If Totally Resistant TB has occurred in these 12 patients in India, how has it occurred?  TB treatment is a long and often arduous experience.  Patients have to take a number of drugs daily, for 6-8 months, and if they default, they fall ill again, and can then develop Multi-Drug resistant TB, which is much more complex and expensive to treat.

So why do people default?  Poverty and a lack of support are two major factors.  Taking TB drugs every day is tough going when you don’t have a good diet and the drugs can initially make you feel even worse – this is why Directly Observed Therapy Short-Course (DOTS), the package of care recommended for people with TB by the World Health Organisation is so important.  It focuses on ensuring people have the support they need to complete their treatment within their own community, and has been proven to greatly reduce the number of people who default on their treatment.

Helen Njele is 31 and lives with her two small children in Eastern Zambia.  Helen told us that immediately after starting her TB treatment she felt awful, she complained “I am taking drugs, feeling worse, coughing more and feeling weaker.  What’s the point?”  Helen wanted to stop taking her treatment, but thankfully she was being given DOTS support by a locally trained Target TB volunteer, Thompson Banda.  Thompson encouraged her to stick with her treatment, explaining that feeling worse wouldn’t last and she would soon start feeling better and sure enough after a few weeks the side effects subsided and Helen started to feel better.

Helen said that Thompson (pictured together right) has been of great support to her; always providing encouragement and when she was too weak to walk he would collect her weekly supply of drugs from the clinic. And after just three months of treatment, Helen is feeling much better and says “I can care for my children, collect water, I can even ride a bicycle. I am back to how I was before.” She is really grateful for the support given to her and says that she is very interested in becoming a volunteer herself.

We work with partner organisations in Africa and Asia, training local people to have the capability to support those living in their own community through their TB treatment.  It is essential that this level of support is provided, otherwise with MDR-TB on the rise, and the possibility of a Totally Drug Resistant from of TB, the outlook for those with TB is bleak.

TB is the leading cause of death in people living with HIV. Every minute, three people living with HIV have their lives snatched away by TB. But it doesn’t have to be this way. Target TB helped Mwasana, living with HIV,  in Zambia.

Mwasana is 30 and lives in a dry, dusty compound in the Zambian capital of Lusaka. Mwasana isn’t married, so she lives with her father and stepmother, and looks after her five young brothers and sisters. Mwasana became extremely ill and weak in 2009 but didn’t know what was wrong. Luckily, she lived very close by to Precious, one of Target TB’s community volunteers. Precious took Mwasana straight to our project for diagnosis and help. Mwasana diligently took her antibiotic TB treatment, and with Precious supporting her, she started to gain strength.

However, her bad chest just wouldn’t improve and eventually she was tested and found to be HIV positive. Co-infection with HIV can often make TB extremely difficult to diagnose and to treat.

So, Mwasana had to change her treatment and she needed the support of Precious more than ever before. When Mwasana was diagnosed with TB, she felt stigmatised and she experienced discrimination from some people in her community. Mwasana became so ill, and had so much difficulty moving about, that she was often carried in a wheelbarrow. She was laughed at and made to feel very unhappy.

Even her family reacted badly to her illness. They were worried that she was so sick and unable to work, and therefore unable to earn money for food. Happily, Mwasana’s health has been improving steadily since then. When we met her in early 2010, she was on the road to full recovery from TB, feeling much stronger and better able to look after her siblings. Mwasana says it is the support she received from Target TB and its partner Zatulet that has helped her to cope. She told us ‘I look forward to Precious visiting every week’.

TB doesn’t have to be a death sentence to people living with HIV. Target TB aligns itself with the aims of ‘Time To Act – Save a million lives by 2015′ by the Stop TB Partnership.

As Nelson Mandela said in 2004 ‘We cannot win the battle against AIDS if we do not also fight TB’.

Target TB helped Pasquela survive TB in Timor-Leste while she was still breast-feeding her child.

This November Target TB is teaming up with the White Ribbon Alliance to raise awareness about the impact of TB on maternal and child health and to encourage people to take action.

