F IELD NOTES Interpreter of a malady
1
O n the outskirts of Tarwadih vil- lage in Jharkhand’s Latehar district, a path winds through paddy fields and leads to Bhuiantola, a hamlet where Bhuian Da- lit families live. That month, four resi- dents of Bhuiantola hamlet were being treated for tuberculosis (TB), a bacterial infection that mostly affects the lungs. Radha Devi, the village sahiya or fron- tline health worker, an Accredited So- cial Health Activist (ASHA), was walking down the village path and hollered out to Ramavtar Ram, a farmer in his 50s, who was working in the fields. “Nine number medicine course is over for you,” she said. “You will now be on CP.” Ram had contracted TB six months ago and looked emaciated from the infection. Stepping in Devi, who has been supervising Ram’s treatment for the past six months, is not a trained doctor or nurse. She has stu- died only till Class IV and is one of the over 1,325 health activists appointed un- der the National Health Mission’s com- munity health programme in Latehar. “I am not fully literate, but I recognise medicines through a number or an al- phabet in the drug’s name,” Devi said, explaining how she had memorised 13 long and complicated names of TB drugs. TB can be fully cured with a six- month antibiotics course. But India ac- counts for a fifth of TB-related deaths worldwide. In Jharkhand alone, nearly 40 people die of the disease every day. The government has recognised that pe- ople in remote tribal districts, with poor access to nutrition and medicine, are a priority group. Jharkhand’s Adivasi villages lack criti- cal healthcare infrastructure. Rajabau Yole, a World Health Organization TB consultant working in Jharkhand, said that although every community health centre is supposed to have an X-ray ma- chine and a courier service to transport sputum samples for testing, these are missing in most districts. Then there is also the major shortfall of doctors. Raksh Dayal, Jharkhand’s State TB ocer, said the State has only 2,200 doctors (of 3,400 posts) and only half the required contractual health staff for the treatment programme. In Latehar, one of the poorest Adivasi re- gions in Jharkhand, 13 of 23 posts in the district TB hospital have been vacant for five years, including the post of TB med- ical ocer. It is here that health workers like Rad- ha Devi step in to fill a critical gap. Deadly smoke Latehar families are especially vulnera- ble to TB because of their work. When the season’s paddy harvesting is done, they migrate for work to the brick kilns in Benaras in Uttar Pradesh and Auran- gabad in Maharashtra. Here they are ex- posed to smoke that damages lungs and reduces immunity to many infections, particularly TB. In fact, before Devi was chosen as the sahiya in 2007, she too worked in brick kilns. The contractors offer 10,000 to 12,000 as an ‘advance’, but there are no regular wages. “At the kiln sites, away from towns, there are no health fa- cilities,” said Devi. “Besides, many peo- ple do not complete the treatment course. Some don’t like the taste of the medicines, others worry about the side-effects.” In Tarwadih, Devi met Bartu Oraon, who has had a relapse. Then she coun- selled Neetu Devi, a young farm worker and patient, who had recently delivered a baby boy. Devi advised her to cover her mouth while breastfeeding to pre- vent the infection from spreading to her baby. Teaching precautions Devi has been trained by the TB hospital in Latehar. “I ask patients to take pre- cautions, to use ash to cover their spit, or cough only into a gamchha and boil it in water to prevent the infection from spreading.” And to cover the after-taste of drugs, she even buys them packets of namkeen, she said, showing me a small packet of snacks she was carrying for a patient. Among the more serious patients, Mohan Bhuian, also a brick kiln worker, developed multi-drug resistant tubercu- losis, a more deadly form of the disease that develops when a patient gets in- complete or inadequate treatment. This makes the most powerful TB drugs inef- fective, and it needs a protracted two- year treatment with highly toxic drugs. This deadly strain can be passed to oth- ers through close contact via air dro- plets in much the same way as regular TB. Always there “The sahiya has been coming home to give him medicines every day,” said Sita, Bhuian’s wife. Devi travelled twice with her husband to Itki, 110 km away, where the government runs a sanatorium. Af- ter nine months of treatment, Bhuian now had enough strength to walk and had taken the cattle out to graze. But his family was anxious: one of the medi- cines had impaired his hearing. The medicine can also make patients depressed, paralysed, or completely deaf. “Sadly, I have seen Mohan go through all these stages this year,” said Devi. When he started to display these side-effects, Devi went to Itki a second time to act as his counsellor. “Mohan called me and said he feared he was go- ing to go mad,” she said. “I felt he was like my son; I was worried.” The govern- ment staff did not pay her anything but Bhuian later reimbursed her the 400 she had spent on travel. As a sahiya, Devi is supposed to get 100 as ‘incentive’ for each TB case she reports. She has heard that the govern- ment has promised to double the incen- tive and the honorarium this year. But nothing has happened yet. “I have not been paid anything for more than a year,” said Devi. But she was soon up again, ready to see a new patient. The writer received the REACH fellowship on TB. FIELD NOTES Interpreter of a malady In one of Jharkhand’s poorest districts, a village health worker is the only one watching over TB patients BY ANUMEHA YADAV Critical gaps (Clockwise from above) Villagers in Latehar line up to cast votes; students cross a makeshift bamboo bridge on their way to school; Radha Devi (centre) with a patient’s family. Manob chowdhury < > ‘Mohan called me and said he feared he was going to go mad,’ said Devi. ‘I felt he was like my son; I was worried’ < > To cover the after-taste of drugs, she even buys patients packets of namkeen, Devi said, showing me a small packet of snacks
Transcript of F IELD NOTES Interpreter of a malady
On the outskirts of Tarwadih vil-lage in Jharkhand’s Latehardistrict, a path winds throughpaddy fi��elds and leads to
Bhuiantola, a hamlet where Bhuian Da-lit families live. That month, four resi-dents of Bhuiantola hamlet were beingtreated for tuberculosis (TB), a bacterialinfection that mostly aff��ects the lungs.
