Doctor’s tenacity nudges government to overhaul TB programme

Haryana-based Dr Raman Kakar learnt that in several cases patients had completed full course of medication on six occasions but the disease still resuscitated, forcing them to seek another dose.

Written by Utkarsh Anand | New Delhi | Published:November 22, 2016 2:42 am
tuberculosis, tuberculosis programme, TB programme, TB relapse, tuberculosis relapse, tuberculosis treatment, TB treatment, india news Dr Raman Kakar.

IN THE last six years, Haryana-based Dr Raman Kakar compiled a list of 5,300 cases where patients had a relapse of tuberculosis (TB) even after completing the full medication dose. He learnt that in several cases patients had completed full course of medication on six occasions but the disease still resuscitated, forcing them to seek another dose.

On Monday, he was vindicated when his PIL nudged the Central government to overhaul the entire TB programme and set a deadline for the new drug regimen. The new regimen will introduce daily dosage instead of intermittent dose that involves giving medicines thrice a week.

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Submitting its affidavit in response to a notice issued by a bench led by Chief Justice of India T S Thakur, the Ministry of
Health and Family Welfare mapped out the revised TB programme, wherein the 20-year-old regimen will see a radical change in the manner patients are administered the dosage.

Additional Solicitor General Maninder Singh, representing the government, apprised the bench that the transition from intermittent dosage to daily drug regimen has already been approved and that the programme will be phased out starting December 2016, when five states will introduce daily dosage. The affidavit spelled out that the entire country will be covered under the new programme by June 2018.

The government’s stance came as a surprise for Kakar, who, as a doctor at a state government hospital in Haryana, had spent the last six years trying to convince everyone that intermittent drug regimen was prone to multi-drug resistance (MDR) TB and chances of relapse were high under this programme.

After leaving his private practice, Kakar, now 63, joined a TB hospital in Faridabad, Haryana, in 2010 and took over the TB control programme. “I have done extensive research on TB and have been working tirelessly for its eradication. I have made a movie on TB, ‘A death every minute’, written books and delivered lectures to spread awareness about dangers of the disease,” Kakar told The Indian Express. “So when I was called to join the hospital on ad hoc basis, I treated it as an opportunity to serve hundreds of people instead of helping a few dozen who would come to my private clinic.”

The stint at a government hospital, which catered to scores of TB patients from various Haryana districts, however, proved his biggest fears to be true – that patients had relapse despite multiple courses, and also even after having been administered the drug as part of the Directly Observed Treatment (DOTS).

He said, “There were 5,300 repeaters. Two sisters came to me after relapse. Both died within a week. Patients who had been given medicines six times before also came to the hospital, asking for another dose. Their families had also been affected and they were now moving factories of germs.”

Moving a PIL in Supreme Court was also not an easy task — Kakar said he knew nothing about the technicalities. “I filed the PIL in August 2015 but the registry informed me that I must cure 32 defects (in the petition) if I wanted it to be heard by court. It took me months to rectify all that and be able to stand before the CJI to argue my case,” he said.

Accepting that he was nervous arguing his petition on his own in court, Kakar recalled that when his PIL had come up for hearing the first time, the bench asked the ASG to consider his suggestions on revamping the TB programme but did not issue a formal notice to the government. “I was a little confused what had happened. I asked a few lawyers who said there was a hope that my PIL would get admitted on merits,” Kakar said.

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