Stephen Lewis (left) with chest physician Dr. Zarir Udwadia.
Stephen Lewis of AIDS-Free World surveyed healthcare facilities in New Delhi, Mumbai
Mumbai: India has miles to go before it successfully tackles
tuberculosis, Stephen Lewis, co-founder and co-director of international
advocacy organisation AIDS-Free World, has said. Mr. Lewis, who was on a
fact-finding tour of New Delhi and Mumbai earlier this month, has come
out with ‘TB in India: Rhetoric vs. Reality’, a report that says it’s
too early to shower accolades on the Indian government, and nothing in
the last several years lends confidence.
Mr. Lewis claims in his
report that many in India and other countries feel India has
dramatically turned the corner on TB, with the government calling for
its elimination by 2025, charting out a National Strategic Plan, rolling
out the diagnostic tool GeneXpert, going in for a broader rollout of
two new drugs, bedaquiline and delamanid, and the Prime Minister too
adding his voice to the crescendo of endorsement.
“I want, with
all my heart, to believe that this picture of achievement is real. But I
am seized by incredulity. There are too many factors that give me
pause,” Mr. Lewis said. He spent four days in New Delhi and three in
Mumbai with colleague Georgia White, visiting public and private sector
facilities, senior bureaucrats, the World Health Organisation, USAID,
the Clinton Health Access Initiative, Gates and the Médecins Sans
Frontières in both cities.
Mr. Lewis, who has been Canada’s
Ambassador to the United Nations, says the goal of eliminating TB by
2025 is aspirational mythology. “During our trip, we barely heard
reference to latent TB, although a third of the population has it, and
it could, with hallucinatory implications, lead to active TB. The social
determinants of health lie in tatters: homelessness, overcrowding, poor
nutrition, food insecurity and excruciating poverty, taken together,
constitute a death knell for public health.”
Referring
to a visit to a paediatric hospital in New Delhi, he said, “Toddlers
were lying three and four to a bed. Dr. Singh, the lead doctor, was
explaining to us that there was no way to isolate children with TB, nor
was there focused paediatric care for children in specialised Multi Drug
Resistant-TB settings. They were breaking pills for adults into small
fragments, hoping for successful treatment of childhood TB.”
Mr.
Lewis also talks about the 18-year-old girl from Patna, who had to go
to court to get access to the highly-controlled anti-TB drug
bedaquiline, and how she has not shown any signs of the disease after
bedaquiline. “It is, however, incomparably sad to report that her lungs
are so compromised that survival will be a constant struggle. It should
never have come to that for the girl: she stands as a medical billboard
for the failures of the Indian health system in addressing
tuberculosis.”
Dr. Zarir Udwadia, a Mumbai-based chest physician,
said Mr. Lewis eloquently exposes the hypocrisy and doublespeak still
surrounding TB in some government circles. “As he points out, unless we
build bridges between public and private sectors, the problem will
worsen.”
Dr. Sunil Kharpade, who heads the Central TB Division
under the Union Ministry of Health and Family Welfare in New Delhi, said
he isn’t aware of Mr. Lewis, his visit or his statement. “Many such
people keep visiting. They are mainly activists. India’s TB programme is
doing very well and has received global recognition.”
Stephen Lewis (left) with chest physician Dr. Zarir Udwadia.
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