Satyamev Jayate Season 3 26th October 2014 4th Episode on Fight Against Tuberculosis (TB) – Written Snapshot

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Satyamev Jayate

Aamir welcomes all and speaks about his first guest on the show – Dr. Shekhar Khandare, a doctor by profession but will speak there as a brother.

Discussion with Dr. Shekhar Khandare
Aamir speaks that Shekhar’s sister Samidha Khandare was also a doctor thus there were 2 doctors in the same family and their parents have lot of hopes with them. But unfortunately, Samvidha passed away at the young age of 24 yrs and she became a doctor a year ago before her death. Dr. Shekhar Khandare speaks of coming from a taluka place in Akola in Maharashtra and have did the schooling there until 10th standard. He speaks that her sister followed his dreams and wanted to become a doctor as well. They have small fights, care and love like other brother and sister bond. Shekhar speaks that after Samidha’s completed her M.B.B.S studies and she was pursuing her internship in December 2013. Around that time, she was getting fever, got some illness and weakness, short of breath but didn’t got conclusive results. She was given antibiotics and resumed work. But after some time, she started getting short of breath even while sitting and without any work like walking. She then went on to give X-ray and it turned out that TB have spread to her eyes and brain. She was given treatment with first-line drugs and the treatment went on for 1 month and she showed some improvements and her appetite also improved. She went home and in one week she started getting earlier symptoms – vomiting, high fever and she was admitted again to hospital’s ICU. She was shifted to a private hospital and on 6th March 2014, she was shifted to Hinduja hospital and became bit normal. In April 2014, her health started deteriorating and on 5th May she was having breath problems and the MRI scan revealed that almost 70 to 80 % of her brain is dead. She was being treated but remained on ventilator and finally she passed away in June 2014. Thus, she died within a span of six months after being diagnosed with TB. Samidha’s convocation photo is shown with her MBBS degree while she was in hospital. Aamir speaks of sharing and supporting the grief of Shekhar and his family.

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Discussion with Dr. Zarir Udwadia
Aamir speaks that the knowledge until now suggests that TB can be treated and curable but it takes some considerable period with proper medication then asks about the case of Samvidha – even after all attempts by doctors she could not be saved ? The AV shows TB disease since many decades and it origins from the bacteria – micro bacterium and medical science has the answer. In Hinduja hospital, research is going on TB’s treatment and Dr. Zarir Udwadia (Consultant, Hinduja hospital), a prominent doctor comes on the show. Aamir asks about Samvidha’s TB case with him. Dr. Zarir who replies that on average in 6 months, 90 % of the people gets treated and recovers from TB. Aamir asks about what does he mean by sensitive patient ? Dr Zarir replies that if four medicines have an impact on you then it means you are sensitive to the treatment and you will get treated well and in 6 months you will be fine. Such a treatment is not expensive and have saved lives of lakhs of people. Dr Zarir then speaks about MDR TB patients in India being the largest in the world and MDR TB (multi-drug resistant) is the one on which few medicines doesn’t have any effect. The bacteria doesn’t kill and the patient needs further treatment of 2 yrs which is called second-line drug and those medicines are very toxic and also the expenses cost becomes 500 times more than the normal TB treatment. He speaks that 30 % of the patients leave the MDR TB treatment because of the side effects since the patient has to take 15,000 tablets and 200 injections. The side-effects of those medicines – hearing impairment, weak body, kidney problems and the patient wants to end the treatment. Dr. Zarir speaks that after MDR, then there is XDR (Extremely Drug resistant) TB and the situation can go more worse than this in which 4 medicines doesn’t have any effect. Then the final class is TDR TB (totally drug resistant TB) in which no medicines will work. Aamir learns that there are 13 medicines for TB and if 2 medicines out of them doesn’t work on a person then he is having MDR TB, if 4 medicines doesn’t work then XDR TB, and if no medicines out of 13 then it is TDR TB for which no treatment possible. Dr Zarir puts blame on government programs, private doctors, other doctors, societal factors.

