Tuberculosis burden in tea gardens of Assam

By Dr Dharmakanta Kumbhakar

Tuberculosis (TB) is a major health problem in the tea gardens of Assam. Despite being curable, people continue to die in the tea gardens of Assam because of tuberculosis. There have been heart-breaking cases in which families have been wiped out because of tuberculosis. About 16 to 18 percent of the workers in every tea estate of Assam are affected by tuberculosis. There has been no control over the spread of infection and significant improvement in the situation over the years. Ignorance among tea garden workers and “no magement support” are to blame for this situation. Proper preventive measures have not been taken by the magement of the tea gardens. The top magement does not want ‘too much development’ for the labour community. The community that deserves maximum benefits remains at the rock bottom of the policy maker’s priority list. The magement of tea plantation wants to increase productivity and cut costs, and in the bargain, medical expenditure always gets the axe first.

Nothing has been changed ever since as so far as the lifestyle of tea garden workers. The estate executives continue to lead luxurious lives, while the workers continue to live in poor condition in the labour colonies, where diseases thrive. The labour colonies are lack better housing, electrification, safe drinking water, scientific sanitation, proper draige and better living conditions. The government does not have a tea garden-specific health report till date, even the rate of mortality continues to be alarming. The situation is becoming worse. The drug resistance TB is now becoming common in the tea gardens of Assam. Although the WHO-recommended Directly Observed Treatment, Short Course (DOTS) Programme, relaunched as the Revised tiol Tuberculosis Programme, has achieved success, leading to a slight decline in numbers, but HIV co-infection and multi drug resistance TB (MDR-TB) are adding a new dimension and keeping the numbers high in the tea gardens of Assam.

The failure of the immune system to control infection leads to active tuberculosis. Malnutrition reduces a person’s immunity making them susceptible to tuberculosis. Similarly, fighting tuberculosis requires rich diets full of fats, vitamins, minerals and proteins. Aemia and malnutrition continue to cripple the tea garden population of Assam making them most vulnerable to diseases like TB. Health-wise, malnutrition is common in the tea community. Nearly 95 percent of tea garden population of Assam is aemic and malnourished. A study by the UNICEF and the Assam Medical College found that of the 14 meals in a week, only two are nutritiol in a tea tribe family. Co-morbidities such as HIV, diabetes mellitus, smoking and consumption of alcohol which debilitate the immune system put individuals of the tea garden population of Assam at a greater risk of developing TB.

Tuberculosis is a social disease with medical aspects. Studies have pointed to the association of lower socio-economic status of the tea garden communities of Assam with the risk of developing TB. The socio-economic factors include many non-medical factors such as poor quality of life, poor housing, overcrowding, indoor air pollution, large families, early marriage, population explosion, under-nutrition, illiteracy, consumption of tobacco and liquor (as most of them do so), close contact to smear positive patients and lack of awareness of cause of tuberculosis, etc. All these factors are interrelated and contribute to the occurrence and spread of TB in the tea gardens of Assam.

Overcrowding (higher population densities) and unhygienic living condition in the tea garden labour colonies aid the spread of the infection, and ignorance among tea garden population further fuels it. The tea garden workers live in one-bedroom houses with big families. Since tuberculosis is contagious, family members of a patient immediately become vulnerable. Plus the level of awareness is low, so the patient is not isolated. The release of smoke from biomass fuels used by garden people for domestic cooking also largely contributes.

The disease physically and economically devastates not just individuals but also families and tea communities of Assam. Tuberculosis primarily affects the people of tea gardens of Assam in their productive life years. Almost 80 percent of tea garden tuberculosis patients are aged between 15 to 54 years and are key breadwinners for their families. In a study conducted by this writer amongst tuberculosis patients of the tea garden community of Assam, 60.5% male and 39.5% were female with a male to female ratio of 1.53:1. The median age was 33 years. Tuberculosis was most prevalent in the age group of 16-30 years (41.6%), followed by 31-45 years (36.4%). The tuberculosis prevalence was 16.8% above 45 years age group and 5.2% below 16 years age group. Since tuberculosis hits the productive age group the most, absenteeism from work because of ailing health is high, putting stress on the meagre family income of the daily wage earners. It weakens those who are on treatment and their by affects their physical ability to work, earn a living and support the family. Many a time tuberculosis patients are stigmatized and obstracted by family or employers. A patient of tuberculosis takes an average three to four months to recuperate, loosing that much income. The loss is disastrous for those struggling against poverty. As most garden labours are poor, they usually don’t take medicines regularly after diagnosis with tuberculosis and they are most likely to be defaulter of treatment. The vast majority (more than 90 percent) of the economic burden of tuberculosis in tea garden population of Assam is caused by the loss of life rather than morbidity. Tuberculosis kills more women in reproductive age group than all causes of materl mortality combined in the tea garden population of Assam, and it creates more orphans than any other infectious diseases. The indirect impact of tuberculosis on children is considerable. Many-a-times children drop out from school to work and supplement the family income.

 The situation can be improved. The tuberculosis burden in the tea gardens of Assam can be controlled. But, concrete steps at the tea garden community level and the magement need to be taken for that. Early detection and complete treatment of tuberculosis cases, better health care system, proper health education and tuberculosis awareness, prevention of malnutrition, and better living condition among the tea garden population are the keys to reduce the tuberculosis burden in the tea gardens of Assam.