . kvfnf hf/L /x] klg, v]/ uPsf] kfgLsf] k"lt{ ug{ cfdfn] kof{Kt emf]ns'/fx? lblG5g\ egL lglZrt x'gsf] nflu pgnfO{ x]b}{ ug'{xf];\ . hn ljof]hgsf lrGxx¿ km]l/ gkmls{pg\ egL lglZrGt x'gsf] nflu aRrfnfO{ ;do ;dodf hfFRg'xf];\ . ;Demg'xf];\

olb aRrfn] lkpg ;Sb}g eg], cfO= le= cyjf Pg= lh= pkrf/sf] nflu aRrfnfO{ t'?Gt} ghLssf] pkrf/ s]Gb| jf c:ktfndf k|]if0f ug'{xf];\ . olb o:tf] aRrfn] Nkm'O8\; kfPg eg], p dg]{5 .

94

cEof; M kl/lzi6 ‘u’ – #

!= @ jif{sf] -!@ lsnf]u|fd_ aRrf Hof]ltdf, kvfnf nfuL s8f hnljof]hg ePsf], t/ /QmcNktf tyf w]/} sd tf}n gePsf] eGg] juL{s/0f 5 . p;nfO{ cfO= le= pkrf/sf] cfjZostf 5, t/ tkfO{sf] :jf:Yo rf}sLdf cfO= le= cyjf Pg= lh= pkrf/ pknAw 5}g . tkfO{ Hof]ltnfO{ s]xL 3'6\sf] k'gh{nLo emf]n v'jfpg ;Ifd x'g'x'G5 .

s= tkfO{n] Hof]ltnfO{ t'?Gt} k|]if0f ug'{k5{ ls k'gh{nLo pkrf/ ug]{ k|of; ug'{k5{ < v= tkfO{n] p;nfO{ slt k'gh{nLo emf]n lbg'k5{ < u= Hof]lt 3l/ 3l/ jfGtf u5{ . tkfO{n] s] ug'{k5{ < 3= # 306fkl5 tkfO{n] Hof]ltnfO{ ;':t kfpg' x'G5 . p w]/} yfs]sf]n] lkpgdf sl7gfO 5 .

cfFvfx¿ u8]sf 5g\ tyf k]6sf] 5fnf cf}+nfn] tfg]/ 5f]8\bf w]/} la:tf/} kmls{G5 . ca tkfO{n] s] ug'{k5{ <

95

@= !% lsnf]u|fd tf}nsf] ljho eGg] jRrfnfO{ kvfnf nfu]sf] 5 . p;sf a'afn] p;nfO{ ghLssf] :jf:Yo rf}sLdf Nofpg' x'G5 . :jf:Yo sfo{stf{n] ljhodf Pp6f ;fdfGotof b]lvg] vt/fsf] lrGx, ;':t kfpg' x'G5 . pxfFn] ljhosf cfFvfx¿ u8]sf] tyf k]6sf] 5fnf cf}+nfn] tfg]/ 5f]8\bf w]/} la:tf/} kms]{sf] kfpg' x'G5 . :jf:Yo sfo{stf{n] p;nfO{ kvfnf nfu]/ s8f hnljof]hg ePsf], /QmcNktf tyf w]/} sd tf}n gePsf] egL juL{s/0f ug'{x'G5 . To; :jf:Yo rf}sLdf cfO= le= cyjf Pg= lh= ;fdu|Lx¿ 5}gg\ . ;a} eGbf ghLssf] c:ktfn @ 306f eGbf 6f9f 5 . :jf:Yo sfo{stf{n] ljhonfO{ s]xL 3'6\sf] k'gh{nLo emf]n lkpgsf] nflu k|f]T;flxt ug'{x'G5 . aRrfn] la:tf/} lkpF5 .

s= ljhosf] a'afn] p;nfO{ cfpFbf] ! 306fdf slt k'gh{nLo emf]n v'jfpg'knf{ < # 306fkl5, :jf:Yo sfo{stf{n] ljhosf] k'gd"{Nof+sg ug{'x'G5 tyf p;nfO{ a9L rgfvf] / p;sf] xfO8«];g l:ylt ;'wf/ ePsf] kfpg'x'G5 . jxfFn] ljhonfO{ c¿ # 306fsf] nflu k'gh{nLo emf]n lbg hf/L /fVg'x'G5 . To;kl5 :jf:Yo sfo{stf{n] ljhosf] k'gd"{Nof+sg ug'{x'G5 tyf p;df s]xL hn ljof]hg ePsf] egL juL{s/0f ug'{x'G5 . v= ca :jf:Yo sfo{stf{n] s] ug'{knf{ < u= :jf:Yo sfo{stf{n] ljho / p;sf] a'afnfO{ slt ;do;Dd :jf:Yo rf}sLdf a:gsf] nflu

k|f]T;flxt ug'{knf{ < lsg <

96

#= xh'/ cfdfn] cfˆgf] gflt nlntnfO{ :jf:Yo rf}sLdf lnP/ cfpFl5g\ lsgls pgsf] ljrf/df nlnt dg]{ cj:yfdf k'u]sf] 5 . pgL nlntnfO{ ljut s]xL lbgb]lv kvfnf nfu]sf] s'/f :jf:Yo sfo{stf{nfO{ atfpFl5g\ . :jf:Yo sfo{stf{n] nlntnfO{ hufpg ;Sb}gg\ . nlnt a]xf]z cj:yfdf 5 eGg] s'/f pgL lgwf{/0f u5{g\ . nlntsf cfFvfx¿ u8]sf 5g\ tyf k]6sf] 5fnf cf}+nfn] tfg]/ 5f]8\bf w]/} la:tf/} kmls{G5 . nlntnfO{ kvfnf nfuL s8f hnljof]hg ePsf], /QmcNktf tyf w]/} sd tf}n gePsf] egL juL{s/0f ul/G5 . To; :jf:Yo rf}sLdf cfO= le= cyjf Pg= lh= ;fdu|Lx¿ 5}gg\ .

:jf:Yo sfo{stf{n] nlntnfO{ arfpgsf] nflu emf]ns'/fx?sf] cfjZostf 5 egL ;Demfp5g\ .

pgn] nlntnfO{ rflxg] Nkm'O8\; :jf:Yo rf}sLdf lbg ;lsb}+g eGg] s'/f xh'/ cfdfnfO{ atfp5g\ / c:ktfndf 8fS6/x¿ x'G5g\ h;n] nlntnfO{ d2t ug{ ;S5g\ egL ;DemfpF5g\, t/ c:ktfn @ 306f 6f9f 5 .

:jf:Yo sfo{stf{n] s] ug'{knf{ < $= ( dlxgfsf] aRrf ho]Gb|, vf]sL tyf kvfnf nfu]/ :jf:Yo rf}sLdf cfpF5 . p lkpg ;Sb}g .

p;sf] ;f;b/ k|lt ldg]6 %% eGbf a9L 5, t/ p;sf] sf]vfxfg]sf] 5}g . ;fdfGotof b]lvg] vt/fsf lrGxn] ubf{, p;nfO{ s8f Go"df]lgof jf w]/} s8f /f]u nfu]sf] egL juL{s/0f ul/G5 . p;sf cfFvfx¿ u8]sf 5g\ tyf k]6sf] 5fnf cf}+nfn] tfg]/ 5f]8\bf w]/} la:tf/} kmls{G5 . p;nfO{ kvfnf nflu s8f hnljof]hg ePsf] eg]/ klg juL{s/0f ul/G5 . p;df c¿ /f]usf juL{s/0fx¿ 5}gg\, /QmcNktf tyf w]/} sd tf}n gePsf] eGg] 5 .

ho]Gb|sf] pkrf/ s;/L ul/g'k5{ <

k|lzIf0f ;xof]uLnfO{ cfˆgf pQ/x¿ hfFRgsf] nflu eGg'xf];\ . To;kl5, v08 ^=$ – bL3{ kvfnfsf] pkrf/nfO{ x]g'{xf];\ tyf k9fO hf/L /fVg'xf];\ .

97

kl/lzi6 ‘3’

s8f hnljof]hgsf] nflu OG6«fleg; pkrf/

!= pkof]u ug]{ ;Lk M cfO= le= Nkm'O8\; lbg] ;Lk s'g} cg'ejL JolQmåf/f s]jn k|of]ufTds ljlwaf6 dfq l;sfpg

;lsG5 . s]jn tflnd k|fKt JolQmx¿n] dfq cfO= le= pkrf/ lbg'k5{ . s]xL ;fdfGo hfgsf/Lx¿ o; k|sf/ 5g\ M

* cfO= le= pkrf/df k|of]u ePsf ;'O{, gnL, af]tn tyf emf]ns'/fx? lgd{nLs[t x'g' clt

cfjZos 5 . * s'g} klg ;lhn};+u k]mnfkfg]{ g;fdf cfO= le= pkrf/ lbg ;lsG5 . ;a}eGbf ;lhn} km]nf kg]{

g;fx¿ ;fwf/0ftof s'lxgfsf] cufl8 cyjf xftsf] k5fl8kl§ x'G5 . lzz'x¿df, ;lhn} km]nf kg]{ g;fx¿ 6fpsfsf] 5]plt/ x'G5g\ .

3fF6Lsf g;fx¿sf] k|of]u ug'{ cyjf g;f kQf nufpgsf] nflu ;fwf/0ftof 5fnf sf6\g]

cfjZostf kb}{g / ;Dej eP;Dd 5fnf sf6\g] sfo{ ug'{ x'Fb}g . t'?Gt} arfpg' kg]{ cj:yfx¿df eg], lkmdf]/n12 g;fdf ;'O{ nufpg ;lsG5 . ;'O{nfO{ /fd|/L

c8fpg' k5{ / ;s];Dd rfF8f] x6fpg' k5{ . s8f hnljof]hgsf s]xL cj:yfx¿df ljz]if u/L jo:sx¿df ˆn'O8 lbgsf] nflu @ j6f

g;fx¿sf] cfjZostf kg{ ;S5 . la/fdLsf] hnljof]hg 7Ls ePkl5 Pp6f g;faf6 eg] ;'O{ x6fpg ;lsG5 .

* g;faf6 ˆn'O8 lb+bf, ˆn'O8 lbg] af]tnx¿df slt ;dodf slt ˆn'O8 hfg'kg]{ xf] ;f] s'/f

;+s]t ug]{ lrgf] nufpg'xf];\ . lrgf] nufPcg';f/ ˆn'O8 uP guPsf] x]/L ;do ;dodf k|ltldg]6 emg]{ ˆn'O8sf] yf]kfsf] ;+Vof 36fpg] a9fpg] ug'{k5{ . ˆn'O8sf] ;xL kl/df0f k|lt306f lbgsf] nflu yf]kfx¿sf] ;+VofnfO{ k|ltldg]6sf] lx;fan] lgoldt kfg'{xf];\ .

@= OG6«fleg; OGo'hgsf nflu ;f]No';g -emf]n_ x¿ cfO= le= ;f]No';gx¿ w]/} lsl;dsf pknAw 5g\, t/ s8f hnljof]hg ePsf la/fdLx¿nfO{

rflxg] sG;]G6«];gdf s]xL On]S6«f]nfO6x¿sf] sdL tL ;a}df x'G5 .

12 lkmdf]/n g;f v'§fsf] d'Vo g;f xf] . of] lkmdf]/n /QmgnL 7Ls leqkl§ cjl:yt x'G5 . lkmdf]/n cf6{/L -g;f_ v'§fsf]

d'Vo cf6{/L -g;f_ xf] . o;sf] w8\sgnfO{ sf5df cg'ej ug{ ;lsG5 .

