REACH Lilly MDR-TB PartnershipMedia Fellowship Programme

2014-15

REPORTINGON

TUBERCULOSISFROM ACROSS INDIA

A third compendium

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REACH Lilly MDR-TB Partnership Media Fellowship Programme

Every day, almost one thousand people die of TB in India. Despite being a preventable and treatable disease, tuberculosis remains a major public health challenge and India bears the highest TB burden in the world. There is a growing concern about the increase in cases of drug-resistant TB and its subsequent social and economic impact on society. All of this is compounded by a general lack of awareness of TB and its consequences—most of all, that TB is completely curable if timely and high-quality diagnosis and treatment can be accessed.

The media has a powerful role to play in informing the public about prevention and control of TB in India. Accurate, sensitive, effective and timely journalism can improve public understanding of TB, increase access to TB services and dispel the many myths and misconceptions that persist about the disease. Since 2009, the REACH Lilly MDR-TB Partnership Media Initiative has worked closely with journalists across India to improve the quality and frequency of media reporting on TB.

The Fellowship Programme

The Media Fellowships were constituted in 2010 to provide working journalists from local language newspapers and magazines across India with support to undertake in-depth analysis of various aspects of TB. These fellowships are intended to encourage journalists to explore TB as a critical public health concern, by identifying and telling stories that have remained untold. In the years since its inception, 50 journalists from across the country have written over 180 stories on a range of TB-related issues, and in multiple languages.

support to a senior journalist from any national newspaper, with the objective of improving media focus on TB-related issues at the national and policy levels. In the two years since, senior journalists, Dr Prasad of The Hindu and Dr Radheshyam Jadhav of The Times of India have written 40 stories on childhood TB and urban TB respectively.

This compendium brings together a selection of stories by our 2014-15 Fellows.

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National Fellowship

Dr Radheshyam Jadhav Assistant Editor, The Times of India, Pune, Maharashtra

Local Language Fellowships

Dev Vyas, Freelancer, Jodhpur, Rajasthan

Avinash Rawat, Senior Reporter, Dainik Bhaskar, Indore, Madhya Pradesh

Geetha PT,

Jhilam Karanjai, Senior Correspondent, Ei Samay (TOI), Kolkata, West Bengal

Monuranjan Bori, Sub-editor, Dainik Janambhumi, Guwahati, Assam

Pradip Srivastava, Senior sub-editor, Amar Ujala, Jhansi, Uttar Pradesh

Praveen Prabhakar,

Rajiv Kumar Pandey, City Reporter, Prabhat Khabar, Ranchi, Jharkhand

Rohit Verma, Sub-editor, Rajasthan Patrika, Bhopal, Madhya Pradesh

Sajil C, Sub-editor, Mathrubhumi Aarogyamasika, Calicut, Kerala

Fellows 2014-15

REACH Lilly MDR-TB Partnership

Media Fellowship Programme

Ten journalists from across India were awarded the REACH Lilly MDR-TB Partnership Media Fellowship for 2014-15 after a competitive evaluation process. In all, over 40 applications were received from experienced journalists across the country. All those chosen as Fellows attended a two-day intensive orientation programme in Chennai, meeting scientists, learning about TB, and brainstorming on story ideas. On returning to their newsrooms, each Fellow identified TB-related themes specifically relevant to his or her local readers, whether in Madhya Pradesh or in Assam. Over a three-month Fellowship period, ten Fellows researched and published over forty stories exploring different aspects of TB.

PRADIP KUMAR SRIVASTAV PRAVEEN PRABHAKARMONORANJAN BORI

RAJIV PANDEY ROHIT PRASAD VERMA SAJIL C

DEVKINANDAN VYAS V G GEETHA JHILAM KARANJAIAVINASH RAWAT

2014-15 FELLOWS

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The Fellowship Process

A call for applications to the Local Language Fellowship Programme is announced in August every year, inviting applications from Indian journalists who either work with or are associated with (in a freelance capacity) any local language newspaper (i.e. other than English); and who have demonstrated interest and an ability in reporting on health issues. This year we received over 40 applications from across the country; ten Fellows were chosen after a careful and rigorous evaluation.

All chosen Fellows receive Rs 30,000 to support any related travel and research expenses. Over a period of three months, Fellows are responsible for researching and producing a minimum of three in-depth stories on a TB-related theme or issue. All Fellows attend an orientation workshop in Chennai,

Tuberculosis Control Programme in India, challenges in TB control and also learn to interpret data and

On returning to their respective newsrooms, they are expected to identify TB-related issues that are

announced in April every year.

