dna edit: In the face of mounting toll

If only the suicide of a depressed 35-year-old HIV-positive woman, being treated for multi-drug-resistant tuberculosis at Sewri TB hospital, had been an isolated incident. What makes it more painful is the irony that she chose to end her life on World TB Day on Monday, an occasion to strengthen the collective resolve to battle the deadly disease. The claptrap of politicians and some sporadic measures by the Centre aside, India lacks both willpower and infrastructure to handle a growing epidemic. The facility at Sewri, one of the biggest in Asia, is a death trap, having claimed 13,727 lives in seven years. Among other things, it lacks hygiene, leaving both patients and doctors vulnerable to the mutant strains of the bacterium.

Statistics reveal the precarious situation in Mumbai, with cases of relapses, MDR and Extensively Drug Resistant (XDR) TB steadily rising. In 2013, 10 per cent of the total 40,000 TB patients had to enroll for re-treatment. Though official figures in the three years preceding 2013 do not show a staggering increase on that count, doctors claim a lot of such cases go unreported since many patients visit private hospitals.

However, one thing is certain: The figures of MDR TB shot up drastically as 2013 saw 2,093 new patients besides the 2,604 already receiving treatment. In the same year XDR TB cases rose to 90 from 32 the previous year — in 2014, 24 patients have been diagnosed with XDR.

The official approach can be gauged by the BMC’s tardy response in times of such emergency. The richest civic body looks up to the Centre for funds as part of the latter’s nationwide outreach programme for TB. Of the Rs2,906 crore the civic body has allocated for health care — a mere 8 per cent of its annual budget — only a few lakhs are spent every month as salaries of a handful of medical officers and health workers that it had recruited for tackling TB.

TB is a poor man’s disease, thriving in Mumbai’s slums. Cramped existence, unhygienic conditions such as open drains, and lack of nutrition contribute to the spread of the highly contagious bacterium. The growing incidence of MDR and XDR is an ominous sign since those in close proximity of a patient are most likely to suffer. Slumdwellers cannot afford the luxury of safe distance, separate utensils for the patient and other preventive measures. The BMC’s lack of thrust for cleanliness in such squalid quarters has been a long-standing problem.

On the other hand, the money released by the Centre for the Mumbai wards is considered grossly inadequate since a large part of the battle against TB involves extensive campaigns in the media through advertisements — a cost-intensive affair. It is only now that BMC is thinking of beefing up its TB programme, which involves buying new GeneXpert machines to diagnose multi-drug-resistant TB faster. It has been clamouring for an annual central aid of Rs40 crore, but has to contend with Rs12 crore.

The battle against TB gets more challenging by the day. Moreover, the stigma attached to the disease makes it difficult for the BMC to assess hidden cases — around 10,000, according to some estimates.

Once treatment is discontinued midway, chances of contracting MDR increase manifold. The success rate of second-line treatment for DR TB doesn’t inspire confidence. Now the XDR strain has called for sweeping measures in the city. But that will take time because for the BMC to act on a war-footing, it will take nothing short of a miracle.