This World TB Week, we are highlighting stories that matter, those stories of people and communities affected by tuberculosis (TB). Dr. Vijayashree Yellappa, KNCV TB expert, started her work on TB as a clinical practitioner over 25 years ago. Medicine and biomedical sciences have focused on bacteria, medications and tests, and have historically overlooked the emotional toll and the human stories.
When I started, the broad assumption was: “If you have the right guidelines, the right drugs, and the right diagnostic tests, you can cure TB. Patients will comply if you instruct them properly.” – Dr. Vijayashree Yellappa
Many healthcare professionals can relate to her experience as a TB doctor and the universal rhetoric on TB care. Today, she narrates a personal story, one that reflects the impact of stigma, personal fears and social dynamics.
A Case that Haunts Me
Sometimes, even a decades-long career is defined by a few memorable patients. One was a gentle older woman who came to our district hospital late in her disease progression. In the dusty waiting area, I saw her leaning on her grandson for support. She was skeletal, with a persistent, rattling cough. After a cursory exam, I suspected advanced TB. But she had never been officially diagnosed, let alone started on treatment. She told me she had tried to seek help from various places: a local faith healer, a small private clinic that gave her a few injections (without investigating TB), and even a traveling homeopathic doctor. Each time, her money and hope ran out. By the time she reached us, she was so weak that we were battling not just TB, but also severe anaemia and malnutrition.
I arranged for a sputum test. The next day, when she was supposed to bring her sample, she couldn’t produce one in public. She was embarrassed about having to cough forcefully in the presence of other patients. When we finally got the sample and confirmed TB, her family hesitated to enrol her in the government’s DOTS program because they were afraid the rest of the community would discover the diagnosis. They took her back home. A week later, I learned that she had passed away. I remember feeling a profound sense of guilt and frustration. I asked myself, “What more could I have done? Why did the system allow this to happen? Why was it so humiliating for her to simply produce a sputum sample in a well-lit corridor?”
That moment forced me to confront the emotional side of TB care. My medical textbooks had never prepared me for the sting of losing a patient to easily treatable TB simply because no one had considered the patient’s comfort or dignity. I realized that if we do not factor in social stigma, personal fears, and family dynamics, we end up losing the patient’s trust. And once we lose their trust, all our advanced diagnostic tools and regimens count for very little.
Let’s change the narrative, embrace human stories
We are at a turning point for global health and TB care. We can end TB if we work together and direct our efforts to put people at the heart of every intervention.
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