Tuberculosis threat to carpet weavers

Laxmi Tiwari is desperate to hold her three-month old daughter but they have been separated to prevent the child catching the tuberculosis Tiwari was diagnosed with last week. She contracted the infection at a carpet factory in the capital, Kathmandu, to which she and her impoverished family had come barely a month ago to escape the poverty in their village.

“Now we are poorer because I can’t work and my husband has to work harder to make enough money to feed us all,” said 22-year-old Tiwari. She regrets having joined the factory where she was offered a good salary by local standards for knitting carpets eight hours a day.

“I hope this treatment helps me to get cured soon,” Tiwari told IRIN. She is being helped by a non-governmental organisation, Friends of Shanta Bhawan (FoSB), with an eight-month Directly Observed Treatment Short-Course (DOTS).

Friends was among the first NGOs in Nepal to start the DOTS programme since it was introduced in 1996 by the National Tuberculosis Centre with support from the World Health Organization (WHO).

TB is a leading cause of death among women, according to WHO. Annually, about 750,000 women die of TB worldwide and three million contract the disease. As TB affects women mainly in their economically and reproductively active years, the impact of the disease is also strongly felt by their children and families, WHO states.

Since the introduction of DOTS centres, more Nepalese TB patients have had easy access to treatment, which is available to all citizens free of charge. A large number are internal migrants from rural areas to Kathmandu, which has the highest rate of TB prevalence in the country due to crowded workplaces such as carpet and garment factories where workers work and live together.

Friends alone receives more than 200 TB patients every year and estimates that about 80 percent are carpet and garment factory workers. Carpets are one of Nepal’s key exports.

“The problem is that there is no data due to lack of effective study in these factories,” said Nawaraj Subedi, DOTS supervisor from Friends. There is a problem getting access to these facilities as the owners’ fear negative publicity and losing business in Europe and the US.

Subedi says the history of cases they receive from the TB patients who are involved in carpet weaving is enough evidence to suggest that carpet and garment factory workers are vulnerable to the disease.

“Fortunately, there is an easy way to cure the patients as long as they take the medicines regularly and follow the DOTS course,” said Shova Oli from Helping Hands. The NGO, which treats about 150 TB patients every year, said more than 80 percent work in Kathmandu carpet factories.

According to WHO, the Himalayan nation is one of the model countries in Asia to have successfully implemented the DOTS programme, thereby saving thousands every year from TB-related deaths.

There are about 80,000 TB patients and 40,000 people are infected with the disease every year, according to the Ministry of Health.

Despite the treatment available, TB kills about 5,000 people annually. The reasons vary from complications of HIV, serious illnesses and advanced stage of TB caused by delay in applying for treatment.

“When we started our TB treatment programmes, we initially failed to realise the socio-economic impact of the disease and this is still a huge challenge for us,” said Bhawana Shrestha, director of the German Nepal TB Project, which has been fighting the disease for more than two decades.

Shrestha added that TB patients faced stigma attached to the disease. “Infected factory workers would have difficulty finding a house to rent as the house owners would ask the patients to leave if their disease is uncovered,” she said. In addition, they would risk the lives of other workers if they continued living in the factories where they get free accommodation.

Nepal aims to reduce the rate of TB prevalence by half by 2015 as one of its Millennium Development Goals and plans to eliminate the disease by 2050.

“We’re doing our best to achieve our target but again we can never be sure,” Shrestha said.

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