Last month at the Every Women, Every Child event timed to coincide with the UN General Assembly, Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership called for greater attention to TB.

“Tuberculosis is somehow forgotten, but incredible in its global spread,” said Dr Ditiu. “Speaking in terms of MDG 4 and 5, if we do not act against it now, more than three million women and one million children will die, and millions more children will be left orphaned” by 2015.

Today fewer people are dying of tuberculosis and fewer are falling ill.  But too many millions still develop TB each year and too many die.  TB has a significant negative impact on the lives of women and children in the developing world.  But until now the need to tackle TB within a maternal and child health setting has been neglected. WRA has teamed up with Target TB to draw attention to the burden of TB faced by women and children in some of the poorest regions in the world and to call for increased advocacy efforts to help address this problem.

TB is both preventable and curable and yet it causes more deaths among women than all the causes of maternal mortality combined.  3.6 million women develop TB and 700,000 die from it each year. The majority of these cases take place in the developing world. For women of a reproductive age, TB is the third leading cause of death worldwide. TB can cause infertility and contributes to other poor reproductive health outcomes, particularly for women with HIV.

At an Every Women, Every Child event timed to coincide with the UN General Assembly last month, Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership highlighted the impact of TB on women and children and called for urgent action.

There is a lot that can be done. Providing access to relevant information will help women better understand the risks associated with TB during pregnancy and childbirth. Providing access to TB and HIV screening services, particularly in high prevalence, resource limited settings, will ensure women and children with TB receive the treatment and care they need. Making use of new, more efficient diagnostic tools will help ensure that TB infection is diagnosed as early as possible and that treatment is initiated quickly. Programmes to reduce stigma and discrimination will help reduce the social and cultural barriers both women and children face to accessing services.

But this must start happening now. We call upon you, as advocates for safe and effective maternal and child health services, to push for appropriate measures to be taken in both policy and programming and to ensure that the burden of TB on women and children is reduced and finally eliminated.  For more information about TB and maternal and child health, and for some practical things you can do to help, please click the image below:

White Ribbon Alliance and Target TB - Action of the Month November 2011

If you or your organization is a WRA member and you would like to submit a blog related to TB & maternal health, please email takeaction@whiteribbonalliance.org as they will be featuring various blogs throughout the month.

A visit to Timor Leste is always interesting. It is one of the youngest and poorest nations in the world – after a 24 year struggle withIndonesia, Timor Leste gained independence in 2002.

Now, TB is a major public health problem. Severe poverty, malnutrition, an under-resourced health service and a population spread over an island with difficult terrain and many isolated areas, mean that tackling the disease is extremely difficult.  However, our Director Nikki has just returned with a great story of hope. We helped to save Theresa’s life when she had TB – and she has gone on to have a baby boy, a new sibling for her daughter, pictured here with Theresa. 

Nikki first met Theresa back in May 2010. At that point, Theresa had been sick with TB for a long time and was too weak to look after her family. She had been to traditional healers but their advice was useless. She had wasted away to just 31kg.

It was Theresa’s mother in law who knew of the Klibur Domin clinic elsewhere on the island – this is Target TB’s partner and it is a medical life line to some of the poorest people in the country. Despite Theresa’s ill health, together they had to walk 20 long kilometres to the nearest road. Then they had to take a bus for another 60km, just to get help.

Theresa was so ill with TB she was admitted immediately. Because of the long difficult journey back to her village home, she had to stay on a specialist ward for many months. So, she had to leave her baby daughter behind. And that was where Nikki had last seen her. Her last words to Nikki were ‘I am looking forward to seeing my daughter again’.

This time, Nikki went back to see what had happened to Theresa. She takes up the story:

‘I was very pleased to see that Theresa is now cured of TB. She is now living with her husband and his family. And surprisingly, she has just given birth to a son!

