Psychiatrist Dr Austin Fernandes’ family was apprehensive when he told them he was going to work at the Group of TB Hospitals in Sewri - Mumbai’s main TB treatment facility. The family’s apprehension was not unfounded as several employees of the hospital, including a doctor, have died of drug–resistant TB in the recent past.
Dr Fernandes joined the hospital in November 2014 following which, four more psychiatrists joined the hospital which, despite reporting suicide attempts by patients, never had a counsellor to treat drug-induced psychosis among patients.
The availability of psychiatrists has helped patients at the hospital, said its medical superintendent, Dr R Nanavare. Their work has improved the mental health of patients at the hospital. “The last time we had a patient committing suicide was in October 2015. There have been attempts by patients to harm themselves but we have been able to prevent it,” said Dr Fernandes. At least 80% of TB patients are at the risk of developing psychosis which impairs emotion and thoughts in patients. At the Sewri hospital, the psychiatrists receive anywhere between 30 to 40 references about patients who need counselling.
Apart from drug-induced psychosis, many patients at the hospital who have been abandoned by their families need counselling. In October 2015, a patient committed suicide by strangling himself with oxygen pipe in the ward. “There is no one to blame. Family members start abandoning patients,” said Dr Kedar Tilwe, a psychiatrist, recalling a case of a 47-year-old man who developed hearing loss because of medicines. “He had started getting delusional thoughts. We had to counsel him as well his family. As a result of the medicines, several patients have an agitated behavior.”
Dr Nanavare said that in absence of psychiatrists, doctors would just stop the medicines to control psychosis, but this increased drug-resistance in patients. “We have seen improvement in adherence (to medicine) after the psychiatrists have joined,” said Dr Nanavare.
Now, the team prescribes medicine to control such suicidal thoughts and the anti-TB drugs are continued which has helped reduce the defaulter rate. “Some patients are so weak that we have to give them bed-side counselling. Prior to starting them on medicine for drug-resistant TB, we take their detailed interview to pick any psychological issues,” said Dr Prathmesh Kulkarni, psychiatrist at the hospital.
Doctors said that owing to stigma and the duration of treatment, TB patient easily slip into depression.