98

kof{Kt dfqfdf On]S6«f]nfO6sf] cfk"lt{ lglZrt ug{, cfO=le= pkrf/ rln/x]s} a]nf klg s]xL

k'gh{nLo emf]n la/fdLn] lkpg ;Sg] lalQs} lkpg lbg'k5{ . tnsf] 5f]6f] 5nkmn s]xL cfO= le= ;f]No';gx¿sf] u'0f;DaGwL xf] .

pko'Qm ;f]No';g l/Ë;{ n]S6]6 ;f]No';g, -o;nfO{ ;'O{af6 lbg] xf6{DofG; ;f]No';g klg elgG5_, ;a} eGbf a9L

Jofkfl/s ¿kdf pknAw x'g] ;f]No';g xf] . o;n] kof{Kt dfqfdf ;f]l8odsf] sG;G6«];g tyf oy]i6 n]S6]6 k"lt{ u5{ h'g Pl;8f]l;; 7Ls ug{sf] nflu jfOsfjf]{g]6df kl/0ft x'G5 .

s'g} klg sf/0faf6 cfsl:ds kvfnf nfuL x'g] hnljof]hgsf] nflu ;a} pd]/sf aRrfx¿df l/Ë;{

n]S6]6 k|of]u ug{ ;lsG5 . k'gh{nLo emf]nsf] l56f] Joj:yf tyf vfgfsf] l56f] z'?jftn] rflxg] kl/df0fdf kf]6fl;od / Un'sf]hsf] cfk"lt{ u5{ .

cGo pkof]uL ;f]No';gx¿ lgDglnlvt pkof]uL ;f]No';gx¿n] la/fdLnfO{ kof{Kt kf]6fl;od, afOsfaf]{g]6 / ;f]l8od pknAw

gu/fpg ;S5g\ . To;sf/0f hlt rfF8f] la/fdLn] lkpg ;S5 k'gh{nLo emf]n lkpg lbg'k5{ gd{n ;nfOg, o; lsl;dsf] ;nfOgnfO{ cfO;f]6lgs jf lkmlhof]nlhsn ;nfOg klg elgG5, of]

k|foM ;lhn} pknAw x'G5 . o;n] Pl;8f]l;;nfO{ 7Ls kfb}{g . o;n] v]/ uPsf] kf]6fl;odnfO{ k"lt{ ub}{g . ;f]l8od afOsfaf]{g]6 jf ;f]l8od n]S6]6 tyf kf]6fl;od Snf]/fO8nfO{ Pp6} ;dodf lbg ;lsG5 . o;sf] nflu ;fjwfgLk"j{s kl/df0fx¿sf] lx;fa ug'{kg]{ x'G5 tyf cg'udg ug{ sl7g x'G5 .

%∞ 8]S:6«f]hdf xfkm gd{n ;nfOgdf hnljof]hgnfO{ k|efjsf/L ¿kdf 7Ls ug{sf] nflu rflxg]

eGbf sd ;f]l8od Snf]/fO8 x'G5 . gd{n ;nfOgn] h:t} o;n] klg Pl;8f]l;;nfO{ 7Ls ub}{g g t v]/ uPsf] kf]6fl;odnfO{ g} k"lt{ u5{ .

cg'kof]uL ;f]No';gx? hnljof]hgsf] pkrf/df ;fbf Un'sf]h tyf 8]S:6«f]h ;f]No';gx¿nfO{ k|of]u ug{ x'Fb}g . ltgn] s]jn

kfgL / rLgL dfq} pknAw u/fpF5g\ . ltgdf On]S6«f]nfO6x¿ x'Fb}gg\ . ltgn] On]S6«f]nfO6sf] sdL cyjf Pl;8f]l;;nfO{ 7Ls ub}{gg\ .

99

kl/lzi6 ‘ª’

hxf“ k|]if0f ;Dej 5}g

w]/} s8f /f]ux¿ nfu]sf] aRrfsf] nflu pQd ;DefJo pkrf/ ;fwf/0ftof c:ktfndf x'G5 . slxn] sfxL+ k|]if0f ;Dej / plrt gx'g;S5 . c:ktfn;Ddsf] af6f] w]/} 6f9f x'g;S5, c:ktfndf dgUo cf}hf/x¿ gx'g ;S5g\ cyjf aRrfsf] x]/rfx ug{sf] nflu kof{Kt sd{rf/Lx¿ gx'g ;S5g\ . oftfoftsf] ;'ljwf pknAw gx'g ;S5 . slxn] sfxL+ o;sf] cfjZostfaf/] :jf:Yo sfo{stf{n] ;DemfpFbf klg cleefjsx¿n] aRrfnfO{ c:ktfn n}hfg c:jLsf/ ug{ ;S5g\ . olb k|]if0f ;Dej 5}g eg], aRrfsf] x]/rfxsf] nflu tkfO{n] kl/jf/nfO{ h] hlt ;Sg' x'G5 ;xof]u ug'{k5{ . s8f lsl;dn] la/fdL ePsf t/ k|]if0f ug{ ;Dej gePsf aRrfx¿sf] d[To'b/ 36fpgdf ;xof]u k'¥ofpgsf] nflu tkfO{n] aRrfnfO{ :jf:Yo ;+:yfdf cyjf ghLs} a:gsf] nflu Joj:yf ldnfpg ;Sg' x'G5, hxfF p;nfO{ lbgdf w]/} k6s x]g{ ;lsof];\ . olb ;f] ;Dej geP, 3/df uP/ aRrf hfFRg] Joj:yf ug'{xf];\ . o; kl/lzi6n] ljz]if s8f /f]usf] juL{s/0fx¿df k/]sf, t/ k|]if0f ug{ g;lsg] aRrfx¿sf] nflu lbOg] pkrf/sf] j0f{g u5{ . o;nfO{ @ efudf ljeflht ul/Psf] 5 M …cfjZos x]/ljrf/Ú tyf …pkrf/ lgb]{zgx¿ M s8f lsl;dn] la/fdL ePsf, t/ k|]if0f ug{ g;lsg] aRrfx¿sf] nflu, ljz]if pkrf/ s;/L lbg] eGg]jf/] l;kmfl/zx? .Ú kl/lzi6sf] k|of]u ug{, ;j{k|yd aRrfsf juL{s/0fx¿ kQf nufpg'xf];\ tyf rflxg] cfjZos x]/ljrf/nfO{ n]Vg'xf];\ . To;kl5 afn–pkrf/ tflnsfsf sf]7fx¿ tyf kl/lzi6sf] bf];|f] efusf lgb]{zgx¿nfO{ x]g'{xf];\ . aRrfnfO{ :jf:Yo rf}sL cyjf 3/df ljz]if ;dox¿df pkrf/ lbg ufx|f] x'g ;S5, To;}n] pkrf/ lgb]{zgx¿n] ljleGg lsl;dsf cf}iflwx¿ lbgsf] nflu ^ 306f, * 306f tyf !@ 306fdf lbOg] dfqf ;"rLx¿ ;dfj]z u/]sf] 5 . s8f juL{s/0fdf gk/]sf aRrfx¿nfO{ klg tkfO{n] pkrf/ lbg'k5{ eGg] s'/f gla;{g'xf];\ . s'g aRrfnfO{ s:tf] pkrf/ lbg] eGg] s'/f la/fdL aRrfsf] clen]v kmf/ddf lrgf] nufpg' k5{ . pbfx/0fsf] nflu, olb aRrfnfO{ s8f Go"df]lgof tyf cf}nf]] ePsf] 5 eg], tkfO{n] cf}nf]sf] pkrf/ ug'{ k5{ clg s8f Go"df]lgofsf] pkrf/ ug{ tnsf lgb]{zgx¿sf] cg';/0f ug'{k5{ . s]jn ;fwg ;DkGg tyf tflnd k|fKt sd{rf/Lx¿ ePsf] c:ktfnn] dfq s8f lsl;dn] la/fdL ePsf] aRrfsf] nflu ;xL x]/ljrf/ lbg ;S5 . oL lgb]{zgx¿sf] cg';/0f ugf{n] To:tf c:ktfnx¿df k|]if0f ;Dej gePsf] cj:yfdf klg pRr vt/fdf k/]sf aRrfx¿sf] d[To'nfO{ 36fpg ;S5 .

100

ljifo;"rL cfjZos x]/ljrf/ M @ dlxgfb]lv % jif{;Ddsf] la/fdL aRrf

s8f Go"df]lgof jf w]/} s8f /f]u ............................................................................................ !)!

s8f bL3{ kvfnf .................................................................................................................... !)#

w]/} s8f Hj/f]hGo /f]u ........................................................................................................... !)#

s8f hl6n bfb'/f ................................................................................................................... !)%

Dof:6f]]O8fOl6; ...................................................................................................................... !)%

s8f lz3| s'kf]if0f .................................................................................................................. !)%

s8f /QmcNktf ..................................................................................................................... !)*

#) lbg eGbf nfdf] vf]sL ..................................................................................................... !)*

sDkg ..................................................................................................................................... !)(

cfjZos x]/ljrf/ M @ dlxgf;Ddsf] la/fdL lzz'

AofS6]l/ofsf] ;Defljt uDeL/ ;ª\qmd0f ............................................................................... !!)

pkrf/ lgb]{zgx¿ M

h]G6fdfOl;g............................................................................................................................ !!!

PlDkl;lng .............................................................................................................................. !!!

lSjgfOg ..................................................................................................................................!!@

dfqf ;"rLx¿ Mk|To]s ^ 306f ................................................................................................. !!#

k|To]s * 306f........................................................................................................... !!#

k|To]s !@ 306f ........................................................................................................ !!$

/utdf rLgLsf] dfqf sd x'gaf6 hf]ufpg ......................................................................... !!$

kf]6fl;od Snf]/fO8 ;f]No';g .............................................................................................. !!$

8fOh]kfd / Kof/flN8xfO8 ................................................................................................. !!%

101

cfjZos x]/ljrf/M @ dlxgfb]lv % jif{;Ddsf] la/fdL aRrf

s8f Go"df]lgof jf w]/} s8f /f]usf] nflu cfjZos x]/ljrf/ != PlG6afof]l6s pkrf/ lbg'xf];\ s8f Go"df]lgof jf w]/} s8f /f]u nfu]sf aRrfx¿n] PlG6afof]l6s pkrf/ kfpg' h?/L 5 .

olb aRrfsf] ;fdfGo sf]vfxfg]sf] 5 / ;f; km]g{ ufx|f] 5}g eg], vfg] sf]l6«df]S;fhf]n lbg'xf];\ .

aRrfnfO{ x/]s lbg x]g'{xf];\ . aRrf 7Ls x'Fb}5 eGg] s'/f kSsf ug'{xf];\ . olb aRrf 7Ls ePg

eg], vfg] sf]l6«df]S;fhf]nsf] ;§f OG6«fd:s'n/ -cfO= Pd=_ PlDkl;lngsf] ;'O{ lbg'xf];\ . olb aRrfdf ;fdfGo vt/fsf] lrGx jf s8f lsl;dn] sf]vfxfg]sf] 5, t/ w]/} s8f Hj/f]hGo

/f]usf] juL{s/0f 5}g eg], OG6«fd:s'n/ -cfO= Pd=_ PlDkl;lngsf] ;'O{ lbg'xf];\ . !) lbg ;Dd pkrf/ ug'{xf];\ .

aRrfsf] cj:yfdf t];|f] lbg ;Dd ;'wf/ gePdf k|]if0f ug'{xf];\ . olb aRrfdf w]/} s8f Hj/f]hGo /f]usf] juL{s/0f klg 5 eg], o; juL{s/0fsf] nflu tn

cfjZos x]/ljrf/af/] lgb]{zgx¿sf] cg';/0f ug'{xf];\ . k|f]s]g k]lgl;lng lbg'xf];\ . cf}nf]sf] ;Defjgf pRr ePsf] If]q 5 eg] lSjgfOg lbg'xf];\ .

