On The Occasion Of World T.B. Day
Causes And Cure Of T.B.

By Dr.Thir Man Shakya

TUBERCULOSIS popularly called T.B. had been in existence in the human history for centuries. The actual cause of this desease was not known till 24th March 1882 when Robert Koch placed before the medical world his momentous discovery of rod shaped organism, which he named the Tubercle Bacillus as the cause of the disease tuberculosis.’ Knowledge of tuberculosis advanced more and more with the advent of the anti-tuberculosis drugs in mid 29th century, which is potentially cent per cent effective in curing this disease if properly used. Thus, the rays of hope of wiping out this dreadful disease spread naturally. ‘We are privileged to live in the age when we have every effective tools of diagnosis, detection and treatment of tuberculosis but inconceivably these medicines proved not to be the only answer for the effectiveness of the treatment of tuberculosis and its control. Inadequate and improper use of this medicine has produced drug resistance bacilli not affected by the treatment. The disease still claims three million lives every year. Of the total global death due to T.B., nearly 95 per cent are in developing countries. In Nepal about 15,000 people die from tuberculosis alone every year mostly in their most productive age (15-59 yrs.) It estimated that about 80,000 people have tuberculosis. Nearly 50,000 people develop tuberculosis annually in Nepal. The disease mainly affects the lungs but can also involve other organs of the body.

T.B. which once called’ consumption ‘ i.e. wasting disease in the past, ranked among the common causes of the death in the world. Today, the improved methods of prevention, detection, diagnosis and treatment have greatly reduced the number of deaths from this disease in developed countries. However, the above mentioned improvements have not reached to majority of the people living in adverse situations in the developing countries. The anti T.B. drugs which are potentially effective have been found not properly or adequately used by the patients and treatment providers. In developing countries due to slender resources, inadequate health facilities, difficult terrain and ignorance, majority of cases of tuberculosis are still lying undetected thus not being treated. Such untreated T.B. patients live for about 2 years infecting 15-20 others in contact with them.

The tragedy of tuberculosis cannot be measured by death rates alone. Think of the breadwinner of a poor family becoming a victim of this disease. The entire resources of the family are turned over. Further being an infectious disease, T.B. is not uncommon for two or more members of the same poor family to be affected at about the same time. Therefore, in countries, like ours the disease has to be conceived as socio-economic problem.

T.B remains as health problem for the coming generations too because of the facts that children and young adults continue to be infected with T.B. some 40 per cent of the children below 15 years have been found infected with tubercle bacilli in Nepal. Infection does not mean diseased. Only 10 per cent of those infected with T.B. bacilli develop disease annually, the rest 90 per cent remain as symptomatic or healthy. But such healthy carriers however run the risk of developing disease for life long.

What prevents most of the infected persons from developing the disease? Our body possesses innate immunity system, which are able to prevent infection from spreading into disease. Due to various causes, emotional or physical, such immunity of the body may be lessened, the potential cause of it ever known is Human Immuno Deficiency Virus (HIV) infection. One of the important causes of increase of tuberculosis patients in this world today specially in Africa and South East Asia is due to the pandemic nature of HIV infection.

In Nepal, nearly 40,000 people have been estimated to have HIV infection. One of the opportunistic disease that HIV infected people gets is tuberculosis. What is most essential to be done in the field of tuberculosis in such situation is to protect individuals from getting infection of tuberculosis which is possible only through proper and adequate treatment of infective, T.B. excreting T.B. bacilli in their sputum. Treatment itself is the most effective method of preventing infection.

Developed countries also experienced the increase of prevalence and incidence of T.B. due mainly to T.B. in immigrants and refugees and also due to spread of HIV infection. It has thus stimulated those countries as well to concentrate on tuberculosis control activities. Considering the rapid worsening situation of T.B. in the world. WHO requested all member countries to improve the case detection of infections. T.B. and treatment of those cases until cured with standardised short course chemotherapy (6-8months).

Directly Observed Treatment with short course chemotherapy popularly known by DOTS, is the strategy recommended. This has been felt necessary because many patients of tuberculosis not closely supervised, often stop taking anti T.B. drugs prematurely because they feel letter soon. Certainly it needs a good network of primary health care throughout the country and as nearer to the patients home as possible, had fulfillment of stuff and regular supply of drugs in them. Above all, the commitment of the government and people participation are utmost important to make DOTS successful.

Rehabilitating The Rescued Girls

INCIDENTS of girl trafficking in Nepal are on the rise with the increasing demands of sex workers in the Indian and international markets.

It is reported that thousands of Nepalese girls are living a hellish life at several brothels in the neighbouring country. They are forced to accept prostitution as a profession. Moreover, involvement of the Nepalese people in trafficking young Nepalese girls has really been a matter of serious concern.

Several national and international organisations have been working in the country to prevent the Nepalese girls from being trafficked across the border. However, they are failing to achieve their targets, or else the number of trafficked girls should decrease. There are some non-governmental organisations which have been able to make their presence felt in the prevention of girl trafficking. Several girls have been rescued from the Indian brothels and others barred from becoming the victims.

However, the condition of the rescued girls is not satisfactory mainly in the absence of rehabilitation centres for them in the country. Many people raise the girl trafficking as a social issue but they hardly point at the need of the rehabilitation facilities to the rescued girls.

A research was conducted with the aim of finding the present scenario of the rehabilitation of the girls rescued and brought back to Nepal who were previously trafficked to the Indian brothels. The study conducted within a time span three months using both primary data and secondary data has also explored how the government. NGOs and INGOs have been effective in solving the problem of rehabilitation of the rescued girls.

Rehabilitating the rescued girls is undoubtedly an important issue. It is the most challenging activity that requires a pragmatic programme of actions to restore the trafficked girls back to their social life with proper employment opportunities.

