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DOTS centre razed, TB spreads its tentacles in Majnu Ka Tila (The Asian Age-21 July 2010)

City anchor tibetan refugee colony categorised as high-risk area with 127 patients enrolled for medication, 31 of them children

EKHA gets irritated easily, R especially when told that she needs to gain weight. The 12year-old is
among 31 children in Majnu Ka Tila who have developed tuberculosis in the past few months.

The Tibetan refugee colony has 127 patients enrolled at the DOTS centre and, according to conservative
estimates, up to 10 new cases are detected every month. What worries health workers is the number of
undiagnosed patients, who need to be enrolled urgently.

However, despite its `high-risk' area status, due to high rates of injecting drug users, TB and HIV patients, the
only Direct Observed Treatment-Shot Course (DOTS) centre at Balak Ram Hospital in Majnu Ka Tila was
demolished this January. Amid the rubble of the old laboratory, diagnostic centre and polyclinic, now stands a
small room where patients, who manage to turn up, are handed the day's dose of drugs.

For TB health visitors like Rajiv, work has tripled since the DOTS centre was demolished. "There are no
follow ups and when patients do not turn up, chances of developing drug resistance increases. This is a
congested colony and increasing infection rates among children is a ripple effect of the closure of the centre.
In a few more months, rates of multi-drug-resistant (MDR) TB will also increase if nothing is done," said
Rajiv. MDR-TB develops when the DOTS course is interrupted and the levels of drug in the body are
insufficient to kill the bacteria. What makes it even more dangerous is that the patient becomes resistant to the
first line of treatment, increasing mortality to nearly 80 per cent.

Worried by the increasing prevalence of TB in her area, Vimal Talk has volunteered to become a health
worker. "It costs Rs 40 to just go to the DOTS centre and as a result many patients choose not to. I enrolled for
training to become a TB health visitor so that I can distribute the drugs myself. Patients will not skip the
medicine if it is distributed within the colony," she says.

"We need more volunteers and the population needs to be motivated. In a few months, the effects of closing
down the DOTS centre will start showing with more patients registering for MDR-TB," says Swapna Naveen,
project manager for TB Alert India, an organisation of health workers. Her organisation has decided to push
the State Tuberculosis Association for opening a laboratory in the area. "We need extensive coverage in this
area if we are to stop the spread of infection," she added.