WHITE TB V/S BLACK TB.
Medically, there is no such distinction as White TB or Black TB. So, are the guidelines of Indian module acceptable universally? No.
An American TB patient is diagnosed as per a superior protocol. State of the art ‘Sputum Culture and Sensitivity Test for AFB’ (no doubt, unaffordable, unrealistic and impossible in India) is the cornerstone. Specialists’ opinion is available at the click of a mouse. What to talk of chest X-ray, every test that WHO guidelines prohibit Indian doctors from conducting on innocent citizens can be and are often done there – if needed PCR, Eliza, Ultrasound, CT scan, MRI, Bactec, DNA finger printing. Daily dose or five doses per week is preferred at least during the initial intensive phase and supervision is executed to near perfection. Patients and health workers receive plentiful incentives.
The man, the germ & disease-patterns are precisely the same; yet in our chaotic cosmos there subsist two criteria of diagnosis and cure that are poles apart.
USA: WHO guidelines as provided in Indian program, are not considered good enough for an American TB patient who is diagnosed and managed as per “The Official Joint Statement of ‘The American Thoracic Society’, ‘Center for Disease Control and Prevention’ and ‘Infectious Diseases Society of America’ approved in Oct. 2002”* (19):
· Chest radiography is an integral constituent. Sputum culture and sensitivity test, that too fast track (costing over Rs. 4000 in an Indian private lab) is the cornerstone of management there. Besides sputum smear microscopy, every investigation that DOTS prohibits in India, is routinely done in the US e.g. chest X-ray, sputum for AFB C&S, & if necessary PCR, Eliza, Ultrasound, CT scan, MRI or DNA finger printing etc. – virtually everything given in the text books.
· Daily regime (or 5 days per week) is preferred, at least during the intensive phase. Intermittent regime is not compulsory. A patient is offered various options (and that includes daily regime) and is free to choose any one that suits him.
· Crucially, the element of supervision is executed to near perfection; a health worker religiously supervises each dose. Work culture is superb & accountability tremendous. On an official car, he delivers medicines and incentives at the time and place of patient’s choosing, merely to 5 or 6 patients in a full working day. Unlike his Indian counterpart, his duties are not cluttered with a multitude of trivial non-TB assignments nor does he cater to a battalion of patients.
Most rich nations: Modules would be probably closer to the US than Indian model.
China: Unlike India, China has retained the traditional X-ray screening for all patients. Every Chinese suffering from symptoms suggestive of TB undergoes both – sputum test as well as chest X-ray. And that includes all sputum positive (infectious PTB) patients as well. Chinese treatment regime differs during the CP when 3 drugs are given (instead of 2 as in India). Regime for new sputum positive cases is 2 H3R3Z3E3 / 4 H3R3E3.
Russia: Unconvinced, Russian scientists have not accepted the DOTS module or associated enormous funding, refusing to join the DOTS bandwagon of the WHO.
As per (rather sketchy and unconfirmed) information available with the petitioner:
· Several low-income nations have indeed adopted the purely sputum based diagnostic algorithm similar to Indian model and some West African countries do use thrice weekly regime.
· India is one of probably few countries that practice a ‘thrice-weekly regime’.
· Scores of countries continue to use daily regime even today.
· 62 countries receive grant support and 34 purchase anti-TB drugs from GDF (Global TB Drug Facility). Since some countries are common in the list i.e. receive grant support as well as purchase from GDF, the total GDF countries are 74. Notably, the list of 74 countries also includes India. It is known that for most of the countries, GDF supplies FDCs / daily regime.