Opening of New Delhi TB Centre by Her Excellency, the Marchioness of Linlithgow on 20th November 1940 was one of the most important events in the history of Tuberculosis control in India. New Delhi Tuberculosis Centre was established in 1940 as model clinic in pre independence era by an agreement between TB Association of India (which is registered society under Societies Registration Act no. XXI of 1860 having registration no. 143 of 1938-39) and then Government of India. The aim for establishing NDTB Centre was to provide; a) Diagnosis and treatment of TB, b) Domiciliary service (TB Care) and c) Training and Research.
The story of its establishment is fascinating. Admission in a Sanatorium, supplemented by collapse therapy for pulmonary tuberculosis, was the universally accepted treatment all over the world at that time. We had about 7000 beds in various hospitals and sanatoria in our country but these were grossly inadequate by world standards, viz., one bed per 1,000 population. It was estimated that even if the entire resources of the Government of India and all the provincial governments were spent only on tuberculosis for one year, it would still not be possible to provide the requisite number of beds. Therefore, the first task which the Tuberculosis Association of India took upon itself, after its establishment on Feb. 23, 1939, was to evolve a new and suitable approach to tuberculosis control and to lay down principles thereof and to suggest ways and means for their implementation consistent with our limited resources. It was against this background that the scheme of Organised Home Treatment was evolved.
In the constellation of the patient, the home, and the community, the patient was to be the focus around whom the scientific treatment, organized search for unknown cases from amongst contacts, organized preventive measures in the homes, and organized social relief, represented the totality of curative, preventive and relief measures of the scheme. It was to be run as a service for the family and the community rather than a treatment Centre for the individual alone. Thus the New Delhi TB Clinic was chosen to test the possibility of Organised Home Treatment in the control of TB; within the available limited resources . The scheme though admittedly not an ideal one, was the only realistic approach to the gigantic problem.
A pilot experiment was started in a slum area having horrid living conditions i.e. Municipal Ward No.10, with a population of nearly 25,000. A small basic staff was provided to work in cooperation with the general practitioners serving in the area. A voluntary Care & After Care Committee was formed to provide relief from economic distress, even though the help often was only a token one. The concept soon proved popular, and the clinical work actually facilitated preventive work instead of coming in its way as it was once feared, and co-operation from those who benefitted from the treatment was easily perceptible. The benefits derived the patient in clinical improvement and the economic help provided a cascade effect for the scheme in attracting patients even from other areas. Minor surgery, brought from the sanatorium to the out-patients department of the clinic became the means of mass treatment. In 1941 we started Artificial Pneumonthorax (AP) on 93 patients, and in 1952 the figures for initial AP rose to 529 – total refills during that year being 8,385. In Delhi, this Clinic was also the first to start major surgeries of Pneumolysis and Thoracoplasty. The needs of such an extensive surgical programme from the OPD were met by a phenomenal speed of turn-over of the Clinics 15 emergency beds and as many as 440 patients were admitted to these bed in 1948.
In pre-chemotherapy era, when no anti-TB drugs were available, the emphasis was laid on early diagnosis and prevention of the disease. The Centre advocated and practiced use of collapse therapy, nutritional support as the treatment and BCG vaccination for prevention of disease.
During chemotherapy era, when drugs were available, Dr. B.K. Sikand (the first Director of the Centre) developed and tested the concept of Organized Home Treatment. The same was later adopted as Domiciliary Treatment in National TB Control Programme.
The year 1951 was an important landmark in the history of the development of the institution when with the assistance of Government of India, WHO and UNICEF the clinic was upgraded as the first TB Demonstration cum Training Centre in the country with the added responsibilities of training, research and epidemiological investigations. The formal ceremony of the upgrading of New Delhi Tuberculosis Clinic to the New Delhi Tuberculosis Centre (NDTBC), and the opening of the new extension block was performed by the Honble Health Minister Rajkumari Amrit Kaur, Government of India. The new sections of Epidemiology, BCG vaccination and Statistics were added. Equipment for these sections and also for strengthening the laboratory and x-ray sections were provided by UNICEF. Significant additions to the staff were made. Domiciliary TB services were made available to an approximate population of 6,00,000 residing in its catchment area.
In 1957, the results of the Centres experience presented at the International TB Conference held at Delhi, showed that 80 to 85% sputum conversions could be achieved under the Organised Home Treatment, and that Home Treatment, if properly used, had the potentiality of paying four times larger dividend as against the same amount of money spent on hospital beds. The success of Home Treatment was duly recognized, and it came to receive top priority in our 5-year Plans, second only to BCG.
In the late fifties, the Centre advocated Sputum Clinics at the periphery for case-finding since X-ray facilities could not be made available. This approach was later adopted by National Tuberculosis Programmes in the developing world as well as by WHO as the basic tool for TB case finding.
