Dr BK Mishra is the State Tuberculosis Officer. (Photo Credit: reachindia.org.in)

As the State Tuberculosis Officer of Bihar, I’ve had the privilege of engaging with numerous representatives from Community Radio, and these conversations have been both enlightening and thought-provoking. What stood out to me most during our discussions is how, despite the growing awareness of tuberculosis (TB), the power of radio remains as relevant as ever. In fact, radio continues to be a cornerstone of information dissemination, and as we work toward the goal of eliminating TB, it will undoubtedly remain a vital tool in reaching communities across the state, particularly in rural India. Personally, I find myself enjoying the simplicity and warmth of radio. Every evening at 8 PM, I ask my driver to turn up the volume and say, “Let’s tune in; I love this moment!” It’s a ritual that connects me to the world around me. Today, I’d like to share some key messages about TB—messages that we, together with community radio stations like yours, can amplify to the public. But before we dive into the specifics, I’d love to hear your thoughts: What do you believe is the most important message we need to communicate about TB?

One thing we must address is that if anyone in the family is showing symptoms or has been diagnosed with TB, the most important thing is to ensure that all family members get tested. For those who are already diagnosed, we have a clear message: complete the entire course of medication that has been prescribed. If you feel like you’re recovering and think you can stop the medication, do not discontinue it. Consistent medication is key to recovery.

Another point I want to emphasize, as you rightly mentioned, is trust in the healthcare system. When someone is diagnosed with TB, it is vital to trust the system—trust the healthcare infrastructure, testing facilities, and the medications provided. Unfortunately, there’s still a lot of distrust at the grassroots level, and we must address this. We need people to have faith in the resources available to them and encourage their use.

Let me share a personal story that highlights the importance of trust and treatment. My mother-in-law was diagnosed with breast cancer at the age of 84. For four years, she lived with it without telling anyone in the family. Despite having several doctors in the family, none of us knew about her condition. She had lost several family members to cancer but kept it a secret. It wasn’t until a bleeding incident that she sought medical help, and the doctors were surprised when they discovered the tumor. She had access to top doctors, but she didn’t speak up. Her reasoning was that she had lived a full life and didn’t want to burden anyone with her illness. After diagnosis, the doctors recommended aggressive treatment, but due to her age, they didn’t suggest surgery. However, she went through the procedure, and the cancer was successfully removed. Now, after her surgery, she’s doing well. This success story shows that no matter the diagnosis, we must not lose hope.

Similarly, when it comes to TB, people often think it’s a death sentence. They might think, “I’ve been diagnosed with TB; there’s no hope.” But let me assure you, TB is curable. With the right treatment and care, you can fully recover from TB. So, the first message I want to convey is simple: TB is not untreatable. With the right medication and proper precautions, we can fully recover from TB and prevent it from spreading.

There is also a misconception in society that if a young girl is about to get married, and someone in her family has TB, it creates a stigma. People might say, “Why should we marry into a family with TB?” This reflects a lack of understanding about TB. It’s not hereditary; it’s caused by bacteria, not genetics. TB is caused by Mycobacterium tuberculosis, similar to pneumonia or dysentery. It spreads through bacteria, not inheritance. We need to dispel the myths about TB being a family disease.

We have strong antibiotics available to kill the bacteria that cause it. But completing the full course of treatment is essential. For children, the BCG vaccine, administered at birth, provides protection against serious forms of TB. However, this vaccine is less effective for adults, which is why early detection and treatment are so important.

Another key point: when someone is diagnosed with TB, it is essential to also test for drug-resistant TB. We need to identify if the TB strain is resistant to drugs, so we can administer the correct treatment. 

Now, let me clarify something many people don’t know. Sometimes, certain bacteria can become resistant to the medications we use against them. In Bhojpuri, we say, “Thethar ho gayil ba”—the bacteria become stubborn. This happens when medications are taken irregularly. If people take their medicine sporadically—one day at 8 AM, the next at noon—or break up the prescribed dosage, taking one tablet in the morning, another in the afternoon, and yet another at night, it allows the bacteria to survive and adapt, making them resistant to antibiotics. This is what we call drug-resistant TB. 

But here’s the good news: over 80% of TB patients in our country are still susceptible to first-line drugs. This means 8 out of 10 patients can recover with these standard treatments. Our message to society should be: don’t fear TB, fight it. Treating TB doesn’t require expensive procedures or medications. The treatment is available in both private clinics and through the government’s healthcare system, which provides excellent medicines.

TB spreads through airborne droplets. When I cough, if I don’t cover my mouth, the droplets can linger in the air and infect others. We all learned about the importance of masks during the COVID-19 pandemic, and for TB, wearing a mask is just as crucial, particularly during the initial months of treatment. This is when 90% of the bacteria haven’t yet been eliminated.

Patients should stay in well-ventilated areas and avoid crowded spaces. If they need to interact with others, they should wear a mask or cover their face with a cloth. Even when breastfeeding, the mother should cover her face to prevent the spread of infection.

Certain groups are more vulnerable to TB—smokers, those with malnutrition, and the elderly. Malnutrition is a significant concern; 40% of our children suffer from it, which is alarming. Parents should regularly monitor their children’s height and weight at Ayushman Bharat Health and Wellness Centers or Primary Health Centers. If the child’s growth isn’t on track, improving their diet should be a priority.

When someone in the household has TB, they must take precautions. They need to cover their mouth, take their medication regularly, and ensure that all family members, including children, undergo screenings like X-rays. The government provides modern diagnostic tools like Truenat and CBNAAT machines at no cost. Private clinics may charge up to ₹2,000, but these services are available free of charge in government centers.

In rural areas, radios play a pivotal role in spreading this crucial information. Through this medium, we can encourage people to visit their nearest Ayushman Bharat Health and Wellness Center if someone in their family exhibits symptoms like a persistent cough, fever, night sweats, weight loss, neck swellings, or chest pain.

We are also introducing new tests like the CYTB  test, which can detect TB infections more effectively, particularly latent TB. If an infection is detected but no active TB disease is found in the X-ray, preventive treatment can be initiated. This involves just one dose of Rifapentine and Isoniazid every week for three months—12 doses total—to prevent the disease from spreading. This is given to the relatives of TB patients as a preventive measure. 

Lastly, TB patients can benefit from the “Nikshay Poshan Yojana,” a scheme providing nutritional support. Those registered in the TB portal can receive ₹1,000 directly to their bank accounts to support their recovery.

So, let us all continue working together to fight TB. Educate the public that TB is treatable, preventable, and not hereditary. Let’s build trust in the healthcare system and encourage everyone to take the necessary steps to protect themselves and their families.

Note: This is an excerpt from BK Mishra’s address during the Orientation Session for Community Radios on Programming for the 100-Day TB Elimination Initiative

(Cover Photo: TB Campaign SMART)