@= a|f]ª\sf]8fOn]6/ lbg'xf];\ olb aRrfdf :6«fO8/ 5 / tkfO{l;t a|f]ª\sf]8fOn]6/ 5 eg] lbg'xf];13 . #= Hj/f]sf] pkrf/ ug'{xf];\ olb aRrfsf] sfvLsf] tfkqmd #*=%° ;]= cyjf a9L 5 eg], x/]s ^ 306fdf Kof/fl;6fd]fn vfg

lbg'xf];\ . of] Go"df]lgof ePsf aRrfx¿sf nflu ljz]ifu/L dxTjk"0f dflgG5 lsgeg] Hj/f]n] clS;hgsf] vktnfO{ a9fpF5 .

13 lgb]{zgx¿, 8fS6/ tyf jl/i7 :jf:Yo sfo{stf{x¿sf] k'l:tsf, PSo'6 /]l:k/]6/L OGkm]S;g Og lrG8«]gM s];

Management in small Hospital df lbOPsf 5g\ .

102

$= emf]ns'/fx?sf] Joj:yf ;fjwfgLk"j{s ug'{xf];\ Go"df]lgof jf w]/} s8f /f]u ePsf aRrfx¿sf] z/L/df slxn] sfxL+ kfgLsf] dfqf a9L x'g ;S5 . t/

klg pgLx¿ lkpg ;S5g\ eg], emf]ns'/fx? vfg lbg'xf];\ . lsgls, Go"df]lgof jf w]/} s8f /f]u ePsf aRrfx¿df Zjf;–k|Zjf;sf] ;ª\qmd0fsf] a]nf k|foM kfgL a9L v]/ hfG5, ljz]ifu/L Hj/f] 5 eg], To;sf/0f, emf]ns'/fx¿ lbg'xf];\, t/ emf]ns'/fx? lb+bf ;fjwfgLk"j{s lbg'k5{ .

olb ;f; km]g{ ufx|f] ePsf] 5}g eg] aRrfnfO{ :tgkfg hf/L /fVgsf] nflu cfdfnfO{ k|f]T;flxt

ug'{xf];\ . olb aRrf w]/} la/fdL eO :tgkfg ug{ ;Sb}g, t/ lgNg ;S5 eg], Pp6f skdf cfdfnfO{ :tgsf] b"w lgrf]g{ nufpg'xf];\ tyf aRrfnfO{ la:tf/} rDrfn] v'jfpg nufpg'xf];\ .

aRrfnfO{ lkpgsf] nflu k|f]T;flxt ug'{xf];\ . olb aRrfn] lkpg ;Sb}g eg], la:tf/} p;nfO{

emf]ns'/fx? lbgsf] nflu of t Pp6f 8«k/ k|of]u ug'{xf];\ cyjf sk of l;of] ljgfsf] l;l/+hn] v'jfpg'xf];\ . olb aRrfnfO{ ;f; km]g{ ufx|f] ePsf] 5 eg] Pg= lh= gnLsf] k|of]u gug'{xf];\ . olb csf]{ ljsNk 5}g eg] csf]{ lbg;Dd klv{g'xf];\ .

s8f Go"df]lgof jf w]/} s8f /f]udf lbOg] emf]ns'/fx?

pd]/ lbg'kg]{ b"w jf kmd'{nf b"wsf] k'u

gk'u kl/df0f @$ 306fdf lbOg] hDdf

kl/df0f !@ dlxgf d'lg !@ dlxgfb]lv % jif{

% ld=ln=÷lsnf]u|fd÷306f #–$ ld=ln=÷lsnf]u|fd÷306f

!@) ld=ln=÷lsnf]u|fd &@–(^ ld=ln=÷lsnf]u|fd

aRrf zs (Shock) df 5}g eg] OG6«fleg; ˆn'O8 glbg'xf];\ . zsdf ePsf] aRrfsf xft v'§fx¿

lr;f, sdhf]/ x'G5g\ gf8L l56f] l56f] rNg'sf ;fy} p ;':t x'G5 . %= ;f; km]g{ ;lhnf] u/fpg'xf];\ y'lgPsf] gfs ;kmf ug'{xf];\ . y'lgPsf] gfsn] vfg]s'/f vfgdf afwf k'¥ofpg ;S5 . gfsaf6 cfpg]

l+;ufg ;f]:gsf] nflu Pp6f lagf ;'O{sf] Knfl:6s l;l/+h k|of]u ug'{xf];\ . ;'Vvf jf afSnf], 6fFl;g] l;+ufgsf] l9sfnfO{, g"g kfgLdf lehfPsf] Pp6f g/d 6fnf]n] k'5]/ g/d kfg{ ;lsG5 . vf]s]/ skmx¿nfO{ aflx/ ˆofFSgsf] nflu aRrfnfO{ d2t ug'{xf];\ .

^= lzz'nfO{ Gofgf] kf/L /fVg'xf];\ lzz'x¿sf] z/L/sf] tfkqmd l5§} 36]/ hfG5 . ljz]if u/L leh]sf] cj:yfdf cem l56f] 36]/ hfG5 .

lzz'sf xft tyf v'§fx¿nfO{ 5fDg'xf];\ . ltgdf tftf]kgf x'g'k5{ . zf/Ll/s tfkqmd agfO{ /fVgsf] nflu, la/fdL lzz'nfO{ ;'Vvf tyf /fd|/L a]/]/ /fVg'xf];\ . ;Dej eP lzz'nfO{ cfˆgf] z/L/l;t, cem ;xL ¿kdf eGg] xf] eg] cfˆgf :tgx¿sf] aLrdf /fVg cfdfnfO{ nufpg'xf];\ . 6fpsf]df 6f]kL nufO{ lbgfn] 6fpsf]af6 tfkqmd sd x'g lbb}g . To;}n] ;Dej eP, ltgsf] k|of]u ug'{xf];\, sf]7fnfO{ Gofgf] kf/L /fVg'xf];\ .

103

s8f bL3{ kvfnfsf] nflu cfjZos x]/ljrf/ != k'g{hnLo pkrf/ pko'Qm k|0ffnL k|of]u u/L ug'{xf];\ . @= bL3{ kvfnf nfu]sf] aRrfnfO{ s;/L vfg]s'/f v'jfpg] eGg]af/] cfdfnfO{ ;Nnfx lbg'xf];\ . …cfdfnfO{ k/fdz{Ú tflnsfsf] sf]7fnfO{ x]g'{xf];\ . ^ dlxgf;Ddsf] pd]/sf] lzz'sf] nflu, k"0f{¿kdf

:tgkfg u/fpg' w]/} dxTjk"0f{ x'G5 . olb cfdfn] :tgkfg u/fpg 5f]8]sLl5g\ eg], pgnfO{ km]l/ :tgkfg u/fpg] sfddf d2t ug'{xf];\ -cyjf km]l/ s;/L :tgkfg u/fpg nufpg] eGg]af/] ;Nnfx lbg hfGg] s'g} JolQmsf] ;xof]u lng'xf];\_ .

#= le6fldg / vlgh kbfy{x¿ lbg'xf];\ . k"/s le6fldg tyf vlgh kbfy{x¿ @ xKtf;Dd k|lt lbg lbg'xf];\ . w]/} y/Lsf le6fldg / vlgh

kbfy{x¿ ePsf] dlN6–le6fldg k|of]u ug'{xf];\, h;df kmf]n]6, le6fldg …PÚ, lh+s, DofUg]l;od, cfO/g tyf sKk/sf] dfqf k|ltlbg l;kmfl/z ul/Psf] dfqf eGbf slDtdf bf]Aa/ dfqf ;dfj]z ePsf] xf]cf];\ .

$= ;ª\qmd0fsf] klxrfg tyf pkrf/ ug'[{xf];\ bL3{ kvfnf ePsf aRrfx¿df Go"df]lgof, ;]lK;;, d"q gnLsf] ;ª\qmd0f, sfgsf] ;ª\qmd0f, cfpF

/ut tyf cfpF (Amoebiasis) h:tf ;ª\qmd0f x'g ;S5g\ . logLx¿nfO{ ljz]if PlG6afof]l6s pkrf/sf] cfjZostf kb{5 . olb s'g} lsl;dsf] ljz]if ;ª\qmd0fsf] klxrfg ePg eg], PlG6afof]l6s pkrf/ glbg'xf];\, cgfjZos PlG6afof]l6s pkrf/ k|efjsf/L x'Fb}g .

%= aRrfsf] cg'udg ug'{xf];\ cfdf / aRrfnfO{ x/]s lbg x]g'{xf];\ . aRrfsf] vfgf tyf pkrf/x¿ / k|ltlqmofx¿sf] cg'udg

ug'{xf];\ . aRrfn] s:tf] vfgf vfG5 tyf slt vfG5 ;f]Wg'xf];\ . slt k6s lb;f u¥of] ;f]Wg'xf];\, hnljof]hgsf lrGxx¿ tyf Hj/f] hfFRg'xf];\ .

aRrfn] /fd|/L vfg yfn]kl5 tyf hnljof]hgsf lrGxx¿ gePdf, aRrfnfO{ km]l/ @–# lbgdf

x]g'{xf];\ . olb hnljof]hgsf s'g} lrGxx¿ 5g\ cyjf vfg]s'/fdf kl/jt{g x'Fbf ;d:ofx¿ b]lvG5g\ eg] aRrfnfO{ k|To]s lbg x]g{ hf/L /fVg'xf];\ . cfdfnfO{ hlt ;Sbf] d2t ug'{xf];\ .

w]/} s8f Hj/f]hGo /f]usf] nflu cfjZos x]/ljrf/

!= PlG6afof]l6s tyf cf}nf]sf] cf}iflw lbg'xf];\ w]/} s8f Hj/f]hGo /f]u ePsf] aRrfnfO{ d]lgghfOl6; tyf s8f cf}nf]] b'a}sf] pkrf/ rflxG5 -

cf}nf]sf] ;Defjgf Go"g jf pRr ePsf] If]qdf_ . aRrfdf d]lgghfOl6; jf cf}nf]] 5 ls 5}g eGg] lg0f{o ug]{ tkm{ gnfUg'xf];\ . b'a} ;Defjgfx¿sf] pkrf/ ug'{xf];\ .

d]lgghfOl6;sf] nflu, cfO=Pd= PlDkl;lng tyf k|f]s]g k]lgl;lng b'a} lbg'kg]{ x'Fbf c:ktfn

k|]if0f ug'{xf];\ .