In India, there are many reasons for TB to live and spread – poverty, malnutrition, cigarrete/Beedi use, diabetes and HIV Aids give a helping hand to the TB bacteria. The TB govt program has not consider (left) the MDR TB patient and Dr Zarir informs that the MDR patients are given the medicines for normal TB which doesn’t help them. MDR TB patients were given the category 1 medicines which doesn’t have any effect on them and their treatment goes on for another 8 months and repeated with same medicines. Thus, in total of 14 months, they were not tested whether the medicines will work for them or not. This means that patient were transferring TB to other people in those 14 months. Dr. Zarir informs that in a year a MDR or any TB patient can pass on the disease to 10 people. The TB spreads by air, cough/sneeze and can spread in large numbers and you can get TB in car, trains if the patient coughs/sneezes. Dr Zarir thinks that private sector is unregulated – Unani, Homeopathy, Ayurvedic, tantrik, Hakeem and they all want to attract patients and calls themselves as experts for TB. In Mumbai’s Dharavi (slum) study, only 3 doctors out of 103 doctors who were practising there were following the right standards (regimen) for TB treatment. If the doctor give wrong medicines, or wrong combination of medicines, then the normal TB will become MDR TB. Aamir gives an analogy of how TB if not treated well will turn out to become much deadly – MDR, XDR and TDR. Aamir asks people diagnosed with TB to complete the course of medication as prescribed by doctor like 6 months and not leave after some months. Dr Zarir informs that TB bacteria is present in 30 crores people and in around 40 lakhs people, the TB bacteria is active. Around 1 lakh patients are diagnosed with MDR TB and these data doesn’t have private sector patients and this insight might be 5 to 10 times more if private sector patients details are taken into account. Dr Zarir speaks of the MDR TB dangers and we need to take swift action ASAP to curb it.

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Discussion with TB survivor – Prathamesh Balgi
Aamir then welcomes Prathamesh Balgi who was working in ICICI bank and in December 2010 his life changed when he was diagnosed with MDR TB. Prathamesh speaks of the painful thing is the injections and took 400 injections and thought many times to give up his life. He used to get headache, loss of appetite and he was going through weight loss. Soon, he was informed by doctors that his treatment needs surgery to remove a part of his lungs. He already took 8 months of medication and was worried about his family. A part of his lungs were removed after surgery and was in much pain.. Sooner then, he did bronchoscopy and the doctors found that TB came back to him. He went for 2nd surgery and his treatment went for 4 years. During his treatment, he became a father to a girl child before his 1st surgery. He speaks of people ignoring TB patients and it happened to him and people will ask how come he has got TB ? Aamir speaks that society needs to accept patients but take precautions as needed. Prathamesh speaks that his office ICICI bank has given him salary and holidays when needed and also supported by his family and total expenses is 20 to 25 lakh INR. He wants the people to make medical insurance policy for themselves. Aamir speaks that TB spreads by air and communicable and if a patient infected with MDR TB then he will pass on the same MDR TB to others. Aamir asks Dr. Sheilija Singh who shares an experience of consulting a lift man who was diagnosed with TDR TB. She learnt in next 2 days that he has passed away. Aamir suggests that the lift man might have passed on the TB to many people and he continued to work thinking to keep his job.  Aamir suggests that we need to fight together and we can swim (sail) together or drown together. He speaks about the govt’s program to fight TB and its name is Revised National Tuberculosis Control Programme (RNTCP) whose goal was to give free treatment and medicines to fight TB for the entire country. An integral part of this program was DOTS (Directly Observed Treatment Short-course) and DOTS centres were opened throughout the country and more than 1 crore people have got benefit from it and it is largely successful. Whether there are more improvements needed in this program ? Does it capable enough to fight MDR TB ?

Prathamesh on Satyamev Jayate - TB survivor

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Discussion with Dr. Lalit Kumar Anande
Aamir then speaks with Dr. Lalit Anande – Chief Medical Officer, Group of TB Hospitals, Sewri who suggests that people have lot of myths about TB. It was not much aggressive before and earlier the patient used to develop cavities in lungs in 4 yrs time when he haven’t took medicines but now the patient gets cavities in lungs in 1 month time and just after he realized about being diagnosed with TB. The symptoms show early signs of cavities and Dr. Lalit suggests that we need to identify first whether the patient has normal TB or MDR TB, this is important. He speaks that many patients don’t know that they are diagnosed with MDR TB thus early detection of MDR is essential. Aamir speaks with a young boy patient’s father Sadanand Lanjewar who is diagnosed now with MDR TB and while speaking Sadanand ji breaks down and Aamir goes to support him. His son got 6 months of treatment with govt program (RNTCP) and MDR TB was detected later after his son was already suffering from it. Dr. Lalit Kumar speaks that Sadanand’s son MDR TB was unknown to him when they came to him and only after doing test they found MDR TB and cites that timely MDR treatment was not given to that young boy which has led to his left lung being damaged fully. Aamir speaks that a good doctor will first test whether the patient have normal TB or MDR TB. He asks why the govt is not doing such thing and what’s there in their program ? Dr. Lalit informs that procedure to check whether a patient have normal or MDR TB is not in their program and then smiles. Aamir speaks of first knowing whether he has normal or MDR TB if gets one since both TB’s have different treatment and speaks on Gene Xpert test which will identify whether you have MDR TB in one day. If you come to know of having MDR TB then there is another test – culture test which will tell out of 13 medicines which will work and which won’t work. Aamir calls it as the normal and step-by step procedure and Why it’s not present in Govt programs ? Dr Lalit speaks of his opinion that many years ago, the municipalities have same hospitals for king and inhabitants but now there is disparity between king (rich) vs. people (poor) in terms of hospitals and facilities. The tests for common man and the king  (rich ones) are different and the rich fellow will make sure to give first the culture test to know which medicines will work for him. Aamir again reiterates that for TB’s disease either we will sail together or drown together since the disease is one of its kind and different from others. Unlike cancer, in which only the patient suffers if he/she is not treated well. But in case of TB, dangers can also spread to your family and proximity areas.

