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|