When I last met Theresa, despite having a daughter with her husband, she was not allowed to live with him as dowry had not been paid to Theresa’s grandfather. However her husband’s family has now paid so she is able to stay with them with her daughter and new baby.  Both Theresa and her husband’s family are extremely poor. Nevertheless a dowry of $1,660, 2 goats, 2 boxes of beer & 2 gold plates had to be paid – and this is just an initial installment. There could be further installments and, if Theresa hadn’t survived her TB, they would have still had to pay. I asked them how they could afford this, and they told me that the wider family members are asked to contribute which is the traditional way.

Theresa stayed at our partner’s in-patient ward for three long months until her health was improved enough to be able to return to her village and see her family. The she got full support from Target TB’s project staff for the remaining five months of treatment, receiving treatment support at home. Completing her antibiotic treatment and getting enough food to become strong at the right time saved Theresa’s life.

When I met her again she had just given birth to her new baby boy, Chrisantho – just 3 weeks old! She ended up having the baby at home, as although they called for an ambulance to take her to hospital for delivery, by the time they traveled across the rough terrain to her isolated rural home, she had already had the baby. Where Theresa is living now with her husband and his family is very remote, and a significant distance from the main road, which means basic facilities such as health clinics and hospitals are difficult to access.’

When I asked her and her family about their experience of TB, her father in law said that he had thought ‘she was going to die’, and that they’re so glad that she got to the clinic supported by Target TB and received the treatment she so desperately needed.’

Nikki Jeffery

Director of Target TB

Nikki, Target TB's Director, looking very happy with Mike Wooldridge after recording our BBC Radio 4 Appeal!

Back in January this year we were chosen to be one of the charities featured each Sunday on BBC Radio 4′ s Charity Appeal  - a broadcast that has been going on in some shape or form since 1928, raising millions upon millions for lesser known good-causes in the UK. What an achievement. We know and appreciate an opportunity when we see it, so we have been working hard ever since.

This is our big chance to talk to many thousands of people about the global TB crisis and, crucially, make them care enough to take action. Will you tune in to hear us? I hope so! We are on at 7.55am on Sunday 11th September, again at 9.26pm and on Thursday 15th September at 3.27pm. It will be on Iplayer all next week to Saturday 18th.

Along with Target TB’s Director, Nikki,  I went along to the recording of our appeal at Broadcasting House in London. What a wonderful morning! We’ve been lucky enough to get the much respected BBC World Affairs Correspondent Mike Wooldridge, to deliver our appeal. It was a little nerve racking to hand over our script to such a professional broadcaster, who has been crafting compelling news stories for over 30 years! But he could not have been more helpful and passionate about getting it right for us.

I loved sitting in the studio, finalising the script with Mike, Nikki and the lovely Radio 4 Appeal Producer Sally Flatman (and Dave – recording it all for us!). When Nikki and I heard Mike read the script and truly bring it to life for the first time, it was a tingling moment that we will remember.

Everyone at Target TB cares deeply about the people we help to surive the disease in some of the poorest parts of the world. To hear Mike talk about how we helped Margaret Banda not only to survive but to thrive, becoming strong and well enough to care again for her six children, was important and memorable to us.

I so hope it moves listeners to care, to donate to make our work possible and to get in touch with Target TB .  After all, Tuberculosis is compeletely preventable and curable.  I have been here at Target TB for nearly two years and that single fact still makes be burn with the injustice of it – no one should suffer or die from TB, just because they are living in poverty.

We  really can’t thank Sally and everyone at the BBC Radio 4 Appeal enough for helping us tell the facts to more people!

Check back here to see how the appeal helps us or take a look at www.targettb.org.uk for updates. Listen online after 7.55am on Sunday at www.bbc.co.uk/radio4/appeal

Lynn Stevens

Fundraising Manager at Target TB 01273827070

TB is a disease of poverty. Lack of access to safe and clean water is a huge factor in the lives in thousands of people we reach in Africa and Asia.

