Bangladesh Controls TB at 'Cough Collection Centers'

As one of the world's most crowded countries, Bangladesh has been especially vulnerable to tuberculosis, which claims 1.5 million lives annually worldwide. But with an aggressive detection and treatment program, the country's cure rate is more than 95 percent.

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From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.

Tuberculosis kills one and a half million people each year. A new World Health Organization report says there's been little progress in reducing the number of cases or deaths, and that's mainly because of the spread of HIV making people vulnerable to TB. There are drugs to treat tuberculosis. The problem for many people is getting reliable access to them.

One country that is making progress is Bangladesh. Its teeming cities and crowded rural areas would normally be a perfect environment for TB, which is spread by coughing and spitting.

Fred de Sam Lazaro has this report on what Bangladesh is doing right.

FRED DE SAM LAZARO: Each year, about 300,000 Bangladeshis develop active TB; most will never reach a hospital or see a doctor. Instead, almost all of them will wind up in places like this dingy building called a cough collection center. Sputum samples are collected, numbered, and later tested for tuberculosis bacteria.

(Soundbite of person coughing)

DE SAM LAZARO: It can sound - well, pretty disgusting to the unknowing ear, but this is the sound of one of the world's most successful campaigns to curb tuberculosis.

Dr. FAZLE ABED (Director, Bangladesh Rural Advancement Committee): Detection rate is 90 percent, and cure rate is more than 95 percent.

DE SAM LAZARO: Three and a half decades ago, Fazle Abed founded a grassroots organization to tackle this country's entrenched poverty and illiteracy called the Bangladesh Rural Advancement Committee, or BRAC. Today, with grants from international donors, BRAC runs most of the country's TB control program.

Dr. ABED: The treatment still is quite good in the sense that, you know, efficacious treatment is available and people can get well.

REEVES: The challenge is finding those infected people, especially in rural areas, and getting them on and keeping them on the antibiotic treatment. That's where the Rural Advancement Committee fits in.

Over the years, it's built a vast network of local associations or committees for various development and work programs. BRAC had a ready army of people like Amina Tiwari(ph) who are trained to look for people with symptoms like anemia, fever, chills, persistent coughing, things that may suggest TB.

Ms. AMINA TIWARI (Village Health Worker, Bangladesh Rural Advancement Committee): (Through translator) If anyone has symptoms for three weeks, I give them a cup for collection, or I take them to the cough collection center.

DE SAM LAZARO: Today, this 50-year-old widow is one of 70,000 women at the front lines of a methodical health surveillance campaign. Every morning after breakfast, she sets out to visit and check up on 15 neighboring families.

Ms. TIWARI: (Speaking in foreign language)

Unidentified Woman: (Speaking in foreign language)

DE SAM LAZARO: Tiwari has a sixth-grade education and a few days of training from the TB program to be a village health worker. She's the closest most of her neighbors will come to seeing a doctor or pharmacist. She carries a notebook to keep track of her visits and also a bag with various everyday drugs like pain killers and rehydration salts, which she dispensed at one home.

Ms. TIWARI: (Speaking in foreign language)

DE SAM LAZARO: She's allowed to sell this for a much needed source of income in the extended quarters she shares with a son and daughter-in-law on whom she'd otherwise be dependent.

Ms. TIWARI: (Through translator) Now, I have some of my own earnings. It's very important. I can give some money to my sons, to their families, for my grandchildren.

Ms. TIWARI: (Speaking in foreign language)

DE SAM LAZARO: On her route, Tiwari saw a gaunt, 50-something woman she'd been admonishing for some time. I don't have any appetite, the woman complained. I've told you numerous times, Tiwari scolded, get tested. She handed her two specimen cups and promised to take her to the cough collection center.

Typically, about 1 in 10 suspected cases turns out positive for TB. From these patients, the program will collect the equivalent of five U.S. dollars and begin a six-month antibiotic regimen. The medicines are given not to the patient but to the health volunteer to ensure compliance with the prescription.

Dr. ABED: In most cases, what happens is that after one month of drug taking, the patient feels quite okay, normal, and then he gets up, and nobody is following up with the patient.

DE SAM LAZARO: That incomplete course of antibiotics is a recipe for new drug-resistant strains of TB that are much harder to contain. A recent World Health Organization report found an alarming rise of multi-drug-resistant TB in many countries, particularly those of the former Soviet Union and China.

So every day, patients like Bashanti Tiwari(ph) show up at Amina Tiwari's house - they're not related. Bashanti is three months into her treatment. Amina Tiwari will hand her patient every single pill in the six-month prescription and watch it go down.

What keeps patients coming back even when they feel better? They'll get their $5 back. It doesn't seem like a lot, but by this country's per capita income, that's two a half days' wages. And the tuberculosis initiative has opened the door to other public health problems.

Ms. TIWARI: (Speaking in foreign language)

DE SAM LAZARO: On her daily rounds, for example, Amina Tiwari also prods mothers to immunize their kids. Today, 80 percent of Bangladeshi children are up to date on their shots, including a vaccine to prevent TB - a disease that program officials say just could be eradicated from Bangladesh in the next 10 to 15 years.

For NPR News, I'm Fred De Sam Lazaro.

SIEGEL: Fred De Sam Lazaro directs The Project for Under-Told Stories at Saint John's University in Minnesota. His story is a co-production of NPR and The News Hour on PBS.

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