Herculean task awaits total drug resistant-TB experts

Even as a group of experts arrived in the city on Monday to take stock of the total drug resistant tuberculosis (TDR-TB) cases, DNA investigates the possible challenges that the team will have to face.

The group comprises a member from the Centre Tuberculosis Division team (which handles India’s TB programme), one from the World Health Organisation and one from the state health department.

The experts say it won’t be an easy task for state officials to deal with TDR-TB cases.

“The government is only focusing on the TDR-TB cases in PD Hinduja Hospital. It didn’t bother to take down the details of the other patients we have. This shows the commitment of the officials,” said Dr Yatin Dholakia, secretary and technical advisor, Maharashtra State Anti-TB Association. 

“The team will meet the TDR-TB patients of Hinduja Hospital, and counsel them and their families. They will basically take stock of the entire situation. On Wednesday, another team will arrive and take final decisions on the guidelines,” said a senior state health officer.

“Identification of TDR-TB cases will be a major challenge. More than 60% of TB patients go to private practitioners,” said Dr Dholakia.

“Another challenge is addressing the human rights of the patient. You can’t force anyone into isolation, and that too so far off. This will mean displacing the entire family.”

The experts feel that instead of isolating patients to Sangli, the officials should upgrade the available facilities in the city.

Dr Dholakia said, “The Sewri TB hospital is an 8-10-acre plot. It badly needs upgrading. Also, the civic body needs to expedite their programme to have special wards for MDR-TB management in peripheral hospitals.”

Dr Zarir Udwadia, chest physician from Hinduja Hospital who headed the TDR-TB study, said: “The government needs to give equal importance to MDR-TB and XDR-TB, to ensure no more TDR-TB is added because of mismanagement.”

The city has 2,500 MDR-TB cases a year, and the government has reached out to about 200.

The other challenge is for the MDR-TB management to go beyond the guidelines prescribed by the centre team.

“We find more XDR-TB cases in civic hospitals. This is because the BMC follows the standard treatment protocol blindly without considering substitute drugs available in the TB programme. This leads to MDR-TB patients continuing with medicines they are resistant too, and developing XDR-TB,” said Dr Dholakia.

The final challenge that the team will have to face is that of migrating population. One of the TDR-TB patients had migrated to Mumbai four years ago for better treatment for his wife, who has TDR-TB.

“The centre needs to upgrade the TB programme for the entire country. TDR-TB is not just in Mumbai,” said Dr Udwadia.