Archive for January 2011
I call this a vignette because it is an impressionistic piece. My claims are not backed by data because I could not find them. The contents of this post are derived mainly from conversations which I have no reason to disbelieve. Why Vrindavan? That’s simply because I have a job that involves travel and Vrindavan is one of the places I went to recently. I intend to collect these vignettes from each place I go to.
At the end of a three hour drive, around 150 kms away from New Delhi, is Vrindavan, one of India’s most famous and hallowed pilgrimage towns. The town is dotted with hundreds of little and big temples devoted to the Lord Krishna and Radha.
Vrindavan is actually a little more than a village with dusty lanes and open drains and houses set close to one another. Parts of it are rapidly developing what with scores of real estate developers having descended on the place. So you find modern buildings nestling cheek by jowl with old dilapidated dwellings.
Bright lights and loud devotional music assault the eyes and ears while driving through the main road of Vrindavan in the evening. Devotees who have come to visit Vrindavan bustle about happily shopping for souvenirs and the beautiful jewelled pictures of Radha and Krishna that adorn the shop shelves.
Amidst all this, it is difficult to find a clinic. Where do the locals go for their ailments one wonders. A few enquiries reveal that there are indeed a few clinics in the town. One is strangely sharing space with what looks like a TV repair shop. The doctor in the clinic is more than willing to talk when I go in and ask whether he can talk to me about TB. He says he also works at the local Ramakrishna Mission Hospital. In the evenings he sees patients at his clinic. And he reveals some startling facts that make me gulp.
He says he sees 60-80 patients a day and more than 50 per cent of them are suffering from TB. They come to him from villages around Vrindavan and could have sometimes travelled around 20 kms just to reach the hospital or his clinic. What is even more startling is his statement that most of them come to him after complications have set in. He is more than certain that they have first seen a local physician or quack in their villages, have been treated for TB on suspicion alone and have dropped out of treatment as soon as they began to feel better. He cannot say for sure whether they qualify as MDR TB cases but has a suspicion they could. When asked about testing facilities, he says that he refers them to the local DOTS centre where standard testing facilities are available. But he also says that some of these patients have already been scared into undergoing expensive and ineffective tests by some private practitioners; this has burnt huge holes in their pockets and they are in debt.
A little distance away is a little clinic that has a bed and a forlorn drip bottle suspended above it, indicating that the clinic also doubles up as a ‘hospital’ of sorts. Near the entrance, surrounded by dusty bottles and potions, sits the registered medical practitioner who says that he does not know how to diagnose TB and only administers treatment for primary illnesses such as cold, cough, fevers etc. My question about whether any of these cases could actually be TB does not find favour with him and he indicates he does not want to take any more questions by pointedly talking to a lady who has come in after me. After waiting for some time, I leave, taking the cue. I am told there are two or three more clinics in the town and go in search of them. Despite walking through the badly lit interior alleys in the town, I am unable to find them.
Before the reader begins to wonder what I’m trying to say, let me hasten to clarify. I don’t have answers. Only questions. Where does a patient go when he or she is sick with cold, cough and/or fever? Does the person go immediately to the nearest DOTS centre? The question precludes an answer. It is obvious that the first point of care is the general physician or the registered medical practitioner. Does that not make TB primarily a primary health problem? What hope does the person have if the doctor is not alert enough to pick up symptoms and seek referral help? What does it take for each local DOTS centre to sensitise the local doctors, (who are very often also very popular among the locals) to the problem and encourage them to be alert to possible cases of TB? We have the figures, we have the evidence and we absolutely know we have a problem. What does it take to aggressively take it on and solve it? The questions beg answers.
A new, promising candidate vaccine against TB has attracted global attention this week. The vaccine has been developed by researchers at the Statens Serum Institut in Denmark and should protect against both latent and active infection. So far, the vaccine has been tested on mice in a pre-clinical phase of the research project. It is expected that the vaccine will soon enter a new phase of testing.
The development of new vaccines is considered crucial in the fight against Tuberculosis (TB). The Stop TB Partnership aims to eliminate TB by 2050. In order to reach this goal, it is necessary to combine better diagnostics and improved drug regimens with the development and introduction of new and more effective vaccines. The increasing problem of multi-drug resistant (MDR) and extensively drug-resistant (XDR) TB and TB/HIV co-infection makes the issue even more complex and the need for new vaccines more urgent.
