Author name: Dr. Vijaiyalakshimi Praveen

I recently attended a TB Centre Stage discussion organised by REACH TB (NGO) & USAID on Building an equitable & inclusive response to TB in India. It involved an open house discussion starting from the DDG- TB, Director USAID, an advocate from Madras high court, HIV TB partners including that of a Transgender social worker from John Hopkins, India & a Multi Drug Resistant (MDR) TB Champion cum TB survivor from Thiruvallur. Anecdote: I could feel the MDR TB survivor’s (young women) anecdote from the above discussion very dearly when she said that her ex-husband and ex-Mother in law mapped out a clear plan to file for divorce the moment they came to know she was diagnosed of MDR TB, though they both were the culprits for her not being able to complete the course 2 previous times when she was diagnosed with TB as they offered zero support because she was pregnant both the times. Let me share my personal story that happened in 2008 right after my internship & at the very early months of marriage, wherein I was diagnosed of TB with loculation 2 cubic meters empyema (2 liters of pus drained via Inter costal Drainage over few days) followed by operative procedures & was treated for the same for 6 months. My mother, a then top level central Government employee still talks high to me about her son-in law stating “he was there when you had TB, he will be with you supporting you always”. I am not sure if my Mother in law might speak high about me, had I assisted and supported my husband if he had been down with Tuberculosis. I am sure my duty as a wife would be discussed that time. Points to Ponder: Let me start with the question – Will you share with your friends & extended family if you are diagnosed with Diabetes/ Hypertension? Mostly yes. Will you share the news if you/ your spouse is diagnosed with fatty liver grade 2? 50-50 chance. Finally, will you share with your friends if your female adolescent child is diagnosed with Pulmonary Tuberculosis? Mostly not. TB is not only an infective disease but also a social disease like mental illness where in a third eye view on the need to provide rehabilitation (psychosocial) has to be thought about. Lack of Social Media Awareness: These days in social media people review all niche topics, including once a stigmatised talk of the society like feminine hygiene products, but, why are we not seeing anybody sharing their TB journey with the World? Celebrities have even shared their COVID journey, pregnancy journey, infertility journey but why none of them share their TB journey? “TB kills 3 people every minute worldwide & according to WHO, India has the World’s largest TB epidemic”. India’s TB incidence for the year 2021 is 210 per 100,000 population (note that our MMR is 97 per Lakh Live births in 2021). May be it reflects the negligence we show towards the disease. TB infection (TBI) & TB Disease: TB bacteria can live in the body without making one sick. This is called latent TB infection. TB bacteria become active if the immune system can’t stop them from growing, this is called TB Disease. People with active TB disease might be able to spread the bacteria to people they spend time with every day. Prevalence of TBI is so high (40%) among the Indian population that it is obvious that if we are diagnosed with a TB disease, it need not come as a shocker to any of us. Us being Health Care Professionals/ workers we are a higher risk (60 -70%) of TBI, yet if the infection which is already with in the body turns into an overt disease (TB disease) in us or our loved ones, we want to hide it or maybe we think that it’s really not necessary for others to know it, as if it’s important for others to know if we are diagnosed of DM. Recommendations: We have enough evidence based studies that our interns, PGs & staff nurses are at the highest risk of contracting the infection as they spend longest hours of a day in the IP wards. Printed Information, Education & Communication (IEC) materials on TB & preventive TB behaviour to alert high risk personnel similar to Hand washing practices & COVID protocols should be flashed everywhere to emphasis on the importance of wearing masks all the time, to double mask when they are entering TB wards, to destigmatize TB & those condemning the stigma. Even before COVID, doctors and nurses were dying of nosocomial TB & continue to succumb to it, why did we never ask for compensation? Are we taking life loss due to TB for granted? We need to talk!

