The Echoing sound of the patients
By Dr. Shadhana Ningthoujam
After World TB day, it’s still echoing in the ears of the powerful sharing of some patients undergoing MDR-TB treatment (i.e. Multi drugs resistance TB) and another patient who have completed MDR-TB treatment. The first patient Mr. Ibobi expressed that he love the health care providers of Imphal West district more than his family members. Our RNTCP programs focus more on patient’s friendly approaches. He is getting better day by day all because of the efforts of the care providers who look after and monitor time to time the required investigations to support his treatment.
The first District where MDR-TB treatment was implemented in the year 2012 as a pilot project at Imphal West, 35 cases were detected within a year period. The line listing among the treatment failures of Category1& 11 and new MDR-TB cases were included. The prevalence rate of MDR-TB new cases is >3% and among the re-treatment TB cases is >19% now, but previously the prevalence rate was 2-3% MDR-TB new cases and among the re-treatment cases was 12-17%.
One of the patients among the treatment completed and cured patient is Mr.Tilak. He was detected in the year 2013 at the outside Manipur. He shared on the World TB day that he did not want any of his dear and near ones to suffer his disease and even his personal enemies and the neighboring countries too. He has contacted MDR-TB from outside, when his health was deteriorated and it took long times to confirmed his disease. The final diagnosis has arrived at last, the uncertainty has been over and the confirmation of his disease from SRL, New Delhi in the year 2013. He had taken his decision to take his medicines for the said infection from Imphal because there was no one to take care plus the duration of the treatment is more than 2years.
So he has to fly back home and his fear psychosis was to travel by plane because it fly under compressed air and AC accommodation. If he coughs out he might spread the infection directly to the passengers inside the plane. On the day of going home, his seat was in the front where few children were there, he even changed his seat at the back to avoid the close range from the children. He was so much frightened that if he coughs out, the minor low immunity children group would receive the dreaded gift of MDR-TB infection from him. What a noble hearted of this patient!! He was very thin and weak and his body weight was only 26kgs before receiving the treatment. The toughest part of the patient was to swallow the medicines and daily injection of kanamycin for 6 months except on Sunday the injection was off. The duration of the intensive period of the treatment is 6-9 months and continuous period is 18 months, a total period of treatment is 24-27 months of MDR-TB treatment. The patient shared the toughest moments of his life was to swallow 16 drugs and injection plus depression and the psychological impact of the disease and the side effects of the medicines.
The inner strength is the ongoing counseling given by the health care provider and the District TB program officer and her teams who have rendered proper supervision and monitoring services throughout. There was no place for hospitalization so the treatment was imparted as ambulatory basis under good co-ordination with the DOTS plus committee members of JNIMS and Imphal West, DTO, M.O DR-TB and DOTS plus supervisor. It was a big challenge of the District TB officer, Imphal West and her teams to take up the pilot project of MDR-TB treatment.
Mr. Tilak’s journey of long treatment was completed and when his result was confirmed negative, he was declared cure from MDR-TB. He was reborn again, fit and healthy now. Likewise, one of the technical students studying at outside Manipur contacted the airborne disease, MDR-TB from her room-mate. She could not continue her studies due to her health condition. It very difficult to diagnose her disease, we have taken the history all over again enquired about her room-mate and from where her room-mate belongs to, this are very important because the geographical places and the communities also have some clues for the diagnosis. Her room-mate was very sick and she was helping her throughout and she left the Technical course later on. On suspicious grounds, we have sent her sputum test to detect the organism through CBNAAT and found to be MDR-TB.
She was provided conventional MDR-TB treatment for 2 years. She was not allow to stay at the Ladies hostel and she appeared her semester exams on sick bed at the rented house with family members and a nurse to provide her injection during her stayed for the exams. Then she was brought back home after her exams. When her treatment completed and her result confirmed negative, she was allowed to stay in the Ladies hostel and continue her technical course. The pathetic scene of this dreaded disease is the fear and lack of awareness in the communities. We have very frightening situation came across about a case of XDR-TB (most extensive form of drugs resistant TB) of Imphal West District, she was a female patient and a primary teacher involving tender children who are more prone to get this infection. We jointly counseled her and almost forcefully helped her to undergo XDR-TB treatment.
The District TB officer Imphal West took her to Churachandpur DRTBC, with the help of family members and also with the help of MSF Holland based NGO to start the treatment in the District hospital identified as DR-TB ward. After one year of pilot project of MDR-TB treatment in 2012, all the preparation of setting up drugs resistant TB management in other districts to follow simultaneously by backing up human resources, training the key staffs and storing the drugs at the particular humidity and temperature of the drugs store at the different districts and then only the implementation follows. TB is a notifiable disease; so reporting and registration are necessary. It’s time to End TB by 2025 needs many hands to support our program and over and above the deep research reports of TB vaccine for adult to achieve our Goal. Our proud moment of RNTCP is that our RIMS, Medical superintendent, Chest and Respiratory Department and other faculty members of RIMS, supported multi drugs resistant-TB case management at the Identified ward. It is the zeal and enthusiasm will without much Man power and is functioning on humanitarian basis. Such kind of commendable ventures are necessary at other districts especially in hills region. Now, also we are looking after a young professional personal from far flung hill district being treated on short course MDR-TB treatment at JNIMS, Nodal center (Nodal Drugs Resistant TB center). She requires acute supervision and monitoring for her cardio-vascular system, lungs and her physique during her stayed in the hospital.
All the major arrangement are being taken care by the Medical superintendent, JNIMS, Chest and Respiratory department, DTOS of Imphal East and Tamenglong and the key staffs from RNTCP side. So RNTCP program involves many programs for the public. Our RNTCP strategy plan focuses on active case finding among the vulnerable high risk groups in both the Hill and Valley regions. We are providing investigation facilities, medicines, treatment guidelines and nutritional monitory supports all free of cost to the patients. We extend our programs towards the Private sectors so that they should notify TB cases to us. Because 50% of the population goes to Private Sectors and our DATA of TB cases is never a complete picture without the inclusion of Private Sectors. There is no provision of cases follows-up mechanism in the Private Sector. The patients usually landed to discontinuation of TB treatment because of financial constraint in the family, half way treatment leads to drugs resistant TB which is very difficult condition to tackle the cases. So there is a need to co-ordinate between RNTCP and Private Sectors, NGOs to notify TB cases to us so that our key staffs to follow up the patients. The reason behinds are:--
1. To provide TB medicines at the private sector
2. To offer free of cost investigation packages like CBNAAT etc
3. To reduce the financial burden of the patients
4. To provide monitory nutritional supports during the long course of TB treatment
5. To follow-up the Private cases by our RNTCP key staffs and screening the children below 6 years in the family, if found infected than provide treatment for TB care and if not found infected than to provide Chemoprophylaxis of Isonized daily dose for six months to the children for protection
6. To tackle relapse cases by following up for 2 years after TB treatment completed patient and checking every 6 months till 2years.
7. To sensitize all the staffs of the Private Sector with all the new information’s of TB care
8. To register in our soft ware Nikshay Version 11
Let’s joint hands together to fight and End TB infection by active participation, creating mass awareness to the public, with good sanitation, good environmental hygiene, air borne infections control, pollution control measures and proper biological waste management will contribute healthy living and a better world.
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