Human rights violations in people with TB
Human Rights have long been ignored in TB 'Control', but are a foundation for improving care as outlined in the International Standards for TB Care (ISTC) and the Patients' Charter for TB Care (PCTC). At the 40th Union World Conference on Lung Health, delegates spoke about human rights violations that challenge TB care and control on the frontlines in their national contexts.
"Dominant human rights violations in TB patients are in those who have co-infection of HIV. There is absolutely no doubt in my mind or in those who work in the field, that when you have HIV combined with TB, there is immense stigma and shame apparently associated with HIV. My own sense is that TB patients are partially discriminated against it is not as extreme not as severe and not as comprehensive open system that we have against HIV. But I am speaking in southern African environment and it might be different in other parts of the world. Certainly the struggle against both, stigma and discrimination against TB and HIV, or any other diseases, because sexually transmitted diseases are also discriminated against, should be fought against vehemently. In the case of TB and HIV one of the drawbacks of this discrimination and isolation of patients is that it drives the disease underground and actually leads to greater public health damage by being widespread and therefore is fundamentally a bad result from public health point of view not only from ethical or moral point of view" said Professor Hoosen Coovadia, noted paediatrician and expert in perinatal HIV transmission, former Head of the Department of Paediatrics at the University of Natal until 2000 and Victor Daitz Professor for HIV/AIDS research at the University of Natal, South Africa.
"Every TB patient has the right to get high quality standards of prevention, treatment and care services. At present TB programmes don't reach every patient who needs care in India. Some issues like working hours of TB-services which don't suit some patients, need to be addressed by adjusting timings. TB patients should get proper diagnosis and other services as required in reality - just drugs available on paper is not enough, the services must reach the patients. One of the good TB strategies should be to engage TB patients. The cured TB patients can advocate with new TB patients and in communities to improve TB responses. These cured TB patients can spread the message that TB is curable, thereby reducing TB-related stigma. They can also be engaged in strengthening social movement to eradicate TB" said Dr D Behera, Union Karel Styblo Awardee for Public Health 2009 and Director of LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi, India.
"The literacy rates among TB patients are low, they are less aware of their own rights and responsibilities related to TB care and services. There is enormous social stigma related to TB prevalent in our society that further put them at risk of human rights violations. Patients of TB are often not comfortable with disclosure" said Dr Darakshan Badar, Programme Manager, Provincial TB control Programme (PTP), Lahore, Pakistan.
"Bangladesh is a success story in terms of TB control. However previously we had lot of TB-related stigma due to which TB patients were isolated at times from their families. Now TB patients go on their own to seek TB care" said Dr K Zaman from ICDDRB Bangladesh. All is not good too in Bangladesh. "Lot of TB patients go to general practitioners outside DOTS and get treated with a range of antibiotics instead of being referred to DOTS" says Dr Zaman. "I conducted study in the past, where 50% of new TB patients were found to be resistant to at least one anti-TB drug, and 5.5% had MDR-TB" adds Dr Zaman.
"In DRC, we have organizations of cured TB patients to help other patients to minimise stigma. TB patients can share their difficulties and concern with each other in this network during the treatment and successfully complete DOTS. These TB patients' groups have been there in DRC for the last ten years. In Kinshasa, many TB patients were defaulting earlier so NTP realized the importance of engaging cure TB patients and counselling new TB patients on taking TB treatment on time. These TB patients' led groups have upped the TB cure rate in DRC to 90%" said Dr Jean Pierre Kabuayi Nyengele, Deputy NTP Manager, Democratic Repubic of Congo (DRC).
"It is a right of TB patients to access prevention, diagnosis, treatment and care services. But that is not happening because of range of reasons including weak health systems, suboptimal infrastructure, lack of facilities" says Dr Peter Kimuu, TBCAP, Kenya.
"In our context, female TB patients have more problems in accessing existing services for TB. Female TB patients find it difficult to get engaged, married or those who are already married, often get divorced due to stigma related to TB" shares Dr Ejaz Qadeer, National TB control Programme (NTP), Pakistan.
"Female TB patients face a lot of problems and we need to establish protocol and guidelines to address gender-specific issues in TB programmes" suggests Dr Razia Fatima, Programme Officer, National TB Control Programme (NTP), Islamabad, Pakistan.
There are many more points to ponder and decide whether these qualify as human rights violations too:
- Requiring patients pay for any diagnosis and treatment of TB, a declared "threat to public health".
- Denying patients social support through peer-groups and hotline services.
- Forcing innocent people to take toxic drugs that are not quality assured by WHO standards.-
- Not adhering to treatment for infectious TB and knowingly putting others at risk.
- Refusing to treat extra-pulmonary MDR-TB because it is non infectious.
- Not informing patients of their Rights and Responsibilities (PCTC/ISTC).
- Requiring public healthcare personnel to work without adequate infection control.
- Not providing palliative care for MDR/XDR patients for whom treatment is not available or viable.
Do they and many other such situations people with TB deal with on daily basis, qualify as human rights violations? Speak your world!
Published in:
Citizen News Service (CNS), India/Thailand
Twitter.com
Elites TV News, USA
Hard talk on association between public health advocates and pharmaceutical companies
Hard talk on association between public health advocates and pharmaceutical companies
Is it ethical for public health advocates to accept funding from pharmaceutical companies, or organizations directly/ indirectly affiliated to them? Should all direct/indirect engagement with Pharmaceutical companies should be declared openly and publicly? The delegates at the 40th Union World Conference on Lung Health in Cancun, Mexico, responded differently to this contentious issue.
The World Health Organization (WHO) and many other indexed publications ask people to sign a declaration form to declare any association with tobacco companies. The Article 5.3 of the WHO Framework Convention on Tobacco Control (FCTC, the global tobacco treaty) give teeth to the treaty which states, "in setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law." The WHO FCTC Article 5.3 guidelines include the following recommendations, rooted in the principle that the tobacco industry has a fundamental and irreconcilable conflict with public health:
- governments should reject partnerships with the tobacco industry;
- conflicts of interest such as the "revolving door" between the tobacco industry and public health offices, government investments in the tobacco industry and tobacco industry representation on tobacco control bodies should be avoided;
- government interaction with the tobacco industry should be strictly limited and transparent;
- the tobacco industry should be required to be transparent about its activities, a measure which will help to counter interference by Big Tobacco's front groups and allied organizations.
Similar examples exist where people need to declare their association openly with formula food companies for instance. So is it ethical for public health advocates to take funding from pharmaceutical companies? Should it be declared openly?
When asked to respond to this question, Professor Hoosen Coovadia, noted paediatrician and expert in perinatal HIV transmission, former Head of the Department of Paediatrics at the University of Natal until 2000 and Victor Daitz Professor for HIV/AIDS research at the University of Natal, South Africa, said "unfortunately there is no simple yes or no answer to this. I guess in many instances that association [between pharmaceutical companies and public health advocates] has to be acknowledged and expressed fully. For example many of the good journals will not accept an article unless that association with food company, pharmaceutical company, depends what the company is, is openly acknowledged."
"People do believe in taking pharmaceutical companies' support in undertaking [clinical/ research] trials. It happens in National Institute of Health and many other institutions or these [public health] products will simply not have been tested. You can imagine a world where new drugs for TB and HIV are not available or not acceptable because those [clinical trials/ research] studies were not done" adds Professor Coovadia.
"There are some extreme examples on refusal to accept money [from companies]. One instance is taking money from tobacco companies because of their egregious behaviour of denying the damaging effects of tobacco. I am a paediatrician and we have been through decades of fighting formula food producing companies for the damage they do in developing world and probably in other parts of the world too in promoting their products in absence of support for exclusive breastfeeding for first six months. I think in those two instances public health advocates will take the position that any association with food company or tobacco company is inherently unacceptable" asserts Professor Coovadia.
"Any such association [between pharmaceutical companies and public health advocates] has to be declared openly. One of the examples is of one of the best drugs that we initially started off with to prevent mother to child transmission of HIV. It is a drug called nevirapine and we had the support from the manufacturers of nevirapine to do those studies. Now that is openly acknowledged, publications mention their association clearly, mention the role of drug company, and say in absolutely unambiguous terms that those companies have no influence on whatsoever in collection of the data, certainly not in the analysis of the data, or in the conclusions. In other words the scientific content of the paper or the article or the document was uninfluenced by that type of association. I think association with pharmaceutical companies can continue as long as those restrictions are adhered to" further adds Professor Coovadia.
"Pharmaceutical companies have enormous amounts of money that should be spent on research and development. It should be made mandatory for pharmaceutical companies to earmark funding for research and development, particularly in high burden countries" says Dr Darakshan Badar, Programme Manager, Provincial TB Control Programme (PTP), Punjab, Pakistan.
However, Dr Badar's colleague at the National TB Control Programme (NTP) in Pakistan, Dr Ejaz Qadeer, has a different opinion: "Public health advocates should not take money from pharmaceutical companies. There is an obvious conflict of interest and taking money from pharmaceutical company is risky for the [TB/ health] programme and also for the government. All association with pharmaceutical company of public health advocates should be open and [information regarding interaction should be] accessible to the public and other stakeholders to see what interaction is taking place between public health advocates and pharmaceutical companies."
"In Bangladesh, taking funds from pharmaceutical companies for TB is not common. Pharmaceutical companies are not willing to fund TB programmes because TB drugs are not available over-the-counter and given free to TB patients through DOTS" says Dr Zaman from Bangladesh.
"We can accept money from pharmaceutical companies to help TB patients but this should be open and publicly declared" says Dr Jean Pierre Kabuayi Nyengele, Deputy Manager, National TB Control Programme (NTP), Democratic Republic of Congo (DRC).
"The association between pharmaceutical companies and public health advocates should be openly declared" says Dr Peter Kimuu, TBCAP, Kenya.
"I don't think it is unethical to accept money from pharmaceutical companies. [However] the pharmaceutical companies shouldn't do unethical actions like promoting drugs or irrational use of drugs [after giving money]. It [association between pharmaceutical companies and public health advocates] should be declared openly and publicly, just like [we treat] tobacco companies" said Dr D Behera, Director, LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi, India. Dr Behera was also awarded the Union Karel Styblo Public Health Award for this year 2009 at the 40th Union World Conference on Lung Health.
"For public health advocates, it is not ethically right to take money from pharmaceutical companies. All association between public health advocates and pharmaceutical companies should be open, and the agenda should be made public too" says Dr Razia Kaniz Fatima, M&E (Monitoring and Evaluation) ACSM Officer, NTP, Pakistan.
Well, there might be extreme difference of opinion on how ethical it is to engage with pharmaceutical companies and taking funding from them, but there is clear support to making this association open and public. Dr Coovadia's example of how manufacturers of nevirapine funded the research but had no control on scientific outcomes is worth remembering. The debate is certainly on, and more viewpoints and perspectives on this contentious issue be coming forth.
Published in:
Citizen News Service (CNS), India/Thailand
Modern Ghana News, Accra, Ghana
Scoop.com, New Zealand
Media for Freedom, Nepal
Pakistan Christian Post, Pakistan
Banderas News, Mexico
Media For Freedom, Nepal
Bihar and Jharkhand News Service (BJNS)
Is it ethical for public health advocates to accept funding from pharmaceutical companies, or organizations directly/ indirectly affiliated to them? Should all direct/indirect engagement with Pharmaceutical companies should be declared openly and publicly? The delegates at the 40th Union World Conference on Lung Health in Cancun, Mexico, responded differently to this contentious issue.
The World Health Organization (WHO) and many other indexed publications ask people to sign a declaration form to declare any association with tobacco companies. The Article 5.3 of the WHO Framework Convention on Tobacco Control (FCTC, the global tobacco treaty) give teeth to the treaty which states, "in setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law." The WHO FCTC Article 5.3 guidelines include the following recommendations, rooted in the principle that the tobacco industry has a fundamental and irreconcilable conflict with public health:
- governments should reject partnerships with the tobacco industry;
- conflicts of interest such as the "revolving door" between the tobacco industry and public health offices, government investments in the tobacco industry and tobacco industry representation on tobacco control bodies should be avoided;
- government interaction with the tobacco industry should be strictly limited and transparent;
- the tobacco industry should be required to be transparent about its activities, a measure which will help to counter interference by Big Tobacco's front groups and allied organizations.
Similar examples exist where people need to declare their association openly with formula food companies for instance. So is it ethical for public health advocates to take funding from pharmaceutical companies? Should it be declared openly?
When asked to respond to this question, Professor Hoosen Coovadia, noted paediatrician and expert in perinatal HIV transmission, former Head of the Department of Paediatrics at the University of Natal until 2000 and Victor Daitz Professor for HIV/AIDS research at the University of Natal, South Africa, said "unfortunately there is no simple yes or no answer to this. I guess in many instances that association [between pharmaceutical companies and public health advocates] has to be acknowledged and expressed fully. For example many of the good journals will not accept an article unless that association with food company, pharmaceutical company, depends what the company is, is openly acknowledged."
