Tuberculosis in M Ward, Mumbai: Between access and advocacy

DEBASHISH

Phd Student IIT Mumbai

Tuberculosis (TB) is a worldwide pandemic and the leading cause of death among HIV-infected people, says World Health Organization (WHO). Currently India’s DOTS (directly observed treatment-short course) programme is the largest and fastest expanding initiative in the world, in terms of patients initiated on treatment; and the second largest, in terms of population coverage.

An emerging threat to TB eradication is multidrug-resistant TB (MDR-TB), a life threatening disease, which is a result of poor TB control programmes. But, through “STOP TB” strategy, WHO has given a vision to eliminate TB as a menace to public health by 2050. WHO assures that the number of MDR-TB cases among new and previously treated TB patients is greatest in the South-East Asia and Western Pacific Regions.

Sarathya, an NGO based outside Mumbai is closely working with CHAI (The Catholic Health Association of India) in extending access to TB treatment and awareness in the M East Ward of Mumbai, which mostly consists of slums. This initiative serves as support to the Revised National Tuberculosis Control Programme. M East Ward has the lowest Human Development Index according to the Brihanmumbai Municipal Corporation’s Human development report of 2008.

Sarathya, while implementing this programme observes a lethal gap in providing the patients with access, especially for the most vulnerable, the MDR patients.

The donating agencies focus on the numbers of patients connected to the DOT centres. The work of Sarathya consists of identifying those patients with TB symptoms or patients who have discontinued their medication. The workers who identify the patients are largely untrained and are directly exposed to the infected patients, which involved a great risk. Moreover the social stigma attached to disease, hinders the person affected to disclose the condition or even be ready to get diagnosed. This issue puts at risk both the patient and the surveyor.

In one of the stark events, Mr. Atul, a Sarathya team member, extended his support in accompanying a TB patient to the hospital. While travelling, the patient, who was in a drunken state said: “I had earlier taken medicine but nothing happened”. This is when Atul realized that this patient had a TB history. On diagnosis he turned out to be an MDR patient.

Current government health-care neglects such patients. Like in this case, many discontinue taking medicines. This is a threat, not only to the patient but also to their family. One of the key factors is that there is no food supplement along with the medicines. In areas like M East Ward, the process of addressing MDR issues needs a severe overhauling, as social problems like poverty and social stigma make the situation even more challenging.