The Bombay Hospital incident, in which an HIV+ patient suffering from brain TB killed another patient and injured two, is a sharp reminder of the negligence shown to mental illness and its patients, especially if they are suffering from chronic ailments, even by the medical fraternity.
Dr Yusuf Matcheswalla, a psychiatrist attached with Masina hospital, said: "The problem with treatment of chronic ailments is that specialists are so busy trying to diagnose the patient with respect to their area of expertise (ie a chest physician focussing on TB) that they forget s/he can also have mental illness and be on the verge of a nervous breakdown. Abroad, chronic patients are mandatorily referred to a psychiatrist."
A similar incident happened in Sewri TB hospital on February 12, when a 40-year-old multi-drug-resistant TB (MDR-TB) patient attacked a ward boy and other patients with knife. This was followed by a teenaged TB patient ending his life.
An ailment like tuberculosis often ends up isolating the patient socially, say doctors. The absence of support from friends and relatives, coupled with physiological and mental side effects of the disease, has made it a thumb rule for doctors to advice psychiatric counselling for these patients.
Dr Jaising Phadtare, professor of pulmonary disease and intensivist at Grant Medical College, admits to the need for robust counselling for patients, especially during the first three months of treatment, for MDR-TB.
"The doctor has to counsel the patient and make him/her understand the basics of medicine and its effects. For instance, the doctor must explain the need to take a particular drug at a certain time..." said Phadtare. "Helping build the patient's confidence in the initial three months of treatment can go a long way for the next couple of years of treatment."
Agreeing with Phadtare, Dr Nagsen Ramraje, head of chest medicine department at Sir JJ Group of Hospitals, said the prolonged course of treatment makes the patient anxious. "The anxiety is coupled with social stigma and insecurity about the future. Also, side effects of the drugs precipitate depression," said Ramraje.
Doctors also feel that a few things in the TB control programme need to be changed. A second-line drug, cyclocerine, is known to induce psychosis and, hence, doctors say an alternative tericox, which has fewer side effects, must be included in the programme.
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