A frail hand held out the OPD card towards me. One look at her and I prayed she was not pregnant. When you are posted in the OBGyn OPD in a Primary Health Centre, it is not uncommon to find such frail figures coming for their fourth or fifth delivery. On probing her complaints, she looked down, covered her mouth with the edge of her saree and said “cough”. Sometimes, certain images get pasted in our minds. There is often no specific reason for it. But your eyes would have captured an image and your crazy brain just gets fascinated by it and decides to store it in a folder titled, “Worth a Thought”. That frail lady. Her yellow saree. The way she looked down. The swift movement of her hands as she covered her face. All of it got imprinted in my head. And there was just one caption that could be given- Stigma.
Cough for two months. Productive. Considering her malnourished appearance, the obvious thought in my head was Tuberculosis. “Have you had your Sputum tested?”, I probed. She bowed her head even lower, turned around to see if anybody was listening, and then whispered, “Yes. And I was told it shows TB. I have been sent here to get my blood sugar and other tests done”. After getting the rest of her history and examining her, I wrote the slip for the necessary investigations and referred her back to the RNTCP DOTS centre for initiation of treatment. But my conscience told me, there was something more I had to deal with here. Stigma.
The time that you regret a language barrier at work place is when you really want to try and counsel someone. I made the best effort to tell her that Tuberculosis is curable if treatment is followed properly. After two minutes, she was in tears. And she poured out her fears. The main demon in her eyes was not the disease. It was the stigma. What would people say now? She was standing at the edge of a dark pit. One push and she might succumb. Succumb to stigma.
India has come a long way in management of Tuberculosis. As a matter of fact, we are trying to achieve the sustainable development goal of ending TB by 2025, five years ahead of the global targets. Our National programme, Revised National Tuberculosis Control Programme (RNTCP)has been recently renamed as National Tuberculosis Elimination programme (NTEP). We have more efficient and feasible methods of diagnosis and better chemotherapy. The mycobacterium can now be detected easily and terminated. But none of these drugs can deal with the fear I saw in that lady’s eyes. A fear called Stigma.
We definitely have a long way to go. To tell people that falling sick is not a mistake. That it could have been anyone, including ourselves. Compliance is important and the cure will be just around the corner. Tell them how to prevent disease from spreading. Tell them what to do. Tell them what not to do. Tell them stigma is just the reflection of people’s ignorance.Tell them it is OK. Tell them there is hope.
We have reached the point of eliminating TB. Laudable beyond doubt. Next stop might just about be eradication. But as we try to give the best treatment to our patients, lets not forget the small (yet significant) issue of stigma. This is the social evil that could turn that yellow saree into a loop for the poor woman to end her life. Yes, we have a long way to go. Miles more. Like Robert Frost penned,
“The woods are lovely, dark and deep,
But I have promises to keep,
And miles to go before I sleep,
And miles to go before I sleep.”
Yes, we have miles to go before we can outrun stigma. But at least lets start by trying. I wondered how much of my broken Hindi the lady had understood. But as she was leaving the room, she no longer had the saree over her face. Her eyes were no longer downcast. There was some light in them. Stay strong and fight, I wished her in my head. She sure has a long way. But at least she will try and cut the Gordian knot of stigma. Hopefully.