104

k|To]s ^ 306fdf ;'O{ lbg' /fd|f] x'G5 . olb of] ;Dej 5}g eg], * 306f jf !@ 306f dfqfsf] k|of]u ug'{xf];\ . -pkrf/ lgb]{zgx¿ x]g'{xf];\_ .

sDtLdf # b]lv % lbg;Dd b'a} PlG6afof]l6s ;'O{åf/f lbg'xf];\ . of] cjlw;Dd aRrfdf olb

;'wf/ cfof] eg], vfg] PlDkl;lngdf hfg'xf];\ . hDdf pkrf/ cjlw !) lbg x'g'k5{ . s8f cf}nf]]sf nflu lSjgfOg lbg'xf];\ . olb tkfO{l;t lSjgfOg 5}g eg], cf}nf]sf] vfg] Snf]/f]lSjg cf}iflw lbg'xf];\ .

@= ;fjwfgLk"j{s emf]ns'/fx?sf] Joj:yf ug'{xf];\ emf]ns'/fx? lbg] of]hgf ug{] k|0ffnL aRrfsf] lrGxx¿df lge{/ u5{ .

olb aRrfdf kvfnf eO s8f hnljof]hg klg 5 t/ 3fF6L c//f] 5}g tyf s8f s'kf]if0f cyjf s8f /QmcNktf 5}g eg], pkrf/ k|0ffnL …uÚ cg';f/ emf]ns'/fx? lbg'xf];\ .

;fdfGotof b]lvg] vt/fsf lrGx, olb s8f Hj/f]hGo /f]udf kl/0ft x'g k'u]sf] 5 eg] Tof]

s]jn hnljof]hgsf] sf/0faf6 ePsf] x'g;S5 . k'gh{nLo pkrf/ ug'{xf];\ tyf To;kl5 aRrfsf] k'gd"{Nof+sg ug'{xf];\ tyf k'gj{uL{s/0f ug'{xf];\ . k'gh{nLo pkrf/kl5 ul/Psf] k'gd"{Nof+sg tyf k'gj{uL{s/0fn] pkrf/ k|0ffnLdf km/s Nofpg ;S5, olb aRrfnfO{ ca w]/} s8f Hj/f]hGo /f]u ePsf] egL juL{s/0f ul/Pg eg] olb aRrfdf k'gh{nLo pkrf/kl5 vt/f lrGxx¿ l56f] l56f] x/fpF5g\ eg], lSjgfOg, k|f]s]g k]lgl;lng / PlDkl;lngåf/f pkrf/ hf/L g/fVg'xf];\ .

olb aRrfdf w]/} s8f Hj/f]hGo /f]usf ;fy} 3fF6L c//f] jf tfn' pS;]sf] 5 eg], emf]ns'/fx? lbg sd ug'{xf];\ . aRrfdf d]lgghfOl6; x'g;S5 . emf]ns'/fx?sf] kl/df0fnfO{ lgDg cg';f/ ;ts{tf;fy ug{;lsG5 M

olb d]lgghfOl6;sf] z+sf 5 eg] -pS;]sf] tfn' jf 3f“6L c//f]_

pd]/ lbg'kg]{ b"w jf kmd'{nf b"wsf] k'u gk'u kl/df0f @$ 306fsf] hDdf kl/df0f

!@ dlxgfeGbfd'lg !@ dlxgfb]lv % jif{;Dd

#=# ld=ln=÷lsnf]u|fd÷306f @=% ld=ln=÷lsnf]u|fd÷306f

*) ld=ln=÷lsnf]u|fd÷lbg ^) ld=ln=÷lsnf]u|fd÷lbg

OG6«fleg; emf]ns'/fx? glbg'xf];\ . olb aRrfn] ;a} yf]s jfGtf ul//xG5 cyjf lkpg jf :tgkfg ug{ ;Sb}g eg], Pg=lh=

6\o'aaf6 emf]ns'/fx? lbg'xf];\ . olb tkfO{nfO{ Pg= lh= 6\o'a k|of]u ug{ cfpFb}g tyf aRrfn] lgNg ;S5 eg], aRrfnfO{

la:tf/} v'jfpgsf] nflu Pp6f 8«k/ k|of]u ug'{xf];\ cyjf sk jf lagf ;'O{sf] l;l/+hn] d'vdf v'jfpg'xf];\ .

olb aRrfdf s8f s'kf]if0f 5 eg] s8f s'kf]if0fsf] nflu cfjZos x]/ljrf/ cGtu{t j0f{g

ul/Pem}+ emf]ns'/fx? lbg'xf];\ .

105

#= /utdf rLgLsf] dfqf sd x'gaf6 hf]ufpg aRrfsf] pkrf/ ug'{xf];\ pkrf/ lgb]{zgx¿ x]g'{xf];\ .

s8f hl6n bfb'/fsf] nflu cfjZos x]/ljrf/ != bfb'/fsf hl6ntfx¿sf] pkrf/ ug'{xf];\ . pkrf/ hl6ntfx¿dfly lge{/ u5{ .

olb aRrfsf] d'vdf 3fpx¿ 5g\ eg], )=@%Ü h]G;]g efof]n]6 nufpg'xf];\ . aRrfnfO{ vfgf v'jfpgdf cfdfnfO{ d2t ug'{xf];\ . olb aRrfn] lgNg ;Sb}g eg], aRrfnfO{ Pg= lh= 6\o"aåf/f v'jfpg'xf];\ . cfO= Pd= PlDkl;lngaf6 pkrf/ ug'{xf];\ .

olb aRrfsf cfFvfsf] slg{of wldnf] 5 eg], aRrfsf] cfFvf hfFRg] a]nfdf ;fjwfgL k"j{s

hfFRg'xf];\ . 6]6«f;fOlSng cfFvfsf] dndn] ;fjwfgLk"j{s cfFvfsf] pkrf/ ug'{xf];\ . cfFvfsf] s]jn tNnf] 9sgLnfO{ tfGg'xf];\ tyf cfFvfsf] 3]/fdfly bafa glbg'xf];\ . cfFvfdf Pp6f ;kmf uhn] g/d u/L k§L nufpg'xf];\ .

bfb'/fsf cGo hl6ntfx¿Ù h:t}M Go"df]lgof, kvfnf, sfgsf] ;ª\qmd0fnfO{ klg pkrf/

ug'{xf];\ .

@= le6fldg ‘P’ lbg'xf];\ le6fldg …PÚ # dfqf lbg'xf];\ . klxnf] dfqf klxnf] lbgdf tyf bf];|f] dfqf bf];|f] lbgdf lbg'xf];\ .

t];|f] dfqf ! dlxgfdf lbg'xf];\ . #= s'kf]if0fsf] /f]syfd ug{ aRrfnfO{ vfg]s'/f v'jfpg'xf];\ .

df:6f]O8fOl6;sf] nflu cfjZos x]/ljrf/ cfO= Pd= k|f]s]g k]lgl;lng tyf cfO= Pd PlDkl;lng lbg'xf];\ . !) lbg;Ddsf] nflu pkrf/ ug'{xf];\ . # b]lv % lbgkl5 vfg] PlDkl;lngdf abNg'xf];\ .

s8f lz3| s'kf]if0fsf] nflu cfjZos x]/ljrf/ s8f lz3| s'kf]if0f ePsf aRrfx¿nfO{ k"/s vlghx¿;lxt ljz]if lsl;dn] tof/ ul/Psf] vfg]s'/f rflxG5 h'g ;fwf/0ftof s]jn c:ktfn cyjf kf]if0f k'g:yf{kg s]Gb| (Nutrition Rehabilitation Center) df pknAw x'G5 . aRrfnfO{ o:tf 7fpFx¿ dWo] s'g} Pp6fdf k|]if0f ug'{xf];\ . iff]if0f /li6«o gLlt cg';f/ w]/} sd tf}n ePsf aRrfx?nfO{ klg s8f lz3| s'kf]if0f elg alu{s/0f ul/Psf] 5 . o;} ul/ sd tf}n ePsf aRrfx?nfO{ klg s'kf]if0f pkrf/ ug{'kg]{af/] hf]8 lbPsf] x'Fbf oL b'j} sd tf}nsf jlu{s/0f ul/Psf aRrfx?nfO{ klg glhssf] kf]if0f k'g{:yfkgf s]Gb|÷cfp6 k];]G6 y]/fKo"l6s ;]G6/df k|]if0f ug{'xf];\ . d'NofÍg ubf{ k'8\sf]kg kfpg'ePsf aRrfx?sf] nflu cfdfnfO{ vfgfaf/] pd]/ cg';f/sf] tflnsf k|of]u ul/ k/fdz{ lbg'g} dxTjk"0f{ pkrf/ xf] .

106

tkfO{n] aRrfnfO{ k|]if0f ug'{ cl3 M != PlG6afof]l6s pkrf/ lbg'xf];\ aRrfdf ;ª\qmd0fsf s'g} lrGxx¿ geP klg aRrfnfO{ PlG6afof]l6sx¿ lbg'xf];\ . lz3| s8f

s'kf]if0fdf, ;ª\qmd0fsf ;fwf/0f lrGxx¿ k|foM b]lvb}gg\ . pbfx/0fsf] nflu, o:tf aRrfdf ;ª\qmd0f eP klg Hj/f] gx'g ;S5 . s8f lz3| lsl;dn] s'kf]lift ePsf] aRrfdf Go"df]lgof eP klg p;n] :j:y aRrfn] em}+ l56f] l56f] ;f; gkm]g]{ x'g ;S5 tyf p;sf] sf]vfxfg]sf] gb]lvg ;S5 . To;sf/0f, s8f lz3| k|sf/n] s'kf]lift ePsf ;a} aRrfx¿nfO{ PlG6afof]l6sx¿af6 pkrf/ ug{' dxTjk"0f{ x'G5 .

@= lbg / /ftdf klg af/Daf/ :tgkfg u/fpg hf/L /fVg'xf];\ . #= aRrfnfO{ v'jfpg'xf];\ ;fwf/0ftof o:tf jRrfn] vfg ?rfpFb}gg\ / b"w gcfPklg cfdfsf] b"w r';]/ ;+tf]if dfGg] x'G5g\ .

o:tf aRrfnfO{ af/Daf/, olb cfjZos eP Pg= lh= gnLaf6 vfgf v'jfpg' k5{ . vfg]s'/fsf] 5gf}6 h] pknAw 5 To;dfly lge{/ ub{5 .

klxnf] 5gf]6M kl/jlt{t w"nf] b"w -Dried Skim Milk_, rLgL tyf t]ndf ld;fO a9L kf}i6s kf/L

b"w vfg lbg'xf];\ . @% u|fd ;f] ;'Vvf b"w, !)) u|fd rLgL, #) u|fd jg:klt t]nnfO{ !))) ld=ln= agfpgsf] nflu kof{Kt kfgL xfNg'xf];\ . b"w, rLgL / t]nnfO{ ld;fP/ lkm6\g'xf];\ / la:tf/} pdfn]sf] tftf] kfgL yKb} !))) ld=ln= b"w agfpg'xf];\ .14

oL a9L kf}li6s kfl/Psf] b"wsf vfgfx¿df sd n]S6f]h x'G5 . o:tf] b"wnfO{ klg s8f s'kf]if0f

ePsf] aRrfnfO{ lbg ;lsG5 . s8f lz3| lsl;dn] s'kf]lift ePsf] aRrf w]/} sdhf]/ x'G5 / p;nfO{ yf]/} / 3l/3l/ vfgf

rflxG5 . la:tf/} vfgfsf] kl/df0fnfO{ a9fpg'xf];\ tyf la:tf/} v'jfpg] ;+VofnfO{ 36fpg'xf];\ . aRrfnfO{ hlt rf]l6 ;Dej 5 Tolt rf]l6 v'jfpgsf] nflu cfdfnfO{ d2t\ ug'{xf];\ . aRrfn] /ftL hlt w]/} ;Dej 5 Tolt vfgfx¿ -slDtdf @ k6s_ v'jfpg' dxTjk"0f{ 5 . s8f lsl;dn] s'kf]lift w]/} aRrfx¿nfO{ /ftL vfgf VjfOPg / Gofgf] kf/L /flvPg eg] d5{g\ . o:tf aRrfx?nfO{ 3/df :ofxf/ ug{ sl7gfO{ x'g]x'Fbf k'g{:yfkgf s]Gb|dfg} k|]if0f ug{ pko'Qm x'G5 . olb tkfO{ k'g{:yfkgf s]Gb|dfg} sfo{/t x'g'x'G5 eg] kf]if0f sfo{qmdsf] gLlt cg';f/ Joj:yfkg ug{'xf];\ .

