Not missing a dose: Shahida, a patient, recounts her experience with BRAC

Shahida usually speaks quickly, her raspy voice sharpening every word. But she smiles and softens when asked if she’d rather just take her tuberculosis medications at home. “No,” she says matter-of-factly. “I’d forget to do it every day.”

As it stands, Shahida has yet to miss a single dose, a testament to the effectiveness of the anti-TB program of Dhaka-based BRAC, the world’s largest development nonprofit, as detailed in an upcoming book Making Tuberculosis History: Community-Based Solutions for Millions.
Halfway through her six-month treatment course, Shahida, a resident of the northern Dhaka slum of Badda, continues her treatment under the watchful eye of her neighbor Shanta, one of BRAC’s “community health promoters,” or shasthya shebikas – an army of 80,000 trained lay practitioners who form the centerpiece of BRAC’s anti-TB strategy.

Shahida’s symptoms have already disappeared. In fact, she feels completely cured. For many, this would be the signal to stop taking the medicine, but Shahida knows the importance of finishing the full course from her conversations with Shanta. Not only will it prevent relapse, but failure to complete the treatment would encourage the emergence of dangerous drug-resistant strains of the bacteria that causes tuberculosis. The growth of drug-resistant strains is one of the greatest fears of global health advocates as TB continues to kill 5,000 people daily worldwide.

So Shahida continues her daily visits to Shanta’s house. She sees the positive side: “It’s nice to see her every day,” Shahida says. “It provides a short break from all my daily chores. We usually end up talking about other things going on in the community.”

It all began with a persistent fever. Shahida fell ill in May with a high temperature that didn’t subside even after several days of medication. She wasn’t coughing, so when she approached the doctor at a nearby clinic, TB wasn’t even on her mind. But X-rays clearly indicated she had the disease.

Recognizing Shahida might be unable to afford the required treatment, the doctor recommended a visit to BRAC, which provides medications at no cost thanks to its partnership with Bangladesh’s National Tuberculosis Program. A sputum test at Shahida’s local BRAC branch office confirmed the diagnosis. Here, Shanta entered the picture: The patient and her shasthya shebika neighbor agreed on a time for daily visits.

Shahida prefers to keep her illness private, sharing it only with family. Though she does not buy anything else from Shanta – the shasthya shebikas have a basket of health products for sale, like vitamins and sanitary napkins – she’s able to visit her regularly without eliciting suspicions from others in the community. The two women have developed a comfortable rapport.

In urban areas, local pharmacists, physicians and drug sellers (often untrained) are the first place poor people go for health care. These are often conveniently located in or near the slums and are open in the evenings, when public facilities are closed. A strategy employed by BRAC and other organizations working with the National Tuberculosis Program is to engage these providers in training and orientation to teach them about TB, the importance of adherence, and the availability of free treatment options.

Within the neighborhood of Badda alone, diverse options exist. BRAC tries to reach as many of these providers as possible, from the proper pharmacy shop to the individuals selling health products in rickshaw garages. Particularly in the complex context of Dhaka’s unregulated and fragmented health care system, these partnerships create important pathways for patients to access quality TB services.

Partnership and engagement with health care providers are just two of many strategies BRAC is using for urban TB control. Learn about how BRAC works with garment factories to reach another vulnerable population.

Making Tuberculosis History, the comprehensive book on BRAC’s experiences with TB, comes out on October 27. For more information, write to makingtbhistory@bracusa.org.

Next in the series, we’ll feature the story of Rana, a garment worker who contracted TB.