Innovative Tuberculosis treatment in Mon hospital

M. Konyak, a farmer from Shanghah village of Mon — a remote district in Nagaland — is currently undergoing treatment for drug-resistant TB at the Civil Hospital in Mon town.

His village is a long way from the clinic and so each month, he has to take a bus early in the morning to reach the hospital to collect his monthly medication. The journey to the hospital takes him three to four hours over bumpy roads and sometimes just a dirt track. If he misses the bus back home at midday, which is the case more often than not, then he has to find somewhere to stay overnight as there is only one bus service back home.

Konyak was initially diagnosed and put on TB treatment in a private clinic in Sonari in the neighbouring State of Assam in 2010. He underwent treatment for two years in a private hospital there. But a few months after completing his regimen, he started coughing again and had chest pains. He then underwent a further round of treatment at another clinic in Dimapur. However, when his condition failed to improve, the doctor advised him to consult the hospital in Mon.

Suspecting DR-TB, doctors at Mon sent his sputum to Kohima and later to Mumbai for testing which confirmed drug-resistant TB. His treatment began in December 2012. “In the three months since I started taking the medicines, I have become very weak. During the treatment in Dimapur, I was not at my best but I could at least walk. Now my back hurts all the time due to the daily injections. I cannot sleep and even my coughing has got worse. I have become very skinny. I was never very healthy but at least I used to look like a human being. Now my weight is below 40 kg,” says Konyak. Konyak takes 13 pills a day and an injection daily as part of his treatment. Suffering from so many side-effects, he often feels like quitting therapy.

But the counsellors are encouraging him to continue. “When I am cured I would like to sit and chat with my friends in the evenings. I would like to open a shop and sell groceries and earn for my kids to give them a better future.” Like Konyak, many suffering drug-resistant TB, find it challenging to undergo the painful treatment. In Mon, the long distance to hospital and back makes it more difficult for patients to adhere to the course.

Since 2010, Medecins sans Frontieres (MSF) has been fully supporting the Civil Hospital in Mon, under the public-private partnership of the National Rural Health Mission. Together with the National TB programme, the MSF started treating patients with drug-susceptible TB and drug-resistant TB in April 2012. Since then, about 190 sensitive TB patients and DR-TB patients have been put on treatment. MSF has introduced an innovative home-based model of care in Mon wherein patients diagnosed with DR-TB are admitted to the hospital initially for a month and provided treatment under close supervision. The patients and their caretakers are also counselled about the therapy and how to contain infection.

Later, medicines are given to these patients and their caretakers/DOT provider on monthly basis, as the patients have to travel long distances to reach Mon town and they cannot afford to pay for the transport to access the treatment more regularly. “Drug-resistant TB is a problem in India with non-adherence to medicines being the main reason for developing resistance to drugs. TB drugs are strong with acute side-effects and patients find it difficult to tolerate them,’’ says Anshu Prakash, joint secretary, Ministry of Health and Family Welfare. The drugs are to be taken for 6 to 9 months but patients discontinue as they start feeling fine in two months, he explained.

MSF projects in India are seeing increasing numbers of people with MDR-TB, with drug resistance found not only among patients who have previously failed TB treatment but also in patients newly diagnosed with TB – a clear sign that MDR-TB is being transmitted in its own right. “We have been waiting for half a century for new drugs that are effective against tuberculosis,” says Joanna Ladomirska, Medical co-ordinator for MSF in India. “People with MDR-TB often experience awful side-effects from the drugs they are taking and quite often it is very challenging for us to motivate them to continue with treatment,” says Ladomirska. “We need a much shorter, less toxic, and oral treatment urgently.”