Topic 1 : TB control in India calls for person-centred solutions
Context
Even though World TB Day (March 24) has passed, recognising the needs and the interests of patients and communities must form the basis of disease elimination.
Tuberculosis – a concern
- Globally, and in India, tuberculosis (TB) continues to loom large as a public health challenge impacting millions.
- Access to efficient and high quality care — diagnosis, treatment and support — is still not available to every person suspected to have TB or diagnosed with the disease.
- As India grapples with the complexities of controlling TB, we need a paradigm shift urgently — one that places those affected and their lived experiences at the centre of tackling this ancient disease.
- At the core of this shift lies a fundamental recognition: the needs and the interests of patients and communities must be prioritised within the care paradigm and the health-care system.
Understanding lived experiences
- Perhaps our greatest gap has been in understanding the lived experiences of the affected individual fighting and surviving TB.
- We have, at times, been guilty of over-medicalising this disease, as doctors and public health folks often do.
- We have often forgotten to see TB as a human crisis, a gendered crisis, an economic challenge, and a social and environmental one as well.
- Over the years, they have sought change in key areas and governments have listened and modified their own approach to meet community needs.
- A case in point is nutritional support, which while limited, is an important step.
- Further, the growing focus on patient support, addressing stigma, and gendered aspects of TB has also been important.
Suggestions
- To provide high quality, person-centred care, we need to bridge the gap between policy intent and on-the-ground realities.
- We need to expand the reach of TB testing facilities, particularly in rural and underserved areas, and ensure the availability of free, affordable and quality-assured TB drugs.
- Molecular testing is the gold standard and less than a quarter of symptomatic patients are getting that as their first test.
- Recent reports of drug and diagnostics stockouts are troubling and unacceptable.
- Additionally, we need to focus on efforts to make care more humane.
- Hence, mental health support and gender responsive care become critically important.
- Efforts are also needed to strengthen community-based TB care models, empowering frontline health-care workers to deliver comprehensive care which addresses not just treatment but also social, economic and mental health needs.
- By supporting frontline TB workers, strengthening supply chains and procurement mechanisms, decentralising TB services and empowering local communities, India can reduce stigma, overcome barriers to access and enhance treatment outcomes.
- The disease has gone beyond being a health crisis alone. It is an economic crisis which by some estimates, costs India billions in losses each year and pushes families and communities into debt and poverty.
- Poverty alleviation, improvement in nutritional status, well-ventilated housing and better air quality will all contribute towards reducing TB.
- Leveraging technology and innovation holds promise in enhancing TB care efforts in India.
Way forward
- By tackling the underlying root causes of TB, India can make significant strides towards eliminating the disease and improving the overall health and well-being of its population.
- By investing in developing better vaccines, we can hope to ultimately eliminate this airborne disease.
- The path to TB elimination in India requires a concerted effort to prioritise person-centred care, address social determinants of health, and embrace innovation.
Topic 2 : Can ‘good sounds’ help coral islands recover from bleaching?
Introduction
Global warming has many consequences, including rising sea levels and changes in the frequency of extreme weather. Another is the destruction of coral reefs. India’s Lakshadweep islands for instance are islands formed on such reefs.
Coral reefs have started to die
- Coral reefs are built by a type of organism that, when it accumulates, forms reefs and islands. They live in large colonies.
- Corals have a symbiotic relationship with microscopic algae called zooxanthellae, which live in the corals’ tissues.
- Life becomes tough when the temperature of the water around them rises. When it does, the corals expel the zooxanthellae.
- An important visual symptom of these effects is that the colour of the coral reef changes, and subsequently they die off in droves. This event is called bleaching.
- However, not all coral bleaching events are due to warm water.
- Ocean acidification – which is when the pH of the water drops as more carbon dioxide dissolves in it – is another well-known cause.
- More acidic water reduces the availability of calcium minerals that the corals need to build and repair their exoskeletons.
- In many parts of the world, coral reefs have started to die due to global warming experienced over the years.
- The U.S. lost half of its coral reefs in the Caribbean in one year in 2005 due to a large-scale bleaching event after warm waters around the Virgin Islands and Puerto Rico expanded southward.
- The Great Barrier Reef in Australia is the largest coral reef in the world.
- Recently many people there protested strongly against a plan to open a new coal mine because they were worried about the survival of the reef – not because the mine would directly affect the reef but because of the effects of burning fossil fuels at large.
- Many small island countries like Tuvalu and Vanuatu are facing the threat of submergence and have articulated their concerns at international climate conferences.
The coral polyps
- Coral reefs are built by an organism called a polyp. A coral group is a colony of a large number of genetically identical polyps.
- Each polyp is a sac-like animal, usually a few millimeters wide and a few centimeters tall.
- It has a set of tentacles surrounding a mouth-like opening. Polyps are gregarious: they like to socialise.
- Every polyp also sheds an exoskeleton at its bottom and over many generations this discarded substance accumulates to form a large structure up to several metres wide.
- The polyps organise their lives around this structure. A coral reef is formed when a large number of polyps collects in this way.
- Polyps use sound to communicate with each other. Naturally, the sound of a healthy colony will differ from that of an unhealthy colony.
Conclusion
Coral reefs have sustained life for over a million years. Its diverse ecosystem keeps marine life running. It would not be in our best interest to interfere with the coral reefs. Conservation methods should therefore be taken to protect these beautiful polyps. Laws should be strictly enforced and if not followed, penalties should be imposed swiftly. It is in our best interest to protect our corals from eroding and withering away.