"People do believe in taking pharmaceutical companies' support in undertaking [clinical/ research] trials. It happens in National Institute of Health and many other institutions or these [public health] products will simply not have been tested. You can imagine a world where new drugs for TB and HIV are not available or not acceptable because those [clinical trials/ research] studies were not done" adds Professor Coovadia.
"There are some extreme examples on refusal to accept money [from companies]. One instance is taking money from tobacco companies because of their egregious behaviour of denying the damaging effects of tobacco. I am a paediatrician and we have been through decades of fighting formula food producing companies for the damage they do in developing world and probably in other parts of the world too in promoting their products in absence of support for exclusive breastfeeding for first six months. I think in those two instances public health advocates will take the position that any association with food company or tobacco company is inherently unacceptable" asserts Professor Coovadia.
"Any such association [between pharmaceutical companies and public health advocates] has to be declared openly. One of the examples is of one of the best drugs that we initially started off with to prevent mother to child transmission of HIV. It is a drug called nevirapine and we had the support from the manufacturers of nevirapine to do those studies. Now that is openly acknowledged, publications mention their association clearly, mention the role of drug company, and say in absolutely unambiguous terms that those companies have no influence on whatsoever in collection of the data, certainly not in the analysis of the data, or in the conclusions. In other words the scientific content of the paper or the article or the document was uninfluenced by that type of association. I think association with pharmaceutical companies can continue as long as those restrictions are adhered to" further adds Professor Coovadia.
"Pharmaceutical companies have enormous amounts of money that should be spent on research and development. It should be made mandatory for pharmaceutical companies to earmark funding for research and development, particularly in high burden countries" says Dr Darakshan Badar, Programme Manager, Provincial TB Control Programme (PTP), Punjab, Pakistan.
However, Dr Badar's colleague at the National TB Control Programme (NTP) in Pakistan, Dr Ejaz Qadeer, has a different opinion: "Public health advocates should not take money from pharmaceutical companies. There is an obvious conflict of interest and taking money from pharmaceutical company is risky for the [TB/ health] programme and also for the government. All association with pharmaceutical company of public health advocates should be open and [information regarding interaction should be] accessible to the public and other stakeholders to see what interaction is taking place between public health advocates and pharmaceutical companies."
"In Bangladesh, taking funds from pharmaceutical companies for TB is not common. Pharmaceutical companies are not willing to fund TB programmes because TB drugs are not available over-the-counter and given free to TB patients through DOTS" says Dr Zaman from Bangladesh.
"We can accept money from pharmaceutical companies to help TB patients but this should be open and publicly declared" says Dr Jean Pierre Kabuayi Nyengele, Deputy Manager, National TB Control Programme (NTP), Democratic Republic of Congo (DRC).
"The association between pharmaceutical companies and public health advocates should be openly declared" says Dr Peter Kimuu, TBCAP, Kenya.
"I don't think it is unethical to accept money from pharmaceutical companies. [However] the pharmaceutical companies shouldn't do unethical actions like promoting drugs or irrational use of drugs [after giving money]. It [association between pharmaceutical companies and public health advocates] should be declared openly and publicly, just like [we treat] tobacco companies" said Dr D Behera, Director, LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi, India. Dr Behera was also awarded the Union Karel Styblo Public Health Award for this year 2009 at the 40th Union World Conference on Lung Health.
"For public health advocates, it is not ethically right to take money from pharmaceutical companies. All association between public health advocates and pharmaceutical companies should be open, and the agenda should be made public too" says Dr Razia Kaniz Fatima, M&E (Monitoring and Evaluation) ACSM Officer, NTP, Pakistan.
Well, there might be extreme difference of opinion on how ethical it is to engage with pharmaceutical companies and taking funding from them, but there is clear support to making this association open and public. Dr Coovadia's example of how manufacturers of nevirapine funded the research but had no control on scientific outcomes is worth remembering. The debate is certainly on, and more viewpoints and perspectives on this contentious issue be coming forth.
Published in:
Citizen News Service (CNS), India/Thailand
Modern Ghana News, Accra, Ghana
Scoop.com, New Zealand
Media for Freedom, Nepal
Pakistan Christian Post, Pakistan
Banderas News, Mexico
Media For Freedom, Nepal
Bihar and Jharkhand News Service (BJNS)
Responding to TB, HIV, COPD and tobacco smoking needs coordinated approach
Responding to TB, HIV, COPD and tobacco smoking needs coordinated approach
Tobacco smoking, TB, HIV and chronic obstructive pulmonary disease (COPD) are all burgeoning problems in resource poor settings. The evidence of their potentially devastating effects on global public health is increasing and they require a coordinated approach for control. These diseases all occur in predominantly resource-poor countries. They are perpetuated by poverty and inadequate resources and their control and management require coordinated approach for control, said delegates at the 40th Union World Conference on Lung Health, in Cancun, Mexico.
Statistically, there is 1 TB-related death that takes place every 18 seconds, 1 HIV death every 16 seconds and 1 smoking-related death every 13 seconds. The enormous public challenge posed by the combined epidemics of tobacco smoking, HIV, TB and COPD, is undoubtedly alarming. But is there a link between TB, HIV, COPD and tobacco smoking? Do they increase the risk of each other?
"At the beginning of 21st century we really are facing convergence of several epidemics like HIV, TB, COPD and tobacco smoking among others" said Richard N van Zyl-Smit work works with Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town, South Africa.
"Tobacco smoking is unquestionably the primary risk factor for COPD. The importance of "total burden of inhaled particles" (occupational, household, environmental) is increasing" said Richard.
"Smokers have two fold higher risk of developing active TB disease" said Dr Madhukar Pai from McGill University and Montreal Chest Institute in Canada. Dr Pai was referring to three meta-analysis studies from 2007/2008. "Tobacco smokers have 2 times more risk of dieing of TB" added Dr Pai, referring to the data from India. India has enormous tobacco use and COPD rates, and also the highest TB burden in the world. "It is not a universal estimate, and is population specific" cautioned Dr Pai, outlining the need for more research on the association between TB, tobacco smoking, COPD and HIV. "There is very little data to study association between TB and passive smoking" said Dr Pai. However there are studies to show that passive smoking escalates risk of developing active TB disease by three times. "How can passive smoking have higher risk (three times) for developing active TB disease than active smoking (two times), so we do need more data in this regard" said Dr Pai.
Tobacco smoke increases the risk of pneumonia, influenza, menningococcal meningitis, among others. Evidence is accumulating that smoking is a risk factor for TB. However there is no published data on the cellular interactions of tobacco smoke and mycobacterium tuberculosis, said Richard.
At least 15 more studies have been published since the three major meta-analyses in 2007/2008. All studies report a positive association between tuberculosis and tobacco smoking. Studies also show that current male smokers have a higher risk for active TB disease than former smokers. In a study conducted in India, 900 non-medical staff monitored 1.1 million people for 3 years for cause of death taking place in this population. TB was the biggest cause of death reported in this study in India, and 66% of those who died of TB during the study, were active smokers.
The risk to develop active TB disease is higher when tobacco smoking is combined with alcohol.
"Mortality rates, particularly from Asian countries suggest that there is an urgent need to target TB patients for smoking cessation interventions" said Dr Pai. However he stressed that tobacco cessation should be encouraged regardless in all disciplines of medicine because of proven public health outcomes.
The second edition of the International Standards of Tuberculosis Care (ISTC), which is an official component of the WHO Global Stop TB Strategy also mentions tobacco smoking cessation among other measures to improve TB treatment outcomes. The ISTC standard 17 says: "This plan should include assessment of and referrals for treatment of other illnesses with particular attention to those known to affect treatment outcome, for instance care for diabetes mellitus, drug and alcohol treatment programs, tobacco smoking cessation programs, and other psychosocial support services, or to such services as antenatal or well baby care.
Dr Donald Enarson stressed that tobacco smoking cessation is an important part of the comprehensive tobacco control programme, and not the only part. So all components of the comprehensive tobacco control measures should be implemented for improving public health outcomes. Dr Enarson was referring to MPOWER report from Tobacco Free Initiative (TFI) of WHO which outlines the MPOWER package, a set of six key tobacco control measures that reflect and build on the WHO Framework Convention on Tobacco Control (FCTC, global tobacco treaty). Another delegates remarked that MPOWER is in line with the global tobacco treaty - FCTC - and we should be demanding implementation of the treaty to which governments have committed to enforce. The WHO FCTC is the first public health and corporate accountability treaty, said a delegate from India. Comprehensive tobacco control programmes can yield major public health outcomes, as 30% of male TB patients die of tobacco smoking.
Although lethal association between tobacco smoking, COPD and TB was becoming clear, we needed more discussion on association between smoking with HIV. "Tobacco smoke increases the risk of human papiloma virus (HPV) and HPV increases the risk of HIV" said Richard in response to a question on the link between HIV and smoking.
Kristina Crothers from Department of Internal Medicine, Yale School of Medicine in USA, shed more light on this association with HIV. She was referring to long term complications of HIV and progression to AIDS, which does get influenced by the above risk factors.
TB continues to be the biggest cause of mortality among people living with HIV (PLHIV) worldwide. However, HIV related long-term complications get aggravated by noxious agents which include tobacco smoke. The risk to develop pulmonary infections and respiratory tract colonization is also upped. The history of childhood illnesses, low socio-economic status, malnutrition among PLHIV does increase their vulnerability to further severe the HIV-related long-term complications. All these are contributing factors for PLHIV to develop chronic lung disease, and COPD in case of smokers, among other conditions that include fibrosis, pulmonary hypertension and lung cancer.
Kristina cited smoking prevalence among PLHIV in northern America. Although tobacco smoking prevalence among general population in USA is 22%, yet the tobacco smoking prevalence goes up among PLHIV to 54%.
In India, in a study conducted by Tuberculosis Research Centre at Madurai, the following results were reported: 66% of PLHIV men were smokers.
In another study, those PLHIV who reported 12 pack years of smoking, had 37% of emphysema, and those who reported 25 pack years of smoking, had 46% of emphysema.
"HIV is associated with chronic lung disease, particularly COPD" said Kristina. "This chronic lung disease can substantially contribute to morbidity and mortality" added Kristina. However long term impact of HIV infection on lung health is unknown, said she.
Studies show that smoking may impact progression to AIDS among PLHIV, said Kristina.
Although more research and data may further clarify the lethal synergy between the epidemics of TB, HIV, tobacco smoking and COPD, among other public health challenges, there is no doubt that collaboration between different single disease or health programmes will be truly beneficial and have major public health outcomes.
Published in:
Citizen News Service (CNS), India/Thailand
The Seoul Times, Seoul, Korea
Elites TV News, USA
Modern Ghana News, Accra, Ghana
Media For Freedom, Nepal
Thai-Indian News, Thailand, Bangkok
News From Bangladesh, Bangladesh
World News Network, USA
Bihar and Kharkhand News Service (BJNS)
Connect.in.com
HealthDev.Net
World Care Council
Health News
Tobacco Industry Today
Tobacco smoking, TB, HIV and chronic obstructive pulmonary disease (COPD) are all burgeoning problems in resource poor settings. The evidence of their potentially devastating effects on global public health is increasing and they require a coordinated approach for control. These diseases all occur in predominantly resource-poor countries. They are perpetuated by poverty and inadequate resources and their control and management require coordinated approach for control, said delegates at the 40th Union World Conference on Lung Health, in Cancun, Mexico.
Statistically, there is 1 TB-related death that takes place every 18 seconds, 1 HIV death every 16 seconds and 1 smoking-related death every 13 seconds. The enormous public challenge posed by the combined epidemics of tobacco smoking, HIV, TB and COPD, is undoubtedly alarming. But is there a link between TB, HIV, COPD and tobacco smoking? Do they increase the risk of each other?
"At the beginning of 21st century we really are facing convergence of several epidemics like HIV, TB, COPD and tobacco smoking among others" said Richard N van Zyl-Smit work works with Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town, South Africa.
"Tobacco smoking is unquestionably the primary risk factor for COPD. The importance of "total burden of inhaled particles" (occupational, household, environmental) is increasing" said Richard.
"Smokers have two fold higher risk of developing active TB disease" said Dr Madhukar Pai from McGill University and Montreal Chest Institute in Canada. Dr Pai was referring to three meta-analysis studies from 2007/2008. "Tobacco smokers have 2 times more risk of dieing of TB" added Dr Pai, referring to the data from India. India has enormous tobacco use and COPD rates, and also the highest TB burden in the world. "It is not a universal estimate, and is population specific" cautioned Dr Pai, outlining the need for more research on the association between TB, tobacco smoking, COPD and HIV. "There is very little data to study association between TB and passive smoking" said Dr Pai. However there are studies to show that passive smoking escalates risk of developing active TB disease by three times. "How can passive smoking have higher risk (three times) for developing active TB disease than active smoking (two times), so we do need more data in this regard" said Dr Pai.
Tobacco smoke increases the risk of pneumonia, influenza, menningococcal meningitis, among others. Evidence is accumulating that smoking is a risk factor for TB. However there is no published data on the cellular interactions of tobacco smoke and mycobacterium tuberculosis, said Richard.
