Contributor: Alison Christie

Larkana, Sindh Province, Pakistan — It was the eyes that struck me most. Deep, dark, penetrating, yet not wanting to reveal too much. But they could not hide Mrs. Hussna's weariness from battling a debilitating disease.

She was one of many patients I spoke with at the Dokri Diagnostic Clinic. It's one of 13 health centers, spread across two provinces, which participate in a Mercy Corps initiative to stop the spread of tuberculosis, or TB, a bacterial disease spread through the air by infected persons. If not treated properly, it can be fatal.

Pakistan has a higher TB burden than all but five other countries, according to the World Health Organization. Each year, approximately 270,000 people here develop TB. Only 27 percent of the cases are detected, the WHO says.

Even when caught and treated, tuberculosis takes a tremendous toll on family livelihoods. Sufferers, many of whom are young adults, lose three to four months of work and earnings. And because TB is considered a disease of poverty - virtually all TB deaths are in the developing world - it is particularly devastating to development in Pakistan, where more than 20 million people live on less than $1 a day.

So far, Mercy Corps has made headway in combating the disease in Pakistan, helping to open the doors for greater economic and social progress. We have demonstrated the efficiency and effectiveness of using community health workers to deliver medications and observe treatment regimens in patients' homes. And the Government of Pakistan has recognized us as a leading partner in the fight against the disease.

By April 2006, Mercy Corps' TB initiative had treated 4,700 patients; trained 1,000 paramedics, lab technicians, outreach workers and other health care professionals in how to detect and care for TB; and held about 400 "awareness sessions" in schools and villages. The project also has blanketed the region's airwaves to try to raise the public consciousness about TB, broadcasting thousands of public-service messages on radio and television.

Here at the dimly lit Dokri Diagnostic Clinic, patients from 70-year-old Mr. Harwarjio to 8-year-old Samina praised Mercy Corps' free treatment regimen, which is funded by the European Commission. The woman with the striking eyes, Mrs. Hussna, was initially shy and reticent. But she soon opened up and told me about her disease and treatment, and their effect on her and her family.

At 51 kilos, she looked slight and lithe. It was troubling to imagine how gaunt she must have looked five kilos (more than 10 pounds) lighter, which is what she weighed when she was diagnosed last September.

"I was unwell for three months, with backaches and fevers," she told me. "It was difficult to keep working in the tea shop and look after my family. I was tired all the time."

Many patients at the clinic were there because they'd failed to rid themselves of the disease by visiting private doctors. Mrs. Hussna paid a doctor 16,000 rupees — the equivalent of four to five months' salary for her family — to initiate treatment, but says she didn't get the right dosage of drugs over the right period of time, so the symptoms returned.

This is a common problem. Patients start feeling better after only a few weeks on a multi-drug regimen that kills the disease-causing bacteria. But it's important for them to continue treatment for six months or more, until all the bacteria are killed. Not doing so could cause TB to return, sometimes in a form that's resistant to drugs.

For that reason, the WHO treatment protocol for TB calls for "treatment supporters" whose job is to make sure the patient abides by the treatment regimen until they test negative for the disease. In its program, Mercy Corps is trying to improve and institutionalize the treatment-supporter model by forming coalitions of small, grassroots organizations, and asking members of these groups to volunteer as treatment supporters.

"These coalitions represent an innovative approach to controlling TB," says Dr. Arif Noor, medical director for Mercy Corps Pakistan. "It has not been tried here before."

Mrs. Hussna is now the treatment supporter for her husband, who was diagnosed last November. Many former TB sufferers, in fact, become treatment supporters themselves - and all become advocates for the program. They educate their families, neighbors and friends about the symptoms of TB, and urge people to seek treatment if infected.

This growing, community-wide sense of vigilance against TB's spread is perhaps the project's most auspicious sign. Everyone has a stake at curtailing what the Pakistan government in 2001 called a "national emergency," and in making sure this country of 162 million people reaches its social and economic potential.

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