Friday, September 2, 2016

Drug-Resistant TB and a Physician Hero in India

Today's New York Times described Dr. Zarir Udwadia's campaign against drug-resistant TB. He is earning well-deserved international respect.

Dr. Udwadia is a pulmonologist in Mumbai. He did his medical training in Mumbai and Scotland. When he returned to Mumbai in 1991 he followed his pulmonologist father in starting a private practice. But he wasn't busy enough, and to use his knowledge he started a free clinic for patients with TB. It's now the busiest clinic at his hospital.

In 2011 Dr. Udwadia published a letter describing four patients whose TB infection was resistant to all antibiotics currently available in India. The Indian government's initial response was to attack the messenger, not to respond to the message. But Dr. Udwadia refused to be silenced, and brought the government to recognizing and responding to the medical crisis. The government now pays for drugs that were not subsidized in 2011.

I'm currently teaching medical students who are going into their first clinical rotations, and we've been talking about the patient-physician relationship. From that perspective I was especially moved by this passage:
The tall, lean doctor with a halo of black hair refuses to wear a mask to protect himself, even though his wife says he does worry about contracting TB. “How can you connect to a patient that way?” he asks. Instead, he leaves open his window so there is good air circulation, which reduces the chances of infection.
In the jargon of ethics, his actions are "supererogatory" - morally admirable but above and beyond what is reasonable to expect. If I were advising Dr. Udwadia, I would encourage him to protect himself to ensure that he continues to be available for his ministry to the poor. But his commitment to making a real human connection with his patients is in the best tradition of medicine and the spirit of Mahatma Gandhi.

Here are the closing paragraphs from the article:

When Mrs. Sheikh, a tiny woman wearing a salwar kameez, showed up for her recent checkup, Dr. Udwadia grinned and reached across the table to shake her hand, unable to contain his excitement as he reviewed her tests. They were negative for TB for the third successive year.
Her lungs are so scarred from the disease that she becomes breathless after walking several steps, but she says she is grateful to be alive. She takes a two-day train ride from her hometown in northern India to Mumbai every six months for a checkup.
“I know it sounds like a cliché, but these times are what I live for,” he says. “In India, all patients tell the doctor, ‘You saved my life,’ but with Rahima Sheikh, I know it’s really true.”
 When I see the brilliant, idealistic young medical students next week, I'll hope to convey some of the values that Dr. Udwadiah evinces so powerfully!