Sunday , March 29, 2015

3 years after scare, city's TB fightback

Publication:Mumbai Mirror, Edition:Mumbai, Page No:1, Location:Top-Left Size(sq.cms): 1060   

3 years after

scare, city's

TB fightback

58 TB control units, 400 BMC workers

tracking patients; 385 centres

dispensing free drugs, hundreds of pvt

docs offering support Lata.Mishra@timesgroup.com

TWEETS@latamishra23

n Wednesday afternoon, when Mumbai recorded its second hottest March day in 10 years, BMC health workers Surekha Mane and Bhavsar

They spotted the patient, out-of-work watchman Ambadas B, who had stopped his tuberculosis medication, exiting a narrow passage that only accommodated people who walked sideways.

Sunday , March 29, 2015

3 years after scare, city's TB fightback

Publication:Mumbai Mirror, Edition:, Page No:1, Location:Top-Left Size(sq.cms): 1060  

More than 380 free TB drug

centres opened in two years

»PAGE1_________________ After quick counselling, Ambadas, 49, promised to resume his medica-tion, which will prevent him from developing hard-to-cure drug-resist-; ant TB and spreading the disease that sickened over 30,000 Mumbaikars and killed 1,334 last year, among the world's highest incidence rates.

Mane and Nikam perform a small but important function in the BMC's revamped TB control programme. A network of 400 such workers who monitor patients' medicine intake; 385 free drug-dispensing centres; 24 psychological counsellors; 24 programme managers; 18 diagnostic facilities where tests are conducted in a matter of hours; and an upgraded Sewree TB Hospital form Mumbai's flghtback against Mycobacterium tuberculosis, the bacteria that causes the disease.

The efforts were sparked by a 2012 study by Hinduja Hospital's Dr Zarir Udwadia who revealed that 12 TB patients in Mumbai had developed resistance to all TB drugs. The fact that they were the first such cases in the country served as a frightening reality check for city health officials, who have since then been fine-tuning and expanding the TB control programme.

The efforts are supported in large parts by central and state govern-ments, and the Bill and Melinda Gates Foundation. The BMC now has tied up with 300 private doctors and 88 hospitals in 15 high-risk zones to ensure TB patients are promptly diagnosed and the cases are reported. Similar cooperation has also been secured from 1,000 general practitioners, who attend to a large number of patients with early TB symptoms.

Another key feature of the pro-gramme is providing free high-nutri-tion meals to all multi-drug-resistant (MDR) and ex tens ive ly d rug-resistant (XDR) TB patients, most of whom are poor and do not eat properly, rendering the treatment ineffective.

District tuberculosis

control offices Nadeem Sheikh, 9, who was diagnosed with TB two months ago, arrives at a health centre in Mankhurd to get his medicines

the disease," said the father, who runs a small garment business.

"TB spread so quickly in our locality, it was scary. We followed the BMC's advice on precaution and medication, and after nine months, my three daughters are healthy."

'A NEW LIFE' A 21-year-old college student from

recently joined a college, didn't want to be identified as they feared the disclosure might alter fellow students' attitude towards them.

"My eldest daughter, aged 24, lost the battle against MDR TB in 2012. A month after her death, my second daughter caught TB. By the time she completed her treatment last year, her two sisters were diagnosed with

Senior DOTS plus TB-

HIV 6 supervisors 27 Tuberculosis control units

Senior

tuberculosis

supervisors Senior tuberculosis

lab technicians

Tuberculosis health post ...» 

officers r»? Community health

EARLY SUCCESSES The multi-pronged approach against the disease, described by the World Health Organization as the second "greatest killer" after HIV/AIDS, has produced success stories in just two years: TB deaths are down from 1,396 in 2013 to 1,334 last year, and around 33,000 patients, including 3,000 MDR and 300 XDR cases, are on monitored medication, improving their chances of recovery.

The total number of TB cases has gone up because of greater screening and speedier diagnosis by the BMC, but more people are now being declared "cured".

Three sisters from Mankhurd's Shivaji Nagar locality, who had con-tracted TB from a fourth sibling, have been successfully treated under the new programme. The sisters, who

Mankhurd, which ranks among the areas with most TB cases, was diagnosed with extremely drug-resistant (XXDR) strain in March 2012. Because of interruptions in treatment, she had developed resistance to 12 of the 13 drugs.

