Fiona to move HC as 1st autopsy doc now cries murder

Preetu Nair | TNN

Preetu Nair | TNNPanaji: As theories of a drug and sex ring contributing to the death of
British teen Scarlette Keeling gained ground, the Goa police on
Wednesday went back on their first assumption of death due to drowning
and promised a fresh probe.
North Goa SP Bosco George said: “We are
connecting the missing links to solve the case. We will be basing our
final report on the second autopsy report.” Doctors conducted the
second autopsy on Tuesday evening.
Keeling’s mother Fiona McKeown
had refused to take back the body of the 15-year-old, found dead on the
Anjuna beach on February 18, if the government did not conduct a second
autopsy. With the case receiving national attention, CM Digambar Kamat
promised to personally look into the matter.
Scarlette used to be
seen around Anjuna with a duo believed to be linked to the thriving
drugs network. Local people say she was introduced to drugs by the
local dealers and once she got hooked, they forced her to pay in kind
for her daily fix.
Investigations reveal that just like Scarlette,
European girls from working class backgrounds are often lured into the
world of drugs in coastal Goa. The modus operandi is to befriend minor
girls from poor European homes at trance parties and introduce them to
drugs. They pretend to be a friend, who provide food, shelter and
money, and the drugs. Once hooked, the girls are not only sexually
abused but used for “outsourcing” synthetic drugs abroad.
“Drugs
like LSD, cocaine, MDMA and ecstasy are expensive and these girls don’t
have money to pay. Once they are addicted, they are willing to do
anything,” informed a rave party organizer in Anjuna. At present, one
gram of MDMA has a street value here at Rs 2,500, cocaine costs nearly
Rs 4,500, ecstasy tablets cost Rs 800 and LSD sells for Rs 400.

Drug abuse is so high that tourists have often been hospitalized due to
overdose or consumption of adulterated drugs. Some lose their lives,
like Japanese Urano Asaki and Keigo Yashiki, who died of drug abuse
last Monday. “In the last tourist season, we treated 37 foreigners who
collapsed due to overdose or contaminated drugs. This year the figure
has already touched 53,” said Dr Jawaharlal Henriques, who runs a drug
rehabilitation centre in Anjuna.

However, Home Minister Ravi
Naik stated that there is hardly any drug abuse in Goa and everything
is under control. “We have a special Anti Narcotic Cell which looks
into this issue and everything is under control. I don’t even know from
where Scarlette used to get the drugs,” added Naik.

March 6, 2008 , The Times of India , Times Nation, Page 15

Mum won’t take back girl’s bodyCalling It Murder, Demands 2nd Autopsy On Brit Teen Found Dead In Goa
Preetu Nair | TNN

Panjim:
A disheartened Fiona McKeown, whose minor daughter was found dead under
mysterious circumstances at the Anjuna beach in North Goa, has refused
to take her teenage daughter’s body home to Devon, UK, till the police
conduct a second autopsy. “I am absolutely convinced of foul play in my
daughter Scarlette Keeling’s death and want the police to conduct a
second autopsy. I suspect that my daughter was sexually abused and
assaulted,” said Fiona.
Her suspicions are not baseless as even the
autopsy report submitted by the police surgeon states that 15-year-old
Scarlette had abrasions on the forehead and eyelids and bruises on both
shins which were made with a blunt cousative weapon.
North Goa
superintendent of police Bosco George confirmed that he had received
the letter and said that he would request a second autopsy. “Meanwhile,
we are making arrangements to send the girl’s viscera and smear stride
and swabs for forensic tests at the forensic laboratory in Delhi,” he
said.
Though the Goa police at first dismissed the British girl’s
demise as death due to drowning, they are now examining if her death
was homicidal or accidental. “Within two days, we will give a report on
whether her death was homicidal or accidental. At present, we are
checking on the people who were last seen with the girl,” said SP
George.
According to the police, 15-yearold Scarlette was last seen
at Lui Café in Govekarwado, Anjuna, in the company of two men—a popular
restaurateur and a runner (local drug supplier), both from Anjuna, who
were known to her. A waiter at Lui Café confirmed this. “Scarlette was
at the café with two locals till about 4 am on February 18. She was in
an inebriated state and couldn’t even stand straight. Once we closed
the café at 4 am, she left with the two men,” the waiter revealed. At
7.15 in the morning, the police found her semi-naked body floating
along the Anjuna beach near Lui Café.
Locals who knew Scarlette
find it difficult to believe that she died due to drowning. “Her family
members are good swimmers and she wouldn’t have gone into the sea at
night, knowing very well the risks of swimming in a rocky area at
night,” said Richard Pereira, a local shack owner.
Even as the
locals described the girl as a friendly, warm person, they alleged that
there was a darker side to her personality. “She was heavily into
drugs. She used to pay for the drugs in kind as she had no cash,” a
local beach boy revealed. The mother admitted that Scarlette would
frequently experiment with charas, but she had never purchased it. “She
never had much money and always smoked charas in a group,” the mother
said.
Police officials investigating the case said that the family
had arrived in Goa on November 22 last year and was regularly seen at a
shack named Curlie’s in Dando, Anjuna, which is owned by Anjuna
sarpanch Edwin Nunes aka Curlie. “She was friendly with Curlie and his
friends Roy and Julio and would go as an escort with customers for the
dolphin and crocodile trips that Roy and Julio organised. But she was
never paid for the job,” the mother said.
However, Curlie denies
personally knowing the girl and her family. Interestingly, there are
complaints of alleged illegal activities at Curlie’s which Mapusa
police are investigating. “We are keeping a watch on all activities at
Curlie’s,” said the DSP of Mapusa, Subhash Goltekar.
The Goa State
Commission for Children, shocked at the turn of events, has decided to
take up the matter with the state government. “We are studying the
matter and we will follow up with the police and the state government,”
said Chairperson Uday Ballikar.


