Fellowships are an exciting concept, not only for the ones who apply for them but also for the ones who look at it from an outsider’s point of view. All over the world, especially in India; being a recent college graduate coupled with being in the early 20s, brings with it a plethora of queries from friends, family and acquaintances. Amidst all the varying questions, one query is a common one, i.e. “what are you doing presently?”
Right after our ten-day virtual Orientation for the AIF Clinton Fellowship, I had to face this question, along with the query of “what is a fellowship”? They were posed to me at one of our family dinners, by a childhood friend’s father, who also happened to be the medical superintendent of the hospital in my locality. Since my project was on public health and tuberculosis, to be specific, I was elated to talk about the AIF Clinton Fellowship and the work that I would be pursuing over the next eight months.
While the jury is still out on giving a specific definition to the broad term of “fellowship”, the conversation that surrounded tuberculosis, and public health, in general, was one of a kind. As I explained my work, along with talking about the worrying numbers of tuberculosis in India and Bihar (my fellowship placement site), he came up with a line, which struck me very deeply. I quote him: “you don’t need to go as far as Bihar to understand the TB problem, look at your locality and you will understand the intensity of it”. At the same time, he mentioned to me that the hospital in our locality was a Directly Observed Treatment (DOT)/Designated Microscopy Center under the Revised National Tuberculosis Control Program (RNTCP). The RNTCP is the Government of India’s flagship program to make India TB free by 2025. He offered me to visit the same to see how the centre works and talk to the people managing the affairs of the centre. This offer exhilarated me, and I was quick to accept the offer, keeping in mind the following reasons:
- It would enable me to share my local learnings with my host organization and compare the similarities in the challenges faced in both the locations, the administrative styles, and challenges my host organization isn’t aware of, till now.
- While working virtually is the new normal, having the option of learning from the ground is always an added advantage to have.
Keeping all the above points in mind, I paid a visit to my local hospital – Vivekananda Kendra Hospital.
I visited Dr Konwar, a senior doctor who looks after the Microscopy/DOT Centre. After a quick explanation of the structure of the “Revised National Tuberculosis Control Program”, given in the diagram below, I was allowed to visit the DOT/Microscopy centre.
On enquiring with the medical staff from the centre, I found out that 3-4 TB patients on average are diagnosed every month by the centre. While going through the “TB Notification Register”, the fact that startled me the most was that out of the 110-120 odd cases reported during the previous three years, more than 60% of them belonged to the nearby tea garden.
According to the medical staff, along with Dr Konwar; the lack of awareness about TB among tea garden workers, their low incomes, low living standards, lack of gas facilities, living in crowded spaces, insufficient nutrition and alcoholism were some of the contributing factors to this dismal statistics. With a low income, travelling to hospitals to acquire treatment was near to luxury for these workers. These facts also show the inter-dependent relationship between income, health and education. All the observations were precious as my host organization in Thakurganj, Bihar is surrounded by tea gardens too, and it would be interesting to note if the same observations were prevalent there also.
Luckily, as I was leaving the centre, I got the chance to interact with ASHA worker Bobita Baruah. She hailed from the worst affected tea garden mentioned above and had come to the DOT centre to collect her monthly share of TB medications for the patients that she looks after. Grabbing the opportunity, I quickly asked her a few questions. When asked about the reasons behind such a high number of cases from her area, her responses were the same as mentioned above. At the same time, she specifically emphasized the poor economic conditions of the population in her place. When asked about the two most essential requirements for her; provision of gloves/face masks, timely payment of her salary, along with the timely release of the financial assistance provided to TB patients under the Nikshay Poshan Yojana, were some of her responses. Apart from these, some of the responses that weren’t specifically TB related but had caught my attention were:
- When asked about what gives her the most satisfaction in this line of work, she showed me her registry of TB patients that she has been maintaining since the last two years, and mentioned to me that she had saved all these lives, and she wants to keep adding people to this list. While she was saying this, I could sense her happiness. The pride in her voice was evident. I knew she had found the purpose of her life.
- When asked if I could click a picture of hers, she happily agreed to the same. Once her photo was taken, she was delighted to see her picture and had asked me to share the same with her. Finally, before we parted ways, she thanked me for taking the efforts to listen to her, for giving her respect, and for giving her a voice.
We often underestimate the power of listening. The ASHA workers in our country selflessly listen to the problems and woes of the underprivileged at the grassroots level. However, how many listen to their struggles? Is mental health a concept for the privileged only?
Tuberculosis is an epidemic that has been plaguing India since decades. According to the India TB report 2020, India is the highest TB burden country in the world, with an estimated incidence of 26.9 lakh cases in 2019 (WHO). According to data from the Directorate of Health Service, Government of Assam, out of the 27 districts in Assam in 2016, eight districts had put more than 1700 patients under TB treatment. My home district of Golaghat was one of them, thereby making it one of the worst-hit TB districts in Assam.
As I was walking back home, I was wondering how could I have not known about the highly worrying numbers of tuberculosis in my district, a district where I have been living for the past twenty-two years. How could I have not known that the local hospital, which is less than 500 metres away from my house was a TB DOT/Microscopy centre? While we debate a whole lot of varying topics in school, why do issues surrounding public health take a back seat, and are never discussed right from the high school level? I believe there is a considerable gap which needs to be addressed, right at the bud. Hopefully, the AIF Clinton Fellowship gives me the platform to address these gaps and enables me to bring conversations around public health among the youth in varying capacities.
“Revised National Tuberculosis Control Programme.” Government Of Assam Health & Family Welfare Directorate of Health Service, 30 Dec. 2020, http://dhs.assam.gov.in.
Ministry of Health & Family Welfare-Government of India. India TB Report 2020: Ministry of Health and Family Welfare, tbcindia.gov.in/showfile.php?lid=3538.