Public hospitals are major pitfalls for country’s
efforts to curb rising cases
Hindustan
Times (Gurgaon) 22 Mar 2016 Sanchita Sharma sanchita.sharma@gmail.com
India’s revised national
tuberculosis control programme (RNTCP) is thriving, but only on paper.Only
those who cannot afford treatment in the private sector use it. With the
government unable to monitor India’s unregulated private sector, which is the
first point of diagnosis and care for the majority of the 2.2 million people
diagnosed with TB each year, extensively drug resistant TB is spreading (XDR
TB) rapidly.
Meena Dhadke, 30, is one
such person who was diagnosed with “sensitive” TB — the kind that can be easily
treated — in March but is getting treated at a private hospital in Mumbai. Her
husband Ambaji Dhadke, 31, has been fighting XDR TB for two years and he weighs
only 30 kg for his 5’ 6” frame.
“Her husband is a serial
defaulter who stopped treatment five times in the past two years, which has
made his infection impossible to treat,” says Dr Gaurav Ghatawat, the chest specialist at the charitable Fauziya
Hospital in Kurla West, Mumbai, who is treating the couple.
Treating XDR TB involves
having a cocktail of 12-15 drugs and injections that cause side effects such as
appetite loss, stomach cramps, vomiting, diarrhoea, fever and depression. “He
stops having medicines when he feels too sick to take them,” says Dhadke.
In the private sector,
treating sensitive TB costs less than ` 1,500 a month, multidrug resistant TB
costs around ` 5,000, and XDR TB costs close to ` 20,000 a month, yet Dhadke —
who works in homes for a living — refuses to take her husband to be treated
free at the government’s TB Hospital in Sewri East.
“Everyone who goes there
dies, I want him to live,” she said. Sewri Hospital is known for poor infection
control, which has led to several doctors and nurses working there developing
XDR TB.
She struck gold by
choosing Fauziya Hospital, where TB diagnostic and treatment protocols are
followed, unlike at many other unregulated clinics and hospitals where
irrational drug combinations are prescribed in wrong doses.
“Irrational fixed drug
combinations containing important anti-TB drugs such as quinolones and
linezolid are rampantly available in the market, which has worsened the
prevalence of XDR in India,” said Dr Grania Brigden, TB and AMR ( antimicrobial
resistance) advisor, access campaign, Medecins Sans Frontieres (MSF).
Keeping patients on
course is the other challenge. For many, the compliance that the RNTCP’s
directly observed treatment short-course (DOTS) regimen hopes to achieve by
giving drugs under observation is threatened when they are too sick to go to a
government centre.
“The biggest indicator of a good programme is
whether people are choosing to use it... People go to DOTS centres as a last
resort,” says a doctor in the
government sector who does not want be named.
THE AVAILABILITY OF
IRRATIONAL FIXED DRUG COMBOS CONTAINING IMPORTANT ANTI-TB DRUGS WORSENED THE
PREVALENCE OF XDR