14 ljsNkdf cGo ;'wfl/Psf b"wsf vfgfx¿, u'lnof] gkf/L jfikLs/0f ul/Psf] k"0f{ lrNnf] b"w -!@) ld=ln=, !)) u|fd

rLgL / @) ld=ln= t]n_, ufO{sf] tfhf b"w -#)) ld=ln=, !)) u|fd rLgL / @) ld=ln= t]n_ cyjf t/\ lems]sf] u'lnof] gkf/L jfikLs/0f ul/Psf] b"w -!@) ld=ln=, !)) u|fd rLgL tyf #) ld=ln= t]n_ cflb x'g\ . ;a} ljlwx¿sf] nflu, !))) ld=ln= agfpg pdfn]sf] tftf] kfgL yKg'xf];\ .

107

$= kvfnfn] ubf{ ePsf] hnljof]hgnfO{ ;fjwfgLk"j{s Joj:yf ug'{xf];\ s8f lz3| s'kf]if0f ePsf tyf kvfnf nfu]/ s]xL cyjf s8f hnljof]hg ePsf aRrfx¿df

lrGxx¿n] ;+s]t u/] hlQs} hnljof]hg gx'g ;S5 . h:t}M k]6sf] 5fnf cf}+nfn] tfg]/ 5f]8\bf la:tf/} kmls{g', u8]sf cfFvfx¿, ;':t x'g' jf lem+lhg' cflb s8f s'kf]if0fsf] sf/0faf6 x'g ;S5 .

s8f s'kf]if0f ePsf aRrfx¿sf] nflu k'gh{nLo emf]ndf w]/} g"g tyf sd kf]6fl;od x'G5 . Ps

k'l/of k'gh{nLo emf]nnfO{ @ ln6/ kfgL -Ps ln6/sf] ;§f_ df ld;fpg'xf];\ . To;kl5 %) u|fd rLgL -jf !) lrof rDrf_ tyf $% ld=ln= kf]6fl;od Snf]/fO815 ;f]No';g yKg'xf];\ . ;fjwfgLk"j{s ld;fpg'xf];\ .

:jefljs eGbf a9L la:tf/} k'gh{nLo pkrf/ ug'{xf];\ . aRrfsf] cg'udg ;fjwfgLk"j{s ug'{xf];\ .

k'gh{nLo pkrf/ ul/Psf] a]nf olb aRrfsf] ;f;b/ tyf d'6'sf] b/ a9\5 eg], o;n] w]/} emf]ns'/fx? l5§} lbOP5 eGg] s'/f a'emfpF5 . emf]ns'/fx? v'jfpg aGb ug'{xf];\ . ;f;b/ / d'6'sf b/x¿ sd ePkl5 km]l/ emf]ns'/fx? v'jfpg z'? ug'{xf];\ .

%= aRrfsf] tfkqmdsf] cg'udg ug'{xf];\ aRrfnfO{ Gofgf] kf/L /fVg'xf];\ . aRrfnfO{ ;a} ;dodf, ljz]if u/L /ftL sk8fn] 5f]k]/ /fVg

ge'Ng'xf];\ . olb /]S6n tfkqmd #%=%° ;]= eGbf sd 5 eg], lzz'nfO{ cfdfsf] gfËf] k]6df /fVg'xf];\ . aRrfnfO{

sDann] 5f]Kg'xf];\ cyjf ghLs} lx6/ /fVg'xf];\ . aRrfnfO{ sk8f nufOPsf] 5 tyf 6fpsf]df 6f]kL 5 egL kSsf ug'{xf];\ . o:tf] aRrfnfO{ /fd|f] geP;Dd x/]s @ 306fdf vfgf v'jfpg' ljz]ifu/L dxTjk"0f{ x'G5 . ;Defljt ;]lK;;sf] nflu cfO= Pd= PlG6afof]l6sx¿ lbg'xf];\ .

15 !)) u|fd kf]6fl;od Snf]/fO8 k|ltln6/ ePsf] :6s ;f]No';gaf6 %)Ü DofUg]l;od ;Nkm]6df $ ld=ln OSo'Eofn]06

(mEq) DofUg]l;od k|lt ln6/ x'G5 .

108

s8f /QmcNktfsf] nflu cfjZos x]/ljrf/ s8f /QmcNktf ePsf] aRrfdf x[boult aGb x'g] vt/f x'G5 . To;sf/0f o:tf aRrfx?nfO{ c:ktfndfg}

k|]if0f ug{'kg]{x'G5 . /QmcNktfsf] cfjZos x]/ljrf/M != cfO/g vfg lbg'xf];\ . @= olb cf}nf]sf] ;Defjgf Go"g jf pRr÷dWod ePsf] If]q 5 eg], cf}nf]sf] cf}iflw lbg'xf];\ . sfo{qmdn] lzkmfl/; u/]g';f/ k|efjsf/L cf}nf]sf] cf}iflwaf6 pkrf/ ug'{xf];\ . tkfO{sf] If]qdf c+s'z] h'sf jf sf]/]{ h'sfsf] ;d:of 5 eg], cNa]08fhf]n klg lbg'xf];\ . #= aRrfnfO{ vfgf v'jfpg'xf];\ . /fd|f] lsl;dsf k"/s vfg]s'/fx¿ lbg'xf];\ . $= olb Hj/f] 5 eg] Kof/fl;6fdf]n lbg'xf];\ . x/]s ^ 306fdf Kof/fl;6fdf]n lbg'xf];\ . %= emf]ns'/fx? ;fjwfgLk"j{s lbg'xf];\ . aRrfnfO{ Kof; nfu] hlt lkpg lbg'xf];\ . cfO= le= cyjf Pg= lh=4f/f emf]ns'/fx? glbg'xf];\ . #) lbg eGbf nfdf] vf]sLsf] nflu cfjZos x]/ljrf/ != Go"df]lgofsf] nflu k|yd kª\lQmdf kg]{{ PlG6afof]l6s lbg'xf];\ . olb aRrfnfO{ Go"df]lgofsf] nflu xfn;fn} s'g} k|efjsf/L PlG6afof]l6såf/f pkrf/ ul/Psf] 5}g

eg], % lbgsf] nflu Pp6f PlG6afof]l6s lbg'xf];\ . @= ;fnJo'6fdf]n lbg'xf];\ . olb aRrfdf lx\jh 5 jf /ftL vf]ls/xG5 cyjf kl/jf/df s;}nfO{ bd /f]u 5 eg], ;fnJo'6fdf]n

!$ lbgsf] nflu lbg'xf];\ . #= aRrfsf] tf}n lng'xf];\ tyf kl/jf/df Ifo/f]u 5 ls egL ;f]Wg'xf];\ . $= aRrfsf] cg'udgsf] nflu @ xKtfdf af]nfpg'xf];\ / x]g'{xf];\ . olb PlG6afof]l6s -;fnJo'6fdf]n ;lxt jf lagf ;fnJo'6fdf]n_ lbP/ s'g} ;'wf/ b]lvPg eg] cyjf

aRrfsf] tf}n 3l6/x]sf] 5 eg], aRrfnfO{ km]l/ ! k6s c:ktfn k|]if0f ug]{ k|of; ug'{xf];\ . olb cem} klg k|]if0f ;Dej 5}g eg], Ifo/f]usf] pkrf/ z'? ug'{xf];\ . o;sf] nflu /fli6«o Ifo/f]u lgoGq0f s]Gb|sf lgb]{zgx¿ x]g'{xf];\ .

109

sDkg -xfnsf] sDkg, o; /f]usf] cjlwdf_ sf] nflu cfjZos x]/ljrf/ != ;f; km]g]{{ ;lhnf] u/fpg] Joj:yf ldnfpg'xf];\ . ;f;–gnLdf s]xL k:g] ;DefjgfnfO{ sd ug{sf] nflu aRrfnfO{ sf]N6] kfg'{xf];\ . d'vaf6

;f;km]/fpg] k|of; gug'{xf];\ cyjf rDrf jf :k]6\o'nfn] d'vnfO{ v'nf g/fVg'xf];\ . aRrf ;f; lng ;Ifd 5 eGg] kSsf ug'{xf];\ . skmx¿n] ;f; lngdf afwf k'¥ofO/x]sf] 5 eg], gfsaf6 ˆol/+S; -Pharynx_ df Pp6f Sofy]6/ k;fNg'xf];\ tyf skmx¿nfO{ tfg]/ ;kmf ug'{xf];\ .

@= 8fOh]kfd16 lbg'xf];\ / To;kl5 Kof/flN8xfO8 -Paraldehyde_ lbg'xf];\ pkrf/ lgb]{zgx¿df x]g'{xf];\ . #= olb pRr Hj/f] 5 eg], 36fpg'xf];\ . Kof/fl;6fdf]n lbg'xf];\ tyf aRrfnfO{ dgtftf] kfgLn] kfgL k§L nufpg'xf];\ . $= /utdf rLgLsf] dfqf sd x'gaf6 hf]ufpgsf] nflu aRrfsf] pkrf/ ug'{xf];\ . pkrf/ lgb]{zgx¿df x]g'{xf];\ .

16 8fOh]kdsf] Pp6f ;fdfGo Jofkf/Ls gfd Eoflnod xf] .

110

cfjZos x]/ljrf/M @ dlxgf;Ddsf] la/fdL lzz'

AofS6]l/ofsf] ;Defljt uDeL/ ;ª\qmd0fsf nflu cfjZos x]/ljrf/ o:tf] lzz'df Go"df]lgof, ;]lK;; jf d]lgghfOl6; x'g;S5 . != cfO= Pd= k|f]s]g k]lgl;lng / cfO{=Pd= h]G6fdfOl;g lbg'xf];\ . olb d]lgghfOl6; -pS;]sf] tfn', ;':t jf a]xf]; jf sDkg ePsf] sf/0fn]_ sf] z+sf 5 eg], k|f]s]g

k]lgl;lngsf] ;§f olb pknAw 5 eg], cfO= Pd= PlDkl;lng lbg'xf];\ . hDdf !$ lbgsf] nflu pkrf/ ug'{xf];\ .

olb d]lgghfOl6;sf] z+sf 5}g eg], slDtdf % lbgsf] nflu pkrf/ ug'{xf];\ . slDtdf # lbg;Dd

jf lzz' /fd|f] geP;Dd pkrf/ hf/L /fVg'xf];\ . lzz'sf] cj:yf ;'wf/ ePkl5, pko'Qm vfg] PlG6afof]l6sdf abNg'xf];\ h:tf] ls cfO= Pd= k|f]s]g

k]lgl;lng cyjf cfO= Pd= PlDkl;lngsf] ;§f Pdf]lS;l;lng vfg lbg] . h]xf];\, Go"gtd pkrf/ glbP;Dd cfO= Pd= h]G6fdfOl;g lbg hf/L /fVg'xf];\ .