The Centre acquired all modern equipment such as mobile and static mass radiography units, a start of the art laboratory as well as other essentials. This gave a big fillip to the research activities of the Centre. During 1962 and the following decades, a lot of epidemiological data, vital for drawing up the countrys anti-TB programmes were collected from the allotted area of the centre. A series of clinical trials were also carried out to assess fixed drug regimens suitable for mass application, taking into account not merely clinical efficacy but also cost, acceptability etc. to solve many problems arising in domiciliary treatment of TB. The Centre was also one of the institutions which participated in National sample survey of Tuberculosis prevalence in 1955-58 under the auspices of Indian Council of Medical Research.
When NTP (National TB Programme) was launched in 1962, the Centre was one of the 10 participating District TB Centres in Delhi and covered the domiciliary area of old Delhi providing free diagnosis and treatment facilities. When short course chemotherapy was introduced, many clinical trials for evaluating suitable treatment regimen and duration for Indian population were conducted by the Centre and the same were later incorporated in the national TB control programme.
Another great achievement of the Centre was the establishment of care and after care committees, consisting of lay social workers to look after the social and economic needs of patients and their families in the area of the Centre. These committees functioned with such efficiency that even before provision of free anti-TB drugs was adopted as state policy, not a single patient in the domiciliary treatment area went without drugs for the lack of money.
During this period, there was OPD and a functional ward. The ward was as per NTP guidelines and usually patients were admitted for drug trials. In pre-chemotherapy era, treatment was in form of supporting treatment like calcium, cod-liver oil etc. in addition, collapse treatment was given to patients in the form of artificial pneumothorax/ pneumo-peritoneum done by Lilington and Pearsons APPP set for which patients were admitted in the ward.
When drugs were available, patients were given streptomycin and PAS to start with after launch of NTP in 1962, treatment as per the guidelines was given, OHT (organised home treatment) was first practised in patients of this area which was incorporated in NTP as domiciliary treatment and trained health visitors supervised patients treatment periodically at home.
In 1966, a new chapter opened in the activities of the Centre in another field. in addition to work in Delhi, the Centre included in the ambit of its activities the five northern states in the country. Thus the Centre became a referral centre and patients from all parts of the country could attend here to avail the diagnosis and treatment facilities besides those residing in the catchment area spread over 15 sq. km. mainly in the old walled city of Delhi.
Since 1952, Centre was running MLT Course which was one of one year initially and later on increased to two years duration. But the course was discontinued as we could not get it accredited from technical board as we have only mycobacterial laboratory. The Centre was also conducting TB Health Visitor course of nine months duration which is still continuing as three months course accredited by Central TB Division.
Till 1992, eight longitudinal community based surveys were conducted in the domiciliary area of NDTBC to monitor the trend of disease in the same population. Tools used was MMR (Mass Miniature Radiograph using Mobile X-ray machine) and sputum for AFB by direct smear and rapid culture.
In 1993, on the recommendations of an expert committee, a revised strategy to control TB was pilot tested and was then extended to some areas of the country. As time changed, the development at the Centre also occurred. In the year 1998-99, New Delhi Tuberculosis Centre joined hands in implementation of DOTS strategy under RNTCP. At this time the Centre covered a population of about 0.4 million spread over an area of 15 sq. km. mainly in the old walled city of Delhi. On 24th December 1998 under the Revised National Tuberculosis Control Programme, 4 DOTS cum Microscopic Centres were started, each one covered about one lakh of population. All the DOT cum Microscopic Centres have one health visitor and one laboratory technician for managing the tuberculosis patients. DOTS, a systematic strategy of RNTCP is based largely on Indian research and was adopted with great success at the Centre. In the year 2001-2002, with re-organisation of domiciliary area, half of the area was transferred to LN Chest Clinic and the Centre retained a population of 2 lakh spread over an area of 6 sq. km. of old Delhi.
The Institution won the honour of becoming State TB Training & Demonstration Centre for the state of Delhi in the year 2005 with added responsibilities of training of all the medical and paramedical staff in Delhi on various aspects of RNTCP, with support of State TB Department. However, the 2 lakh population was also transferred to LN Chest clinic but the DOT Centre in the NDTBC premises covering 1 lakh million population continues to be monitored by NDTBC.
In July 2008, Centres laboratory was certified as Intermediate Reference Laboratory for the state of Delhi. This truly is a step forward to development and enhanced recognition of the institution. The BSL-3 Laboratory has been established in our Centre and newer diagnostic tests like Line Probe Assay and MGIT system have been introduced for the benefit of patients for early diagnosis of MDR cases.
The NDTB Centre started TB Supervisor course in 2013. It is a three months duration course whereby students from various parts of the country are selected. Classroom teaching, practical training, field visits and demonstrations are an integral part of the training. During three months period, students are sensitized about various aspects of TB viz. diagnosis, treatment and prevention.
Central TB Division certified our laboratory for rapid culture (2008) First line LPA (2013) and second line LPA (2014). Gene sequencer was added for laboratory service in the year 2018 and our laboratory has got NABL accreditation in year 2018.
During 2020, laboratory started COVID 19 testing and training of microbiologists and technicians of government and private laboratories for COVID testing and their approval. The Microbiologists of the Centre also supervising the activities of these COVID labs by periodical visits to them. Director and three microbiologists are also member of COVID 19 laboratory monitoring team of Delhi.