USAID helps Pakistan's public sector provide free diagnosis and treatment

I just kept all the pain bottled inside.

-- Sabiha, 18, a TB sufferer for two years who finally found a USAID-supported public treatment facility in Karachi. Above, a lab technician examines sputum samples from suspected TB patients in Karachi.

Sabiha thought she had typhoid or malaria when she went to a Karachi hospital two years ago with a hacking cough, fever and appetite loss. When doctors instead showed her an x-ray of her ravaged lungs, Sabiha, then 16, panicked. She had tuberculo-sis. Relatives taunted her family, saying they would never be rid of the disease. Others said her father should abandon them. Her mother worried about her ability to marry. "People act strange when you tell them of this disease. They avoid you. They need to be told there is a cure," said Rukhsana Parveen, a Karachi woman whose husband had TB, now cured. "If they knew, they wouldn't behave this way."

Tuberculosis remains Pakistan's leading cause of death among infectious diseases. It carries a social stigma because of its link with poverty and overcrowded living conditions. Every year, at least 250,000 Pakistanis develop TB, a bacterial infection that spreads through inhalation and primarily affects the lungs. Left untreated, it eats away at bones and organs. Hobbled by poverty, shame or a lack of awareness, three-fourths of sufferers in Pakistan are never diagnosed by a doctor. Since 2003, USAID has contributed nearly $5 million toward the National Tubercu-losis Control Program in Pakistan, supporting free diagnostic sputum tests, free medication and training of community health workers to supervise patients' medication through home visits.

All government health centers in Pakistan now offer programs where community workers learn to identify TB symptoms during their regular house calls, bring suspected patients in to nearby health centers for diagnosis, ensure patients take their medication for the full 8 months and encourage community awareness. Such intervention is crucial because, like Sabiha, two-thirds of registered TB patients stop medication prematurely, tiring of it, finding it expensive or a social embarrassment or believing their loss of symptoms to mean they are cured. As a result, TB bacteria can bounce back resistant to previous drugs. Initially treated at a private clinic, Sabiha stopped her drugs two months early, unable to afford the 550 rupees ($9) a month. Soon, her symptoms returned. For the next year, Sabiha suffered silently as the pain in her lungs and ribs worsened. Finally, Sabiha learned of a public USAID-supported treatment program a short bus ride from home. Now 18, Sabiha is improving slowly from her long bout with TB and recovering a normal life.

April 29, 2006