TB News from India, November-December 2005

Health and Development Initiative-India, (www.healthinitiative.org), publishes 'TB News from India' once every two months. The objective of newsletter is to highlight issues related to Tuberculosis and HIV/AIDS control in India and enlist political, public, professional and administrative support for its cause. Health and Development Initiative-India is a not-for-profit organization and the news items have been quoted from various sources for fair use and in public interest. Reproduction of the material published is welcome provided a reference is made to the original source of the news item and TB News from India.

Editorial note:  

Patients' Charter of the Tuberculosis Community

Activists of TBTV.ORG have come together to produce a patients’ charter of tuberculosis community. The charter aims to explain both the rights and responsibilities of those infected by TB, and to empower people with the disease and their communities through this knowledge. The organisation believes that Knowing and understanding these rights and responsibilities will make the relationship of patients with health care providers a mutually beneficial one. The first draft of the charter is now available for review and suggestions from any one concerned with welfare of patients of tuberculosis or those living with HIV/AIDS.

The charter has achieved a judicious balance of rights and responsibilities of patients. It is inspiring that people who have been unfortunate victims of this deadly duo have come forward to help their fellow patients. This will come as a big morale booster for TB advocates, front-line TB workers and TB programme managers. The active participation of ‘patient volunteers’ will go a long way towards achieving global tuberculosis control. No doubt, ‘God helps those who help themselves’!

Draft Charter is available here

Anthem Against Poverty from 'Mozart of Madras'
Ranjit Devraj, Inter Press Service News Agency

Looking for the answers to all the questions in my life.
Will I be alone? Will you be there by my side?
It is something He did, I wonder why!
He is searching for the answer to stay alive...
Could you ever listen, could you ever care to speak your mind?
Only for a minute, for only one moment in time! This joy is around you.
Show me the love we must find. Are you searching for a reason to be kind?
He said pray for me brother...

Thus go the strains of A.R. Rahman's latest composition written for the Sep. 14-16 U.N. World Summit in New York but first presented at the People's Summit Against Poverty (PSAP) last week, which saw a 12,000-strong crowd from Asian countries gather in the Indian capital to highlight the causes of poverty and how it could be removed.

Accompanying Rahman -- often referred to as the "Mozart of Madras" for his sheer musical genius -- at the release of the anthem at a concert during the PSAP was Junoon, the well-known Pakistani band and the local group Indian Ocean.

Rahman described his number, already a hit, as a ''wake-up call to end poverty,'' especially the kind that causes large numbers of people in India to die needlessly and agonisingly from tuberculosis often leaving behind helpless dependents.

''One-third of the people in the world who die from TB are Indians and this pains me,'' said Rahman, last week, when he visited Mangolpuri -- a slum cluster in the western part of this sprawling capital, ridden with disease and wretchedness but co-existing with glittering shopping complexes, air-conditioned software parks and bungalows set into tree- lined boulevards.

Globally around two million people die of TB every year and 30 percent of the world's TB population lives in India. ''There is close link between TB and poverty,'' he observed

Rahman moved easily through the adoring crowds stopping to speak to TB patients placed on Directly Observed Treatment Short-course (DOTS) that involves ensuring that victims received their daily doses of a special cocktail of powerful drugs, without fail and continuously over six months.

The international celebrity patiently heard complaints including those from Sahasi a volunteer agency that organised Rahman's interaction with TB patients but is no longer involved with DOTS administration because of a new policy. ''We used to give patients their doses but the government now wants that patients be treated only in government hospitals,'' explained a volunteer.

With the general air of apathy at government hospitals there have been reports of patients dropping out of DOTS, a dangerous trend because they then quickly develop multi-drug resistant tuberculosis (MDRTB), which is difficult to cure and translates into a death sentence for poor patients.

But the ever-beaming Rahman, who is an International Brand Ambassador for the World Health Organisation's ''Stop TB Partnership'' was in the Mangolpuri slum mainly for the launch in India of a network of TB patients called ''TB Sangharsh'' (Fight TB) capable of tackling the disease in the slum.

"TB Sangharsh is the first of its kind in this country and has been created so that TB patients can get treatment with or without the help of government hospitals,'' said Sarla (full name), who leads the campaign.

