The medical practitioner has a major part to play in early diagnosis of pulmonary TB, thorough and systematic treatment of all detected cases till their disease is arrested, prevention of the spread of the disease by BCG vaccination to the uninfected, isoniazid chemoprophylaxis to all children below 5 years of age who are infected and to all adult contacts, health education of the people and finally in the rehabilitation of those who lose their jobs or require comparatively light work. He has to participate in this “Mahayagna” launched to eradicate TB from our land as speedily as possible.

The panel discussion highlighted some basic administrative, organizational, technical and patient factors relevant to the problem of Treatment Default in the TB programme. In urban areas, the proper motivation of the patients, keeping of suitable records, prompt defaulter-action, adequate supply of drugs and the need to provide suitable facilities for patients coming from outside the clinic area, constituted the key administrative and organizational factors affecting treatment default. Regarding technical considerations, there was a need for a more precise definition of a case. It was pointed out that a large proportion of the patients were not really defaulters either because they were not cases of pulmonary TB at all or the patients took treatment from outside the clinic. Also, many so-called defaulters took the treatment after the expiry of the 12 months, while some were resistant to the treatment offered at the time of their first registration. In rural areas, the TB programme could only be strengthened with a concurrent strengthening of the over-all health administration.

There is still some need for rehabilitation of certain groups such as the chronically ill and the drug-failure patients. TB continues to afflict the various low-income groups. As the joint family system is fast disintegrating in India and longevity is increasing, people are to rely on their own resources, especially, when other family members are reluctant to bear the burden of the incapacitated person. None of the sheltered workshops or the colony established near Tambaram in the second Five- Year Development Plan have succeeded because the light industries or handicrafts started at each center were few and people could not find jobs after the training. The problem of rehabilitation is likely to arise among the unemployed and poor, urban population than among the rich or in the rural population. The practical solution to this problem is to get ex-patients trained in small, industrial/ vocational establishments near their homes to avoid difficulties such as daily travelling for long distances. Suggestions have been made to add certain trades to those that are offered for rehabilitation purposes. It is also recommended that social workers, with the doctors, should review the possibility of rehabilitation for every patient soon after the start of treatment to prepare the patient to adjust psychologically to the changed condition and for training.