World TB Day

This morning I was walking around the Ashok Nagar slum with Hanifa Sayyed, a community health worker responsible for several DOTS centers, clinics that help to ensure patients stay on their course of TB treatment.  As we were walking around the community I noticed that a few men were stringing up what looked like Christmas lights; thinking that it would make a nice picture I asked if the lights would be turned on in the evening.  Hanifa told me that they would and we made a plan for me to return at dusk to take pictures.  She gave me her mother’s telephone number and told me to call her when I arrived at the main road, and then wait for her to come and get me.   I doubted that this plan would work, but agreed and we continued walking.

We were walking to visit one of Hanifa’s patients, a seriously ill woman who was bed ridden and unable to come to the clinic.  I realized that almost all of the very sick patients I was visiting where female and made a mental note to ask if that was a coincidence or if there was some social reason that the majority of bed ridden patients were women.  Several people told me a variation of the same answer which seems to make sense, and was backed up by anecdotal evidence and the cultural understanding that comes from spending years living and working in the slums. 

I was told that women are usually the last part of a family to seek help for any health problems; they will wait as long as possible before visiting a clinic or seeing a doctor, preferring to meet the needs of their children and husband before tending to their own problems.  They will typically wait the longest to enter the health system and, when they do, they will seek the cheapest care possible.  Because of all of this, women will often seek care when their sickness is very developed, harder to treat and more debilitating. I was told that this was true not only for women with TB, but for any health problem.

In the evening when I returned, I arrived to the main road and began to walk in to the slum.  After about 5 minutes I stopped and called the number Hanifa had given me, but the call did not go through.  I continued walking, hoping that something would look familiar and I would be able to find her house, which we had walked by earlier in the day.  I quickly realized I did not know where I was or how to get where I was going.  But, as I have experienced throughout my time in Mumbai, people were more that friendly, trying their hardest to help me in spite of my inability to speak Hindi. I remembered that Hanifa’s house was near the community public toilet, and asked the owner of a store for the “public toilet” in English.  He pointed up the hill and I began to walk.  Sure enough, I ran in to Hanifa’s house about 5 minutes later and was invited in for tea, which I drank with her entire family, include 4 generations of the women of her family.

Photojournalist David Rochkind, winner of the 2009 Stop TB Partnership Images to Stop Tuberculosis Award is travelling in India and producing a photo reportage about TB

(8 votes, average: 4.88 out of 5)

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Anti-TB week from tomorrow

BANGALORE: To raise awareness about detection, prevention and treatment of tuberculosis (TB), several hospitals and agencies in the State will come together to observe “Anti-Tuberculosis Week” from February 17.

Addressing presspersons here on Monday, Secretary of Karnataka State Tuberculosis Association (KSTA) Shashidhar Buggi said the objective was to inform people about the free facilities provided by the Government under the Revised National Tuberculosis Control Programme (RNTCP).

http://www.thehindu.com/2010/02/16/stories/2010021653810400.htm

courtesy : The Hindu, Bangalore – 16/02/10

(1 votes, average: 5.00 out of 5)

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A local NGO called Inter Aide is helping me coordinate my visit in Mumbai.  The French group, which started operating in India in 1980, initially offered a variety of social services, but quickly saw a need to incorporate TB into their programming.  Today they coordinate the activities of 5 smaller NGOs that operate in the slums of eastern Mumbai, heling them organize and implement services to TB patients.  I have been spending quite a bit of time with Lok Seva Sangam(LSS), one of the groups that works with Inter Aide.

When I began working on and learning about TB I had a lot of questions about why the disease was spreading.  If TB is treatable, then why is it not simply found and treated?   I quickly learned that there are a variety of social and economic factors that make it very difficult to diagnose patients, and very difficult to ensure that patients stay on their treatment program.  LSS tries to mitigate the social and economic variables that often stand in the way, leaving only the simple solution: diagnose and treat.  This is often much more difficult than it sounds.

To understand these difficulties I found it easiest to look at the progression of a TB patient, from the time they begin to feel sick through the end of their treatment.

 To begin, there is often a general lack of awareness and education about the disease and what the symptoms are. If a person living in a slum in Mumbai has chest pain, nausea or night sweats, they may not understand that these are potential symptoms of TB.  The same lack of understanding about where the disease comes from and what it’s effects are often leads to a social stigma being attached to having the disease, meaning potential patients would do everything they can to not be diagnosed with TB and ostracized by their communities.  In many communities there is simply a lack of health services to diagnose the disease; if a patient only earns $60/month, it is a real sacrifice to miss a day of work and pay transportation costs to travel to the nearest clinic capable of making a diagnosis.  Often a decision has to be made between earning money to provide for one’s family, or going to a clinic to be diagnosed with a disease that you know little about, except that in your community it is taboo to have it.

LSS tries to tackle these issues by running a series of education programs that aim to raise awareness about TB, its symptoms and just how treatable it is.  They pass out information at high transit sites, like train stations, and run workshops at schools, community groups and occupational training courses.  The group also visits the offices of private doctors within the slums, educating these primary health providers about TB and urging them to refer patients to diagnosis centers.  People must first know that the disease exists and that it is treatable before they can begin the process of getting healthy.

