Now that the United Nations will soon declare India polio-free, health officials are turning their focus to the next most challenging disease: tuberculosis. Forty per cent of all Indians, across rural and urban India, are estimated to carry the tuberculosis bacteria, and a quarter of all tuberculosis patients across the world are Indian. Two million Indians are diagnosed with the disease every year and a quarter of a million die from it.
In Assam, a state which has 10% of all Indians with tuberculosis – the highest proportion of any state in India – Himanshu Seth, a former Master’s student at IIT Guwahati, has come up with Parichaya, a low-cost medical kit that both dispenses medicine and also educates patients. The kit won the Gandhian Young Technological Innovation Award this year.
Tuberculosis is a strong bacterial infection that attacks the lungs and area around them. If left untreated, it can be fatal, but can be cured entirely if detected early enough. One of the most significant problems with tuberculosis is that it depends entirely on patients adhering to their dosage routine. To completely obliterate the bacteria and prevent a chance of relapse, a patient needs to regularly take medication for anything from six months to two years. If the patient halts treatment midway, it creates the potential for a mutated form of the bacterium to spread, causing the multi-drug resistant and extreme drug resistant strains of the disease that were written about extensively last year.
Seth’s plate-shaped device, which replaces traditional blister packs, uses a touch-responsive audio and visual interface for patients to interact with while their medicine is being dispensed. Each stage of medication is accompanied by an audio recording explaining the purpose of each medicine.
“In our opinion, the government has always been about tracking, not awareness,” said Keyur Sorathia, Seth’s faculty supervisor. “While tracking is important, if you create awareness as well, because India is social in nature, people will start learning about it and it will have larger impact in the long run.”
Unlike polio, which is easily prevented with a vaccine, the BCG vaccine for tuberculosis is not entirely effective. The disease can only be treated with a strenuous course of medication that can last anywhere from six months to two years, depending on when it is diagnosed. The medicines used to treat the disease today are identical to the original antibiotics developed in 1944. As with all antibiotics, it is toxic and causes numerous side effects such as nausea and fever.
“We realised that TB awareness was very low in Assam,” said Seth in a conversation with Scroll.in. “At a local level, doctors suggest taking a small gap between each pill to reduce their side effects. We thought of utilising that down time of five or six minutes each for the patient to interact with the medical kit.”
Patients using Parichaya can listen to up to 14 segments of information during these gaps, which amount to a total of an hour and a half. The information discs can be replaced so that a patient will get a new disc at each treatment session.
India already has a national scheme to eradicate tuberculosis. Its Revised National Tuberculosis Control Programme provides medicines for free and provides for healthcare centres to be set up across the country to monitor the disease. Last year, the government made it legally mandatory for all doctors, private practitioners or otherwise, to report any case of tuberculosis they come across.
A crucial part of the scheme is its DOTS, or “directly observed treatment, short course”. DOTS is a system that requires community workers to personally administer medication to patients and ensure that they never skip a dose. This is intended to reduce the risk of MDR-TB.
“The last-mile delivery of TB medications is the hole in this system,” said Shelly Batra, head of Operation ASHA, a non-governmental organisation that works in tandem with the government to help people get treated at a community level. “The government has invested a lot in TB infrastructure and the entire network of public diagnostics is geared towards TB. But then, after patients are diagnosed, they have to travel to a clinic 50 times because they have to take their medication in view of an observer.”
Parichaya, she said, sounded as if it would be a good addition. “New technology needs to be encouraged. But it is the community that is crucial in educating others.”
Seth has included certain community-inspired elements. The audio part of the set has a voice intoning information in the style of a headmaster. “We thought it might help people to believe that information,” said Sorathia.
Seth and Sorathia worked on the project for eight months between August 2012 and April 2013, and were able to pilot it informally only at a limited local level. They now hope to pitch it to the government to integrate into its TB prevention programme. “There are no other such information communication technology solutions in Assam,” said Sorathia. “This too is important.”
This article was first published on Pulse on Scroll.in.
