After months of diagnostic delay...Migrant worker could access TB services only when a community health worker met him

Shobha Shukla and Bobby Ramakant (CNS)
A migrant worker who was sick for over three months, actively sought medical help and advice, but his health kept deteriorating. Despite having constant cough, fever, and increasing weakness since months, neither he nor his treating doctor(s) thought of TB. And this did not happen in an area with low TB rates but in India’s national capital Delhi – a state with highest TB rates nationwide – and a country which is home to the largest TB burden in the world.
It was only when a frontline community health worker met him, that she thought of TB and he could access TB services, increase his health and treatment literacy, and successfully complete his treatment. One of his daughters too who was found positive for TB (of the lungs and abdomen) in the contact tracing done by the community health worker, is as of now currently on treatment. Both could access a range of social support to help them adhere to the therapy, thanks to the community health worker.
Manjit, who is a native of Bihar state of India, had migrated to Delhi many years back with his parents. He works in a pipe market and lives in New Seemapuri urban slum, East Delhi, in a rented accommodation with his wife and three daughters. The area he lives in, is home to many homeless people and rag pickers and is also a site for garbage processing. This area is about 2-3 kilometers away from Delhi’s famous Guru Teg Bahadur (GTB) Hospital – the only tertiary care government hospital in East Delhi.
Eliminate diagnostic delays
If we are to stop the spread of TB infection it is imperative to diagnose early and accurately, and put each person diagnosed on treatment with medicines that are effective on that person. It is equally vital to ensure that the person is fully supported - in every possible way - to complete the therapy successfully. As per a study done by Dr Susmita Chatterjee et al, average diagnostic delays in those at heightened risk of TB is 12 weeks. We must eliminate these diagnostic delays if we are to end TB.
In July 2023 Manjit started suffering from bouts of cough and fever. He went from one doctor to another, seeking medical help and advice, but neither could his illness get diagnosed nor did he get any relief. On the contrary, his condition kept worsening.
"I was very sick. My body had become very weak. I was unable to walk by myself. There was constant coughing and fever. I consulted many doctors and followed their advice. Many medicines were tried on me. I was even put on typhoid medication for more than 20 days. But with every new treatment, instead of improving, my condition worsened. I suffered like this for more than three months. I had no clue what was happening to me, and perhaps neither did the doctors. I underwent a battery of tests. But no doctor asked me to get my sputum tested [for TB],” said Manjit to CNS (Citizen News Service) in April 2024.
Then luckily, one day a neighbour suggested him to contact Shanti, a community health worker who works as a field officer for Humana People to People India (HPPI). The neighbour told him that Shanti had been regularly going around the community raising awareness on TB and actively reaching out to those who had similar symptoms as Manjit and helping them access healthcare services.
Thanks to Shanti, same day test and treat made possible for one of the most vulnerable
Shanti took Manjit to the nearby private x-ray clinic in Saboli area of East Delhi and with support from HPPI a free x-ray was done, which showed Manjit as presumptive for TB. Then, they went to Red Cross healthcare centre where sputum microscopy confirmed TB. His Ni-kshay ID was made, and he was put on treatment on the same day (Ni-kshay is a web-enabled real-time patient management system of government’s National TB Elimination Programme).
After this, they went to GTB Hospital for a free WHO recommended molecular test via CBNAAT (Cartridge-Based Nucleic Acid Amplification Test) and drug susceptibility test via Line Probe Assay (LPA). Drug susceptibility test is done to ensure that the TB bacteria that infects a person is not resistant to the medicines he or she is treated with.
Same day test and treat is important when it comes to TB – the deadliest of all infectious diseases – so that the person can become non-infectious soon after beginning the therapy and also reduce spread of TB, as well as lessen human suffering.
Counselling of Manjit was important. Shanti did daily follow-up of father and daughter during their entire course of treatment. Both received health education, treatment literacy, importance of treatment adherence, nutrition, infection control (like wearing of mask) and other support to tide through their treatment journey. For instance, Manjit wore a mask regularly, thanks to Shanti. Shanti also ensured that both got food ration supplements every month, courtesy an NGO operating in New Seemapuri dispensary.
(To be contd)