As we complete yet another year, we continue to stare at a TB epidemic in India. As I mentioned in my post last year that we have done precious little and often we seem to be distracted by newer and cooler diseases like AIDS.

I was talking to one of the health workers in Karnataka and came across a very interesting insight. She told me that Tuberculosis is a social problem in India more than health. When I asked her if she was referring to the social stigma attached with the disease, she just smiled and told me that the problem goes deeper. After an hour of our discussion I understood what the problem was…

Tuberculosis is a debilitating disease. That means as one gets infected with the disease he loses appetite and obviously the strength to work. As most of the people infected with the disease are daily workers, this means they lose their livelihood and are forced to depend on others for their daily bread and butter.

Once a patient enters a program like DOTS at any of the government hospitals, he immediately shows signs of improvement. As the treatment continues his appetite comes back and he develops a voracious hunger which goes in line with the medicines to ensure total recovery.

Now here comes the catch

As the patient does not have a job, he has no resources to feed himself. Being dependent on others belonging to a similar daily wage background does not help either.

So the net result is that he stops taking his medication to reduce his hunger and the problem goes back to how it was.

That’s the reason why TB treatment fails. Not due to the lack of medicines but due to the lack of an effective social program to manage the nutrition needs of the patients.

As we approach World TB day on the 24th of March, we need to look at policies to create an integrated Social program and combines the treatment modality with the nutrition and social needs.

Otherwise we would still be discussing this issue next year at the same time just in time for World TB Day 2015….