''Sangharsh has set an example in Mangolpuri which I want to take to other parts of India,'' said Rahman adding that more than anything else there was a need for awareness of what TB is and what can be done to stop it, especially by involving the patients themselves.

At Mangolpuri, Rahman exhorted people to demand treatment against TB as their right. ''Your health is important not only to you and your family but to all of society,'' was his simple but forceful argument.

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Regularise TB project staff: Delhi High Court
The Times News Network

In view of the fact that TB kills more people in India than HIV, STD (sexually transmitted diseases), Malaria, Leprosy and tropical diseases combined, the Delhi High Court (DHC) has ordered regularisation of tuberculosis health visitors and laboratory technicians who have been working under a Delhi government project for the past eight years on contract.

Justice Vikramjit Sen did not uphold the government's plea that the funding of the project was temporary. It is the state's constitutional obligation to continue projects that have the objective of eradicating highly communicable and contagious diseases, the court said in a significant judgement handed out in October this year.

Seventy-seven of the hundreds of laboratory technicians and health visitors working for Delhi Tuberculosis Control Society had approached the DHC, seeking a direction to treat them at par with regular employees with all monetary consequential benefits.

These employees are involved with the project since 1997 on a meagre monthly salary of Rs 5,000 (US $ 115). Justice Sen ordered the government to regularise their jobs and fix their seniority from the date on which they reported for duty.

Justice Sen, however, clarified that in case the government decides to end the project, the services of the petitioners will also be terminated. Opposing the plea, government claimed it was receiving funds from various organisations like the World Bank and British Overseas Development Agency.

Since the funding is temporary in nature, the inflow of finances could stop anytime. Justice Sen said even if international organisations stop funding, the state is obliged to continue the project.

Source: The Times of India Website

 

Social workers honoured for helping tuberculosis patients
The Hindu

This Sunday was special for social worker Leela and 19 others like her. Cheered on by a capacity crowd at the Sivagami Pethachi auditorium in Chennai, these `ordinary people,' chosen from among 100 community volunteers, were honoured for performing a simple but critical act all through the year — making sure that tuberculosis patients took the prescribed drugs.

Film actress Manorama handed them mementoes. "Most patients default after taking treatment for a month since they start feeling better. However, they need to complete the usual six month course without missing a single dose, to prevent relapse and drug resistant forms of TB from emerging," says a background note issued by REACH (Resource Group for Education and Advocacy for Community Health), a Non Governmental Organisation working to create awareness within the community about critical public health issues.

Leela, who works at `The Banyan,' a home for mentally ill destitute women, has overseen 54 TB patients swallow their medicines every single day. The importance of this simple act cannot be overstated, said the Additional Health Secretary, Supriya Sahu. "The cure rate has tripled and the death rate is down to a seventh. We need to thank the Revised National TB Control Programme (RNTCP) for this," she said.

Ensuring that the patient took his tablet on time and for the specified period was an important aspect of the programme. Ms. Sahu lauded the efforts of REACH in Chennai and said that this was one of the best examples of public-private partnerships. The Government was looking at the possibility of involving Self Help Groups in this process. Ms. Sahu also released a patient information booklet on the occasion.

Read the complete story

Work to make India free of TB by 2010: Kalam
PTI

President APJ Abdul Kalam has exhorted all those involved in the area of Tuberculosis control to work "in a mission mode" to make India free of the disease by 2010.

While receiving a seal from the Tuberculosis Association of India, on Mahtama Gandhi’s birthday celebrations in October, Kalam said he would like to see India free of Tuberculosis by 2010.

All those involved in the tuberculosis control should work in a mission mode towards the goal, he said.

It is the 56th year of the tuberculosis seal campaign.

Read the complete story

Doctors raise alarm on drug resistance
Times News Network

If you're the kind who stops taking medicines prescribed by the doctor the moment you feel better, watch out. Health experts say that irregular and inappropriately timed medicine dosage is leading to a rising incidence of drug-resistant diseases in the country.

As a result, patients and scientists are grappling with the emergence of drug-resistant variants of malaria, TB and AIDS/HIV. This fact was highlighted in September this year at a national consultation organised by the public health machinery led by the civic-run KEM Hospital, Mumbai in association with the US Department of Health and Human Services.

