In response to my previous article on the GlobalTuberculosis Report 2012, someone had sent me an article from the Lancet. It
made quite an interesting read.
I’m certain that we in India have a lot to learn from the
European countries on how tuberculosis was controlled. I quote the Lancet paper
. . .
Riding on the antibiotic wave in the 1960s, tuberculosis
increasingly failed to trouble public health authorities in developed
countries. Chest physicians and surgeons reoriented their interests;
tuberculosis journals and antituberculosis charities widened their remit. At
the same time, many nascent eff orts in the developing world were stalling. Not
enough attention was paid as the world entered economic turmoil in the 1970s
and expensive vertical disease programmes were replaced by a new emphasis on
primary health care. Tuberculosis rates remained high, fuelled by social
determinants, poor living and working conditions, poor medical infrastructure,
and high comorbidity.
I’m a bit sad to infer that the author unknowingly seems to
berate the new emphasis on primary health care. However, please do note that in
India, we have the vertical disease programme which has been quite expensive
and has unfortunately not produced the sort of result we’ve seen in countries
like China. We have a robust primary health care system on paper. However, most
of us very well know that in many a state the primary health care system is
just for namesake.
I would be very much interested to know the incidence rates
calculated for the different states of the country. I understand that studies
are on to find out the latest incidence rates.
From the incidence rates which were accepted about ten years
back, most of the better off states in social indices had a lower incidence
compared to the EAG states. As mentioned in the Lancet article, social
determinants, poor living and working conditions, poor medical infrastructure
etc has fuelled tuberculosis in countries such as ours. I’m surprised that the
author left out malnutrition and smoking.
Any doctor seeing tuberculosis cases will vouch that almost
all of his patients are poor and quite a huge proportion of them are addicted
to tobacco and alcohol. Most of them live in cramped one room huts in the
villages (along with his cattle and sheep) or shanties in the cities with
hardly any food to eat. And once a person has tuberculosis his whole world
caves in. He gets into a vicious cycle where the disease makes him weak to earn
a living; the lack of work makes him poor and the tubercle bacteria feeds on his
poverty stricken body mass starting at the lungs.
I’m not sure on how we reduce poverty in a country as large
as ours. But, one thing we can do is to decrease the effects of poverty
especially the aspect of nutrition. I believe that targeted food subsidy has
failed. The corruption of this country is so much that subsidised food never
reaches the target population.
There have been on and off stories of self sufficiency and
empowered food security in certain pockets. But on a larger scale, we are
nowhere when it comes to providing good nutrition to our people. It is only the
well affording who can buy nutritious food. To make matters worse, we have
enough beliefs about food that the sick are forced to follow. It is not
uncommon to find our patients avoiding eggs, milk etc.
With enough and more reports about high numbers of malnourished children in our communities, the same should hold true even for adults.
Recently, my better-half did a small study in the hospital of the
characteristics of our outpatient crowd. She found that 37% of our outpatient
crowd had a BMI of less than 18.5. And our patients are usually the lower middle
class and above and not the really poor. If this is the case, I wonder what
would be the condition of the really poor.
Solving many of our country’s scourges of ill health would
be to offer a robust system of public distribution of nutritious food for each
of its citizens irrespective of how poor or rich they are. Various types of
food distribution systems which are immune to market fluctuations and
inflations have to be somehow worked out.
So, my solution number one to decrease the incidence of
tuberculosis in the country . . . a
ROBUST PUBLIC DISTRIBUTION SYSTEM OF FOOD. I welcome suggestions . . .
