Tuberculosis has become a one-time killer since the World Health Organization (WHO) declared it a global emergency in 1993. The Bangladesh government and several private organizations have taken simultaneous steps to eradicate tuberculosis. In Gaibandha, like the rest of the country, various public and private health institutions are using state-of-the-art 4 and 16 module gene expert machines, LED tests, Truant machines, general X-ray and Portable X-ray machines to detect potential tuberculosis patients. Despite all this, the number of tuberculosis and Medicine Resistant tuberculosis (MDR) patients is increasing at an alarming rate in Gaibandha. From January 2023 to March 20 of this year, the number of patients suffering from drug resistant tuberculosis in this district is 37. Which is the highest among the eight districts of Rangpur division. Besides, two people died. And till March 22 this year, the number of affected patients in the district is 681.

Those related to the tuberculosis program say that although all types of tests and medicines are provided free of charge to identify potential tuberculosis patients, the number of patients is low. Rather, people are being affected by new types of tuberculosis. Why can't the number of MDR or TB patients be stopped as expected even after taking various steps at the public and private level?

221 people are affected by tuberculosis every year in the country. And 24 identified patients died in the year.

According to the data of Rajshahi Chest Disease Hospital (CDH) from 2023 to March 20 of this year, the number of patients with Medicine Resistance Tuberculosis (MDR) in Rangpur Division is 125. Among the eight districts of the division, the highest number is in Gaibandha. The number of people affected by this disease in this district is 37. Among them, two people have died, including one last year and one this year. The least number of patients in this category (5 people) is in Kurigram.

On the other hand, Gaibandha National Tuberculosis Control Program or National Tuberculosis Control Program (NTP) sources said that the number of tuberculosis patients in Gaibandha in 2023 is 3,603. Out of which 2 thousand 609 positive patients. Besides, the number of extra pulmonary (EP) patients is 855 and children are 102. And till March 22 of this year, the number of affected patients in the district is 681.

At least 10 people from BRAC and ICDDRB who work directly in the field to identify potential TB patients in Gaibandha were interviewed. They said, despite having all the symptoms of tuberculosis, people do not want to disclose easily. At the root of which is society's superstition, people's shame and ignorance, neglect and unawareness about the disease. A prospective patient refuses to cough and X-ray after various persuasions. Even though he took the cup, he returned it due to negligence and various excuses.

Besides, they also said that family members of TB positive patients should be tested for TB and TPT (TB Preventive Therapy) should be given if necessary. In that case they have to face more complications. Because, the patient's relatives do not want to come under the TPT in any way claiming to be healthy.

Tuberculosis Control Program (NTP) Rangpur TB expert Dr. Rana told Barta24, Tuberculosis is an airborne bacterial infectious disease caused by the Mycobacterium tuberculosis bacterium, which is spread through the air through sneezing and coughing. The main symptom of tuberculosis is a cough lasting more than two weeks at a time. In that case blood may or may not come with the cough. In addition, the patient's weight loss, gradually weakening the body, loss of appetite, fever in the afternoon and evening. Fever with sweat in the morning and night and pain in the chest and back are symptoms of tuberculosis. If a person has these symptoms then he should be tested as a possible tuberculosis patient. Tuberculosis can be completely cured by regular full term medication if detected.

This doctor said that tuberculosis can not only affect nails, teeth and hair. Moreover, tuberculosis can develop anywhere from the brain to abnormal lumps, boils, skin, intestines, liver, kidneys, bones, uterus, and surgical sites anywhere in the body with blood circulation. In that case, the part of the body where the tuberculosis germ will be infected will swell.

He said the disease usually affects densely populated and poverty-stricken areas. Besides, those who have weak immune system are more likely to be affected by this disease. In addition, diabetes patients, drug addicts, malnutrition, poverty, environmental pollution and all patients not detected at the right time are among the reasons for increasing the rate of tuberculosis, according to experts.

Regarding the current success of the program, he said that Bangladesh has made a lot of progress in identifying and treating patients. And 96 percent of patients are being cured with treatment. NTP and its partners have made significant progress in TB control over the past few decades. He said that in 2015, where there were about 45 deaths per 1 lakh, now it has come down to 22.

MDR patient question - Rajshahi Chest Disease Hospital (CDH) Resident Medical Officer (RMO) Dr. Shovon Pal told Barta24 on mobile phone that MDR tuberculosis patients are mainly of two types. 1. Directly by the germs of the patient with drug-resistant tuberculosis. Two. If a TB positive patient takes irregular medication, or many stop taking medication thinking they are cured, these patients are later identified as MDR (drug resistant tuberculosis). The normal course of tuberculosis in these patients no more work was done.

In response to a question, this doctor said that since tuberculosis is a long-term disease, you need to take long-term medicine for it. Depending on the type of disease, extent and age of the patient as per the advice of the doctor it may take 6 to 9 months to complete the course of medication or even longer depending on the condition of the patient. Otherwise, the patient often dies. In such a situation, this doctor advises tuberculosis patients to take the medicine for the entire period according to the prescribed dosage with patience. If not treated at the right time, this bacterium can spread to other parts of the body and the patient may die, and there is a risk of spreading the bacterium from one person to 10 to 15 people.

To reduce the number of TB and MDR patients, apart from increasing the immunity of TB patients by eating a lot of nutritious food, being more vigilant of those who care for TB patients, conducting regular examinations of people living in unhygienic and crowded environments, detecting the disease before a carrier patient arrives at the hospital, someone so that Monitoring of mid-course discontinuation of treatment, regular follow-up of identified patients for two, three and five months and providing financial support to poor people with TB along with treatment. Apart from this, this doctor also thinks that it is important to involve the local public representatives and religious leaders (Imam, Muazzin, Priest) and educational institutions to raise awareness about tuberculosis by taking people from different levels of society together to achieve the target.

Although all activities including patient registration and counseling are done by the government, the challenging work of patient identification is done by private organizations like BRAC, ICDDRB. In this regard, District Manager (DM) of BRAC Tuberculosis Program (BHP TB) Gaibandhar Nazmul Hasan said, Bangladesh government and BRAC have been jointly carrying out a tuberculosis control program since 1993. 56 BRAC workers are working directly at the field level and 3200 health nurses are working in the district in support of them. We collect the cough directly from the patient and submit it to the hospital for examination. If detected as positive, we are arranging for regular follow-up and TPT, giving the patient's medication by the health worker as per the doctor's advice. Super poor patients, transport workers, rickshaw pullers, bricklayers and families of these categories of patients are being assisted with travel expenses for examination and nutritious meals. BRAC continues to provide medication to patients by subsidizing children's check-ups and treatment and subsidizing dot providers.

The World Health Organization has announced the elimination of tuberculosis from the world by 2035. Asked how easy it will be in the current reality of Bangladesh, this official said that although there is a lot of work on tuberculosis in the country, it is very difficult to eliminate it by 2035. Because, on the one hand people are not aware, on the other hand it is very difficult to identify the patient. As a result, it is not possible to eradicate this disease by 2035. However, he thinks it is possible to control it during that time.

Director of Rangpur Health Directorate Dr. Md. Abu Hanif told Barta24 on mobile phone, "We have all plans including modern treatment methods to eradicate tuberculosis." Tuberculosis is being diagnosed in a large number of laboratories of private institutions including BRAC, apart from the government chest clinic of the district, all upazila health complexes, community clinics and even prisons and garment workers' treatment centers. For this, modern testing equipment has been attached to the examination centers. Still, we are trying to overcome the crisis and challenges in the elimination of tuberculosis. We hope to eradicate tuberculosis by 2035.