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Discussion with Dr. Kuldeep and Dr. Soumya:
Aamir speaks of an AV that shows how govt’s TB control program has made an impact. In AV, the voiceover speaks that the program though has some weakness, (1) Alternate day therapy, Dr. Yatin speaks that in different parts of world the medicines are given daily and also International union of fight against TB recommends daily therapy since alternate day therapy reduces resistance. (2). Timing of DOTS centres is not according to patient’s best time and the timing is from 9 am to 2 PM. (3). Shortage of drugs – many patient’s relative and social workers speak about lack of shortage of drugs and patients not completing treatment. (4) Poor monitoring.  (5) Corruption – patients speak about DOTS worker asking for bribe. Aamir speaks with Dr. Kuldeep Singh Sachdeva (Additional deputy Director General, Central TB Division, Ministry of Health) and Dr. Soumya Swaminathan (Director, National Institute for Research in TB) . Aamir asks Dr. Kuldeep about the govt’s program and asks whether testing is done initially to know a person has normal or MDR TB so that he can take right medicines. Dr. Kuldeep replies that for new patients  it is not advisable scientifically to take MDR tests and speaks of unncessary exposure. Aamir then speaks that MDR test doesn’t have exposure and only you have to spit. Aamir then asks Dr. Soumya about her opinion ? She speaks that drug suspectibility test should be done at the start and govt also has plans to implement such tests at the start within the next 5 yrs.

Aamir then speaks to Dr. Kuldeep that countries like Pakistan, Nepal, Bangladesh are having daily TB therapy and why not in India we don’t have daily. Dr Kuldeep replies that even those countries have alternate day therapy at the start and now they change to daily. Even, in India also we have same thinking to switch to daily. Dr Kuldeep doesn’t want to say better results with daily therapy and then speaks about the feasibility issue with daily implementation. Dr. Kuldeep speaks of taking action against the workers whom people have make complaints and thinks there are adequate stocks. Dr Soumya speaks that there is a matter of concern since every year in India 2.5 to 3 Lakhs people die which is a shame for us. We talk about growth and we need to take challenge to control it in the next 10 to 20 yrs and cites the example of China which has controlled it in 10 yrs.

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Aamir speaks about the Mumkin Hai question which needs to be raised for fight against TB – Should TB be treated as a national health emergency which a war needs to be waged jointly by Government, doctors and society ? If people agree with it, then they can go ahead to give a missed call on toll free no 1800-833-4004.

Discussion with Dr. Anurag, Rebeca Stevens and Operation ASHA
Aamir speaks of getting motivation and strength from people’s support. Aamir then welcomes Dr. Anurag Bhargava (Himalayan Institute of Medical Sciences) and asks what is the miraculous vaccine which we can use to fight TB ? Dr. Anurag speaks whether we have gone to the root cause of the problem – TB and why he have such disease in India on a large basis ? He speaks that 90 % of the people are able to fight with TB infection. If you have malnutrition then the chance to get TB increases by 4 times. We have to see TB crisis with malnutrition. Dr. Anurag suggests the miraculous vaccine is sufficient and balanced diet. In the 19th century, Europe faced the similar problem of TB like we are facing in India now. We need to make malnutrition as our enemy and good and balanced food will help in fighting TB.

Aamir speaks that America has had a problem of TB in 1990’s and shows an AV of how New York dealt with the crisis during that time. The health dept has started a campaign and the govt has increased the funds on fighting TB by 10 times and open TB centres at many places in the city and every one should get treated to keep the city safe. Many volunteers were taken and their duty to go in remote parts and also to meet criminals, drug dealers and human trafficking people and give the medicines for TB if they are infected with it.  The volunteers manage to reach them and in 4 years New York was able to control and manage TB health crisis. Aamir then speaks with Rebeca Stevens who worked during the TB crisis time in New York via 3G link. Aamir thanks her and  asks that she has worked with TB patients and some of them were criminals, drug dealers. Rebeca speaks of seeing crime and people running with guns and she just wanted to provide health to them and not wanted to change them. She speaks of those people illness and wanted to help them and not to give any decision on them. Aamir speaks that Operation ASHA organization has improved DOTS provider and has brought those centres closer to the patients. The health worker belongs to the same area and Operation ASHA have set-up a supervision system eCompliance system which captures patient’s fingerprint and records it. It proves that the patient have taken the medicine and following the course. Dr. Shelly Batra from Operation ASHA speaks that the total cost per patient for 6 months comes out to be 150 INR which is small. The SQL database shows the patient’s records and details. Operation ASHA has brought good results and have used technology to good use and she speaks that her patients have not left the treatment. Aamir speaks that Dr. Shelly Batra and Sandeep Ahuja from Operation ASHA is there in the studio and people can support Operation ASHA by donating at Axis Bank, Airtel Money, and Reliance Foundation will give 1 Crore INR to it.

