Patients not completing course deals blow to government's fight against deadly disease
Patients can be expected to spend between a few months to six or seven years at the Sewri TB hospital. File Pic
No matter how much money the government spends on fighting tuberculosis, it all comes to nought if patients don't complete treatment. And yet, as many as 3,272 patients have quit treatment at the Sewri TB hospital in the past five years, after losing hope in the long and lonely battle against the disease.
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There's a simple solution: counselling. But, shockingly, the hospital does not have a single full-time psychiatrist in service. A mid-day investigation under the Right To Information (RTI) Act revealed that as many as 3,272 tuberculosis patients have taken discharge against medical advice (DAMA) from the Sewri TB hospital since 2013. Patients can have to spend anywhere between a few months to six or seven years in hospital, depending on the severity of the case, and much of this time is spent in isolation, as the disease is highly communicable. When these depressed patients choose to quit treatment and go home, they not only risk developing drug-resistant TB, but could also expose their loved ones and others to infection.
Faced by a long and lonely stint at the Sewri TB hospital, many patients choose to turn their backs on the treatment instead. File Pic
In March, Prime Minister Narendra Modi said his government is implementing a national strategic plan (NSP) to end TB by 2025, with funding of over R12,000 crore for the next three years, to ensure every patient has access to quality diagnosis, treatment and support. Crores have been spent as well, but the authorities seem to have missed out one basic facility — counselling.
There are over 2,000 patients at the Sewri hospital, and just four part-time psychiatrists to attend to them. The doctors can attend to around 10 patients a day, which means it could be 200 days before a patient's turn comes. Due to the highly infectious nature of TB, not many psychiatrists are ready to work in such environments.
Our failure, say docs
Speaking to mid-day, Dr Lalit Anande, chief medical officer of the hospital, said medicos needed to be sensitised, too. "Only through proper communication can they gain the patients' confidence and trust, and convince them to stay. It is our fault that we fail to provide this human touch to patients," he said.
"TB treatment takes a long time, and patients have to be kept in isolation. Frustrated, they decide to take DAMA. Depressed patients often threaten suicide unless they are discharged, said Dr Rajendra Nanaware, pulmonologist and former medical superintendent at Sewri TB hospital. "Incomplete treatment can not only lead to development of drug-resistant TB, and the patient can also spread it to other people," he added.
HIV success story
Dr Nanaware suggested that more counsellors be recruited at the hospital for one-on-one communication with patients. "The dropout rates in HIV decreased drastically because of counselling. The same thing is needed for TB, which is equally deadly. When depressed patients want to flee, we need experts who can convince them not to."
Case study
A 34-year-old resident of Kanpur was languishing in solitude at the Sewri TB hospital for months, far away from his two daughters. He would spend his days staring at the ceiling, and the effect of the medicines gradually made him depressive. He decided to return home mid-treatment, against the advice of doctors. "He started blackmailing the doctors, claiming he would commit suicide. If a patient wants to leave, we can't stop them," said a hospital staffer. Sadly, he succumbed to the disease within a month of discharge.
Number crunching
Although the number of DAMA applications have dropped from 640 in 2013 to 511 in 2017, the change is not substantial enough. Interestingly, most of the DAMA patients are male (60%), with just 1,307 women quitting treatment since 2013.
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