Fifteen years ago at Nav-jivan in Palaumu when Dr Bethsheba and Mr Andy Eicher decided to introduce the DOTs under the RNTCP programme ,it was not a cake-walk.There were sceptisism all the way.The hospital had been treating tuberculosis since the outset with patients coming in from as far as the adjacent states of UP and Bihar.Dr Bethsheba fortunately had not done internal medicine like myself but had done the more balanced family medicine under excellent teachers who had strong opinion on the subject.The model at the mother institution in Oddanchattram was reproduced at Nav-jivan including an erstwhile 'Ganeshan clone' who did a great job with the counselling and follow up.
When they were to leave the institution they were wise enough to leave the charge of the clinic to a spate of junior doctors-well-trained,extremely sincere,focussed,comitted and convinced by the thrice weekly RNTCP regime.The systemn was in place and the clinic ran almost mechanically with the counsellors well-versed in most aspects of the disease except the side where the control programmes invariably fail.
Fifteen years hence, in the regional body meeting, when I tell the body MDR is not a problem in Satbarwa,they give me a puzzled look.In a TB unit catering to around six lakh population we barely get two to three cat 2 failures who get sent in for sensitivity.Even they turn out to be sensitive to the first line drugs sometimes.
Moving out from NJH to the other hospitals and seeing the onslaught of MDR and XDR tuberculosis I begin to see the extent of impact the programme has made to the public health in Palaumu.
All our friends have moved on to other pastures...Andy,Sheba,Arpit,Jeevan,Augustine......sitting in another health clinic ...seeing the mammoth job at hand...I marvel at each of their contribution and find myself trying to encourage a friend who is going through the usual blues of starting a new service with the Nav-jivan TB story and it is a story indeed!