TB Burden in Tea Gardens of Assam

Prof. (Dr.) Dharmakanta Kumbhakar

(The writer can be reached at drkdharmakanta@yahoo.com)

Tuberculosis (TB) is a major health problem in the tea gardens of Assam. Despite being curable, it continues to claim human lives in the tea gardens. There have been heart-breaking cases in which entire families have been wiped out because of TB. Sixteen to eighteen per cent of the workers in every tea estate of Assam are affected by TB. There has been no control over the spread of infection and noteworthy improvement in the situation over the years. Ignorance among the workers and lack of support from the management are to be blamed for this situation. Proper preventive measures have not been taken by the tea garden managements. The top management does not want ‘too much development’ for the labourer community. The community that deserves maximum benefits remains at the rock bottom of the policymakers’ priority list. Managements of tea plantations want to increase productivity and cut costs, and in the bargain, medical expenditure always gets the axe first.

Nothing has changed ever as far as the lifestyle of the tea garden workers is concerned. The estate executives continue to lead a luxurious life, while the workers continue to live in poor conditions in the labour colonies where diseases thrive. The labour colonies lack better housing, electrification, safe drinking water, scientific sanitation, proper drainage and better living conditions. The government doesn’t have a tea garden-specific health report to date; even the rate of mortality continues to be alarming.

The situation is becoming worse. The drug-resistant TB is now becoming common in the tea gardens. Although the WHO-recommended Directly Observed Treatment, Short Course (DOTS) Programme, relaunched as the Revised National Tuberculosis Programme, has achieved success, leading to a slight decline in the infection rate, HIV co-infection and multi-drug-resistant TB (MDR-TB) are adding a new dimension and keeping the numbers high in the State’s tea gardens.

Failure of the immune system to thwart infection leads to active tuberculosis. Malnutrition reduces a person’s immunity, making him susceptible to tuberculosis. Similarly, fighting TB requires rich diets full of fats, vitamins, minerals and proteins. Anaemia 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 per cent of the tea garden population of Assam are anaemic and malnourished. A study by UNICEF and the Assam Medical College found that of the 14 meals in a week, only two are nutritional in a tea tribe family. Comorbidities such as HIV, diabetes mellitus, smoking and consumption of alcohol which debilitate the immune system put individuals of the tea garden population 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 with smear-positive patients, lack of awareness about the causes of tuberculosis, etc. All these factors are interrelated and contribute to the occurrence and spread of TB in the state’s tea gardens.

Overcrowding (higher population densities) and unhygienic living conditions in the tea garden labour colonies help in the spread of the infection, which is further fuelled by ignorance among the tea garden population. The workers live in one-bedroom houses with big families. Since tuberculosis is contagious, members of a patient’s family immediately become vulnerable. In addition, the level of awareness is low, so the patient is not isolated. Smoke released from biomass fuels used by the garden people for domestic cooking also largely contributes to the infection.

The disease physically and economically devastates not just individuals but also families of the tea communities of Assam. Tuberculosis primarily affects the State’s tea community in the productive years of their lives. Almost 80 per cent of tea garden TB patients are aged between 15 and 54 and are key breadwinners for their families. In a study conducted by this writer amongst the TB patients of the tea garden community of Assam, 60.5 per cent of the patients were male and 39.5 per cent female, with a male-female ratio of 1.53:1. The median age was 33 years. Tuberculosis was found to be most prevalent in the age group of 16-30 years (41.6 per cent), followed by 31-45 years (36.4 per cent). TB prevalence was 16.8 per cent among workers above 45 years of age and 5.2 per cent in the below-16-year age group. Since tuberculosis hits the productive age group the most, absenteeism from work because of ill health is high, putting stress on the meagre family income of the daily wage earners. It weakens those who are on treatment and thereby affects their physical ability to work, earn a living and support the family. Many a time, tuberculosis patients are stigmatised and ostracised by their families or employers. A TB patient takes an average of three to four months to recuperate, thus losing that much more income. The loss is disastrous for those struggling against poverty. As most garden labourers are poor, they usually don’t take medicines regularly after being diagnosed with TB, and they are most likely to be defaulting in treatment. The vast majority (more than 90 per cent) of the economic burden of tuberculosis in the tea garden population of Assam is caused by the loss of life rather than morbidity. Tuberculosis kills more women in the reproductive age group than all causes of maternal mortality combined in the tea garden population of Assam, and it creates more orphans than any other infectious disease. The indirect impact of tuberculosis on the garden children is noticeable. Many a time tea garden children drop out of 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 both at the tea garden community level and the management level need to be taken for that. Early detection and complete treatment of TB cases, a better healthcare system, proper health education and tuberculosis awareness, prevention of malnutrition and better living conditions among the tea garden population are the keys to reducing the TB burden in the tea gardens of Assam.