Some months ago, Satyamev Jayate, our nation’s favourite conscience-keeper, did something unusual. It devoted an entire episode to an ancient disease called tuberculosis or TB. Satyamev Jayate (“truth shall triumph”) painted an alarming picture of death, devastation and continued suffering for millions of Indians, telling us many uncomfortable truths about TB and its more virulent drug-resistant strain.
Soon after, our former Health Minister travelled to the 2014 World Lung Congress. In his address to the global TB community, he committed himself to addressing India’s TB crisis, emphasising the need to prioritise private sector engagement, economic and nutrition support, community empowerment and changes in programmatic thinking. A tipping point, it seemed, had finally arrived for India’s TB crisis.
To ensure that this tipping point and momentum in the management of TB does not remain undercapitalised, it is important to revisit a few important truths about the disease. It will help the government, the political class and the Indian people understand the magnitude of India’s TB crisis. The current Health Minister, who has prior experience in the field of health, will now be faced with a choice — to believe oft-repeated untruths or to discover new “truths” about TB.
The truth is that TB is India’s silent epidemic, neglected by politicians and bureaucrats, now a virtual ticking time-bomb. Unless we create a nationwide movement against TB and drug-resistant TB, we will continue to create widespread suffering and deaths by neglect.
Curing TB requires more than appropriate diagnosis and treatment. A majority of the TB-infected in India are poor and lack sufficient nutrition, suitable housing, and have little understanding of prevention. TB then devastates families, makes the poor poorer, particularly affects women and children, and leads to ostracisation and loss of employment.
The truth is that even if TB does not kill them, hunger and poverty will. Another truth is that deep-seated stigma, lack of counselling, insufficient access, expensive treatment and lack of adequate support from providers and family, coupled with torturous side-effects, de-motivate patients to continue treatment — with disastrous health consequences.So how should we as a nation begin to address these truths about India’s TB epidemic? The answers are simple if we momentarily put patients at the centre of our discussions.
For patients, the most important aspects are the economic, social and familial dimensions of this disease. In an ideal scenario, every Indian must be aware of the symptoms of TB and should be able to go to the public or private sectors for free diagnosis. This must include a drug sensitivity test to ensure that drug-resistant TB is detected and treated early. If found infected, the patient and his or her family must be provided counselling and support immediately. Irrespective of where they seek care, patients must have immediate access to free and similar treatment in both the public and private sectors.
Patient families must also be provided with sufficient nutrition and economic support through development programmes for the treatment period when they cannot work. Simultaneously, a targeted and well-planned campaign and effective community engagement programmes are essential to ensure that communities come together to prevent and address TB, reduce stigma and create support for TB patients.
For sceptics of such approaches, there exists sufficient evidence that can tell us how this can be achieved. There are also experiments under way in India right now on how the private sector can be engaged effectively as a partner in TB. These experiments need to be studied and scaled up. This is critical as close to 70 per cent of patients continue to seek care first in the private sector.
Yet none of this is possible unless we have the political will, administrative commitment and sufficient resources. This is why our Health Minister must become a champion for TB. Considering that TB is an engine of poverty and suffering, all political parties should make TB a priority and recognise TB as a national emergency. Millions of TB patients can only hope that the political and administrative leadership will understand the insufficiency of our efforts in controlling TB, and the truth ultimately shall prevail.
(Chapal Mehra is an independent public health consultant)
