BRAC Frontline Health Workers –fighting a war against Tuberculosis and re-establishing the social status of TB patients

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BRAC has been recruiting and training Shasthya Shebikas (SS), front line health workers, in Bangladesh since 1972. Currently 97,000 Shasthya Shebikas and an additional 10,000 Shasthya Komi are providing a multitude of health services in Bangladesh’s communities. For Tuberculosis, they provide TB information, identify TB cases and administer Directly Observed Treatment Short Course (DOTS). They also refer more than 40% of the TB symptomatic cases to health facilities. SSs receive an incentive of 500 BDT after successful completion of DOTS. This is the story of how Maya, a Shasthya Shebika, helped Zakia, a TB patient, through a difficult period in her life.

Tuberculosis 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 Sadar. Zakia 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 medications, 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 shared her daughter’s ill-health. Maya immediately advised Zakia to do a cough test to check if she was suffering from tuberculosis. 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 tuberculosis. The doctor relayed the news and told her that tuberculosis is fully curable if she consistently takes the prescribed medicines.

Zakia was distraught. Already nervous she would not recover, sales revenue from her family-owned shop also 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 worker Maya knew how to manage directly observed treatment (DOT) for TB patients; she observed Zakia as she took their medications. She also helped Zakia understand she could overcome the taboos associated with TB.

After two months, Zakia went to the health facility for a follow up sputum test; no tuberculosis 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 tuberculosis is not a deadly disease; it can be cured if properly detected. BRAC community health workers 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.

BRAC (www.brac.net) is a development organisation dedicated to alleviating poverty by empowering the poor to bring about change in their own lives. It was founded in Bangladesh in 1972 by Sir Fazle Hasan Abed. Currently BRAC is providing healthcare services to over 120 million people in Bangladesh alone.