The Times of India, March 4, 2008,Times Nation Page 13

NGO spits fire at Goa State Aids Control SocietyBy Preetu Nair

PANJIM:
An NGO, working with people living with HIV/AIDS, has alleged that
people living with HIV/ AIDS are feeling discriminated, as very little
budget is provided to the drop-in-coping centres (DIC) for people
living with HIV/AIDS, even as the money is being wasted in printing
“unnecessary” materials.

Demanding the removal of the present
Project Director and two Deputy Directors of Goa State AIDS Control
Society (GSACS), accusing them of corruption, the NGO -- Positive Lives
Foundation (PLF- Goa) — in a press conference stated that they would
submit their charter of demands to the government soon. “If the
government fails to take action within a month, then we would sit on an
indefinite hunger strike,” threatened Jaffer Inamdar, Program Manager,
PLF.

Incidentally, things went sour between GSACS and PLF, when
PLF was allotted only Rs 5 lakh for the year 2007-08, to run their DIC,
a centre where people living with HIV/AIDS gets together. A fact not
denied by Inamdar. “We need to receive more funds to help people living
with HIV/AIDS, who have greater needs. They need to have access to
medicines, nutritional food, educational material to understand
HIV/AIDS better, economic and moral support as they are fighting a life
threatening illness,” said Inamdar.

Besides, they have demanded
that the state government should make allocation of funds for a new CD4
count machine at South Goa, issue a discount "Traveling Identity Cards"
to all individual without disclosing their identities, ensure free of
cost medicines for management of opportunistic infections (OI) to avail
at all talukas and ensure women's empowerment program and nutritional
and supplement for HIV positive women and children.

Squarely
blaming GSACS for its lack of commitment towards people living with
HIV/AIDS, Inamdar alleged that there is only Anti-Retroviral Therapy
(ART) centre at Goa Medical College which doesn’t have adequate sitting
arrangement or drinking water facility. “Doctors in the OPD’s at GMC
are rude with a positive person and don’t treat them properly,” added
Inamdar.

FUNDS allocated as per NACO norms:Dr Kaur

Speaking
to GT, an apparently shocked Dr Dilraj Kaur, Director, GSACS refuted
all charges made by PLF. She stated, “We are doing whatever is possible
for people living with HIV/AIDS. We have to spend money as per National
AIDS Control Organization’s (NACO) guidelines. Funds to be allocated
component wise, either to NGOs or to DIC, are first allocated by NACO
and re-appropriation between components is not permissible as per NACO
guidelines”.

She stated that whatever funds have been allocated
have been strictly in adherence to the guidelines and instructions
issued by NACO. “At the highest level, the policy makers have allocated
more funds for prevention of new HIV infections and spread of awareness
(that is through IEC related activities). The allocation of funds for
care, support and treatment are calculated based on the number of
people infected with HIV and living with AIDS and accordingly the
figures are disbursed to GSACS for further allocation of funds to the
DIC. It is understandable that since the number of people not infected
with HIV is much more than those infected, it is logical that the
prevention effort and funds put in to ensure that new infections are
prevented, would definitely be much more.”

