Mumbai- Sick treating the sick at Sewri’s TB hospital #healthcare

Probable tuberculosis



Published: Sunday, Mar 24, 2013,
By Maitri Porecha | Place: Mumbai | Agency: DNA



After nearly twenty-five years of selfless service at Asia’s largest tuberculosis hospital situated in the heart of Mumbai, Barkhu Pandurang Kharat (53) was perhaps destined to die of tuberculosis (TB). Kharat’s death in January this year raised the number of employees to have died after contracting tuberculosis, at BMC-run Sewri TB Hospital to 42.

“In 2008, my husband started working in the mortuary at the hospital, transporting infected dead bodies from wards to morgue and back. The hospital alone sees close to 150 deaths every month. In 2008, he was first diagnosed with TB. He was hospitalised multiple times as he transgressed to multi drug resistant TB (MDR-TB) and later extensively drug resistant TB. His condition worsened by the start of this year and he succumbed on January 30,” said his widow Sunita Kharat.

Kharat is not the only one. Since 2005, more than 70 workers in Sewri TB Hospital have contracted the infection, 42 among them died. Official figures obtained from the hospital state that two employees in their twenties contracted TB within six months of joining service.

Even though the hospital is quoting conservative estimates, unofficial figures of infected employees roll much higher, say sources. BMC has made tall promises to manage TB on a war footing in its 2013-14 strategy on the World Tuberculosis Day but the civic body would do well to introspect on the appalling conditions prevailing in its own backyard. “Of 12 MDR-TB cases amongst the hospital employees, most of them are relapse cases. In case of these patients, tuberculosis has gripped them as many as three times over the past ten to twelve years. After a brief period of treatment, they resume work in the same wards which makes them all the more vulnerable to contracting TB repeatedly,” said a senior labour union member, Sewri TB Hospital.

What’s worse is that even as a large number of employees including doctors and nurses contract tuberculosis rapidly in the hospital, they are not taken care of in the hospital. A disheartening case in point is the treatment meted out by BMC officials to 38-year-old Balaji Amjuri, a permanent employee of the hospital and a TB patient for the past 12 years.

Amjuri is an extensively drug resistant (XDR-TB) patient. Such patients are advised complete rest but Amjuri is compelled to do his daily duties including sweeping, disposing garbage, washing infection-laden clothes from the ward, all because he has exhausted his three-years’ worth of sick leave. “The head clerk instructed me that I will not be entitled to any more leave.

Inspite of being an XDR-TB patient I am compelled to work. I have spent more than Rs3 lakhs for my treatment. I have to continue working to support my family,” said Amjuri. “BMC rules for availing leave are the same for all employees. However, we may sanction special leave inAmjuri’s case,” said Dr Rajendra Nanavare, medical superintendent at the hospital.

A measly diet and a defunct operation theatre to perform TB surgeries only add to the woes of the employees and patients at the hospital. In 2012, BMC had assured that the high protein breakfast to be provided to its 1,000-odd employees including doctors and nurses will be adequate and palatable. Workers complain that the diet has fallen short on both these grounds.

“The diet chart clearly mentioned that two eggs and 150ml milk is to be provided. We don’t get more than 50ml of milk and one boiled egg. This is grossly inadequate,” said an employee requesting anonymity.

Doctors have not performed a single surgery since the past two months for the lack of surgical equipments. “The anaesthesia machine is not in place for performing surgeries. The OT is temporarily shut,” added the medical officer.

Doctors say that the high rate of deaths in the hospital occur as early diagnosis of tuberculosis is not possible. “Samples for culture tests or Line Probe Assay (LPA) which confirm if the patient has MDR-TB are still outsourced to JJ or Hinduja Hospital. Basic infrastructure is not in place. It takes up to a month for results to arrive,” said a seniormedical officer at Sewri TB Hospital.




India bans Serological TB Tests , a step in right direction

Cell culture plates

Cell culture plates (Photo credit: Sanofi Pasteur)

In a welcome step, a gazette notification by the Ministry of Health & Family Welfare banning serological test (commonly referred to as blood or antibody test) for TB, under the Drugs & Cosmetic Act, has finally been made public today. This gazette notification also, in particular bans the importation of the serological test kits.

The serological test for TB is widely used in the private sector, even though they are known to be inaccurate, inconsistent and with no clinical value for TB diagnosis. The World Health Organization (WHO) in its first-ever negative policy recommendation recently called on governments to immediately ban blood tests prescribed and used to detect TB. See WHO Factsheet on TB serological tests:

The Revised National TB Control Programme (RNTCP) has never recommended these tests. In fact, guidelines such as the International Standards for TB Care and those by the Indian Academy of Pediatrics actually discourage their use. According to a paper in National Medical Journal of India, “Despite the evidence and lack of any supporting policies, 15 lakh (1.5 million) TB serological tests are estimated to be done in India and as a result patients end up spending an estimated INR 75 crores (US$ 15 million) per year.” See attached paper published in National Medical Journal of India: “Tuberculosis Control in India: Time to get dangerously ambitious?”

As per this paper, “every major private laboratory in India offers TB serological tests, mostly ELISA kits imported from countries such as France and the UK. These countries, apparently, do not approve the same tests for clinical use on their own TB patients!”

Last year RNTCP’s committee on diagnosis asked the Drug Controller General of India (DCGI)’s office to investigate and if necessary ban the serological tests conducted by the private sector.

An expert group set up by the DGCI found that blood tests are mostly inaccurate for TB detection. It had recommended to the Union health ministry to immediately ban them. (Report of the expert committee is not publicly available).

What do treatment and health activists working on TB feel about this regulation: A welcome move to check irrational practices on TB diagnosis in the private sector. But it needs strict implementation across the country to check this practice among doctors who prescribe and labs who conduct these tests. The import of serological test kits should be immediately stopped, which will improve the implementation of this government notification. At the same time, it is also equally important to increase access to accurate culture and drug sensitivity testing (DST) for drug-resistant TB (DR-TB) in the public sector. A large number of patients with extra-pulmonary and drug resistant TB are pushed into the private sector when their TB is left undiagnosed in the public sector.


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