By Ramesh Menon, Womens Feature Service
Pallavi Sharma (name changed) looked out of the window of her New Delhi business school hostel room at the vast spaces of green below. She loved the view. But, today, her mind was disturbed. Anxiety attacks had taken over since the moment her doctor had diagnosed that she had tuberculosis (TB). In sheer panic, she broke down, grabbed her mobile phone, called a friend, and asked, “Will I die?”
Pallavi needn’t have been so distressed at the news. All she had to do was to strictly follow the doctor’s orders: Take the right dosage of medicine daily without fail. Pallavi was put on DOTS (Directly Observed Treatment-Shortcourse), or, simply put, the course of drugs that were to be consumed by her had to be directly observed by the doctor or someone else to ensure that no dose was missed until the completion of treatment and until she was fully cured. Eight months later, Pallavi had recovered completely.
While Pallavi was able to follow treatment religiously and get better, there is a staggering number of people in India who are unable to follow DOTS properly and end up succumbing to the disease.
TB kills more people in India and South-East Asia than any other infectious disease – more than HIV/AIDS, STDs, malaria and tropical diseases combined. In fact, it has emerged as one of the gravest health hazards, as every minute, someone, somewhere in the country, dies of TB. Every day, on an average, more than a 1,000 die, while the yearly toll is pegged at around 400,000. Almost 75 per cent of this number are in the productive age group.
With around 1.8 million new cases emerging every year, India shares one-third of the world’s TB burden – the highest in the world. Until recently, it was widely thought that TB only affected the poor. But that is not the case anymore. Now, even the affluent are seen frequenting TB wards in hospitals. They pick up the disease in crowded shopping malls, multiplexes, trains and buses.
Dr Rajesh Chawla, chest specialist at the Indraprastha Apollo Hospital, New Delhi, says, “Despite excellent drugs, the prevalence of TB is rising. There has to be a concentrated effort to stem this rise. Education of the dangers of TB is a must. Anyone coughing for two or three weeks must be told to take a TB test.”
TB is an infectious bacterial disease caused by Mycobacterium tuberculosis. It usually impacts the lungs, but can affect the heart, kidney, bones, skin, lymph glands and brain, as well. It spreads through the air when a patient coughs, sneezes or spits. One person can infect ten or more people in a day. Most patients ignore the disease as a rudimentary if persistent cough.
Many TB patients skip a dose or stop taking the medicine when they start feeling better. This leads to Multidrug Resistant (MDR) TB that is extremely difficult to treat, as the strains of the tuberculosis bacteria become resistant to the two most effective anti-TB drugs – Isoniazid and Rifampicin. Addressing this condition requires at least 18 to 24 months of treatment with regimens that are at least 100 times more expensive and toxic and there is no guarantee of a cure. Points out Dr Sanjay Sobti, Senior Consultant at the Indraprastha Apollo Hospital, “Doctors need to spend more time explaining to the patient all these implications.”
Women are among the worst sufferers of TB, especially in India. For instance, millions of women here cook on wood-fired stoves. This means that they are constantly inhaling smoke, which makes them extremely vulnerable to contracting TB. Nearly one third of infected women in India die due to late diagnosis or poor treatment. The reasons for this tragic reality range from lack of money or time, transportation and, unfortunately, a social reality that treats women as second-class citizens.
Most women do not seek medical help in the initial stages, as they do not want to neglect household responsibilities or be a financial burden on their families. They also suppress the symptoms, as they fear that if their condition is revealed, their husbands may desert them or relatives and neighbours reject them.
TB deaths among women have major implications for child survival, economic productivity and family welfare. An affected mother is a real threat to the household, as she is constantly with her children and has to perform household duties. In many cases it was found that children whose mothers had died of TB were also infected.
Actually, advocating prevention is the only way to control the spread of the disease. In India, one in two adults is infected with the tuberculosis bacilli, but having a strong immune system can help the body fight back. Better nutrition builds up a weak immune system. Better-ventilated houses and offices help. Cleaner kitchens with improved air quality, where fossil fuels are replaced by LPG, can save thousands from becoming vulnerable to the disease. It is also a good idea to stay away from TB patients and encourage them to cough with their mouths covered. Smokers can easily contract the disease, so it’s advised to give up the habit.
Also, it’s important that India sees TB as a national health programme and not just as a disease control programme. Only then will the war against TB succeed. Around 50 years ago there was no cure for TB. Now that we have cures, they have to be employed effectively and systematically. Otherwise, the cursed disease of the past will return to plague future generations.