Background:Tuberculosis

Fighting tuberculosis in the slums of Delhi

The net draws tighter: private health workers create the conditions that ensure that simple antibiotic treatment is effective and lasting.

Beyond the broad avenues of the government and embassy district of the Indian capital New Delhi, in the suburbs, one is confronted by the real life of the continually expanding metropolis. Coolies’ hand carts, piled with vast quantities of fruit and vegetables, are pulled to the vegetable market. Ox carts push their way through the street, and bicycle rickshaws and pedestrians complete the picture.

Cars seldom stray into the narrow alleys of the Jahangir Puri slum, even more rarely a government vehicle. About 200,000 people are living here in crowded houses and shacks, many of them day labourers. Close by is one of the biggest rubbish heaps of the megalopolis. The people search through the rubbish for things they can use. Poverty and the unhygienic, extremely cramped living conditions are a breeding ground for tuberculosis.

Chinanjeet hands out pills in her house.

Simple treatment is possible

Every year TB strikes many thousand people in Delhi alone, particularly in the slums. The World Health Organization (WHO) estimates that 1.7 million people a year are affected by TB in India alone. Officially it is reported that more than 300,000 people die of this disease every year.

Lung tuberculosis is the most common form. It is transmitted by droplet infection and weakens its victims quickly. Infected people lose weight and are barely able to go to work. The bacteria take control of the body – but they can be combated with antibiotics.

The seamstress Shahnaz is suffering from a rare form of the disease, bone tuberculosis. The 20-year-old could hardly stand upright. Walking was even more difficult. She has been receiving a life-saving treatment for a few weeks. Now she can even look after her one-year-old son again. Three times a week she visits Chinanjeet, a DAHW health worker: Chinanjeet dispenses medication from her own home. Shahnaz takes the tablets under supervision for two months, and then she is given a supply to take away. The treatment lasts half a year, after which she will once again be able to look after her household and take on sewing jobs.

Treatment available in the vicinity helps in the cure

People are glad that help is available in the neighbourhood. The health centre was too far away for many, who had to go on foot. Very few can afford a ride in a rickshaw – which is why TB patients often stop their treatment. They feel significantly better after taking only a few tablets, are gaining weight and are able to work again. But if they stop taking the drugs too soon, TB breaks out again, resistance develops, and the patient can no longer be cured by simple and cheap antibiotic treatment. Many therefore die.

Chinanjeet treats about 20 people. She keeps patients’ records and also visits sick people at home. “It is very significant when someone suddenly doesn’t turn up,” she says. “They may have been weakened by another illness, or may just need something to eat so that they can better tolerate their drugs.”

Even a simple mask over the mouth can prevent further infections.

Associated assistance

The head of the local DAHW office, Dr. Rajbir Singh, explains the new project approach: “TB work doesn’t just mean handing out pills. The disease affects the whole family. Our workers also provide health education, explain hygiene, and help families to get back on their feet after the treatment.” One former patient received a loan to establish a little stall. There he sells snacks, sweets and chewing gum to children. He has repaid his loan to DAHW and his small income means he is now able to keep his family’s heads above water.

Medicines from the shop break down stigma

The “private health centres”, which DAHW started in September 2005, have one thing in common: they have long opening hours, particularly in the evenings. Chinanjeet is there for her patients from seven in the morning until eight in the evening. The watch seller Kamal Jaiswal has set up scales next to his wares, so that he can weigh patients. In his cabinet he stores medicine boxes for each individual patient. He keeps a meticulous record of the treatment. All the health workers have learnt to do this at a DAHW seminar.

Another health worker, who sells food and drinks in his small shop, also has long opening hours. In the tiny adjoining room a new patient is just introducing himself. While he is weighed, the shop owner’s wife looks after sales. “This breaks down the stigma of TB. The customers buy things at the grocer’s, and as they do so they find out what they or members of their families can do if they have a long-lasting cough”, says Dr Rajbir Singh.

A model is adopted 

By spring 2006, this new DAHW programme had already treated more than 200 patients. Health officers are observing this good example closely. Perhaps as a result more vehicles of government health services will soon find their way into the narrow alleys of Jahangir Puri – and the example is spreading to other Indian slums.