Asia’s largest TB hospital struggles, as do its patients

Even as bad news on tuberculosis (TB) continue to make headlines, the operation theatres in Asia’s largest TB hospital in Sewri, which had a success rate of 97% in surgeries, are more or less shut. Only minor surgeries are done. The last major operation was performed in 2006. Patients in need of surgery are now sent on an endless journey from one peripheral hospital to another.

“One problem is the absence of cardiovascular thoracic surgeons capable of performing thoracic (lung) surgeries. In the last few years, more and more CVTS (cardiac, vascular, thoracic surgeons) are going for cardiac surgeries, and the experts have retired. Lung surgery for a TB patient is an art. We also don’t have anaesthetists for lung surgeries. These factors have led to the shutdown of operation theatres,” said a doctor.

“The OTs are used for minor surgeries like removing accumulated pus, water and air,” said another senior doctor.

“It is tragic that we have such a big hospital dedicated to TB treatment but the quality of care is poor. Civic authorities never encouraged people to join the hospital,” Dr Ashok Mahasur, chest physician, PD Hinduja hospital, said. “TB was in control a decade back; not many cases needed surgery. Hence, less training was provided. The problem of experienced surgeons is not acute as many factors come into consideration. The disease needs to be localised and the patient should be totally drug resistant. The body should also have the capacity to withstand surgery,” Mahasur said, when asked about the CVTS ignoring thoracic for cardiac.

Dr Yatin Dholakia, secretary and technical advisor of Maharashtra’s anti-TB association, said, "There are many patients waiting for surgery but we do not have doctors to operate on them. CVTS now concentrate more on cardiac surgeries as those are far more lucrative than lung surgeries. Experienced doctors who dedicated themselves to lung surgeries are too old and retired."

Apart from the OTs being shut, another problem facing Sewri TB hospital is a shortage of doctors and health care staff to treat its more than 850 patients. "One doctor has to handle 150 patients a day, instead of the usual 20, as do the nurses and ward boys.

Over-exposure to TB patients has led to the staff contracting TB.

We had brought this issue to the notice of the authorities but no one paid attention to the problem," said a senior doctor.

Currently, two doctors are undergoing treatment for TB. Many don’t report and quietly take medicines. With the problem of totally drug resistant (TDR) TB looming, many doctors who have children are planning to quit. "They are dedicated towards the treatment but don’t want to put their families at risk. New doctors do not want to join as they are aware of these problems. Two months ago we interviewed 35 doctors. Not one has reverted," said an official.

When DNA asked Dr Rajendra Nanavare, medical superintendent, Sewri TB hospital about the sorry state of affairs, he said, "We are trying to fill the vacancies at the earliest." The posts have been vacant for five years but he refused to explain why, and also did not comment when told of doctors’ fear of contracting the disease.

The hospital does not even have basic diagnostic equipment, which enables doctors to detect TB at an early stage. "We do the MGIT 960 technique that gives us drug sensitivity tests result in two months to help us know if the patient is extreme drug resistant or multiple drug resistant. We have asked the authorities to buy the machine that does the test by the Line Probe Assay technique. It gives the same result in one day and costs Rs40 lakh. This will help us treat patients at the earliest and in a better manner," said the senior doctor.

Doctors associated with TB management said that a few months ago there was a rumour that the authorities wanted to shut down the hospital. "This shows their commitment. If Hinduja hospital had not reported the TDR-TB cases, it would have been difficult for us to prove the importance and need of this hospital," said an official.