World TB Day: How danger looms over Indian weavers
The state of a community's health is a vital indicator of the quality of governance provided to it. A healthy community signifies the presence of adequate nutrition, hygiene, sanitation and successful provision of quality health care. It signifies the presence of a policymaking environment committed to delivering the best health interventions to the people, as well as the infrastructure and resources necessary for successful implementation.
India is a country of paradoxes. While we have taken tremendous strides forward in public health, there still remains a lot to do. Communicable diseases account for 24.4 per cent of India's disease burden, and since they take root in areas with poor sanitation and hygiene, inadequate nutrition and a lack or absence of quality health care, this is cause for alarm.
Let us take tuberculosis (TB), for example. India has the world's highest TB burden, accounting for one-fourth of all new infections. The government has spared no effort to contain the disease, its Revised National TB Control Programme (RNTCP) achieving full geographical coverage in 2006. The RNTCP provides free treatment to all notified TB cases through over 4,00,000 directly observed treatment short-course (DOTS) centres. However, TB is an adversary that evolves continuously, requiring that our strategies to contain it evolve as well.
The TB landscape in India presents the same diversity that we associate with our country. Depending on the specific community in question, the disease may arise out of some common and some unique circumstances. However, it uniformly and indiscriminately leaves great suffering in its wake.
One example is the Indian weaver community. The beautiful, many coloured products of their craft are famous worldwide and eagerly sought after. They are the fruit of the weavers' ceaseless toil, the end result of long hours spent in dingy, confined spaces working constantly at their looms. Theirs was once a thriving and prosperous industry. Today, however, the advent of cheaper, mass-produced textiles has pushed them to the margins. Like many traditional artisans across India, they have seen a steep decline in the demand for their craft. Many of them now live in conditions of extreme poverty, unsanitary conditions and ill-health, thus becoming vulnerable to infectious diseases. TB constitutes an ever-present mortal threat in their lives.
TB is driven by different primary factors across the world. In Africa, the TB epidemic is driven by AIDS. In India, it is driven by malnutrition. The weavers' extreme poverty denies them access to adequate nutrition, which gets compounded by a lack of access to quality health care. However, the incidence and subsequent prevalence of TB among themis also the result of occupational hazards.
A lack of risk perception and the absence of an organised mechanism to enforce health and safety guidelines leads to unsafe working practices, where constant exposure to cotton dust and harmful chemicals in unventilated rooms increases the risk of respiratory diseases such as byssinosis and TB. The fine cotton fibres that the weavers inhale also induce coughing, which releases the TB bacillus into the atmosphere.
Timely TB diagnosis through a sputum test and adherence to the full course of treatment is essential for successfully curing the disease. A lack of awareness and poor treatment adherence makes patients vulnerable to drug-resistant TB, which is more difficult and expensive to treat and causes heavy side-effects. Drug resistance also makes the infected weavers carriers of a much deadlier TB strain. Caught in a deadly cycle of disadvantage and disease, the weavers contribute a significant number to the morbidity and mortality figures due to TB, news of their plight crossing our borders and causing alarm worldwide.
Clearly, then, this is a problem that needs to be acknowledged and addressed on a war footing. The provision of adequate TB prevention and control measures will also raise the weavers' standards of living, as it will involve better hygiene, sanitation, access to better nutrition and the prevalence of better health-seeking practices. Additionally, the use of preventive measures such as masks and stringent implementation of health and safety guidelines at workshops will go a long way in reducing the threat of TB to their community.
It is not all bad news though. India's legislative practice has a record of delivering well-deliberated, comprehensive policies. The RNTCP is a prominent example of the timely implementation of a well-enacted policy. Its nationwide coverage provides a ready platform to work towards better implementation, so that better TB care reaches the lives of those who need it most. India will win when TB loses. TB harega, desh jeetega.