Reaching the unreached Tribals and TB in Malkangiri

Situation

This tribal, rural area of Orissa is a difficult place to work in–it is prone to cyclones and flooding. Tribals face more poverty, ill health and discrimination than the general population and more tribals in Malkangiri die from TB than the national average. Some tribals are very hostile to ‘outsiders’ and travel between villages is difficult: there are few roads and the mountains and forests make it inaccessible. LEPRA respects the culture of tribal groups and works closely to build trust with their leaders. We identify volunteers from within the community, who are passionate about helping their own people, and train and work closely with them to achieve the project’s objectives. Because they are part of the indigenous community, understand the local language and age-old traditions, these volunteers encourage others to go for testing and treatment. Conduct health education To create understanding of the symptoms of TB, where to go to get treatment and how to take it. Increase the number of people with one or both infections referred for treatment. Train traditional healers We know that traditional healers are respected and influential in tribal communities and tribals consult them first. It is essential that patients get prompt treatment as TB is highly infectious. LEPRA trains traditional healers to recognise and quickly refer TB cases for testing and sometimes to supervise treatment. Increase testing A lack of government health facilities in many remote villages means that people have to walk distances of around 30 km to the nearest centre to get tested. To reach these ‘unreached’ people, LEPRA brings testing services to communities by setting up sputum collection centres in existing village buildings. Tribal volunteers take an active role in running these centres. They are trained to take sputum samples from people, which they deliver to the nearest TB microscopy lab for testing and diagnosis. Treat more people If the person’s test is positive, they are given counselling and treatment. LEPRA recruits and trains DOTS (Directly Observed Treatment Short course) providers who ensure treatment is taken regularly and completed correctly. Map the results TB cases are being recorded and mapped, helping decision-makers understand where most of the cases are and allocate resources accordingly. Provide food and nutrition Good nutrition helps a person’s immune system to overcome disease. However, tribal people are often affected by crop failures or other natural calamities. To safeguard against food shortages and starvation, LEPRA has set up 20 grain banks this year in the remotest communities. In times of need, people will take a ‘loan’ in the form of grain and repay it after the harvest. This project is partly-funded by the EC and LEPRA is seeking the remainder of the funding. Total remaining cost of the project: £61,000 Equipment £16,540 Health Education activities £10,752 Training £15,040 UK support costs £6,240 Project support costs £12,428

Solution