For more information on the Fellowships, please visit www.media4tb.org

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R A DH E SH YA M JA DHAV STORY

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R A DH E SH YA M JA DHAV STORY

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AV I NASH R AWAT STORY

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CONCERN

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TRANSLATION

TB patients dying daily due to lack of nutritionMeant to Get Ration Worth Rs.50/- daily

The rule to give TB patients nutritious food along with medication is being ignored in the region. Here, patients are given nothing in the name of nutritious food, whereas they are supposed to get Rs. 50/- for this every day.

Patients Get No Ration Despite Provisions

Irony: TB patients not getting support of nutritious foodDeaths are taking place almost every day in Indore due to TB patients not getting nutritious food. 38-year-old Ramsingh Kushvah, who lives in Samver Road industrial area suffers from TB. He gets medicines free of cost from the government. 42-year-old Govind,

But merely free medicine is not enough to treat TB. To become healthy, they need a nutritious diet along with the medication. But it is the breadwinners of the family who themselves have fallen prey to the disease. Taking the medication regularly affects their capacity to work as they don’t get nutritious food. Thousands of patients like Ramsingh, Govind and Amit are struggling because of lack of a nutritious diet.

Ignoring nutritionEvery year the government spends crores of rupees providing free medicine to TB patients, but ignores the need to provide nutritious food which is necessary for them to become healthy again. There are provisions in the region for giving patients ration worth Rs.30/- in ESI TB hospitals and ration worth Rs. 50/- in MY and other hospitals. This means that patients are meant to be served a meal one time worth Rs.15/- in ESI hospitals and Rs.30/- in MY and other hospitals. It is essential to take fruits, milk, green vegetables and other healthy food along with a normal diet.

Nutritious diet essential

“Along with completing their course of medication, it is extremely essential for TB patients to have a nutritious diet.” – Dr. Sanjay Vaidya,

Superintendent, ESI TB Hospital

AV I NASH R AWAT

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matter.” – Narottam Mishra, Health Minister

Every month there are more than a dozen deaths in Indore due to TB.

Many provisions in other regionsThere are various similar schemes in operation in Tamilnadu, Karnataka, Andhra Pradesh, Punjab, West Bengal and Delhi. In Tamilnadu, homeless TB patients are given Rs.1000/- per month.

No separate facility for patients’ food“There is no separate facility for providing food for TB patients. When they get admitted to the hospital, they are given the same rations

as other patients in the hospital. They have to look after their own food requirements.” – Dr. Sharad Pandit, Joint Director

No provision from administration“Medication is available free of cost for TB patients, but no provisions related to giving them ration have been made. While patients are

TRANSLATIoN AVINASH RAWAT

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SToRyDEV VyAS

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TRANSLATIoN DEV VyAS

Mining TB from MinesUnsafe mining: Mine owners prosper, Workers suffer

The sandstone mines situated in the city and nearby areas may be showering mine owners with riches, but for the workers who work here, they are a cause of life threatening diseases like TB and Silicosis. The situation is such that neither the Mining Division nor the medical authorities are paying attention to this. The result is that unsafe mining conditions are claiming the lives of mine workers.

Hard working mine workers always work with the shadow of a possible accident looming large. The workers of this mine have fallen prey to TB and Silicosis. The government has not created any welfare scheme for the workers working in deep mines, and neither have they been included as a part of any other schemes. What is surprising is the fact that a few years ago the government gave mine owners a directive to get these workers insured, but due to lack of monitoring, this was never carried out. Most workers remain devoid of this facility even today. Treatment being given assuming tbIt is now common for mine workers to suffer from Silicosis, but the symptoms of Silicosis and TB are similar. Under such circumstances, even doctors fail to recognize this at the primary stage. Often the treatment for TB is even started off. Though a few years ago, after the intervention of the Supreme Court and Human Rights Commission some mine workers were given health checkups, this too

because of not getting treatment on time, some of them have died.Waiting for a scheme….There are various schemes for unorganized labourers created by the state as well as central government, but it is unfortunate for mine workers that there is no scheme for their welfare at all. In 2007-2008, the “Vishvakarma Pension Contributory Scheme” was

place in this list as well.No Insurance done…There are around 6102 mines listed in Jodhpur district. There are more than 30,000 labourers and workers employed in these mines. For their safety, the Mining Division had directed the owners of all these mines to get these employees and workers insured. What is surprising is the fact that even after such a long time, only a few of the labourers have been insured so far.

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Gave a directive and forgot about itAccording to Rana Sengupta, head of the mine workers’ organization, because of the negligence shown by the Mining Division, thousands of labourers are compelled to work under the shadow of fear today. A year ago, the Division did issue a directive for mine owners to get insurance for the workers, but never followed up with any monitoring to see if it was done or not and neither did they take any action against the mine owners who had not done so. Under these circumstances, the entire burden of the division’s negligence falls upon the mine workers. The gift of diseaseWorking in mines may ensure basic sustenance for workers, but they also end up struggling with diseases throughout their lives. Most of them end up in the clutches of diseases like TB and Silicosis. Doctors believe that if people work in these mines for 4 to 5 years at a stretch, they start developing symptoms of Silicosis. Doctors say that TB lowers the body’s immunity levels quite a bit and hence patients end up suffering from some or the other ailment throughout their lives.

