March 24: World TB Day Magazine

The enemy within

A DOTS provider giving medicines to a tuberculosis patient. Photo: R. Ragu  

Today we have a progressive economy, electrifying lifestyles, exotic vacations, everything at the click of a mouse. But we’re still battling an age-old disease: tuberculosis (TB). When I walk with an outreach worker or talk to patients, a million questions come to my mind. Why do we have a disease that is curable but has gone totally berserk?

It doesn’t matter who you are, TB can still attack you. Of course, people from the lower socio-economic strata are more vulnerable because of various factors like poor sanitation, ventilation and overcrowding. The infection is transmitted by air through droplets of sputum dispersed into the environment via coughing, sneezing etc.

“In India, people cough and spit openly, so the amount of germs in the phlegm is massive,” says Dr. Beena Thomas. “A person with TB symptoms needs to access care. Multi Drug Resistant (MDR) and Extensively Drug Resistant TB (XDR) are severe forms and people should not take it casually. A person with MDR can transmit it. It is not just up to medical people to curb the problem of TB; there has to be a holistic approach.”

Doctors say if TB is not controlled now, the spread will be disturbing. Patients have to take their drugs regularly. The primary reason why TB patients stop treatment is that after about seven weeks of using the drug, major symptoms of TB reduce and the patient assumes that his/her health has improved. Basic precautions include covering the mouth when coughing/sneezing and making sure that the sputum/phlegm is put in a closed container and burned or disposed off safely.

Another factor to be considered is the difference in TB in adults and children. Dr. Sowmya Swaminathan, a paediatric TB expert and Director of National Institute for Research in Tuberculosis, says, “TB in adults tends to be more infectious (if it’s in the lungs). In children it tends to be more in lymph nodes and less in the lung tissue. So when an adult patient coughs, they may be transmitting lots of bacteria, whereas in children this is less common. The other big difference is that in very young children particularly under two, the immune system is not very well developed. So they tend to get more severe forms of TB, like TB Meningitis — what we call disseminate TB, which means the disease spreads all over the body. Meningitis can lead to permanent disability; and brain functions too are affected permanently. Diagnosing TB in a child is not just through sputum, but also involves a combination of clinical and X-Ray procedures.”

Even with effective treatment, the stigma persists. This is often the result of ignorance and lack of awareness. “Family members must give the patient good nutrition, love and care. In Chennai, we have been in talks with the commissioner to launch an information campaign, without scaring people. We need to inform them how it is spread and diagnosed and that it is completely curable,” says Dr. Swaminathan.

Directly Observed Treatment Short Course (DOTS) is the most-followed strategy for controlling TB. Patients are given the drugs under the direct observation of a health provider. DOTS providers and field workers are a constant source of motivation and play a vital role in the cure. “I come across patients who cry their heart out, telling us about their physical problems, and asking if they will be alive or dead, if their family will be safe and if the drugs will really help. But as a field worker, I cannot afford to be emotional. Whether I talk at a community awareness programme or meet a TB patient, I make sure to counsel and motivate them,” says Bahadur Singh, a field worker from Damien Foundation, a national NGO that has been supporting TB control activities since 1998. NGOs like these are invaluable in the war against TB, a war that can so easily be lost if we let our guard down, even for a single moment.

Case Study

Nazia Khatoon is a lively and ambitious 17-year-old, dreaming of achieving big things. But her dreams came crashing down when she was diagnosed with TB. After suffering from severe cough for two weeks, she saw a doctor. But when the problem continued, she went to the Damien Foundation. Her phlegm sample revealed TB germs. She was given an explanation about the disease and the required treatment. She promised that she would adhere strictly to the advice.

When she completed the six months of treatment, she thought her problem was over. Later, when there was no relief, a laboratory test revealed that she had XDR TB. Shocked, she asked for more information. The staff told her that she would be surely cured and began her treatment with another drug cocktail. Her sister and brother-in-law were constant sources of support. She had to take a fistful of pills and injections every day. Slowly, her symptoms started waning. When her phlegm did not show any TB germs, it was celebration time.

Nazia says, “During that time, I was worried about whether I would survive or die. I really want to get an admission in a college. I envision myself as a social sciences teacher. All I want is to lead is my life with dignity.”

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Printable version | May 17, 2021 2:00:37 PM | https://www.thehindu.com/features/magazine/the-enemy-within/article6989777.ece

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