The Constitution of India considers ‘right to life’ as one of the fundamental rights of every citizen and the government is obliged to ensure right to health for all citizens. The government comes up with different public health initiatives to control and minimize communicable and non-communicable diseases. Tuberculosis is a communicable disease and remains a severe threat to the world. There is high chance of transmission of infections to others if it remains untreated.
As the national call ‘TB Harega, Desh Jiteega’ clearly emphasizes on TB elimination by 2025 in India, it tries to trace out and treat every case of the disease in the country with its national programme named National Tuberculosis Elimination Programme.
The government of India, all state governments and voluntary organizations have been trying to defeat TB on all fronts together. The treatment of TB starts with tracing the cases and notifying all active cases. The TB Report 2020 says that India has notified 24.04 lakh TB cases in 2019 as against an estimated 26.9 lakh cases by WHO that hints at missing cases of around 3 lakh.
Laxmi (name changed) was rescued from Bhanjanagar, Odisha, in 2011 by the rescue team of a Khurda-based voluntary organisation working for rehabilitation of mentally sick women and men. After Laxmi was rescued, her medical tests reflected both tuberculosis and HIV. Her treatment started in consultation with government hospital.
“We successfully completed her TB treatment, her symptoms disappeared and she was declared TB-free. However, her treatment for HIV and mental illness continue, she seems very violent, not keeping mentally stable,” remarked Tanaya, in-charge of the rehabilitation centre.
Similarly, Rinki (name changed), another girl from tribal community, was rescued by the police in Bhubaneswar. She was diagnosed with MDR TB in 2017, with her condition being very critical. She suffered from tremendous coughing along with blood vomiting, and she was admitted to SCB Medical College and Hospital, Cuttack. After completion of treatment from the government fold, she also got cured of TB completely.
“Once we get any new member with TB symptom, we are concerned about TB screening first because it’s a communicable disease and we have to ensure protection of all other inmates too,” says Jyostna, staff nurse at the rehab home.
While narrating her experience as centre in-charge, Tanaya appreciates the support being provided by the government hospitals in treating TB patients. She also appreciates the timely supply of medicines to identified TB patients which makes it easier to treat them without interruption.
As per experts, vulnerability of women is much bigger than men because women undergo prolonged stress due to domestic violence for demand of dowry, extramarital affairs of husband and not giving birth to male child. These may result in mental illness and they are abandoned by family members.
“We have experienced that for males, family members reach us and get their fellows back to home while for women, hardly any reunion happens with the family,” describes a caretaker at the rehabilitation home.
These homeless people with mental illness are prone to different types of torture, exploitation, human rights violation and diseases including tuberculosis. There are TB patients among these unfortunate and homeless population. They are ignorant about TB, thus putting their lives at risk and unknowingly transmitting the infection to others as well. Thus, there is urgent need of giving special attention towards tracing and providing treatment facilities to these people in order to achieve complete TB elimination by 2025.
TB Survivor, Ayurvedic physician and TB activist Dr Reeta Sahoo said that there is lack of attention to such patients under TB prevention and elimination programme. She also talked about discontinuance of TB treatment in case of reunion of the patients from rehabilitation centres. Since stigma is a stumbling block in successful completion of TB treatment, the entire system must be extra attentive towards follow-up of treatment after they are reunited with their families, pointed out by Dr Sahoo.
N.A. Shah Ansari, Human Right Defender and President of Community Radio Association, India remarked: “After the intervention of State Human Rights Commission, Odisha, in response to my petition, 23 homeless people, including mentally unstable or sick people have been rescued by the district administration of Puri district.”
The Puri District Social Security Officer mentions that testing for COVID-19 is done after rescuing such mentally unstable patients, but TB is not tested unless there are specific symptoms. No specific dada is available about people wandering on roads with mental illness. So our priority should be to save them first after rescuing them.
Treatment of mental illness is the first priority, says an official of Directorate of Health services, Odisha government. Currently there is no specific guideline for screening the TB cases among wandering population with mental illness.
However, State TB Officer Odisha, Dr P.K. Hota informed that they are coordinating with line departments to reach this population as well.
While narrating the total policy and programmes of TB elimination in the state and country, it is understood that despite tremendous efforts by the government, right from tracing to treatment and completion of treatment, there is urgent need of focusing on left-out population which includes wandering or homeless people. Under the efforts of active case finding, initiatives need to be taken to trace out this population too.
Missing out this population will lead to misery of these TB patients followed by the risk of transmission of cases to others because of mobility of these people. In the fight against tuberculosis, let the most marginalized and voiceless population like citizens on roads with mental illness not be left out at all.
