No One Is Missing TB

Not just heroines of movie sets in the 1950s fall prey to this disease; every year, TB claims the lives of more that 300,000 Indians

New Media Fellows 2013

By Anindita Sengupta

July 21, 2013

Also published at Bangalore Mirror

The recent Bollywood movie Lootera has Sonakshi Sinha coughing pitifully as the tragic heroine, beset by grief and loneliness, drifts towards her own death. It has been a long time since tuberculosis has been shown on screen and perhaps this is only because Lootera is set in the 1950s. There was a time when Hindi film heroines frequently coughed blood — both on screen and off — but nowadays, tuberculosis does not feature as prominently in popular consciousness. But it should.

TB is hardly a thing of the past, done and dusted, or put to rest. It is estimated that every year around 330,000 Indians die because of it. We also have 66,000 cases of multi-drug resistant tuberculosis every year. What’s at stake is thousands of ill people who now have no access to medicines and who may develop a fatal version of this disease because of this. Tuberculosis is an exacting disease; patients need to take their medicines exactly on time, as prescribed, and without interruption. Otherwise, the disease becomes more complicated and dangerous, stops responding to drugs and becomes more expensive to treat. Multi-Drug Resistant (MDR) tuberculosis is a growing threat. The possibility of MDR-TB shoots up when a patient does not take medication exactly as prescribed or their medication is interrupted.

Shockingly, for the past month, there have been persistent stock-outs of TB medicines. Activists explain this lack of medication to sheer negligence on the part of officials. According to a fact sheet issued by the Stop TB Partnership (WHO, Geneva) last month, the contract with the procurement agent was not renewed for almost two years so they could not buy the drugs. Whether it is corruption, inefficiency or plain forgetfulness is in anybody’s guess. The contract was finally renewed in the first quarter of this year but supplies are obviously running behind schedule. Approvals have been given for emergency procurement to the states but most of the states cannot manage in the mad scramble for TB drugs.

India already has some of the highest number of cases of MDR-TB. Many TB patients die without being properly diagnosed of drug-resistant strains. According to Doctors Without Borders, we do not have enough qualified laboratories to scale up diagnosis of MDR-TB. Diagnosis in the private and public sector is often incomplete, leading to inappropriate treatment and the spreading of resistance. What is required then is a commitment toward providing better testing facilities and more appropriate TB treatment. It is critical that we ramp up measures to prevent and curb it. Instead, we’re working in the negative with drug stock-outs and people being compelled to miss treatment.

Blessina Kumar of Stop TB Partnership (WHO, Geneva), says that they are getting reports from different parts of the country about clinics turning people away. “People are becoming drug-resistant,” she points out. “People are dying. Who is going to take responsibility for that?” Kumar believes that despite government promises that the drugs are ‘in transit’, it may take a few months before the situation is resolved. This means thousands of TB patients will become drug-resistant every month because they are interrupting their treatments.

And yet, it’s not something we’re talking about enough. TB is seldom discussed in the drawing rooms of the middle class. Partly, this is because it’s thought of as a disease of the poor. Or, it’s thought of as curable. It doesn’t have the hype of HIV. It doesn’t affect popular consciousness the way cancer does. No new first-line tuberculosis drugs have been developed for 50 years even though TB is the world’s second leading cause of death from infectious disease (after HIV). Even though the drug stock-out continues, the media hype around it has already died down.

But while we’re dedicating coloured ribbons to different causes, TB should be right up there for its reach, its infectivity, plus its proliferation in new and deadlier forms. What is required is continued emphasis on the crisis and constant cynosure in the media. On that note, aeras.org has a series of short films, called Exposed, on the global epidemic of tuberculosis. They’re available on their website at exposed.aeras.org and on youtube.com. Do take a look the next time you’re online. The real stories of illness and innovation in these movies make Hollywood spectacles like Contagion pale in comparison. They serve as a reminder that 1950s heroines are not the only ones suffering from the ‘wasting disease’.

Anindita Sengupta writes about health with a fellowship from the International Reporting Project in Washington, D.C.