Making it clear that
she understands the problems of people living with HIV/AIDS, Dr Kaur
said that she was the only Project Director to visit the DIC programme
run by PLF and interact with HIV positive persons. “We have always
taken up the issue of HIV positive persons and worked to find a
solution to their woes,” added Dr Kaur.
Sources at GSACS reveal that
as per the annual action plan approved by NACO for the year 2007-08,
Goa would get Rs 569.91 lakhs. Of this, Rs 315.09 lakhs would be spent
to prevent new infection and only Rs 10.66 lakhs would be spend on
care, support and treatment. NACO has allotted Rs 10.66 lakhs to run
the DIC, which is a sub-component of care, support and treatment.

“With
two NGO’s running DIC in Goa , the money is equally divided between
them. The above figure is a ceiling beyond which expenditure shouldn’t
be incurred on any activity,” revealed a source at GSACS. Further,
there is no allocation of fund for more ART centres or purchase of CD4
or CD8 machines.

Sources further reveal that the Project
Director has already taken up the matter of CD 4 count machine with the
Health Minister and a file has already been put up for procurement of
machine from the state government funds.

(This article appeared in Gomantak Times,Panaji edition, Saturday, November 17,2007)

Asmi's marriage to Raja is an indication of a new liberation that's sweeping the women who had so far led a life of prolonged violence and self-destructive behaviour as commercial sex workers. Economically rehabilitated, she is the third woman who has changed the rules and her life, reports PREETU NAIR.


VASCO: Asmi married Raja in a low profile ceremony in a temple in Vasco on Friday. The wedding ceremony was performed, Raja applied sindoor on Asmi's forehead and they took seven pheras, legitimizing their relationship of last 4 years.

Their marriage may have been planned in heaven, but it needed courage and self-belief for the couple to break the shackles of tradition and say "I do" on the big day in their life. With this ceremony, Asmi has broken the age-old cultural taboo that prohibits a "Devdasi" from entering the wedlock.

Asmi was dedicated to Goddess Yellama at the age of 12 and forced into prostitution as a Devadasi in Goa. Devadasi is a religious practice, whereby parents marry a daughter to a deity or a temple. The marriage usually occurs before the girl reaches puberty and requires the girl to become a prostitute. A Devadasi is forbidden to enter into a real marriage.

The mass demolition of cubicles in Baina's unofficial red light area on June 14, 2004, didn't change her situation, but in fact worsened it. With no economic rehabilitation in sight, she was forced to travel to other parts of the state for "business".

The real opportunity to transform her life came when she was economically rehabilitated by ARZ, an NGO working with trafficked victims in Goa, as part of its economic rehabilitation programme. She started working in a fully mechanized laundry unit, "Swift Wash", at Sancoale Industrial estate, which provides employment to 40 trafficked victims like her, mostly from Baina.

While the employment programme made women financially self-sufficient, marriage has given them social acceptance. Asmi is the third woman working at Swift Wash to tie the nuptial knot.

"I am very happy. I feel liberated and hope to inspire other women like me. Its nice to marry the man you love," reveals Asmi. Her act reflects a growing confidence among the women, who were once trafficked into the flesh trade and exploited everyday. Besides being a moment of great emotional and personal satisfaction, it is also a moment of realization for other girls like her: the onus of changing their lives is on them.

However, it wasn't easy for Asmi. Among the many tests she went through was refusal by her "parents" to except the relationship and Raja's initial resistance to commit. Asmi's "parents" were aghast that their daughter had dared to break the social tradition. "We have realized that our love for each other is more important than anything else. Initially, I was reluctant to marry, but now I am happy that I married Asmi," said Raja.

Seeing women resettled and doing well is the most rewarding part for Arun Pandey, Director, ARZ. "Economic rehabilitation has empowered trafficked victims who no more want to be in a relationship that is exploitative. They are increasingly emphasizing on marriage, which not only has legal sanctity but also social acceptance, which helps them in joining the mainstream," says Pandey.

This newfound confidence and inspiration would definitely help the survivors of the country's worst social tradition to pick up the threads of their lives by breaking the socio-economic compulsions.

(Name of the couple changed on request)
(An earlier version of the article appeared in GT Weekender, Panaji edition, 24 June 2007)

No DOT(ted) lines for them…

Not just homes, but hopes were razed on June 14, 2004. Further pushed into a life of poverty, added with their high risk behaviour, have made commercial sex workers fall easy prey to TB and HIV. PREETU NAIR walks through the narrow lanes of Baina to understand the extent of the problem.When earthmovers and bulldozers tore through, brutally and indiscriminately obliterating Shenaz's home in Baina in the western state of Goa, India on June 14, 2004, she didn't breakdown. She didn't cry even when she had to push her minor daughter into commercial sex work to pay the house rent. After all, she had learnt to tackle poverty and live with the little opportunities and choices that life bestowed on her.

