A Scar on the Face of the Earth

“Tuberculosis is a scar on the face of the earth”, says Dr. Shelly Batra, a leading gynecologist in New Delhi, India and the President of Operation Asha - a 501c3 non-profit organization aiming to eradicate tuberculosis from the world.

And a deep scar it is indeed. Every minute, a patient dies of tuberculosis in India. This disease poses medical problems, but poses even more social and economic problems. Lower class Indian societies perceive tuberculosis as disgraceful. Married women are banished from their homes only to be left to live on the streets, where they eventually die of starvation. Many children who have contracted the disease are expelled from their schools. Millions of dollars are lost every year because tuberculosis renders a sizable percentage of the work force unproductive.

It may come as a surprise that tuberculosis is a treatable disease. If this is so, why is it that tuberculosis has not yet been eradicated? The answer lies in the fact that it is a poor man's disease. Not much attention is paid to the realm of the poor, since many believe that tuberculosis doesn’t affect the general population. This is quite contrary to the truth, as tuberculosis is highly contagious. On average, someone infected with tuberculosis spreads the disease to twelve other people by coughing. While the poorer social classes tend to be afflicted with tuberculosis, it is easy for a lower class worker to come into contact with a higher class worker, propagating the disease through the ranks of society.

Even though the Indian government provides free treatments for tuberculosis, the government centers where drugs are distributed are not readily accessible to patients. In addition, associated opportunity costs for receiving the treatments are especially high among poorer classes.

Since most government operated centers are open from 10 am to 1 pm, a patient needs to miss work in order to get treated. After several thoughts about unemployment, many patients choose not to go for this reason. Many who decide to receive treatment stop their course of medicine immediately after they feel better. Missing doses results in MDR (Multi Drug Resistance), which leads to XDR (External Drug Resistance), which is fatal.

Enter Operation ASHA: this organization connects the last mile of the cable by making tuberculosis treatments readily available to poorer classes. The Operation ASHA centers are situated in various communities and make use of preexisting buildings such as places of worship and popular shops. Each center has a treatment provider, who dispenses the tuberculosis medicine under direct supervision. Operation ASHA employs counselors, who belong to the community they serve. Counselors help patients in getting tested by a sputum test, and provide supervised treatment. once diagnosed. Counselors educate the patient and his family about the disease and explain the consequences of missing doses. Operation AHSA has been highly successful in eliminating the problem of missed doses.

 This entire procedure is provided for an amazingly low cost of only $15 per patient. In comparison, other non-governmental organizations spend over $350 per patient. Eighty percent of the funding Operation ASHA receives goes to the salaries of the counselors and drug distributors and twenty percent is devoted to administration and fund raising. What is even more remarkable is that each Operation ASHA center becomes completely self sufficient after 2 years. This is because the Indian government gives a grant of $15 per successfully treated patient. The funding it receives can go toward opening new centers and treating more patients.