Why Tuberculosis Persists In Society

Tuberculosis (TB), caused by Mycobacterium Tuberculosis, is one of the deadliest infections of all time. It remains a world-wide public health problem despite the fact that the causative organism was discovered more than 100 years ago and highly effective drugs and vaccines are easily available making TB a preventable and curable disease. At a time when we are gearing up to end TB by 2030, an estimated 87 persons suffer from the disease, and some 16 die due to it every day in Nepal. Nepal accounts for a considerable burden of TB despite long-time efforts to contain its prevalence. 

TB can be fully treated with six to eight-month-long uninterrupted medication through Directly Observed Treatment Short course (DOTS) scheme. There are two types of TB: pulmonary, which affects lungs; and extra-pulmonary, which affects outside lung. Being a highly communicable and airborne disease, the former is hundred times more fatal than the latter. Although it can be  prevented  by inoculation of BCG vaccine in childhood and full course treatment of freely supplied chemotherapy by the government, it is raising its ugly head in Nepal more vigorously than before. 

Routine immunization

This is the consequence of gross mistake at the time of routine immunization by government-run health facilities. If vaccine is not properly inoculated within one year of child birth at recommended dose and temperature, it does not works later on. To prevent this, front line vaccinator in rural healthcare centre and guardians of village wards must be vigilant. Rise of body temperature in the evening, loss of appetite, loss of body weight, blood in sputum, non-stop cough for three weeks or more are cardinal signs of Pulmonary TB. 

Many people in Nepal are believed to be infected with latent or sub-clinical TB, and scientifically it has been predicted that ten per cent of them will manifest the disease as old age and other illness compromise their immune system.  Extra-pulmonary TB frequently attacks any part of our organ except lung. As such, the public health activities of any country must be innovative and result oriented. The greatest challenge in Nepali public health sector is making TB-related services available nationwide round the clock. It is imperative to change the archaic practice of handling TB programme as well as the policy of disease control method as per the need of time. 

Moreover, communicable diseases like Malaria, Kalazar, Typhoid, Dengue and others must be nipped at bud. If it is not managed at initial period, it later becomes matter of serious public health concern. Among the major three diseases of public health concerns - TB, Malaria and HIV-AIDS - TB is the only disease for which we have really effective vaccine for prevention and hundred per cent curable drugs for radical treatment. TB treatment and management has been incorporated in routine health care service of Nepal government service. 

There are three reasons why TB persist in Nepali society: political leaders do not understand the socio-economic and clinical factors behind it, Nepali doctors and bureaucrats lack an effective paradigm to attack it, and since it is a disease of the poor, the rich no longer die from it. Despite the government supplying medicine for free, number of cases are still rising. TB afflicts the most vulnerable section of any society: those lacking adequate balanced diet, illiterate and without access to basic health care. Eight out of those struck are in economically productive age group of 15-49 years. 

It kills more adults than any other infectious disease. Hence, it has become an ideal meme for writers and other social activists to create awareness. Let us hope in days to come National Tuberculosis Centre, a reliable wing of Department of Health Service, will surely realise the subject matter and do the needful. A few years back, while in government service, this scribe also worked at some healthcare centres as a team leader of the then government-run health care facilities of Nepal. Rural health care facilities like primary health care centres, health posts are manned to provide basic health care services including diagnosing TB case, its treatment and prevention.

Treatment

As a manager of rural based health centre, I had to train people in small villages of my catchment area to identify the disease early and to administer treatment as per the model of DOTS, as well as to build policy systems that focus on the underlying values of self-determination and compassion, which strengthen any society. Innovation often comes from introducing insights and tools from different domains. Untreated and complicated pulmonary TB behaves more like HIV-AIDS/cancer than like other infectious diseases. The lung lesion in pulmonary tuberculosis from TB bacteria is believed to be equal to solid tumours in size, a predisposing factor for lung cancer. 

Scientifically, it has been proven that TB lesion has many of the pathological features of lung cancer. As such, priority must be accorded high in reducing vulnerability to TB in our society. The present national health information, education and communication policy must be fully revamped in a way similar to advanced countries which are doing well in this field. Medical practice in Nepal has been slow to catch up with what is currently in practice across globe. As such, our government mechanism must be revamped in such way that our health policy will also cater best options for TB patients. Government and bureaucracy involved in this sector must be receptive to TB patient's concern. So long as government fails to work in tandem with burgeoning trend of TB cases, the pathetic plight of the poor patients continues to proliferate.

(The writer is a retired public health officer of Nepal government)