Tuberculosis (TB) has been around for ages and so are the programs implemented aiming to eradicate it. But why is it still a large looming burden on society? Let’s see what to do, where to do, why to do and how to do the things needed to eradicate TB.
REASONS WHY TB LYSIS HAS NOT HAPPENED YET!! As far as TB is concerned, we have to look at it from two perspectives- rural and urban. There are contrasting reasons in both these regions as to why TB is not eradicated.
1. Asymptomatic carriers are the people to be blamed but can’t be blamed because they have no idea about the disease. Though treatment of latent TB (TB preventive treatment {TPT}) has been main goal of recent international programmes, the adherence of asymptomatic healthy individual to drugs is less, leading to further burden of drug resistance. Here is where we can blame them but the blame game does not take us anywhere in our goals.
2. Patients with symptoms who take over the counter symptomatic drugs are the cause of TB prevalence and are a difficult target groups to identify and treat.
3. Increase in INDEX cases of multi drug resistance (MDR) TB has put us on the backfoot against the war on TB. Not to forget the environmental factors in urban cities like crowded trains and congested apartments.
4. Though these seem to be reasons on the population side, the government has also not been up to par when it comes to budget allocation and utilisation of the same.
5. Inadequate data and surveillance.
6. Lack of proper communication from health care workers when it comes to treatment modality. Heard of cases where TB patients are charged a huge sum for treatment since they are not aware of the government free treatment and also incentives given by the govt which causes defaulters and increases drug resistance.
7. Non screening of high-risk individuals like patients living with HIV (PLHIV), immunocompromised patients, and contact tracing of TB patients.
8. High work stress among young people especially medical students combined with very bad nutrition leads to easy susceptibility to TB.
HOW CAN INDIVIDUALS INVEST AGAINST TB?? It’s like David vs goliath but as the saying goes, drops of water makes a mighty ocean. So as an individual if we can invest not only money but time and share knowledge, it can go long way.
1. Health education and health camps are the basic steps towards it as a health care professional. Busting the myths about TB and providing true facts about the disease and the treatment would have huge positive effect in eradicating TB.
2.Councelling of patients at risk in opd about nutrition, preventive measures and symptoms to look out for.
3. Though individual investment to programs as big as TB eradication is impossible, we can do our bit in spreading awareness by investing money in mass communication such as posters in our locality. If capable to invest large sum of money, we can join NGO’s who have been battling this war along with government.
HOW CAN GOVT AND NON GOVT ORGANISATIONS INVEST TO END TB??
1. Needless to say government and international agencies have come up with so many programs aiming to eradicate TB but we fall short, not due to ineffective strategies but ineffective implementation of the programs.
2. In India we have three levels of governance with three objectives, comprising of three pillars and components which are the backbone for TB program but yet we fall short. This is where the public private mix (PPM) comes into play. Government has made it mandatory for some large private companies to invest in labs in remote areas in collaboration with govt TB unit and it will become mandatory for reporting of TB cases which will enhance data surveillance and case detection. It will also become 1st point of contact for people. The PPM has been started and it is on development stage and is to be implemented from 2023 to 2030. It comprises of costed intervention, bold measures, all hands-on deck, transparency, equality for every patient of TB to get diagnosed, treated and to know the cause.
4. Private pharmacists should be more responsible while giving over-the-counter drugs for long standing cough and fever. The diagnosis rate is low and the patient comes to hospital setting with complication of TB because of this.
3. Personally I feel that though our PM comes in advertisements and slogans raised such as TB mukt bharat through audio visual mass communication, I don’t think it has the capacity to ingrain in minds of people. Entertainment and media can make huge difference if used properly as we have seen in this covid times. Every march or camp conducted should be shown on media, not just on auspicious days but at regular intervals instead of useless content for TRP.
MYTHS ABOUT TB AND HOW TO BUST THEM
1.Stigma that once patient is diagnosed with TB, he is infective lifelong and is on death march.
2.Patient avoids allopathy medicine for TB because they think meat is contraindicated for treatment.
3.TB affects only lungs.
4. Low-income people are affected. Though it is true to some extent, students and professionals who work under stressful conditions barely eat nutritious food making them prone to TB.
5.Spreads with handshake.
6.Genetic.
7. BCG vaccine protects all TB.
The only way to bust all these myths is through health education. It can be done via camps, in opd, media, movies, posters not only in hospitals but in social places like malls, govt buses, trains, factories and other places where overcrowding is expected. Rallies with patient who have completed treatment needs to be done to enhance trust in the TB treatment process. As we have seen, an individual’s effort will lead to huge changes.
COMMUNITY KNOWLEDGE ATTITUDE AND PRACTICES (KAP) TOWARD TB
1.Community knowledge is based on not only what they hear and see but how they hear and see it. The attitude may differ with each person but it is up to us to get across the message in whatever way possible by busting the myths about TB.
2.The WHO ENGAGE-TB approach guides the implementation of integrated community-based TB activities. Through the Civil Society Task Force on TB, WHO listens to affected communities’ voices into decision making, policy, programmes and activities at global, regional and country levels.
3.Placing of Indian council of medical research (ICMR) posters in factories, trains and other crowded places will make more people aware of the disease and guide them if symptom arises. I truly believe that if everyone works together in this, we not only can lyse the TB crisis but build a community with an oasis of knowledge to curb down any disease that arises.
4.Last but not the least, the way we interact with patients makes a huge impact that too in case like TB where regular follow-up is needed. We have to be empathetic and not just see them as another case because for us they are one in many but for them we are THE Doctor. So, lets act responsibly. Thank you.
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