At least 15 more studies have been published since the three major meta-analyses in 2007/2008. All studies report a positive association between tuberculosis and tobacco smoking. Studies also show that current male smokers have a higher risk for active TB disease than former smokers. In a study conducted in India, 900 non-medical staff monitored 1.1 million people for 3 years for cause of death taking place in this population. TB was the biggest cause of death reported in this study in India, and 66% of those who died of TB during the study, were active smokers.
The risk to develop active TB disease is higher when tobacco smoking is combined with alcohol.
"Mortality rates, particularly from Asian countries suggest that there is an urgent need to target TB patients for smoking cessation interventions" said Dr Pai. However he stressed that tobacco cessation should be encouraged regardless in all disciplines of medicine because of proven public health outcomes.
The second edition of the International Standards of Tuberculosis Care (ISTC), which is an official component of the WHO Global Stop TB Strategy also mentions tobacco smoking cessation among other measures to improve TB treatment outcomes. The ISTC standard 17 says: "This plan should include assessment of and referrals for treatment of other illnesses with particular attention to those known to affect treatment outcome, for instance care for diabetes mellitus, drug and alcohol treatment programs, tobacco smoking cessation programs, and other psychosocial support services, or to such services as antenatal or well baby care.
Dr Donald Enarson stressed that tobacco smoking cessation is an important part of the comprehensive tobacco control programme, and not the only part. So all components of the comprehensive tobacco control measures should be implemented for improving public health outcomes. Dr Enarson was referring to MPOWER report from Tobacco Free Initiative (TFI) of WHO which outlines the MPOWER package, a set of six key tobacco control measures that reflect and build on the WHO Framework Convention on Tobacco Control (FCTC, global tobacco treaty). Another delegates remarked that MPOWER is in line with the global tobacco treaty - FCTC - and we should be demanding implementation of the treaty to which governments have committed to enforce. The WHO FCTC is the first public health and corporate accountability treaty, said a delegate from India. Comprehensive tobacco control programmes can yield major public health outcomes, as 30% of male TB patients die of tobacco smoking.
Although lethal association between tobacco smoking, COPD and TB was becoming clear, we needed more discussion on association between smoking with HIV. "Tobacco smoke increases the risk of human papiloma virus (HPV) and HPV increases the risk of HIV" said Richard in response to a question on the link between HIV and smoking.
Kristina Crothers from Department of Internal Medicine, Yale School of Medicine in USA, shed more light on this association with HIV. She was referring to long term complications of HIV and progression to AIDS, which does get influenced by the above risk factors.
TB continues to be the biggest cause of mortality among people living with HIV (PLHIV) worldwide. However, HIV related long-term complications get aggravated by noxious agents which include tobacco smoke. The risk to develop pulmonary infections and respiratory tract colonization is also upped. The history of childhood illnesses, low socio-economic status, malnutrition among PLHIV does increase their vulnerability to further severe the HIV-related long-term complications. All these are contributing factors for PLHIV to develop chronic lung disease, and COPD in case of smokers, among other conditions that include fibrosis, pulmonary hypertension and lung cancer.
Kristina cited smoking prevalence among PLHIV in northern America. Although tobacco smoking prevalence among general population in USA is 22%, yet the tobacco smoking prevalence goes up among PLHIV to 54%.
In India, in a study conducted by Tuberculosis Research Centre at Madurai, the following results were reported: 66% of PLHIV men were smokers.
In another study, those PLHIV who reported 12 pack years of smoking, had 37% of emphysema, and those who reported 25 pack years of smoking, had 46% of emphysema.
"HIV is associated with chronic lung disease, particularly COPD" said Kristina. "This chronic lung disease can substantially contribute to morbidity and mortality" added Kristina. However long term impact of HIV infection on lung health is unknown, said she.
Studies show that smoking may impact progression to AIDS among PLHIV, said Kristina.
Although more research and data may further clarify the lethal synergy between the epidemics of TB, HIV, tobacco smoking and COPD, among other public health challenges, there is no doubt that collaboration between different single disease or health programmes will be truly beneficial and have major public health outcomes.
Published in:
Citizen News Service (CNS), India/Thailand
The Seoul Times, Seoul, Korea
Elites TV News, USA
Modern Ghana News, Accra, Ghana
Media For Freedom, Nepal
Thai-Indian News, Thailand, Bangkok
News From Bangladesh, Bangladesh
World News Network, USA
Bihar and Kharkhand News Service (BJNS)
Connect.in.com
HealthDev.Net
World Care Council
Health News
Tobacco Industry Today
TB Voice network has improved TB responses locally
TB Voice network has improved TB responses locally
"TB Voice network is led by cured TB patients and other stakeholders and provides community treatment supporters in developing countries with the technical expertise they need to implement sustainable TB control programmes" said Chief Austin Arinze Obiefuna, who is the founder-President of Afro Global Alliance and National Coordinator for Stop TB Partnership in Ghana. Chief Austin was speaking at a pre-conference meeting of the 40th Union World Conference on Lung Health in Cancun, Mexico.
"Till today, in most developing countries DOTS (directly observed treatment shortcourse) which underpins the Stop TB Strategy, has improved greatly but now without challenges like inadequate public health personnel, inconsistent drug supply, more effective and accessible tools for testing and treating TB and community involvment" said Austin. "In order to address these challenges, Afro Global Alliance and Chest Department of Korle-Bu Teaching Hospital, with financial support from the Stop TB Partnership's Challenge Facility for Civil Society, created the initiative of TB Voice Network (TVN)" further explains Austin.
The TB Voice Network is committed to reinforce the role of community treatment supporters in the national policies and TB and HIV programmes in developing countries. Through its network of experts, TB Voice Network trains stakeholders in all areas of prevention, testing and comprehensive care related to TB and TB/HIV. It also assists in community DOTS implementation and conducts situational analysis of community treatment supporters in the field of TB. It provides counselling on DOTS adherence, referral and contact tracing of TB patients, among other community-led roles in TB programmes locally.
The TB Voice Network has also developed a website to give voice to the network of people who got cured of TB (www.tbvoice.net), informs Austin.
"75% population in Ghana lives in rural areas. There are many misconceptions related to TB - including the belief that offending Gods may get a person infected with TB" says Austin. Not surprising, the TB-related stigma and discrimination rages high in these communities and blocks access to existing TB services on prevention, treatment and care. This was a key motivation to bring cured TB patients together and establish ways in which they can have a voice to reduce TB-related stigma and increase access to existing services.
"The voices of cured TB patients are needed to help people understand that TB is curable" asserts Chief Austin. The TB case detection rates have gone up in communities TB Voice Network works, suggesting the role of community involvement in improving TB responses at all levels.
The National TB Programme (NTP) in Ghana also uses the TB Voice Network in its advocacy, communication and social mobilization initiatives. "TB Voice Network is one of the success stories of NTP" says Austin.
"We are meeting parliamentarians to declare TB as a national emergency and also demanding laboratories in Ghana [to test for anti-TB drug resistance]" says Austin.
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Elites TV News, USA
Health Dev.Net
World Care Council
"TB Voice network is led by cured TB patients and other stakeholders and provides community treatment supporters in developing countries with the technical expertise they need to implement sustainable TB control programmes" said Chief Austin Arinze Obiefuna, who is the founder-President of Afro Global Alliance and National Coordinator for Stop TB Partnership in Ghana. Chief Austin was speaking at a pre-conference meeting of the 40th Union World Conference on Lung Health in Cancun, Mexico.
"Till today, in most developing countries DOTS (directly observed treatment shortcourse) which underpins the Stop TB Strategy, has improved greatly but now without challenges like inadequate public health personnel, inconsistent drug supply, more effective and accessible tools for testing and treating TB and community involvment" said Austin. "In order to address these challenges, Afro Global Alliance and Chest Department of Korle-Bu Teaching Hospital, with financial support from the Stop TB Partnership's Challenge Facility for Civil Society, created the initiative of TB Voice Network (TVN)" further explains Austin.
The TB Voice Network is committed to reinforce the role of community treatment supporters in the national policies and TB and HIV programmes in developing countries. Through its network of experts, TB Voice Network trains stakeholders in all areas of prevention, testing and comprehensive care related to TB and TB/HIV. It also assists in community DOTS implementation and conducts situational analysis of community treatment supporters in the field of TB. It provides counselling on DOTS adherence, referral and contact tracing of TB patients, among other community-led roles in TB programmes locally.
The TB Voice Network has also developed a website to give voice to the network of people who got cured of TB (www.tbvoice.net), informs Austin.
"75% population in Ghana lives in rural areas. There are many misconceptions related to TB - including the belief that offending Gods may get a person infected with TB" says Austin. Not surprising, the TB-related stigma and discrimination rages high in these communities and blocks access to existing TB services on prevention, treatment and care. This was a key motivation to bring cured TB patients together and establish ways in which they can have a voice to reduce TB-related stigma and increase access to existing services.
"The voices of cured TB patients are needed to help people understand that TB is curable" asserts Chief Austin. The TB case detection rates have gone up in communities TB Voice Network works, suggesting the role of community involvement in improving TB responses at all levels.
The National TB Programme (NTP) in Ghana also uses the TB Voice Network in its advocacy, communication and social mobilization initiatives. "TB Voice Network is one of the success stories of NTP" says Austin.
"We are meeting parliamentarians to declare TB as a national emergency and also demanding laboratories in Ghana [to test for anti-TB drug resistance]" says Austin.
Published in:
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Patients' Charter for TB Care is in favour of doctors, not against them
Patients' Charter for TB Care is in favour of doctors, not against them
It was not surprising to hear from a community activist at the World Health Organization (WHO) Stop TB Symposium before 40th Union World Conference on Lung Health opens in Cancun, Mexico, that when she asked TB programme managers on why are they not implementing the Patients' Charter for Tuberculosis (TB) Care [PCTC], she got the response: "doctors say that it [PCTC] actually goes against them." Blessina Kumar, TB/HIV activist from India was addressing the WHO Stop TB Symposium in Mexico.
This is not surprising to hear because despite of community-centric Global Stop TB Strategy and rising mandate for community engagement in TB programmes, there are healthcare providers like the one quoted above who still belong to old school where TB was a medical problem and response too was medical.
The WHO Global Stop TB Strategy and Global Plan to Stop TB (2006-2015) support community involvement. The Patients' Charter for TB Care (PCTC) is an official part of the Global Stop TB Strategy which is meant to be a tool to mobilize and empower communities in achieving the International Standards of TB Care (ISTC). It is an official component of national TB programmes in many countries including India. However there is no doubt that the investment and efforts that have gone into rolling out the Charter, are grossly inadequate. It is not just a "chart" in the clinic, as commented a delegate yesterday.
The Charter (PCTC) is not against what doctors are trying to achieve in TB care and control - it is a tool to make their task easier in improving TB programmes - in terms of achieving earlier diagnosis, active TB case finding, counselling, contact tracing, adherence counselling, reducing stigma and discrimination related to TB, among other benefits this tool can provide if used in the right spirit.
"We need to raise awareness about the rights and responsibilities of people with TB, use the Charter as a tool for empowering the communities and mobilizing them to advocate for enhancing the standards of TB treatment and care in their localities" asserts Maxime Lunga, Vice President of World Care Council (WCC).
In South Africa, a MSF report released earlier this year on World TB Day (24 March) showed how community-based approaches to drug-resistant TB have improved treatment outcomes considerably.
The people with TB, particularly those who have successfully completed the anti-TB treatment, is central to improving the TB response. The communities have a key role in increasing TB case detection, reducing TB-related stigma, partnering with healthcare staff, community awareness, screening of household contacts, encouraging rapid diagnosis to decrease the delay before starting treatment, improving treatment protocols, providing education and adherence counselling for patients and implementing infection control measures in clinics, patients' homes, and in the community, believes Maxime.
Experts at the WHO Stop TB Symposium had earlier listed out the high risk populations the TB programmes should reach out to for earlier diagnosis of TB. With different levels of multi-faceted stigma-related to TB, how will the doctors operationalize these policies on active TB case finding? The answer honestly lies in The Charter among other approaches.
Affected communities need to be engaged meaningfully at all levels of TB programming to use the Charter as a tool to achieve higher standards of TB care (ISTC). They need to be treated as equal partners in TB care and control, and treated with dignity, along side other stakeholders including doctors. Innovative solutions often come up from among the affected communities - since they know what works in their communities best. Affected communities are more than passive recepients of pills - their rightful place as equal partners in solving issues that affect them most on daily basis - has been long denied to them.
"Unless TB patients are diagnosed earlier, the quality of life will be compromised despite of successful anti-TB treatment" said Dr M Muniyandi, Health Economist, TB Research Centre, Indian Council of Medical Research (ICMR). "To attain better quality of life, it is important to diagnose people earlier for TB and treat them successfuly" emphasized Dr Muniyandi.
