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Nutrition Initiative for Poor TB Patients in Rural Bihar

Tuberculosis.  Commonly known as TB, is an infectious disease which can be fatal for the person infected if left untreated. TB usually affects the lungs but can affect any other part of the body (other than a person’s nails and hair). People with lower immunity are more likely to be affected by the bacteria which cause TB.

The treatment for TB is a long process. Taking medicines daily takes a toll on the body, further weakening an individual. Generally, a TB patient has to take as many as seven medicines in a day for a long period (usually 6-9 months). These drugs cause several side effects- nausea, no appetite, blurred vision, vomiting, etc. For a patient who is already weak and not getting enough nutrition, the added effect of these strong TB medicines makes them weaker.

Innovators In Health (IIH) has been working on tuberculosis in Samastipur district of Bihar since 2010. During their intervention, they saw that the patients whom they were treating were quite poor. Such individuals would take these medicines without having a proper meal. The probability of patients dropping out and not completing the course of the treatment is quite high because they are unable to continue having such strong medicines. IIH tried to solve this issue by providing nutrition to the patients of two Panchayats- one glass of milk and two boiled eggs each day, which the patient was supposed to have along with the medicines.  The IIH team would visit the patient’s house and give them the food and the medicine. This also ensured proper monitoring of the patient’s on a regular basis. In this way, they provided nutrition to around 150 patients for a period of one and half years.

After a year or so, someone who had visited the program had raised an observation that the TB patients are taking medication only because of the supplementary nutrition provided to them. This model was not replicable in the long run when the number of patients would increase. The team then stopped this nutrition initiative for few months where they were directly giving food to the patients. The need for supplementary nutrition could be seen but the method of providing that was a major concern.

With time, the team realized that the nutrition initiative is an important link to ensure that the health of TB patients improves during their course of medication.  They wanted to restart this program but in a new way. Adding to this, the community has a lot of myths related to TB and even till date people do not behave properly with TB patients. So the IIH team thought that this would be a good opportunity to create awareness in the society as well as get nutrition for the TB patients from the community itself. A team member took the initiative and arranged a community meeting inviting the ward members, the ‘mukhiya’, ‘sarpanch’, PRI’s, teachers and other people from the community from 17 Panchayats of Dalsinghsarai which is a block in Samastipur. With collective understanding and decision, the concept of ‘adopt a patient’ was forwarded by the community and 15 TB patients were adopted by various donors.

This meant that the donor would give nutrition, ie half a litre of milk daily to the patient for the entire duration of the treatment. This also meant that the patient had a moral obligation to complete his treatment. Along with this nutrition was also being provided to some patients through Anganwadi’s ICDS and government schools Mid-day Meal schemes for 6 days in a week. In 4 Panchayats, the Anganwadi workers and some schools had easily agreed to provide meals for the poor TB patients. After the completion of the treatment, the patient would thank the donor and present them with some handmade gift for their help during the treatment. This initiative brought the community closer and managed to do away with many myths regarding this disease.

An IIH team member is writing the details of a community donor and a TB patient.
A happy patient gifting her donor a handmade basket after completion of her course.

The nutrition initiative was working well until a year when another challenge cropped up. The donors did not wish to give nutrition to multiple patients and IIH wasn’t able to find new donors. People had also stopped coming to the community meetings fearing that they would be asked to adopt a patient. During this time, sarpanch of a Panchayat named Harishankarpur, Shri. Vijay Narayan Chaudhri proposed an idea which seemed like a possible solution for all the challenges. He suggested that IIH should approach the various milk cooperatives to give nutrition in the form of milk to the TB patients. Milk cooperatives have a provision where they have to distribute 10% of their bonus every year to help poor people in their community. This is called ‘Datavya Nidhi’ (दाताब्य निधि). Within a week, some members of IIH spoke to the MD of Sudha Dairy (known as Mithila Dairy in this region) who understood the relevance of the nutrition project. Since mid-2014, many TB patients started getting half a litre (in some cases 250ml) of milk from the various cooperatives. The IIH team had to regularly attend the meetings of the milk cooperatives and ensure that the needy patients get nutrition during their course of medication.

IIH team with sarpanch Vijay Narayan Chaudhri and D.K. Shrivastav, MD of Sudha Dairy.
A Bulk cooler meeting of milk cooperative where a member of IIH is talking about the nutrition initiative.

Till date 132 TB patients have got nutrition through this new initiative, 52 have got from community donors and 80 from milk cooperatives. IIH currently provides nutrition to only those patients who are extremely poor and cannot afford the minimum nutritional requirement which is needed to ensure that their health does not deteriorate further due to the TB medicines.

As an organization, IIH has its limitations and it is not feasible to provide supplementary nutrition to every TB patient. But the organization continues to help as many patients as it can through its nutrition initiative and hopes to build a model where in the long run donors are mostly people from the community.

Dyuti Sen

2016 fellow, placed with Innovators In Health in Dalsinghsarai, Bihar as part of her fellowship. Working on strengthening the maternal and neonatal healthcare program by strengthening the women groups. In her words, "a person with a broad mind and an open heart".

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