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Challenges faced by TB Patients

Imagine you are locked in a room, isolated, and everybody else in the world is having

fun out there. Even worse, nobody wants you anywhere close to them because they

think youre a carrier of some gross disease. How does it feel? Bad? Worse? Pathetic?

Well, unfortunately that is how a person suffering from Tuberculosis (TB) is usuallytreated! The question is whyone could possibly think of doing anything like this. The

answer to that lies with not anybody else, but within you!

There has been an unprecedented rise in the incidence of TB. It is regarded as one of

the most infectious diseases that have continued to dominate the global burden of

communicable diseases. Globally speaking, TB accounts for deaths of about 2 million

and about 9 million infections annually. Though an ancient disease, TB is regarded as

the most common infectious agent responsible for global human disability and

mortality. Having stated the statistics & facts, the ultimate challenge associated with

addressing the problem of TB is stigma. People suffering from TB have constantly

faced (and are still facing) a discrimination by friends, neighbours, family, employeesat organisation and possibly even at public places if they get to know. The constant

fear of the spread of diseasehas led to a widespread desertion of such patients and

consequently, they have been shunned by their respective families and receive

diminutive amount of care. They are very often abused and even humiliated by their

own family members who tend to regard them as a burden to the family.

Talking of the procedural challenges the TB patients deal with, the daily

dosage of injections are really painful. Patients sometimes even develop painful

swellings at the injections site. Moreover, these injections cannot be given by the

regular community health workers, instead the patients have to pay a minimum

amount per day to a local nurse. These are patients who are living below poverty line

as defined by the World Bank. The social stigma of these patients is such that they

often lose jobs and livelihood. So there is very little food on the table. This, combined

with the expenses they incur to get access to the treatment makes matters worse.

Not to forget that the side effects of the second line drugs are multifarious.

Patients suffer from nausea, vomiting, acidity, electrolyte imbalance, thyroid

disturbance, psychological problems such as depression and suicidal tendencies, and

even liver and kidney problems. These patients have to make several visits to the

public hospital for over two years, for repeated tests and consultation by the TB

specialists. They are forced to incur huge expenses in transport. The even have to buy

the expensive antibiotics on their own. Unfortunately, the Government of India does

not provide free medication for these patients. All this, ultimately resulting in a lowerquality of life of the patient.

Other difficulties that patients often face but are not highlighted are the ones like the

appointment times with doctors that are not convenient to the patients, long waiting

periods and even lack of privacy at the health care facilities where they undergo

regular treatment. Sometimes, patients tend to have an inclination towards causing

disruption in taking drugs because of the usually lengthy period of treatment in

addition to the fear of the never-ending agonising injections. Outside the health

facility, further limits to successful treatment uptake might be linked to low voluntary

counselling and testing uptake by adult TB patients. These challenges are multifaceted

behavioural problems arising from various reasons. These challenges depend onsociological factors like race and gender, which might influence adherence. Cultural

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beliefs, especially in relation to usage of traditional medicines, can also be a challenge

in addition to the adverse effects of poverty on families and communities, which may

be characterised by constant hunger, trauma and issues of food insecurity.

At a macro level, it can be said that patients tend to experience three sets of

indistinguishably linked barriers to successfully treating TB: attending the healthcentre initially, attending the health centre repeatedlyand experiences while getting

the treatment at the health centre. These barriers are further complicated by

demography, poverty, gender and various such stimulus. The challenge before us lies

in moving beyond just documenting the barriers from patients' perspective to actually

addressing them.

Such challenges, when not addressed, the possibility of adhering to the

treatment is compromised. It is only when weconsider that these patients of TB are

the same like us in all parameters and have inalienable rights like all of us, can we be

able to address the challenges.