-------------------------------------------------------
CONVENTION OF THE GOAN DIASPORA FROM GOA INTO THE WORLD
Lisbon, Portugal June 15-17, 2007 Details at:
http://www.goacom.org/casa-de-goa/noticias.html
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>I appreciate this report with certain observations having done a lot of
field work in the rural area although incidences of TB may rise due to
rising air pollution, congested living conditions, malnutrition etc.
making one susceptible. Differential medical diagnosis is required
before a decision is made about TB. What's the source of following
figures?.
" In Goa, more than 1 person die of TB every month.
Goa has a high prevalence of tuberculosis as compared to
other states
Annual risk of TB infection is 1.5 % in rest of India, while
in the Western region, especially Goa, the risk of TB
infection is 1.9 %
200,000 people in Goa 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."
The source of the above statistics is not revealed. I would be interested
in getting it for crosschecking and verification. And if it from ICMR or
WHO/UNICEF then better to forget it. IS 15 % of Goa's population suffering
from Pulmonary TB despite universal BCG vaccination ( anti _TB)
programme?. Then what happens to our health indicators? Then why the
government is promoting Iodised salt instead of controlling TB?.
>The writer has probably not cross checked with Dr. Bhonsulo of Goa TB
association.
Even if people hide TB after diagnosis , the causes of death reveal the
true story.
The writer should have referred to the annual reports of the registrar of
births and deaths. However these are belatedly published with a gap of a
year or two.
But only these reports give the true and judicially valid picture of
mortality as indicated in the death certificates. there is no other
evidence. Death certificates are mandatory in Goa. All the causes of death
follow an international coding system.
All the deaths due to TB are given a code of 010 t0 018 and include deaths
due to primary TB infections, Pulmonary TB, other respiratory TB, TB of
meninges, CNS, intestinal peritoneum, mesenteric glands, bones, joints,
genitourinary system, other organs and miliary TB.
(how the rural people know about symptoms of the above?. These are so
complicated.)
Let us look at the 10 year span (1988-1998) to see the variation of deaths
due to TB. Let us look at the decadal TB mortality profile.TD stands for
total deaths, U for urban and R for rural.
{1989-TD310, u-189 r-121} {1990-297, u184, r103),(1991-298-u-184, r-114),
(1992-337, u-216, r-121), (1994-361, u-212, r-149), (1995-323, u-184,
r-139), (1996-300, u-143, r-157), (1997-244, u-131, r-113)
Contrary to the picture of morbidity of rural people due to TB as
presented in the GT report, the mortality picture consistently shows more
deaths in Urban areas.
In 1988, the government report says that 353 people died due to Pulmonary
TB. 221 in urban and 132 in rural areas.
(note higher deaths in urban areas)
TB of meninges and Central nervous system killed 11 persons and one died
on account of TB of bones and joints.These causes are separately
classified. So the total deaths due to TB in 1988 were 365. ( the
journalist claims that one person dies of TB in Goa every month. whereas
the govt. figures show that one person died EVERY DAY IN 1988)
Let us look at 1998 figures with the expectation that the death figures
should come down if the TB control programme was successful..
In 1998, total 290 deaths were reported, 148 in urban area and 142 in
rural area. ( note higher deaths in urban areas again) So in 10 year span
there was some improvement (from 365 to 290) because despite a higher
state population, deteriorating enevironmental quality and changing
diets, ACTUALLY LESS PEOPLE DIED DUE TO TB IN 1998 THAN IN 1988.The
decadal trend does not show increasing mortality.
If rural areas face higher morbidity due to TB and people discontinue the
treatment then higher mortality should result.
I wish I had the latest reports from the registrar of births and deaths
for the years 1999-2007. But as soon as I get these ( at least reports
till 2004-05 should be available) I would report back.
I wish the Indian medical association-Goa and Goa TB association, the
preventive medicine and social health dept. of GOMECO take cognizance of
the GT report and initiate action so that morbidity figures are brought
down and mortality figures are controlled by 2010.
-dr. Nandkumar Kamat, goa University
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> CONVENTION OF THE GOAN DIASPORA FROM GOA INTO THE WORLD
> Lisbon, Portugal June 15-17, 2007 Details at:
> http://www.goacom.org/casa-de-goa/noticias.html
> -------------------------------------------------------
>
> A DEADLY STIGMA: INTERIOR GOA STRUGGLES WITH T.B. IN A WAY STATS DON'T
> SHOW
>
> By Preetu Nair
> [EMAIL PROTECTED]
>
> Scary cases of TB plague the inner areas of the
> state. Journalist PREETU NAIR walks into the heart
> of Goa, into a different world. For the people
> living there, TB is not just a public health
> problem, but a social stigma.
>
> A youth in Sattari in the Western State of Goa, India
> believes that TB kills and is not curable. In a remote
> village in Sanguem, an anganwadi (government-run creche)
> worker has no access to patients, due to the fear that she
> may spread the news that they have TB in the village.
> Meanwhile, Anil Sawant stopped the magic pills because he had
> to travel 25 kms to the health centre for his medicines.