Now, Shenaz is in total despair. She finds herself in a vicious circle of stigma, economic hardship and discrimination, aggravated by the fact that she was detected with TB in February. "Life has changed for me. I have lost weight, feel weak and easily tired," said Shenaz. Being detected with TB and put on DOTS was just the beginning of her woes.

Recalling the happenings of the past few months, Shenaz said that she was asked to take medicines for six months from the local STD clinic at Baina. "I got medicines for a week. Later, when I went to the clinic, I was insulted and denied medicines because there was no doctor or nurse on duty. This went on for more than a week and my condition deteriorated and I had to be hospitalised," she revealed.Shehnaz's first time to the STD clinic was a bitter experience. She says, "I am going to the STD clinic because I get medicines free of cost."

Policy makers claim that the DOTS strategy is based on the availability of free, quality anti-TB drugs for all actively infected patients through the public health network, the reality is quite different. People like Shehnaz are denied easy access to treatment because they belong to a stigmatised group in Baina.

However, officials at the Goa State Tuberculosis Control Society (GSTCS) blame the failing primary health system and shortage of doctors in the health centres for such goof-ups. "At present, there is no doctor at the Baina STD clinic. We are trying to cover up for it with the help of auxiliary workers and they are doing good work, but there is an obvious lack of doctor, which shows," explained Dr VR Muralidharan, District TB Officer, North Goa.

However, Shenaz doesn't understand these arguments. All she knows is that her health deteriorated because she, a single breadwinner, didn't get medicines on time. "It is really difficult times for us. Each time I have fought to rebuild my life. Now I am tired," she added.

OUT OF REACH
Dr Maryam Shahmanesh, Clinical Research Fellow and Clinical epidemiologist for EFA, University College London, reveals that their studies have shown that the forced eviction of Baina has made the women much more mobile than before. "If they had TB it would have been very difficult for them to access DOT services and even more difficult for services and NGOs to find them. An additional factor is that the demolition led to a further erosion of the women's trust towards both public health services as well as NGOs for the Baina women felt let down by these services/agencies," she said.

Although there are no accurate estimates of TB in Baina, Dr Maryam believes that given the high prevalence of HIV amongst the Baina "sex workers" and the higher vulnerability to TB and HIV, it is very likely that the prevalence of TB in the women of Baina would have been much higher than the general population.

Arun Pandey, Director, ARZ, an NGO working with trafficked victims in Baina admits that many women in Baina didn't get the benefits of the Revised National Tuberculosis Control Programme because it started in Goa in September 2004, a few months after the Baina demolition. "Now it is also difficult for NGO's to have access to TB patients, as the trafficked victims have spread around. Their behavioural pattern, fear of discrimination and stigma make it difficult for them to come for treatment," said Arun.

NO DATE WITH DOTS
When a physically weak Rupa was taken for a sputum test at the Cottage hospital at Chicalim, she was sent to the TB hospital at Margao. At the TB hospital, she was tested sputum positive. The doctor advised her to be admitted for monitoring. However, the condition placed on her was: She should arrange for someone to stay with her at the hospital.
"Often patients are dumped at the TB hospital for months together because no one is ready to take them back home due to stigma. We wanted to fix responsibility and therefore we insist that someone should accompany the patient to the TB hospital and stay with them. This ensures family support and takes care of patient's needs besides the nursing part," added Dr Muralidharan.
"As no one was ready to stay with me, I made an excuse that my little child was alone at home and as there is no one to look after him, I would prefer to stay at home," she said. The doctors agreed and put her on DOTS. A month later, she went on a date (that's outstation trips for a period of 10 or 15 days for commercial sex work) during which she stopped the treatment. Now back in Goa, she is admitted in the TB hospital, struggling hard to survive.

"When you have the strong medicines to cure TB you need to have nutritious food and vitamin supplements. For this, they have to prostitute and to prostitute they drink alcohol. Alcoholism added with the kind of job they indulge in, ensures that they have no discipline in life. Further they are stressed out, depressed and have suicidal tendencies as they have no expectation from life, so it is difficult to convince them to continue with the medicines", observed Pandey.

Officials at GSTCS admit that dropouts are high amongst these vulnerable sections. "Sometimes they don't reveal their proper address. Neither do they inform us when they go out of station. This is the case with many here. Stopping the medicines abruptly and re-starting has resulted in many cases of drug resistance in Baina," admitted Dr Bidan Das, State TB Officer, GSTCS.

