Surgeries, an important aspect of the treatment, have taken the back seat

Experts here treating Tuberculosis (TB) have contested the high-cure rate claimed by the civic administration and says the city lacks modern machinery to properly diagnose and treat patients. Surgeries, an important aspect of the treatment, have taken the back seat. The operation theatre in the Maharashtra government's only specialised TB hospital has been lying unutilised for major surgeries for more than five years now.

They have also said the government should allocate more funds towards the expensive treatment as lack of funds leads to discontinuation of treatment, putting the patients in a high-risk category.

Nearly a month ago, a team of doctors from the Hinduja Hospital detected 12 cases of TDR-TB (Totally Drug Resistant Tuberculosis). An expert team of doctors from the Central government immediately visited the city and termed the cases XXDR-TB (Extra Extensively Drug Resistant TB). The team later graded it as XDR-TB for want of international acceptance of the term TDR-TB.

“I think TDR-TB should not be used. There is no international validation for the term. Moreover, if such a thing happens, it will lead to human disaster. The terminology has created panic among doctors, staff working in hospitals, consultants, trainee doctors, persons working in laboratories, post-mortem sections. They are the high-risk group,” according to Jaisingh Phadtare, a pulmonologist and professor at the Department of Medicine, Grant Medical College, Mumbai, who has been practising since 35 years.

The civic administration has said the cure rate of the New Sputum Positive (NSP) is 86.42 per cent for 2011. New Sputum Positive (NSP) cases are those patients whose sputum tests positive when tested for TB for the first time.

But experts have contested the claim. “How does the sputum get examined? Not many places in the city have fluorescent microscopes. They have simple binocular microscopes in which one has to observe the sputum continuously for seven minutes. If there are, on an average, nearly 70 samples sent to a laboratory, is it possible that the person will properly examine each sample,” Dr. Phadtare asked.

“Moreover, there are many cases where the patients are X-Ray positive and sputum negative. Of the 14.5 million cases, only 3.5 million are sputum positive. Do you not treat the rest of the TB patients then? Only talking about sputum examination is wrong,” he said.

The civic administration does not have the count of all the TB patients in the city. Those who take private treatment are not included. The civic administration has the numbers of only those patients who are enrolled in the government-run Revised National Tuberculosis Control Programme (RNTCP).

Doctors say patients keep going to various doctors for better treatment and thus get out of the RNTCP net. Till recently, private patients could not re-enrol for RNTCP. A new criteria has recently been added, which will enable patients of private doctors to enrol under the RNTCP. The figures given by the civic administration are for the year 2011 when the new criteria was not included and thus give an incorrect view of the number of TB patients in the city.

“There is lot of mistreatment of TB patients. The fault lies with the doctors as well as with the patients. Proper diagnosis is not done most of the times. Early detection and regular treatment are key to the cure. But even the patients keep hopping around,” Dr Jehangir Sorabjee, Consulting Physician and Professor of Medicine at Bombay Hospital told The Hindu.

He said that there was no particular age-group less immune to the TB bacilli. “Our patients are mainly from the middle class or the poor. Those suffering from HIV [Human Immunodeficiency Virus] and diabetes are more at risk mainly because their immune system is weak. Nearly 50 per cent cases are non-pulmonary,” he said.

Side-effects

He said the patients drop out of the treatment or seek new doctors due to the side-effects and the cost of the treatment. Lack of proper nutrition aggravates the problem.

“This is where NGOs play a very important role. In fact, the government cannot function without the NGOs. They are involved in counselling, ensuring uninterrupted drug supply, financing the drugs, facilitating access to health service, giving moral support to the family, creating awareness about the need for nutrition,” Dr. Phadtare said.

NGOs such as the Chetana Foundation, the Lalbaugcha Raja Trust and the Mahalakshmi Trust have played an important role for years to support TB patients, he said.

Doctors lamented the lack of thoracic surgeons in the city. “It does not pay all that well. So hardly any surgeon chooses it now. But surgeries form a definitive role in the treatment of TB. The infected part is surgically removed, which takes off the load on the patient's body,” Dr. Phadtare said.

The only State-run specialised TB hospital, at Sewree in Mumbai, has an Operation Theatre, but no major TB surgery has taken place there since 2006, the doctors at the hospital told The Hindu. No steps were taken to operationalise it till the news of the cases of alleged TDR-TB patients put the spot on the dilapidated condition of the hospital.

“We will operationalise the OT by the third week of February. The surgeons attached to KEM hospital, Nair Hospital, Sion Hospital will come on days allotted to them. The honoraries too are being contacted,” Manisha Patankar-Mhaiskar, Additional Commissioner, Municipal Corporation of Greater Mumbai, told The Hindu.

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