Dangerous

Almost everyday, we at Kachhwa are reminded of how dangerous a disease, tuberculosis is turning out to be. Last week, we had a perfect example of how the disease has got itself entrenched in our communities and how helpless we have been in controlling the spread.

Mr. KK, a young man, about 25 years was brought to our outpatient with complaints of cough and fever since the last one year. He had already completed 8 months therapy of DOTS under the Revised National TB Program of the government. He had not improved. He had skipped medicines in between and therefore the 6 month long treatment took 8 months.

He did not remember whether he checked his sputum or not. He had only one X-Ray with him which he had taken 2 weeks back. The picture was bleak. 

2 weeks back someone told him that the persisting cough and fever was dangerous and therefore, he had been running from one hospital to the other – a whopping 4 places in 15 days.

The prescriptions are self explanatory. There is mention of MDRTB in at least 2 prescriptions. One place demanded a payment of 20000 INR which he could not cough up and therefore the concerned doctor crossed off the prescription.

Please note the crossed off medications.
Crossed off, as the patient could not afford 20,000 INR which the doctor demanded for admissiona and treatment.
The patient claims that this doctor guaranteed cure . . . 

The biggest problem is he is still not aware about the seriousness of the condition.

The challenges in Tuberculosis treatment remain quite basic –

1. Non-adherence to regular treatment

2. Late diagnosis and improper follow up

3. No mechanism in the ground level to detect resistance

4. Availability of anti-tuberculous medication as over the counter drugs

5. Mistrust of drugs provided through public healthcare

We’ve referred him to a tertiary care centre. I hope he gets the right management.

However, as each day progresses, we realise how dangerous MDRTB is slowly turning out to be. I wonder if the calculated prevalence rates are low . . .

I hope that we would be able to do at least the following in our Community Health Centres over the next year . . .

a. Drug sensitivity testing for all cases of tuberculosis

b. Curtail sale of anti-tuberculous medication over the counter. 

Till this is done, the situation can continue to become worse . . . 

Photo credit: StopTB