Healthcare Delivery Public Health

Why we need to focus on serious problems like Tuberculosis before tackling more complex problems in India? A few thoughts on World TB day 24th March


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In India it is cool to start tackling conditions like Alzheimer’s and Parkinson’s disease. Actually most celebrities lend their support to even cooler issues like AIDS. But the biggest killer in India today is Tuberculosis(TB). Almost 1/5th of the global cases according to the WHO occur in India. Of the 2 million Indians that develop tuberculosis almost 8,70,000 have the type that turns infectious and out of those people, almost 330,000 die every year. Compare that to 134,000 people that died in India due to road accidents in 2010, an issue that gets more coverage than the epidemic of Tuberculosis.

So why has TB become such an issue and why has it fallen off the radar of the empowered Indian. Well first and foremost TB affects a strata of society that is usually ignored by all the main stream channels. Secondly the social stigma attached with TB prevents the patient from going public and in some cases he refrains from help as well. Thirdly half the patients are treated by the private healthcare set up where the standards of care are not on lines with the government – WHO prescribed model, hence the private players themselves don’t report these cases.

As of last year TB has become a notified disease, hence any private hospital or nursing home treating TB is mandated by law to inform local health authorities. Now though the Government’s intentions in this move are noble again the social issues would force patients out of the healthcare system and actually not seek any help. The fight against TB is based on the early detection and right treatment of the condition.

The treatment of choice recommended by WHO and followed by Govt of India is DOTS (Directly Observed Therapy- Short Course) which includes

DOTS (directly observed treatment, short-course), is the name given to the World Health Organization-recommended tuberculosis control strategy that combines five components:

  • Government commitment (including both political will at all levels, and establishing a centralized and prioritized system of TB monitoring, recording and training)
  • Case detection by sputum smear microscopy
  • Standardized treatment regimen directly observed by a healthcare worker or community health worker for at least the first two months
  • A regular drug supply
  • A standardized recording and reporting system that allows assessment of treatment results

For more on DOTS please visit this page.

How can we as individuals help with TB?

Well I have a personal story here, one of my colleagues, once came to me with a peculiar problem, his maid had just fainted and collapsed in the middle of the household chores. I had suggested that he take her to a local hospital where they discovered that she had the beginning of onset of tuberculosis. As usual her family had refused to come to her aid and actually shunned her asking her not to come back home. In such a situation I reached out to a govt hospital, whose chief medical officer was known to me. Not only did the govt hospital admit this lady but also they treated her for free and organized a counselling session for her family members.

The lesson from this episode is that TB is curable, it needs to be diagnosed and treated at an early stage. If you do come across a patient who is suffering due to lack of help and treatment, just direct that person to the nearest govt hospital, which is mandated to treat these cases for free. Please note seeking help from a Govt hospital is better than going private in TB cases and this is important point to note.

So on the 24th of March which is World TB day, let us at least make a start in getting this issue out in the open and taking the step in eradicating this disease from the face of the earth. For more on the WHO trategy for TB in India, please read this

In conclusion, the fight against TB has to be fought on two fronts- Medical front and on the Societal front. On the medical front our doctors and health workers are in action, but it is upto us to Galvanise the society and do what is needed.