LSS has set up a collection of diagnosis centers were potential patients can give sputum samples that are then transported to one of their own labs for diagnosis.  These centers are placed in the heart of poor communities, and kept open early in the morning and late in the evening, in the hope that patients will be more likely to begin the diagnosis process if they can quickly walk to a center without missing work or spending money. 

Once a patient is diagnosed with TB they must begin a treatment regiment that can last for six to eight months.  They must take as many as 7 pills a day for the first 2 months.  The pills are difficult to swallow and can have some unpleasant side effects; it is important that people know how necessary it is to take the pills every day without fail, even when it is difficult.  Failure to stay on the medicine can allow a drug resistant strain to emerge, making the disease much more difficult and expensive to treat.  In order to ensure that patients stay on treatment, LSS has set up clinics where patients must go every other day to get their medicine.  If a patient fails to show up to the clinic an LSS worker will go to their house to ensure that treatment continues.

There are many reasons why a patient may fail to show up for treatment:  they might not understand the importance of taking the daily dosage; they don’t want their community to see them going in to a TB clinic; they may feel better after a few months and not realize they need to continue the treatment; there is a death in the family and they have to travel for a funeral; they are unable to get off work to go to the clinic.  The LSS community workers try to deal with all of these problems when they arise, and find solutions that will allow the patient to continue taking their medicine.

Photojournalist David Rochkind, winner of the 2009 Stop TB Partnership Images to Stop Tuberculosis Award is travelling in India and producing a photo reportage about TB.

(30 votes, average: 4.83 out of 5)

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Indian Development Foundation is all geared up for the World TB Day 2010.  Massive awareness campaign through the county is planned by IDF.  School-teams, B-Schools, Trusts, Societies, Corporates, Companies and General public will be involved in this massive ongoing awareness programme.  IDF spearheads in  advocacy and awareness campaigns.  IDF is committed to StopTB.

Dr. Narayan B. Iyer
idfmumbai@gmail.com

(1 votes, average: 5.00 out of 5)

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On my third day in Mumbai I met Rehmat Shekh, a 28 year old woman who is HIV postive and battling TB for the first time in her life. When I walked into her home, a small 8×10 foot room that she shares with 3 family members, she was on the floor, her gaunt frame covered by a thin blanket. She is weak, unable to sit up for more than 10 minutes at a time, and usually needs an hour to get all of her pills down.

Rehmat lives in Rafik Nagar, a slum in eastern Mumbai. She shares the small room with her mother, husband and son; the family cooks and bathes in the room, and sleeps lined up in a row on the floor. There are no windows in the room, but a ceiling fan helps to combat the stifling heat.  I had come to Mumbai to continue a photo project I am working on about TB across the globe. I began the story in South Africa, where I documented the effects of the disease within the country’s gold mining community. The mining industry relies on migrant labor, with workers coming from across South Africa as well as neighboring countries. The miners have always battled TB, traditionally living in cramped dormitories, suffering from high rates of silicosis (an occupational lung disease that increases the likelihood of developing active TB), and having had very little access to health care. With the explosion of HIV within the work force, TB incidence has risen dramatically, reaching levels three times what is commonly defined as an epidemic. Many of the miners develop active TB after leaving the mines and returning to their home communities, which are often in rural areas and have little or no health infrastructure. While there are organizations that are working on the issue, there is still very little awareness of the disease and a significant stigma attached to it. The miners are forced to live, and often die, with a disease that is entirely treatable. I want the stories I am working on to profile entire communities that are affected by TB, moving beyond depictions of the sick to give an idea of what it means, and what it feels like, to live surrounded by the disease. The mining community in South Africa is largely a rural community, so for the next chapter I wanted to focus on an urban setting.

During the next few weeks I will be documenting TB in the slums of Mumbai, focusing on the relationship between the disease and urban poverty. I will look at the risks associated with living in the slums, the obstacles that arise and also some success stories. I am interested in learning what is unique to the fight against TB in urban slums and if there are common threads that can connect communities divided by geography and demographics. I will be in India until the end of February and will make regular blog posts. Please check back for updates.

Photojournalist David Rochkind, winner of the 2009 Stop TB Partnership Images to Stop Tuberculosis Award is travelling in India and producing a photo reportage about TB.

(15 votes, average: 4.07 out of 5)

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WE ARE  GEARING UP TO OBSERVE WORLD TB DAY 2010 WITH A THEME “INNOVATE TO ACCELERATE ACTION” IN COLLABORATION WITH THE STATE / DISTRICT TUBERCULOSIS OFFICES ” CHAI is implementing TB programmes with financial support from GFATM & USAID

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ADRA-INDIA, ACSM Project funded by USAID-INDIA and World Vision is all geared up to celebrate world TB Day with families, individuals affected and infected with TB in eight districts of Bihar State in India.

Visit us at www.adraindia.org, twitter: ACSMBIHAR

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