A compelling article published in the Wall Street Journal last weekend tells the story of TB patient Rahima Sheikh, detailing a six-year journey that has resulted in Sheikh having one of India’s first documented cases of TB that is resistant to virtually all medicines available.
Sheikh, who was diagnosed with TB in 2006, spent the past six-years journeying throughout India in search of a cure for her illness. It has been a journey that has forced her to mortgage her family’s rice fields, spend her father and brother’s life savings, as well as causing her considerable physical and mental anguish. Despite these sacrifices, Sheikh still has no guarantee that she will survive her illness.
Treating TB ordinarily requires a six to nine month course of treatment, and, therefore, it may seem strange that Sheikh has been on this six-year journey. However, if TB cases are mismanaged, if doses aren’t correctly prescribed or if treatment is taken incorrectly or inconsistently, the TB bacteria can re-emerge and become resistant to medication.
In the case of Sheikh, it is suggested drug-resistant strains of TB were able to emerge because she was prescribed the wrong treatment on the basis of a misdiagnosis when she first sought treatment.
As Geeta Anand, author of the article, states,
Sheikh’s “six-year journey to all-but-incurable TB exposes a blind spot in an Indian medical bureaucracy that, for decades, neglected to implement widespread testing or treatment for drug-resistant strains. As a result, a curable disease has mutated into a killer”.
In countries such as the UK and other developed nations, patients are first tested for drug resistance as means of prescribing and administering the correct treatment. Tailoring treatment in such a way ensures a higher likelihood that resistant strains do not develop. In Mrs. Sheikh’s case:
Specialists who reviewed her records for the Journal say the drug cocktail Dr. Singh prescribed was too weak to kill her strain. So the bacteria likely mutated further, they said. In fact, when she was tested again four years later, she had developed resistance to two of the four drugs in Dr. Singh’s regimen.
This is not just a concern for India, the WHO estimates that only two thirds of countries with serious drug resistance problems have enough labs equipped to diagnose these strains. It is also important to acknowledge that along with the lack of effective resources for diagnosis, mismanagement and a lack of any new first-line anti-TB drugs also play a considerable part in the emergence of new drug resistant strains.
Essentially, the WSJ article highlights the growing concern surrounding drug-resistant strains of TB. Only recently we blogged about a study published by The Lancet that found much higher rates of drug resistant TB than previously estimated in eight countries around the world. It is clear that there needs to be greater political commitment and investment into the TB response.
You can read the full story on Rahima Sheikh here.