Thanks Dr Muniyandi for speaking up - the point you make is right on-spot: quality of life. This should be an explicit and core aim of TB programmes to EARLY diagnose and treat people with TB successfully so that they can enjoy highest attainable standards of health and life. And in passive case finding, it is a distant dream. Engaging communities can up the active case finding among many other benefits TB conference is raising (and has been raising in past years).
The absence of the Charter (PCTC) in the local stop TB strategy operationally is often the very barrier that blocks access to existing TB care services. Long waiting hours, stigma and discrimination related to TB, lack of confidentiality at times, unfriendly healthcare services for people with certain conditions, are well documented barriers that impede access to existing services. Other obstacles that limit the impact of TB programmes which are now coming to light over past years, were the realities people with TB were dealing with. Long distances they have to travel to clinics, economic impact on their livelihood during anti-TB treatment which may further exacerbate vulnerabilities to TB and other conditions of them and their families/ communities, are just some of them. Communities knew it before, and knew it best. Empowering them will not only bring problems in light sooner, but also give them a right and responsibility as equal partner to come up with effective solutions that work in their own contexts.
HIV/AIDS programmes have shown remarkable outcomes by genuine community engagement at all levels, however the involvement of communities in TB programmes is clearly sub-optimal, if not absent.
The outcome of not implementing the Charter is what no nation can afford - affected communities need to be supported by the Charter, to use the rights and responsibilities framework it promotes in mobilizing them to work as equal partners with other stakeholders (including doctors) to achieve higher standards of TB care (ISTC).
Published in:
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Modern Ghana News, Accra, Ghana
Elites TV News, USA
Citizen News Service (CNS), India/Thailand
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World Care Council
Health Dev.Net
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Celebrifi.com
It was not surprising to hear from a community activist at the World Health Organization (WHO) Stop TB Symposium before 40th Union World Conference on Lung Health opens in Cancun, Mexico, that when she asked TB programme managers on why are they not implementing the Patients' Charter for Tuberculosis (TB) Care [PCTC], she got the response: "doctors say that it [PCTC] actually goes against them." Blessina Kumar, TB/HIV activist from India was addressing the WHO Stop TB Symposium in Mexico.
This is not surprising to hear because despite of community-centric Global Stop TB Strategy and rising mandate for community engagement in TB programmes, there are healthcare providers like the one quoted above who still belong to old school where TB was a medical problem and response too was medical.
The WHO Global Stop TB Strategy and Global Plan to Stop TB (2006-2015) support community involvement. The Patients' Charter for TB Care (PCTC) is an official part of the Global Stop TB Strategy which is meant to be a tool to mobilize and empower communities in achieving the International Standards of TB Care (ISTC). It is an official component of national TB programmes in many countries including India. However there is no doubt that the investment and efforts that have gone into rolling out the Charter, are grossly inadequate. It is not just a "chart" in the clinic, as commented a delegate yesterday.
The Charter (PCTC) is not against what doctors are trying to achieve in TB care and control - it is a tool to make their task easier in improving TB programmes - in terms of achieving earlier diagnosis, active TB case finding, counselling, contact tracing, adherence counselling, reducing stigma and discrimination related to TB, among other benefits this tool can provide if used in the right spirit.
"We need to raise awareness about the rights and responsibilities of people with TB, use the Charter as a tool for empowering the communities and mobilizing them to advocate for enhancing the standards of TB treatment and care in their localities" asserts Maxime Lunga, Vice President of World Care Council (WCC).
In South Africa, a MSF report released earlier this year on World TB Day (24 March) showed how community-based approaches to drug-resistant TB have improved treatment outcomes considerably.
The people with TB, particularly those who have successfully completed the anti-TB treatment, is central to improving the TB response. The communities have a key role in increasing TB case detection, reducing TB-related stigma, partnering with healthcare staff, community awareness, screening of household contacts, encouraging rapid diagnosis to decrease the delay before starting treatment, improving treatment protocols, providing education and adherence counselling for patients and implementing infection control measures in clinics, patients' homes, and in the community, believes Maxime.
Experts at the WHO Stop TB Symposium had earlier listed out the high risk populations the TB programmes should reach out to for earlier diagnosis of TB. With different levels of multi-faceted stigma-related to TB, how will the doctors operationalize these policies on active TB case finding? The answer honestly lies in The Charter among other approaches.
Affected communities need to be engaged meaningfully at all levels of TB programming to use the Charter as a tool to achieve higher standards of TB care (ISTC). They need to be treated as equal partners in TB care and control, and treated with dignity, along side other stakeholders including doctors. Innovative solutions often come up from among the affected communities - since they know what works in their communities best. Affected communities are more than passive recepients of pills - their rightful place as equal partners in solving issues that affect them most on daily basis - has been long denied to them.
"Unless TB patients are diagnosed earlier, the quality of life will be compromised despite of successful anti-TB treatment" said Dr M Muniyandi, Health Economist, TB Research Centre, Indian Council of Medical Research (ICMR). "To attain better quality of life, it is important to diagnose people earlier for TB and treat them successfuly" emphasized Dr Muniyandi.
Thanks Dr Muniyandi for speaking up - the point you make is right on-spot: quality of life. This should be an explicit and core aim of TB programmes to EARLY diagnose and treat people with TB successfully so that they can enjoy highest attainable standards of health and life. And in passive case finding, it is a distant dream. Engaging communities can up the active case finding among many other benefits TB conference is raising (and has been raising in past years).
The absence of the Charter (PCTC) in the local stop TB strategy operationally is often the very barrier that blocks access to existing TB care services. Long waiting hours, stigma and discrimination related to TB, lack of confidentiality at times, unfriendly healthcare services for people with certain conditions, are well documented barriers that impede access to existing services. Other obstacles that limit the impact of TB programmes which are now coming to light over past years, were the realities people with TB were dealing with. Long distances they have to travel to clinics, economic impact on their livelihood during anti-TB treatment which may further exacerbate vulnerabilities to TB and other conditions of them and their families/ communities, are just some of them. Communities knew it before, and knew it best. Empowering them will not only bring problems in light sooner, but also give them a right and responsibility as equal partner to come up with effective solutions that work in their own contexts.
HIV/AIDS programmes have shown remarkable outcomes by genuine community engagement at all levels, however the involvement of communities in TB programmes is clearly sub-optimal, if not absent.
The outcome of not implementing the Charter is what no nation can afford - affected communities need to be supported by the Charter, to use the rights and responsibilities framework it promotes in mobilizing them to work as equal partners with other stakeholders (including doctors) to achieve higher standards of TB care (ISTC).
Published in:
Thai-Indian News, Bangkok, Thailand
Modern Ghana News, Accra, Ghana
Elites TV News, USA
Citizen News Service (CNS), India/Thailand
World News Network (WNN), USA
Bihar And Jharkhand News Service (BJNS)
World Care Council
Health Dev.Net
ZivisoWorldpress.com
Celebrifi.com
Denying IPT to people-with latent TB is a human rights violation
Denying IPT to people-with latent TB is a human rights violation
"In Lesotho, Isoniazid Preventive Therapy (IPT) to prevent latent TB infection from becoming active TB disease, is not available for ordinary citizens but only for health workers. Those people who have latent TB infection have a right to protect themselves and access IPT services to prevent latent TB from becoming active TB disease. I consider these people have a right to get IPT. Everybody has a right to health, when it comes to TB prevention" said Maketekete Alfred Thotolo, Treatment Literacy & Advocacy Coordinator, Adventist Development and Relief Agency (ADRA), Lesotho, who also represents AIDS and Rights Alliance for Southern Africa (ARASA). Alfred was speaking to this Key Correspondent on the sidelines of pre-conference sessions before the 40th Union World Conference on Lung Health opens in Cancun, Mexico this week (3-7 December 2009).
The Global TB/HIV Working Group of the Stop TB Partnership has clearly stated that: IPT works, IPT is safe, and IPT works with ART or by itself.
TB is a major cause of illness and death in people living with HIV, even in those taking antiretroviral therapy. TB could be prevented in millions of people infected with both HIV and TB through the use of IPT. IPT is an important intervention for preventing and reducing active TB in communities affected by HIV - preventing active TB can prevent millions of people from being infected in the community and in health care services.
IPT is safe and effective and the treatment lasts for 6-9 months. It is only given to people who have confirmed latent TB infection (not to be given to those with active TB disease). Effective IPT treatment reduces the development of active TB disease in 40-60% of patients.
Despite of the potential public health outcomes of using IPT effectively in high burden TB countries, and IPT being one of the key interventions recommended by WHO in 1998 to reduce the burden of TB in people living with HIV, the uptake of IPT has been very low. Clearly there is a need to mobilize TB-HIV affected communities and other stakeholders to integrate IPT as part of the package of health services.
Alfred is possibly right on-spot: everybody has a right to health - and this includes the right to access IPT services to prevent latent TB infection from becoming active TB disease. It also means increasing TB screening in the communities so that people go for TB test to ascertain whether they have latent TB or active TB disease or no TB at all. IPT advocacy boosts the effort behind scaling up TB screening among people living with HIV - so that appropriate services can be provided and this does include IPT if the person has latent TB. Is denying IPT and putting people at risk of developing active TB disease,not a human rights violation?
Integrating IPT services for TB prevention doesn't mean upping the cost at country level, possibly. A 2007 World Bank research report "The Economic Benefit of Global Investments in Tuberculosis Control" found that 22 countries with the world’s highest numbers of TB cases could earn significantly more than they spend on TB diagnosis and treatment if they signed onto a global plan to sharply reduce the numbers of TB-related deaths. Highly affected African countries could gain up to 9 times their investments in TB control. When the economic benefits of effective TB care and control are estimated to be greater than the cost, governments shouldn't delay improving TB responses by preventing TB in those who have latent TB effectively.
After all, Alfred is right: health is a fundamental human right and this includes right to have IPT for those who are eligible for it.
"In Lesotho, Isoniazid Preventive Therapy (IPT) to prevent latent TB infection from becoming active TB disease, is not available for ordinary citizens but only for health workers. Those people who have latent TB infection have a right to protect themselves and access IPT services to prevent latent TB from becoming active TB disease. I consider these people have a right to get IPT. Everybody has a right to health, when it comes to TB prevention" said Maketekete Alfred Thotolo, Treatment Literacy & Advocacy Coordinator, Adventist Development and Relief Agency (ADRA), Lesotho, who also represents AIDS and Rights Alliance for Southern Africa (ARASA). Alfred was speaking to this Key Correspondent on the sidelines of pre-conference sessions before the 40th Union World Conference on Lung Health opens in Cancun, Mexico this week (3-7 December 2009).
The Global TB/HIV Working Group of the Stop TB Partnership has clearly stated that: IPT works, IPT is safe, and IPT works with ART or by itself.
TB is a major cause of illness and death in people living with HIV, even in those taking antiretroviral therapy. TB could be prevented in millions of people infected with both HIV and TB through the use of IPT. IPT is an important intervention for preventing and reducing active TB in communities affected by HIV - preventing active TB can prevent millions of people from being infected in the community and in health care services.
IPT is safe and effective and the treatment lasts for 6-9 months. It is only given to people who have confirmed latent TB infection (not to be given to those with active TB disease). Effective IPT treatment reduces the development of active TB disease in 40-60% of patients.
Despite of the potential public health outcomes of using IPT effectively in high burden TB countries, and IPT being one of the key interventions recommended by WHO in 1998 to reduce the burden of TB in people living with HIV, the uptake of IPT has been very low. Clearly there is a need to mobilize TB-HIV affected communities and other stakeholders to integrate IPT as part of the package of health services.
Alfred is possibly right on-spot: everybody has a right to health - and this includes the right to access IPT services to prevent latent TB infection from becoming active TB disease. It also means increasing TB screening in the communities so that people go for TB test to ascertain whether they have latent TB or active TB disease or no TB at all. IPT advocacy boosts the effort behind scaling up TB screening among people living with HIV - so that appropriate services can be provided and this does include IPT if the person has latent TB. Is denying IPT and putting people at risk of developing active TB disease,not a human rights violation?
Integrating IPT services for TB prevention doesn't mean upping the cost at country level, possibly. A 2007 World Bank research report "The Economic Benefit of Global Investments in Tuberculosis Control" found that 22 countries with the world’s highest numbers of TB cases could earn significantly more than they spend on TB diagnosis and treatment if they signed onto a global plan to sharply reduce the numbers of TB-related deaths. Highly affected African countries could gain up to 9 times their investments in TB control. When the economic benefits of effective TB care and control are estimated to be greater than the cost, governments shouldn't delay improving TB responses by preventing TB in those who have latent TB effectively.
After all, Alfred is right: health is a fundamental human right and this includes right to have IPT for those who are eligible for it.
Implementation of right to health of indigenous peoples essential to Stop TB
Implementation of right to health of indigenous peoples essential to Stop TB
"Basic human rights as enjoyed by others have not benefitted indigenous peoples. Therefore the respect and recognition of the rights of indigenous peoples is critical to our dignity and survival. In particular, implementation of our right to health is essential if we are to stop TB" said Wilton Littlechild, Regional Chief, Assembly of First Nations, on the sidelines of the TB and human rights session before the 40th Union World Conference on Lung Health begins in Cancun, Mexico this week.