HIV V/S TB
In a late night raid at Baina on July 24, 2006, Laxmi was rescued and produced by the police before the Mormugao Deputy Collector and SDM, who remanded her to protective custody. The next day, the SDM ordered the police to take her to GMC for medical examination, which was delayed.
On July 27, the SDM learned from an NGO that Laxmi was receiving DOTS treatment and she had missed the medicines because she was sent to the State Protective Home at Merces, and immediately passed an order stating that Laxmi be allowed to take any medical treatment. Few days later, the in-charge of Protective Home wrote to the SDM stating that Laxmi has revealed that she has TB and HIV and is bleeding, which is risky for others and there is no medical staff to give her medicines nor any vehicle to transport her to the hospital in case of an emergency.

"With this case I was put in a peculiar situation. Immediate medical check-up is essential under section 15 (5)(A) of ITPA and I had asked for her to be sent for medical check-up. Had we got the reports on time, there wouldn't have been any problem. Further, I was in a fix once the State Protective Home in-charge expressed their inability to keep her and so I had to seek the help of an NGO ASRO," stated SDM Levinson Martins.

Despite the HIV pandemic presenting a massive challenge to the control of TB at all levels, there is no joint effort between various agencies to decrease the burden of TB and HIV especially amongst the vulnerable section and ensure timely treatment. At the moment, the only joint effort in Goa is between Goa State AIDS Control Society and GSTCS, but their role is also very limited.

(Few names have been changed to protect the identities of the individuals)
The article appeared in Gomantak Times, Panjim Edition dated April 13, 2007This article is written with the support of PANOS STOP Media Fellowship

A youth in Sattari in the Western State of Goa, India believes that TB kills and is not curable. In a remote village in Sanguem, an Anganwadi worker has no access to patients, due to the fear that she may spread the news that they have TB in the village. Anil Sawant stopped the magic pills because he had to travel 25 kms to the health centre for his medicines. These are some of the scary cases that plague the inner areas of the state. PREETU NAIR walks into the heart of Goa, into a different world. For the people living there, TB is not just a public health problem, but a social stigma .

TB kills. We don't even drink water from a house if there is a TB patient living there. What if I get TB after drinking the water?" asked Shidhu Varak, an 18-year-old literate youth from Dhangarwada, Poriem in Sattari. His friend, Dilip Gaonkar from Gholwada, Poriem added, "We don't even get married into a family if we know that anyone in the family had TB. It is a contagious disease and no medicine can ever cure it."

On the other hand, Nago Bhavdan from Corla Moti in Quepem has never heard of TB. His son, a student of standard IX has read about infectious TB and strongly believes that it is incurable. Believe it or not, TB still continues to be a dreaded, incurable disease caused due to a curse or sin in rural Goa. "

TB is not just a public health problem. It is a social problem and the patient is stigmatised and isolated in society. The failure of the health authorities to create awareness about the advances in treatment of TB has added to the woes," said Rajendra Kerkar, a school teacher and grassroots worker in Sattari taluka.

Despite social mobilisation, the TB control programme has not been able to break the myth that TB is contagious nor has been able to spread the message that there are other forms of TB besides pulmonary TB. They have yet to work to improve access to DOTS services in remote areas and overcome stigma of TB and discrimination against TB patients.

"TB is a dirty secret everyone wants to hide. In my village, three men died of TB in the last two years. They didn't take regular medicines and drank alcohol. Whenever I used to go to advise them, they would insult me and ask me who it was that told me that they have TB," revealed an anganwadi worker from a remote village in Sanguem taluka. Under the Revised National Tuberculosis Control Programme (RNTCP), modes of observation in villages are often Anganwadi workers who have no access to TB patients, due to the fear that she may spread the news that they have TB in the village and they will be stigmatised.

Further, talking on the condition that she is not quoted, she said, "Most of the people in and around the mining areas have symptoms of pulmonary TB. But they don't go for treatment as they believe that TB is not curable."

"The effort to stop the spread of TB and to ensure a TB free world is curbed by social stigma attached to the disease," admits Dr Bidan Das, State TB Officer, GSTCS. Even Dr Arvind Salelkar, Director of Health Services admits that the effort of changing the mindset of all persons concerned with TB has been a daunting task but yet intensive IEC efforts, training and retraining of staff we have taken a giant leap forward in tackling TB as its very roots.

But official facts are different from field reality. Even as officials at the Goa State Tuberculosis Control Society (GSTCS) demonstrate that DOTS is having its impact and excellent progress has been made with DOTS with case detection and treatment success rates, people in the remote villages in Goa live without easy access to the magic pills.

