In her bright red sari, Manjula Devi stands out from the rest at Tondiarpet’s Anna Park. Having set up a banner on a tree, she begins following, and handing out pamphlets, to whoever meets her eye. “It’s World TB Day, and we are here to help you learn how to prevent it, get it checked,” says the 45-year-old pharmacist. “You see the big umbrella?” she points at the multicoloured shade near the banner, “Meet me there, I’ll only take 10 minutes of your time,” she persuades them, mostly succeeding.
She doesn’t mind the odd rejection; conducting TB awareness programmes in this park is something Manjula has been doing for the past 13 years.
Born and raised in Tondiarpet, Manjula joined Bala pharmacy, owned by her cousin, in 2006, soon after her husband passed away, leaving in her care their teenage son and daughter.
Right from the start, she had been an inquisitive and talkative woman: “I would talk to the patients, and notice what type of medicines they regularly take. There would be some who kept coming back for cough medicines for months, and I began noticing a pattern,” she says, explaining how she would engage them in conversation about their troubles.
Eventually, her customers became comfortable enough with her to speak about their medical history. “I realised that there is a stigma attached to it; people don’t really want to talk about tuberculosis in their families,” she says, noticing the difference between that, and conditions like diabetes or high BP, which people easily own up to, despite them not being as curable as TB. “That’s why I started holding awareness programmes.”
Finding the right support
In 1999, the Chennai-based NGO REACH (Resource Group for Education and Advocacy for Community Health) was established for providing support, care and treatment for TB patients. Not only does it fight the stigma associated with it, but it also conducts research, and does public education programmes. REACH identifies local government officials, private hospitals, and community-based providers who could help spread awareness. In 2007, they began working with pharmacists: Manjula was one of them.
“During our initial stages of research, we found that though doctors give a six-month course of medicines, patients stop after the first three months, the minute they start feeling all right. So pharmacists are key players; patients sometimes go directly to them, and generally, these are people from their own community they know and trust. That’s why we trained them to identify symptoms, and direct them to doctors,” says Dr Ramya Ananthakrishnan, executive director of REACH.
- India is leading in terms of diagnosed TB cases, carrying 26% of the global burden.
- Tests, which can tell whether a patient has drug-resistant TB, are available free of cost in all Government and some private centres.
- A person diagnosed with TB, can not only avail of free treatment, and have access to a six-month medicine course, but also receive ₹500 per month, to take care of their nutritional needs under Nikshai Poshan Yojana.
Now, Manjula is able to identify the vestigial symptoms of TB in whoever comes to her pharmacy, and suggest nearby government hospitals they can go to. “Sometimes people go for one TB check-up, and then just keep coming back to take the same medicines without getting a second consultation. That’s when I direct them to REACH,” she says.
However, unlike the 2,500 other pharmacists REACH works with, she goes one step further and builds in-roads into the community. “I would hold awareness programmes before as well, but REACH gave me the confidence to do it more regularly,” she says.
One day at a time
Soon after the break of dawn, Manjula goes up to Anna Park. On most days, it is just for a walk, but twice a week, it is to gather people for her talks. “You can’t keep talking to people about TB, they’ll get fed up; you have to be their friend and a familiar face too,” she says.
She plucks people away from their activities, a cajoling tone and ready smile on her lips: “You’re just sitting here, so why not come over there and sit with us?”
In a quintessentially Indian way, after some people have gathered around her, the next five join in to see what the first five people are there for. And so the crowd grows. Given that she’s been doing this for a decade, she naturally meets quite a few familiar faces. “But there are always some new people around, whom I can rope in,” she says.
Today, she faces a group of 15 men and women, half of whom stay for the entire length of her talk. She briefs them about the symptoms, the statistics, the prevention and treatment.
Of the 15, one woman admits to her, “I had TB as a child, but it was cured. Now my mother-in-law has it, and I have had a cough too, since the past month.” Manjula has a brief chat with her, and punches her number into the woman’s cell phone: “Call me if you need any help.”
TB Helpline: 9962063000; Helpline for private practitioners: 9790977331