Two weeks have passed since the International Women’s Day was celebrated with much enthusiasm. Twenty thousand women the world over have since died of Tuberculosis (TB), a third of those Indian. Two weeks, 20,000 women.
March 24 is World TB day, a day marked to raise awareness for a scourge that kills 18 Indian women every hour, roughly three times the number of women dying per hour due to all causes of maternal mortality combined.
Because TB is air-borne, tending to TB patients or simply sharing breathing space with them puts one at risk of acquiring the infection in lungs, spine, brain or any other site. Women, the primary caregivers to the sick in Indian households, face extended exposure to TB, whether immunised against the ailment or not. The effectiveness of the BCG vaccine is a modest 27 per cent, and short-lived. With a near zero protection after the age of 10, TB can strike anyone, anywhere. And it does.
There are many more women victims outside of the reported statistic for patients with severe forms of TB. Photo for representation: AP
The risk is the highest for those living and working in conditions characterised by poor hygiene and undernutrition. Most women in India are conditioned to feed their family before self. Besides, not complaining and self-effacement is not just held as a virtue, it is a primary expectation.
Unsurprisingly, according to a 2016 Lancet study, as many as 101 million Indian women (across socio-economic categories) were reported moderate to severely underweight, the highest number in the world – a shameful statistic burdened further by the fact that 80 per cent of Indian women suffer from Vitamin D deficiency.
Being underweight and deficient in Vitamin D, both hold a bidirectional link with TB, heightening a woman’s risk of contracting it. In turn, TB causes malnutrition as it progresses, sparking an instant change in her societal status. Once called dutiful, multi-skilled and caring, the same woman now becomes a stigma, the carrier of an infectious disease, who deserves to be isolated out of fear of transmission, or altogether ostracised for fear of blemishing family honour.
If it is the daughter of the house, who would marry her? If it is the wife, who would take care of the daily chores or bear kids or contribute to the family income? If an employee, who would compensate for the time and money lost with her lower-than-usual productivity at work? These are typical reactions from her own kin.
When her son, husband, brother or father gets TB, she takes up additional responsibilities in her multiple roles of a care provider, an emotional pillar, and a bread-earner. But when TB strikes her, she more often than not has to cope on her own, both physically as well as psychologically.
Lower the socio-economic strata, greater the worry, and higher the barrier to seek diagnosis and treatment. Lack of access to quality healthcare at affordable prices exacerbates one’s chances further. Those who are wilfully or forcefully put on treatment, whether delayed or timely, don't comply with the full anti-tubercular therapy regimen that can last up to nine harrowing months.
In their haste to break out of the self or society-imposed stigma, or to ease the inherent guilt of increasing their family’s hardship of bearing medical bills, they abort treatment when visible symptoms begin to subside. As a result, many women go undiagnosed or un-notified and partially-treated in India’s TB epidemiology statistics. There may be many more than 18 dying an hour of TB in India, not to mention many more women outside of the reported statistic for patients with severe forms of TB.
More expensive and more stubborn to treat, their TB may have transformed into a multi-drug resistant (MDR) or an extensively drug resistant (XDR) or, worse, into a totally drug resistant (TDR) type. Treatment cost of drug-resistant forms of TB is 80-100 times higher than that of the non-resistant type, and the side-effects of powerful drugs to manage drug-resistant TB may adversely impact her quality of life, rendering her infertile, permanently impaired of hearing, emotionally scarred, and much more.
Being diagnosed with TB is not a stigma just as being diagnosed with hyperthyroidism or gastrointestinal ulcers or dengue isn't. TB is fully curable if diagnosed in time. If. No wonder the scourge has kept its deadly label intact since ancient times. TB remains one of the top ten causes of death worldwide, more than 2,000 years since it found a detailed mention in Charaka Samhita (4th century CE).
All TB patients need care and understanding, more so the women for whom the suffering is also deeply psychological due to archaic and overbearing societal norms. If the society continues to be ambivalent towards its neglect for women TB sufferers, it will pay a huge price by turning undiagnosed and untreated women patients into breeding grounds, mothering superbugs causing deadlier and untreatable types of TB.
The Prime Minister’s gallant dream of eradicating Tuberculosis from India by 2025 would then remain just that – a gallant dream. Not unless he listens to the brave women TB survivors-turned-activists, and their awe-inspiring Bolo Didi campaign to counsel women TB sufferers. Beti padao, beti bachao has captured the nation's imagination. Bolo Didi should be next in line. And today is a day as good as any to popularise it.