She was recently declared cured after two years of treatment, involv-ing a combination of drugs, under the supervision of chest physician Dr Vikas Oswal, who has his own clinic but volunteers as a BMC con-sultant - a fine example of public-private partnership. "I have been given a new life," the patient said. "Earlier, I was tired of taking 16 tablets daily. Because of the side effects, I felt I was dying every day. At one point, I considered committing suicide."

People with TB, caused by bacteria that attack the lungs, need supervised medication for six to nine months. Many patients stop the treatment midway, either because they think they are getting better or because the side effects — dizziness, nausea and joint pains — make it dif-ficult for them to function normally. Almost 90 per cent of Mumbai's TB patients are poor and cannot afford to skip a single day at work.

Breaks in treatment make them

vulnerable to developing drug resist-ance and also increase the risk of transmission. Tuberculosis spreads easily through the air, when a patient coughs, sneezes, talks or spits.

TRIGGER FOR REVAMP In January 2012, senior chest physician Dr Zarir Udwadia, from Hinduja Hospital, shocked health officials by revealing that 12 patients in Mumbai had totally drug-resistant tuberculosis. Though government experts contested the

» TURN TO PAGE 12

Volunteers from the national TB programme perform a street play in Shivaji Nagar

visitors

Sunday , March 29, 2015

3 years after scare, city's TB fightback

Publication:Mumbai Mirror, Edition:, Page No:1, Location:Top-Left Size(sq.cms): 1060  

HELPING HAND Support from non-government groups has been crucial to the city's ightback. PATH, an NGO supported yf the Bill and Melinda Gates Foundation, encourages private clinics to treat needy TB patients by affering to cover the costs.

PATH not only pays for X-rays and other tests, but medicines too. Since September last year, it has spent over Rs 50 lakh for the cause. "The objective is to involve private doctors in the government's efforts to fight TB," said PATH project director Shibu Vijayan.

The NGO and the civic body have trained 4,000 private doctors, including 1,389 chest physicians, in diagnosis and reporting cases to the government.

Sai Hospital in Dharavi was the first private facility to join PATH'S initiative.

"Many of our patients are poor. Whenever there is a suspected tuberculosis patient, we conduct tests without demanding a fee. PATH later pays the bill," said hospital director Dr Khalid Sheikh.

Chest physician Dr Vikas Oswal, who runs a clinic in Mankhurd, was among the first private practitioners to join the BMC's programme. He has been serving as a consultant in M East Ward since 2012. "Currently, I am treating 700 drug-resistant cases and almost all of them have been taking medication regularly," he said.

Dr Oswal and Dr Udwadia pro-vided breakthroughs in the TB fight Dr Oswal used a new combination of four non-TB drugs to cure a young woman diagnosed with extremely drug-resistant tuberculo-sis. The success came after a four-year effort.

Dr Udwadia cured a 39-year-old man by treating him with Bedaquiline, the first anti-TB drug to be developed in the last 40 years. Bedaquiline had not yet been intro-duced in India when Dr Udwadia began treating the man in 2012, but had just been launched in the US.

Dr Udwadia had to seek special permission from the Indian govern-ment to have the drug imported, in order to treat his patient.

Despite the gains, TB remains a stubborn health crisis. A 21-year-old third-year science student, who was diagnosed with the disease in 2011, completed his treatment last month after some false starts. However, the Chembur resident's parents have now contracted the illness.

"No one in our locality knows that we suffer from TB. If my neighbours and relatives learn about it, they will stop talking to us," said the father, who works as a driver, barely earning Rs 10,000 a month.

term 'totally drug-resistant', many officials agreed that tough-to-treat strains of the disease had emerged.

The findings of Dr Udwadia's study prompted the state govern-ment and the BMC to review their disease-control efforts. As doctors and officials began to classify more and more patients, it became clear that Mumbai had one of the highest numbers of drug-resistant TB cases in the world. Last year, 3,522 MDR and 296 XDR cases were reported in the city, up from 410 and 33 in the period 2011-12, respectively.

In 2013, the BMC began putting in place new diagnostic and treat-ment channels. With funding and guidance from the Revised National TB Control Programme (RNTCP), the civic body introduced a network of officers who form new strategies, coordinate ground efforts, register and track patients and suspected cases, supervise medication and raise awareness in each of the city's 24 zones.