Helping people living in poverty in the developing world means being involved and mindful of every aspect of their lives, not just the focus of your own particular cause. When people are ill with TB but still need to make a huge effort just to get clean water, it affects their recovery. When getting water for your family is a priority every day, it can affect you being mindful of sticking to your treatment for months on end. If your chidlren are sick because of dirty water, they are wekeaned and TB is such an opportunistic disease.

We are glad to be part of the huge international effort to help people living in poverty – only working together can we make a real difference.

Near the end of this eye opening trip I joined our partners on the ground in Kampala, the International Medical Foundation, as they went into school to talk about TB with children. After the general hilarity of me being in the school (a Mzungu!) the whole school turned their attention to TB.

Ruth is the lead social worker for our TB project and heads up a team of nearly 200 volunteers – a big job.  And an important one. This team delivers preventative health education during the school day – a captive audience of children who not only learn about TB themselves but take those important messages home to their families.

Ruth was in her element, busting myths about TB with nearly 100 kids aged between 12-16. This school in central Kamapala is provided for particularly vulnerable children from the surrounding slum area, who are of course more likely to be affected by TB because of their living conditions.

Question and answer, laughter, role play, posters, leaflets, competions – for over an hour Ruth and her team made learning engaging and memorable. This wasn’t the first visit, and I was impressed with how much the children already knew about TB symptoms – though the eager hand that went up and declared ‘red lips’ caused a ripple of laughter!

This time round, they focussed on how TB was transmitted and Ruth made sure to dispel some common myths like TB being passed on through sharing cups and cutlery. Many people are ostracized in their own families, and are not even allowed to share meal times, leaving them even more lonely and depressed with their illness – so this kind of education is not only vital for halting the spread of TB but also to help those who have it to recover with support and care from their loved ones.

Getting this proper understanding of TB embedded in young children will help to limit TB long into the future. For now, they are enjoying their monthly chance to talk, laugh and learn with Ruth.

One of the best moments of this trip has been meeting Ronald – he’s 17 and has TB, he lives in the slum.

Target TB’s Director Nikki met him in April, and listened to his story – how he was bedridden in his one room home that he shares with 9 family members until one of our Community TB Carers found him. She helped him to get tested for TB and to get treated – he was a couple of months into his treatment then and feeling a bit better but he wasn’t back at school. He’d missed months of schooling.

He’d been scared when he had TB because his neighbour told him wrongly that he would die – this isn’t true. People can be treated and cured of TB, as our projects prove everyday! It’s been interesting on this trip to hear how one of the first things the TB volunteers do is to allay fears and give people the right information.

We told Ronald’s story to many of our supporters and they were moved to support Target TB and its work in Africa and India. So for me, to be able to meet Ronald and see how he is doing now was great pleasure.

And how is he doing? Well, he’s back at school and very pleased to be there! He has been well enough to go to school for nearly 2 months. He walks there every day – its about 30 minutes each way outside of the slum. His family has to pay for his school uniform.

Ronald is still taking his treatment – he has to do so for another 4 months but he is getting the help he needs. He is gaining weight again and looking well.

It is fantastic news that Ronald is getting better. However, I can’t lie and say that everything is wonderful for Ronald and his family. As you have seen, day to day life in the slum is hard and it is certainly so for this family. His mother has lost 5 children to illness. She is grateful that Ronald is still with her and we are grateful to our supporters on their behalf.

Lynn, Fundraising Manager at Target TB

Imagine living in Namuwongo. Firstly, you are living under constant threat of evacuation. The slum has been around for nearly 50 years but is effectively on Government land, trapped between a wetland and disused rail track, on the edge of Kampala city. You are living in a small, one room, maybe with a crumbling concrete floor, or compacted earth, and the walls may be bits of wood, old advertising signs, aluminium or even mud and straw.

But you don’t even own this room – its squalid, though you are trying to make it homely with blankets and benches, yet you are paying rent to live there. People in the slums are paying rent to people who don’t live in Namuwongo, and given that the land is owned by Government, to people who don’t have any rights to the land at all. But you have to – else they will move you out. Another risk.

