Abey Sushan

@abeysushan

medical doctor | public health

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On the scourge of TB

Sushama1, a 45 year old widow from a rural neighbourhood in Anicadu, found herself in a quandary one morning. She had just braved a gruelling 6 months and completed her TB treatment successfully. Now, the doctors said, her 14 year old autistic child has been diagnosed with TB. She had been the sole breadwinner for her family, but couldn't go to work owing to her illness. Now, she looks at another 6 months of not being able to work to take care of her younger son who is diagnosed with TB.

Sushama's story is one of many. Tuberculosis is still very much a disease of the downtrodden. The overcrowding in houses, inadequate control of diabetes due to irregular treatment, use of firewood inside homes to cook, vicinity to quarries etc . contribute to reduced immune response and flaring up of a latent TB infection into a disease. Poor access to healthcare services compound their disadvantage - the symptoms drag on for a few months or years before they finally decide to get treatment. In the meantime, the infection will have spread to household contacts and to elsewhere in the community. This vicious cycle of poverty and disease can be broken only through the proactive efforts of a committed health system.

Government of Kerala is attempting to bring about a change in TB care through its TB Elimination Mission. Kerala is bringing primary prevention and secondary prevention to the doorsteps of these disadvantaged families. Health workers and volunteers across the state conducted a field survey during the period December 2017 - March 2018 to identify vulnerability to TB among individuals and as an active case finding effort. That was phase I of the TB elimination mission. In phase II, the vulnerability data is put to use - vulnerable people are tracked actively every three months for symptoms of TB. In phase III, Kerala plans to implement/strengthen risk reduction measures like ensuring diabetes control and tobacco cessation. In phase IV, it plans to eliminate latent TB infection as well through c-TB skin test screening.

Apart from this, Kerala also initiated the 'Treatment Support Groups' for TB patients which is a voluntary social support mechanism for support of TB patients facilitated by the treating institution. Since the implementation of new technical and operational guidelines, treatment supporter and support group has been scaled up nation-wide.

It is important to proactively diagnose TB in the community, ensure treatment compliance through treatment support groups, and treat latent infection to eliminate TB. With the gains Kerala has made in the field, elimination of TB from the community is now an achievable goal.

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  1. Name changed for anonymity 

On the scourge of TB

Sushama[1], a 45 year old widow from a rural neighbourhood in Anicadu, found herself in a quandary one morning. She had just braved a gruelling 6 months and completed her TB treatment successfully. Now, the doctors said, her 14 year old autistic child has been diagnosed with TB. She had been the sole breadwinner for her family, but couldn't go to work owing to her illness. Now, she looks at another 6 months of not being able to work to take care of her younger son who is diagnosed with TB.

Sushama's story is one of many. Tuberculosis is still very much a disease of the downtrodden. The overcrowding in houses, inadequate control of diabetes due to irregular treatment, use of firewood inside homes to cook, vicinity to quarries etc . contribute to reduced immune response and flaring up of a latent TB infection into a disease. Poor access to healthcare services compound their disadvantage - the symptoms drag on for a few months or years before they finally decide to get treatment. In the meantime, the infection will have spread to household contacts and to elsewhere in the community. This vicious cycle of poverty and disease can be broken only through the proactive efforts of a committed health system.

Government of Kerala is attempting to bring about a change in TB care through its TB Elimination Mission. Kerala is bringing primary prevention and secondary prevention to the doorsteps of these disadvantaged families. Health workers and volunteers across the state conducted a field survey during the period December 2017 - March 2018 to identify vulnerability to TB among individuals and as an active case finding effort. That was phase I of the TB elimination mission. In phase II, the vulnerability data is put to use - vulnerable people are tracked actively every three months for symptoms of TB. In phase III, Kerala plans to implement/strengthen risk reduction measures like ensuring diabetes control and tobacco cessation. In phase IV, it plans to eliminate latent TB infection as well through c-TB skin test screening.

Apart from this, Kerala also initiated the 'Treatment Support Groups' for TB patients which is a voluntary social support mechanism for support of TB patients facilitated by the treating institution. Since the implementation of new technical and operational guidelines, treatment supporter and support group has been scaled up nation-wide.

It is important to proactively diagnose TB in the community, ensure treatment compliance through treatment support groups, and treat latent infection to eliminate TB. With the gains Kerala has made in the field, elimination of TB from the community is now an achievable goal.

--
[1]: Name changed for anonymity

On challenges

Populations world over (even in the most developed nations) are facing challenges to their health and well-being on multiple fronts. Availability, access and affordability are challenges faced by all health systems to varying degrees. Vulnerable population groups bear the brunt of the suffering. If there is one solution that is propounded to make a difference in the lives of most people, it is comprehensive primary healthcare. Now, while it is simple in principle, ensuring a wide and comprehesive range of primary heatlhcare services has proved challenging in most settings. Most countries and states try to provide some 'version' of primary care, but does not quite cover everyone. Reasons thereof are the function of the health system, demographic composition and the political & business environment of the country/state and is the subject of another post altogether.

Solutions to public health problems are, more often than not, multidisciplinary. People of several domains have to come together to achieve the goal. This blog is simply an attempt at demystifying the narrative of public health - to look at public health problems faced by humanity, and to create conversations around it so as to arrive at solutions.