Batch of 2002 finished her undergrad from IRT Perundurai Medical College and internship from CMC Vellore. She did her masters in Community Medicine from Sri Ramachandra Medical University from 2013 to 2016. Till 2018 she was working as Assistant Professor in a private medical college and then joined as a PHC Medical Officer in Kalambur Block PHC, Tiruvanamalai district. From 2018 to 2021 she worked as Program Officer in Tamil Nadu Health System Reform Program, a 3000 Crore rupees program, funded by World Bank, which is a successor of erstwhile Tamil Nadu Health System Project (TNHSP). She played the lead role of administrator of Project Management Unit in addition to looking after Quality wing and Operational Research teams of TNHSRP, a crucial role in prominent activities of TNHSRP such as Quality accreditation of close to 300 Government institutions, initiation of NCD – WHO STEPS survey, Creation of Emergency Departments (ED) in Medical Colleges, RCH Household survey, conduction of various World Bank Missions and workshops including the prestigious launch program of TNHSRP by the then Chief Minister of the State in March 2020. She was also physically trained from Harvard T. H. Chan School of Public Health during a 11-day training program on Improving the Quality of Health Services funded by TNHSRP in October 2019. She worked as Assistant Program Officer in National Health Mission, for Mental Health Program from 2021 Dec to 2022 June. She kicked off the weekly program of “Mana Nala Viyazhan” (Mental Health Thursday similar to Vaccination Wednesday) that is being conducted in all Primary g Secondary Care Institutions across the state with a vision of fighting the stigma against seeking Mental health care and to spread the awareness of priority towards Mental health showcased by our government. The primitive brain – amygdala’s (aka lizard brain) function is that of flight or fight or freeze. Stone age man’s major brain function was that of amygdala’s for his survival as he was frequently exposed to threat of his life by a larger predator in response to which he had to yell or scream his lungs out along with other associated physiological responses. Fast forward to now, our lives have had changes multi folds and after generations of technological advances, we don’t face life threatening events day in day out anymore to the extent that one can easily spend his entire life without encountering a situation where death is staring right in front of us. Does that mean amygdala stopped functioning and shrunk into a vestigial organ in current ages (like appendix)? Answer is No. Amygdala still does that same work every time we are exposed to a threat, only difference is that we now are exposed to emotional threat. Everyday. Are they as serious as life threats that we humans were exposed to, thousands and thousands of years ago? Obviously not, our threats are much simpler now, one need not run away faster than the predators of emotions (triggers), but one still needs to fight them. Similarly do we need to fight to the extent that we have to scream our lungs out? Of course not, we can always choose not to, Yes! You read it right, Yelling is a choice, a conscious one at that not to use it. There are sharp tools and instruments laying around the house we choose not to use it as a tool to show power (coz we know we aren’t kings anymore and there is no kingdoms to be snatched away from us). In the same lines, just coz there is an option of yelling at the other person (usually who is of a lesser rank/ post/ cadre/ age/ salary) doesn’t mean we have to create an imaginary portal and impersonate that of a primitive man who happened to stumble upon a violent fox & howl louder than the fox to show his higher power (though he inherently knew he is actually not). Yelling is not the ability or power to handle the given situation, yelling doesn’t make someone a better leader or manager 1. Raising your voice at the right level and the right time for a right amount of time is the skill of a great leader. There are 2 types of yelling, Professional yelling & Personal. In Professional yelling there is a strong vision, there are emotions but it is well controlled and never lost, no profane or personal words used that would insult the other person’s character. The desired outcome of the listener is inspiration with an edge of bewilderment. If you’ve left them emotionally shaken, or confused, you’ve yelled unprofessionally. It should be a motivating, clear, and positive. If you see the other person/ persons depressed, hating their jobs and didn’t want to work anymore, then it’s time to accept your failure in communication. Your yelling was not done for a betterment but it was done to take control of the other person’s character (abuse of power). If not for doctors nobody else will best know the beauty (inevitable pain) of failing at a given task (saving lives) how much ever we try, at times. It is okay to fail! It is true that, yelling release the negative (fear) energy off a person’s system, but the amount and extent of damage it does to the person or persons who are at the receiving end is completely uncalled for. When we’re in survival mode, we’re not thinking about creative solutions as effectively2. Brain’s limbic system gets activated, blood pressure rises, breathing becomes shallow, and muscles tense up. Since our history factors in, we can start making assumptions. Adrenaline makes everything go faster, and our attention narrows and one starts yelling. When the opponent decide to not yell and ends up holding anger in, the same physiological process takes place. He might not be making a lot of noise, but he is far from calm or looking to improve the situation. The chain of reactions it causes in the minds of those who are exposed to repetitive