Anil Sawant was put on DOTS in 2005. Directly Observed Treatment Short-course (DOTS) is an effective strategy for curing TB, which involves monitoring a patient for six months. The monitoring is crucial because failure to complete the drug treatment can lead to multi-drug resistant TB, which is extremely difficult to cure.

But within three months he stopped the treatment. Reason? "I was feeling better and I couldn't leave my shop and travel every alternate day to go to Hospicio Hospital, Margao, which is 25 kms away from my village for medicines," said Anil Sawant, who runs a tea stall in Dadolem, Sanguem taluka. Recollecting the days of ordeal he says, "I would leave at 6.45 am by bus and return at around 1 pm. This affected my business."

Even his 60-plus mother is suffering from infectious pulmonary TB, but she refuses to go to Margao every alternate day for medicines, which is given free of cost. "She is week but she feels weaker after the travel and therefore has stopped the medicines midway," he added.

Despite World Health Organisation's clear regional strategic plan (2000-2015) to sustain and enhance DOTS to reach all TB patients, improve case detection and ensure treatment success, the patients continue to drop-out of DOTS and nobody no filed visitor visits them to facilitate defaulter retrieval. If the so-called "success" of (RNTCP) is due to its directly observed treatment, then in rural Goa, the directly observed treatment has led to incidents of drop-outs as patients find it difficult to travel miles for treatment.

Worse still is the fact that with the primary health centres and sub-health centres failing to meet the need the health care needs of individuals and families in the community, people are forced to travel long distances to go to the district hospital. ""Earlier we used to go to the Community Health Centre at Savordem, which is 26 kms away from our village. But it doesn't have doctors and adequate equipments. We are made to wait for long hours, only to be sent back without treatment. Due to this we prefer to go to a private doctor," revealed Satyavan Dessai from Sulcorna in Quepem taluka.

Dr Debabar Banerji, Professor Emeritus, Centre of Social Medicine and Community Health, JNU believes that the problem with RNTCP is that it is not being implemented not being fully implemented. "RNTCP is responsible to create a condition wherein the patients take the pills regularly.

Unless RNTCP ensures that person as a whole is dealt with, it has no meaning," he said. Dr Banerji further added, "There is a group of TB patients who are harassed by poverty and alcoholism. For them TB is a minor problem. The solution lies in solving the major problems of life along with treating TB".

No wonder despite claims of intensification of supervision and monitoring, rigorous record keeping and thorough follow-ups, people like the Sawant's continue to drop-out of the treatment midway.

Free pills, but no food

She doesn't have food to eat but gets the magic pill free of cost. Jani Singadi's was put on DOTS when she was tested sputum positive in January 2006. But the moment, 65-year-old Jani started treatment she felt weaker and had severe stomach ache. Added to that were the multi-layered crisis within the family: three orthopaedically disabled sons, surplus of hunger, no money, an illegal house gifted by a few philanthropists, rising debt, etc.

Unable to deal with the increasing health problems and with no one to take her to the sub-health centre, which is 2 km away at Nanoda, Bicholim, she stopped taking pills for a month. "I couldn't go because I was feeling weak. No field officer ever came to visit me. I started medicines again after sometime when I became seriously ill," she accepts candidly. Now after a year, she is again tested sputum positive at Goa Medical College.

This despite Dr VR Muralidharan, District TB Officer, North Goa claims that we have default retrieval action to retrieve the patient back on track to take medicines. "Our success rate in retrieving patients is very high," he added.

NO TIME FOR HEALTH

For the last three months, Shanti Shetikar has been feeling week. She has had consistent cough since last two months and has lost lot of weight-all symptoms of pulmonary TB. She went to the nearest sub-health centre at Kevona were the doctor gave her iron tablets. But all this has not helped. She has not bothered to go back to the sub-health centre.

"The doctor only comes once a week and that too for an hour. So it's really difficult to meet him. Moreover, we are very poor and no one looks at us in the government hospital. We are made to wait for long hours and then sometimes send back without check-up due to lack of facility. Because of this we prefer to go to a private doctor," she reveals.

So she went to a quack in the village who gave her six vitamin injections stating that she was feeling weak because she was vitamin deficient. However, it has not helped. For long she has been planning to go to for a proper medical check-up at the government hospital in Margao, which is nearly 30 kms away from her mining village in Quinamol, Sanguem, but she has not got time.

"What can I do? Everyday I have to go to the market to sell vegetables. The day I don't go, there is no money at home to feed to two hungry kids," she reveals. Shanti cultivates vegetables and sells them in the market to earn a living.

