Was on and off for the sympossium conducted by the Bill and Melinda Gates foundation and FIND on tuberculosis in ICGEB in Delhi.It was on diagnostics and with the current onslaught of GenXpertMDR/RIF being endorsed by WHO the mood in the TB world is upbeat no doubt.However,in one of the presentations on ethics some points were highlighted which were rather disturbing.I,being a clinician working in a relatively rural set-up where MDR is rampant would naturally have a single question in my mind and that would be-how is it going to effect my patients with MDR?I came back totally discouraged by a few points put forward by a speaker who was discussing the ethical aspects of the tests in hand.
He was putting forward the options that lay before the government of India.I thought the cost of the infrastructure would be a case in point but what was on discussion was the dramatic increase in case load,without a back-up of proportionate treatment facility which could have moral and legal implications for the government.
The options put forward were to use the GenXpert only for diagnosis of TB and not for detecting drug resistant cases in the national programme.Sounds morbid to say the least!
To me the options sounded like deprivation of right to life either ways..
Someone suggested in one of the presentations that in India tuberculosis is so rampant that one could very well put Isoniazid in the drinking water for community prophylaxis....
There were experts come in from all the world over,there was but one presentation to be made by the RNTCP to put forward the visions of the programme and the big man had deputed someone else to speak on his behalf..he was apparently busy with a meeting conducted for another programme where he seemed to hold responsibility.Questions came as one would expect it to come for a programme that has an implication for the mass in our country.....there was defensiveness for response and the questions had not even started!
Does the government even perceive tuberculosis as a major threat to public health in the country at all.There is so much of hue and cry made out of calamities that happen off and on where a few lives may be lost whereas this killer disease which is killing and compromising the quality of lives of millions of Indians continues to be a side issue.
As one of the speakers rightly put it..methods to interrupt transmission may be the key to the backbone of control of tuberculosis in India.
We might after all have to put isoniazid into our drinking waters!!