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1. THE GENESIS
1.2. In the beginning
|1||Among 1000 persons there were 2-8 persons bacteriologically positive, i.e., persons in whose sputa TB bacilli were demonstratable.|
|2||Among 1000 persons, 13-25 showed active or probably active disease, indicating that they were suffering from the moderately advanced disease, requiring treatment.|
|3||The disease was more or less equally prevalent in cities, towns and villages.|
|4||The disease prevalence was lower for females than for males, specially in the age group above 35 years.|
The NSS scientifically revealed what was common knowledge for some time. The government could not be complacent. Action on a massive scale was needed. What kind of action? Who should take it? In fact, the problem was so large that no amount of expansion on formal lines viz., more sanatoria, more TB clinics would suffice. The findings of NSS and TRC revealed that the control of TB would require a totally new approach. The focus should be on the preventive aspects: to find and deal effectively with potential cases. Such work must be done on a community basis, especially in the hitherto neglected rural areas. A National TB Training Centre must be established, to develop the modus operandi of such work and to train personnel who would translate the tasks as envisaged25.
The objectives with which the TRC was established were limited in scope and content; despite being important could not be assigned the work of developing a nationally applicable programme. Intense discussions followed. As stated earlier, Dr Mahler and Mr Stig Andersen were already working in India for the BCG Campaign. They had toured the country extensively and had acquired first hand knowledge about the land, the people and their behaviour. Dr Nagpaul had joined the TB Division in the DGHS which had Dr Benjamin as Adviser. There were many supporters like Mr TG Davies of UNICEF and Dr C Mani of the WHO-SEARO. With Dr Benjamin as the driving force, the government found the necessary support from the WHO and the UNICEF. In 1958, it reached an agreement, most of which is enshrined in the Plan of Operations4. Work began in right earnest for establishing the NTI.
As Dr Nagpaul recalls in 1998: But why did India need NTI? Sometime in 1954, at Jaipur in Rajasthan, I was called to the office of Dr Kelavkar, Director of Health Services (DHS) to discuss the problem of TB. In his office, I was introduced to Dr Halfdan T Mahler, WHO MO, who had come to introduce the Mass BCG Campaign in Rajasthan. I confessed that my knowledge about BCG was quite academic, my interest in the subject was minimal. As a surgeon, I was already neck deep in setting up thoracic surgery facilities in King George V Sanatorium, where I was the Medical Superintendent. I was advised by Dr Lodha, his Deputy, to accept a position in the TB division because in Rajasthan there was hardly any one who knew anything about BCG in early fifties. Giving up surgery for few months, I spent a lot of time with Dr Mahler in the field to find out that he was not a TB worker but a dynamic public health person. He left behind two public health nurses, one of whom was Ms Moller, a sister of Dr Frimodt Moller of Madanapalle sanatorium, to show me how the campaign was to be organised and supervised. In my last meeting with Dr Mahler at Deeg, he asked me why I had taken so keen an interest in a public health oriented programme when I was a surgeon. I told him about my personal disillusionment with surgery for TB and my plan for organising a network of TB clinics in Rajasthan, if only the state government would let me do so. Perhaps, that message got stuck in Dr Mahlers mind as he returned to Delhi.
Early in 1955, I heard from Dr PV Benjamin, asking whether I would be interested in going over to the Centre (GOI) to help organise a network of TB clinics in the country, as recommended by the Bhore Committee. For a couple of years, I had gone round the states looking at how the existing TB clinics were operating, when I was asked to go to West Bengal to report on the care being given to TB patients in the Refugee Camps. Before leaving, Shri Dharam Vira, then Rehabilitation Secretary wanted the impression to be checked that a considerable number of the TB patients were actually masquerading as TB patients in order to get additional benefits. I came back completely confused, frustrated and somehow convinced that we were not doing the right things for TB patients. Dr Benjamin listened to my account in silence: He neither endorsed my view nor contradicted me. However, a few months later, I was asked to work with two WHO experts, Dr Mahler and Mr Stig Andersen, a Sociologist, in order to prepare a plan for control of TB and care of TB patients which is more suitable for Indian conditions. At the end of three or four months of continuous application, we came up with a plan of operations which could be submitted to the GOI and the WHO as well as the UNICEF for approval and support. The Plan centred around the creation of an institute to provide the required answers.
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