This essay explores the investment of Government and Non-Government organizations in eliminating the rising threat of tuberculosis under two central targets- epidemiological triad, and private sector involvement.
Breathe the warmth, not the fire Breathe the warmth, not the fire Breathe the warmth. Do not breathe the fire.
My patient, Ms Kamla, lies defeated on her 80-inch hospital bed. Her sweat drenching the white sheets underneath. Her lungs trying to siphon the air from my mouth. The surrounding air tumescent with blood-red cough droplets. She continues chanting as the bacteria rears its ugly head, and slowly consumes her. She shrivels, like the bougainvillea that rest by her bed side, while devouring this agony.
We can do nothing but watch as she withers away. An orb that becomes a mere ember by the end of the day. Her eyes shut with insolent ease, and the ridiculous mockery of the vital signs monitor is hushed.
We mourn that day. In the cold weather, with these cold bodies, only our hearts are warm enough to light her pyre. After spending a fair amount of time in Hospital wards, which house bleeding immunities and grief ridden conversations, I have realized that Tuberculosis is more of an excuse for determining hierarchy, than it is a disease.
I think I would compare it to a wild, growing weed. And a sharp scythe is needed to yank it out of a community.
A few days ago, I visited the United States of America. While maneuvering through the traffic, I observed how integrated their traffic system is. There seems to be no leverage and unnecessary bigotry when it comes to communal driving. This is unlike in India, where the driving system largely represents the inequality and disparity that dictates the spread of communicable diseases, such as Tuberculosis. It is haywire and uncoordinated. The safety of smaller, inexpensive vehicles is suppressed by the safety of larger, expensive ones.
One of the pillars of the WHO’s End TB Strategy is promoting human rights and equity, [1] which is spearheaded by patient-centered care for the entire population, including regions with limited healthcare access. In a country like India, where social factors govern the massive influx of communicable diseases, [2] the major target of all government and non-government organizations should be eliminating this aforementioned social and cultural bias.
In doing so, two of the three elements of the Epidemiological Triad are targeted- The host and the environment. An interruption in this triad helps in eliminating the communicable disease. [3]
The targeted host factors include- personal hygiene, risk of exposure, nutrition, and socio-economic status. While the environmental factors aim at promoting cleanliness and eliminating any breeding or transmissible grounds. [4]
Non-Government Tuberculosis organizations such as The Tuberculosis Association of India [5] are responsible for disease notification and monitoring drug administration in patients. Government national programs like National Tuberculosis Elimination Program (NTEP), [6] which houses initiatives like Nikshay, an IT based web service for patient monitoring, [7] and Directly Observed Treatment Short Course (DOTS), where healthcare workers directly observe patients taking their medicines.
Beyond all of these efforts, the loophole in Tuberculosis elimination struggle is the limited involvement of private sectors. Most of the times, the diagnosis of Tuberculosis patients in Private health sectors go unnotified- which propels the lower number of cases and affects treatment adherence, despite the availability of programs that focus on patient monitoring. This not only results in wastage of time and effort, but also money and material.
Moreover, this provides a groundbreaking threshold for analyzing the shortcomings that the private health sector faces while treating tuberculosis patients, which includes delayed diagnosis and patient noncompliance. This then further thrusts the spread of disease, especially in poverty ridden communities.
A close-knit integration of services- Government, non-Government, and private sectors- will provide a way for elimination of tuberculosis. In that, a car will only run with all of its wheels in synchrony.
In conclusion, puncturing the disease epidemiological triad with national awareness programs, assessment of Knowledge, Attitude, Practices (KAP) of the communities, eliminating social biases by way of education and infrastructural developments, along with unification of all of the sectors and organizations via a common portal and introduction of new national programs, will help pave way for an effective and efficient approach for eliminating tuberculosis.
References:
https://www.who.int/teams/control-of-neglected-tropical-diseases/lymphatic- filariasis/morbidity-management-and-disability-prevention/global-tuberculosis- programme
https://pubmed.ncbi.nlm.nih.gov/34194045/
https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section8.html
https://www.open.edu/openlearncreate/mod/oucontent/view.php?id=84&printa ble=1
http://www.tbassnindia.org/
https://en.wikipedia.org/wiki/National_TB_Elimination_Program_(India)
https://www.nikshayaushadhi.in/IMCS/hissso/loginLogin.imcs