DOT – A Reason to Smile

Dr Vashisht, State Tuberculosis Officer – New Delhi

Laxmi has a glee on her face again. She can prepare lunch-box for her school going children, keep her house the way she used to do earlier, relieve her husband from extra load he bore during her illness, got her job back and most importantly she feels welcome again by her relatives. She is one of the more than 1.6 million treated tuberculosis patients in India who discovered smile again after receiving DOT (Directly Observed Treatment).

Laxmi typifies a classical lower middle class of India who often fall prey to this scourge. In India, because more than 80% of the patients are in economically productive age group(15-54 years), the economic and social cost of the illness to them and to their families is enormous. Laxmi has a happy family with doting husband and five adorable kids. She lives in Dakshinpuri area of South Delhi, India. This area has a large concentration of daily wage earners who live in slum. There is over-crowding with poor ventilation in their houses and poor hygiene and sanitation in their locality. Malnutrition and poverty is aggravating the condition all the more. Delhi, being the capital of India attracts hordes of people from far flung area, who come to seek their bread in this town and are often relegated to spend their lives in slums. A rough estimate says that about 40% of Delhi’s population resides in slums which make them more susceptible to the illness.

Laxmi’s husband used to work in a dhaba (eating joint for poor ) and she worked as a domestic help ingiene and sanitation in their locality. Malnutrition and poverty is aggravating the condition all the more. Delhi, being the capital of India attracts hordes of people from far flung area, who come to seek their bread in this town and are often relegated to spend their lives in slums. A rough estimate says that about 40% of Delhi’s population resides in slums which make them more susceptible to the illness.

Laxmi’s husband used to work in a dhaba (eating joint for poor ) and she worked as a domestic help innsary in their locality. Laxmi’s husband got himself registered under the program. After undergoing three sputum examinations, as a mandatory routine her husband was asked whether anybody else in the family had cough for more than three weeks. Laxmi had cough for more than four months, but she never bothered about her illness; her husband’s cure was her paramount concern. Fortunately, her husband brought her to the dispensary and she was detected positive for tuberculosis.

Heaps of misery befell on her head, she could no longer help her children to the school, and her eldest daughter had to leave her school to help her in house. More than 0.3 million children leave school as a result of parent’s tuberculosis in India. Laxmi couldn’t do the household chores, her relatives also deserted her and she lost her job as her employer knew that she is infected with tuberculosis. On an average in India, three months of work time is lost if an adult has tuberculosis, resulting in loss of 20-30% of annual household income as was evident in Laxmi’s case. A happy joint family where so many people shared their joy under the same roof was split and she had to shift to another house. In India, according to a rough estimate, more than 0.1 million women are rejected by their family on account of tuberculosis every year.

After a month of therapy Laxmi’s husband started recovering and started helping his daughter in the household work. Laxmi also recovered after six months of successful treatment under DOTS. Now her eldest daughter has resumed her school. With a new found confidence and vigor Laxmi went out looking for the job of a domestic help, which she found with a better remuneration. Laxmi’s husband has returned back on his dhaba and started earning again.

Delhi with its more than 250 DOT centers has ameliorated the lives of likes of Laxmi and bailed them out from sure death and misery. The DOT programme in Delhi has saved 7179 lives in the year 2002. Since the inception of the program in India, in 1998, treatment success rate has tripled from 25% to 84% and death rate cut seven fold (according to rough estimates). It has placed more than 1.6 million on treatment and saved 0.2 million lives.

Today, many families like Laxmi and her husband have found their bearing again which they were in danger of loosing because of this deadly disease. DOTS is the most cost effective health intervention available for TB control in India which accounts for nearly one third of the global TB burden.