Diagonal Interventions in Treating Tuberculosis
The Communicable Killer:
Kishanganj, Bihar- Project Potential’s home- is nestled between the borders of India, Nepal and Bhutan with proximity to border trade routes and entry. Despite its strategic location, it has one of the highest poverty rates of any district in Bihar, which has one of the highest poverty rates of any state in India.
We frequently hear stories of tragedies brought on by disasters like floods, collapsing bridges, and lack of stable work. Meanwhile, access to regular, nutritious food remains a distant reality for many families as they grapple with lack of access to safe drink water and sanitation facilities. Inadequate health care services lead to a high burden and level of suffering due to infectious diseases such as malaria, tuberculosis, leprosy and HIV/AIDs, as well as other challenges like maternal and child mortality.
What is worrying is that TB is the seventh largest cause of mortality in India and the number one cause of deaths amongst infectious/communicable diseases. Meanwhile, in our context, as per the Global TB Report of 2019, Kishanganj saw 1271 persons diagnosed with Tuberculosis out of which only 531 cases were successfully treated in the public sector. There has been no record or mention of the other 740 cases demonstrating the urgent need to support recovering patients and eradicate TB from our local communities.
What We’re Doing About It:
The upshot is that TB can be cured; diagnostics and treatments exist, which should push us to work even harder to eradicate this disease once and for all. Our hope is that our efforts to do so will also ultimately strengthen the public health ecosystem in Kishanganj overall. In particular, toward these dual goals, we are supporting and incentivizing ASHAs (community health workers) to actively find, diagnose and treat TB patients.
Empowering Community Health Workers:
ASHAs (Accredited Social Health Activist) are an all women cadre of community health workers constituted by the Ministry of Health and Family Welfare under the National Rural Health Mission. Selected from the local village itself, ASHAs are trained to work as the mediator between the community and public health system. In our TB project, we work with 70 ASHA workers across 4 panchayats of Kishanganj, Bihar, providing them with capacity building and incentives to help our fight to end TB.
TB Screening in Communities:
Post our orientation and initial interaction with ASHA workers, we receive referrals from them on suspected patients who may be suffering from Tuberculosis. This is entirely dependent on the various symptoms they have been demonstrating such as rapid weight loss, prolonged fever and cough. From these referrals, our team at Project Potential visits the houses of presumptive patients to do an additional screening. The other objective is to rapidly increase the rate at which TB diagnostics are conducted. Since December 2020, our team has screened almost 90 people who were referred to us with likely TB symptoms.
TB Diagnosis and Treatment:
TB Diagnosis happens through testing of sputum samples and chest x-rays. The headquarters in Kishanganj have a sub centre hospital which does TB testing using a CBNAAT Machine. However, the rate of diagnosis via CBNAAT is very low given that only one machine exists and can test samples with a spacing of 5–6 hours between tests. The diagnosis is essential to undermine the type of TB the concerned patient is suffering from and thereby administer proper treatment. Since December 2020, our team has facilitated the diagnosis of 40 persons and is supporting the treatment of 11 positive patients.
TB Community Awareness:
In an attempt to combat the social stigmatization associated with Tuberculosis, our team mobilizes the community through awareness about and engagement regarding tuberculosis. Going village to village, we speak to groups of people telling them about TB — its symptoms, effects, and available treatment and support. Since February 2021, our team has managed to build awareness on TB for roughly 1,800 persons across 20 villages.
Ration Distribution:
One of the major concerns for persons undergoing TB treatment is the lack of access to basic and nutritious food. While the Nikshay Poshan Yojna is supposed to provide respite through monetary incentive payments given on a monthly basis to positive patients who are undergoing treatment, many patients are unable to avail of these benefits due to low awareness and not having formal bank accounts. While our team facilitates this process of availing government schemes, we have been working with various organizations like Goonj and Fischer Jordan LLC to provide ration kits in the form of food grains and clothes to provide respite to patients during their treatment cycle. Since October 2020, we have provided ration kits to almost 200 families whose members have TB patients undergoing present treatment.
Thinking Global to be Local:
Our interventions and impact is driven and created by our dynamic local team. Born and raised in Kishanganj, our local team comes together with a common vision of being change agents that transform their communities through a visionary leadership approach. This is combined with hands-on implementation and a continuous desire to learn, reflect, act and change.
As eArth Swasthya grows in impact, reach and intervention- we hope to have more health warriors joining hands with us to mobilize technology, government, resources and ideas to facilitate the improved public health ecosystem first of Kishanganj, then of Bihar and ultimately of India.
