( By Radhika Ramasubban, Bhanwar Singh & Nigel Crook )

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Rameshís TB And Bahadurís Fight

How Air Pollution And Congestion Promote Diseases Requiring Long Duration Cures

At the Siddhi Vinayak Textile Mill in Lalbaugh, Bahadur, a young migrant from Nepal, had found a temporary job. Thapa, a neighbour in his village who had come to Bombay some years earlier and who was working here, had fixed up the job for him. Thapa had impressed the factoryís Welfare Officer as a sincere worker and when a vacancy arose the Welfare Officer agreed to give Thapaís man a chance. Thapa was happy to have someone from home around and found Bahadur a place in Pintoís ( another worker in the same mill ) hut in the Sanjay Gandhi Nagar Zhopadpatti Sangh on Senapati Bapat Marg.

Homesick for the village and feeling strange being in a city for the first time in his life, Bahadur was devoted to Thapa, Pinto and the Welfare Officer Joseph George - the only three persons he felt were his well wishers. His childlike ways endeared him to Joseph George who also found in him a willing and intelligent worker.

A few months after he began working in the mill, Bahadur developed a persistent cough. He worried about it. In one of his chats with Joseph George , he confided his worries in him.

"It is only after I cam to Bombay that I developed this nagging cough, " he said. " Now, I donít seem to be able to stop coughing. IN my village they say all ailments are due towater. Perhaps it is the Bombay water which doesnít agree with me. I have tried boiling pudina leaves in water and dry ginger in water but nothing seems to relieve the cough. "

" Cough have nothing to do with water, " replied Joseph George with an amused smile. " Why donít you go and see a doctor ?"

"Going to a doctor for a cough doesnít come easily to me, " laughed Bahadur. " In my village people rarely ever visit a doctor for such ailments, unless they are willing to walk two days to the nearest town. "

It was evening and the Welfare Officer rose to leave. Bahadur went back to the shop floor. A small shaft of the evening sunlight was coming in through the single ventilator high up and in it he could see the hundreds of tiny specks that kept the hot heavy air inside the huge shed permanently hazy.

He talked to Thapa about his cough. " It is not water, perhaps, that is the culprit. But so many of the men are coughing. Pinto, my partner, is greatly bothered by a cough, too. But I seem to worry about my cough more than the others do. Perhaps I Ďll get used to it, like them. "

Pinto, Bahadurís partner, was suffering from TB. He was on a long course of medicines for it. But he went and brought his medicines as and when he felt like it and swallowed them even more irregularly. Recently, when he had gone to his native place in Goa, he had just forgotten all about his medicines.

Bahadur was beginning to understand that there was something serious about his cough with so many people in the factory had. Pinto seemed to be swallowing an awful lot of medicines even if he did it irregularly. He often went into long bouts of coughing which left him breathless and exhausted. And every night he insisted on drinking his favorite Fein which made him cough even more. Bahadur forced him to rest whenever he was home and willingly did the chores around the house. But he lay awake at nights worrying.

Pinto seemed to be getting thinner day by day.

Then one day another worker, Ramesh, doubling up in a coughing bout, suddenly brought out blood. Terrified that he might be dying, Bahadur rushed to call the Welfare Officer.

"Rameshís problem is a very serious one,"said the officer gravely. "Probably an advanced case of untreated TB."

"Canít we take Ramesh to the doctor ?í asked Bahadur. " Please, sir, let us take him to the mill doctor, " he pleaded.

"He is not a permanent worker although he has been working in the factory, off and on, for some years. And the mill cannot take responsibility for his medical problems. He can go to a private doctor if he wishes to. " There was a sharp note in the officerís voice which Bahadur had not heard before.

By now there was a crowd around them. The officer abruptly went back to his cabin. Ramesh, wanting to escape the attention, was feebly hobbing away saying, " I am better now. Bahadur, donít put yourself out for me. You are young and hot blooded and still new to the city. But once you have seen life like I have, a few drops of blood coughed out will become routine. "

" Enough of all this commotion. Get back to work, all of you," the Supervisor called out.

For the next few days Bahadur remained quiet and thoughtful. His happy laugh and friendly jokes were missing. Some of the workers knew what was bothering him. But Ramesh coughing out blood on the shop floor had set everyone thinking.

" Let us go to the Union, " said Bahadur to some others one afternoon as they sat eating their lunch. "Even if some of us temporary workers are not members, let us ask the Union to take up this issue of workers health. But we should also learn something about the diseases which can affect us and not just leave it to the Union. "

Thapa told Bahadur about the Bombay Social Education Society which was running night classes for workers in the BDD Chawls. Thapa had attended them for a while. They hadnít taught anything about health. But he told Bahadur that he might be able to find out from the Society Secretary whose office was in the chawls.