The only vaccine currently available is Bacille Calmette Guerin (BCG), first used in 1921. The vaccine protects many newborns against severe forms of TB but is not safe for HIV infected babies. Also, BCG provides little to no protection against pulmonary TB in (young) adults, the most common and most infectious form of TB. In the meantime, drug resistant forms of TB are rapidly spreading. These infections are difficult, sometimes impossible, to treat and the cost of treatment is high. New vaccines could not only protect people against these harsh forms of TB but also improve cure-rates.
Research shows that the introduction of a new vaccine could reduce the number of new TB cases by ninety percent within thirty to forty years. Hard work over the past decade is starting to pay of with some promising results but the process of developing, testing and licensing new vaccines is complicated and lengthy. In order to battle TB, several different vaccines will be needed; so-called ‘priming’ vaccines that can be given to newborns and ‘boosting’ vaccines to be used for infants, adolescents and adults. Vaccines should not only prevent people from initial infection, they also have to prevent people with a latent infection from developing into active TB. In addition to this, vaccines have to be safe for HIV-infected people.
From candidate to vaccine
The process of bringing a candidate vaccine from initial discovery to licensed vaccine involves different phases of testing and trying. Many candidate vaccines will not survive this process and therefore dozens of candidates are needed. The TuBerculosis Vaccine Initiative (TBVI) is an independent non-profit foundation. TBVI facilitates the development of new vaccines by giving financial support and bringing expertise to a network of over 40 universities, institutes and industries that have promising candidate vaccines. Currently, TBVI supports a portfolio of 39 candidates that are in different phases of development and testing. The organization is hopeful that two of those candidates could make it to the market by 2020 and another two by 2025. Worldwide, there are about ten candidates in various stages of clinical trials and about 50 more in development.
2050, a feasible goal?
Can TB be eliminated as a global public health problem by 2050? Researchers within the TBVI-network describe this goal as particularly ambitious . However, the introduction of new and more effective vaccines would mean a huge step forward in the fight against TB. For this to happen, ongoing attention and a considerable amount of funding are needed. Still, if new vaccines can enter the market, these investments will be more then justified both from a humane and an economic perspective.
Jojanneke Nieuwenhuis is Associate, Communications, at the TuBerculosis Vaccine Initiative (TBVI)
The views expressed in this blog are entirely of the author.
When I was young, TB was a killer in UK industrial towns and cities because of a poor diet, lack of sanitation and the wholesale burning of coal on domestic fires for cooking and heating during long winters. Children living in slums were especially prone to TB and rickets (both now eradicated) and the elderly were at risk from TB and other life-threatening bronchial conditions until our Clean Air Act was introduced in the Fifties.
I can remember being dispatched to a bedroom, warmed by a coal fire, whenever I caught a cough or cold. Mothers in those days used to apply chest poultices soaked in goose fat in an effort to ‘sweat’ the cold before other members of the family succumbed. We were a family of six, crowded into a two-up, two-down terrace house in the shadow of a Yorkshire woollen mill and main-line steam railway, both of which spewed out black smoke 24 hours a day to add to the pollution created by row-upon-row of domestic chimneys.
Those were the days of much colder winters leading to regular foggy conditions (the term ‘smog’ was coined to describe a potentially lethal mixture of smoke and fog) which were so bad that, at times, it was difficult to see a couple of yards ahead and we couldn’t go to school (hooray!).
Sadly, there is a risk of TB making a comeback in the so-called developed countries of the West because of the collapse of the global economy, consequent food shortages and price rises and the freer migration across Europe of poor people from the former Soviet-controlled Eastern Block countries – now in the European Union – who are ‘importing’ this highly contagious disease from areas where is still prevalent. Quite naturally, they’re hoping to escape from poverty to a better place where there are jobs, social benefits if they can’t find work and – above all – where there is free healthcare.
All these life-threatening conditions are treatable and I hope the World Health Organisation can galvanise richer countries and the powerful drugs companies to help arrest and alleviate them in addition to crucial campaigns to combat influenza pandemics, malaria and – of course – HIV/AIDS.
Derek Woodcock is a journalist who spent 14 years in newspaper journalism and 25 years in the British Broadcasting Corporation (BBC)
CNN IBN, one of India’s premier electronic news channels has a unique initiative called Citizen Journalist, which is positioned as a …platform of empowerment for the citizens of India, which lauds the democratization of news and is built on the principles of inclusive journalism… And the initiative has delivered on its promise, with the quality of stories that are telecast through it.
To take this further, CNN IBN also awards the best stories every year under six categories, Fight back, Save your city, Be the change, Fight for her right, etc . But there is a glaring gap in the categories. There is a category for the girl child, there is one for civic amenities, there is also one for changemakers, but where is health?
