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Tuberculosis and DOTS

For decades, the country has been striving towards decreasing the burden of Tuberculosis (TB) on its population. The introduction of Directly Observed Treatment Strategy (DOTS) through the Revised National Tuberculosis Control Program (RNTCP) was expected to bring about a major change in controlling the disease. In spite of many efforts, the indicators of TB fail to impress. Failure of adherence to the DOTS program and discontinuation of the treatment is attributed as an important cause for the current state of the disease. Linda, a friend of ours describes her experience with Tuberculosis, DOTS program and importance of completing the treatment.

Government of India DOTS Program

I was down with typhoid in March 2011. During that time I noticed a swelling below my jaw, towards the left side. The swelling did not subside even after a couple of weeks.  It was diagnosed to be lymphocytes, that is TB of the lymph nodes. A particular physician advised me to get the lump removed surgically. In fact the surgery was fixed for the next day. Then the doctors at Institute of Public Health (IPH), Bangalore referred me to another doctor for second opinion. The second doctor advised me to start TB medicines under Government of India DOTS Program. So I went and got myself registered for the program in Primary Health Unit in Cox Town, Bangalore. The staff their immediately started me on medicines and assigned me to a Social Health worker close to my house. A box containing the medicines of my full course was given to the health worker. I had to go regularly to her and pick up my medicines. She wrote my name on the box and kept a complete record of the medicines issued.

Initially when started my medicines I started feeling very weak and had severe pain and tingling sensation all over the lower part of my body mostly my legs. The pain was so severe I could not even move about. The swelling also increased rapidly and I was losing weight rapidly. I was feeling really frustrated and depressed. The doctors at IPH counseled me regularly and encouraged me to continue the course. My husband and my son also were very supportive. After a couple of months the swelling started reducing. I started feeling normal and started gaining weight. I still have 5 more weeks of treatment. I feel perfectly normal and have no swelling at all.

I would like to stress that the Government DOTS Program is most effective.  I would advise people with TB to go undergo Government DOTS Program and not to private practitioners. The quality of the medicines is excellent although it is completely free of cost. I would also like to add here that to bounce back to good health, one needs to complete the entire DOTS course.

 

-          LINDA DANIEL

 

4 Comments

  1. Thank you Linda,
    Nothing like hearing the story from the person who went through the experience. And, as our professor of Community medicine Dr. Abraham Joseph taught us in CHAD, Vellore – ” Your cured patient is your best health educator.”
    Good luck with the rest of the treatment !

  2. Dear Linda,
    First of all I congratulate you in communicating your story so perfectly.I hope its you who have written this. You are blissfully lucky to have doctor friends who are neither into government practice nor private practitioners. But diagnosing non-pulmonary Tuberculosis is not that easy. In any case excision biopsy or FNAC (fluid is taken through a needle) would have been one of the ways to diagnose it so your G.P was not on wrong track as long as he would have prescribed you the right kind of anti TB drugs.

    DOTS is not a drug but a method to provide anti-TB drugs which is universally accepted modality of treatment irrespective of public or private. Perhaps private practitioners not promoting it might be due to lack of any mechanism of direct supervision and loss of patient/client in follow up and for that matter a DOTS provider in government system does not care about his patient too.

    I respond to this blog as you and other advocates of DOTS should understand that in India, private sector is the dominant health service provider and success of DOTS depends on their involvement in the programme too. It is also true that almost 30-40% of new TB patients go to private practitioners.

    One can very easily criticize on the unimpressive TB indicators because they have not worked in the programme. People say that every three minutes a TB patient dies in India but they forget that every seven minutes a TB death is averted due to new enrollment in the programme.

    Having said this, it is true that there are many weaknesses in the RNTCP programme as it is a vertical programme like HIV/AIDS and runs mainly on four people- STO,DTO,STS and STLS. It’s amazing to see that any suggestion to improve the programme is consulted with their HQ in Central TB Division because there is no (so called)’guidelines’ for it. It is also true that a WHO consultant rather than acting as a bridge/catalyst in the programme has actually been involved in implementation of it and hardly visits (with some exceptions)the patients or field; thanks to their reporting format that they capture all the information at DTC/TU barring their field visits except quarterly triangulation party.

    You talk to a RNTCP consultant and you will find in his behavior the effect of working in silos. Nevertheless, wherever health system is strong the programme has also experienced success proving the need to strengthen the system and not otherwise(similar story of Polio programme where a young and dynamic Surveillance Medical Officer has made the system so dependent on him/her that the District Surveillance Officer has gone into disuse).

    In weak health systems where cash incentives are not distributed to DOTs providers, reagents are not purchased, money is not released by state level, programme is run without flexibility in approach, only workshops are conducted and seen as success, discriminatory behavior against contractual staff, bribes for renewing the contracts, there is Boss and sub-ordinate relationship between Central TB Division and State, lack of ownership by the system, lack of true involvement of medical colleges (except making them chairman of zonal task force for name sake), cross-referrals between TB and HIV, have not seen the success and will never see it in their wildest dreams.

    There will indeed be one day when failed states will spoil the success of other states by spreading Multi Drug Resistant (MDR)TB which is difficult to estimate (current conservative estimates are <5%).

    I wish you treatment completion and cure. I hope you and your family knows that you were a non-infectious patient,so,can not spread the disease. This is for information sake to avoid stigma and discrimination, if any.

    regards

    • Dear Jagdishji

      My wife was having fever. We went to a private practiotioner who suggested for starting of Typhoid treatment. When the fever persisted and my wife complained of slight pain on right side below her lungs my friend (a medical practioner) suggested to go for TB diagnosis. i visited L. R. S. Institute of Tuberculosis and Respiratory diseases. My wife was diagnosed with extra pulmonary TB and referred for DOTS treatment.
      After taking medication, her fever diminished and the lump and pain was gone.
      She was diagnosed free of TB at the stop.
      But one problem occured after stopping the treatment.
      She has developed some swelling in front, below her lungs.

      Can TB re occur after stopping the treatment or is it due to some effects of the treament she has taken for 6 months.

      Regards

  3. Hai everybody!
    This is Linda here again.
    I feel fit and normal.
    Two more days of medicines left.
    Then I have to start worrying about ways of loosing the kilos that I have gained.
    Thanks for all your support

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