Radha Devi, the village sahiya or fron-tline health worker, an Accredited So-cial Health Activist (ASHA), was walkingdown the village path and hollered outto Ramavtar Ram, a farmer in his 50s,who was working in the fi��elds. “Ninenumber medicine course is over foryou,” she said. “You will now be on CP.”Ram had contracted TB six months agoand looked emaciated from theinfection.
Stepping in Devi, who has been supervising Ram’streatment for the past six months, is nota trained doctor or nurse. She has stu-died only till Class IV and is one of theover 1,325 health activists appointed un-der the National Health Mission’s com-munity health programme in Latehar. “Iam not fully literate, but I recognisemedicines through a number or an al-phabet in the drug’s name,” Devi said,explaining how she had memorised 13long and complicated names of TBdrugs.
TB can be fully cured with a six-month antibiotics course. But India ac-counts for a fi��fth of TB-related deathsworldwide. In Jharkhand alone, nearly40 people die of the disease every day.The government has recognised that pe-ople in remote tribal districts, with pooraccess to nutrition and medicine, are apriority group.
Jharkhand’s Adivasi villages lack criti-cal healthcare infrastructure. RajabauYole, a World Health Organization TBconsultant working in Jharkhand, saidthat although every community healthcentre is supposed to have an X-ray ma-chine and a courier service to transportsputum samples for testing, these aremissing in most districts.
Then there is also the major shortfallof doctors. Raksh Dayal, Jharkhand’sState TB offi��cer, said the State has only2,200 doctors (of 3,400 posts) and onlyhalf the required contractual healthstaff�� for the treatment programme. InLatehar, one of the poorest Adivasi re-gions in Jharkhand, 13 of 23 posts in thedistrict TB hospital have been vacant for
fi��ve years, including the post of TB med-ical offi��cer.
It is here that health workers like Rad-ha Devi step in to fi��ll a critical gap.
Deadly smoke Latehar families are especially vulnera-ble to TB because of their work. Whenthe season’s paddy harvesting is done,they migrate for work to the brick kilnsin Benaras in Uttar Pradesh and Auran-gabad in Maharashtra. Here they are ex-posed to smoke that damages lungs andreduces immunity to many infections,particularly TB.
In fact, before Devi was chosen as the
sahiya in 2007, she too worked in brickkilns. The contractors off��er ₹��10,000 to₹��12,000 as an ‘advance’, but there areno regular wages. “At the kiln sites,away from towns, there are no health fa-cilities,” said Devi. “Besides, many peo-ple do not complete the treatmentcourse. Some don’t like the taste of themedicines, others worry about theside-eff��ects.”
In Tarwadih, Devi met Bartu Oraon,who has had a relapse. Then she coun-selled Neetu Devi, a young farm workerand patient, who had recently delivereda baby boy. Devi advised her to coverher mouth while breastfeeding to pre-vent the infection from spreading to herbaby.
Teaching precautionsDevi has been trained by the TB hospitalin Latehar. “I ask patients to take pre-cautions, to use ash to cover their spit,or cough only into a gamchha and boil itin water to prevent the infection fromspreading.” And to cover the after-taste
of drugs, she even buys them packets ofnamkeen, she said, showing me a smallpacket of snacks she was carrying for apatient.
Among the more serious patients,Mohan Bhuian, also a brick kiln worker,developed multi-drug resistant tubercu-losis, a more deadly form of the diseasethat develops when a patient gets in-complete or inadequate treatment. Thismakes the most powerful TB drugs inef-fective, and it needs a protracted two-
year treatment with highly toxic drugs.This deadly strain can be passed to oth-ers through close contact via air dro-plets in much the same way as regularTB.
Always there“The sahiya has been coming home togive him medicines every day,” said Sita,Bhuian’s wife. Devi travelled twice withher husband to Itki, 110 km away, wherethe government runs a sanatorium. Af-
ter nine months of treatment, Bhuiannow had enough strength to walk andhad taken the cattle out to graze. But hisfamily was anxious: one of the medi-cines had impaired his hearing.
The medicine can also make patientsdepressed, paralysed, or completelydeaf. “Sadly, I have seen Mohan gothrough all these stages this year,” saidDevi.
When he started to display theseside-eff��ects, Devi went to Itki a secondtime to act as his counsellor. “Mohancalled me and said he feared he was go-ing to go mad,” she said. “I felt he waslike my son; I was worried.” The govern-ment staff�� did not pay her anything butBhuian later reimbursed her the ₹��400she had spent on travel.
As a sahiya, Devi is supposed to get₹��100 as ‘incentive’ for each TB case shereports. She has heard that the govern-ment has promised to double the incen-tive and the honorarium this year. Butnothing has happened yet. “I have notbeen paid anything for more than ayear,” said Devi. But she was soon upagain, ready to see a new patient.
The writer received the REACH fellowshipon TB.
FIELD NOTES
Interpreter of a maladyIn one of Jharkhand’s poorest districts, a village health workeris the only one watching over TB patients BY ANUMEHA YADAV
Critical gaps (Clockwise from above) Villagers in Latehar line up to cast votes;students cross a makeshift bamboo bridge on their way to school; Radha Devi(centre) with a patient’s family. Manob chowdhury
<>‘Mohan called me andsaid he feared he wasgoing to go mad,’ saidDevi. ‘I felt he was likemy son; I was worried’
<>To cover the after-tasteof drugs, she even buyspatients packets ofnamkeen, Devi said,showing me a smallpacket of snacks