There are approximately 370 million indigenous peoples globally in more than 70 countries. Although programmes have been designed to combat TB, indigenous populations globally have been left out of such efforts due to cultural barriers, language differences, geographic remoteness, and economic disadvantage. TB rates among indigenous people are consistently higher than general public. During the five year period 2002-2006, the first nations TB rate was 29 times higher than others born in Canada - for the Inuit, it was 90 times higher. Pacific islanders and Maoris are 10 times more likely to contract TB than other people living in New Zealand. In Kalaallit Nunaat, Greenland, residents have a risk rate more than 45 times greater than Danish born citizens.
"These challenges will not be easily met - but they can be met by ensuring indigenous peoples are true partners in global TB control. We have a comprehensive and achievable plan to stop indigenous TB globally, but to realize our goal we need support" had said Chief Littlechild.
Indigenous people have a consistent pattern of health inequality across a variety of jurisdictions from resource poor to the resource rich. Indigenous health inequalities are multi-faceted, and are both social and political in nature.
Highlighting the problem of TB treatment default and risk of developing drug-resistant forms of TB in indigenous people, Chief Littlechild had earlier said to this Key Correspondent that "we wish to establish a secretariat to collect data of TB programmes in indigenous communities. Due to a broad range of reasons, indigenous people aren’t able to access TB-related treatment and care services and if they are, then they are more likely to default, increasing the risk to develop drug resistance" said Chief Littlechild. In response to another question then, Chief Littlechild said that "human rights based approach calls for genuine partnership and indigenous communities can be part of the solution."
The inequities faced by indigenous peoples are much severe than in general population. "Countries like Canada report that poverty has gone down but poverty in indigenous peoples has gone up. In prisons too there are a significant number of indigenous peoples. There are host of other life conditions that put these people at an elevated risk of infectious diseases like TB - overcrowded housing and lack of access to safe drinking water are just few of those challenges" had said Chief Littlechild to this Key Correspondent.
The strategic framework to control TB among indigenous peoples was developed through consultations with indigenous leaders, TB experts and health advocates from over 60 countries. It is designed to take an indigenous approach that links the right to health, education, housing, employment, and dignity. It is based on equality of opportunity to the highest level of health attainable world wide. It will serve as a tool to build a social movement to raise awareness of indigenous TB, to develop targets and messages, to pilot interventions and to monitor TB trends among indigenous peoples. An important component to this framework calls upon indigenous peoples to demand access to TB prevention and treatment measures in their communities.
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Human Right Today
"Basic human rights as enjoyed by others have not benefitted indigenous peoples. Therefore the respect and recognition of the rights of indigenous peoples is critical to our dignity and survival. In particular, implementation of our right to health is essential if we are to stop TB" said Wilton Littlechild, Regional Chief, Assembly of First Nations, on the sidelines of the TB and human rights session before the 40th Union World Conference on Lung Health begins in Cancun, Mexico this week.
There are approximately 370 million indigenous peoples globally in more than 70 countries. Although programmes have been designed to combat TB, indigenous populations globally have been left out of such efforts due to cultural barriers, language differences, geographic remoteness, and economic disadvantage. TB rates among indigenous people are consistently higher than general public. During the five year period 2002-2006, the first nations TB rate was 29 times higher than others born in Canada - for the Inuit, it was 90 times higher. Pacific islanders and Maoris are 10 times more likely to contract TB than other people living in New Zealand. In Kalaallit Nunaat, Greenland, residents have a risk rate more than 45 times greater than Danish born citizens.
"These challenges will not be easily met - but they can be met by ensuring indigenous peoples are true partners in global TB control. We have a comprehensive and achievable plan to stop indigenous TB globally, but to realize our goal we need support" had said Chief Littlechild.
Indigenous people have a consistent pattern of health inequality across a variety of jurisdictions from resource poor to the resource rich. Indigenous health inequalities are multi-faceted, and are both social and political in nature.
Highlighting the problem of TB treatment default and risk of developing drug-resistant forms of TB in indigenous people, Chief Littlechild had earlier said to this Key Correspondent that "we wish to establish a secretariat to collect data of TB programmes in indigenous communities. Due to a broad range of reasons, indigenous people aren’t able to access TB-related treatment and care services and if they are, then they are more likely to default, increasing the risk to develop drug resistance" said Chief Littlechild. In response to another question then, Chief Littlechild said that "human rights based approach calls for genuine partnership and indigenous communities can be part of the solution."
The inequities faced by indigenous peoples are much severe than in general population. "Countries like Canada report that poverty has gone down but poverty in indigenous peoples has gone up. In prisons too there are a significant number of indigenous peoples. There are host of other life conditions that put these people at an elevated risk of infectious diseases like TB - overcrowded housing and lack of access to safe drinking water are just few of those challenges" had said Chief Littlechild to this Key Correspondent.
The strategic framework to control TB among indigenous peoples was developed through consultations with indigenous leaders, TB experts and health advocates from over 60 countries. It is designed to take an indigenous approach that links the right to health, education, housing, employment, and dignity. It is based on equality of opportunity to the highest level of health attainable world wide. It will serve as a tool to build a social movement to raise awareness of indigenous TB, to develop targets and messages, to pilot interventions and to monitor TB trends among indigenous peoples. An important component to this framework calls upon indigenous peoples to demand access to TB prevention and treatment measures in their communities.
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Rights and Responsibilities Roadshow: Raising standards for care in Indonesia
Rights and Responsibilities Roadshow: Raising standards for care in Indonesia
More than seventy people from across the country spoke about rights and responsibilities to improve tuberculosis (TB) and HIV responses on 24-25 November 2009 in Jakarta, Indonesia. From a 13 year old ex-patient (she was a TB patient when she was 9) to the representative from sub-directorate of National TB and HIV programmes had an open consultation to raise the right of access to care. The Director of HIV programme in Indonesia acknowledged the problem and committed to making the rights and responsibilities framework a reality. Yoana Anandita from National TB Programme (NTP) in Indonesia who was speaking at the Advocacy, Communications and Social Mobilization (ACSM) meeting before the 40th Union World Conference on Lung Health opens in Cancun, Mexico, reaffirmed the genuine engagement and consultation this roadshow provided between different stakeholders.
"The Roadshow rolled in Indonesia raising rights and responsibilities for HIV and TB up the agenda, down in the streets of our communities and on high in the towers of power. We invited diverse people to consult, discuss, write, plan, agree and act - to move forward locally in global common cause" said Case Gordon, President, World Care Council (WCC).
The World Care Council (WCC) has been a global leader in driving forward a Rights and Responsibilities approach to health, advocating that people suffering from infectious diseases have specific universal rights to quality care, and have an individual responsibility to prevent the spread of illness to others. Health providers, both public and private, have the responsibility to provide consumers with the highest possible quality of care, and the right to have the appropriate tools to do so.
The methodology of joining the human right to life through access to healthcare with the individual duty to act responsibly in face of a public health threat is one that allows people with TB, HIV and other communicable diseases to forge partnerships with care providers and programs. This relationship is a mutually beneficial one - people in need can work with providers to access better care and providers can work with patients to better succeed in managing the pandemics that impact on the populations they serve.
As both providers and people with the diseases need to know their rights and responsibilities, the World Care Council has developed innovative tools to reach a broad based agreement on what these are. Using its 'Outreach for Input' system of consultation, the WCC has produced two editions (2006 and 2009) of the Patients' Charter for Tuberculosis Care (PCTC) with the inputs of over one thousand people who have direct experience of the disease on four continents. The PCTC has been incorporated into the Strategies of the WHO and most of of the governments of high burdened countries, and is the tandem document to the International Standards for Tuberculosis Care. These two guidelines form the basis of the Patient Centered Care approach to TB treatment and prevention, and serve as levers for change from decades of poor programmatic TB 'Control' to quality TB 'Care', a major step forward for both people with the disease and the communities devastated by it.
The Rights and Responsibilities Workshop Roadshow 2009 which took place in Jakarta, Indonesia during 24-25 November 2009, is part of a series of public meetings and workshops in nine cities in Africa and Asia highly burdened by the TB and HIV pandemics.
The drive for Rights and Responsibilities is a core activity for the World Care Council, and has shown itself to be an effective tool for raising the standards of care on the ground. As it is powered by people with the diseases, it embodies the principles of greater and more meaningful involvement of TB Patients and PLHIV (GIPT and GIPA). Turning principles into practice, the drive for Rights and Responsibilities is rolling out the roadshow on the streets.
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More than seventy people from across the country spoke about rights and responsibilities to improve tuberculosis (TB) and HIV responses on 24-25 November 2009 in Jakarta, Indonesia. From a 13 year old ex-patient (she was a TB patient when she was 9) to the representative from sub-directorate of National TB and HIV programmes had an open consultation to raise the right of access to care. The Director of HIV programme in Indonesia acknowledged the problem and committed to making the rights and responsibilities framework a reality. Yoana Anandita from National TB Programme (NTP) in Indonesia who was speaking at the Advocacy, Communications and Social Mobilization (ACSM) meeting before the 40th Union World Conference on Lung Health opens in Cancun, Mexico, reaffirmed the genuine engagement and consultation this roadshow provided between different stakeholders.
"The Roadshow rolled in Indonesia raising rights and responsibilities for HIV and TB up the agenda, down in the streets of our communities and on high in the towers of power. We invited diverse people to consult, discuss, write, plan, agree and act - to move forward locally in global common cause" said Case Gordon, President, World Care Council (WCC).
The World Care Council (WCC) has been a global leader in driving forward a Rights and Responsibilities approach to health, advocating that people suffering from infectious diseases have specific universal rights to quality care, and have an individual responsibility to prevent the spread of illness to others. Health providers, both public and private, have the responsibility to provide consumers with the highest possible quality of care, and the right to have the appropriate tools to do so.
The methodology of joining the human right to life through access to healthcare with the individual duty to act responsibly in face of a public health threat is one that allows people with TB, HIV and other communicable diseases to forge partnerships with care providers and programs. This relationship is a mutually beneficial one - people in need can work with providers to access better care and providers can work with patients to better succeed in managing the pandemics that impact on the populations they serve.
As both providers and people with the diseases need to know their rights and responsibilities, the World Care Council has developed innovative tools to reach a broad based agreement on what these are. Using its 'Outreach for Input' system of consultation, the WCC has produced two editions (2006 and 2009) of the Patients' Charter for Tuberculosis Care (PCTC) with the inputs of over one thousand people who have direct experience of the disease on four continents. The PCTC has been incorporated into the Strategies of the WHO and most of of the governments of high burdened countries, and is the tandem document to the International Standards for Tuberculosis Care. These two guidelines form the basis of the Patient Centered Care approach to TB treatment and prevention, and serve as levers for change from decades of poor programmatic TB 'Control' to quality TB 'Care', a major step forward for both people with the disease and the communities devastated by it.
The Rights and Responsibilities Workshop Roadshow 2009 which took place in Jakarta, Indonesia during 24-25 November 2009, is part of a series of public meetings and workshops in nine cities in Africa and Asia highly burdened by the TB and HIV pandemics.
The drive for Rights and Responsibilities is a core activity for the World Care Council, and has shown itself to be an effective tool for raising the standards of care on the ground. As it is powered by people with the diseases, it embodies the principles of greater and more meaningful involvement of TB Patients and PLHIV (GIPT and GIPA). Turning principles into practice, the drive for Rights and Responsibilities is rolling out the roadshow on the streets.
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Global TB Candlelight Meditation on 27th May
Global TB Candlelight Meditation on 27th May
The Global TB Candlelight Meditation (GTBCM), an initiative of Afro Global Alliance, began in Accra, Ghana, to scale up advocacy, communications and social mobilization campaigns for TB awareness in the world. The GTBCM is held on every 27th of May in remembrance of those who have died of TB. It is led by volunteer advocates who host meditation for their communities worldwide. Chief Austin Arinze Obiefuna, who is the founder-President of Afro Global Alliance and National Coordinator for Stop TB Partnership in Ghana, spoke to this Key Correspondent on this unique and community centric initiative at the Advocacy, Communications and Social Mobilization (ACSM) annual meeting of the Stop TB Partnership before the 40th Union World Conference on Lung Health opens in Cancun, Mexico later this week (3-7 December 2009).
The Global TB Candlelight Meditation (GTBCM) initiative has engaged different stakeholders at all levels, said Chief Austin. The programme has brought together a large number of stakeholders in the past including: Coalition of NGOs, Ghana Stop TB Partnership, TB Network, Ghana HIV/AIDS Network, WHO, National TB Control programme, Ministry of Health and the Ghana Health Service, said Chief Austin.
"The Global TB Candlelight Meditation aims to scale up global awareness through grassroots community involvement of all sectors and stakeholders in the annual GTBCM campaign on every 27th of May" said Chief Austin Arinze Obiefuna.
