DR Narges Mistry, Director of the Foundation of Medical Research, warns that the costs of ignoring TB could be too high.
What are the main problems in controlling TB in rural areas?
What is decided in New Delhi takes a longer time to reach rural areas than it does to reach urban areas. That compromises the quality of care in terms of what the rural population gets. Rural TB is a larger problem in terms of prevalence of the cases. We know that to some extent it is exacerbated because of the use of firewood in households and being restricted in tiny hutments. That makes women prone to not only TB but also other respiratory ailments arising from firewood. Ventilation is bad in several areas of rural Maharashtra where the hutments don't have windows, which are expensive. Air exchange that would ward off the transmission of TB is low which is what you see even in tribal areas as they share the living environment.
Does migration of population play a role?
There is a transmission of drug resistant TB from urban to rural areas due to the migration apart from the newer types of strains. In Mumbai there are six different types of strains.
Apart from that in rural areas the biggest problem is the diagnosis facilities. Does the rural infrastructure have the ability to provide treatment to patients with MDR-TB? What is the quality of tests that are being administered as it does require some expertise? Do you have councillors in place who will motivate people to stick to the regime and can handle the side-effects due to the medicines? These are the major challenges.
Why are we not treating TB on a far footing despite having the largest number of TB patients?
We hear public health officials mumble about it being a public health emergency but the effort to counteract it is missing. It takes ages for officials to fast-track regulations. The TB germ is not going to wait for two years before the regulation comes in. TB is curable so far. It might not be 10 years from now. These antibiotics have been around since 1970s and they will not be effective forever. The more you use them the quicker they will fade because resistance is building up so fast.
What should be our approach in tackling TB?
We are not addressing drivers of TB which is environment and socio-economic conditions. All of this can be tackled with good housing. Without a holistic view TB can't be tackled in urban or rural areas. The TB patient is a completely disempowered creature. A stigma reduction programme would help in this situation. Due to the strong side-effects many migrants run back home. Doctors there are not capable and we don't know what happens back there.
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