TB Stigma Still Haunts Indian Women

Tuberculosis (TB) is curable, but unfortunately in India this disease carries a stigma so much so that in some instances women suffering from tuberculosis are abandoned by their husbands and sent away from home because their husbands are ignorant of this fact. Tuberculosis for many years has been the leading infectious cause of death in women not only in India but also worldwide. The disease poses a major threat to women's health security. It is estimated that almost one-third of the world's population is infected with TB, and in developing countries it affects most women in their reproductive years. Many cases are in the passive stage and hence diagnosis can be difficult unless some triggering factor like HIV or diabetes brings about a flare up of the disease. A WHO report says that ‘The fear and stigma associated with tuberculosis have a greater impact on women than on men, often leaving them in a more precarious social and economic position. Tuberculosis in women creates orphans, impoverished families and reduces the economic development of society’. Another report from WHO mentions- `The stigma associated with TB causes women to be divorced or to be unlikely to become married. A study in India found that male patients with TB expected their wives to care for them but infected wives rarely received care. Thus, married women may try to hide their symptoms instead of seeking help’

Medindia’s visit to the TB ward at the Kasturiba Gandhi Government Hospital for Women in Chennai, South India, confirmed the sad truth about this  social stigma  that still hampers all genuine efforts made by private and public medicare systems in India to get rid of tuberculosis.  Of the ten women currently in the TB ward, eight women have been abandoned by their husbands as soon as they were diagnosed with TB and have not seen their children in years.  The other two women don’t come into this category only because one is not yet married and the other is a widow.

Ganga, 35, was happily married and living with her husband and two kids until tuberculosis hit her hard in 2007. Initially she dismissed her continuous cough as a ‘dry’ cough brought on by the humid weather and went about her household chores of cooking, cleaning, washing and doing everything to make her family comfortable. When the coughing spasms were severe and fever and chills raked her body along with excruciating pain in both her legs, her husband took her to a government doctor who told them Ganga’s TB was at an advanced stage and said it could be cured if Ganga took medicine continuously for six months. Ganga’s ordeal began soon after. 

She was admitted to hospital and the government provided nutritious food and medicines all free of cost, but Ganga’s husband never came to visit her at the hospital. After two months of not seeing her husband and children, Ganga took the doctor’s permission to visit her family promising to take her medicines regularly. She was sent away by her husband saying she would infect the family and she stayed with her aged parents making frequent attempts to see her children. Ganga slowly started neglecting herself (maybe out of depression) and became irregular in taking her medicines and during a visit to the hospital, the doctor observed that Ganga’s neglect had triggered a virulent form of Multidrug-resistant TB (MDR-TB), that would further challenge treatment. Her husband filed for divorce stating Ganga was mentally unstable. Now a frail Ganga is in and out of hospital, working as a cook to pay for her lawyer’s fees to seek her minor children’s custody and the doctors are at their wits end trying to treat her against the odds she faces both socially and medically.

So it is with Razia Sultan aged 31, sent away by her husband and in-laws even though she was cured of TB and carried a doctor’s certificate to prove it.  She was subsequently given Talaq (Muslim divorce), and landed in the TB hospital ward within a couple of years after she suffered a relapse while caring for her poor and aged parents. Annapurna, Gowri and all the other women in the ward are young women left destitute by their husbands fearing infection. They have similar sad life stories to share and they couldn’t care less that their real names are mentioned in this report.

An aged nurse Kausalya, who strictly monitors their drug intake and encourages these inmates  to read and chat as a group so that they do not sink  into depression, is their only family now. Says Kausalya, "I have seen many women come and go in this ward and often the same women come after suffering a relapse. Mere medicines and rich protein diet will not do the trick to cure these unfortunate victims. People with TB have to be loved and given the emotional support to live and get over their illness, barring which their body automatically loses resistance and they fall sick repeatedly."

Dr. G. Usha MD, Thoracic Medicine, Kasturiba Gandhi Government Hospital for Women says, "TB is curable, provided people take their prescribed medicine regularly along with protein rich diet. Government hospitals provide inpatients with 2-4 eggs, half liter milk, rice, bread, vegetables and 100 grams meat for non vegetarians per person, per day along with medicines. Door to door supply of medicines and reminders through primary health centers are promptly done. In spite of it the stigma attached to TB is still a challenge that doctors confront in TB treatment in these parts of the world."

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Said Dr. Usha, "Directly Observed Therapy Short-course (DOTS) is found to be successful in curing male TB patients because their womenfolk ensure that the men take medicine regularly and get cured. DOTS efforts are negated at the patient end in the case of female patients, especially in the lower income group because no one is so keen on monitoring their daily medicine intake and women who are set aside by their spouses just don’t have the will to go on – with their treatment, or with their lives. The situation is worse in rural areas and tertiary and peripheral centers where education and awareness of the disease is lower and a lot of superstition drives people away from seeking medical treatment for TB."

Women don't have a problem saying they have malaria or chikungunya, asthma or high blood pressure and diabetes for that matter—it is even fashionable to say so. But the infectious nature of TB and the social stigma attached to it frighten women from approaching a doctor in the initial stages when it is easier to cure the disease. They rarely seek medical help until TB is in a very advanced stage and it takes longer and more intensive medical treatment for a cure. Women power takes a nosedive in the case of women TB patients seeking cure from tuberculosis and a trip to the TB ward at the Kasturiba Women’s Government Hospital proves that more than medicine and nutritious food, tons of love and a caring family is what takes to completely cure women of tuberculosis.

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Source-Medindia
Thilaka Ravi/L