"The objectives of GTBCM were to honour and remember those lives lost to TB, to support TB patients by de-stigmatising the disease and preventing anti-TB drug resistance, to defend all those who are not infected with TB, to promote DOTS and the implementation of Millennium Development Goals (MDG) no. 6, and to support TB-HIV collaborative activities and forge more efforts towards the eradication of TB by 2050" further added Chief Austin.
"Annually the GTBCM selects a new theme which is designed to give the global community a strong commitment in the fight against TB" said Chief Austin. One of the themes of the meditation in past years was "Togetherness will eradicate TB."
"TB-related stigma and discrimination is a very serious issue. It is a barrier for suspected TB patients to seek existing TB-care services. What we have been advocating is to diagnose TB early and treat successfully and unless we address stigma and discrimination of those seeking TB care in healthcare facilities and in communities, it is difficult to improve TB responses" said Austin.
The Global TB Candlelight Meditation is one such initiative that engages communities and reduces stigma and discrimination related to TB in healthcare facilities and communities as well.
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Integrated community health services in Timor-Leste
Integrated community health services in Timor-Leste
After a two hour walk across several hills and through valleys in a mountainous part of Timor-Leste, have Paula and her four-year-old daughter Maria arrived at a simulation exercise of the integrated community health service. Driven by guilt she embarked on her tiresome journey with febrile Maria.
As I watch Paula line up amongst the many others jostling to register
for health care in this remote sub-district of Marobo, I could not help but wonder where all these Timorese had come from. This is a western part of the country with very little in the way of facilities or even infrastructure. Today’s activities are being carried out on the grounds of a recently completed school, where a makeshift thatched roof of dried palm leaves is providing limited shelter from the scotching sun. In this covered area are several booths for the community to visit and receive basic medical care.
It begins with a registration booth. Many here proudly tell the assistants their names and where they have come from but the old swiftly fumble when asked their age. They are simple cannot remember. Shortly after they are given a slip of paper with their names written in bold, they are whisked away to the next booth. A couple of weighing scales are placed on the dusty ground and each individual is asked to stand on the weighing scales so that the health volunteers can take note of their weight and proceed to fill the next box on this slip of paper. Children too have come with their parents but many refuse to stand on these weighing scales, terrified of this strange object. This slows the pace as the health officials struggle to find a solution and fi
nally a solution is in sight. Both parent and child step confidently on the scales, a record is taken. Then the child is swiftly removed from the parent for a split second. This is hardly sufficient time to take note of the parent’s weight but it is done just before the terrified child is aware he is in the hands of a stranger. The result shows that many of the adults and children are underweight, some grossly.
Booth number three dishes out information on reproductive health and family planning, evidently thin on patronage but nonetheless those manning the booth are gradually soliciting interest. A husband and wife, with their three children ranging from eight months to four years, are being coerced into better family planning. The young mother is shy and giggles occasionally but the father seemed noticeably perturbed, not by what the ladies at this booth are saying but the restlessness of the infant in his arms. After a sojourn of less than ten minutes they make their way to the next booth.
It is here where a little more enthusiasm ignites the children. They are each given a bar of soap to wash their hands and dirty little fingers. It’s the sanitation booth where parents and children are sensitized to the importance of basic hygiene. “You’ve got such a pretty little face but look at that black dirt beneath your finger nails,” exclaims the health worker who then embarks on cutting the child’s fingernails. Embarrassed by the comments, the child nestles her face into her mother’s armpits. She quickly perks up again when she’s given a tiny bag containing a small face towel and a bar of soap to take home.
There seems to be a longer wait at booth five, several rows of young and old men and women, already seated in line, waiting their turn to consult with the several doctors available. Waiting patiently is Paula and Maria. “I just hope the doctors can tell me what is causing Maria to be this sick. I want some answers. Maria has been unwell now with a high fever for the last four days and when it gets too much, she screams and I feel so helpless. I cradle her in my arms and kneel in front of our altar at home,” says the mother of three.
The simulation exercise is gaining momentum. “I’m pleased to see so many people here today. This is a good sign that SISCa is working,” comments the Minister of Health for Timor- Leste, Dr Nelson Martin. But could this be because the minister himself has come from the capital, Dili and the district chief and village heads have mobilized the community to welcome the guest and his entourage? “I’m convinced at least some of these people have come for their benefit and not because I’m here. That is my hope after all the aim of SISCa is about community participation for equitable distribution of health care. But I also believe only through greater advocacy will this service work better ensuring health care for all is possible” stressed Dr Martins who is observing the last of the simulation exercises to take place today in this sub-district located in the west of the country bordering Indonesia.
Meanwhile, Maria is pricked on her finger gently by the attending nurse so that a rapid test on her blood can be done to check against Malaria. It clearly does not hurt her but instead she is intrigued by the process. The prognosis is negative for Malaria. It’s a viral infection and because she has not had it treated till now, the infection led to the high fever. Paula listens intently to the doctor relieved so hear some answers. She takes note of what she should do with the medication she will receive from the pharmacists at the next booth and also how she can take simple steps at home to ensure this does not happen again to Maria or other members of her family.
“It will be awhile before we reach home now but I’m glad we came. Look even Maria is feeling better already it seems,” quips Paula as she places a bottle of water and some bananas in her a woven basket and begins her journey home.
What is SISCa?
Servisu Integradu da Saúde Communitária (SISCa) which translates from Portuguese to Integrated Community Health Services stands on the principle of “From, With and To the Community”, which signifies that it is the community who would help conduct the activity, mobilize people; men and women, children, youth, the elderly; together with all health workers to work side by side to give assistance, protect and improve the state of community health in the country.
Communities need to be part of this strong commitment to the importance of health. Hence, community leaders such as sub-district council members and chiefs, hamlet chiefs, youth organizations, women’s’ networks and other community leaders take the lead.
SISCa provides assistance in the areas of health promotion, prevention of diseases, treatment for sickness and rehabilitation as well as health interventions such as combating against infectious diseases, family planning, nutrition, maternal and child health and environmental health. It covers all sub-districts in all 13 districts in the country. Its activities are carried out once a month to ensure sustainability. The activities at SISCa last for a minimum of four hours, to ensure that communities will have time and the opportunity to participate. Community members play a role in deciding the schedule of SISCa activities.
- Citizen News Service (CNS)
Published in:
Citizen News Service (CNS), India/Thialand
Modern Ghana News, Accra, Ghana
Media For Freedom, Nepal
Bihar and Jharkhand News Service (BJNS)
Banderas News, Mexico
After a two hour walk across several hills and through valleys in a mountainous part of Timor-Leste, have Paula and her four-year-old daughter Maria arrived at a simulation exercise of the integrated community health service. Driven by guilt she embarked on her tiresome journey with febrile Maria.
As I watch Paula line up amongst the many others jostling to register
for health care in this remote sub-district of Marobo, I could not help but wonder where all these Timorese had come from. This is a western part of the country with very little in the way of facilities or even infrastructure. Today’s activities are being carried out on the grounds of a recently completed school, where a makeshift thatched roof of dried palm leaves is providing limited shelter from the scotching sun. In this covered area are several booths for the community to visit and receive basic medical care.It begins with a registration booth. Many here proudly tell the assistants their names and where they have come from but the old swiftly fumble when asked their age. They are simple cannot remember. Shortly after they are given a slip of paper with their names written in bold, they are whisked away to the next booth. A couple of weighing scales are placed on the dusty ground and each individual is asked to stand on the weighing scales so that the health volunteers can take note of their weight and proceed to fill the next box on this slip of paper. Children too have come with their parents but many refuse to stand on these weighing scales, terrified of this strange object. This slows the pace as the health officials struggle to find a solution and fi
nally a solution is in sight. Both parent and child step confidently on the scales, a record is taken. Then the child is swiftly removed from the parent for a split second. This is hardly sufficient time to take note of the parent’s weight but it is done just before the terrified child is aware he is in the hands of a stranger. The result shows that many of the adults and children are underweight, some grossly.Booth number three dishes out information on reproductive health and family planning, evidently thin on patronage but nonetheless those manning the booth are gradually soliciting interest. A husband and wife, with their three children ranging from eight months to four years, are being coerced into better family planning. The young mother is shy and giggles occasionally but the father seemed noticeably perturbed, not by what the ladies at this booth are saying but the restlessness of the infant in his arms. After a sojourn of less than ten minutes they make their way to the next booth.
It is here where a little more enthusiasm ignites the children. They are each given a bar of soap to wash their hands and dirty little fingers. It’s the sanitation booth where parents and children are sensitized to the importance of basic hygiene. “You’ve got such a pretty little face but look at that black dirt beneath your finger nails,” exclaims the health worker who then embarks on cutting the child’s fingernails. Embarrassed by the comments, the child nestles her face into her mother’s armpits. She quickly perks up again when she’s given a tiny bag containing a small face towel and a bar of soap to take home.
There seems to be a longer wait at booth five, several rows of young and old men and women, already seated in line, waiting their turn to consult with the several doctors available. Waiting patiently is Paula and Maria. “I just hope the doctors can tell me what is causing Maria to be this sick. I want some answers. Maria has been unwell now with a high fever for the last four days and when it gets too much, she screams and I feel so helpless. I cradle her in my arms and kneel in front of our altar at home,” says the mother of three.
The simulation exercise is gaining momentum. “I’m pleased to see so many people here today. This is a good sign that SISCa is working,” comments the Minister of Health for Timor- Leste, Dr Nelson Martin. But could this be because the minister himself has come from the capital, Dili and the district chief and village heads have mobilized the community to welcome the guest and his entourage? “I’m convinced at least some of these people have come for their benefit and not because I’m here. That is my hope after all the aim of SISCa is about community participation for equitable distribution of health care. But I also believe only through greater advocacy will this service work better ensuring health care for all is possible” stressed Dr Martins who is observing the last of the simulation exercises to take place today in this sub-district located in the west of the country bordering Indonesia.
Meanwhile, Maria is pricked on her finger gently by the attending nurse so that a rapid test on her blood can be done to check against Malaria. It clearly does not hurt her but instead she is intrigued by the process. The prognosis is negative for Malaria. It’s a viral infection and because she has not had it treated till now, the infection led to the high fever. Paula listens intently to the doctor relieved so hear some answers. She takes note of what she should do with the medication she will receive from the pharmacists at the next booth and also how she can take simple steps at home to ensure this does not happen again to Maria or other members of her family.
“It will be awhile before we reach home now but I’m glad we came. Look even Maria is feeling better already it seems,” quips Paula as she places a bottle of water and some bananas in her a woven basket and begins her journey home.
What is SISCa?
Servisu Integradu da Saúde Communitária (SISCa) which translates from Portuguese to Integrated Community Health Services stands on the principle of “From, With and To the Community”, which signifies that it is the community who would help conduct the activity, mobilize people; men and women, children, youth, the elderly; together with all health workers to work side by side to give assistance, protect and improve the state of community health in the country.
Communities need to be part of this strong commitment to the importance of health. Hence, community leaders such as sub-district council members and chiefs, hamlet chiefs, youth organizations, women’s’ networks and other community leaders take the lead.
SISCa provides assistance in the areas of health promotion, prevention of diseases, treatment for sickness and rehabilitation as well as health interventions such as combating against infectious diseases, family planning, nutrition, maternal and child health and environmental health. It covers all sub-districts in all 13 districts in the country. Its activities are carried out once a month to ensure sustainability. The activities at SISCa last for a minimum of four hours, to ensure that communities will have time and the opportunity to participate. Community members play a role in deciding the schedule of SISCa activities.
- Citizen News Service (CNS)
Published in:
Citizen News Service (CNS), India/Thialand
Modern Ghana News, Accra, Ghana
Media For Freedom, Nepal
Bihar and Jharkhand News Service (BJNS)
Banderas News, Mexico
Endoscopic breast surgery - a new hope for cancer patients
Endoscopic breast surgery - a new hope for cancer patients
Exclusive CNS interview with Internationally acclaimed expert Dr Eisuke Fukuma (Japan)
Dr Eisuke Fukuma, Director of Breast Cancer, Kameda Medical Centre at Chiba, Japan, has done pioneering work in the field of endoscopic breast surgery and cryosurgery as a nonsurgical ablation.
He was recently in India to attend a conference on Minimal Invasive Surgery, hosted during the 35th Annual Conference of the Association of Surgeons of India, UP Chapter, at Lucknow, India, where he wowed everyone with his simplicity of manners and surgical expertise in the field of Endoscopic Breast Surgery.
In an exclusive interview to Citizen News Service (CNS), he spoke at length on the recent advances made in the area of breast surgery.
Breast cancer is on the rise in India, with 80,000 new cases being added every year and an annual death toll of more than 14,000. Yet there is very little awareness about the disease, especially in its earlier stages. Also, India has very few female breast surgeons, which very often acts as a deterrent to the female patients in seeking medical/surgical interventions.
