Manabpur is a thickly populated industrial township located at the Western corner of India. The place is inhabited by huge number of migrant workers who generally hail from poverty-stricken states of Bihar, Uttar Pradesh and Madhya Pradesh for livelihood. The place is also occupied by a large section of female sex workers and transgender with flourishing flesh trade.
Tuberculosis is a common problem of the poor local residents because mainly of their unhealthy living condition and gross lack of awareness. Most of the TB cases visit the flock of private doctors of Manabpur and spend their hard-earned money for the treatment. They are clueless about the fact that Govt. of India has a National TB Control Program where all TB patients are entitled to receive treatment free of cost.
The threat of HIV transmission is also looming large over Manabpur. The number of cases suffering from Sexually Transmitted Infections is rising. They are highly stigmatized mass, often visit unqualified local quacks for treatment and finally land into more trouble with incomplete and faulty treatment. The sex workers and transgender depend mostly on the quacks for their health problems including frequent genital infections. They hardly go for HIV testing. They don’t know their HIV status. And they care a damn for condom if the clients offer more compensation.
Vinod came to know quite a lot about Manabpur from his friend Sudha who was working as a nurse of the local district hospital. Sudha told him that the district hospital receives off and on TB patients and some of them are also infected by HIV. She suspected the situation is really bad and something has to be done before it sneaks into the stage of ‘no return’.
Vinod just completed his Masters in Social Work and in search of a job. Sudha suggested him to apply for the contractual position of TB Health Visitor of Manabpur in the National TB Control Program. Vinod carried long cherished desire to be associated with disease control program the one like TB, so he immediately submitted his application. He had previous experiences of pulse polio and Mother & Child Health program. He got the job and his happiness knew no bounds.
The National TB Control Program of India hires one TBHV for the population of 1 lakh. The position is based in the urban set ups. The TBHV is responsible for field activities like visiting potential high risk groups of TB in the town/city, creating TB awareness and referring the TB suspects to the demarcated cough collection centres of the TB program. A person having cough for more than 2 weeks is a potential TB suspect.
Vinod came to know from Sudha that many of the TB cases belonging to Manabpur and adjacent areas visit private practitioners for treatment. Unfortunately, those practitioners are mostly unqualified and not trained at all on the management of TB. But they are strongly influential in the area both politically and at the medical business circuit. Nobody actually wants to disturb the equilibrium with them.
Vinod made them his first targets. He kept on visiting those practitioners on regular basis. His supportive behaviour and friendly nature won the hearts of those practitioners within a short span of time. He was able to convince them to refer the poor TB suspects visiting their chambers to the district hospital of Manabpur for free check-up and treatment. He even converted some of them into DOT (Directly Observed Treatment) provider to offer the medicines to their TB patients under direct observation on behalf of the National TB Program with an incentive from the program. Many of those private practitioners also participated in the training program organized by the district hospital and Vinod ensured that they would receive a certificate of attendance of the training that is duly signed by the District Administrator and District Tuberculosis Officer. The certificates were true motivator of the practitioners which made their engagement stronger with the National Program.
But Vinod didn’t draw full stop there. He still had miles to go.
He met with the coordinator of the newly formed District AIDS Society and fed him with the current HIV situation in the township of Manabpur. He gathered most of that information from Sudha and the private practitioners who used to treat a large number of Sexually Transmitted Infections as well in their clinics.
One day, a team from the District and State AIDS Societies came down to Manabpur and conducted the primary assessment survey. They met and interacted with the sex workers, pimps, transgender and the private practitioners and tried to capture as much information possible to have a clear stock of the situation. They also met the doctors of the district hospital. Vinod was their constant companion from the beginning till end of the survey.
Soon after, the State AIDS society appointed a local NGO to design a HIV project for the sex workers and transgender of Manabpur and submit a project proposal for the same. Vinod was specially requested by the District AIDS Society to guide the NGO in developing the proposal.
The proposal for the HIV project was approved by the state society and the NGO started their activities to enhance safe sex and health seeking practices among the sex workers. Vinod found it to be a good opportunity to initiate collaboration between the TB and HIV programs of Manabpur.
He started creating TB awareness among the female sex workers and transgender under the banner of the HIV project and triggered off TB suspect referral to the district hospital from these groups. Initially the sex workers were very reluctant to visit the hospital. They suspected once their identity gets disclosed they would have been grossly discriminated and ill-treated over there. But Vinod, with his sheer determination and exemplary managerial skill, overcame that challenge. He invited her nurse friend Sudha and other staff of the hospital including 2-3 doctors to have a round of discussion with the sex workers. A number of issues and doubts raised by the sex workers regarding their health seeking at the district hospital got clarified by the hospital staff. Gradually, the sex workers started moving to the hospital and utilizing the TB, STI and HIV counselling and testing services of the place. They could not find discriminatory behaviour from the hospital staff.
The TB program of the district does not have counselling services as per the norm of the National TB Program. Vinod fully utilized services of the counsellor who was hired for the HIV project of the sex workers. He brought his TB patients to the counsellor for motivating and mobilizing them for HIV counselling and testing in the district hospital.
The work load of the hospital increased many folds after Vinod joined the TB program of Manabpur.
His strategic move and hard work to improve the TB and subsequently HIV/AIDS situation in Manabpur have received high praise and accolade by the District Administration and Health authorities.
Vinod has recently been nominated for the award of the best health worker of the state for the year.
Sugata M
