Last day of Week 2

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We visited the Larsen & Toubro Limited Health Center in Andheri East, Mumbai. This is a health center of the L&T Public Charitable Trust, a private corporation.  The health center focuses on creating awareness through camps and outreach programs on reproductive health, tuberculosis, HIV / AIDS, health and hygiene, and immunization. The center also collaborates with the local administration and participates in the initiatives under the National Rural Health Mission, in India.

Outpatient care at the health center is open to the public on all days except Sundays and public holidays between 8.30 a.m. and 5 p.m. Consultants in gynecology, pediatrics and eye care are on the panel of specialists.

This center works in conjunction with the Mumbai Districts AIDS Control Society (MDACS). It was established it on 27th July 1998 for the prevention and control of HIV/AIDS.

                       

MDACS mission can be summed up as 4 strategies:

Prevent the spread of AIDS

Reduce the vulnerability of individuals and communities to HIV/AIDS

Alleviate the socio-economic and the human impact of the epidemic

Provide care and support to those infected and affected by the disease

The L&T center has a total of 1150 HIV patients that are registered. 850 of them are receiving A.R.T. (Antiretroviral Therapy) treatment. Medical services and testing are highly subsidized. Patients only pay ¼ of the actual cost. For example, an ultrasound only costs Rs./ 400.00 that is equivalent to $9 dollars. A medical consultation costs Rs./ 50.00 that is equivalent to $1 dollar. This center also has outreach programs in the remote areas of the state of Maharashtra that have aided in controlling HIV infection, leprosy, polio vaccination and contribute to family planning.

Our second visit of the day was to the Brihanmumbai Mahanagarpalika T.B. Detection and Treatment Center, in Andheri East, Mumbai. This center is under municipal and private partnership to provide adequate treatment and eradication of tuberculosis in Mumbai.

Tuberculosis (TB) is the single largest infectious disease in the world. India sees an estimated two million new cases a year and 1,000 deaths a day due to the disease. Within India, Mumbai has the most cases. 15% of all the deaths (nearly 9,000 people) in the city were caused by TB in 2010. This situation persists despite the fact that India has the highest number of anti-TB projects in the world. The majority of the cases treated here are TB, however there is also COPD, upper respiratory infections, malaria, and diabetes.

Since 1997, India’s Revised National TB Control Program (RNTCP), under the central government’s Ministry of Health, has been very successful in rolling out the DOTS program, and the country has achieved the international targets of 70% case detection and 85% cure rates. In spite of this success, there has been a recent increase in detected cases. TB spreads through the air: when a person with TB coughs sneezes or spits, he sprays droplets containing TB bacteria, and people nearby breathing are in risk becoming infected. Because of the cramped and often times unventilated living conditions in poor urban settlements, such as slums, the urban poor are at greater risk of infection than their richer counterparts, especially given their lower nutrition levels.

We meet Dr. Dholakia. He shared with us the latest increase effort to tackle TB in Mumbai is financed by a huge rise in the healthcare budget. This will go hand-in-hand with a decentralized strategy of controlling TB. Mumbai was previously one single RNTCP district from a TB administration and control perspective. However, each of Mumbai’s 24 wards has become a RNTCP district, resulting in 24 new RNTCP districts, each with its own TB officer (a licensed medical practitioner) and one senior coordinating officer for the whole of Mumbai. Each of these new RNTCP districts have received improved infrastructure, including additional TB drug stores and lab centers.

Anyone who is suspected to have a chronic cough for more than 2 weeks is required to have a sputum test. If the results are positive, then the physician will ask about any previous history of TB treatment. If there is none, then the patient is treated as a new TB case. This is considered category I (one), and treatment is given in two phases for a total length of 8 to 9 months. One of my questions to Dr. Dholakia was about the difference between the drug dosage and frequency of the TB treatment in India and the rest of the world.  In India the standardized treatment regimens are one of the pillars of the DOTS (Directly Observed Treatment Short Course) strategy established by the World Health Organization.

Isoniazid, Rifampicin, Pyrazinamide, Ethambutol, and Streptomycin are the primary antitubercular drugs used. Most DOTS regimens have thrice-weekly schedules (3 times per week) and typically last for up to 8 months, with an initial intensive phase and a continuation phase. However, in the rest of the world including the United States, the treatment for tuberculosis is based in daily doses of these drugs to have the most effective results and eradicate any possible spread of TB infection. After making this comparison in the way that India treats tuberculosis, he explained to us the reasons, although he thinks the TB program in India is not the adequate to fight this terrible disease. He said that the drug dosage is based on the replication cycle of Mycobacterium tuberculosis, and the half-life of the antibiotics in the blood. These two factors keep the drug levels in the blood high enough to kill bacteria, but due to a new high rise in drug resistance TB known as MDR-TB, the 3 times per week treatment is not effective any longer. This has become a huge economic burden to many families that have to choose whether to spend their earnings on medicine or food. The Indian government only provides free medical care and drugs to treat the sensitive type of TB (normal), which costs $50.00 per patient in comparison to MDR-TB that costs about $1800.00 per patient. Some of the challenges that the Indian health system faces are to increase the number of healthcare workers with the appropriate training to establish a new TB treatment. “It requires time, money and resources to train new medical personnel due to the number of people that are infected with TB” Dr. Dholakia said.

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