Are we ready for ZERO TB?

Are we ready for ZERO TB? 
A reality check in India

Tuberculosis (TB), one-third of the world's population has fallen victim to this communicable disease. Numerous organizations across the world have been working hard to control it since many years. Recently, all have come together, and a collaborative environment has built up. Now the target is to achieve ZERO TB death by 2050. A dream which when becomes reality will save millions of humans on this planet, and may further lead to complete TB eradication.

The condition of India is very disappointing, it’s number one on Tb deaths and no matter how bigger is the approach to fight for it the success rate is very low in contrast to what is claimed by many Tb control programs. To check how is the TB control program and treatment, as well as the awareness amongst the people; I recently visited few places in the state of Maharashtra (India).

  My visit to a village (Umroli) in Palghar said a very different story. Palghar has been on the radar TB for high incidence of the disease and of MDR TB which led me to investigate more on why is this so. I interacted with few affected ones and some who are under treatment. Mostly people are not aware of what the disease is.  The economical conditions of the families are very poor.

 A family head says that “if I go to take DOTS every alternate day at the health center, who will earn bread and butter, so I took the treatment for few days regularly, and now I very rarely go there”. One of the key problem lies here is that the health center is very far from the home, which discourages the people from visiting it regularly. If an area is having such a high prevalence of Tuberculosis it’s the responsibility of the health center and the government to find a convenient way to help the affected ones and to educate the villagers on tuberculosis.

Later, I visited Pune city and its adjoining areas (Khadki, Pimpri, Chinchwad, kasarwadi), and visited few hospitals in this area. The condition of patients in the ward is pathetic; HIV and TB patients are kept together, which is an open invitation for the HIV patients to die early. Patients cough continuously, and the ventilation system isn’t very proper either. Not only the patients in this ward, but also in other wards are more likely to get infected. So what can anyone do if the hospital itself becomes a factory to produce TB patients? Even if the case is of an MDR TB, all the other patients are kept in the same ward. This not only risks the lives of the other patients but also the hospital staff and they are unaware of this risk.

Speaking to some doctors who are specializing in TB, it threw light on more intense problems. And the conclusion I got from this is well enough to understand that why we need a good and different approach if we have to achieve the target of ZERO TB death.

I asked the following Questions and the answers I got from the doctors (they preferred to be kept anonymous).

1. What is the condition of TB in the city?

A.      On an average, most of the big hospitals in the city register over 50 cases daily.

2. What are the problems that patients usually face?

A.      The problems are numerous. TB is a poor man’s disease, and most of them lack in literacy. It becomes very challenging task for doctors to make understand a patient on the disease. Since the incidence of TB is very high, the ratio of number of doctors available for tb patients is highly misbalanced, because of which it becomes very difficult for doctors to counsel the patients in detail.

3. So what may be the possible solution for this?

A.      Government must come up with counseling centers, where we can refer patients. From where they can get information on hygiene, importance of timely medication, and the diet to be followed. They should be encouraged to educate other family members and neighbors’ about it so the spread of the disease can be restricted.

4. What is your opinion on the DOTS program which is so successful in the country?

  

  A.   The reality is very different from the statistics. The procedure of referring to the DOTS program is very cumbersome; the patient has to go around lots of formal procedures. Since many are not that literate, they generally quit the procedure and the treatment in between. Doctors are not updated properly by the RNTCP. The 6 months DOTS therapy has been kept same for all type of TB. The primary health centers are dispatched with the DOTS package, but there is no way to check if the patient is regularly and timely administered with the medicine.

5. Zero TB death, it’s a global target now. What’s your opinion on it? How soon we may achieve it?

A.      In India there are much more cases of tuberculosis than estimated. There is no health information system in place to keep a proper track of the existing cases. The diagnosis of disease itself is problematic. We can’t rely on just sputum tests, and the other good methods are costly. Diagnosis is unable to reach at the grass root level; this is where the system fails. No matter how hard we try to control, the disease spreads faster than our imagination and remains undetected because of the above problems. It’s hard to say that I will see this mission become reality till I live, I would be very happy to see the day of ZERO TB death, but we if it has to be real then, then a new and systematic and an effective way has to be designed to overcome tuberculosis completely. Problems which we face here should be studied in detail and then a proper methodology should be put in place buy the organizations and the government. The problem is not just restricted to this city; the condition is same all over the country.

(Thanks to all those who have supported me to prepare this report. Special thanks to my friend
 Dr.Dhiraj Pal for his help and support)