>
> "TB kills. We don't even drink water from a house if there is
> a TB patient living there. What if I get TB after drinking
> the water?" asked Shidhu Varak, an 18-year-old literate youth
> from Dhangarwada, Poriem in Sattari. His friend, Dilip
> Gaonkar from Gholwada, Poriem added, "We don't even get
> married into a family if we know that anyone in the family
> had TB. It is a contagious disease and no medicine can ever
> cure it."
>
> On the other hand, Nago Bhavdan from Corla Moti in
> Quepem has never heard of TB. His son, a student of
> Standard IX has read about infectious TB and
> strongly believes that it is incurable. Believe it
> or not, TB still continues to be a dreaded,
> incurable disease caused due to a curse or sin in
> rural Goa.
>
> "TB is not just a public health problem. It is a social
> problem and the patient is stigmatised and isolated in
> society. The failure of the health authorities to create
> awareness about the advances in treatment of TB has added to
> the woes," said Rajendra Kerkar, a school teacher and
> grassroots worker in Sattari taluka.
>
> Despite social mobilisation, the TB control programme has not
> been able to break the myth that TB is contagious nor has
> been able to spread the message that there are other forms of
> TB besides pulmonary TB. They have yet to work to improve
> access to DOTS services in remote areas and overcome stigma
> of TB and discrimination against TB patients.
>
> [DOTS (Directly Observed Treatment, Short-course) has been
> identified by the World Bank as one of the most
> cost-effective health strategies available. Globally, DOTS is
> estimated to costs the equivalent of only US $3-$7 for every
> healthy year of life gained. DOTS get people back to school,
> work and their families. The DOTS strategy combines
> appropriate diagnosis of TB and registration of each patient
> detected, followed by standardized multi-drug treatment, with
> a secure supply of high quality anti-TB drugs for all
> patients in treatment, individual patient outcome evaluation
> to ensure cure and cohort evaluation to monitor overall
> programme performance. See
> http://www.tbalert.org/worldwide/DOTS.php ]
>
> "TB is a dirty secret everyone wants to hide. In my village,
> three men died of TB in the last two years. They didn't take
> regular medicines and drank alcohol. Whenever I used to go to
> advise them, they would insult me and ask me who it was that
> told me that they have TB," revealed an anganwadi worker from
> a remote village in Sanguem taluka.
>
> Under the Revised National Tuberculosis Control Programme
> (RNTCP), modes of observation in villages are often anganwadi
> workers who have no access to TB patients, due to the fear
> that she may spread the news that they have TB in the village
> and they will be stigmatised.
>
> Further, talking on the condition that she is not quoted, she
> said, "Most of the people in and around the mining areas have
> symptoms of pulmonary TB. But they don't go for treatment as
> they believe that TB is not curable."
>
> "The effort to stop the spread of TB and to ensure
> a TB-free world is curbed by social stigma attached
> to the disease," admits Dr Bidan Das, State TB
> Officer, GSTCS. Even Dr Arvind Salelkar, Director
> of Health Services admits that the effort of
> changing the mind-set of all persons concerned with
> TB has been a daunting task but yet intensive IEC
> efforts, training and retraining of staff we have
> taken a giant leap forward in tackling TB as its
> very roots.
>
> But official facts are different from field reality. Even as
> officials at the Goa State Tuberculosis Control Society
> (GSTCS) demonstrate that DOTS is having its impact and
> excellent progress has been made with DOTS with case
> detection and treatment success rates, people in the remote
> villages in Goa live without easy access to the magic pills.
>
> Anil Sawant was put on DOTS in 2005. Directly Observed
> Treatment Short-course (DOTS) is an effective strategy for
> curing TB, which involves monitoring a patient for six
> months. The monitoring is crucial because failure to complete
> the drug treatment can lead to multi-drug resistant TB, which
> is extremely difficult to cure.
>
> But within three months he stopped the treatment. Reason? "I
> was feeling better and I couldn't leave my shop and travel
> every alternate day to go to Hospicio Hospital, Margao, which
> is 25 kms away from my village for medicines," said Anil
> Sawant, who runs a tea stall in Dadolem, Sanguem taluka.
>
> Recollecting the days of ordeal he says, "I would leave at
> 6.45 am by bus and return at around 1 pm. This affected my
> business."
>
> Even his 60-plus mother is suffering from infectious
> pulmonary TB, but she refuses to go to Margao every alternate
> day for medicines, which is given free of cost. "She is week
> but she feels weaker after the travel and therefore has
> stopped the medicines midway," he added.
>
> Despite World Health Organisation's clear regional strategic
> plan (2000-2015) to sustain and enhance DOTS to reach all TB
> patients, improve case detection and ensure treatment
> success, the patients continue to drop-out of DOTS and nobody
> no filed visitor visits them to facilitate defaulter
> retrieval. If the so-called "success" of (RNTCP) is due to
> its directly observed treatment, then in rural Goa, the
> directly observed treatment has led to incidents of drop-outs
> as patients find it difficult to travel miles for treatment.
>
> Worse still is the fact that with the primary health centres
> and sub-health centres failing to meet the need the health
> care needs of individuals and families in the community,
> people are forced to travel long distances to go to the
> district hospital.