Bahadur went to see the Secretary. It felt new and exciting, going to find out things. So far all he had been doing was feeling homesick and finding comfort in a small social circle. In any case some friendships did not last long, like the one with the Welfare Officer, Joseph George.


Deaths due to TB have been steadily growing in Bombay. IN fact, the annual rate at which TB deaths were increasing in the recent past was faster than the rate of growth of the population of the city. Since TB strikes mainly those who are poor ( and therefore under-nourished ), who live in overcrowded houses and who both live and work in environments where the air is thick with dust, smoke and chemicals, it means that the poor in Bombay die in greater numbers than the rich.

Even among the poor in Bombay, men die of TB more than women. Men tend to be more concentrated in factories / workshops where the air is heavily polluted. TB can also be aggravated by habits like smoking and drinking which men tend to do more than women.

Smoking adds to lung congestion and expenditure on liquor most often means less money for proper food both for the TB sufferer and also for his family. In Bombay the greatest number of TB deaths is in the island city. This is because of the large concentration of chawls and footpath hutments along the big roads with their heavy traffic and vehicular fumes. Also, in many of these chawls there are concentrations of single men whose families are in the village. The reason why poor people live in the island city even in the most difficult housing conditions is because it is easier to find employment there and means less money spent on commuting to work. But they pay the heavy cost of contracting crippling disease and dying early deaths.

While in the cities of Maharashtra men die of TB between the ages of 35-50 years, women die of this disease even younger --- between the ages of 20-35. Often this is because of poor health that women suffer from very young ages, when the fact that they are girls causes them to be discriminated against in the allocation of foods in the household, and early domestic responsibilities and child bearing along with responsibility of earning an income cause further deterioration in their health.

In Bombay, of all the diseases caused by air, water and food, respiratory diseases are responsible for the maximum number of deaths among both men and women.

" I have heard that a persistent cough could be an indication of TB. But I do not know what causes it, " he told the Secretary of the Education Society. " I am a 9th standard pass and was keen to finish school. But my family couldnít afford it. Could you give me some books in Hindi that I could study from ?"

Bahadur spoke earnestly to the other workers about what he had learnt. "WE all live in chawls and hutments ; we cannot do much to get better housing. At least in the factory we have a Union. Shall we put up certain demands through the Union in the interests of our health ?"

With Bahadurís guidance, though he was only a temporary worker, the union laid down the following demands. During the period, the Welfare Officer Joseph George had left to take up another higher paid up job. The new Welfare Officer, fresh from the University , was enthusiastic to find a trade union which was beginning to take workersí health seriously. He had studied about occupational diseases in his text books and arranged for Dr. Patel the ESIS doctor to whom many of the workers went, to come to the factory one evening to talk about TB. Bahadur asked if the Secretary of the Bombay Social Education Society might be invited too. It took a lot of work by Thapa, Bahadur, Pinto and Ramesh to persuade the workers to attend the meeting. This was not something they were used to doing but Ramesh reminded them of the gloom that they had all felt just a few days earlier when he had collapsed on the factory floor. Even Pinto seemed to have become serious.

"Ramesh is a case of advanced untreated TB," explained DR. Patel.

"And Pinto is a case of person who is taking treatment, but carelessly and irregularly, There are many,many like you in Bombay, who suffer from TB. Many are not diagnosed early. Many who are told to begin the treatment never show up again and go to private doctors now and again for temporary cures. By neglecting the problem we are spreading the disease to our wives and children and others around us. All those who breathe in TB germs do not get TB, but whenever they become weak due to not being able to regularly eat sufficient food, the TB germs can begin to multiply in their bodies. "

"Can children also get TB?" asked one of the workers. "Yes, children can get it easily. That is why it is very important to give them the BCG vaccination as soon as they are born. This protects them against TB in the early years. But as children get older, continuously live in overcrowded houses and in the midst of the TB patients the germs can quietly lie in their bodies. Whenever their bodies become very weak due to inadequate food or other illnesses, there is a chance that TB germs might begin to multiply as the bodyís soldiers are too few and too weak to resist, " explained DR. Patel.


TB is caused by a germ that especially affects all those who work in polluted, overcrowded environments and whose living environments are also polluted and overcrowded. But what causes the germs to multiply in the body and cripple it is poor nutrition. A persistent cough is a symptom but what is happening inside the body is that the germs invade the lungs and make it difficult for the person to breathe.

Coughing out blood is an advanced symptom. There are many kinds of TB but the one which affects the lungs is the most common. Many with TB can also suffer from cardiovascular disease so that death can also come about through a heart failure. Heavy manual labour which puts pressure on the chest and lungs along with drinking poor quality alcohol and smoking poor quality tobacco can all combine with malnutrition to cause heart disease related to TB. TB is an infectious disease and we can give it to each other in the factory and to our families at home. Every time we cough, fine droplets which are coughed out spread the germs in the air and every time we spit onto the ground we have the germs about to spread.

