DOT Providers of the islands

Sugata M

(SHIS TB boat that sails around the islands)

Sundarban is the largest Delta of the world, comprised of 102 islands. Out of them 54 islands are habitable with a population of approximately 4.8 million. The unique feature of Sundarban is its dense forest denned by the world-famous Royal Bengal tigers. Tiger-bite is a common phenomenon among those villagers who infiltrate into the forests in search of wood and honey. Sometimes desperate bunch of tigers swim across the water to reach the villages to taste human flesh.

The public healthcare system of Sundarban is not sufficient to meet the need of the poor ailing people.  Transportation of emergency and complicated patients from the islands to the hospitals located at the main land always remains a challenge in the absence of speedy moving boats. Traditional man-drawing boats and slow-going motor launches are the only mode of communication between the islands. Electricity does not reach many of the villages till now.

Tuberculosis is not uncommon in Sundarban. An NGO named SHIS (Southern Health Improvement Samity) has been tirelessly working for the TB affected population in 30 islands since 1992. Currently, SHIS is helping the government to extend and expand the TB services in Sundarban.  SHIS operates mobile TB services through their motor launches within the islands. The launches are equipped with microscopes (for sputum examination), X-ray machines and other materials for diagnosing TB and carry the drugs to treat the TB cases.

SHIS developed a network of highly motivated cadres of community DOT (Directly Observed Treatment) providers across the islands over years. These providers have devoted their lives to cure the TB patients and give them new lives.

DOT providers are responsible to ensure that the TB patient is taking the medicines without missing a dose and completing the course in the due time.  The TB patients have to visit their respective DOT providers’ places and take their medicines in front of their eyes. So it is called directly observed treatment.

Sarbeswar Roy of Taranagar island had TB five years back. He was very ill and finally sought the TB services of the government. He got completely cured and the incidence brought sea change in his life. He decided to become a DOT provider.

(Sarbeswar and his wife with Patient wise Boxes at his hut)

 

‘I know what the hell a TB patient goes through. The sufferings sometime become unbearable. When I was cured, I decided to help the sufferers like me. So I become a DOT provider.’ said the 30 year-old Sarbeswar in front his small hut in Taranagar. ‘I cured 15 TB patients so far and am currently providing DOT to 3 patients.’

He has no fixed income. He has no lands to cultivate. His key earnings come through providing DOT, which is as small as Rs 250-00 ($5) per patient he cures. The disbursement of that remuneration is often delayed due to the bureaucratic complicacies of the government system, but Sarbeswar is undaunted.

‘I feel proud to be DOT provider. I will do this work till I die’ He said with a glow of satisfaction in his face.

When asked ‘what he does when a TB patient doesn’t turn up to take the medicines at his place’ he said, ‘I visit his or her residence to give the medicines. The patient can’t escape from me.’

Sundar Chandra Mondal of Amtoli island has been providing TB medicines to the patients since 1992 when the DOTS strategy was not even adopted in India’s TB program.

‘I am one of the oldest DOT providers created by SHIS during its initial years. I myself had TB many years back. Since then I vowed to get rid of this disease from the island.’

Sundar Chandra Mondal has crossed 70 few years back. He is still going strong to continue his fight against TB. ‘I treated more than 1000 TB patients in my life. I also give injectable drug for TB’. He is presently treating 1 TB case in his island.

Mohammad Shaheb Ali Gayin alias Gaiji of Kathalberia has been in DOT business since 2001. He has provided medicines to more than 70 patients of his village and currently in charge of 3 patients. Gaiji is a simple hearted man and dreams to make his place free from TB.

‘I look forward to the day when people will not suffer from TB any more’ he said with sheer determination in his voice.

I saluted them all.

  

INTERVIEWING HEALTH WORKERS AND NON HEALTH WORKERS ON THEIR PERCEPTION TOWARDS HIV/AIDS IN NIGERIA.

Uchena Anozie

In Nigeria HIV/AIDS is still seen as a disease for a certain people, people who are sinners, fornicators, adulterers therefore they have to be segregated, yes this stigmatization might not be voiced out but the smell of it is all over the place, unfortunately health workers champion all forms of discrimination against people living with HIV/AIDS in Nigeria ranging from denying health services to people living with HIV/AIDS to the manner and attitude they exhibit to these patients, confidentiality is history, people test HIV positive and the next moment everyone in the community hears about the person’s HIV status.

I came back to my country Nigeria late December 2011 after being away for sometime and I took a personal survey on health workers approach and perception towards people living with HIV, I further ascertained from the ordinary people outside the health sector about their perception towards people living with HIV/AIDS. Though I did not carry out an analysed statistical detailed survey I interviewed health workers and other people on this.

To my astonishment I found out that majority of our health workers do not even believe in treatment of HIV patients, they just give HAART because they are told to do so, this belief affects the counselling delivered to the patients, patients that are supposed to be encouraged by health workers are not. Some health workers don’t believe that HAART works properly and they discourage sero-discordant couples instead of counselling them on safer sex practice, Family planning and reproductive health management.

HIV couples are not given proper attention on family planning and most health workers claimed that they lack knowledge of family planning for people living with HIV, most of the health workers never knew of PEP post exposure prophylaxis which is meant to be either occupational or non-occupational. I had a talk with a nurse and he told me he discourages sero discordant couples from having sex forgetting the fact that sex is a natural instinct in man and sex is a right not a privilege.

On another interview with a laboratory technician practising in a private hospital, she told me that people living with HIV should be left with no drugs so that they die off, when I asked reasons for her opinion, she said that some patients she knew because of HAART live healthy lives and they go ahead to have sex with other HIV free people therefore spreading HIV.

Talking with a retired nurse in her home she narrated to me how she despised people living with HIV, she told me of about 6 people that died of AIDS  in the late 90’s and early 2000’s. She still had the mentality that ART was just given for giving sake and that any infected person must surely die of AIDS. She told me that once upon a time a HIV patient died in their hospital and people avoided going for treatment in that hospital for so many months because an HIV patient died there. After that incident they began to chase away people living with HIV from their hospital.

After having interactions with health workers I interviewed non health workers and their response were baffling, a few agreed that HIV can be treated and managed though no cure yet while majority openly said that they will never have anything to do with any person living with HIV.

Funny enough both health workers and non health workers showed very low knowledge, attitude and practise on HIV/AIDS management. I tried finding out if there was this habit of people going for voluntary HIV testing and the response was extremely poor. Most people only went for HIV screening when they were sick, mandated to, during antenatal checks or before marriage.This implies that most people I interviewed did not even know their current HIV status and they were very repulsive towards relating with people living HIV.

With this study I found out that there is still great need for orientation of both health workers and the masses at large on HIV /AIDS management, there is need for training and retraining of health workers. We need to know facts about HIV intervention, control and treatment, people are misled, misinformed and uninformed on issues concerning HIV/AIDS, a lot of people are still dwelling in the past and believe strongly that HIV/AIDS is untreatable and incurable. Issues on correct and consistent use of condom, regular voluntary HIV counselling and testing must be addressed.

Our government is full of corruption and the ministry of health/NACA national action committee on AIDS is doing nothing on these issues, they are rather making unrealistic budgets, ghost projects  carrying out ineffective and inefficient workshops and seminars without any positive impact due to lack of supervision, lack of proper monitoring and evaluation.