Saturday, 15 September 2012

Be afraid, be very afraid

Tucked inside this morning's newspaper was a small article that stated that the BMC (the Mumbai Municipal Corporation) was looking for new 'Gene Xpert' machines which could detect TB and drug-resistance to anti-TB medications within 2 hours.

All well and good.

The article finished with these chilling lines:

The door-to-door survey of BMC, which started in March, will continue in the second phase.

During the survey, 6,561 people were screened and 1,407 diagnosed with multi-drug resistant TB. “We are treating 885 people and 179 are in the process of being enrolled for treatment. The remaining are seeking private help or are from outside the city,” Mhaiskar said.

Now we have 2 options open for us.

One is that the reporter has got things hopelessly wrong. The figures have been mis-written. The categories of 'screened' 'diagnosed' and 'multi-drug resistant TB' are just floating words that the writer has somehow cobbled together.

Possible. A newspaper hack has made hash of public health before.

But the other option is also there.

That what the reporter has written is real.

That of the '6,561 people screened' there were '1,407 diagnosed with multi-drug resistant TB'.

Ok, lets run the maths. Percentage is numerator divided by denominator times 100.

What do we get?



Obviously this cannot have been a true a 'door to door survey.' However high the amount of TB we have - 20% of the population is not suffering from Multi-drug resistant TB. That would mean almost everyone has TB of some sort.... The figures have got to be from some kind of screening of people who already have active TB or at least the symptoms of TB. The door-to-door stuff may be case-finding.

But even if the figures are only from known TB cases, the numbers are still totally and horribly beyond our worst fears.

In our work at JSK we teach alot about TB treatment and control.

In our sessions we use figures and statements like "1.5% of our population in India has active TB."

We often say that due to incomplete treatment - we expect about 4-5% of people with active TB are now drug resistant.

But I never, never thought the figure could be as high as 1 in 5!

I hope, I very very much hope, that this figure is a journalistic slip.

At Jeevan Sahara we have been treating 3 people with multi-drug resistant TB. The meds are horrendous. Each month a partner agency comes by with 3 huge plastic tubs that contain the meds the patients - one tub per patient. Every day they need to take multiple doses. Get their injections by our nurses. It is distressing for the patient, the care-giver and the nurse to see the patient retching painfully after having to swallow the dose. The drugs seem almost worse than the disease. But at this point this huge mountain of meds seems to only hope for a person with multi-drug resistant TB.  And it isn't only the pill burden for a day or two. It is for 18 months of daily medication!

We live in a society awash with medications, with half-treatments, with haphazard dosages of all kinds. That levels of drug-resistance are rising has never been hidden. But to have the bitter fruit of pharmaceutical-overabundance right at our door is hard.

There are many things to be afraid of in this world (and our Lord tells us that perfect love casts out fear). But if you are living in Mumbai and want to worry about something - how about this: The air you breath is likely to contain Multidrug Resistant TB.

If our figures are true - that 1.5% of the population with TB - and a fifth of these are sick with MDRTB then that means 0.3% of the population has MDRTB. If at least 1/3 of these are still healthy enough to be walking around it means 1 in a 1000 people you meet has this basically fiendishly-hard-to-cure communicable disease. Think of the 5000 people who crowd into a crush-hour train. Consider the thousands of people who pour past you on every street. Think of the fact that TB can remain on droplet particles upto 18 hours after someone has sneezed or coughed in an un-ventilated room.

If you live in the greater Mumbai area, the question is not whether you have been exposed to MDRTB - but rather how many times - and how severely.

For those of us who willingly work with people who are suffering with MDRTB knowing that there may be such high levels of the disease only serves to make it more grim for all of us. Whatever the final truth of the numbers are - we do know that MDRTB is not just a scientific curiosity anymore - its the grim and horrible reality for so many.

Cause for concern. Fuel for prayer. Plenty of things to be done. The time to act is now!

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