@= lzz'nfO{ Gofgf] kf/L /fVg'xf];\ -kfgf !@!, cfO6d % tyf kfgf !@*, cfO6d & df lgb]{zgx¿ x]g'{xf];\_

. #= emf]ns'/fx?sf] ;fjwfgLk"j{s Joj:yf ug'{xf];\ . cfdfn] lzz'nfO{ af/Daf/ :tgkfg u/fpg' k5{ . olb lzz'nfO{ ;f; km]g{df ufx|f] ePsf] 5 cyjf w]/}

la/fdL e} b"w r':g ;Sb}g eg], cfdfnfO{ cfˆgf] b"w lgrf]/]/ lemSgdf d2t ug'{xf];\ . lzz'nfO{ cfdfsf] lems]sf] b"w 8«k/ cyjf Pg= lh= 6\o'aaf6 lbgdf ^ k6s v'jfpg'xf];\ . x/]s k6s vfgfdf @) ld=ln= cfdfsf] b"w aRrfsf] z/L/sf] tf}nsf] k|lt lsnf]u|fdsf] lx;fan] lbg'xf];\ . lbgsf] hDdf !@) ld=ln=÷lsnf]u|fd lbg'xf];\ .

olb cfdfn] cfˆgf] b"w lemSg ;lSbgg\ eg], To;sf] ;§f c¿ b"w agfpg'xf];\ cyjf cfdfnfO{

k/fdz{ eGg] k'l:tsfsf] v08 #–! df j0f{g ul/P em}+ ufO{sf] kftnf] b"w rLgL yk]/ lbg'xf];\ . $= /utdf rLgLsf] dfqf sd x'gaf6 hf]ufpg aRrfsf] pkrf/ ug'{xf];\ . pkrf/ lgb]{zgx¿df x]g'{xf];\ .

111

pkrf/ lgb]{zgx¿

l;kmfl/zx¿ o; kl/lzi6df cf}iflwsf # j6f dfqf–;"rLx¿ lbOPsf 5g\ . tL ;"rLx¿ k|To]s ^ 306f -jf lbgsf] rf/ k6s_, k|To]s * 306f -jf lbgsf] tLg k6s_ tyf k|To]s !@ 306f -jf lbgsf] @ k6s_df lbOg] dfqfx¿sf nflu x'g\ . tkfO{n] lbg ;Sg] ;a} eGbf a9L k|of]u ;"rL 5fGg'xf];\ . jf:tjdf cf}iflw v'jfpg] ;dosf] cGt/ j/fj/ x'G5 . /ftdf cf}iflw v'jfpg sl7gfO x'G5 . ;Dej eP;Dd dfqfx¿nfO{ ;s];Dd j9L ;do km/s kf/L rflxP cg';f/sf] ;do ldnfpg'xf];\ . tn j0f{g ul/Psf s]xL pkrf/x¿, :jf:Yo sfo{stf{sf] ;xof]u lagf aRrfnfO{ 3/df lbg cJojxfl/s 5g\ . pbfx/0fsf] nflu, ;'O{x¿ lbg' cyjf s8f lsl;dn] s'kf]lift aRrfnfO{ cfjZostf cg';f/ a/fa/ vfg]s'/fx¿ v'jfpg' . s]xL cj:yfdf :jf:Yo sfo{stf{n] cfdfnfO{ 3/df g} pkrf/ hf/L /fVg] / a]nf a]nf cfkm}+ la/fdLsf] 3/ uP/ /]vb]v u/L lbg] klg ug{ ;S5g\ . s'g} cj:yfx¿df aRrfnfO{ rflxg] pkrf/x¿ lbg 3/}df k6Ss} Jojxfl/s x'Fb}gg\ .

h]G6fdfOl;g

x/]s *÷* 306fdf cfO= Pd= h]G6fdfOl;g lbg'xf];\ . olb tkfO{n] of] ug{ ;+ej 5}g eg] k|To]s !@ 306fsf] cGt/df lbg'xf];\ . h]G6fdfOl;g gkfPdf / JofS6]l/ofsf] ;DefJo u+eL/ ;+s|d0f ePdf k|f]s]g k]lgl;lng / Snf]/fdkm]lgsn lbg'xf];\ .

PlDkl;lng

cfO= Pd= PlDkl;lng % lbgsf] nflu lbg'xf];\ . To;kl5, !) lbgsf] PlG6afof]l6s pkrf/ k"/f ug{sf] nflu vfg] PlDkl;lng lbg'xf];\ .

cfO= Pd= PlG6afof]l6s lbg ;Dej geP PlDkl;lng Pg= lh= gnLaf6 lbg'xf];\ . ;Dej 5 eg], x/]s ^ 306fdf lbg'xf];\ .

112

s8f cf}nf]sf] nflu lSjgfOgsf] ;'O{ lbg'xf];\ (High Risk) xfd|f] b]zsf] /fli6«o gLlt cg';f/ lSjgfOgsf] ;'O{ lrlsT;ssf] lgu/fgLdf lhNnf c:ktfn jf ;f] eGbf dflysf c:ktfnx?df dfq lbOg] 5 . w]/} s8f Hj/f]hGo /f]u ePsf] k|]if0f ul/Psf] aRrfsf] nflu M Ps dfq ;Nkmf8f]S;Lg kfOl/ldyfldg lbP/ k|]if0f ug]{ . k|]if0f ug{ ;Dej geP M lSjgfOgsf] klxnf] dfqfsf] ;'O{ IM lbg'xf];\ .

aRrfnfO{ Ps 306f;Dd ;'tfP/ /fVg'xf];\ .

klxnf] dfqf lbPsf] $ / * 306fsf] ;dodf km]l/ ;f]xL dfqf lSjgfOg ;'O{ lbg'xf];\ .

clg ha;Dd aRrf cf}iflw vfg ;Ifd x'Fb}g ta;Dd k|To]s !@ 306fdf ;'O{ lbg'xf];\ .

lSjgfOgsf] ;'O{ ! xKtfeGbf a9L lbg' x'Fb}g .

vfg] lSjgfOgsf] dfqf M -@) ld=u|f=÷s]=lh=÷lbg, lbgdf # k6s & lbg;Dd_

lSjgfOgsf] ;'O{ IM lbg]

pd]/ / tf}n !%) ld=u|f=÷k|lt ld=ln= -@ ld=ln= sf] PDk'ndf_

#)) ld=u|f=÷ld=ln= -@ ld=ln= sf] PDk'ndf_

@ dlxgfb]lv $ dlxgf;Dd -$–^_ s]=lh )=$ ld=ln )=@ ld=ln=

$ dlxgfb]lv !@ dlxgf;Dd -^–!)_ s]=lh )=^ ld=ln= )=# ld=ln=

!@ dlxgfb]lv @ jif{ -!)–!@_ s]=lh )=* ld=ln= )=$ ld=ln=

@ jif{b]lv # jif{ -!@–!$_ s]=lh !=) ld=ln= )=% ld=ln=

# jif{b]lv % jif{ -!$–!(_ s]=lh !=@ ld=ln= )=^ ld=ln=

lSjgfOg

lSjgfOgsf] klxnf] dfqf lbg'xf];\ . cfO= Pd= lSjgfOg ;'O{ $ 306f / kl5 * 306fdf bf]xf]¥ofpg'xf];\ .

To;kl5, of t lSjgfOg -ToxL dflysf] dfqf_ x/]s !@ 306fdf lbg'xf];\ of x/]s * 306fdf

-* 306] dfqf–;"rL k|of]u u/L_ lbg'xf];\ . ha aRrfn] cf}nf]sf] cf}iflw vfg ;Sg] x'G5 cfO Pd lSjgfOg aGb ug'{xf];\ .

lSjgfOg ;'O{x¿ ! xKtf eGbf a9L lbg x'Fb}g . w]/} a9L dfqfn] alx/f] / cGwf] u/fpg'sf ;fy

;fy} d'6'sf] w8sg clgoldt ug{;S5 -h;af6 x[bo 3ft x'g;S5_ . lSjgfOgsf] ;'O{kl5 /Qmrfk 36\g ;Sg] ePsfn] k|To]s ;'O{ kl5 aRrfn] ! 306f;Dd klN6g'

k5{ . !%–@) ldg]6kl5 lSjgfOgsf] c;/ 36]/ hfG5 . aRrfn] cf}nf]sf] vfg] cf}iflw vfFbf s8f cf}nf]sf] pkrf/ k"/f ug{sf nflu /fli6«o lgb]{zgx¿

cg';f/ k"/f dfqf cf}iflw lng' k5{ . w]/} h;f] b]zx¿df, l;kmfl/z ul/Psf] cf}nf]sf] vfg] cf}iflw ;Nkmf8f]lS;g–kfOl/d]yfldg xf] .

113

dfqf ;'rL–OG6«fd:s'n/ / vfg] cf}iflwx¿M x/]s ^ 306f -jf lbgsf] $ k6s_

pd]/ jf tf}n cfO=Pd= PlDkl;lng

dfqf M @) ld= u|fd÷lsnf]÷dfqf vfg] PlDkl;lng

dfqf M @) ld= u|fd÷ls=u|fd÷dfqf !))) ld= u|f efondf %=) ld=ln=

l8l:6N8 jf6/ kfgL yKg'xf];\ %=^ ld=ln =!*) ld= u|f=÷ld=ln=

l;/k–!@% ld= u|fd÷% ld=ln= emf]n -kflNd6]6_

SofK;"n @%) ld= u|fd

! lsnf] u|fd @ lsnf] u|fd )=@ ld=ln= !=% ld=ln=

-!÷$ rDrf_ !÷$

# lsnf] u|fd )=# ld=ln= @=% ld=ln= -!÷@ rDrf_

!÷$

$ lsnf] u|fd )=$ ld=ln= #=) ld=ln= -!÷@ rDrf_

!÷$

% lsnf] u|fd )=% ld=ln= $=) ld=ln= -#÷$ rDrf_

!÷@

$ dlxgfb]lv ( dlxgf -^ — < * s]=lh=_

)=* ld=ln= %=) ld=ln= !÷@

( dlxgfb]lv !@ dlxgf -*–<!) s]=hL+_

!=) ld=ln= &=% ld=ln=

-! !÷@ rDrf_

#÷$

!@ dlxgfb]lv # jif{ -!) – <!$ s]=lh=_

!=@ ld=ln= !)=) ld=ln= -@ rDrf_

!

