TB or not to be!!

TB or not to be: MDR TB going to be the new face of TB epidemic in India?

“You can't connect the dots looking forward you can only connect them looking backwards”- Steve Jobs

I would sound a bit like Steve Jobs here as I recount my delving into TB research way back in 1998 for doctoral work when India was transitioning to Revised National Tuberculosis Programme with DOTS. Little did I know then how I was paving my way into public health research and one day with this research experience combined with my training in Medical Anthropology will make so much sense in the domain of TB control in India, especially when we are talking about a muti-cultural country with medical pluralism and a disease like TB which has a long treatment period which leads to patients consult multiple practitioners leading to treatment default or mixing different lines of treatment leading to delayed or poor diagnosis, and treatment failure. This is a perfect area to marry Medical Anthropology and Public Health with doctor shopping among patients, unregulated use (abuse) of antibiotics, and making a case for lack of uniform regime across medical fraternity.

Indeed, it did make sense that afternoon when I was introduced to this professor from that University all the way from the States who was visiting my institute to establish collaboration in TB research in India. I know what I said to her that afternoon and I was also quite conscious of my passionate anecdotes and I constantly balanced the researcher and the advocate in me. We discussed the issues of MDR, issues of rampant use of antibiotics and consequences of non-regularised over the counter sale of antibiotics and the whole pros and cons in India and South Africa. Later, reading her blog, which she wrote two days before our meeting in Gurgaon, I am more at ease with my passionate ramblings as she had echoed the similar concerns.

With this new demon of MDR looming large, she plans to work on datasets (large ones, of course) and I plan to look at treatment pathways (retrospective) and combine our work to throw some light on this problem and create policy recommendation for MDR-TB in Indian setting. Joining dots would help us see some pattern in this juggernaut of a problem like MDR, hopefully!