>
> "Earlier we used to go to the Community Health Centre at
> Sanvordem, which is 26 kms away from our village. But it
> doesn't have doctors and adequate equipments. We are made to
> wait for long hours, only to be sent back without treatment.
> Due to this we prefer to go to a private doctor," revealed
> Satyavan Dessai from Sulcorna in Quepem taluka.
>
> Dr Debabar Banerji, Professor Emeritus, Centre of
> Social Medicine and Community Health, JNU believes
> that the problem with RNTCP is that it is not being
> implemented not being fully implemented. "RNTCP is
> responsible to create a condition wherein the
> patients take the pills regularly. Unless RNTCP
> ensures that person as a whole is dealt with, it
> has no meaning," he said. Dr Banerji further added,
> "There is a group of TB patients who are harassed
> by poverty and alcoholism. For them TB is a minor
> problem. The solution lies in solving the major
> problems of life along with treating TB".
>
> No wonder despite claims of intensification of supervision
> and monitoring, rigorous record keeping and thorough
> follow-ups, the Sawants continue to drop-out of the treatment
> midway.
>
> FREE PILLS, BUT NO FOOD
>
> Take a look at this other case: she doesn't have food to eat
> but gets the magic pill free of cost. Jani Singadi was put on
> DOTS when she was tested sputum positive in January 2006. But
> the moment 65-year-old Jani started treatment she felt weaker
> and had severe stomach ache. Added to that were the
> multi-layered crisis within the family: three orthopaedically
> disabled sons, surplus of hunger, no money, an illegal house
> gifted by a few philanthropists, rising debt, and worse.
>
> Unable to deal with the increasing health problems and with
> no one to take her to the sub-health centre, which is two km
> away at Nanoda, Bicholim, she stopped taking pills for a
> month. "I couldn't go because I was feeling weak. No field
> officer ever came to visit me. I started medicines again
> after sometime when I became seriously ill," she accepts
> candidly. Now after a year, she is again tested sputum
> positive at Goa Medical College.
>
> Notwithstanding such setbacks, Dr VR Muralidharan, District
> TB Officer, North Goa claims they have default retrieval
> action to retrieve the patient back on track to take
> medicines. "Our success rate in retrieving patients is very
> high," he added.
>
> NO TIME FOR HEALTH
>
> For the last three months, Shanti Shetikar has been feeling
> week. She has had a consistent cough since last two months
> and has lost lot of weight-all symptoms of pulmonary TB. She
> went to the nearest sub-health centre at Kevona were the
> doctor gave her iron tablets. But all this has not helped.
> She has not bothered to go back to the sub-health centre.
>
> "The doctor only comes once a week and that too for an hour.
> So it's really difficult to meet him. Moreover, we are very
> poor and no one looks at us in the government hospital. We
> are made to wait for long hours and then sometimes send back
> without check-up due to lack of facility. Because of this we
> prefer to go to a private doctor," she reveals.
>
> So she went to a quack in the village who gave her six
> vitamin injections stating that she was feeling weak because
> she was vitamin deficient. However, it has not helped. For
> long she has been planning to go to for a proper medical
> check-up at the government hospital in Margao, which is
> nearly 30 kms away from her mining village in Quinamol,
> Sanguem, but she has not got the time to do so.
>
> "What can I do? Everyday I have to go to the market
> to sell vegetables. The day I don't go, there is no
> money at home to feed two hungry kids," she
> reveals. Shanti cultivates vegetables and sells
> them in the market to earn a living.
>
> NO TEA IN TB
>
> Vithal Parwadkar, who runs a tea stall in at Assnora, Bardez
> taluka, faces a strange dilemma. Some villagers have raised
> objections to him serving tea to "known" TB patients. "People
> tell me, 'He has TB and you are serving him tea in your
> stall? We don't want to have tea in the same glass, get us a
> new set of glasses'," he added.
>
> Strangely enough, people are so scared of TB that they have
> isolated one family in the village because the head of the
> family died of TB and the rest of the family members are seen
> to be frail and constantly coughing. Vithal reveals that the
> elder daughter had to be married off to a widower, as no one
> was ready to marry into the family. Gomantak Times tried to
> meet the family, but in vain.
>
> FACTS AND FIGURES: TB kills 1 person every minute in India
>
> In Goa, more than 1 person die of TB every month.
>
> Goa has a high prevalence of tuberculosis as compared to
> other states
>
> Annual risk of TB infection is 1.5 % in rest of India, while
> in the Western region, especially Goa, the risk of TB
> infection is 1.9 %
>
> 200,000 people in Goa 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.
>
> --
>
> The article appeared in Gomantak Times, Panjim Edition dated
> April 20, 2007. It was written with the support of PANOS STOP
> Media Fellowship. Preetu Nair is a journalist in Goa.
>
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Goanet recommends, and is proud to be associated with,
'Domnic's Goa' - A nostalgic romp through a bygone era.
This book is the perfect gift for any Goan, or anyone
wanting to understand Goa. Distributed locally by
Broadway, near Caculo Island, Panjim & internationally
by OtherIndiaBookStore.Com. For trade enquiries contact
[EMAIL PROTECTED]
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