Disaster in waiting

Last week, there was a news item about tuberculosis being the leading cause of death in the government hospitals in Mumbai city. One of the comments in a newspaper was that this could be misleading for the whole population as the data was available only from the government hospitals.

Of course, only 20-30% of Mumbaikars use the public healthcare facilities. It would be interesting to know about tuberculosis rates in the private hospitals.

Many a time, it is a challenge too as many a time most tuberculosis patients attending private healthcare facilities like to keep it confidential. To make matters worse, quite often, it becomes difficult to make a diagnosis of tuberculosis with convincing evidence.

It is not uncommon for us to find quite a few of our patients with long standing cough being put on partial treatment for tuberculosis.

With quite a few of the newer and commonly used antibiotics having good amount of anti-tubercle bacilli activity, there is temporary suppression of tuberculous infection followed by a flare up at a later stage. This is also accompanied by drug-resistance.

Most areas of the country especially those with high prevalence of tuberculosis has poor facilities for microbiological culture and drug sensitivity testing.

And the ultimate problem – the disease which was commonly thought of as a problem of only the poor and the impoverished is making inroads into the upper echelons of the society.

To top it all, we’ve recorded cases of healthcare professionals succumbing to the drugresistant forms of the disease. . . obviously contracted from their patients.

All of this calls for some sort of an emergency response to tackling the disease.

The first step would be to do some sort of a drug sensitivity pattern of the tubercle bacilli in different parts of the country. This would also involve setting up of centres for culture and sensitivity studies in every part of the country. The second step would be to convert the thrice a week regimen to daily regimen as soon as possible. Of course, gaps in drug availability etc. would need to be sorted out in a war-footing. The third step would be to step up the health education campaign about the disease.

The information which has come out from the records of government hospitals in Mumbai is a matter of great concern.

I hope our public health professionals in the government sector are serious about this.