NEW DELHI: In February 2015, Rujuta (name changed) moved out of Shelu Kurkundi, a village near Pune where she lives with her septuagenarian parents, to consult a doctor. Rapid weight loss and a persistent cough had bogged her down.
“I had been running a small grocery store for the last 20 years, and never got married because I wanted to take care of my parents,” says Rujuta, whose shop has long been closed and all her savings exhausted. “Life was quiet till the monstrous disease struck me.”
Tuberculosis was instantly diagnosed, but it took three years, more than five doctors, and several changes in the combination of drugs before she got the right line of treatment for multi-drug-resistant tuberculosis (MDR TB).
She nearly lost vision due to the side-effects of a drug she probably didn’t even require.
“I was sick, stigmatised and almost ostracised as my condition worsened. Could it have been different if the first doctor gave me the right drugs?”
The problem in this case, and thousands others, is that private doctors still do not understand or take seriously the need for a “customised” TB treatment protocol, says Alpa Dalal, head of pulmonary medicine at Mumbai’s Jupiter Hospital.
“With the world’s largest TB burden and rising multi-drug resistance, India has a huge challenge ahead as private health care providers serve the first point of contact for 50-70 per cent of patients with TB symptoms,” she says.
“Things are getting particularly serious as drug-resistant TB is on the rise and mistreatment means that MDR turns into extreme drug-resistant TB, which is deadlier and whose treatment is way costlier.”
Rujuta’s hardship is a classic example: In Mumbai, it was detected that she needed only two drugs.
The 40-year-old was first insisted by a Pune doctor to get a drug susceptibility test — to determine which drugs will work best — done from a “trusted” lab.
She was given the standard 4D kit (Isoniazid, rifampicin, ethambutol and pyrazinamide), but medications slightly changed after the test reports arrived.
This cycle was repeated every three months for a year and a half. Whether it was either a diagnostic error or not, the barely literate Rujuta cannot understand but her health had deteriorated to such an extent that she turned into a “living skeleton”.
She was forced to consult a pulmonologist in Mumbai where she was diagnosed with MDR TB. An NGO cleared her medical bills.
That private practitioners are delivering inadequate TB care is well-documented in a study carried out by Madhukar Pai, Director of the McGill International TB Centre in Canada, along with researchers from the University of California, World Bank and other colleagues.
Only 35 per cent cases of TB were handled correctly by the private healthcare sector in Mumbai and Patna between November 2014 and August 2015. It said untreated or partially-treated TB patients may infect others, at least partially nullifying India’s attempts to beat back a disease that kills half a million people every year.
(Tomorrow: Undernutrition major hindrance in eliminating TB)