# jif{b]lv % jif{ -!$–!( s]=lh=_

!=* ld=ln= !@=% ld=ln=

-@ !÷@ rDrf_

!

dfqf ;'rL – OG6«fd:s'n/ cf}iflwx¿ M x/]s * 306f -jf lbgsf] # k6s_


dfqf M #) ld= u|fd÷s]=hL÷dfqf lSjgfOg

dfqf M !) ld= u|fd÷s]=lh=÷dfqf !))) ld= u|fd efondf %=) ld=ln=

:6]/fOn kfgL yKg'xf];\ %=^ ld=ln==!*) ld= u|fd÷ld=ln=

!%) ld= u|fd÷ld=ln= #)) ld= u|fd÷ld=ln=

! s]=lh= )=)& ld=ln= )=)# ld=ln= @ s]=lh= )=# ld=ln= )=!# ld=ln= )=)& ld=ln= # s]=lh= )=% ld=ln= )=@ ld=ln= )=! ld=ln= $ s]=lh= )=& ld=ln= )=# ld=ln= )=!# ld=ln= % s]=lh= )=* ld=ln= )=# ld=ln= )=!& ld=ln=

$ dlxgfb]lv ( dlxgf -^ — < * s]=lh=_

!=@ ld=ln= )=$ ld=ln= )=@ ld=ln=

( dlxgfb]lv !@ dlxgf -*–<!) s]=hL+_

!=% ld=ln= )=^ ld=ln= )=# ld=ln=

!@ dlxgfb]lv # jif{ -!) – <!$ s]=lh=_

@=) ld=ln= )=* ld=ln= )=$ ld=ln=

# jif{b]lv % jif{ -!$–!( s]=lh=_

@=% ld=ln= !=@ ld=ln= )=^ ld=ln=

114

dfqf ;'rL – OG6«fd:s'n/ tyf vfg] cf}iflwx¿ M x/]s !@ 306f -jf lbgsf] @ k6s_


dfqf M $) ld=u|fd÷s]=hL÷dfqf k|f]s]g k]lgl;lng

dfqfM %),))) o'lg6÷s]=hL÷dfqf vfg] PlDkl;lng

dfqf $) ld=u|f÷s]=hL÷dfqf

h]G6fdfOl;g dfqf @=%

ld=u|f÷s]=hL÷dfqf

!))) ld= u|fd efondf %=) ld=ln= l8l:6N8 jf6/ yKg'xf];\

%=^ ld=ln==!*) ld=u|fd÷ld=ln=

$))))) efondf $ ld=ln= l8l:6N8 jf6/ yKg'xf];\ = !)),))) o'lg6÷ld=ln=

l;/k M!@% ld=u|fd÷ % ld=ln= emf]n

-kflNd6]6_

SofK;"n @%) ld=

u|fd

! s]=lh= )=%) = )=@% ld=ln @ s]=lh=

)=% ld=ln= !=)) ld=ln= #=) ld=ln= -!÷@ rDrf_

!÷@ )=% ld=ln

# s]=lh= )=& ld=ln= !=%) ld=ln=

%=) ld=ln= -! rDrf_

!÷@ )=&% ld=ln

$ s]=lh= )=( ld=ln= @=)) ld=ln= ^=) ld=ln= -! !÷$ rDrf_

!÷@ !=) ld=ln

% s]=lh= !=! ld=ln= @=%) ld=ln=

*=) ld=ln= -! !÷@ rDrf_

! !=@% ld=ln

$ dlxgfb]lv ( dlxgf -^—<* s]=lh=_

!=% ld=ln= #=% ld=ln= !)=) ld=ln= -@ rDrf_

!

!=&% ld=ln

( dlxgfb]lv !@ dlxgf

-*–<!) s]=hL+_ @=) ld=ln= $=)) ld=ln=

!%=) ld=ln= -# rDrf_

!

@=@% ld=ln

!@ dlxgfb]lv # jif{ -!)–<!$ s]=lh=_

@=% ld=ln= ^=)) ld=ln= @)=) ld=ln= -$ rDrf_

@ #=) ld=ln

# jif{b]lv % jif{ -!$–!( s]=lh=_

#=% ld=ln= &=%) ld=ln= @%=) ld=ln= -% rDrf_

# $=) ld=ln

gf]6 M !#^ k[i7df lbOPsf] lSjgfOgsf] sf]7fnfO{ -pkrf/ tflnsaf6_ x]/]/ k|To]s !@ 306fdf lbg] lSjgfOgsf] dfqf lgwf{/0f ug{ ;lsG5 .

/utdf rLgLsf] dfqf sd x'gaf6 hf]ufpg aRrfsf] pkrf/ ug'{xf];\ —

olb aRrf xf];df 5 eg], pkrf/ tflnsfsf] lgb]{zgx¿sf] cg';/0f ug'{xf];\ . aRrfnfO{ k6s–k6s, ;Dej eP, x/]s @ 306fdf vfgf v'jfpg'xf];\ .

olb aRrf a]xf];\ 5 tyf tkfO{l;t 8]S:6«f]h ;f]No';g / OG6«fleg; OGˆo'hgsf ;'ljwfx¿ 5g\ eg], cfO= le= OGˆo'hg z'? ug'{xf];\ . Ps k6s tkfO{n] cfO= le= /fd|/L uO/x]sf] 5 egL kSsf ug'{ ePsf] eP s]xL ldg]6sf] nflu !)Ü 8]S:6«f]h ;f]No';g -l8 !)_ % ld=ln=÷s]=lh= sf] lx;fan] lbg'xf];\ cyjf %)Ü 8]S:6«f]h ;f]No';g -l8 %)_ ! ld=ln=÷s]=lh= sf] lx;fan] w]/} la:tf/} lbg'xf];\ . To;kl5, Pg=lh= 6\o'a /fv]/ x/]s @ 306fdf vfg]s'/f v'jfpg yfNg'xf];\ .

kf]6fl;od Snf]/fO8 ;f]No';g - Ps ln6/df !)) u|fd kf]6fl;od Snf]/fO8_ —

k|To]s vfgfl;t )=% ld=ln= -jf 8«k/n] !) yf]kf_ k|lt lsnf]u|fd z/L/sf] tf}nsf] lx;fan] lbg'xf];\ . vfg]s'/fdf /fd|/L ld;fpg'xf];\ .

115

8fOh]kfd tyf Kof/flN8xfO8 -PlG6sGeNh]G6\;_

dn4f/ (Rectum) af6 lbg'xf];\ .

lagf ;'O{sf] Pp6f Nuf; l;l/+h -pknAw ;a} eGbf ;fgf]_ k|of]u ug'{xf];\ . 8fOh]kfd jf

Kof/flN8xfO8nfO{ l;l/+hdf /fVg'xf];\ . xNsf lsl;dn] l;l/+hnfO{ dn4f/df k;fpg'xf];\ / 8fOh]kfd jf Kof/flN8xfO8nfO{ la:tf/} dn4f/ leq lgrf]g'{xf];\ . cf}iflwnfO{ aflx/ cfpg glbgsf] nflu lt3|fx¿ lyRg'xf];\ .

olb 8fOh]kfd tyf Kof/flN8xfO8 b'a} pknAw 5g\ eg], tn lbPcg';f/ ug'{xf];\ M

!= 8fOh]kfd lbg'xf];\ . @= !) ldg]6df, olb sDkg x'g] qmd hf/L 5 eg], km]l/ 8fOh]kfd lbg'xf];\ . #= cem} !) ldg]6df -cyf{t\ k|yd dfqf lbPsf] @) ldg]6df_, olb sDkg hf/L 5 eg],

Kof/flN8xfO8 lbg'xf];\ . $= cem} !) ldg]6df -cyf{t\, klxnf] dfqf lbPsf] #) ldg]6df_, olb sDkg hf/L 5 eg],

Kof/flN8xfO8 km]l/ lbg'xf];\ .

sDkgdf oxL g} /fd|f] pkrf/ xf] . /]l:k/]6f]/L l8k|];gsf] vt/fn] ubf{ 8fOh]kfdsf # dfqfx¿ Ps} nx/df lbg'eGbf of] a9L ;'/lIft x'G5 .

olb 8fOh]kfd dfq} pknAw 5 eg], tn lbOPcg';f/ ug'{xf];\ M

!= 8fOh]kfd lbg'xf];\ . @= !) ldg]6 kl5 klg sDkg hf/L 5 eg], 8fOh]kfd km]l/ lbg'xf];\ . #= cem} !) ldg]6df -cyf{t\ klxnf] dfqf lbPsf] @) ldg]6 kl5_, klg sDkg hf/L 5 tyf

aRrfn] /fd|/L ;f; km]b}{ 5 eg], 8fOh]kfd km]l/ lbg'xf];\ . /]l:k/]6/L l8K/];gsf] nflu aRrfnfO{ Wofg lbP/ lg/LIf0f ug'{xf];\ .

olb Kof/flN8xfO8 dfq} pknAw 5 eg], tn lbPcg';f/ ug'{xf];\ M != Kof/flN8xfO8 lbg'xf];\ . @= !) ldg]6 kl5 klg sDkg hf/L /xG5 eg], Kof/flN8xfO8 km]l/ lbg'xf];\ . #= cem} !) ldg]6df -cyf{t\ klxnf] dfqf lbPsf] #) ldg]6kl5_, olb sDkg x'g] k|lqmof hf/L /x],

Kof/flN8xfO8 km]l/ lbg'xf];\ .

116

dfqf tflnsf – 8fOh]kfd tyf Kof/flN8xfO8

pd]/ jf tf}n 8fOhLkfd

-!) ld=u|f÷@ ld=ln= ;f]No';g_ dfqf M )=@ – )=$ ld=u|fd÷s]=lh=

dn4f/df lbg]

Kof/flN8xfO8 -! ld=u|f÷ld=ln= ;f]No';g_

dfqf M )=!%@ – )=# ld=ln÷s]=lh= dn4f/df lbg]