SAFETY IN NUMBERS In 2012, the BMC had only 27 TB-control units for the city's numerous areas, each unit covering a population of five lakh. The number of units has now been increased to 58, with each unit cov-ering a population of two lakh. In high-risk areas such as Govandi, Mankhurd, Shivaji Nagar and Dharavi, multiple units have been created. The units' work is super-vised by district TB officers, whose numbers have also increased from

Earlier, only 80 healthcare work-ers monitored patients' medication. T o d a y , t h e r e a r e 4 0 0 , a l l accountable to district TB officers, who are essentially programme managers.

Testing of suspected drug-resist-ant cases, done at a single lab, took a week previously. Now, the new Gene Xpert test, currently done at 10 BMC centres and eight private facilities, has reduced the time to a day at most. Under RNTCP, around Rs 5,000 is spent for treatment of a person with normal TB and Rs 2 lakh for a two-year course for an XDR TB patient. For every XDR case, Rs 3 lakh is spent.

At Sewree TB Hospital, a new 324-bed wing has been created at the cost of Rs 3.2 crore for the care of patients diagnosed with tougher strains.

"Earlier, we were short-staffed and did not have enough diagnostic facilities. But we have expanded our programme significantly in the past three years. From one testing lab, we now have 18," Dr Arun Bamane, officer on special duty to control TB,

care of both," the father said.

TRACKING PATIENTS But there are also patients who don't show up at the centre after completing initial treatment. They are declared "defaulters". "In such cases, we send health visitors to their homes to counsel them," Dr Bamane said.

Health supervisor Surekha Mane said monitoring patients' treatment was very challenging, especially when they relocate without notice. "Many of the patients are poor migrant labourers. If they lose their job or don't have enough money to pay the landlord, they move to a different area. Now, whenever we have a patient living on rent, we urge the landlord not to displace him/her until the treatment is over," Mane said.

Similar efforts are made by health workers across the city. They are supported by 24 psychological counsellors, who have received training at the Tata Institute of Social Sciences. The counsellors help the patients suffering from depres-sion to cope with the situation.

BATTLE IN HIGH-RISK ZONES M East Ward (Shivaji Nagar, Govandi, Bainganwadi, Lotus Compound, Lallubhai Compound, Chita Camp) and G North Ward (Dharavi, Mahairn East, Dadar East, Matunga East) rank among areas with the highest number of cases.

"M East Ward has a population of nearly 8.5 lakh. Already this year, there have been 500 drug-resistance

told Mirror. "We not only provide free medicines to patients, but also make sure that the person follows the regimen."

DRUGS COME WITH A RIDER While the medicines are free, the patients are asked to visit the nearest primary health centre with details of their diet and medication timings. The information is collated and a detailed case file is prepared.

At a primary health centre in Shivaji Nagar, Mankhurd, on

stream of TB patients, from mother-of-two Megha Salve to nine-year-old Nadeem Sheikh. In a small room, occupied mostly by stacks of medicine boxes and kept ventilated by a creaking fan, health supervisors quickly studied their medical records and gave them fresh doses.

One woman demanded two weeks of medication to avoid a visit, but was quickly dismissed. A Std X girl student with TB, who arrived alone, was scolded for missing her previous appointment and skipping breakfast that morning. She was excused after she revealed that she could not keep her appointment as her exams were going on.

"I don't skip any dosage. In fact, I take my medicine in front of the supervisors," Salve said. "I have two young children to take care of; I cannot risk falling seriously ill."

Nadeem's father, who works as a labourer, said that the boy was diag-nosed two months ago. "He needs a protein-rich diet along with the med-icines and the BMC has been taking

cases (MDR and XDR)," said Dr Pravin Chandure, district tuberculosis officer of the ward. "In the past two years, we worked really hard to bring down the number of people who stop the treatment midway.

"We have reduced the rate of default from 15 per cent to 4 p e r c e n t . I t ' s a b i g achievement."

The number of MDR and XDR cases is also high in G North Ward, where the civic body has started a pilot project to provide free nutritious meals to the patients to boost their immunity.

"We started the Arogyavardhini project with the help of donors. Over 300 patients get packets of poha and sheera every day," said Dr Narendra Sutar, the ward's district TB officer.

Dr Minni Khetrapal, BMC's TB control officer, said that the meal programme was slowly being started in other areas too, with IDBI Bank and other companies chipping in funds.