And you are likely to be living in that room with many other people, your family, even extended family. There certainly aren’t beds for everyone, so you may be sleeping on the floor. In the slum, there are countless other homes just like this, crowded into narrowing lanes that is a maze to those from outside. They truly are countless, there has never been a census of the community, estimated at about 10, 000 people. The Government have no idea how many people are living in Namuwongo and what services they need.

If its rains, your floor may be flooded, sometimes even washing that room away. And the water comes from the Nakivubo Waterway, effectively an open sewer for the city. Less than 10% of the two million residents of Kampala have toilets connected to the sewer line so waste often ends up in this waterway. When it floods, it floods Namuwongo, bringing with it the risk of cholera and other waterborne diseases. Many have died of all kinds of fevers.

Turning to water –the most basic of things yet that’s difficult too. Of course you don’t have access to water in your own home, for drinking, for washing yourself or your clothes. You have to go the well and collect water in a jerry can – you will probably send your children, so they are struggling back with heavy water cans. Or, you are paying someone else in the slum to carry water to you – when you have little enough money as it is for food. Its precious – so you aren’t going to waste it washing your hands.

Your streets are crisscrossed by water channels, carrying dirty water, unsafe for drinking and useless for washing. But your kids are splashing around in it in the hot afternoon – as kids do. They get sick often and miss school. There is a very real risk they may die – your neighbour has had 12 children and 5 of them have died of ‘fevers’.

And why is the water dirty and unsafe? Well, on top of all this struggle, the ultimate indignity is that not only do you have to share one ramshackle latrine with hundreds of other people – but you have to pay for the privilege. Yes, you have to give 100 Ugandan shillings every time you, or any one of your six children want to use the toilet. But you only have 200 shillings to make last a whole day, including food. What are you going to do? Paying to use the toilet has to come last. So the children never use the toilet and go in the bush or the street – ending up in the water channels. You yourself may even use a plastic bag in your home and get rid of it later, somewhere else in the slum. Things never get better.

Imagine all this. Now imagine you are sick with TB.

I’m going back to Namuwongo later today and in this context, I’ll meet many people whose lives were already hard and then they got sick. I want to find out how our TB work helps in circumstances like this – and tell you all about it.

This is a visit of many firsts – first time in Uganda certainly, but also my first time even meeting someone with TB, seeing the TB bacterium under a microscope, and eating a Rolex…I’ll explain.

So, we are visiting our partner in Uganda, the International Medical Foundation in Kampala. Stepping off the plane into the heat we are relieved to see a large sign saying ‘Morris and Lynn’, and behind it the smiling face of Joseph, who whisks us into the city and to the hospital where IMF is based.

With Target TB’s support, IMF deliver a free TB clinic for a slum dwelling community called Namuwongo. They also deliver life saving health education in the slum about preventing TB and train people living in the slum to support their neighbours who have TB through 8 long months of treatment. We know it works but its exciting to see it in action with my own eyes.

At the hospital base, I get to meet Bosco – with his team, he runs the tests to diagnose TB in people who come to the free clinic. I finally get to look through a microscope at the TB bacteria for the first time. Its strange to finally ‘meet TB’ as it were – truly microscopic yet the cause of so much suffering.

I’ll admit to being a bit nervous about going into the slum for the first time, I don’t know what to expect. Luckily, I’m with Morris, my colleague from the UK, and even more luckily, Deborah the TB Nurse from Kampala  – without her we would be lost in the warren of passageways and a pressing mass of people and activity. That’s what strikes me first – everything is bustle and enterprise. Everyone is selling something in an effort to get by – casava, charcoal, beer, haircuts, all on the narrow streets and outside their homes made of whatever materials they can put to good use.

Namuwongo deserves its own post, to follow. The picture is of a couple of lively kids we met, playing outside their family home.

In the meantime, eating a Rolex? That is true – the nickname for a tasty chapatti wrapped around a fresh omelette – delicious Ugandan street food!

Lynn, Fundraising Manager at Target TB