According to Dr Fukuma, this issue merits a lot of attention, as women need to seek medical intervention during the first stage of the disease. Surgery is ruled out completely in the third stage. He stressed upon the dire need of good quality and sustained breast screening programmes in India, in the same manner as polio eradication programmes.
In Japan, with 40,000 new cases added every year, one, out of every 20, Japanese women suffers from breast cancer. But government sponsored breast screening /awareness programmes done, with the help of MRI, under strict quality control are helping in early detection. Hence timely treatment of the disease is saving many lives.
At Kameda Medical Centre, 50% of the breast surgeons are women. At present, out of the 5 resident doctors in the hospital’s department of breast surgery, 4 are women. This has gone a long way in encouraging women to seek medical advice.
When asked about the reason for the growing incidence of breast cancer, Dr Fukuma rued that the jet set pace of modern living was the main culprit. More and more women are marrying late and opting for late/no child bearing, which affects them biologically. Add to this the high consumption of junk food, as against the more nutritional traditional food. We have a perfect recipe for developing breast cancer
Endoscopic breast conserving surgery was developed originally in Japan, with a view to improve the cosmetic shape of the breast by reducing the scar-size and by changing the position of the surgical wounds. The purpose of endoscopic breast surgery (EBS) is to minimise skin incision and excision, as a skin sparing mastectomy.
This technique uses a long, narrow tube, called endoscope, which allows tiny surgical instruments to be inserted at a point far from the actual site of surgery. It is non invasive surgery, allowing for very small and precise incisions, without damaging nearby healthy tissues.
The surgeon is able to reach the entire breast through a one cm. hole made in the anterior auxilla (lower armpit), through which the tumour is removed. This is called the ‘trans auxiliary retro maminary route’. The cut is so small that it leaves no scar, and the front/upper part of the breast is untouched, obliterating the necessity of contour surgery in most cases. Post surgery, sometimes a depression may appear in the breast which can be simultaneously corrected with breast implants, working through the same holes. Thus, this scar less breast surgery, avoids the second corrective/cosmetic surgery to reshape the breast contour, as both can be done at the same time.
Dr Fukuma started the technique of OSEA - ‘Oncoplastic Surgery With Endoscopic Approach’ in 1995, at the 900 bedded Kameda Medical Centre in Chiba, Japan. Till to date, he has operated upon 2000 patients, with this new technique, and has performed more than 400 total mastectomies with simultaneous reconstruction. According to him, the survival rate in endoscopic breast surgery is an encouraging 95%. Currently about 80% of the patients in Japan are opting for this type of breast surgery, as its cost is the same as that of conventional surgery, and the benefits are immense.
The cosmetic goal of OSEA is to maintain the four S – size, shape, softness and symmetry of the breast. Add to this two more S of Scar Minimize and Spare the Normal Tissue.
This hybrid technique, perfected by Dr Fukuma, to suit the Asian women (who have smaller breasts as compared to their western sisters), entails simultaneous/staged reconstruction after endoscopic total mastectomy; augmentation of breast and mobilization of tissue from the breast or other than the breast.
Dr Fukuma is also very optimistic about the future of Cryosurgery, which is the latest in the field of surgery, and can be used for removing small tumours of the size of 1cm or less. In cryosurgery, an image guided needle is inserted through a 3mm incision (the size of a mosquito bite). The tip of this needle, which is kept at a temperature of -68oC, forms an ice ball around the tumour. The cancerous tissue is killed at this low temperature.
More than 30 such non surgical cryo ablations have been performed successfully by Dr Fukuma under local anaesthesia, with the patient going back home after a few hours of hospital stay. The field of cryosurgery offers exciting possibilities. But it is still in its infancy, just being three years old, and more research is needed in this area before it replaces other conventional methods.
He expressed his gratitude for being given a platform to showcase his technique through video presentations, and to share his ideas with the medical fraternity at the UPASICON 2009. He hoped that his visit to India would mark the beginning of a new chapter of collaboration between surgeons of the two countries. Dr Anand Misra of CSM Medical University, Lucknow has already trained under Dr Fukuma in Japan, and is using these techniques in treating patients, albeit partly, due to lack of proper instruments.
Surely, more such training programmes can be organized, to disseminate the benefits of this latest technology to all and sundry.
Dr Fukuma hopes to extirpate breast cancer completely by developing endoscopic and cryo surgery. His aim is to give a new hope to the patients and to save lives. He has assisted in endoscopic surgeries in the USA and UK, and stresses upon the need of international collaboration in this exciting field of surgery.
His message is loud and clear - Fight the Menace of Breast Cancer Rather Than Surrender.
We hope that he succeeds in his mission to provide high quality relief to breast cancer patients, at affordable prices, without compromising upon the beauty of the end result.
Shobha Shukla
(The author is the Editor of Citizen News Service (CNS), has worked earlier with State Planning Institute, UP, and teaches Physics at India's prestigious Loreto Convent. Email: shobha@citizen-news.org, website: www.citizen-news.org)
Published in:
Central Chronicle, Bhopal, Madhya Pradesh
Modern Ghana News, Accra, Ghana
Punjab News Line, Punjab, India
Citizen News Service (CNS), India/Thailand
Elites TV News, USA
Scoop .com, New Zealand
News From Bangladesh, Bangladesh
Thai-Indian News, Bangkok, Thailand
Northern Voice Online
Newstin News, UK
Pakistan Christian Post, Pakistan
World News Network (WNN), USA
Bihar and Jharkhand News Service (BJNS)
Med India News, India
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Exclusive CNS interview with Internationally acclaimed expert Dr Eisuke Fukuma (Japan)
Dr Eisuke Fukuma, Director of Breast Cancer, Kameda Medical Centre at Chiba, Japan, has done pioneering work in the field of endoscopic breast surgery and cryosurgery as a nonsurgical ablation.
He was recently in India to attend a conference on Minimal Invasive Surgery, hosted during the 35th Annual Conference of the Association of Surgeons of India, UP Chapter, at Lucknow, India, where he wowed everyone with his simplicity of manners and surgical expertise in the field of Endoscopic Breast Surgery.
In an exclusive interview to Citizen News Service (CNS), he spoke at length on the recent advances made in the area of breast surgery.
Breast cancer is on the rise in India, with 80,000 new cases being added every year and an annual death toll of more than 14,000. Yet there is very little awareness about the disease, especially in its earlier stages. Also, India has very few female breast surgeons, which very often acts as a deterrent to the female patients in seeking medical/surgical interventions.
According to Dr Fukuma, this issue merits a lot of attention, as women need to seek medical intervention during the first stage of the disease. Surgery is ruled out completely in the third stage. He stressed upon the dire need of good quality and sustained breast screening programmes in India, in the same manner as polio eradication programmes.
In Japan, with 40,000 new cases added every year, one, out of every 20, Japanese women suffers from breast cancer. But government sponsored breast screening /awareness programmes done, with the help of MRI, under strict quality control are helping in early detection. Hence timely treatment of the disease is saving many lives.
At Kameda Medical Centre, 50% of the breast surgeons are women. At present, out of the 5 resident doctors in the hospital’s department of breast surgery, 4 are women. This has gone a long way in encouraging women to seek medical advice.
When asked about the reason for the growing incidence of breast cancer, Dr Fukuma rued that the jet set pace of modern living was the main culprit. More and more women are marrying late and opting for late/no child bearing, which affects them biologically. Add to this the high consumption of junk food, as against the more nutritional traditional food. We have a perfect recipe for developing breast cancer
Endoscopic breast conserving surgery was developed originally in Japan, with a view to improve the cosmetic shape of the breast by reducing the scar-size and by changing the position of the surgical wounds. The purpose of endoscopic breast surgery (EBS) is to minimise skin incision and excision, as a skin sparing mastectomy.
This technique uses a long, narrow tube, called endoscope, which allows tiny surgical instruments to be inserted at a point far from the actual site of surgery. It is non invasive surgery, allowing for very small and precise incisions, without damaging nearby healthy tissues.
The surgeon is able to reach the entire breast through a one cm. hole made in the anterior auxilla (lower armpit), through which the tumour is removed. This is called the ‘trans auxiliary retro maminary route’. The cut is so small that it leaves no scar, and the front/upper part of the breast is untouched, obliterating the necessity of contour surgery in most cases. Post surgery, sometimes a depression may appear in the breast which can be simultaneously corrected with breast implants, working through the same holes. Thus, this scar less breast surgery, avoids the second corrective/cosmetic surgery to reshape the breast contour, as both can be done at the same time.
Dr Fukuma started the technique of OSEA - ‘Oncoplastic Surgery With Endoscopic Approach’ in 1995, at the 900 bedded Kameda Medical Centre in Chiba, Japan. Till to date, he has operated upon 2000 patients, with this new technique, and has performed more than 400 total mastectomies with simultaneous reconstruction. According to him, the survival rate in endoscopic breast surgery is an encouraging 95%. Currently about 80% of the patients in Japan are opting for this type of breast surgery, as its cost is the same as that of conventional surgery, and the benefits are immense.
The cosmetic goal of OSEA is to maintain the four S – size, shape, softness and symmetry of the breast. Add to this two more S of Scar Minimize and Spare the Normal Tissue.
This hybrid technique, perfected by Dr Fukuma, to suit the Asian women (who have smaller breasts as compared to their western sisters), entails simultaneous/staged reconstruction after endoscopic total mastectomy; augmentation of breast and mobilization of tissue from the breast or other than the breast.
Dr Fukuma is also very optimistic about the future of Cryosurgery, which is the latest in the field of surgery, and can be used for removing small tumours of the size of 1cm or less. In cryosurgery, an image guided needle is inserted through a 3mm incision (the size of a mosquito bite). The tip of this needle, which is kept at a temperature of -68oC, forms an ice ball around the tumour. The cancerous tissue is killed at this low temperature.
More than 30 such non surgical cryo ablations have been performed successfully by Dr Fukuma under local anaesthesia, with the patient going back home after a few hours of hospital stay. The field of cryosurgery offers exciting possibilities. But it is still in its infancy, just being three years old, and more research is needed in this area before it replaces other conventional methods.
He expressed his gratitude for being given a platform to showcase his technique through video presentations, and to share his ideas with the medical fraternity at the UPASICON 2009. He hoped that his visit to India would mark the beginning of a new chapter of collaboration between surgeons of the two countries. Dr Anand Misra of CSM Medical University, Lucknow has already trained under Dr Fukuma in Japan, and is using these techniques in treating patients, albeit partly, due to lack of proper instruments.
Surely, more such training programmes can be organized, to disseminate the benefits of this latest technology to all and sundry.
Dr Fukuma hopes to extirpate breast cancer completely by developing endoscopic and cryo surgery. His aim is to give a new hope to the patients and to save lives. He has assisted in endoscopic surgeries in the USA and UK, and stresses upon the need of international collaboration in this exciting field of surgery.
His message is loud and clear - Fight the Menace of Breast Cancer Rather Than Surrender.
We hope that he succeeds in his mission to provide high quality relief to breast cancer patients, at affordable prices, without compromising upon the beauty of the end result.
Shobha Shukla
(The author is the Editor of Citizen News Service (CNS), has worked earlier with State Planning Institute, UP, and teaches Physics at India's prestigious Loreto Convent. Email: shobha@citizen-news.org, website: www.citizen-news.org)
Published in:
Central Chronicle, Bhopal, Madhya Pradesh
Modern Ghana News, Accra, Ghana
Punjab News Line, Punjab, India
Citizen News Service (CNS), India/Thailand
Elites TV News, USA
Scoop .com, New Zealand
News From Bangladesh, Bangladesh
Thai-Indian News, Bangkok, Thailand
Northern Voice Online
Newstin News, UK
Pakistan Christian Post, Pakistan
World News Network (WNN), USA
Bihar and Jharkhand News Service (BJNS)
Med India News, India
Inbox Robot News
Topix.com
Twitter.com
Reddit.com
Friendfeed.com
Hubpages.com
Farmers facing shortage of DAP fertilizer stage demonstration
Farmers facing shortage of DAP fertilizer stage demonstration
Farmers all over the state of Uttar Pradesh (UP) are suffering from the crisis of diammonium phosphate (DAP) fertilizer shortage. It is wheat sowing time and most of the poor farmers have not received even a sack (50 kg) of DAP from the government fertilizer distribution centres. These farmers have been staging a demonstration since 17 November 2009 demanding DAP fertilizer, said Dr Sandeep Pandey, Ramon Magsaysay Awardee (2002) and member, National Presidium, Lok Rajniti Manch.
Last week sugarcane price issue was highlighted by political parties at the national level and they even forced the central government to backtrack.
"The issue of sugarcane price, no doubt quite important, concerns mostly big farmers. However, wheat is sown by all, including large number of poor and marginalized farmers. If the farmers will not get DAP we can expect a poor wheat crop and impending food shortage" said SR Darapuri, Vice President of People's Union for Civil Liberties (PUCL) UP.
In addition the farmers are also facing a seed shortage. They are also harassed by the revenue department officials who charge money for using water from the canals without actually supplying them any water.
