Eradicating polio was an important step. As we observe world TB day, we must pledge to stem this disease by making it a national priority
Tuberculosis (TB) isn’t a full stop. It’s just a layover. I began fighting TB when I was 16. The doctor didn’t diagnose me correctly. I didn’t get the right treatment. I persisted and fought it. So can you. Don’t keep quiet, seek help.” These were the powerful words by Deepti Chavan, TB survivor and an indefatigable patients’ rights advocate. She beat the odds of her surviving just six months after being diagnosed late for multi-drug resistant (MDR) TB because she refused to give up and didn’t let stigma silence her. The 35-year-old continues to raise her voice for better access to TB drugs, better treatment and diagnosis of this curable disease. Most of all, Chavan — a part of the Survivors Against Tuberculosis, a network working to make the disease more patient-centric — wants TB to be made a national priority.
But is anyone listening? After all, if polio could be made one, why not TB? Considering India has the highest TB burden in the world with an estimated annual incidence rate of 274 per 100,000 people and kills 400, 000 people annually, the case for it to be given equal importance becomes even stronger. Moreover, TB is infectious unlike polio. Caused by bacteria, TB generally affects the lungs. Around 40 per cent of Indians carry the bacteria. In other words, more people in India, than elsewhere in the world, have latent TB. What is worrying is that every case of active TB comes from a person with latent infection. Every new case of latent TB means a person with active TB disease has not been diagnosed or treated effectively and, thus, transmitted the bacteria to an uninfected person. Unless it’s treated with the same anti-microbial drugs used against active TB and taken over nine months, latent TB can’t be ended.
However, it has to first be diagnosed. Over one-third of the cases are not diagnosed or are diagnosed but not treated, according to India’s Revised National TB Control Programme (RNTCP). Many fall through the surveillance system when they don’t go to a doctor or don’t get diagnosed when they do. The situation is further aggravated by inadequately equipped public and private healthcare facilities. Delayed diagnosis coupled with poor treatment and follow-up, prolonged costly treatment, painful side effects, stigma and discrimination often have fatal consequences, leading to loss of lives.
Accredited Social Health Activists (ASHAs), who have been trained as providers of the Directly Observed Treatment Short-course (DOTS), have played an important role. They have managed to identify persons with history of cough for more than two weeks and referred them to the nearest Designated Microscopy Centre for sputum examination. Their duties also include ensuring the patient completes the treatment. ASHAs are paid an incentive on completion of responsibilities. But do ASHAs really have the time to do so much considering they already have so much on their plate? Improving maternal and new-born health care, ensuring institutional births, raising awareness about family planning, menstrual hygiene and management, tracking immunisation and malnutrition and preparing malaria slides are some of the 43 activities ASHAs are required to do in lieu of incentives.
So why not have TB mitras (friends) much like the existing shiksha (education) mitras, who can focus on just TB and provide relief to the overburdened ASHAs? Not only can they be valuable allies, they can plug the surveillance gaps since TB treatment regimen requires a patient to take up to 75 doses of medication under the supervision of an observer, over the course of six months or more. This becomes challenging for families living in urban slums and rural areas to make regular visits to a TB centre to take medication. TB mitras can follow up patients if they stop coming for treatment and ensure they don’t develop the deadlier drug-resistant TB.
These TB mitras would be from the same community, speak the same language and dialect and be familiar with the culture. Once trained, they would make home visits and quietly identify people who have TB so that the fear of stigma doesn’t force them underground. Once people with TB are identified, TB mitras would ensure adherence and treatment. This TB mitra could also be a member of women’s self-help groups (SHGs). Strong SHGs networks across India can play a vital role in reaching out to women, traditionally the last to seek health care. Kerala, which has emerged as the success story in reducing TB in the State, has been the first off the blocks in this case. Its strategy to engage SHGs under the State Kudumbashree women’s empowerment programme has helped in its TB prevention and control programme. According to Dr Shibu Balakrishnan, RNTCP, Kerala, one of the 20 women in the SHG is a trained health worker. Moreover, SHGs are part of the TB task force and map the community, especially women, for infection, thus helping to reduce TB incidence. If India is to achieve SDG 3 (eliminating TB by 2030), it must adopt innovative strategies focussed on individuals. Only then, can it make a real difference.
(The writer is a senior journalist)
