In a rural area outside Delhi, the father of a young girl with tuberculosis came to me, "Doctor, just give me the medicines. I will give the drugs to my daughter myself, not here at the clinic." When I asked him why, he emphatically replied that she would 'never' get married if 'anyone' saw her coming to the TB clinic. By seeking treatment, he told me, her life would be 'ruined!'
I am a tuberculosis physician in Delhi, India, and daily face numerous obstacles and challenges in treating TB. Stigma against people with TB is just one of the many difficulties we face day in and day out as we fight the war on this disease. Drug-resistant TB now adds to the multi-faceted challenge.
Treatment for regular drug-susceptible tuberculosis involves first-line drugs and takes six months. The World Health Organization's Directly Observed Therapy, Short-Course (DOTS) requires patients to come to the clinic three times a week to take their medications under observation of a healthcare worker to ensure that they complete treatment. DOTS is the most effective way to ensure treatment is completed and why I dread pleas like that of the sick girl's father. If a patient defaults for any reason by not taking the treatment as directed, then he or she can become resistant to those drugs and develop multidrug-resistant tuberculosis (MDR-TB).
Since TB is an airborne disease that knows no borders, the frontlines of TB are not just poverty-stricken parts of India and developing countries. India has the highest number of TB cases in the world, but people are on the move, so drug-resistant tuberculosis is spreading.
Treatment for MDR-TB often takes two years - a challenge for any chest physician. The drugs have very toxic side effects, causing both physical and mental problems, so the physician has to counsel each patient to take the treatment regularly. Treatment is a long process, with a number of serious side effects and a low cure rate, and many patients become very depressed. I become a counselor and friend to the patient, cajoling them to continue taking their medicines to prevent spreading the deadly disease to their near and dear ones.
I understand why patients often don't complete their treatment. Even in my own experience, when told to take antibiotics for seven or 10 days, I'm tempted to stop taking them once my symptoms disappear, even if it's only after three or four days. I start forgetting. It's human behavior. But with tuberculosis, this leads to expensive, deadly drug-resistant strains to their loved ones and the community at large.
New TB vaccines could prevent all of this. In March in the medical journal PLoS One, Esther Pronker and her co-authors assert that "immunization strategies - of which the use of vaccines is the most important - have prevented more premature deaths, permanent disability, and suffering, in all regions of the world, than any other medical invention." Those of us fighting the war on TB know this to be true.
I chose to participate in the film series EXPOSED: The Race Against Tuberculosis because I want people everywhere to see how difficult it is to combat the TB epidemic with limited tools and resources. As a physician, I am doing everything I can, but it is not enough. We need research into new TB drugs and diagnostics. Having an effective TB vaccine would solve the entire gamut of problems associated with tuberculosis. No longer would fathers be afraid to bring their children to my clinic. We could save patients from the burden of treatment programs that batter their bodies and rob them of time at their jobs and with families. I wouldn't have to worry about our nurses and staff being exposed to drug-resistant TB in the workplace.
With new vaccines to prevent tuberculosis, we would be looking at a brighter future. I would love to see tuberculosis vanish from this planet in my lifetime.
EXPOSED: The Race Against Tuberculosis is a four-part series of short films that tells the story of the deadly global epidemic of tuberculosis. The series focuses on current efforts to halt this airborne disease, which is growing more difficult to address, as well as the urgent movement to develop new tools to prevent it. You can view the second film, which includes Dr. Banavaliker's story, at www.aeras.org/exposed. To read a blog from Natalie Skipper, an MDR-TB survivor from Tennessee featured in the first EXPOSED film, click here.