We can defeat TB, here’s how

We can defeat TB, here’s how

Representative image.

The optics were ironic. As Finance Minister Nirmala Sitharaman, impeccably dressed and clutching the silk-wrapped bahi khata (budget) in her hands, headed for the Lok Sabha at 9.30 am on February 1 to present India’s annual budget, a mere 10 km away, in a slum settlement a different scenario was playing out.

Just two roads behind one of Delhi’s premier localities, several kitchens were not going to function because there were no food grains. Savita (29) (name changed), a mother of three children all bellow the age of ten, had a gas stove in her little room. But it was not going to be lit because she had nothing to cook at home, barring a few tomatoes. 

Her one-room tenement functions as a living room, bathing area, kitchen and bedroom. Savita’s brother, who has been diagnosed with TB is on treatment, stays with them. She said, “his medication is strong and I know he has to eat well. My husband is the only earning member of our family. He earns around Rs 7000/- during good months and nothing when he can’t get work. With food prices being so high, it is difficult to provide my brother with good nutrition. I sometimes have to deprive my children of food so he can eat well.”  

As the finance minister presented her eloquently themed budget, Savita and her children were oblivious to the fact that she was quoting facts, figures and statistics that were supposed to, but did not better their lives.

The finance minister also announced (probably the first time any finance minister has done so) that a campaign to eliminate TB by 2025 would be launched, five years earlier than the WHO target. This is a laudable initiative. In the same vein, she spoke about the importance of water, sanitation and wellness. With these statements, she had in one breath, held a mirror to all the challenges we face in our route to eliminating TB because TB can be cured with medication but elimination needs much, much more. Here is why...

TB, as we know, is an air-borne infection. When a person with TB coughs he or she releases droplets containing the TB bacteria into the air and there is data to prove that each person with TB can infect 10 others. The latest report released by WHO says that 26,90,000 people have TB in India, of which 19,90,000 have been notified, which means we know where these people are and whether they are receiving treatment.

India also has the maximum cases of DR-TB (drug-resistant TB) with 27% of our TB cases being resistant to at least two first-line anti-TB drugs. This means there is a need for more expensive and severely toxic second-line drugs to treat these cases.  By making mention of TB, the finance minister demonstrated a political will to address the problem. However, political will alone is not enough because TB is a disease that mercilessly shows us a mirror.

It spreads more easily in poorly ventilated and congested areas indicating a need for better housing; people with lowered immunity are attacked more easily; this clearly points to a need for better nutrition. Together all these make a case for a better quality of life and this can only happen with assured employment, better skills for the same and predictability of income. 

If our targets for sanitation, clean drinking water, employment generation and accessibility of affordable food are not met, TB is not going away. It will continue to be among us, and owing to its ability to spread easily, it will affect the rich and poor alike, given that the rich are also prone to lowered immunity owing to a multitude of causes.  The finance minister must fast-track all initiatives that she has outlined. Walk the talk and then, you don’t need a campaign for TB. It will not dare to come near us because we would each be a warrior to defeat it by ourselves.

We must ensure that people like Savita and her family get enough to eat and have access to a clean toilet. If we do this for every person; then we will not have to chase TB away, it will go away on its own because it will not find a safe house to live and thrive in. 

(The writer has been awarded the Journalist in Residence Scholarship in 2015, Institute of Tropical Medicine, Belgium )