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Re: India's TB Strategy Fails

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Dear All,

This is in response to the very vital issue under discussion - " India's TB

strategy fails "

Re: /message/8676

Mr. Arun Menon has rightly sighted many areas where one needs to work to

overcome the hurdles the RNTCP is facing.

What I have onserved is

1) The patients have to travel long distance to reach to the DOTS centres. It is

physically and economically taxing to the patient. Mostly one more relative also

travels(and rightly so) with the patient adding to travel expense and loss of

that days' work/ wages.

2) The DOTS team should formulate a special guidelines to explain and counsel

the pt and the relaltive about the nature of the disease, importance of

adherence, expected adverse effects, role of good nutrition, quitting smoking /

tobacco consumption , to cover the mouth and nose while coughing and sneezing,

no spitting in the open. Just making them gulp down the pills is definitely not


3) Those patients who weigh between 25 to 35,( many fall in this category) the

regular fixed dose combination is not possible. So, either such patients are

turned away or are given the same ATT containing Rifampicin 450, INH 300,PZA

1500, and ETB-800.Such group of pateints need special attension and care on the

part of the heath care provider.

4) All the " MBBS, and MD, MS of all streams-the qualified squacks " ( please

excuse me for the terminology) and quite understandably the genuine quacks add

to the failure of the RNTCP even if they know that they are over

ensthisiastically starting AKT when they should have taken a second opinion,

that the patient is too poor to complete the ATT if he is going to buy ATT from

a chemist.

Sending the patient to DOTS centres even if it is in the vicinity is a total

no-no for the private practitioners. Adding of single drug to a failing regimen

happens to be a regular practice in ATT ( same is with ARV) of private

practioners. As I was arguing on this topic with one of my surgeon friend who

had added Ofloxacin to his original regimen, I got the shock of my life when he

said " any way he is a gone case " So we have such gone cases as patients (as

well as doctors)

5) We at our hospice get patients from various NGOs many working with

destitutes(beggers and sex workers). All such patients cotribute to abig

defaulters list as there is nobody responsible to look into the completion of

treatment after the patient is discharged. Of late, I have been strict with such

NGOs who feel they can just admit a patient and be free of the responsibility.

This is more so when the paient is put on Cat II and has to take S/M injections.

I am sure this is a very dangerous trend and must be faced by some other centres


Now with so many odds, we can still works upon the faulty areas and try to save

our RNTCP which had been crafted so meticulously and had been quite effective.


Dr. Divya Mithel

JCC, Kalamboli

e-mail: <d_mithel@...>

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