R we really ready to control disease in our nation?
Dear Respected and Friends
I would like to discuss one case with you all. This is the case story of Mr. Shyam (Name is changed), 22 years old tuberculosis patient of my district where I was District Tuberculosis Officer. He was suffering of tuberculosis before I joined this post. He came across me and i have started treatment of relapse case (all those who took treatment in past and whose sputum contain tuberculosis are known). This treatment was started for second time. But during whole course his sputum was positive for tuberculosis bacillus. By look he was healthy. He did not have much complain that time.
He was continuously excreting tb organism in his sputum. Later i decided to go for culture and sensitivity test for this patient. Last year in Feb 2007 i have sent patient for drug sensitivity test at ahmedabad. The expert physicians of our TB chest department have examined and took culture for test. He has been advised for similar cat-II treatment as programme guideline says. In our national programme guideline nothing is given for chronic patients. This is the dead end point for DTO. DTO cant do more than referring patients to higher centre. If he tries to do something the hierarchy will ask many unusual question and gestures which nobody likes to answers. But, who is the sufferer? They are the patients and community large.
Ok come to case study, In that visit the lab people has told to come after three months for result. He came back to me and i have followed the advice of esteem experts of apex centre. After three months Shaym reached to collect report. He did not have money to reach to ahmedabad. Our lab tech had given few bugs to him for this travel. But when he reached to ahmedabad, they told your sample was not sufficient for the culture and sensitivity test. You have to give again. He was little confused and he rang me. What i could do? I have to tell ok dear please give it again, they will do needful in next three month. He was again advice same cat-II treatment and came back. The big problem of Shyam is the money. He is really poor. Now the situation started to deteriorate. He has complains of chronic cough, breathlessness, loss of weight and many other problems. Myself and local doctors have given some supportive medicine. But it was not sufficient. We have suspected clear cut case of multi drug resistance tuberculosis. As we all know the treatment cost of MDR TB is more than lac rupee for one patient. Shaym cant afford this treatment cost, obvious. So we tried for funding for treatment. But same time we did not have culture and sensitivity report of Shyam. There was no basis for asking funding to anybody. We are helpless and compulsion to wait the report.
After long wait, I got his culture sensitivity report today on phone that the bacillus of Shyam are resistant to all four primary drugs. It took almost one year to get report, and thats because one district officer was tracking continuously. Just imagine what is happening to those who are randomly reaching the apex centre? In our Gujarat only one state level laboratory for culture and sensitivity and thats still not accredited with our National Reference laboratory.
Now we will write for the funding of this patient and when he will get drugs? I dont know about that. There is one calculation is given in our module that one open TB patient (mean sputum positive patient) will give 12-15 new infection in community. What about Shyam? He must give MDR TB infection in community at least to 10 people. Who is responsible for this? This is the question I want to raise with this case study. There are large number of Shyam suffering of TB and many other simple communicable diseases like malaria, diarrohea and many other. Large number of they are dying. Are we really sensible to control such disease? Are we working in right direction? We have very good primary health care system in world. I think Mr J. Bhore has given right suggestions in his Bhore committee report. Our all health programme are very good when they prepared, but some how we failed to implement, is it right!
When I am teaching to my students the subject Community medicine, I am always giving the example of country Israel, where there were some 8-10 death due o road traffic accidents in some year and it was discussed national level and people have demanded there should not any death due to such prevented cause. The government has implemented nation wide Champaign for same and result in next year, there were no deaths due to rode traffic accidents. I think at least one people died due to road traffic accidents till you read this letter. Our life are this much cheap. Really we, Indian have great power to forget and forgive. But my request to you all dont make such tolerance in case of mortality. We have to discuss case by case for death audit for all cause.
What is the interest of all district office is to achieve all indicators favourable so nobody ask in meeting all goody-goody thing go on. I am also raising question to my all district officers how may of you are not manipulating your data? Please put your hand on your heart and ask to your soul.
It is really difficult to do community work. I know my friends, in community work you will never get any credit, instead you will get punishment; I sure you. With this Shyam case, I am insisting that please do ask to yourself who is responsible? How can we solve such problems? Do we really sensible to control tuberculosis and other disease?
In this case discussion, I dont want to anybody. This is my personal opinion, dont take personal. I am welcoming you comments and always ready for community. If anybody ready to fund the treatment of Mr. Shyam Please do contact.
Dr. Niraj Pandit