Operation ASHA - Satyamev Jayate

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Discussion with Deepti Chavan – TB Survivor:
Aamir then welcomes Deepti Chavan – a fighter whose slogan was Himmat Mein Marda.. Maddat Hein Khuda which literally means in when human show strength then God also comes to support him/her. When Deepti was 16, she learnt that Physician informed that her upper lobe (lung )is damaged. She was not frightened and then went on with the operation. She took medicines for MDR TR for 6 yrs and took 400 injections. No doctor was ready to operate her since it was risky and they think that she has 6 months left and suggested her parents why to spend money on their daughter and instead can live with her and spend time ? Vijay ji (Deepti’s father) speaks about doctor’s words that she will die on table if operated and Deepti speaks of having 28 kgs then. She went to Jaslok hospital and the doctor there Shripal Joshi told her of having only 1% chance of survival. She speaks of going ahead with that chance and not worry about pain and survival. She speaks of singing while she was going for the operation but doesn’t remember. Aamir on a lighter note wants to know that song. She speaks that the surgery went on for 8 hrs and the doctor during operation found that the infection spread to stomach as well from lungs. But went ahead in doing the operation and showed will power. She came back to consciousness the same night instead of 3 days as told by doctor and discharged next day. Aamir speaks that she has only half lung now and she informs on not running. She speaks of seeing patient committing suicide and thus thought that God have saved her life for some reasons. Now, she counsels TB patients. When she was ill, she used to chat on Internet and met her husband Neeraj who is seen there. Aamir asks Neeraj on what he used to speak with her. Deepti speaks that there were just friends and no romance was there. Deepti calls him as her best friend and Neeraj speaks of sharing the pain with her. He speaks of learning from her and calls her the strongest woman in the world. Neeraj speaks of proposing to Deepti on phone and without looking at her. Aamir speaks on lighter note that now love is truly blind. Deepti praises her in-laws who were very supportive and gave her lot of care. Aamir speaks that Deepti’s story can be inspiration for TB’s patients.

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Salman Khan felicitates DOTS provider top workers and Aamir signs off:
Aamir speaks of a special person and informs to Dr. Lalit Anande that this special person has supported many of his patient’s financially but he haven’t replied to his thanks letter. Aamir is speaking about Actor and Superstar Salman Khan and then welcomes and introduces Salman as India’s loved Superstar and his close friend. Salman speaks of not replying to Aamir’s SMS messages and asks why to reply for doing good work. Aamir has invited Salman to come on his show. Salman speaks that his grandmother got TB when his father was around 8 to 9 yrs old. He speaks that his grandmother didn’t identify/recognize his son and at the time she used to stay in Nainital. Aamir compliments Salman and informs that he has shown weakness in Govt program but the program workers are doing great work and the program is supported and run on a large scale. Salman felicitates Meenakshi Sundaram (DOTS provider from Chennai), Dheeraj Kumar (DOTS provider from Ahmedabad), Shamsath Beevi (from Kerala), Paramjeet Kaur, Dr. Jagdish Saini (Chandigarh) and Krishnachandra Das (West Bengal).

Salman with Aamir on Satyamev Jayate

Aamir speaks that British have ruled India for 200 years by Divide and Rule and in the fight of TB we are also divided  and there is different treatment for king (rich) and the common man (people). Because of this, the TB’s bacteria is getting stronger. If we want to win the war against TB then one thing should be clear – Either we will all sail together or all of us will get drown together. Aamir signs off by saying – We have the believe that every life is precious and we will not leave their side. Jai Hind.. Satyamev Jayate !!

Satyamev Jayate - Emblem of India

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Additional Note:
* Satyamev Jayate Website to keep updated about the show and other promos and finer details
http://www.satyamevjayate.in/

* Aamir during Mumkin Hai Live program post the episode telecast became emotional (in tears) and vowed to come back with Satyamev Jayate new season after a gap of 1 or 2 years so as to get himself and his team re-energize and regain emotional strength for the new season. Much respect for Aamir and SMJ team.

* Twitter page of Satyamev Jayate

Image credit: Twitter page of Satyamev Jayate

Episode Video: In Hindi

Episode Video: With English subtitles

Short Video: Satyamev Jayate: All About TB (in Hindi)

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