TRANSLATIoNDEV VyAS

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V.G. GEETHASToRy

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SToRyV.G. GEETHA

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Tuberculosis scaring Tamil NaduWhat are the reasons for increasing number of TB patients?

old child called Shwetha. After the devastating tsunami in the year 2004, they shifted to this colony. Shwetha liked studying science and did very well in that subject, and was able to join a nursing programme. She left her village and joined a college over 12 hours away, where unfortunately she fell sick often and began to lose weight.

When she came home on vacation, they took her to the doctor. With the routine tests, doctors were not able to diagnose her disease. Doctors advised her to take a sputum test and chest X-ray. They found Tuberculosis Bacterium in her sputum test. The chest X-Ray showed that her entire chest was covered with mist. Even though they started administering medicines immediately, they were not able to save her life.

If we had diagnosed her much earlier, we would have saved her life”, said V.P. Durai, Assistant Director, Directorate of TB Division,

India has 10 lakh TB patients. Already 40 percent of the Indian patients are suffering from TB. Bacteria patiently sleep inside our

eighty thousand four hundred and seven patients enrolled in Government Hospital for TB treatment.

When we compare with other states, availability of treatment facility, diagnostic facility, medicines distribution network are better

V.G. GEETHATRANSLATIoN

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visit these areas, at least one person in each family is infected by TB. Mr. Paramasivan of this area worked in Chennai as a biochemist in a laboratory. He often suffered from fevers during the night and his bone joints started paining. He left his job and came back to his native place. When they consulted the government hospital and did tests, they found he was suffering from TB. “I am married, living with my wife and a one year daughter. They depend on me for their livelihoods. The DOTS provider comes to my home on alternate days to give medicines. If others come to know about my disease what will they think”, he says.

months, we found him and convinced him to take medicines. We also counseled him that if he took medicines regularly he could overcome the disease. Within this period, he developed secondary infection, only when we administered drugs for MDR-TB did he recover”, said a DOTS worker.

Mr. Mani from Melapavoor lives with his family (wife and children) in Colony house. He does concrete work. If he works six hours a

has got reduced to 41 kilogram. The DOTS worker distributing medines in his area took him to the government hospital. After the

MDR-TB. “I was not able to get out of my home. With the children, we need to eat eggs and milk and nutritious food. I am working as a coolie and providing everything to him” said his wife.

Susai Pandian from Vellaikal village owns a lot of land. He is very wealthy and has a big home. He was recently diagnosed with TB. If others come to know about his TB, it is a shame for the family. So he decided not to go for treatment in the beginning. With the help of government hospital staff, he agreed to take medicines and has been continuously taking medicines in the last few months. With proper treatment and nutritious food, there is lots of improvement in his health. He is very careful and is properly following the doctor’s advice.

In this area, many young girls in the age group of 20 to 25 years get affected by TB. “When we went to hospital for some treatment, they asked us to take chest X- Ray and sputum tests. They told we were suffering from TB, so there was a need to take medicines for

TRANSLATIoNV.G. GEETHA

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According to a health worker Mr. Muthuraj, “the attitude of the people in this area is a bigger challenge. They are thinking that it is shameful for them and their family. Apart from this, we are having so many day-to-day administrative hurdles and problems. Only one person is there to to distribute medicine around Tenkasi over a 80km radius. The entire region is having more than 80 lakh population with four administrative blocks. With low salaries and limited petrol allowance, we are struggling. We are doing self service as DOTS worker. As a worker, it is not possible for us to keep the medicine at home. There are no primary health centres for this purpose. If we want to keep it in ankanvadiankanvadi worker takes leave on that day it is not possible to give it to the patient. Like this we have so many operational hurdles”.

With nutritious food and regular treatment, one can completely recover from TB. “We provide medicines to patients without the

medicines were not suiting me. I was passing urine in dark red color. My skin became dark. Because of this symptom, I stopped taking medicines. In the six month treatment, one needs to take seven medicines at a time. Especially Rifampicin looks light red colour but when we take this, urine will go reddish brown. So I stopped eating medicines”. Like him many stopped medicines due to scary side effects.

Dr. Durai proved an explanation about these issues. “Within two weeks of taking medicines, 99 percent of bacteria will be killed. After that, one feels hungry. During this time one needs to take nutritious food, fruits, vegetables. Low-income people are not able to afford these. So they go to work in rubber farms in Kerala far away. So we are not able to follow up. One percent of bacteria left in the patient’s body starts attacking more vigorously than the previous time”.