What does this tell us? That CNN IBN does not care for or have space for health stories? On the contrary, I think it reflects an apathy towards health. From media houses as well as us, the general public. One need not labour the point that if there were enough stories on health, there would have been a category allotted to it. Where is the activism around health, save for HIV/AIDS in India?
I have just heard of a very interesting initiative from a reader of our blog, Mr Ken Patterson, who is the Global Grassroots Manager of an organization called RESULTS. He says, “We have a project dedicated to TB. It’s called ACTION. We do a lot of work with the media. Last fall we generated over 90 pieces of media encouraging President Obama to make a multi-year pledge to the Global Fund to Fight AIDS, TB, and Malaria. Because of our work with Congress and the media, the US made the first-ever 3-year pledge to the Global Fund for $4 billion.”
Where is such activism in India? How much access do we have to policy makers? Where is the media support, which can force action? There have been innumerable cases that the Indian media has taken up, which has forced the government to sit up and take note, and in fact investigate because the media had put the government on the mat with evidence. The recently concluded Commonwealth Games in India is a classic example. Riddled with corruption and mismanagement, it was the media’s intervention, which forced action on the part of the government and it will not be an exaggeration to say that we were able to save face just in time and avert a major embarrassment to the country.
So if health has to come to centrestage through the media it will take a lot more proactive measures by agencies, individuals and others working in the sector to exert pressure on the media and thereby impact policy. I am just a writer and can indulge in the luxury of critiquing current efforts. It needs a lot more coming together, a lot more lobbying with the media and a lot more to motivate the media to look at health issues seriously. Seriously enough to realise that ignoring health is also to ignore the fact that a sick population cannot be a productive population. And we have a huge number of sick people in India. What with malaria and TB and HIV/AIDS, and poor maternal and child health, with malnutrition adding the icing to the cake!
CNN IBN was just an example to prove a point…
A reader of our blog has directed us to OSDD, a promising initiative that advocates open source models for drug discovery in a scenario where patents and IPRs prove stumbling blocks to universal access to affordable healthcare. I particularly like the quote on their home page.
OSDD is a CSIR Team India Consortium with Global Partnership with a vision to provide affordable healthcare to the developing world by providing a global platform where the best minds can collaborate & collectively endeavor to solve the complex problems associated with discovering novel therapies for neglected tropical diseases like Malaria, Tuberculosis, Leshmaniasis, etc. It is a concept to collaboratively aggregate the biological and genetic information available to scientists in order to use it to hasten the discovery of drugs. This will provide a unique opportunity for scientists, doctors, technocrats, students and others with diverse expertise to work for a common cause.
The success of Open Source models in Information Technology (For e.g., Web Technology, The Linux Operating System) and Biotechnology (For e.g., Human Genome Sequencing) sectors highlights the urgent need to initiate a similar model in healthcare, i.e., an Open Source model for Drug Discovery.
Funding source – The Government of India has committed Rs. 150 crores (US $38 million) towards this project. An equivalent amount of funding would be raised from international agencies and philanthropists. About 46 crores (US $12 million) has been already released by the Government of India.
I thought mistakenly that the poor suffered more when they contracted TB. Facts however, point to a different reality. Without discounting the fact that the poor definitely have more challenges to deal with, with regard to access to treatment, nutritional requirements and loss of work when they are ill, I also have very unpalatable facts to prove that the not-so-poor suffer equally if not more. In addition to the discomfort of suffering from the disease itself, paradoxically, they also, by virtue of being able to afford better care, more often than not, get exploited by doctors in the private healthcare sector.
As a friend recently recounted, on seeking medical advice for a persistent cough and weight loss, he was first peremptorily treated with antibiotics, which did not solve his problem; his condition, on the contrary,worsened to a point when he began to vomit blood and was completely exhausted and unable to work. On seeking help from a renowned chest hospital in Chennai, he was subjected to a series of complicated and expensive tests without being told what the doctors were suspecting. He is indignant when he says, “I reached a point when I was livid with what was being done to me and combined with my deteriorating health, was at my wits end not knowing where to go for help. The doctors could have told me they were out to make money, and yet treated me. I would still have gone along with them because I wanted to get better.” The fact that he had medical insurance made it worse for him because as he says, “I had reason to suspect that the doctors knew I had TB but they just didn’t want to tell me till they had subjected me to all the tests they were recommending as they knew I had medical insurance. After all, they had to put all their diagnostic equipment to use.”
