Reading Time: 2 minutes
BRAC has been recruiting and training shasthya shebikas, frontline community health promoters, in Bangladesh since 1972. Currently 97,000 shasthya shebikas and an additional 10,000 shasthya kormis, frontline community health workers, are providing a multitude of health services to Bangladesh’s communities. For tuberculosis (TB), they provide TB information, identify TB cases and administer directly observed treatment short- course (DOTS).
This blog was originally published in chwcentral.org/blog.
BRAC has been recruiting and training shasthya shebikas, frontline community health promoters, in Bangladesh since 1972. Currently 97,000 shasthya shebikas and an additional 10,000 shasthya kormis, frontline community health workers, are providing a multitude of health services to Bangladesh’s communities. For tuberculosis (TB), they provide TB information, identify TB cases and administer directly observed treatment short- course (DOTS). They also refer more than 40 per cent of the TB symptomatic cases to health facilities. Shasthya shebikas receive an incentive of BDT 500 after successfully completing DOTS. This is the story of how Maya, a shasthya shebika, helped Zakia, a TB patient, through a difficult period in her life.
TB is a concern in Bangladesh’s Barguna district, where the health system has few basic health amenities and religious beliefs and social taboos often prevent people from seeking formal healthcare services.
Zakia Begum and her family are residents of Barguna town. She has two children and helps her husband, Zakir Shikdar, in the family business. When Zakia became sick, their happy life was interrupted. She suffered from a recurring fever, cough and loss of appetite. She visited the local village doctor (non-qualified medical provider), who gave her medication, but she only got worse and started to lose weight. Zakia’s physical condition continued to deteriorate and she was no longer able to support her husband in their business.
One day, Maya, a BRAC shasthya shebika from the same community, was visiting households as part of her regular schedule. Zakia’s mother approached Maya and told her of Zakia’s ill-health. Maya immediately advised Zakia to do a cough test to check if she was suffering from TB. Maya gave her two sputum collection containers or ‘cough pots’ and showed her how to collect her sputum. The next morning Maya took Zakia to the nearest DOTS corner, housed inside the local health facility. Laboratory examination of her cough sample indicated she had TB. The doctor relayed the news and told her that TB is fully curable if she regularly takes the prescribed medicines.
Zakia was distraught, already nervous she would not recover. The sales revenue from her family-owned shop started declining sharply as community people believed that they would also be infected if they bought products from her outlet. She became depressed seeing her family income going down due to her illness. Maya continued to visit Zakia to keep track of her health and to address her depression. As a frontline health promoter, Maya knew how to manage directly observed treatment (DOT) for TB patients; she observed Zakia as she took the medication. She also helped Zakia overcome the taboos associated with TB.
After two months, Zakia went to the health facility for a follow-up sputum test; no TB was detected. She was told that as long as she continues to take all her medication, she could be completely cured after two more follow-up visits. Zakia was excited. She now understood that TB is not a deadly disease; it can be cured if properly detected. BRAC community health promoters not only delivered healthcare, they also provided psychological support. With their help, Zakia was able to regain her confidence and social identity in the community.
Kazi Amit Imran, based in Dhaka, is the communications manager in BRAC’s health, nutrition and population programme.