V.G. GEETHATRANSLATIoN

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The government is providing Rs.1000 as assistance to TB patients. To avail this assistance, they need a farmer ID card. If one owns land it is not possible for them to have a farmers card. The government must understand that TB is not only attacking people with

TRANSLATIoNV.G. GEETHA

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SToRy JHILAM KARANJAI

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Cooks-cum-TB patients at KS Ray TB hospital of KolkataThey are cooks. They are TB patients as well.

these patients cook their own choices every day.

The list is long and enviable. It usually comprises of Sarso-Sheem, Chicken Kosha, Dal Bora or Chonu Macher Jhal to mention a few! Actual daylong activities of these TB patients will obviously put patients of other hospital to envy.

It is not unusual for patients at state run hospitals to shun the diet served for the low quality of taste and nutrients. But it is quite unprecedented and unique for patients to take up the responsibility of cooking their own choices. But that is what has been happen-ing at a hospital in Kolkata, the state capital of West Bengal. Added to this, realizing the existence of a mini-market amongst patients vegetable vendors are routine features at the hospital almost every alternate day. Buying-selling of food items go on like any other residential complexes.

State health department’s hospital regulations don’t permit this for fear of risking patient’s safety. But for cooking their choosiest items the patients use ‘electric heater’ inside the ward which is completely illegal. They have also expressed fear in private that the quality of food has forced them to this extreme position. Though these have been happening under their nose the hospital authority has kept their eyes closed and mouth shut.

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been initiated. Patients here complain that the food dished out to them is not up to the mark. They complain that the diet quality is

that nowhere has there been any mention of any special diet for TB patients. According to them even the World Health Organisation doesn’t stipulate such norms in normal circumstances. Special nutrition based diet was followed during those days when DOTS was

JHILAM KARANJAI TRANSLATIoN

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electric heater to cook food regularly. They buy the eatables in groups.

Almost every morning in the area adjacent to hospital vendors are found shouting out prices of vegetables and brisk bargaining goes on.

patients are there. Out of them 9 are XDR patients and 25 are MDR patients.

some years. Due to this long stay the hospital diet appears boring to them. It is bound to have an effect on the taste buds. So we don’t stop this practise.’

TRANSLATIoN JHILAM KARANJAI

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MoNoRANJAN BoRI SToRy

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TB and povertyIt was October 28 of 2014. The sudden death of a teenage girl shocked the villagers. The death created ripples around the village as

of her age she never used to roam around in the neighborhood. It was probably one of the reasons why her disease and her ailing health went unnoticed. But her untimely death was surely a shock for the village. The sudden death of the young girl seemed quite

Four years back her brother too passed away at the age of just 22. The young man went out of the state to work, to earn a livelihood. When he died, people thought that he must have caught some disease at his workplace. Some of the villagers thought it was a witchcraft or handiwork of some evil spirits. So, they advised the family to perform some rituals to do away with the evils.

Relatives and well wishers gathered at her place. Her body was taken away by the relatives to perform the last rites; some of them offered to wash the bamboo platform in the sleeping area with warm water. Much later, when her grief stricken father was asked about the girl’s death, the villagers came to know the cause. The cause of her death was hidden by the family. As the truth was revealed, it left the grief stricken villagers in a state of panic.

This is the story of a far away village situated at about 330 kilometres distance from the capital city of Guwahati, Assam. The sleepy tribal village, inhabited by the Mishing community is dotted with Chang Ghars (traditional house on stilt) on the banks of the river Gelabil (a tributary of the Dhansiri which meets the mighty Brahmaputra in the course) is in pristine interiors of Bokakhat sub-division, Golaghat district.

TB occurred in the family some years back. Rongmol, the father of the girl (name has been changed) says that he is completely

incessant cough, pain in the chest, problems in breathing and later on he started losing weight. He went to the nearest govt. health centre which is ten kilometres away. The doctor diagnosed him as infected by TB. and referred him to the Golaghat district civil hospital. The local health centres normally do not keep TB medicines in store. Hence, the TB patients here are instructed to go to the civil hospital for medicines. They get the prescribed medicine for some days against their name after registration. Then they keep

TRANSLATIoN MoNoRANJAN BoRI

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those stored in local hospitals and go there to take the regular course. When the stored medicine stock gets over, the patient needs to show the wrapper at the civil hospital again to get some for next few days.

The father brought the medicines for his son in the initial months, but he could not continue doing so as he was the sole bread earner of his family. When he went to get medicines he had to leave his days’ work behind as the hospital was too far. The medication for his son got discontinued in the process. Irregular medication worsened Prahlad’s health. As a result he died. But in case of his

devastated because he took the utmost care for her medicine.

diseases as her body was battered by TB already. She died after four years of suffering.

