|
By Sandhya Srinivasan A collaborative effort between the Navi Mumbai Municipal Corporation and Alert India to tackle tuberculosis on the outskirts of Mumbai yields results
The township of Navi Mumbai, on the outskirts of Mumbai city, has a population of around 6,20,000 people, an estimated 120,000 of whom are migrant workers. These workers are in the high-risk group for contracting tuberculosis, thanks to the backbreaking nature of their jobs, few benefits, appalling living conditions, poor nutrition and inadequate access to healthcare facilities. Till the early 1990s the region enjoyed a construction boom, employing thousands of contract workers, mostly migrants. Large and small-scale factories mushroomed here. But a national recession in industrial production hit this area too. There were 2,200 units on the manufacturers association records, today they are barely 550, 70 % in 'terrible shape'. Former industrial workers are forced to earn a living selling vegetables or as rickshaw drivers. "It is ironic that while Navi Mumbai is a planned township, the one thing they didn't plan for is the people working in the factories," says Antony Samy, executive director of Alert India. "The 'low income' housing in New Bombay is really affordable only to the 'lower middle class'. The government should have set up sites with basic services; instead, factory workers in Navi Mumbai live in hutment colonies." The Navi Mumbai Municipal Corporation (NMMC) was set up in 1995. Within two years it had established urban health posts (UHPs) and MCH centres. Since its inception in 1981, Alert India's efforts were largely focused on leprosypatients in Mumbai. In 1989, recognising the woeful lack of municipal health services in Navi Mumbai, the organisation decided to extend the scope of its work to that area and to include TB patients. Dr Nagarajan, supervisor at the NMMC's First Referral Unit (FRU) in Vashi says the corporation had noted Alert's work with leprosy, conducted out of municipal dispensaries. Why not rope in Alert India to run the TB programme as well? The NMMC approached Alert India in 1998. Under Alert, treatment was provided to all registered TB patients at the NMMC. Since the organisation maintained patient records, it now became possible to determine the effectiveness of the programme and follow up on people who didn't come in to pick up their fortnight's drugs from the central depot. The NMMC appointed chest physicians, dispensers and laboratory technicians who worked alongside Alert staff. It also provided space for the TB unit at the First Referral Unit. All suspected TB cases in Navi Mumbai were sent to the FRU for tests, registration and follow-up. Drugs provided by the NMMC were dispensed at the FRU. However, while availability of drugs was not a problem, distances were -- patients outside the township of Vashi, where the FRU is situated, had to travel between five and 15 km to pick up their medication. Gita Balasubramanian, project coordinator of Alert's TB programme in the area says: "At times we paid them the money ourselves to make sure they came." This first collaboration ended on December 31, 2000, after which Alert India's responsibility was to continue providing treatment to all patients remaining on the rolls, till the last one was cured. Between November 1998 and 2000, the NMMC/Alert non-Directly Observable Treatment TB programme had 2,622 registered patients. The last patient completed treatment/defaulted/died/ or was transferred in October 2001. According to a report on the programme, overall, 64% of patients completed treatment and were cured. A little less than 50% of sputum-positive patients (572 out of 1,028) became sputum-negative and were declared cured. Of the 1,069 patients who did not complete treatment, 704 (27%) defaulted, stopping before the end of treatment. Treatment failed for 36 patients, 99 died and 107 were transferred to other areas. "A 64% cure rate was a good success rate in those circumstances," says Joy Mancheril, assistant director of the project. "It must be considered better than the earlier programme, which didn't have any idea how many were cured." In November 2000, the NMMC qualified for the Directly Observable Treatment (DOTS) -- Short Course and took over the TB programme from Alert India. However, when the NMMC reviewed its first quarter in April 2001, it decided to re-involve Alert India. From May 2001, Alert worked with the NMMC to follow up on all DOTS patients in five urban health posts in two zones: Turbhe Sanpada and Airoli-Dighe. Alert's current caseload represents about 50% of diagnosed TB patients in the NMMC. A total of 1,219 patients were registered under DOTS in Navi Mumbai between January 1 and December 31, 2001. Since DOTS evaluation is completed five quarters down, the NMMC is yet to finalise its report. Dr Dayanand Katke, medical officer in charge of the NMMC's DOTS programme claims that they have an 85% success rate. A preliminary report by Alert indicates that of the 736 patients on their register cumulatively, 324 are off their registers; of these, 66 have defaulted -- a defaulter rate of 18%. Alert's work begins at 7.30 in the morning, when the 12 staff workers begin visiting the area. They check new addresses of TB patients, follow up and visit the urban health posts. DOTS has undoubtedly helped patients who are unable to visit clinics. They get themselves registered with a 'DOTS provider' close to their home -- an urban health post, doctor, or even the local paanwalla. For the first 'intensive' phase of treatment, they consume the medicine in the presence of the DOTS provider who maintains an attendance register for Alert and the NMMC. "The Alert-NMMC collaboration is fruitful," says Joy Mancheril. "Patients can talk to us about their fears and anxieties in a way that they cannot with the government services. The NMMC staff also feels supported, our records help their work." Contact: ALERT India
CIDCO Community Centre,
1st floor, Sectro III,
Vashi, Navi Mumbai 40703.
Tel: (022) 2782 4134. (Excerpted from Stoppping a Killer: Combatting Tuberculosis in South and South East Asia, Editors Afsan Chowdhury, Esther Griffiths, Bhim Subba, World Health Organization and Panos Institute, South Asia, Kathmandu, Nepal, 2002.) -- Sandhya Srinivasan InfoChange News & Features, March 2003
|
