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India’s Ticking Time Bomb! | Dr. Zarir Udwadia | TEDxGateway

this is not a glamorous disease it kills

you slowly and agonizingly ravaging your

lungs it stops you breathing makes you

cough up blood look your friends and

family will shun you because it’s

infectious it doesn’t require the

mosquito vector of malaria or dengue

doesn’t need the sexual intimacy of

hiv/aids this is the perfect assassin

all it takes is a cough ah

millions of infectious droplets released

and all you folk in the front row could

be infected I see you collectively hold

you probably figured out by now that

it’s tuberculosis or TB I’m speaking

about haven’t you but did you know were

you aware that this one disease over the

last 200 years alone has been

responsible for the death of a thousand

million human beings that’s a lot of

zeros and that the deaths from TB alone

far outnumber those from smallpox and

plague and cholera and malaria and AIDS

and influenza all put together

Ebola gets all the recent attention

doesn’t it and in the last outbreak

which lasted precisely 15 months 11,000

people died terrible publicized

agonizing deaths but in that same time

window TB killed 2.1 million people you

didn’t hear of those deaths perhaps they

didn’t matter

yet TB is Ebola with wings it flies

through bombay’s crowded local trains

ticketless invisibly infecting thousands

every day with millions of coughs and

we’re a nation of coffers you hear the

cacophony around you every day in India

TB exists on an epic scale it’s our

biggest public health problem it refuses

to go away India houses the most TV

patients in the world TB kills the most

Indians globally one Indian dies of

tuberculosis every minute think of it

that’s a grim statistic a shameful one

unchanged over the decades TB cost this

country twenty four billion dollars

every year something a poor country

can’t afford you take this world map

behind me and watch as I mathematically

stretch it in proportion to deaths from

TB finally we emerge as the superpower

we’ve dreamed of being but but perhaps

in not in the way that we would have

wanted I now need to introduce to you

someone very important my patients Alma

but bear in mind that her story could

have been any of yours in this room

today if you had been infected furtively

does not distinguish between the

chauffeur in the front of the Mercedes

from the CEO at the back or the maid in

her kitchen from the Mensa playing

bridge on her veranda Salma was a

resident of Dharavi the world’s most

densely populated slum and she had spent

the last sixty six zero months before

she met me desperately fighting off her

TB in her quest she had criss crossed

two states you pee and Morosco 1500

kilometers apart on multiple occasions

she had accessed for government clinics

12 private practitioners she had

received countless drugs what could be

more soul-destroying

than taking five years of treatment yet

find yourself getting steadily worse

with each doctor visit not better

what made Salma special why do I want to

devote no dedicate my TED talk to her

not the fact that she had TB sadly

millions do in this country you’ve heard

that it was the type of tuberculosis she

had her pattern of resistance let me

explain it’s a simple concept it turns

out that normal TB is really easy

for me to treat I give you four drugs

for six months and at a cost of eight

dollars of course I can cure you 95% of

times but if you are given the wrong

doses the wrong drugs you take your

treatment irregularly your TB bacillus

will mutate to a drug-resistant form the

drugs won’t work

this kind of TB takes two years to treat

this kind cost thousands of dollars of

course 250 painful injections 15,000

tablets you thought seven days of

antibiotics was too long you stack those

tablets up and that is a 30-story tar

your patient has to climb these are

drugs that make you go blind and deaf

and pack your kidneys up and look if

you’re resistant to two of the drugs we

call you mdro multi drug-resistant TB

and if it’s four we call you X dr which

sounds pornographic but means

extensively drug-resistant TB how many

drugs do you think my patient Salma was

resistant to take a guess 12 and how

many drugs did we have to treat TB at

the time we had 12 we called her totally

drug-resistant TB you know I think Salma

understood this concept of resistance

faster than all of us in this room

myself included because at each visit

she sat across me hopelessness in her

eyes and said the drugs don’t work I

take them but they don’t work they

wouldn’t have she was resistant to them


well we wrote her up in a prominent

medical journal and suddenly suddenly

after decades of neglect TB could not be

kept off the news and perhaps off the

nation’s conscience which was a good

thing because finally these marginalized

deprived patients had a voice we were

determined to cure her we gave her a

cocktail of every available drug left we

operated to remove her destroyed left

lung a pneumonectomy but we were

unsuccessful Salma died two days after

surgery therapeutically destitute of an


form of TB who kills Salma that’s easy

to answer we did collectively

drug-resistant TB represents a

collective indictment of us all as a

society of the tests that are too slow

of the drugs that are too toxic of the

government program that’s underfunded

and inefficient of the private

practitioners who will dole out the

drugs but no compassion no science of

public policy failure and of poverty

all these kills Salma so time for a

reality check friends it’s the 4th of

December today and on our count our

shift already from the start of this

year 10 million globally are sick from

TB suffering from it and 2 million are

dead and a hundred and fifty thousand

Indians with drug-resistant TB that’s

the number we produce shamefully each

year back a train station the size of

this room desperate for a train that

will relieve them instead all they see

is the sign which speaks of delays

disruptions disillusion please Prime

Minister Modi forget your bullet trains

help our patients get on this one and

and and give us the tools we need to

fight this scourge give me the drugs the

labs the funds and give us social change

because TB is the perfect expression of

an imperfect civilization isn’t it

there’s there’s one final thing I almost

forgot to say and that is that Salma was

a mother and she often came with her

four-year-old child this is a haunting

picture I still can’t sleep when I see

it at night of mother and daughter on

one of their multiple visits that’s in

my clinic I turns out Salma had infected

her daughter living with her for 60

months and longer it turns out that

probably the strain was the same totally

drug-resistant strain I have yet to see

a more TB ravaged x-ray in a

four-year-old child in all my 30 years

of chess medicine I know for a fact from

her father that I sha her daughter is

still alive today I know that I Shah is

still coughing therefore today and I

guess that I shall still infecting many

around her in Dharavi scrout communities

you don’t need to be a doctor to read

that x-ray just look into their eyes but

there are thousands of Selma’s and

thousands of Aisha’s and I want each of

you as you leave this room for your

lunch to promise not to abandon them

let’s promise to treat all forms of

tuberculosis irrespective of their

resistance pattern for each death from

TB diminishes me diminishes us because

it’s preventable all we need is

collective will to turn the tide for as

the great urban sinner reminds us from a

thousand years ago he said there are no

incurable diseases there is only lack of

will so I’ll end where I began this is

not a glamorous disease I’m sorry to put

your mood off before lunch I am no

glamorous doctor you’ve probably suss

that out already

but if working together we can save some


what could be more glamorous than that [Applause]

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