It was then that someone recommended he go to a government hospital that had the RNTCP programme. The doctor there had one look at his chest x-ray and declared his condition as TB and put him on accurate treatment. Now, three years later, he continues to be healthy and active and thanks his stars that he was able to access treatment which helped to cure him. He is however a little regretful that his pockets are somewhat less heavy and he has spent more money than he needed to, simply because he could afford it! This is besides the six months he lost and the avoidable suffering he had to go through.
Even more horrific is the case of the author’s father who developed a slight cough and a pain in the right lower region of his chest. We had access to the best doctors in Bangalore. One of them advised an ultra sound scan and diagnosed his condition as stones in the gallbladder and scheduled a surgery to remove his gallbladder the very next day after the scan result was out. Wisdom prevailed on us and we sought a second opinion. The next doctor advised a chest x-ray and discovered a patch in his lung but could not determine whether it was pneumonia or TB. My father was probably lucky because the treatment prescribed for him worked and he went on to live a healthy life. So healthy in fact that he lived 15 full years and passed away from a heart attack on the golf course after having played 9 holes of golf!
But that was 15 years ago. Nothing much seems to have changed since then as my friend’s case demonstrates. An earlier post in this blog called for more vigilant regulatory systems in India for the private healthcare sector and for more robust and reliable diagnostics for TB. It bears repetition to say this again here. Gullible patients, when they are suffering, have nowhere to turn and have to trust their doctors. But when the fence begins to eat the crop, who can the crop turn to??
A report by S Nagarathinam – a Lilly MDR TB fellow.
கடந்த ஆண்டு சர்வதேச நுரையீரல் ஆண்டாக கடைபிடிக்கப்பட்டது. உலகமெங்கும் கோடிக்கணக்கானோர் நுரையீரல் பாதிப்புக்கு உள்ளாகி வருகின்றனர். இந்நோய்கள் தொடர்பாக விழிப்புணர்வு ஏற்படுத்தும் வகையில் சர்வதேச நுரையீரல் ஆண்டு கடைபிடிக்கப்பட்டது.
இந்த விஷயத்தில் இந்தியாவிலோ அல்லது சர்வதேச அளவிலோ, மீடியா மிகப்பெரும் கவனத்தை எடுத்துக் கொண்டன என்று கூறிவிட முடியாது. சர்வதேச ஆண்டுகள் அறிவிக்கப்பட்டதுடன் நின்று விடாமல், மீடியாவில் செய்திகள் வருவதற்கான தொடர் முயற்சிகள் மேற்கொள்ளப்பட வேண்டும் என்பதையே இந்த ஆண்டு நமக்கு பாடம் கற்பித்திருக்கிறது.
காசநோய், ஆஸ்துமா, நிமோனியா, இன்புளூயன்ஸா, நுரையீரல் கேன்சர், சுவாசப்பிரச்னை உள்ளிட்ட நோய்களால் ஏராளமானோர் அவதிப்படுகின்றனர். லட்கணக்கானோரை இந்நோய்கள் பலிகொண்டும் வருகின்றன.
நோய்களைப் பற்றி அறிந்து கொள்வதும், அவற்றுக்கு முன்னதாக சிகிச்சை தொடங்குவதுமே இந்நோய்களிலிருந்து நாம் காப்பாற்றப்படுவதற்கான ஒரே வழி. ஆஸ்துமா சுவாசப்பிரச்னைகளை ஏற்படுத்துகிறது. மூச்சுத்திணறல், இளைப்பு ஆகியன இதன் அறிகுறிகள்.
புகைப்பிடிப்பவர்களுக்கு நுரையீரல் கேன்சர் மற்றும் காசநோய் வருவதற்கான வாய்ப்புகள் உள்ளன. நுரையீரலில் வளரும் கேன்சர் செல்கள் நுரையீரல் பிரச்னைக்கு காரணமாக அமைகின்றன.
2004ல் மட்டும் சர்வதேச அளவில் 13லட்சம்பேர் இந்நோய்க்கு பலியானார்கள். பாக்டீரியா, வைரஸ் தொற்றால் ஏற்படும் நுரையீரல் வீக்கம், நிமோனியா நோய்க்கு காரணமாக அமைகிறது. சில வகை இன்புளூயன்ஸா காய்ச்சலும் நிமோனியாவை ஏற்படுத்துகின்றன.
காசநோய் “மைகோபாக்டீரியம் டியூபர்குளோசிஸ்’ எனும் பாக்டீரியாவால் பரவுகிறது பொதுவாக இது நுரையீரலைத் தாக்கும். எனினும் உடலின் இதர பாகங்களிலும் இது நோயை ஏற்படுத்துக்கூடியது.
