But the upper classes are not exempt from it. As I said, as it is a droplet infection. Anyone can be near a TB patient, without even realizing it and can inhale the germs

But people infected with TB bacilli will not necessarily become sick with the disease. The immune system fights it and it can lie dormant for years. But the threat remains. And they are susceptible to the disease. WHO says that someone in the world is newly infected with TB bacilli every second. 5-10% of people who are infected with TB bacilli (but who are not infected with HIV) become sick or infectious at some time during their life. TB is never really healed, only sealed.

At the physicians level: A doctor sees nearly two hundred patients in the Out Patient clinics of government hospitals in towns and cities. He or she is not able brief the patient on protocol. The doctor may not be able to spend enough time with the patient to outline the regimen and the significance of taking the course completely. The doctor may not emphasise the possibility of side effects of the drugs prescribed. There may just not be enough time. Not all hospitals/health centres are equipped with social workers or counselors.

At the patient level: Most often patients are from poorer classes. They are not aware of the importance of completing the course. After a month or so, they might stop as the symptoms subside. They may be day laborers and may find it difficult to miss work and report at the hospital for the next dosage of medication. (Though many of these problems are overcome by the DOTS programme, these have not been solved completely.)

At the community level: The stigma, though not as prevalent as before, still persists. Awareness about spread, prevention and care can be increased.

Of course there are some areas where there are some problems: as in the case of medication for a diabetic.

But overall TB has been more under control after DOTS

In India MDR TB is present but need not be.

Multi Drug Resistance, develops most often because treatment regimens have not been adhered to correctly. Essentially, anti biotics have not been used properly. This can be due to factors I discussed at the physician, patient and caregiver level.

In the second round of illness, the patient may have to take the suggested streptomycin injection. These are expensive and toxic. So the patient may not come in for treatment. Or he may have to travel some way and wait at clinics, causing a loss of livelihood.

So if we are able to get the patient to stick to his medication regiment the first time, we can bring the chances of MDR TB down drastically. Compliance, compliance, compliance is the way to go to reduce MDR TB.

There are cases of Primary MDR TB, where improper use of medication is not the cause. But in 95% of the cases MDR TB is preventable.

HIV patients have a difficult time, but there is a visible change within the community also. The stigma is a little less now.

It is also important that a healthcare worker should be more technically versatile. He or she should be capable of not just giving out medicines or counseling patients but also doing sputum smears…

Apparently a leading pharma company is testing a drug that is more powerful than rifampicin and has less side effects. We will have to wait for this.