Do you know that each minute one person in India is dying because of TB? And 25 per cent of the global cases of tuberculosis are in India,” asked PRID Y P Das, Chairperson of the Rotary India National TB Control Committee, while addressing a meet in Delhi to focus attention on the scourge of TB in India.
For the last 20 years India had been struggling on how to address this disease. But fortunately, this March, Prime Minister Narendra Modi said that let’s go one step further than the global goal to reduce TB by 90 per cent by 2030. “The PM said the goal for India would be not 2030 but 2025, and all the files gathering dust all these years in government offices have surfaced and TB is now being given priority by the Health Ministry.”
PRID Das reiterated that “our priority remains polio eradication but let us sensitise our Rotarians to do whatever they can on controlling TB. We should know that TB cannot be eradicated; it can only be controlled.”
Amitabh Bachchan is a TB survivor, who had TB of the spine and says that if somebody like him with access to the best of healthcare, can get TB, imagine the plight of ordinary people.
— PRID Y P Das
As always, in this area too, Rotary had struck vital partnerships and signed up with both the International Union against TB and Lung Diseases (The Union); REACH and the Tata Trust. The last was taking up a pilot project in Nagpur in partnership with 14 Rotary clubs for active case mining and if successful, this will be replicated throughout the country.
A celebrity such as Amitabh Bachchan had lent his voice to the campaign against TB. “He himself is a TB survivor, who had TB of the spine and says that if somebody like him, who has access to the best of healthcare, can get TB, imagine the plight of ordinary people.”
A lot of headway can be made in controlling TB if the DGs took this up and motivated their clubs. “Whoever is interested can take up this work. We are not going to thrust it down your throats. Those interested can send me an email and I will respond to you in five minutes… we can give you a lot of information,” Das added.
A TB champion
Addressing the meet, which was attended by DGs and several other senior Rotary leaders, Neha Singh, a TB champion, recalled her long-drawn battle with the disease. “When I got TB, I was so young and didn’t know what TB was, neither did my family. We didn’t know how to deal with it.”
She was put on a nine-month treatment but even after that she was coughing and losing body weight and so her parents took her to a private doctor, who said she has got TB again. She was again put on a 10-month treatment. “But even that was not successful. I had to go to a special Government TB hospital where the team of doctors said that I have MDR (multidrug-resistant) TB where many TB drugs don’t work.”
After the trauma of two treatments, now she was told she’d have to undergo a two-year treatment. “I simply wasn’t able to accept it; I had to take 15 medicines a day and an injection every day for seven months.” But having survived this ordeal she now realises that people have lots of myths and misconceptions, especially against girls…. “that if a girl has TB, don’t sit near her. People started avoiding my family and nobody even asked if I was getting better. For several other diseases, people get what is called social support. But I didn’t get it.”
Stressing the importance of early and accurate diagnosis, she said that had she been diagnosed with MDR TB for the first time, instead of the third, she would have been cured much earlier and saved a lot of trauma. She appealed to the Rotarians to help this cause.
Added Das, “Government treatment is 100 per cent free for TB. There is no dearth of money with the government; it just needs the right partners and we Rotarians can do it.”
We say India has done a lot for TB… but all we’ve managed to do in the last one decade is to push TB from the fifth biggest killer to the sixth biggest killer.
— Dr Imran Syed, Country Director, Challenge TB
Addressing the meet, Dr Imran Syed, Country Director, Challenge TB, The Union, said TB is caused by a bacteria, unlike polio, measles etc that are caused by a virus. It affects almost all parts of the body and the main symptoms are fever, cough for over two weeks, weight loss and night sweats. He said that having worked in polio in 2007–08 in Moradabad, he knew how hard Rotary worked to motivate people to allow polio vaccination.
Similarly, Rotary’s help in fighting the “biggest infectious killer” was required; “we lose almost 45,000 people to TB every year. We are one-sixth of the world’s population but have one-fourth of its TB cases. There are some mathematical models which say that if we do not act now, by 2050 we will lose $1.6 trillion to this disease.”
Once a person contracts TB, he has to take treatment for six months; and 24 months if it is MDR TB. A person with TB and no medical insurance gets into a vicious cycle of malnutrition and poverty. First there is no energy to work, then there is no work, and hence no money to feed themselves and their families. “We say India has done a lot for TB… but all we’ve managed to do in the last one decade is to push TB from the fifth biggest killer to the sixth biggest killer.” The worst part is that the age group most affected (15 to 35 years) is the most productive age group, he added.
On how Rotarians can help, he said that yes government funds are available along with the policy for access to free diagnosis and treatment but when it comes to needy people getting those services there is a lacuna and we haven’t even managed to reach 30 per cent of the coverage needed. So, work was required at the grassroots level to give people access to these facilities when and where needed.
“Also important is awareness; TB is not a problem of only the poor; if you drive in an AC car, your driver coming from a slum can give you TB, or your maid can do the same. You are not safe till the time anybody around you has TB as you can contract it.”
On how Rotarians can help, he said clubs can take up this cause and each club can identify three or four patients with MDR TB and give the entire family nutritional support. “A mother with TB will not eat till her children have eaten. So, we have to adopt the ‘feed the family first’ concept,” Dr Syed said adding that since Rotarians did a lot of health camps, they could conduct camps specialising on TB detection and treatment.
Making a presentation on active case finding, Dr Hisamuddin Papa, Co-chairman – Implementation (South), Rotary India TB Control Programme, said doctors should “understand that when a patient comes to us, he does so after suffering from it for quite some time, often having been treated by quacks and others and only after that he ends up at the government hospital.”
Defining ‘early case finding’ he said this was detecting early from the general population TB cases… “the 40 per cent who are infected but do not suffer from the disease. Then there are those who are suffering from TB, but are not infectious, but can become so at a later stage.”
He added that in 2004 in the then RI District 3230 “we had made a TB van with a computerised mobile unit and covered 55,000 high-risk population in many slums and villages, and these included police persons, beedi workers, prisoners, factory workers, etc.” Those diagnosed with lesions were referred to TB clinics for further investigation.
Last year, with a global grant, a bigger and better equipped vehicle was pressed into service, and the work continued.
Pictures by Rasheeda Bhagat