Pavagada, India: Tuberculosis, malnutrition, and poverty
Tuberculosis (TB) is a leading cause of death from infectious disease—a child dies approximately every eight minutes. India has the highest number of infections in the world, and the children of an area of villages in the South have been hit particularly hard due to drought, poverty, and malnutrition. In March 2006, in partnership with the Swami Vivekananda Integrated Rural Health Centre, we launched a rural, mobile pediatric tuberculosis program to reach these children.
Approximately 512,000 people live in the villages of Pavagada, a rural area in the State of Karnataka, about 150 kilometers from the capital city of Bangalore. Farms here once grew crops such as peanuts, but now lie dry from decades of drought, unable to support the local community and economy. With limited access to water and food, people have suffered from severe poverty and disease. Without sufficient infrastructure or political representation, these realities became a prescription for illness and deaths among the children, which could often be prevented with proper resources.
Tuberculosis (TB) is an infectious bacterial disease caused by Mycobacterium tuberculosis. It most commonly affects the lungs and is spread between people through the air when a sick person coughs or sneezes. Once a person is infected they may not experience symptoms for years, however, many people develop "active TB disease" and become sick. The most common symptom of active TB of the lungs is coughing, which may be accompanied by blood in the sputum, fever, weight loss, weakness and fatigue, chest pains and night sweats. There were an estimated 1.6 million deaths globally from TB in 2006.
TB can be cured with a course of antibiotics. However, there are two primary challenges for TB treatment programs: (1) many communities exist in regions without access to the healthcare needed to receive treatment; and (2) for those who do receive treatment, limited resources often prevent a patient from complying with the full regimen of treatment. Making this support available to a person with TB is critical, because if a prescribed course of antibiotics is not taken consistently for the full time period, the patient runs the risk of becoming sick again—potentially with a Multi-Drug Resistant (MDR) strain of TB, where the bacteria have become resistant to the original (and most effective) antibiotics. MDR tuberculosis is very difficult and expensive to treat, and is not only more life-threatening for the individual, but also a greater global risk if it spreads.
The children of Pavagada are challenged by high rates of life-threatening disease and a lack of resources to access proper treatment. In addition, the pervasive malnutrition in this region increases the susceptibility of the children to diseases like tuberculosis, and negatively affects their survival. In our program, medical staff bring antibiotics from the local Swami Vivekananda Integrated Rural Health Centre and nutritious food from local farms to each village. A network of hundreds of volunteers from within the villages ensure that the medicine is taken properly each day in order to maximize successful treatment (and prevent MDR tuberculosis) by implementing the Directly Observed Treatment, Short Course (DOTS) protocol—a method reccomended of ensuring compliance and recording progress for each patient.
Families of treated children are given ragi, a millet grown by local farms, to boost the protein often missing from the diets of malnourished children. This native crop has been instrumental in helping children overcome disease, and this portion of the program is just the beginning element of a larger project to help revive the local agricultural economy.
So far, PHWW's health project in Pavagada has been modest in scope. However, our nutition model gained recognition from the District TB Officer, and has been extended to serve all pediatric TB patients across the Tumkur District as of World TB Day, March 24, 2009. We hope to reach more children's lives by expanding the reach of this clinic, and launching more clinics where treatment is needed. We are also working with the community and agricultural experts to launch a new sustainable, long-term solution for Pavagada's agricultural economy, so they can tackle the underlying causes for disease and poverty that have afflicted their region by growing their own resources for the future.
Here are some resources for more information on tuberculosis:
- TB Alert
- US Department of Health and Human Services
- The Global Fund to Fight AIDS, Tuberculosis and Malaria
- Doctors Without Borders
- The World Health Organization
- The Stop TB Partnership