The most dangerous fact about the family is - besides his wife and the little boy, Rongmol himself also got infected by TB. This is

Rangmol was reluctant to disclose the TB status of his elder children fearing exclusion by the villagers. He hid the fact. The fear of

He is depressed, disheartened because he has lost the zeal to live. He said, ‘I don’t have money to run after doctors. I neither have physical strength nor the spirit to live after losing two grown up children. I have lost every hope to live. I just don’t know what to do now. I am tired and I wish all of us were dead.’

need to be cautious. At least 15 patients have so far been detected by the health centre. Two of them are suffering from MDR-TB. One is treating himself privately in Guwahati. The rest are being treated and are out of danger according to him. The prevailing socio-economic problems, leaving things to destiny, alcohol abuse, and unhygienic living condition are the reasons for the spread of TB in the area. Awareness generation is of utmost importance for the area. He also admits that there are many such unreported cases.

In Golaghat district, there is one hospital, 32 primary health centres, 14 dispensaries, 212 sub health centres,1 sub divisional hospital and 5 CHCs. It is reported that in India 750 people die of TB daily. According to WHO, in 2012, at least 450, 000 people are said to have MDR-TB and most of them are from Russia, China and India. At least 170,000 people in the world died of MDR-TB in 2012.

MoNoRANJAN BoRI TRANSLATIoN

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There are 11 centres in Golaghat where treatment for TB is delivered. Those are Golaghat TB. Centre, Merapani CHC, Kamarbandha

TRANSLATIoN MoNoRANJAN BoRI

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PRADIP SRIVASTAVA SToRy&

TRANSLATIoN

An increase in TB patients every yearIn 2012, 1245 and in 2013, 1295 patients tagged

Jhansi: Despite the DOTS programme in operation, the number of TB patients is increasing every year. The TB virus spreads rapidly through air, breath and spit. That is why the Health Division has made the process of putting an end to TB a part of the national campaign. Under this campaign, BCG vaccinations are given to children. Along with this, DOTS and DOTS Plus medications are made available to infected persons. Under

free of cost to patients. For patients living in remote areas or for those who cannot reach the hospital, medication is given at home through DOTS providers.

Despite this, the disease has still not come under control due to negligence towards the treatment, leaving the treatment midway and general lack of awareness. According to the District TB Control division, in 2012, 1245 patients were tagged, whereas in 2013, this number went upto 1295. In

and are undergoing treatment.

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PRAVEEN PRABHAKARSToRy

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TRANSLATIoNPRAVEEN PRABHAKAR

Fight incomplete without making students awareIndia may have taken on a decisive battle against TB with the help of the World Health Organization, but most of our youth still does not see this disease as a major threat to public health. The truth is that every year 3 lac people die of TB, out of which most are adults

On 19th

new argument, claiming that while smoking has reduced in developed countries, it has increased in developing and underdeveloped countries, especially amongst the youth in particular, and the threat of an epidemic of TB looms large here. If Dr. Paul I. Fujiwara’s words are to be considered in the context of India, which is also a developing nation, then a frightening scenario and it’s possible

has the world’s largest youth population. In the age group of 10 – 24 years, we have 35,60,00,000 people. This age group generally consists of student population – adolescents between the age group of 10 to 18 years, and youth between the age group of 18 to 24 years. Two crores of the nation’s youths are studying in various higher education institutions, and more than 10 crore youngsters are completing their school education. If their young age full of possibilities falls under the shadow of a threat, it is extremely worrisome.

cigarette or beedi smoking which is included, but also consumption of tobacco in the forms of chewing tobacco, eating gutkha and even using gulmanjan for cleaning one’s teeth. In 1918, Dr. G.B. Web had established through a clinical study that TB and smoking

do not.

Various Indian medical research studies indicate that smoking does play a role in one-third of the nation’s deaths caused by TB. Actually, smoking causes harm to the lungs and increases the chances of getting infected by TB. The Indian govt. has taken on a decisive battle against TB with the help of the World Health Organization, but most of our youth still does not see this disease as a major threat to public health. The truth is that every year 3 lac people die of TB, most of whom are adults and youths. One lac

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Organization, if a TB patient is not treated in time, he/she can end up infecting 10-15 people in a year. In a country like India, there is general negligence towards health right from the individual level to the govt. level, and general symptoms of TB such as coughing are often ignored. The risk of this disease spreading in public places is higher, as the TB bacteria can be spread to people by coughing. Thereafter, adolescents and youths who are active and passive smokers fall prey to this. This is a vicious cycle.