"Many patients develop drug resistance because they stop treatment without completing the dosage," said Dr Neelima Kshirsagar, Dean of KEM Hospital, who heads the newly formed Infectious Diseases Society of India (IDSI). "Incorrect dosage allows the bacteria to mutate and the newly formed parasites learn to live with the drug."

Experts believe that such erratic pill-popping has led to 4% of all TB patients in India displaying resistance to normal medicines.

"Since many patients first approach private practitioners, it is essential to rope the private healthcare sector into the WHO-instituted DOTS programme to ensure that patients are getting correct and continuous treatment," said Dr P Kumar, director of the National Tuberculosis Institute, Bangalore.

Where AIDS/HIV is concerned, the country is juggling the expansion of its ART (anti-retroviral therapy) programme on the one hand with the emergence of HIV drug resistance (HIVDR) on the other. "In the 1980s, we faced the challenge of developing drugs for HIV/AIDS; now we are facing a problem of preventing drug resistance," said Dr Suniti Solomon of the YR Gaitonde Centre for AIDS Research and Education, Chennai.

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DOTS Update: Punjab

Uninterrupted supply of good quality drugs to the patients for treatment of tuberculosis has been ensured in Punjab. Mr. D S Guru, Principal Secretary, Health and Family Welfare stated while inaugurating a workshop in Chandigarh in third week of October. Guru said that 17 district tuberculosis centres, twenty-eight microscopy centres and about 13,780 DOTS centres have been set up in the state. Besides this, fifty-one sub-district treatment units are also operational.

The Health Secretary claimed that the health department has identified and trained DOTS providers in almost all the villages of the state.

According to the Revised National Tuberculosis Control Programme (RNTCP) Performance Report for second quarter of current year, new smear positive case detection rate in most districts of the state continues to stagnate below 70%. Even the cure rate in some of the districts is below expected 85% benchmark.

Project to focus TB control programme in special groups

The Central government has chalked out a project to improve the quality and reach of its Revised National TB Control Programme (RNTCP) in special groups like slum-dwellers, migrants and HIV-infected tuberculosis patients in urban areas.

A task force comprising stakeholders like the state TB offices, NGO representatives, private medical practitioners, MDACS (Mumbai District Aids Control Society) and research institutes will assist in the planning and implementation of the 'Urban TB Control Project'.

The project has been set up in four major cities - Mumbai, Hyderbad, Varanasi and Indore - and is targeted at special groups like slum-dwellers, migrants, HIV-infected TB patients, street children and substance abusers and others.

In the metropolis, Inter-Aid Development India has been appointed as the nodal NGO to implement the project in collaboration with the Mumbai District TB Control Society.

Dr. Yatin Dholakia member of TB Control Society of India says 15 wards have been selected in Mumbai for project implementation based on density of slum population and poor access to public health services. These will be covered in a phased manner, he said.

Read the complete story

tbACTION launches stakeholder meets in states

A Delhi based NGO tbACTION, has geared its activities to identify key constraints in the implementation of TB Control Programmes in a number of states according its Country Director John Mathai. The organisation hopes to create a dialogue by bringing different stakeholders together to bridge those gaps thereby helping RNTCP to achieve its set goals in the State as well as the Country. Such stakeholder meets have already been held in Jharkhand and Uttranchal.

The stakeholders meet held in Jharkhand while appreciating the initiative proposed that such meeting should be held frequently to help develop an understanding of needs of stakeholders with varying background. In another recommendation, the participants said that awareness generation activities about TB disease and DOTS should be matched by actual availability of these services in the field.

The meeting also called for invigorated efforts to mobilise community through involvement of local leaders to achieve community ownership of tuberculosis control programme.
 

Millennium Goals: Burma Must Tackle TB and HIV
Marwaan Macan-Markar , Inter Press Service News Agency

For over 15 years a clinic in Mae Sot, a town along Thailand's northwestern border, has offered a glimpse into how widespread tuberculosis (TB) is in neighbouring Burma.

It is to that clinic, run by Dr.Cynthia Maung that a stream of poor men, women and children, escaping military-ruled Burma for Thailand, come to for a health check. ''In 2004 we detected 700 cases of TB, of which 250 needed treatment,'' said Maung, herself a refugee who fled Burma in 1988 following Rangoon's harsh crackdown on a pro-democracy movement.

