Getting a lost tuberculosis patient back on track a challenge for counsellors in Mumbai
I accompanied them for a day to understand the process of tracing patients, counselling them, losses patients go through,when they fail to follow up with their treatment and many other reasons.mumbai Updated: Mar 23, 2018 00:28 IST
At noon, the district tuberculosis (TB) officer from Prabhadevi, a counsellor Vikranti Kanth and I, set out to visit TB patients, who have dropped out of treatment.
I accompanied them for a day to understand the process of tracing patients, counselling them, losses patients go through, when they fail to follow-up with their treatment and finally to coax them to resume treatment.
We made our first stop at the BDD Chawl in Worli, to meet Shankar, a bachelor, who is a police constable and a multi-drug resistant patient. Originally from Satara, he was referred to a hospital in Mumbai in February 2016 for treatment, which was supposed to last two years. But, within a year, he stopped taking the treatment. Sometimes he would resume treatment, but give it up again.
Kanth, who has been following him for the last two years told me that it was almost her 20th visit to his place in order to convince him to resume treatment.
Shankar is also a chronic alcoholic, which makes it an additional challenge to interact and rationalise with him.
“He has never misbehaved, but sometimes when drunk he tends to speak inappropriately. He once asked me if I would marry him and the other time, he accused me of stealing money,” said Kanth.
We could not find Shankar in spite of having informed him well in advance about our visit.
When I spoke to other counsellors about the difficulties, they said, they face the problem of patients evading them, very often.
Another patient, again an alcoholic living in Prabhadevi, runs away every time he sees the TB health visitors approach him. It may look comical to people, but they said, one time they had to chase a patient down the road.
“We had to ask a young man on the road, to help us sit him down. How does one educate them about the public health concerns and the disease?” asked Vanita Chare, health visitor, who has been following up with the patient.
What grabbed my attention at the BDD chawls, was the number of children playing on the same floor where Shankar lives. There are around 15 children living on the same floor, a neighbour told us.
“We don’t know, but Shankar could be infecting other people on the floor,” said Dr Thara Somashekhar, district TB officer, G-South ward, who also counselled him on several occasions.
She solicited his boss’s help in pulling Shankar back into the programme, but he continues to disobey.
While asking about Shankar’s whereabouts, we had to make sure we don’t give away the status of his infection to the neighbours. However, most of them were aware about it.
“This is a serious concern as we cannot breach a patient’s trust,” said Somashekhar.
We could not find Shankar anywhere in the vicinity, but the visit highlighted a crucial problem that public health officials in the city face – finding the lost patient.