According to the World Youth Tobacco Survey, more than 13% of Indian students between the age group of 13-15 consume tobacco in some or the other form. In the Indian Journal of Community Medicine’s survey of 2008, it was found that 28% of students of a medical college in Lucknow smoke, whereas one would have hoped that medical students would take care of their own health and also contribute to keeping others healthy. It is obvious that all the students who smoke would have already come in contact

make its students in schools and colleges TB free. Merely making schools and colleges smoking free zones will not work. Health awareness also needs to be spread at the local level. Information about diseases related to smoking, such as TB and cancer will have to be disseminated in schools and colleges. For such programmes, apart from doctors and school administration, well-wishers and students will also have to be roped in.

PRAVEEN PRABHAKARTRANSLATIoN

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RAJIV PANDEy

capital. Out of these, two were in the age group of 14-16. Apart from this, an 11 year old girl of Pahadi Chola, a 14 year of child of Kokar and a child from Harmoo Colony were also included. Last year four people died due to MDR-TB. MDR-TB is diagnosed by a phlegm culture test, drug sensitivity test, and gene expert test.

Currently the capital has 129 MDR-TB patients

registered in the district. This year, so far 19 MDR-TB patients have been registered. Out of these, 15 patients are below 20 years in age. 5 out of these have already died.

First patient diagnosed in 2010

treatment was also started, but in the end he died.

Disease spreads by contactAccording to Dr. D.K. Jha, if a healthy person comes in contact with an MDR-TB. patient, he or she also gets MDR-TB. This means that an MDR-TB. patient needs to exercise great caution. It is possible to treat MDR-TB but patients need to take the medication for the

What is MDR-TB

When ordinary TB medicines stop being effective on a patient, he or she is called an MDR-TB patient. This happens when a patient does not complete the course of medication, and leaves the treatment midway. Sometimes a patient straightaway gets MDR-TB.

“All efforts had been taken to save the lives of those died from MDR-TB. MDR-TB is a challenge

for the entire world. Earlier it could not diagnosed. Now facilities for diagnosis are there,

– Dr. Yukhi Sinha,

Dangerous….. Last year four

from in the capital

SToRy&

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RoHIT VERMASToRy

09/02/15 12:59 pm , - TB patients identifying by contract tracing -Patrika.com

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TRANSLATIoNRoHIT VERMA

Contract tracing used to identify, dots used for saving livesBhopal: After marriage, Pramilabai came to her husband’s house with great aspirations and big dreams. Her dreams started coming

When after having three daughters she gave birth to her son, Ratan, she was overwhelmed with joy. Despite working hard day and night she had no complaints and was living a happy, healthy life.

Meanwhile, the shadow of the disease known in society as TB, Tuberculosis or disease by touch, quietly entered her house. Her happiness became overshadowed by this disease. She never even realized when she fell into the clutches of this disease.

the disease and save herself as well as her four children.

Case 1Pramilabai, a resident of Mahidpur village, Raisen district in Madhya Pradesh currently stays in Bagmugalaya, Bhopal. According to Pramila, she developed a cough soon after marriage, which she got treated by a private doctor in her village who gave her a packet of medicine for Rs.25/-. This supressed her cough for some time, but the actual disease kept increasing. After this, she got herself treated at various private doctors, but her cough kept getting worse instead of going away, and slowly she became weaker and weaker. When her condition became serious, she got a checkup done at a govt. hospital in Bhopal, where she was diagnosed with TB.

After the checkup, her treatment was begun. Using contact tracing her other family members were tested as well and it was found that her 22 year old daughter Saroj, her second daughter, 16 year old Ladli; her third daughter Suraksha, aged 12; and her 9 year old son Prabhu (all names changed) also had TB. Treatment was begun for all of them.

Today they have all been cured. Two years ago, Pramilabai had taken medication for six months. After this she continued medication for eight months and currently is completely cured. Throughout this entire process, her husband gave her moral support as well as help. He stood by her side at every step.

Case 232 year old Pitabai, resident of Gairatganj Pandoni village, Raisen district, Madhya Pradesh had fallen prey to TB eight years ago. In spite of her getting fever along with a cough, her family members did not get her treated. Later, she came to Bhopal with her husband. Here, when she began vomiting blood she was taken to the Jai Prakash government hospital.

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Her checkup revealed that she had TB, and her treatment was begun. Contact tracing was done for all family members who had been

old husband Masram also had TB. After the checkup, treatment for all of them was begun. Currently this family lives in Bagsevaniya in Bhopal.

These are just a few examples. Today, there are lots of cases of families who have gotten fully cured and are living healthy, happy lives. This has all been possible thanks to the use of contact tracing to identify patients, get them hospitalized and counseled, after which they have regularly taken the DOTS dosages.

not getting treated on time lead to the ruin of many families. On the condition that their names and identities would not be revealed, he told us that there is a family in old Bhopal which lost 13 members to TB. There are also many families which died untimely deaths and were completely wiped out due to TB.

He told us that the situation has changed quite a bit now compared to earlier times. Contact tracing can be used to check if other family members of TB patients suffer from TB or not.