! dlxgfb]lv $ dlxgf -# — ^ s]=lh=_ )=@% ld=ln= -!.@% ld=u|f=_ !=) ld=ln=

$ dlxgfb]lv !@ dlxgf -^ – < !) s]=hL+_ )=% ld=ln= -@=% ld=u|f=_ !=% ld=ln=

!@ dlxgfb]lv # jif{ -!) – < !$ s]=lh=_ )=% ld=ln= -@=% ld=u|f=_ @=) ld=ln=

# jif{b]lv % jif{ -!$– < !( s]=lh=_

)=&% ld=ln= -#=&% ld=u|f=_ #=) ld=ln=

117

pbfx/0fM d}of !* dlxgfsL l5g\ . pgL ! xKtfcl3 la/fdL ePsL lyO{g\ . pgnfO{ Hj/f] cfPsf] lyof], ef]s nfUg 5f]8]sf] lyof] / pgL vf]Sg yfn]sL lyO{g . clxn] jiff{ ofd 5 tyf cf}nf]]sf] ;Defjgf pRr 5 . d}ofsL cfdfn] s]xL Snf]/f]lSjg # lbg cl3 lsg]sL lyOg\ / x/]s lbg d}ofnfO{ k"/f ! rSsL lb+b}l5g\ . d}ofnfO{ cem} Hj/f] 5 / pgL Psbd} ;':t l5g\ . cfdfn] pgnfO{ vfg lb+bf d}of sdhf]/ lsl;dn] ?lG5g\ . ut s]xL lbgb]lv d}ofnfO{ v'jfpg cfdf 8/fpFl5g\ lsgls pgL lgs} nf]nfPsL l5g\ / pgnfO{ lgNgdf ;d:of ePsf] h:tf] 5 . vfgf lgNbf c8\lsG5 ls egL cfdf 8/fpFl5g\ . cfdf ue{jtL ePsL x'Fbf d}ofn] $ dlxgf cl3b]lv :tgkfg ug{ 5f]8]sL lyOg\ . d}ofsf] d"Nof°gn] lgDg s'/fx¿ b]vfp“5 M pgsf] sfvLsf] tfkqmd #(° ;]= 5 . pgsf] tf}n * s]=lh= 5 . pgL w]/} g} ;':t ePsL l5g\ . s]xL a]/ lapFlemlG5g\ / km]l/ lgbfpg yflN5g\ . p;nfO{ sDkg x'Fb}g p w]/} g} ;':t ePsLn] lkpg klg g;Sg] ePsL l5g\ . pgsf] ;f;b/ k|lt ldg]6 %@ k6s 5 . s/ªsf] aLrsf] efu ;f; ln+bf leq k:5 t/ p;sf] sf]vf xfg]sf] 5}g / :6«fO8/ 5}g . pgnfO{ kvfnf nfu]sf] 5}g . :jf:Yo sfo{stf{nfO{ d}ofsf] 3fF6L c//f] ePsf] nfUb}g . pgsf] gfsaf6 l;+ufg au]sf] / hLpdf 8fj/x¿ cfPsf 5}gg\ . d}ofnfO{ sfgsf] ;d:of 5}g . d}of b'AnL–kftnL l5g\ t/ k|i6 ¿kdf z/L/sf] df;' ;'s]sf] 5}g . pgsf] xTs]nf s]xL ;]tf] 5 . pgsf] v'§f lyRbf, ;'lGgPsf] b]lv+b}g . d}ofn] ;a} vf]kx¿ k"/f u/]sL l5g\ . :jf:Yo sfo{stf{n] d}ofnfO{ s8f Go"df]lgof cyjf w]/} s8f /f]u, w]/} s8f Hj/f]hGo /f]u tyf /QmcNktf ePsf] egL juL{s/0f ug'{ x'G5 . ;a}eGbf ghLssf] c:ktfn k'Ug ! lbg nfU5 tyf cfdf ToxfF hfg ;lSbgg\ . pgsf] klt klg aflx/ uPsf 5g\ . pgn] c¿ aRrfx¿sf] klg /]vb]v ug'{k5{ . c:ktfndf cf}iflwx¿ kfOPnfg\ h:tf] nfUb}g / ToxfF vfg]s'/fsf] nflu ltg'{ kg]{ k};f klg pgLl;t 5}g . d}ofnfO{ k|]if0f ug{ ;ls+b}g . pgL cfdfl;t :jf:Yo– rf}sLsf] ghLs}sf] cfˆgL km'k"sf] 3/df al:5g\ . cfdfn] aRrfnfO{ ;'O{x¿ nufpg :jf:Yo rf}sLdf Nofpg]l5g\ . d}ofsf] /]vb]v ug{sf] nflu ;fFem :jf:Yo rf}sLsL Pp6L g;{ km'k"sf] 3/df cfpg /fhL l5g\ . clxn] laxfgsf] ( ah]sf] 5 / :jf:Yo rf}sL lbpF;f];Dd v'nf /xG5 . :jf:Yo sfo{stf{n] cg'udg tyf kf]if0f–;Nnfxsf] nflu cfh # ah]b]lv $ ah];Dd Pp6f ljz]if sfo{qmd ;+rfng ug]{5g\ . :jf:Yo rf}sL ef]ln klg oxL ;dodf v'nf /xg]5 . nueu x/]s * 306fdf ;'O{x¿ lbg ;Dej x'g]5 eGg] s'/f :jf:Yo sfo{stf{n] lg0f{o u/L klxnf] ;'O{ clxn] -( ah]_ lbg]5g\ / bf];|f] ;'O{ :jf:Yo rf}sL aGb x'g] a]nf $ ah] lbg]5g\ . t];|f] ;'O{ d}ofnfO{ /ftL g;{ km'k"sf] 3/df e]6 ug{ uPsf] a]nf lbg]l5g\ . :jf:Yo sfo{stf{n] t'?Gt} lgDgfg';f/sf] pkrf/ lbG5g\ M != k|f]s]g k]lgl;lng M $ ld=ln l8l:6N8 jf6/ $))))) k]lgl;lng efondf ld;fP/ !) ld=ln=

agfOPsf] . -! ld=ln j/fj/ !))))) o"lg6 x'G5 _

118

:jf:Yo sfo{stf{n] d}ofnfO{ OG6«fd:s'n/ ;'Oaf6 $ ld=ln= k|lt !@ 306fdf df;'df lbG5g\ . @= PlDkl;lng !))) ld= u|fd efondf % ld=ln= :6]/fOn -lgd{nLs[t_ kfgL yk]/ %=^ ld=ln=df

agfOPsf] !*) ld= u|fd÷ld=ln= :jf:Yo sfo{stf{n] d}ofnfO{ OG6«fd:s'n/ ;'O{af6 !=% ld=ln=, * 306f dfqf ;"rLsf] cfwf/df

lbG5g\ . oxL dfqf d}ofnfO{ nueu x/]s * 306fdf lbOg]5 . #= lSjgfOg M :jf:Yo sfo{stf{n] d}ofnfO{ !%) ld= u|fd÷ld=ln=sf] )=^ ld=ln= sf] z'?sf] dfqf

lbG5g\ . ToxL dfqf $ tyf * 306fkl5 lbOG5 . To;kl5 :jf:Yo sfo{stf{n] d}ofnfO{ cf}nf]sf] vfg] cf}iflw vfg ;Ifd geP;Dd )=^ ld=ln= x/]s * 306fdf lbg hf/L /fVg]5g\ .

$= rLgL kfgL M :jf:Yo sfo{stf{n] d}ofnfO{ %) ld=ln= rLgL kfgL Pg= lh= gnLaf6 lbG5g\ . :jf:Yo sfo{stf{n] z'4 ufO{sf] b"w lemsfpF5g\ . b"wl;t ld;fpgsf] nflu pxfFn] !)) ld= u|fdsf] Pp6f Kof/fl;6fdf]n rSsLnfO{ w"nf] kf5{g\ . pgn] d}ofnfO{ :jf:Yo rf}sLsf] afFsL ;dodf #) ld=ln= b"w x/]s 306f Pg=lh= 6\o'aaf6 lbG5g\ . klxnf] #) ld=ln= df, pgn] Kof/fl;6fdf]n yK5g\ . pgL To; dfqfnfO{ ^ 306fdf bf]xf]¥ofp5g\ . :jf:Yo sfo{stf{n] d}ofnfO{ Gofgf] kf/L /fVgsf] nflu cfdfnfO{ d}ofnfO{ sfvdf lnP/ /fVg eG5g\ . cfdfn] d}ofnfO{ /fd|/L 5f]Kg, 6f]kL / sDannfO{ ldnfpFl5g\ . g;{n] d}ofnfO{ ;fFem pgsL km'k"sf] 3/df e]6\bf Pg= lh= gnLaf6 la:tf/} pgnfO{ !)) ld=ln= b"w lblG5g\ . g;{n] !)) ld=ln= eGbf a9L lbGgg\, lsgeg] w]/} lbPdf d}ofn] jfGtf ul5{g\ ls eGg] pgnfO{ 8/ 5 . ToxL kl/df0f csf]{ lbg laxfg :jf:Yo rf}sL v'Nbf lbOG5 . To; ;do, d}of a9L rgfvf] b]lvG5] tyf p;sf] d'vdf /flvPsf emf]ns'/fx? lkpg ;lS5g\ . :jf:Yo sfo{stf{n] cfdfnfO{ !) ld=ln= sf] Pp6f l;l/+h, d}ofnfO{ # l;l/+h el/sf] b"w k|To]s 306fdf v'jfpgsf] nflu cfdfnfO{ lbG5g\ . d}of a9L la/fdL ePsL / lgNg g;Sg] ePsLn], t'?Gt cfjZos gkg]{ pkrf/x¿, cfO/g / cNa]08fhf]n, clxn] lb+Ob}g . pkrf/sf] $ lbgkl5, d}of rgfvf] b]lvG5] tyf pgsf] Hj/f] x/fPsf] 5 . pgL skaf6 s]xL 3'6\sf] lkpg ;lS5g\ . pgnfO{ Snf]/f]lSjgaf6 klxn] g} pkrf/ ul/Psfn] :jf:Yo sfo{stf{n] lSjgfOg ;'O{x¿

aGb u/L pgnfO{ ;Nkmf8f]lS;g–kfOl/d]yfldg -!@ rSsL, lk;]/_ lbg] lg0f{o u5{g\ .

:jf:Yo sfo{stf{ w]/} s8f Hj/f]hGo /f]u, d]lgghfOl6; xf] cyjf cf}nf]] xf] eGg] af/] clglZrt x'G5g\, t/ pgL lglZrt x'g rfxG5g\ ls ;a} ;Defjgfx¿sf] k"0f{¿kdf pkrf/ xf];\ . pgL k6s–k6s lbOg] ;'O{x¿nfO{ aGb ug{ rfxG5g\ . To;sf/0f, pgn] cfO= Pd= PlDkl;lng tyf k|f]s]g k]lgl;lngnfO{ aGb u5{g\ tyf vfg] PlDkl;lng -#÷$ rSsL x/]s ^ 306fdf_ lbG5g\ . pgn] o;nfO{ !) lbgsf] pkrf/ k"/f ug{sf] nflu c¿ ^ lbgnfO{ lbG5g\ . :jf:Yo sfo{stf{n] c¿ s]xL lbgsf] nflu d}ofnfO{ k|To]s lbg x]g{ hf/L /fV5g\ . pgsf] cj:yfdf ;'wf/ x'g yfNb5 . pgL vfg z'? ul5{g\ . cfdfn] PlDkl;lng lbgdf $ k6s lbg ;lS5g\ egL :jf:Yo sfo{stf{ lglZrt x'g rfxG5g\ . :jf:Yo sfo{stf{n] ca cfdfl;t d}ofnfO{ of] /f]u nfUg' cl3 s;/L vfgf v'jfOGYof] eGg] af/] ;f]W5g\ . aRrfn] /fd|f] k"/s cyjf kf/Ljfl/s vfg]s'/fx¿ lbgdf slDtdf % k6s kfpg' k5{ eGg] ;Nnfx cfdfnfO{ lbG5g\ . :jf:Yo sfo{stf{n] cfdfnfO{ w]/} rSsLx¿ lbP/ cGof}ndf kfg{ rfxb}gg\ .

119

To;}n] pgn] d}ofsf] k"/f !) lbgsf] PlG6afof]l6s pkrf/ ;dfKt geP;Dd cfO/g–pkrf/ z'? gug]{ lg0f{o u5{g\ . d}of / pgsL cfdf km]l/ cfpFbf, :jf:Yo sfo{stf{n] cfdfnfO{ km]/; ;Nkm]6sf rSsLx¿ lbG5g\ tyf s;/L km'6fpg] / w"nf] kfg]{ eGg] af/] pgnfO{ b]vfpF5g\ . pgL d}ofnfO{ s;/L v'jfpg] eGg] af/] klg b]vfpF5g\ . pgn] cfdfnfO{ x/]s lbg laxfg cfwf rSsL d}ofnfO{ lbgsf] nflu eG5g\ . rSsLx¿ d}of tyf pgsf efO alxgLx¿sf] kx'Fraf6 6f9f /x"g\ egL lglZrt ug{sf] nflu klg cfdfnfO{ pgn] eG5g\ . To;kl5 pgn] d}ofnfO{ @ xKtfdf e]6\g] ;Nnfx lbG5g\ . Tolt a]nf pgn] d}ofsf] /Qm– cNktfnfO{ hfFRg]5g\ tyf cfdfnfO{ pgn] c¿ cfO/g rSsLx¿ lbg]5g\ .

120

This publication of revised CB-IMCI manual has been made possible by the support from USAID, Suaahara under contract with Integrated Rural Health Development Training Center/Nepal. www.irhdtc.org.np

module treat the child -...

Documents