TB six times more common in Tibetan exiles

‘‘TB is a major public health problem,’’ admits the government-in-exile’s Health Secretary Tenpa C Samkhar. ‘‘Starting with the TB Control Programme in 1985, we are making all efforts to control the disease. Incidence has come down, but our aim is to eradicate it completely.’’

It’s a tough goal, considering the CTA’s limited resources. ‘‘Already, we devote 8.2 per cent of our annual budget to health services; 18.6 per cent of this is allocated directly to TB control. But we have just eight hospitals for our entire population. Only if the economics improve can we allocate more funds to healthcare,’’ says Samkhar.

Though TB is not the biggest killer for the community—cancer, more particularly, stomach cancer is—the government has formed an Emergency Action Committee comprising senior officials and doctors for TB. Members meet periodically to evaluate plans and monitor drives.

‘‘Cancer isn’t a public health problem, TB is, since it can be passed on by talking, sneezing or coughing,’’ says Samkhar. ‘‘Most of our old settlements are bursting at the seams. Upto eight people live in a single room without any toilets. Sanitation and water facilities are dismal. But upgrading sanitation and supplying safe drinking water involves huge sums of money.’’

According to TB programme in-charge, Migmar Tashi, 20-25 per cent of the health budget is earmarked for improving toilet and water facilities. But it seems to have made little difference.

The monasteries are worse off. The Demographic and Health Surveillance of the Tibetan Population of India—an official publication based on 1993-96 data—puts incidence of TB among monks at 15.8 per 1,000, or 1,580 per 1,00,000 people.

‘‘The age profile and overcrowding in monasteries are reasons for the high incidence of TB among monks,’’ explains an official. ‘‘As with the settlements, the ones in the south report more cases than those in the north.’’

Besides, youth isn’t really a safeguard against the disease. With little employment available in the hills, 60-65 per cent of Tibetans travel to metros and bigger cities to sell sweaters for a living in early winter. ‘‘They set up shop in the most congested parts of town, where air pollution and dust concentration are very high. To cut costs, they skip meals and work all hours, making them vulnerable,’’ says Samkhar.

Of the 50 beds at the nodal Delek Hospital, 25 are earmarked for TB patients—additional beds are laid out in summer—though there are only two doctors to attend to them.

The CTA is now banking on experts of the Centre for Disease Control and Prevention, Atlanta, and the University of Minnesota. ‘‘They are coming next year. We need them to analyse statistics. Till we know where to focus, we can’t tackle this effectively,’’ says Tashi.