தொடர்ச்சியான இருமல் சளியில் ரத்தம், காய்ச்சல் உள்ளிட்டவை காசநோய்க்கான அறிகுறிகள் காச நோய் பாக்டீரியா உலகில் மூன்றில் ஒருவர் உடலில் இருந்து வருகிறது. இது உடலில் உள் உறைநிலையில் உள்ளது. ஒருவரது நோய் எதிர்ப்புத் திறன் குறையும் போது, இந்த பாக்டீரியங்கள்
பல்கிப் பெருகி காசநோயை ஏற்படுத்துகின்றன. காச நோயை கண்டறிந்து முறையாக சிகிச்சை எடுத்துக்கொண்டால், அதிலிருந்து எளிதில் தப்பிவிடலாம். ஆனால் அதை கண்டுகொள்ளாமல் விடுவது உயிருக்கே ஆபத்தானது.
பல்வேறு மருந்துகளை எதிர்க்கும் திறனை காசநோய் பாக்டீரியா பெற்றுவிட்டால்,முதல் கட்ட மருந்துகளும் எடுத்துக் கொள்ள வேண்டியிருக்கும். இந்தியாவிலும் சீனாவிலும் இவ்வகையான நோயாளிகள் காணப்படுகின்றனர்.
இதுகுறித்து, சுகாதாரம் மற்றும் ஊரக நலப்பணிகள் இணை இயக்குனர் டாக்டர் எம்.எம். சாமி தெரிவித்தபோது மதுப்பழக்கம் உள்ளவர்கள் விட்டு விட்டு மாத்திரைகளை எடுத்தக்கொள்வதால், அவர்களிடம் காசநோய்க் கிருமிகள் பல்வேறு மருந்துகளை எதிர்ப்புத் திறனை பெற்றுவிடுகின்றன. சர்க்கரை நோய் உள்ளவர்களுக்கும் காசநோய் கிருமிகள் மருந்து எதிர்ப்புத் திறன் பெற்றுவிடுவதால் இவர்களுக்கு இரண்டாம் கட்ட திவாய்ந்த சிகிச்சை அளிக்கப்படுகிறது.
குறுகிய காலத்துக்கான நேரடி கண்காணிப்பு சிகிச்சை(டாட்ஸ்) வழியாக வழங்கப்படும் மாத்திரைகள் தொண்டுள்ளம் கொண்டவர்கள் வழியாகவும் நோயாளிக்கு நேரடி கண்காணிப்பின கீழ் அளிக்கப்படுகிறது. நோயாளி தொடர்ந்து மாத்திரை எடுத்து வருகிறாரா என்பதை அவர் கவனித்து வருவார். குடும்பத்தினரிடம் இம்மாத்திரைகளை அளித்தால், சில நேரங்களில் ஏற்படும் சிறிய பக்கவிளைவுகளை கருத்தில் கொண்டோ, அல்லது வேறு குடும்ப காரணங்களுக்காகவோ அவர்கள் கொடுக்காமல் இருக்க வாய்ப்பு உண்டு. ஆகவே காசநோய் சிகிச்சை எடுத்து வருபவர்களில் ஏறத்தாழ 85 சதவீதம் பேர் முழுவதுமாக குணமடைந்து வருகின்றனர்,” என்றார்.
சென்னை காசநோய் ஆராய்ச்சி மையத்தில் 1970களில் நடந்த நேரடி கண்காணிப்பு சிகிச்சை முறை உலக சுகாதார நிறுவனத்தால் ஏற்றுக்கொள்ளப்பட்டு சர்வதேச அளவில் கடைபிடிக்கப்படும். சிகிச்சையாக இருக்கிறது. சர்வதேச அளவில் வெற்றி பெற்ற இம்முறைதான் அரசு மருத்துவமனைகளிலும் இலவசமாக அளிக்கப்படுகிறது.
உலக சுகாதார நிறுவனம் 1993ம் ஆண்டை சர்வதேச காசநோய் அவசர ஆண்டாக கடைபிடித்தது. “ஸ்டாப் டிபி பார்ட்னர்ஷிப்’ நிறுவனம் 2006 முதல் 2015ம் ஆண்டு வரை ஒரு கோடியே 40 லட்சம் பேரை காப்பாற்ற வேண்டும் என்ற குறிக்கோளை அறிவித்தது.
நுரையீரல் நோய்களை அறிந்து கொண்டு, முறையான சிகிச்சையை முன்னதாகத் தொடங்கினால் இந்நோய்களிலிருந்து நம்மை காப்பாற்றிக்கொள்ளலாம்.
– தி லில்லி எம்.டி.ஆர். “டிபி” ரீட் மீடியா பெல்லோஷிப்.