Tuberculosis

This is an age old infectious disease. It has been referred to as “Raj Yog” in the Vedas. While it is known as “Tapedik” in villages, in cities it is called TB or Tuberculosis. It is spread by bacteria called Microbacterium Tuberculosis.

Tubercular bacilli mainly affect the lungs, which causes Pulmonary TB. It also affects other body parts of some people. It is the biggest health problem in India.

Contact Tracing

Under this, the sputum of TB patients’ family members (those living with them) is tested to check if they are suffering from TB or not. Mainly this is extremely important for people who have been coughing constantly for one or two weeks. Under such circumstances, they are checked and the transmission chain which spreads the infection from one person to the next person is broken.

RoHIT VERMATRANSLATIoN

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SAJIL C SToRy

34

SToRy SAJIL C

35

SAJIL C TRANSLATIoN

Kerala faces new challengesImproper use of medicines and patients discontinuing the prescribed medication for the prescribed period of time are major challenges

control is becoming more and more complicated and turning out to be a serious public health issue.

Bhaskar came to the hospital with his two-year-old daughter. The thirty-two-year old man and his family from Bihar reached Malappuram only a few months back. He worked as a construction helper under a building contractor. His daughter was suffering from persistent cough for a few months. As per the doctors direction a sputum test was conducted. The test result showed that child was suffering from TB. Doctor asked about the family’s medical history, living conditions and other details but Bhaskar was not

to the little child. Both the parents were suffering from a persistent cough for the last few months. Suspecting TB, the doctor directed both of them to undergo a sputum test. The test showed that both of them had TB. Bhaskar was not willing to start treatment. But the doctor and health workers talked to him and convinced him to take medicines. The treatment for TB started right away. But much to the chagrin of the health workers they didn’t complete the treatment. They shifted their rental home, and moved elsewhere without informing anybody. Health workers tried hard, but they couldn’t trace them. Six months have passed and no one knows where he is. Knowing Bhasker’s approach to the disease, even an optimist won’t think that he will complete the treatment course. Perhaps he and his family are wandering to other parts of the state seeking jobs. Remember, the whole family including the little child is suffering from TB.

Basheer, 26, from Bihar is a casual labourer. He is a TB patient and is taking medicines now. A health worker from Malappuram introduced him saying that he would not disclose much about the disease. He was busy with his co-workers in a construction site.

treatment course.

about the disease. Before uttering anything he moved swiftly away from his co-workers saying “if they come to know that I have TB they will kick me out of the job. Months back I lost my job in a leather factory because of the same reason. I have not disclosed about my disease even to the room mates.” He hides his illness from the roommates saying that the medicines are for a bad cold.

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TRANSLATIoN SAJIL C

These two incidents show the challenges existing in Kerala for controlling TB. These are not rare incidents. Similar cases are being reported from almost all parts of the state by health workers. Last year a medical camp was conducted in Kollam district for domestic migrant workers. A few of them attended the camp. Among these labourers, around 15 had TB. Only eight of them continued their treatment. The others left their work place without completing treatment and nobody knows where they are. Inconsistent surveillance, long-term treatment course and interrupted treatment are underlying challenges for TB control. Early diagnosis and proper treatment are very important. Under the current situation Kerala is facing new challenges in this area.

The number of domestic migrant workers who are not ready to undergo proper treatment and those who discontinue their treatment before curing their illness is phenomenally high. This situation is badly affecting the TB control programme in the state.

But Kerala is facing new problems in identifying TB patients and providing proper treatment until the illness is completely cured.

people who are treated in private hospitals this will increase up to 10 %. This clearly indicates the gravity of the underlying problem.

Reasons for discontinuing treatment

When people take TB medicines properly for two months the symptoms of the disease will disappear. Many patients think that

discontinued treatment and bring back them onto the treatment schedule. There are no such facilities in private sector treatment. This is a big problem, said IMA TB control technical consultant Dr. P.S. Ragesh. In Kerala more than 50% of the people approach private hospitals for general treatment.

hospital authorities. But the patients are not willing to reveal that they are suffering from TB. This shows that though Kerala is very literate stigma and doubts regarding TB still exists. Furthermore many fear that suffering from TB will lead them to lose their jobs. Because of this fear most of the migrant workers hide their illness. They are not willing to take treatment. The others who discontinue the treatments are those who are alcoholic. They are not ready to get regular treatment, observes Dr. Ragesh.

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Most of them are from West Bengal, Bihar, Assam, Odisha and UP.

Need screening facilities

workers are there, where they are working and what is their health condition. Hence there is a chance for an increase in cases of diseases like TB, which spreadd through air. Those who work on TB say that the number of TB patients is increasing among the

migrant workers.