TB remains one of the major diseases that the hundreds crossing over from Burma suffer from, she explained during a telephone interview from her clinic in Mae Sot. ''We are concerned because every year the cases are high''.

Similar conclusions have been reached by officials at Thailand's ministry of public health, given the number of TB cases that have been detected during mandatory health tests done to the thousands of migrants from Burma who seek legal employment in this country.

In 2003, for instance, there were 1,766 Burmese with TB who required follow-up treatment, states a health ministry study. The infection that followed TB was syphilis, with 952 cases.

In 2002, in the Tak province alone, where Mae Sot is located, Thai health officials had required 885 Burmese to commence medical treatment for TB. That was out of an estimated 30,000 migrant workers who were seeking jobs in the large agriculture farms and the many garment factories there.

The number of migrant workers with TB has added to the incidence rate of this killer disease in Thailand, compelling Bangkok to step up TB detection and treatment efforts. ''This year we put TB among one of the priority problems we have to tackle,'' Dr. Kamnuan Ungchasuk, director of the bureau of epidemiology at the health ministry, told IPS.

These numbers, however, are dwarfed by reports that Burma has 97,000 new cases of TB every year and this South-east Asian nation is classified by the World Health Organisation (WHO) as being among the world's 22 'high burden'countries with the disease.

More troubling for public health experts is the high prevalence of multi-drug resistant TB (MDRTB) in Burma. It has four percent new cases of MDRTB, states the Geneva-based health body.

Read the complete story

A deadly combination
Tuberculosis and HIV/AIDS are twin dangers. The focus of public health policies is on combined programmes to tackle them

By Ramya Kannan, in The Hindu

According to the World Health Organisation's Global Tuberculosis Control Report, 2004, between 2.5 million and 3 million people in this Southeast Asian region are currently estimated to be infected with both HIV and TB; between 50-82 per cent of diagnosed AIDS cases suffer from TB. It also quotes data for a 10 year-period available from Pune showing that HIV seropositivity rate among newly diagnosed TB patients had steadily increased from about 4 per cent in 1991 to about 30 per cent in 2001.

A South Asian Association for Regional Co-operation Tuberculosis Centre (STC) publication (of October 2003) says that in South Asia areas with highest rates of HIV also report the most cases of TB. Hence, the need to treat the twin conditions under a single plan becomes crucial.

The STC in Kathmandu has proposed to rechristen itself "TB and HIV centre," at the November SAARC summit, a step forward for the region. Health care services will be forced to, if they have not already, acknowledge and respond to the mutually aggravating links between the two biggest epidemiological challenges.

As evidence indicating the HIV-TB link built up over the years, the SAARC countries including India, Bhutan, Nepal, Sri Lanka, Pakistan, and Bangladesh decided to adopt a policy to interlink their hitherto divergent approaches in the treatment of the two infections. "We have already developed a SAARC Regional Strategy on TB/HIV Co-infection and a separate action plan on HIV in consultation with all the member-states. The latter is to be signed in the Standing Committee. Once this has been done, we will have a set of activities and a time bound action plan to implement," says K.K. Jha, director, STC.

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TB Document
Fighting TB on the front lines:
Key findings and recommendations on the crucial role played by front-line health workers in TB control

As a member of Stop TB Partnership, Health and Development Networks moderated and managed a time-limited discussion on the Stop TB eForum on the theme of key roles and needs of front-line health workers in stopping tuberculosis. This is a summary document of the discussions on this eForum over the last six months.

The overall aim of the discussion was to share information and assess the critical role that front-line health workers play in turning back the tide of TB. The discussion built upon the recognition that government services cannot defeat TB alone and that further improvements in case detection and cure rates need the active and local engagement of people involved in care provision on a daily basis.

From various sectors and from different countries, including some with among the highest burdens of TB, many members of the eForum took this opportunity to 'speak their world'.

As well as generating the rich tapestry of experience and expertise you will read in this brief summary, it also provided a virtual forum for thousands to think about and discuss together the theme of World TB Day (WTBD)

Complete PDF version, is available on the eForums website