Fifteen–year–old Vina's diagnostic report looks dismal. The lab report shows that the tuberculosis (TB) bacillus in her lungs is only sensitive to two drugs and resistant to eight others.

"The world may debate whether to call her TB an extremely, extensively or a totally drug–resistant form but the fact is how does one treat a child with only two drugs?'' says Ghatkopar–based Dr Amol Manerkar, who is treating Vina. "For all practical purposes,'' he adds, "the child's disease is totally resistant to drugs.''

In the last two months, Mumbai has gained in terms of government attention (a special TB programme), money (the city's TB budget may increase 6 times) and infrastructure (new labs, machines), but the ground reality is grim, say doctors on World TB Day.

Areas in the city with a high population density–such as Ghatkopar and Kurla–are particularly vulnerable. Vina, who lives in Ramabai Colony in Ghatkopar (E), is only one of the three patients whom Dr Manerkar diagnosed with severely drug–resistant TB in the Ghatkopar–Kurla belt in March. One of these new patients is only sensitive to one drug. TB is treated with a combination of drugs. "How can I ask this patient from a modest background to buy this one drug which is not only expensive but cannot guarantee a cure if taken alone,'' asks the doctor.

Mumbai's special TB programme had proposed that patients going to private doctors would also be able to access the government's free drugs. But private doctors say this partnership has not yet started. "I sent two of my patients who have severe drug resistance to government hospitals as they are too poor to afford to buy medicines privately. But they haven't been given any second–line drugs as the government is waiting to test them all over again,'' complains a doctor from Dadar.

In January, Hinduja Hospital had revealed that 12 of its patients had totally drug–resistant TB (TDR–TB). A central team visited Mumbai thereafter and said that it would be premature to label the cases as TDR–TB. However, the Union government gave the green signal for a pilot project in Mumbai to recognize each of the 24 civic wards as a TB district with special staff and infrastructure.

The BMC has diagnosed 683 patients with drug–resistant TB. "As per our protocol, 347 of these patients are in category IV treatment and eight others in Category V treatment,'' says Dr Mini Khetrapal, who is Mumbai's first TB control officer. She is hopeful.

"We have increased the capacity in Sewri TB Hospital to treat drug–resistant TB from 44 to 90 beds. Within a couple of months, all these drug–resistant patients will be covered,'' she says, adding that medicines have already been given to all to ensure that their disease doesn't spread to others. Soon, the BMC will kickstart an initiative of door–to–door surveillance in 10 wards that include Ghatkopar and Kurla areas. "TB is a disease that spreads easily due to overcrowding. The government needs to strengthen its surveillance process to ensure that the disease doesn't spread,'' says a senior doctor at a south Mumbai hospital.

Dr Manerkar points out to hubs such as Thakar Baba colony in Kurla where people work in small, overcrowded shoe–making units. "If one person has drug–resistant TB, the airborne disease can spread to many others. After all, each TB patient can infect 10 others in a year,'' he says.