Assam, January 19, 2015(IANS) Tuberculosis (TB) has become a major problem in Assam's tea gardens, often leading to the death of workers. Experts say ignorance among workers and poor management response are to blame. The disease affects nearly 40 percent of the tea workers and doctors say the situation is going from bad to worse. According to R.N. Roy, district TB officer (under the Revised National Tuberculosis Control Programme) in Sonitpur, there has been no significant improvement in the status of TB among the tea garden workers over the years mainly because of "ignorance" and "no management support".
"TB is a big problem (in the tea gardens). But there has been no significant improvement in the situation over the years. From 2005 until today, the data has been more or less the same. There has been no control over the spread of infection because proper preventive measures are not taken," Roy told IANS.
Of the 8.6 million cases globally, 2.2 million cases are in India - the country with the world's highest TB burden. According to Roy, if one looks at the numbers of registered cases in the tea gardens, 30-40 percent of the workers in every tea estate are affected by TB. "But what is even more worrisome is that drug resistant TB is now becoming common. Almost 80 percent of all drug resistant TB cases come from the tea estates," Raoy pointed out.
Although the WHO-recommended Directly Observed Treatment, Short Course (DOTS) programme, relaunched as the Revised National TB Control Programme, has achieved success, leading to a slight decline in numbers, experts say that HIV co-infection and multidrug-resistant TB (MDR-TB) are adding a new dimension and keeping the numbers high.
Mintu Phukan, a doctor in one of Sonitpur district's tea estates, told IANS: "TB is a serious health concern and despite being curable, people continue to die because of it." "Since it is highly contagious it is difficult for family members of a patient to escape it unless they are very careful. In tea garden workers' colonies, overcrowding and unhygienic living condition aid the spread of the infection, and ignorance further fuels it."
"Overcrowding is a major factor for the spread of infection. The workers live in one-bedroom houses with big families...since TB is contagious, family members of a patient immediately become vulnerable. Plus the level of awareness is low, so the patient is not isolated," Sharma told IANS.
Phukan said that while most tea garden hospitals are equipped to provide treatment, the management can do more to control the problem.
 Another doctor said: "Better housing facilities, proper drainage and better living conditions can go a long way in improving the situation in the tea gardens."
"But not enough is being done. There is pressure on plantation managers to increase productivity and cut costs, and in the bargain, medical expenditure always get the axe

Most of the tea garden workers in Assam are adivasis, or tribals, who hail from Odisha, Andhra Pradesh, Jharkhand and West Bengal, whose ancestors were brought to work in the plantations by the British more than a century ago.
Hardly anything has changed ever since as far as the lifestyle of those living in the plantations is concerned - the estate executives continue to lead luxurious lives in British-style bungalows, while the workers continue to live in poor conditions in their well demarcated "labour lines" (colonies), where diseases thrive.
A healthy workforce, however, brings better productivity and Roy said TB hits the productive age-group the hardest. Women, especially, are amongst the most vulnerable lot. According to a study conducted by Unicef, almost 96 percent women workers in tea gardens are anaemic. Malnourishment, also among children, is high - all of which makes them specially vulnerable to infections.
"Half of all TB cases from the gardens are women," Roy said.
Another study concluded that the female reproductive system is very vulnerable to the TB infection, causing infertility, menstrual irregularity, pregnancy loss - and increased risk of morbidity of both mother and child in pregnant women.
Richa Misra, research associate at CSIR-Institute of Genomics and Integrative Biology, New Delhi, said women are more at risk in their productive years.
"Although biological mechanisms may account for more men being affected in low-income countries, socio-economic and cultural factors leading to barriers in accessing health care may cause under-notification in women," Misra told IANS in an email interaction.
"Tuberculosis control programmes should be sensitive to the constraints faced by women in accessing health care in order to empower women to commence and complete treatment. The fear and stigma associated with tuberculosis have a greater impact on women than on men, often leaving them in a more precarious social and economic position," she added.
The disease, however, is not just a health problem. Since it 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.
"There have been heart breaking cases in which families have been wiped out because of TB. In one such case, the father got the infection first, then his wife, and then both their sons," Roy said. "Treatment in the garden hospital is free of cost, but detection of the disease was late. Over a short span of time the whole family was dead," Roy said.
"The situation can be improved, the disease can be controlled, but concrete steps at the community level and by the management need to be taken for that," he added.

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