The cough is not caused by the water we drink ; but it is related to the dirty and dusty quality of the air that people breathe , especially those who work in particular occupations.

But TB can be cured completely. If detected early and if the medicines are taken regularly.

"Then , does every cough mean TB ? Does it mean that everyone in Bombay has TB because everyone coughs and spits?" spoke up another worker.

There was general laugh.

"No, No ! Only if you cough out blood does it mean you have TB," answered someone else who felt by now that he had understood everything.

" Both of you have got it wrong, " smiled Dr. Patel. "Because of general air pollution, coughs are common in Bombay and acute cough, called bronchitis, is also common. But TB is caused by a very specific germ which multiplies rapidly and kills. Testing of the spit can definitely prove whether one has TB and once you have it, the only way to cure yourself and prevent it spreading from you to others is to take medicines which kill the germs in your body and prevent them from multiplying. "

Pinto suddenly came alive. " But doctor, this treatment is a terrible thing. Who ever can go to a hospital twice a week for one full year just for medicines ? It takes so much time, I get late for work , in the hospital, I have to stand in a long queue and on top of it all they insist that I swallow the medicines there and then. " He looked around at his friends smiling broadly and winking at Bahadur, added " there is a compounded there who allows me to take the medicines home although it is not allowed ! Special for Pinto, you see ! But I never seem to remember when to take what . And once when I was waiting in the hospital they made me pass urine. They said they were gong to test it. And the next time I was shouted at for not having taken the medicines regularly. Are they CIDs or doctors !" "Urine-CIDs," bellowed out another worker. Everybody laughed. "What Pinto is doing is dangerous both to himself and to others, " said DR. Patel gravely. The laughter and jokes were still going on and Bahadur asked everyone to be quiet. "What Pinto is doing by his irregular treatment is to make the TB germs in his body resistant to the medicines. Then, through his breathe he is spreading these drug resistant germs to others so that they in turn will find it difficult to cure themselves unless they take even stronger medicines. The medicines for TB are already very strong and can produce strong reactions in most persons. If more and more people had to take even stronger medicines because of careless people like Pinto, they would be fighting two battles - one against the germs and the other against the reactions to the medicines. "

" And there is anyway a continuing battle at home, " reminded the Secretary of the Social Education Society. "TB patients need to eat specially nourishing food. They could often be sick with the disease.


  1. Demand regular medical check-ups especially sputum examination , and also blood, urine, stool tests and chest X-ray.

  2. Demand that workers found positive for TB are given (a) less strenuous jobs (b) permission to go to the clinics / hospital for medicines and check-ups.

  3. Request the management to provide covered bins for spitting and throwing rubbish.

  4. Request the Welfare Officer to arrange for (a) small educational programs ( slides, film shows, talks by Voluntary Organisations working in health care or interested doctors at the factory site on major diseases liable to affect workers ; (b) short courses of instruction to all workers on how to keep health records for themselves and their families.

  5. Trade unions can also enter into arrangements with voluntary organisations engaged in educational /health care activities for access to books / booklets / other educational material or explore the possibilities of their conducting popular educational programs in slum pockets where union members live.

or with reactions and could lose wages. So the householdís budget must be managed better than otherwise and the patient can show how much he cares for his family by going through the treatment properly and also not wasting money on other habits like smoking and drinking which are harmful anyway. "


We now have medicines which make it possible for a TB patient to live at home and continue to work. But the treatment has to be taken seriously. It is usually for one year and whether he / she has to take one medicine or a combination of medicines depends on his / her particular condition. The reason why patients are expected to come to the clinic to take the medicines under supervision is to make sure that they take them regularly and correctly. Otherwise there is the danger that they may not get cured and, in fact, spread drug-resistant germs to others.

It is true that money and time have to be spent on travelling to the clinic for medicine. It is true that queues at the clinic are long. But it is important for the patient to see how this routine during that one year of treatment can be fitted into his / her life.

One way for those who are working in factories with unions is to get the union to take up the matter.

For others, it is important to realize that one yearís effort can cure them completely, prolong their lives, and save others in the family and outside from getting infected.

By the end of the meeting, Pintoís joking had stopped. He told Bahadur earnestly, " But I didnít know it was such a serious matter. No one had explained to me before in this way. At the hospital or any where else. "

"Yes," replied Bahadur. " It is true that we donít get to learn of these things. When we are sick and go to a doctor or hospital we are just given medicines and sent away. Nothing is explained to us so that we can understand what is happening to us. Perhaps we should take the responsibility in our own hands - to find out more, to understand, by asking questions of people who know better wheneve

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