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
all
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
untreatable
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
lives
what could be more glamorous than that [Applause]