CURBING IGNORANCE- TUBERCULOSIS IN GOA

Incidentally, has a high prevalence of tuberculosis as compared to other states. “The annual risk of TB infection is 1.5 per cent in rest of , while in the Western region, especially , the risk of TB infection is 1. 9 per cent,” revealed Dr VR Muralidharan, District TB Officer, . Yet, reliable sources in the Health Services department inform that not much attention has been paid by the health authorities to eradicate the disease.



It is estimated that 20 lakh people in are at present suffering from pulmonary TB, of which nearly 5000 are infectious. An average 2,100 new TB cases are detected every year, of which 50 per cent are sputum positive.



“In terms of numbers, the number of sputum cases that are investigated has increased. We are now getting cases from the remote areas even without holding medical camps or door-to-door medical check-ups. This shows that people are becoming more and more aware of the possibility of them having TB,” said Dr Muralidharan. He however added, “The stigma about TB has now come down considerably. It now exists only amongst the migrant or illiterate people.”


Better late than never?


Blame it on administrative failure or lack of political will, but RNTCP was started in on September 13, 2004, nearly 11 years after the programme was launched nationwide. But now, the state government is trying to make up for the delay and has pledged to detect 70 per cent of all infectious TB cases and cure 85 per cent of them by the end of 2007. However, few government doctors are not so optimistic. “Once you start later, its always a question of catching up because its an on-going process and the number of cases keep coming up,” said a doctor, on condition of anonymity. Still worse, the District TB Hospitals are terribly short staffed.



But officials at the Goa State Tuberculosis Control Society (GSTCS) insist that efforts are being made to catch up with lost time and ensure that each and every TB patient gets the required treatment, on time. They are working hard to connect with the villages and communities to sensitise people that TB is no more a dreaded disease and is curable.
Women matter

Though 30-year- old Sunita from Valpoi was literate, her ignorance about TB was immense. She didn’t know that TB is curable and the treatment for TB is absolutely free. Worse still, for her, TB meant a disease in which a person ended up in some sanatorium, rejected and isolated by the family.



To get across the message that TB is curable and treatment is free of cost for women, the “hidden section” of the society, GSTCS has now approached the mahila mandals and women’s self-help groups with the aim to ensure that women have access to adequate and important information.



“Women in rural areas don’t have a dominant voice in the family and due to this, they fear that if detected with TB, they may be isolated or rejected by family members,” explained Dr Muralidharan. Interestingly, now GSTCS has also started sensitising school kids about TB, because they believe that children are the best disseminators of information.


Partnerships

Coming to the nearest health centre for his DOTS treatment everyday, meant that Ramesh from Torda, near Porvorim, would lose his daily wage of Rs 150. To make certain that Ramesh had his daily dose of medicines, GSTCS entered into a tie-up with the private JMJ hospital, to become a Directly Observed Treatment, short course (DOTS) provider. A DOTS provider has to ensure that the patients swallow the medicines under their direct supervision. DOTS prevents the spread of TB bacilli, thus reducing the incidence and prevalence of TB and providing credence to TB control efforts. End result: he is now cured.

With the increasing realisation that a sub-health centre may not be able to reach people at the micro-level and to ensure that the patient doesn’t default, the focus has now shifted to anganwadi workers all the talukas of . Moreover, they have easy access to women and children. Already, 700-800 anganwadi workers have been sensitised in a majority of the talukas.
Panch power!



Imagine, an ambitious panch member as a DOTS provider. Sounds impossible? Well, it is possible in . When 20-year-old Sneha in Cumbarjua was tested sputum positive, she was to be put on DOTS. But Sneha was not interested in going to the nearest health centre for her dose of medicine because she had to work from 7 am to 7 pm to ensure that her elderly parents get a decent meal.



Enter a panch member who became a DOTS provider. He would visit her with the medicines after she returned from work and ensured that she had her treatment. Subhash Gawde, a former panch member at Madkai, agrees that the panch members should involve themselves in such community services as it reduces stigma and ensures that TB patients get timely treatment. “TB is curable and the treatment is absolutely free of cost. So one no more needs to be scared of the disease,” added Gawde, whose come forward to become a DOTS provider from Madkai. Inspired by his response, GSTCS now aims to sensitise and train the panchayat members.



(Some names have been changed to protect identities)

The article appeared in Gomantak Times, Panjim Edition dated April 6, 2007