The problem is magnified with the value system of the Nepalese society, which is often apprehensive to these returnees.

The beginning of the rehabilitation process started in the country in 1996 when 228 girls were brought back from the brothels from India. These girls were reluctant in returning back though they were rescued from their miseries in the brothels. Because they often realised that their return would compel them to face an uncertain future and unknown social consequences.

It became imperative that the related organisations focus on both the social and economic rehabilitation of these returnees and also at providing them a life free of stigma and isolation.

Though seven NGOs initiated the rehabilitation of the victims, at present, only three of them are rehabilitating the rescued victims. These NGOs are providing short-term shelter and training cum counseling facilities to these returnees. They are encouraging the victims to be financially sustainable by teaching them income generating skills, mainly in domestic activities such as mushroom farming, kitchen gardening, bamboo crafting, food processing, sewing and cutting to name a few. Some of the organisations have taken an initiative to provide special facilities to such victims. Maiti Nepal has opened the country’s first hospice; a separate village for the HIV/AIDS infected victims. Likewise, Transit Homes have been established in the border areas to prevent the Nepalese girls from being trafficked. The rescued girls are operating these centers themselves.

The rescued victims in various rehabilitation shelters prepare to earn their livelihood through commercial production of various goods like food, clothing and decorative items and so on. The market for these goods has been limited to the international market and the local market’s contribution has been very negligible due to lack of awareness and the non-acceptance by the society.

Realising the obstacle in penetrating the local market, the students organised a one day exhibition of these goods at Basantapur Chowk last year in December. The exhibition attracted a good number of customers through out the day and the public’s response was found to be enthusiastic to the products. Hence, what is needed is awareness and the collective effort of the society to curb the existing problem at least in the matter of being supportive to these victims ordeals.

Rehabilitation is a long drawn and complicated issue that cannot be settled by quick fix solutions. Each year victims have been rescued back to Nepal. Thus, rehabilitation of those rescued victims has been a major problem.

More rehabilitation centres need to be initiated to cope up the inflows. Besides rehabilitation being a very demanding programme the fear of the spread of HIV/AIDS from the returnees has discouraged the concerned bodies from promoting such rehabilitation centres.

With due acknowledgement to the government efforts on the rehabilitation of these victims, it is imperative that the effort still needs to be strengthened by factors like creating more job opportunities to the victims and an honest support to the NGOs working towards this noble path of bringing back hope to these victimised women. Last but not the least, as being a sincere citizen of this land it is the duty of every citizen to support and respect these unfortunate victims back to our society.

(This article is jointly prepared by Anjana Goenka, Grishma Shrestha, Sijan Sharma and Rakshendra
Man Patrabansh, all the MBA 1st Year students of KU.)

Looking Back And Into The Future

By Rajeev Kunwar

FOR Centuries revolutionaries have been dying for democracy and independence because they valve them most. A young boy was shot in his head because he was shouting for independence so that those in power would listents in him. But this ignites a huge flame. People pursuing the path of non-violence are willing to die in accomplishing their mission. Many lives have been sacrificed in this manner.

Not only in the 20th century since time immemorial there were marches for freedom and independence, there were revolutions, wars, invasions, secessions and economic upheavals, which had cost millions of lives in almost all parts of the world. Riots in the streets and protest movements against government were rife in Asia and Africa. The sequence has not ended, it still continues. Independence is cherished by everyone.

. There is still an aggression, subjugation, and fight for every inch of space which has an impact not only in the domestic realm but also in an international arena. House and buildings have been transformed into battle zones leaving behind only razed houses, ramshackled buildings and unburied carcasses. Only smoke from ashes of the houses rise in the air. People flee as refugees only to live in fear and dream of returning home sometime in the near future. Anti-social activities like looting, murders and robberies, are undermining social stability. Population explosion, famine, abject poverty and untimely death marked the end of the 20th century.

High price has to be paid either for the division or unification of a country. In fact Unity is the only strong bond that holds everyone together. Some countries have achieved unification and some are still striving towards it. There have been ethnic cleansing, separatists, have been crushed, today rebels and people of different ideologies co-exist. However, many countries have been pockmarked by the bullets of such violence and international terrorism has also struck each and every part of the world.

This may suggest that we are heading towards our own destruction by direct or indirect means. Even history tells us explicitly by the harrowing experience of the two World Wars, the cold war and numerous civil wars. Millions of innocent civilians and soldiers have been killed due to wars. But war is still going on. Instead of solving issues through peaceful means the medium chosen is violent and blood shedding. Global order, international peace and security have not yet been achieved. There is more insecurity and fear now than ever before in the history of mankind.

The imbalances prevailing in nature are also the making of human beings who rather, than being social animals, have become worse than wild animals in trying to annihilate their own species compounded with it natural disasters, weather changes, pollution, drought and environmental degradation have led to the great loss of life and property.

Due to the revolution in science and technology in n the mid-20th century, we came to learn that a minute particle or an atom could destroy the earth. The spread of knowledge and possession of atomic bombs, punctuated by lack of wisdom, have made this world a dangerous place to live in.

World has also shrunk digitally in the age of the computer. Everything related to communication and information has been digitalised into zeros and ones. We now sit in front of the tiny ‘box’ to go for election e-campaigning, e-commerce, e-mail, playing games, working and communicating with the four corners of the world. Only the tip of the finger is needed to log on to the world. Citizens have changed to netizens. There is also a digital divid-cyber-class warfare of the haves and have-nots.

Poverty alleviation, human resource development, environmental protection, complete disarmament, non-violence and peace and security must be given great importance and emphasis in this millennium. It should be every nation’s resolution.

This new century ought to be for peace, love and friendship,among the world people.