TB spreading Ambience

The living conditions of the migrant workers are very poor. Up to 20 workers are living congested in a small room. This situation is very conducive for spreading the disease. The TB causing bacteria - Mycobacterium Tuberculosis- spreads through air when a person affected by TB coughs or sneezes.

If treatment is discontinued

the treatment is very complicated. They stop medicines when they move from one place to another for jobs. This affects the rhythm of TB control. Data shows that the patients who have TB in the lungs will transmit the disease to 10-15 persons per year.

When they start treatment, within two months the symptoms of illness will disappear. It does not mean TB is completely cured. The bacteria is hiding in their body. So discontinuing treatment is very dangerous. When they discontinue their treatment, the disease may change into another form called MDR-TB (Multi-Drug Resistant TB). This type of tuberculosis is very dangerous. In Multi-Drug

the primary stage of TB. The major risk in this case is that if the MDR-TB treatment is not completed successfully, it will take an even more dangerous form as XDR-TB (Extensively Drug Resistant TB).

TRANSLATIoN

38

Beginning of collective attempt

Since many are getting treatment in private sector, public-private collective efforts are needed. The health department is not getting the details of patients who are under private treatment. To assure the participation of private sector, the government decided to supply free medicines at private hospitals from last year onwards. Free medicines are available in 100 private hospitals. Through the government has not started an integrated effort to control TB, some rare efforts are reported at districts like Kollam and Edappal of Malappuram, where the government has issued health cards to the migrant workers.

TB will be cured through proper treatment

If prescribed medicines are taken for the complete period, TB can cured completely. Hence there is no need for any fear. Moreover

on time. DOTS (Directly Observed Treatment short Course) ensures that patients take the medicines properly. Isoniazid, Rifampicin,

thrice in a week.

TRANSLATIoN

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National Fellowship - 2013

Dr R Prasad, Science Editor, The Hindu, Chennai

Local Language Fellowships 2013-14

Arpan Khare, City Reporter, Dainik Jagran, Bhopal, Madhya PradeshAthar Parvaiz Bhat, Freelancer, Srinagar, Jammu and Kashmir

Jahnavi Anandrao Sarate, Reporter/ Sub-editor, Maharashtra Times, Kohlapur, MaharashtraKanchan Kumari, City Reporter, Hindustan, Ranchi, Jharkhand

V Neelakandan, Pradeep Singh, Reporter, Rajasthan Patrika, Pali, Rajasthan

Prashant Dubey, Freelancer, Hoshangabad, Madhya PradeshPremvijay Patil,

Rajeev Tiwari, Sub-editor, Dainik Bhaskar, Indore, Madhya PradeshReji Joseph, Staff Reporter, Rashtra Deepika, Kottayam, Kerala

Ruby Sarkar, Special Correspondent, Deshbandhu, Bhopal, Madhya PradeshSazzad Hussain, Freelancer, Lakhimpur, Assam

2012-13

Ankita Mishra,

Davis Pynadath,

Mohan Maruti Maskar Patil, Development Reporter, Lokmat, Satara, Maharashtra

Mukesh Kejariwal,

Pavan Shrivastava, City In-charge, Dainik Jagran, Bhopal, Madhya Pradesh

Rubee Das, Consulting Editor, Dainik Janambhumi, Guwahati, Assam

Fellowship Recipients

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R Samban, Chief Reporter, Deshabhimani, Trivandrum, Kerala

Sudeep Kumar, City Reporter, Patrika, Bhopal, Madhya Pradesh

Vivek Shukla,

yasir Fayas, Sub-editor, Mathrubhumi, Alappuzha, Kerala

2011 - 12

Abhay Kumar Nema, Indore, Madhya Pradesh

Amarjeet Pal, Indore, Madhya Pradesh

Dayashankar Mishra, Jaipur, Rajasthan

Raju Kumar, Bhopal, Madhya Pradesh

Rakesh Malviya, Bhopal, Madhya Pradesh

Ranjith Chathoth, Kozhikode, Kerala

Peerzada Arshad Hamid, Srinagar, Jammu and Kashmir

2010 - 11

Ajai Rai, Lucknow, Varanasi, Uttar Pradesh

Anupama Kumari, Ranchi, Jharkhand

Baba Mayaram, Hoshangabad , Madhya Pradesh

Biju C.P., Kochi, Kerala

Lokendra Singh Kot, Bhopal, Madhya Pradesh

S. Nagarathinam,

Sameer A Rajput, Ahmedabad, Gujarat

Shuriah Niazi, Bhopal, Madhya Pradesh

Skand Vivek, Indore, Madhya Pradesh

Sudip Sharma Chowdhury, Guwahati, Assam

Contact REACHEmail: reach4tb@gmail.com

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The views expressed in reports included in this compendium are that of the respective authors

The publication of this compendium is supported by a United Way Worldwide grant