No tea in TB!

Vithal Parwadkar, who runs a tea stall in at Assnora, Bardez taluka, dilemma is strange. Few villagers have raised objections to him serving tea to "known" TB patients. "People tell me, 'He has TB and you are serving him tea in your stall. We don't want to have tea in the same glass, get us a new set of glasses'," he added.

Strange enough, people are so scared of TB that they have isolated one family in the village because the head of the family died of TB and the rest of the family members are frail and constantly coughing. Vithal reveals that the elder daughter had to be married off to a widower, as no one was ready to marry into the family. GT tried to meet the family, but in vain.



TB kills 1 person every minute in India

-- In Goa, more than 1 person die of TB every month.

- Goa has a high prevalence of tuberculosis as compared to other states

- Annual risk of TB infection is 1.5 % in rest of India, while in the Western region, especially Goa, the risk of TB infection is 1. 9 %

- 20 lakh people in Goa are at present suffering from pulmonary TB, of which nearly 5000 are infectious.

- An average 2,100 new TB cases are detected every year, of which 50 per cent are sputum positive.


The article appeared in Gomantak Times, Panjim Edition dated April 20, 2007This article is written with the support of PANOS STOP Media Fellowship

Tuberculosis (TB) kills 1 person every minute in India. In Goa, TB kills 15 people who undergo TB treatment every year. But, no one knows how many people actually live and die with TB, without making it to the success or failure data of the Revised National Tuberculosis Control Programme (RNTCP) in the state, because they have never had access to treatment, either because of stigma or ignorance. In the first of three-part series on tuberculosis in Goa, PREETU NAIR looks at the impact of TB on the state, so far.

Incidentally, Goa has a high prevalence of tuberculosis as compared to other states. “The annual risk of TB infection is 1.5 per cent in rest of India, while in the Western region, especially Goa, the risk of TB infection is 1. 9 per cent,” revealed Dr VR Muralidharan, District TB Officer, North Goa. Yet, reliable sources in the Health Services department inform that not much attention has been paid by the health authorities to eradicate the disease.

It is estimated that 20 lakh people in Goa are at present suffering from pulmonary TB, of which nearly 5000 are infectious. An average 2,100 new TB cases are detected every year, of which 50 per cent are sputum positive.

“In terms of numbers, the number of sputum cases that are investigated has increased. We are now getting cases from the remote areas even without holding medical camps or door-to-door medical check-ups. This shows that people are becoming more and more aware of the possibility of them having TB,” said Dr Muralidharan. He however added, “The stigma about TB has now come down considerably. It now exists only amongst the migrant or illiterate people.”

Better late than never?

Blame it on administrative failure or lack of political will, but RNTCP was started in Goa on September 13, 2004, nearly 11 years after the programme was launched nationwide. But now, the state government is trying to make up for the delay and has pledged to detect 70 per cent of all infectious TB cases and cure 85 per cent of them by the end of 2007. However, few government doctors are not so optimistic. “Once you start later, its always a question of catching up because its an on-going process and the number of cases keep coming up,” said a doctor, on condition of anonymity. Still worse, the District TB Hospitals are terribly short staffed.

But officials at the Goa State Tuberculosis Control Society (GSTCS) insist that efforts are being made to catch up with lost time and ensure that each and every TB patient gets the required treatment, on time. They are working hard to connect with the villages and communities to sensitise people that TB is no more a dreaded disease and is curable.

Women matter

Though 30-year- old Sunita from Valpoi was literate, her ignorance about TB was immense. She didn’t know that TB is curable and the treatment for TB is absolutely free. Worse still, for her, TB meant a disease in which a person ended up in some sanatorium, rejected and isolated by the family.

To get across the message that TB is curable and treatment is free of cost for women, the “hidden section” of the society, GSTCS has now approached the mahila mandals and women’s self-help groups with the aim to ensure that women have access to adequate and important information.

“Women in rural areas don’t have a dominant voice in the family and due to this, they fear that if detected with TB, they may be isolated or rejected by family members,” explained Dr Muralidharan. Interestingly, now GSTCS has also started sensitising school kids about TB, because they believe that children are the best disseminators of information.
Partnerships

Coming to the nearest health centre for his DOTS treatment everyday, meant that Ramesh from Torda, near Porvorim, would lose his daily wage of Rs 150. To make certain that Ramesh had his daily dose of medicines, GSTCS entered into a tie-up with the private JMJ hospital, to become a Directly Observed Treatment, short course (DOTS) provider. A DOTS provider has to ensure that the patients swallow the medicines under their direct supervision. DOTS prevents the spread of TB bacilli, thus reducing the incidence and prevalence of TB and providing credence to TB control efforts. End result: he is now cured.

