Q. What does World TB Day signify?
The World Health Organisation( WHO)
and the International Union against Tuberculosis and Lung Disease (IUATLD) collaborated with NGOs, to mark 24th
of March as
World TB Day. It was to observe the centenary of Robert Koch's identification
of tubercle bacillus on 24th
March 1882. Each year there is a theme
and a slogan, so the slogan for this year is "On the move against
Tuberculosis-Transforming the fight towards Elimination."
Q. Tuberculosis is curable, yet society continues to ostracize and
stigmatise TB patients. Why is that?
Previous experiences and movies.
Movies around the 50s and 60s have romanticised TB projecting patients as
coughing, bleeding and eventually dying. Before the 50s and 60s there was no
concept of chemotherapy and TB patients were kept in ventilated sanatoriums. It
was usually the patients with natural immunity that survived. Somehow the movie
version of TB has been ingested. Hence scientific facts must be gotten right. TB
is curable with correct treatment, and periodic monitoring by medical
professionals trained in it.
Q. TB is complicated to handle. How has it become a primary concern?
TB is everyone's problem especially
in India and China
and it affects the most productive age group, 20 to 40 years. It is also the
largest killer in India.
There are 20 lakh new patients in India apart from the ones yet to be
cured. And that makes it up to one third of world TB patients in India alone. It
is also disturbing to note that 3, 30, 000 people die every year and 8, 70, 000
are infectious making them capable of infecting others.
Q. Last year the DOTS Plus
guidelines had been released. Can you elaborate the effectiveness of DOTS?
Direct Observation Treatment, Short
Course (DOTS), is a procedure where medication is given under direct
observation by a health worker. Since TB is a chronic disease the shortest
course lasts for at least six months and depending on the severity, the
duration is bound to increase to 9 months to even a year. If the treatment
extends, then the motivation to continue the treatment decreases. Also, once
the patient starts to get asymptomatic the motivation to continue treatment
The effectiveness of DOTS will be ensured only if patients follow the
entire treatment until TB is completely eradicated. The educated dutifully
follow the entire treatment; it is the poorly informed who discontinue before
they are cured.
Q. The population is vast, what are your suggestions to provide uniform
One of the challenges is the
accessibility to the centres that provide DOTS. People from rural areas, hilly
regions, find it difficult to reach the centres. Travelling to these centres
could cost them their livelihood in case of casual labourers. In such cases,
even post-men and school teachers are requested to deliver DOTS to patients
living in remote areas.
There should be more centres set up to provide treatment.
Q. What is the difference between the treatment provided by the government
and private hospitals?
DOTS are provided by the WHO and the
government for free. The pills are administered thrice a week, every alternate
day. Whereas in private hospitals 3 to 4 drugs are bought from pharmacies and
the treatment is on an everyday basis. They are both equally effective.
When patients approach me, I spend time telling them the do's and don'ts
and patients are compliant. It is usually the uneducated who are not aware of
the disease and importance of the treatment.
Q. Could you cite some
of the current challenges in treating TB?
The emergence of Multi-drug
(MDR-TB) is dangerous. Drug resistant TB is not
curable by usual TB treatment and treatment is 20 times more expensive and
needs at least 1 and half years to get cured. The time needed for identification of Resistant Tuberculosis is
long(5-6 weeks) and the test is
expensive and not available commonly in usual labs; hence there should be more
In addition, newer diagnostic methods should be implemented, cost factor
should be considered and quicker identification must be enforced. Most
importantly, research and development needs to be in place and encouraged. That
is the theme behind this World TB Day 2011's slogan- Transforming the fight
. This new plan, for the first time,
identifies all the research gaps that need to be filled to bring rapid TB
tests, faster treatment regimens and a fully effective vaccine to market.
Q. What is the frequently asked question?
Some patients are already under
other medical treatments. So their primary concern is the interference of
anti-TB drugs with the other medication. Their concern is justified because rifampicin
(anti-TB drug) interacts with other drugs
and decreases the
effectiveness of oral contraceptives, anti-epileptic drugs, anti-HIV drugs etc.
Hence the medical practitioner must review old drugs to ensure there is no
interaction or adjust the dosage to keep the treatment effective, because TB by
itself requires 3 to 4 drugs. Adverse effects cause problems, so other habits
of the patient should also be considered, such as liver problems, alcohol
history. The functioning of liver under such pretext should be monitored
Q. Can you share some of the other side effects?
The most common side effects of
commonly used TB medications are nausea, vomiting and orangish- yellow
discolouration of urine.
Anti-TB medication could affect visual accuracy. When such things
happen, the physician should be informed. In case of doubts, the patient or
guardian should have them clarified.
In general, the anti-TB medications are very safe. The prevention of
MDR-TB is of utmost importance. In simpler terms, some bugs need 3 pesticides
to kill it; similarly TB always needs 3 to 4 drugs to prevent it from becoming
drug resistant. The wholesome regimen
has to be adhered to ensure the treatment is effective.
Q. With the World TB Day round the corner, what would you propose as a
positive contribution as a community to eradicate TB?
Support TB patients, do not push
them away. They can do with all the encouragement starting with receiving a
simple act of concern such as enquiring about their well-being. Health workers
should exert pressure in a positive way so patients will stay on course when
patients get asymptomatic.
Personally, I think people should be educated especially kids in the
form of health education. The education system should emphasize the need to
create a barrier to protect oneself from bacteria spreading through respiratory
aerosol such as coughing or sneezing. Kids should be made aware of covering
their nose and mouth with handkerchiefs while they cough or sneeze since TB and
other respiratory infections like flu are air borne diseases.
Tuberculosis is curable! Many
patients stand testament to the fact and have been completely cured making them
fully able to resume activities of normal life. The eradication of any sickness
is a collective effort by the society and it's purely ignorance that is holding
us back from eradicating a curable disease. Interestingly, this year's slogan
relates to the march towards elimination
of TB from the face of the earth and it is with sincere hope of achieving
the goal, Medindia thanks Dr. P. Senthilkumar for his views.