It was 12 noon. Rahima Begum was sleeping in her slum which is near Mirpur dam. We woke her up. She has worked whole night in sand-truck. She used to work in daytime too. But now she can not bear that as she is infected by TB (Tuberculosis) for the second time.

Rahima informed that she was infected first about 2-3 years back. She was completely cured after treatment. But last year she has suffered in cough and fever for continuous 4-5 months. After the test it was found that she was attacked by TB again.

There is no ventilation for lights and air in Rahima’s small room. Before, she used to live in another slum of Mirpur. Recently government has demolished that slum. Now she is paying here Tk 800 per month as rent.

Rahima is infected with costly royal disease. To get cured she needs to have good diet. A major portion of her income spent on this purpose. She said, “Sometimes I had to go to work right after taking an injection. If I do not work, what should I eat?” It has been about three months that she is getting medicine supply from BRAC NGO for TB treatment. People familiar to this think the cause of attacked by TB for the second time might be malnutrition and unhealthy environment.

Those who suffer in tuberculosis in Bangladesh, majority of them are like Rahima, very poor. On the contrary people related to this subject are saying that governments’ programs to control TB in Bangladesh could not reach poor people.

Worldwide effective TB control program is widely known as DOTS (Directly Observed Treatment Short Course). In this program medicine intake of a patient is directly observed. In a government research on ‘TB and Poverty” in 2002, it was found that those who come to DOTS center, more than 70% of them live below poverty level.

By fighting back with TB another 30% of the poor population goes below poverty level. Average age limit of population attacked by TB in Bangladesh is 15-45 which is earning age. Therefore the disease put hurdles on their earnings.

Poor people are at most risk:

According to the estimate of CUS NGO, there are around 54 lakhs slum residents in six divisional towns including Dhaka. 34 lakhs people which are 38% of total residents of capital city Dhaka live in slums. They have high risk of TB.

Scientific officer and epidemic expert of ICDDRB Dr. K. Zaman have said, “Poor people suffer in malnutrition. They have low rate of literacy. Many of them live in small area together in a hampered environment. As a result viruses of this disease easily attack them.

If somebody who is attacked by lung TB stays without treatment, his/her sneeze, cough and spit spread germs/virus in the air. Usually TB identified among poor people comparatively at a later stage which itself is another problem.

Near Shaheed Budhdhijibi Sritishaudha in Mirpur BRAC NGO do tests for TB and supply TB medicine free of cost. Abdullah supervise this program. He said one has to test his/her cough three times. First a person should come to the center, give cough for test. Then go back to the house with container and come again with cough sample next and next to next day for tests which takes about 3 days. Many take the container home after the first test but do not come back.

Poor people are neglected in fight programs:

International donor association’s Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) has given 630 crores Taka for 2004-2011. Tuberculosis control programs are running in Bangladesh with this fund. But they have no intensive program for extremely poor people.

National TB control program’s goal is to identify 70% of the patients who have TB virus in cough and cure at least 85% of them (70%). One of the main goals is to keep the success on going. Except this, cut down total number of TB patients and total number of deaths per year for TB by the year 2015 compared to 1990. Government has demanded that they have become successful in identification and cure program. Control programs are directed by 28 NGOs including BRAC. BRAC is working mostly. It manages 18 DOTS center near Dhaka city. In 2006 these DOTS centers have found 3,578 TB patients.

Among them there are only 252 slum residents who are very poor. Patients are people from different occupation like chefs, daily laborers, grocers, drivers of different vehicles, rickshaw pullers etc. BRAC centers found mostly garment and industrial laborer.

But TB management advisor of World Health Organization (WHO) Dr. Khurshid Alam has said to Prothom Alo that this program could not significantly reach to slum residents, garment or industrial laborers yet. He thinks this is a big challenge for the program to keep the success. WHO is giving technical support to national TB control program. He added that slum residents were not even directly included in national strategic plan. BRAC’s health program manager Dr. Akramul Islam also admitted this and remarked, “Although various programs are running encircling the poor population but they hardly reach them.”

Dulu Begum has said that when her son was attacked by TB she understood the difficulty of taking medicine. Her son works in a hotel and stays there. Coming home just to take medicine is costly. Again if someone knows in the hotel about his disease he would lose his job. So, she could not give medicine to her son by herself and observe.

In Shyamoli DOTS center they have listed 34 TB patients this year (up to 23rd March). They are supposed to come to DOTS center and take their medicine there. But only 9 out 34 came on Thursday 23rd March till noon. Workers reported that day before that 15 people came to take medicine. It is hard for poor people like laborers to come to the centers regularly and take medicine.

Most of the poor people do not even know where to go if they get attacked by TB. Therefore their treatment gets delayed. That increases the risk of infection. Abdur Rahim, a rickshaw puller of Adabor, Mohammadpur has informed, “my brother was suffering from cough for a long time. We took him to Mohakhali hospital, Sohrawardi hospital, to different local doctors and spent about TK.5000. After that we went to Shyamoli hospital.”

According to Program manager of TB control program Dr. Vikarunnesa Begum, although there are programs to build awareness, but poor population has yet not become aware enough about TB. She also added that poor patients sometimes spend a lot to have good diet to prevent TB. But it is sufficient to eat regular food within their capacity.

      
Newspaper: Prothom Alo (National)
Date of publication: 25th March, 2007
Translated by: Mir Laila Ferdous