"On 25th November, 2009, the farmers who have not received any DAP so far will be organizing a protest at the Bharawan (Block) fertilizer distribution centre in Hardoi District in UP state. A dharna has been going on here since 17th November, 2009" informed Rambabu, social activist with National Alliance of People's Movements (NAPM) and Asha Parivar.
Farmers all over the state of Uttar Pradesh (UP) are suffering from the crisis of diammonium phosphate (DAP) fertilizer shortage. It is wheat sowing time and most of the poor farmers have not received even a sack (50 kg) of DAP from the government fertilizer distribution centres. These farmers have been staging a demonstration since 17 November 2009 demanding DAP fertilizer, said Dr Sandeep Pandey, Ramon Magsaysay Awardee (2002) and member, National Presidium, Lok Rajniti Manch.
Last week sugarcane price issue was highlighted by political parties at the national level and they even forced the central government to backtrack.
"The issue of sugarcane price, no doubt quite important, concerns mostly big farmers. However, wheat is sown by all, including large number of poor and marginalized farmers. If the farmers will not get DAP we can expect a poor wheat crop and impending food shortage" said SR Darapuri, Vice President of People's Union for Civil Liberties (PUCL) UP.
In addition the farmers are also facing a seed shortage. They are also harassed by the revenue department officials who charge money for using water from the canals without actually supplying them any water.
"On 25th November, 2009, the farmers who have not received any DAP so far will be organizing a protest at the Bharawan (Block) fertilizer distribution centre in Hardoi District in UP state. A dharna has been going on here since 17th November, 2009" informed Rambabu, social activist with National Alliance of People's Movements (NAPM) and Asha Parivar.
Local Welfare in a Global Context: Slums and Urban Welfare in Karnataka’s Development
Local Welfare in a Global Context: Slums and Urban Welfare in Karnataka's Development
In September 2009, CIVIC organized the above public meeting in Bangalore with Dr. Supriya Roy Chowdhuri, Professor ISEC, Bangalore and Mr. Narayanswamy, Joint Director, Karnataka Slum Clearance Board (KSCB).
The former shared findings from ISEC's National Foundation of India supported 2007 project on the Impact of Globalization on Slums and Urban Poor in Karnataka. It highlights globalization's impact and NGO's/CSO's role in reducing disparity especially in Bangalore which expanded rapidly since the 1990's through the Information Technology and Biotechnology industries.
Although Bangalore's economy grew with the knowledge sectors, semi-skilled/unskilled people find minimal jobs. From the mid 1980's, in urban Karnataka: · Small scale industries' manufacturing jobs reduced · Public Sector Undertakings (PSU's) started closing since the 1990's or began hiring contractors ·
The voluntary retirement scheme (VRS) and similar policies increased unemployed and semi-skilled numbers. In 21 class I cities, population decreased but poor increased ISEC's 1973 poverty and employment ratios survey in 11 Bangalore slums and 1990 repetition in 8 found child and coolie labour increasing from 30% to 36% and 26% to 30% respectively and clerical jobs decreasing from 13% to 11%. Studying housing, livelihood, education, health, etc. in 380 households across 6 settlements (including 5 'legalized' ones) in J.C. Nagar, Bangalore through direct questions and focus group discussions in 2007 revealed: · Education, development levels vary widely with no specific job or economic clusters in a ward · Some residents are partly integrated into Bangalore's economy · Occupations: garbage pickers, 26.1 % coolies, 26.5% self-employed (plumbers, mobile/stationary vendors, etc.).
Women - housemaids, cooks, nannies, etc. · 52.6 % of the poorest/unskilled earned between Rs. 1386-3372 · Poverty Ratio: Ramanna Garden - 80%, Papanna Garden - 58%, Average: Bangalore - 56% Karnataka - 26%. Some facts about 2 of the settlements surveyed K.S. Garden · Least Below Poverty Line (BPL) cases · Employment: some in NGO/government/private sector getting Rs. 6000-12000/month and benefits (receptionists, drivers, etc.); other and skilled labour - 33.6%, low income - 52.3% · 'Push factor' - a male relative was a government employee or individuals acquired technical/English skills privately · Fringe population - unskilled, aged, alcohol/drug addicts, infirm Cement Huts · High poverty ratio · Jobs: rag pickers for 70-80 years earning Rs. 3000-4000 monthly through wholesalers or individuals getting Rs. 1500. · Women - 80% aged 40-70 married within the slum and rag pickers nearby or in Chikpete earning Rs. 1800/month. (Ironically, this is the heart of the city beside the Labour Commissioners's erstwhile office).
A street side florist
Around 20 households revealed that their lives remained unchanged for 2 decades. · NGO's Mythri and Waste-Wise's education and vocational training to about 100 families increased their monthly income from Rs.1000 to Rs. 1600. 28% of Bangalore's slum dwellers especially young unmarried women toil long hours in the garment and electronics/electrical factories in hazardous conditions earning below Rs. 2300/month (minimum wage). Such unregulated, capital intensive and mainly export oriented industries exploit the urban poor. Urban Karnataka has less access to credit through Self Help Groups than rural areas or other Indian states although this does not deter them from self-employment as they cannot afford joblessness. Further, government schemes focus on education, sanitation rather than employment generation while most poor people prefer jobs over handouts. Housing campaigns have only provided a "roof over poverty."
Mr. Narayanaswamy with merely 9-10 months in his present role stated that:
- Before 2006, National Slum Development Programme (NSDP) and Housing and Urban Development Corporation (HUDCO) were the only slum development schemes unlike the Jawaharlal Nehru National Urban Renewal Mission (JnNURM) which has Basic Services to Urban Poor (BSUP) and Swarna Jayanti Sahari Rozgar Yojna (SJSRY) for training and employment.
- Residents of Bangalore's areas like Sanyasikunte or Sanitorium may struggle for jobs but NGO's could help such cases
- Only notified slums qualify for welfare schemes - those located on 'illegal' land are unrecognized
- Among Bangalore's 540 settlements with 2 lakh households, 200 are notified. Ragigudda in southern Bangalore, the largest, is still under dispute.
KSCB's staff shortage (only 5 AE's city wide) is slowing attempts to legalize the rest - it requests NGO's to assist its efforts. Many slum dwellers use private healthcare as Primary Health Centres (PHC's), anganwaadis, etc. are ineffective or unavailable.
Also, government hospitals often demand money for 'free/discounted' services. Most government schools' poor standard denies them basic education. Only settlements like K.S. Garden where NGO's like Mythri run an anganwaadi or others, having free tutoring centres benefit. Minimal access to education, livelihood, healthcare and critical developmental schemes precipitates problems in slums. Despite lessening starvation, small jobs don't improve the socio-economic condition. Residents are disillusioned as politicians have rarely helped - some boycotted the 2004 parliamentary elections. While most slum residents know the various government schemes/benefits available to them like Bhagyalakshmi, BPL card, etc. they can rarely access them without NGO/CBO intervention.
Pushpa Achanta
(The author is a freelance writer, a Fellow of Citizen News Service (CNS) Writers' Bureau, and a community volunteer based in Bangalore, India)
Published in:
Thai-Indian News, Bangkok, Thailand
Elites TV News, USA
Modern Ghana News, Accra, Ghana
Media For Freedom, Nepal
Citizen News Service (CNS), India/Thailand
World News Network, USA
Bihar and Jharkhand News Service (BJNS)
Banderas News, Mexico
Little About News
Twitter.com
Inbox Robot.com
Connect.in.com
In September 2009, CIVIC organized the above public meeting in Bangalore with Dr. Supriya Roy Chowdhuri, Professor ISEC, Bangalore and Mr. Narayanswamy, Joint Director, Karnataka Slum Clearance Board (KSCB).
The former shared findings from ISEC's National Foundation of India supported 2007 project on the Impact of Globalization on Slums and Urban Poor in Karnataka. It highlights globalization's impact and NGO's/CSO's role in reducing disparity especially in Bangalore which expanded rapidly since the 1990's through the Information Technology and Biotechnology industries.
Although Bangalore's economy grew with the knowledge sectors, semi-skilled/unskilled people find minimal jobs. From the mid 1980's, in urban Karnataka: · Small scale industries' manufacturing jobs reduced · Public Sector Undertakings (PSU's) started closing since the 1990's or began hiring contractors ·
The voluntary retirement scheme (VRS) and similar policies increased unemployed and semi-skilled numbers. In 21 class I cities, population decreased but poor increased ISEC's 1973 poverty and employment ratios survey in 11 Bangalore slums and 1990 repetition in 8 found child and coolie labour increasing from 30% to 36% and 26% to 30% respectively and clerical jobs decreasing from 13% to 11%. Studying housing, livelihood, education, health, etc. in 380 households across 6 settlements (including 5 'legalized' ones) in J.C. Nagar, Bangalore through direct questions and focus group discussions in 2007 revealed: · Education, development levels vary widely with no specific job or economic clusters in a ward · Some residents are partly integrated into Bangalore's economy · Occupations: garbage pickers, 26.1 % coolies, 26.5% self-employed (plumbers, mobile/stationary vendors, etc.).
Women - housemaids, cooks, nannies, etc. · 52.6 % of the poorest/unskilled earned between Rs. 1386-3372 · Poverty Ratio: Ramanna Garden - 80%, Papanna Garden - 58%, Average: Bangalore - 56% Karnataka - 26%. Some facts about 2 of the settlements surveyed K.S. Garden · Least Below Poverty Line (BPL) cases · Employment: some in NGO/government/private sector getting Rs. 6000-12000/month and benefits (receptionists, drivers, etc.); other and skilled labour - 33.6%, low income - 52.3% · 'Push factor' - a male relative was a government employee or individuals acquired technical/English skills privately · Fringe population - unskilled, aged, alcohol/drug addicts, infirm Cement Huts · High poverty ratio · Jobs: rag pickers for 70-80 years earning Rs. 3000-4000 monthly through wholesalers or individuals getting Rs. 1500. · Women - 80% aged 40-70 married within the slum and rag pickers nearby or in Chikpete earning Rs. 1800/month. (Ironically, this is the heart of the city beside the Labour Commissioners's erstwhile office).
A street side florist Around 20 households revealed that their lives remained unchanged for 2 decades. · NGO's Mythri and Waste-Wise's education and vocational training to about 100 families increased their monthly income from Rs.1000 to Rs. 1600. 28% of Bangalore's slum dwellers especially young unmarried women toil long hours in the garment and electronics/electrical factories in hazardous conditions earning below Rs. 2300/month (minimum wage). Such unregulated, capital intensive and mainly export oriented industries exploit the urban poor. Urban Karnataka has less access to credit through Self Help Groups than rural areas or other Indian states although this does not deter them from self-employment as they cannot afford joblessness. Further, government schemes focus on education, sanitation rather than employment generation while most poor people prefer jobs over handouts. Housing campaigns have only provided a "roof over poverty."
Mr. Narayanaswamy with merely 9-10 months in his present role stated that:
- Before 2006, National Slum Development Programme (NSDP) and Housing and Urban Development Corporation (HUDCO) were the only slum development schemes unlike the Jawaharlal Nehru National Urban Renewal Mission (JnNURM) which has Basic Services to Urban Poor (BSUP) and Swarna Jayanti Sahari Rozgar Yojna (SJSRY) for training and employment.
- Residents of Bangalore's areas like Sanyasikunte or Sanitorium may struggle for jobs but NGO's could help such cases
- Only notified slums qualify for welfare schemes - those located on 'illegal' land are unrecognized
- Among Bangalore's 540 settlements with 2 lakh households, 200 are notified. Ragigudda in southern Bangalore, the largest, is still under dispute.
KSCB's staff shortage (only 5 AE's city wide) is slowing attempts to legalize the rest - it requests NGO's to assist its efforts. Many slum dwellers use private healthcare as Primary Health Centres (PHC's), anganwaadis, etc. are ineffective or unavailable.
Also, government hospitals often demand money for 'free/discounted' services. Most government schools' poor standard denies them basic education. Only settlements like K.S. Garden where NGO's like Mythri run an anganwaadi or others, having free tutoring centres benefit. Minimal access to education, livelihood, healthcare and critical developmental schemes precipitates problems in slums. Despite lessening starvation, small jobs don't improve the socio-economic condition. Residents are disillusioned as politicians have rarely helped - some boycotted the 2004 parliamentary elections. While most slum residents know the various government schemes/benefits available to them like Bhagyalakshmi, BPL card, etc. they can rarely access them without NGO/CBO intervention.
Pushpa Achanta
(The author is a freelance writer, a Fellow of Citizen News Service (CNS) Writers' Bureau, and a community volunteer based in Bangalore, India)
Published in:
Thai-Indian News, Bangkok, Thailand
Elites TV News, USA
Modern Ghana News, Accra, Ghana
Media For Freedom, Nepal
Citizen News Service (CNS), India/Thailand
World News Network, USA
Bihar and Jharkhand News Service (BJNS)
Banderas News, Mexico
Little About News
Twitter.com
Inbox Robot.com
Connect.in.com
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