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Why ailing doctors prefer private hospitals over national TB programme

Going by data provided by the BMC, 24-year-old Dr Samidha Khandare was the sixteenth victim of multi-drug resistant tuberculosis (MDR TB) this year in the city. The Sion hospital intern, who contracted the disease in the hospital, succumbed on Sunday night, after a six-month-long battle.

Dr Samidha Khandare
Dr Samidha Khandare

Khandare’s death has raised concerns about the welfare of resident doctors and interns at the civic-run hospital, 13 more of whom have contracted the disease in the past year.

Khandare’s grieving brother, Dr Dr Shekhar, said, “We can only hope that following this incident, the civic body will start taking the required steps to make sure that other doctors don’t face such a fate.”

Losing battle
Doctors at the hospital have been complaining about over-crowding, poor ventilation and lack of hygiene in the hostel rooms for the last few years, but to no avail. Four to five doctors are forced to stay in a 10x10 ft room in the old RMO quarters of the building. Sion MARD representatives were assured that a 22-storey tower like the one in KEM hospital would be sanctioned in this year’s budget, but the plans never materialised.

Asked why the proposal wasn’t sanctioned in this year’s budget, Additional Municipal Commissioner Manisha Mhaiskar attributed the delay to ongoing projects in the hospital. “The funds for the 22-storey building will be sanctioned in next year’s budget. In the meantime, we are constructing two extra floors in the new RMO quarters and 70 residents were provided rooms on the fifth floor of the new OPD building.”

Going private
Responding to MiD DAY’s report on how squalid living and working conditions in Sion hospital hostel quarters have caused 13 resident medical officers (RMOs) to contract TB in the past year, sources at the hospital revealed that only six of them had registered themselves under the Revised National Tuberculosis Control Programme (RNTCP). But not one of them is currently undergoing treatment under the programme, having opting to get treatment at private hospitals.

“As research has suggested that anti-TB drugs should be taken every day instead of on alternate days as is the practice followed in the RNTCP, all of the RMOs are undergoing treatment in Hinduja hospital for best results,” said a doctor from Sion hospital’s MARD, on the condition of anonymity.

Though the BMC admitted that MDR TB has become a major concern for them over the past two years, little has been done to curb the menace, and safeguard health workers in civic hospitals, who are susceptible to the disease.

In 2010, 53 cases of MDR TB were reported, and the number rose sharply to 181 in 2011. Mhaiskar said that the rise in figures was only because of better detection rates in the city. “After a GeneXpert (a device used to detect MDR TB) was installed in Govandi’s Shatabdi Hospital, there has been a higher detection rate of MDR TB cases, due to better techniques to detect this disease at an early stage,” said Mhaiskar.

The figures are alarming. In 2012, the city recorded 2,195 cases of this MDR TB. In first five months this year, there have already been 1,300 cases of the same.

Asked why RMOs afflicted with TB give the RNTCP a wide berth and prefer treatment in private hospitals, BMC’s TB officer Dr Mini Khetrapal said, “It is due to the stigma attached to this disease. These doctors want to keep this matter under wraps and avoid treatment under directly observed therapy (DOT) in fear of others finding out that they contracted TB. “We’ve tried to counsel these RMOs to undergo treatment under the RNTCP but they think undergoing treatment in a private hospital is more discrete.”

Asked when the Hinduja hospital lab will get accreditation to perform second line tests by the Centre, Dr Khetrapal said that the state’s TB officer Dr HH Chavan is in the process of clearing the accreditation.

16
Number of MDR TB deaths reported this year

48
Deaths were reported in 2012

Why resident docs choose private hospitals
Requesting anonymity, two doctors from Sion Hospital who are undergoing treatment for TB at private hospitals spoke to MiD DAY, explaining why they opted out of treatment under the RNTCP

After conducting a sensitivity test in Hinduja hospital, I was told I am resistant to first line anti TB drugs. Soon after that, I approached the RNTCP officials in the hospital as it is free of cost. However, I was told to first try out the first line of anti-TB drugs. What is the point of taking these medicines when tests results clearly indicated I am resistant to them? Since then I have been on second-line anti TB drugs at a private hospital, where I am given medicines on a daily basis instead of on every alternate day. I was forced to take a two-month-leave but I don’t plan on giving up my residency, as my career is more important. My experience with the RNTCP was unpleasant as they did not provide me with any counseling or even listen to me when I showed the test results, which said that I was suffering from MDR TB.
-- 26-year-old male RMO from the medicine department of Sion hospital, who was diagnosed with MDR TB three months ago

It is a well-known fact that they provide patients with anti TB drugs that are available at the time, instead of considering whether the patient has developed resistance to them. During our first year of residency, six to seven of us used to live in a room meant for not more than three people. On top of that, ventilation in our hostel rooms is poor and hygiene is always compromised in such conditions.
-- 25-year-old female RMO who contracted MDR TB last year in September. She opted for treatment at a private hospital instead of registering under the RNTCP

Victim’s family sold farm to raise Rs 16 Lakh for her treatment
Khandare’s last rites were performed in her hometown, Akola, last afternoon after her family. She had contracted MDR TB barely a month before completing her internship in the hospital. “She was a hardworking, cheerful girl. Even after she contracted the disease, she was excited to get her MBBS degree in the ICU of the hospital,” said Dr Dipti Solanki, her colleague.

Dr Khandare’s parents, who are primary school teachers in Akola, had arrived in the city in January when her condition started deteriorating. “She started displaying symptoms of TB around December but they were not very severe, so she did not panic. However, from the first week of January, her condition declined, and she had to be admitted to the ICU of Sion hospital,” recalled Dr Dipti.

Since then, the Khandare family fought an uphill battle trying to provide their daughter with the best treatment possible. Her parents also sold their share of property in Akola to raise funds for their daughter, who had to be shifted to Hinduja hospital in Mahim for further treatment.

“In the beginning, they were able to afford treatment as she was in the general ward at Hinduja, but after that she had to be put on ventilator support in the ICU. They were forced to sell their farmland back home to raise Rs 16 lakh,” added Dr Dipti.

While Khandare’s brother Dr Shekhar chose to spend all his days at the Mahim hospital to monitor his sister’s health, her parents stayed in the Sion hospital quarters to make ends meet in the city. Seeing their plight, Dr Samidha’s colleagues raised around Rs 5 lakh by urging other students, professors and resident doctors to donate for her treatment.

Khandare’s condition started rapidly deteriorating on Sunday, with her kidneys and brain getting affected.  

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