LANGUAGE – FOR LOVE OR HATRED?

TB or not TB, that’s the question!

March 24^th, observed as World Tuberculosis (TB) Day, commemorates the day in 1882 when Dr. Robert Koch announced the discovery of the miscreant responsible for colossal damage across centuries – a microscopic organism called Mycobacterium tuberculosis. This year, the day unleashed a volley of memories, which I thought were pen-worthy.

As an undergraduate, the first time we were exposed to a live TB patient, was in our clinical chest medicine posting in 2^nd year MBBS. Till then, we knew TB only as the disease caused by pink cylindrical bacteria seen through the microscope. We half expected to see pink tall warriors ready to jump into our lungs and infect us. Parents warned us of the perils of getting infected with TB, and used the opportunity to instill in us the importance of a heavy breakfast. We wore one or two face-masks for protection. With a heavy breakfast, the double mask and white coat, we thought our armor was complete. As soon as the classes finished, we ran as fast as we could back to our hostel. Who wanted to contract the deadly disease! A few months later when I had a severe respiratory infection, the doctor advised a Mantoux test for me. Reluctantly I got it done, and the academic knowledge of the disease gave me cold sweats and sleepless nights. Thankfully, I tested negative.

In the final year of MBBS, a sudden inadequacy of medical knowledge created panic in us, the students. We never wasted an opportunity to examine a patient with “findings”. We spend hours in the wards to learn from patients, as even one missed point in history or examination made us pay a heavy price in front of the professors (cutting a sorry figure of oneself, in the professors` language). Once, during one such clinical quest, we came across a middle-aged woman, Santhoshini, who supposedly had “good lung findings.” (A patient with good findings usually does not have a good prognosis!) We examined her to our heart`s content. Oh, the joy of a drooped shoulder and a dull percussion note! We covered her with stethoscopes on all sides, heard those magical sounds, filled our hearts and books, thanked her profusely, and started to leave with our heads held high. As we were leaving, the resident-in-charge of the ward, who was deeply engrossed in his work for the past 2 hours, looked up at us and said, “If you guys are planning to go near Santhoshini, please wear a mask and go, as she is an open case of TB. She keeps removing her mask. God knows how many people she would have infected by now!”

Our once proud heads stooped low. The sparkle in our eyes dimmed with fear. Our brains froze. In our hype for clinical knowledge, we neither wore masks, nor did we ask the patient to wear. She was breathing and coughing all over us. We scampered back to our rooms in disappointment, embarrassment and with a feeling of imminent doom. For a few months, we tried to keep ourselves healthy, for fear that a weakened immune system may blow up the disease.

During pediatric residency time, our emphasis was not just on the findings, we were expected to diagnose and treat patients too. We were taught to suspect TB for any patient with prolonged or unexplainable symptoms. TB had ameboid manifestations affecting any bodily system and mimicking any disease. The titanic spectrum intrigued us. There was a sick-looking mother who brought a five-month-old baby with unrelenting cough. Baby had enlarged abdominal organs and a bad lung. Both baby and mother were diagnosed to have TB and started on treatment. A preadolescent boy brought up by his father and stepmother whose mother passed away ten years back due to an unknown illness. He was diagnosed to have TB with HIV infection. Then there was the adolescent girl who came with emaciation and a very bad lung. Then an adolescent boy with diabetes mellitus and lung fistula. A girl with paralysis. Another girl in coma who took treatment too late. Yet another case where the patient was brought in the end stage with hydrocephalus (excess fluid in the brain). The stories never end. The magic of timely treatment was fascinating and fulfilling, but the fate of the unfortunate who did not get adequate treatment or chose to be left out was tragic and heart-breaking.

The story would not be complete if I don’t mention that some of my colleagues contracted this nasty affliction from the patients whom they treated, in the form of excessive weight loss, coughing out blood, intractable cough and so on. It opened our eyes to the fact that no one is exempt from the powerful clutches of the scourge. A healthy person may have a subclinical infection with a focus remaining in the lung, which may flare up when the person becomes immunocompromised. Health-care professionals need utmost protection and care for the prevention and treatment of the disease. We care for the sick, but many a time, we forget to take care of ourselves. Fortunately, all my colleagues came out of the fire unscathed.

TB is a disease still rampant in our country and has its roots deep and wide. The reprehensible presence of tuberculosis in humans dates back to 2400-3400 BC; studies say that evidence of TB was found in the spines of mummies. Hippocrates called the disease as “phthisis”, a Greek term meaning consumption, indicating the wasting associated with the disease. Indeed, the disease consumed the human species at alarming ways and speeds. The battle against TB gained momentum in 1882, when Dr. Robert Koch demonstrated the cause of the disease to be an organism called Mycobacterium tuberculosis. Discovery of the first anti-tuberculous drug, Streptomycin, was a breakthrough in the history of the disease. Since then many other drugs and treatment protocols have been discovered to gain mastery over the disease; but TB has been retaliating by persistence. It still continues to be one of the top ten causes of deaths worldwide. However, the world health care system has been making progress by leaps and bounds. The WHO "End TB Strategy", launched in 2014, is the battle cry to end the epidemic by 2030.

The theme of World TB day, 2019 was “It’s Time.” It’s time to stop ignoring symptoms like cough persisting beyond two weeks, excessive loss of appetite or loss of weight. It’s time to stop neglecting any symptom that seems to be treatment resistant. Its time that we realize that there are simple cost-effective investigations to detect TB infection, and the technology is advancing by the hour. There are carefully formulated treatment protocols that are available free of cost from the government. It’s time to stop thinking that we are powerless against the hegemony of the disease. Its time to wake up from our slumber and fight, because victory is in sight. Yes! It’s time for action, its time to end TB.