TB fears cost healthy Indians jobs abroad

They were fit and healthy individuals. Yet, they were branded as tuberculosis (TB) patients. And they were deprived of their livelihoods or rejected jobs. 

A 24-year-old MBA professional, Sameer Kharat, was rejected a job in Dubai by Landmark Group, because he was declared medically unfit to enter a Gulf country. “I had secured a job of an executive trainee with Landmark Group in Dubai earlier this year. I was slated to join in July. Before that I was made to go and get my chest X-rays done at a clinic suggested by the company. Disturbed at not being contacted by the company, just two weeks ago, I called to ask them when I could join. To my utter shock, they said I had been declared medically unfit for the job as I had scars in my lungs. This, the doctors at the clinic said, could be indicative of latent TB,” said Kharat.

Landmark Group is an organization with over 50,000 employees across 22 countries. “All the countries we operate in have defined immigration laws in place for issuing expat work visas. This often includes a government mandated medical screening, which is conducted by the naturalization and visa authority, a process managed by the local government. Every expat candidate selected by the Group is informed that their final employment is based on clearing all immigration formalities, in the country of employment. We comply with the immigration office’s judgment and decision for every assessment, which in turn leads to a visa being approved or rejected,” said Sabina Khandwani, head, corporate communications, Landmark Group.

Government doctors say that scars in the lungs could be a sign of a past case of TB. “Gulf, US, UK or European countries do not accept Indians for jobs on the basis that they may have scars from previous illnesses. This is ridiculous. I am sure if any one of us were to undergo an X-ray of the lungs, scars would become apparent. This indicates that the person might have been previously infected with TB. However, due to good immunity, symptoms like weight loss, coughing or fever may not manifest in the person,” said Dr Lalit Anande, senior doctor at Sewri TB Hospital.

Doctors said hundreds of Indian youngsters may be discriminated against in what they termed as 'TB apartheid,' while seeking jobs abroad. Every third person in India is a youth. Of 1.2 billion persons, 50% of Indians are in the median age of 25 years. In such a situation, widespread discrimination against India's young professionals by foreign countries can cost India dear.

Even multinationals working in India are screening their employees for TB. And purely on the basis of the TB Gold test- which is derided as inconclusive by the World Health Organisation- many employers are making their healthy employees undertake TB treatment even though they may not have any symptoms at all.

A few years ago, hundreds of Mumbai-based employees of a reputed Japanese multinational company, Toyo Engineering India Limited, were made to undergo medical screening at Breach Candy Hospital in South Mumbai.

All of them, after undergoing the TB Gold test, were termed positive. None had symptoms like weight loss or coughing. The test only revealed that TB bacteria were present in their blood.

The test that they had undergone examines a person for 'latent' TB bacteria. Doctors say that 90%-95% of Indians are latent-TB positive due to the high prevalence of the disease in the country and through exposure to TB bacteria from BCG vaccination in childhood.

KS Kumar, 27, was one such employee who was asked to seek 'preventive' TB treatment at Breach Candy for over six months. “Completely healthy youngsters like me were put on potent drug regimen of Isoniazid, Rifampacin and other such drugs to eliminate latent TB bacteria from our bodies. Some of us were asked to take leave of varying duration. However, I am grateful I was not thrown out of job,” Kumar told dna.

A senior official from the company confirmed the incident. “We are an engineering company and we need to depute our engineers to our parent company in Japan. The parent company insisted on strict health check ups for our employees, a few years ago, after some Indians were found coughing. So, we referred all employees to Breach Candy Hospital. We went by what the hospital prescribed us and did it for the best of our employees,” said Arun Khutale, Head, General Affairs Department, Toyo Engineering India Limited. 

Experts in the city find the prospect of putting a healthy person on preventive TB treatment extremely problematic. They fear that in the Indian setting, where TB bacteria are commonly found in the air, preventive treatment does not work. Moreover, World Health Organization (WHO) has derided the TB Gold test and does not consider it a standard test for testing TB anymore.

“I may have infection due to something else but if the doctor wants to put me on TB treatment he may say, do a TB Gold Test and once it comes positive, s/he may start preventive TB treatment. This is not the correct way to go about things. If a healthy person takes treatment for TB, s/he may develop drug resistance to the medicines when s/he actually contracts the disease," said Dr Camilla Rodrigues, senior microbiologist, PD Hinduja Hospital at Mahim. 

(Names have been changed to protect identities)