With the increasing realisation that a sub-health centre may not be able to reach people at the micro-level and to ensure that the patient doesn’t default, the focus has now shifted to anganwadi workers all the talukas of Goa. Moreover, they have easy access to women and children. Already, 700-800 anganwadi workers have been sensitised in a majority of the talukas.

Panch power!

Imagine, an ambitious panch member as a DOTS provider. Sounds impossible? Well, it is possible in Goa. When 20-year-old Sneha in Cumbarjua was tested sputum positive, she was to be put on DOTS. But Sneha was not interested in going to the nearest health centre for her dose of medicine because she had to work from 7 am to 7 pm to ensure that her elderly parents get a decent meal.

Enter a panch member who became a DOTS provider. He would visit her with the medicines after she returned from work and ensured that she had her treatment. Subhash Gawde, a former panch member at Madkai, agrees that the panch members should involve themselves in such community services as it reduces stigma and ensures that TB patients get timely treatment. “TB is curable and the treatment is absolutely free of cost. So one no more needs to be scared of the disease,” added Gawde, whose come forward to become a DOTS provider from Madkai. Inspired by his response, GSTCS now aims to sensitise and train the panchayat members.

(Some names have been changed to protect identities)
The article appeared in Gomantak Times, Panjim Edition dated April 6, 2007

This article is written with the support of PANOS STOP Media Fellowship

OLD GOA: Fulrani Kinalekar has one ambition. Nearing 18 and excellent with embroidery, she wants to become a fashion designer and design a sari for her favourite actress Preity Zinta. She emphasises that the sari designed by her would have lots of hand embroidery.

Sounds like the typical ambition of a star struck giggly schoolgirl? But coming from Fulrani these words are priceless, probably a small proof of her ambition and determination, which has helped her overcome her disabilities and prove to the world that she is a doer and achiever.

Fulrani’s confidence comes from knowing what she wants to do and trying her best. She has fought with her disability and her circumstances, wept often but never stopped believing in her abilities. She struggled but learnt to achieve rather than sit on the sidelines, watch and complain like many abled children her age do.



No wonder, this girl born disabled into a poor family in Pernem, who spend her childhood in her bed, with hardly any friends now has an offer from her principal to become a teacher in the school. "My principal Sister Monica Coelho has said that if I pass standard XII, then I will be recruited at the pre-primary school level as a teacher. I will work under her guidance for three years," said Fulrani. She will appear for the exams through the National Institute of Open Schooling.

Her job would be to teach kids with different abilities the art she has learnt in the school, in the last 12 years. She had come to the institute at the age of 6 as a grumpy girl, completely dependent on others for her needs. "She didn't know how to take care of herself, but today she is independent," said Sister Monica.

No wonder, for Fulrani, lovingly called Fulu, her school is her haven and her principal her inspiration, who has encouraged independent, thought and convinced her to believe in herself rather than be dismayed by the problems in life. No wonder, she proudly states, “The person whom I love the most is Sister Monica. She is very nice, just like a mother.”

PREETU NAIR
preetu.nair@gmail.com
http://goadourado.sulekha.com/blog/post/2007/03/stitching-towards-a-new-life-phulrani-kinalekar-2.htm

rooj ki tarah aaj bhi zindagi ne muzhse ek waada to kiya par muzhe pata tha ki promises are rearly  kept koi baat nahi mai bhi mently to is baat ke liye ready tha
par aaj nahi to kaal i will makr space for myself that is somtihg i am sure about.


with love
a.k.s.

SAPNE AADMI KO CHALTE REHNE KI PRARANA DETE HAI AAP KABHI PARESHAN BHI HO TO AAP KO APNE SAPNE KI YAAD AATE HI AAP PHIR SE MANZIL KO PANE KE LIYE EK BAAR PHIR TAIYAAR HO JATE HAI. ASE HI SAPNE KE SAAT MAI BHI IS SAHAR ME AAYA HU AUR ROOJ SUBAH ZINDAGI SE SAMZHAUTA KARA HU AUREK HI BAAT SOCHATA HU KI APNI MUFLISI BHI KISI DIN DOOR HOGI TAB TAK TO SAB AISE HI CHALE GA. I LOVE IT OR HATE IT BUT I CAN NOT IGNOR IT. FOR ALL SUCH GUYS FOLLOWS UP UR DREAMS ELSE IS JUST PERRINIAL.

WITH LOVE
AMITESH