World Tuberculosis Day

"How my job helped me get through the fight against TB"

Tuberculosis (TB), one of the world's leading causes of illness and death, often strikes people in their prime working years. Workplaces have a critical role to play in its prevention, treatment and care.

Feature | 23 March 2018
Mumbai, India (ILO News) - Preeti Sawant, 39, had to battle with multi-drug resistant tuberculosis (TB) for two years. It was only in September 2017 that she was declared disease-free. Living with TB she says was like “going to hell and back” but she could fight the disease because she had the strong support of her family and her workplace.

Preeti Sawant, 39, a Mumbai resident, battled with multi-drug resistant TB (MDR-TB) for two years before she was declared disease-free in September 2017. ©ILO/A.Bishnoi 2018 
Sawant works as an assistant in the legal department of Mumbai’s state-run public transport and electricity provider, BEST. “After I was diagnosed with TB of the lymph nodes I consulted Dr Anil Singal, the chief medical officer of my firm. He explained that the company has a provision for paid leave for all employees suffering from TB for up to a year.”

At first, she was given a month’s paid leave and referred to a DOTS  (Directly Observed Treatment Short Course) centre. Then her sick leave got extended. "TB took a toll on my health, morale and family life. My daughter lost a year in school. While I couldn’t help my daughter with her studies, I also felt lucky to have job security and that my workplace was actively monitoring my health,” says Sawant.

Challenging TB, focusing on the world of work

TB continues to be a critical health challenge especially in India. According to WHO’s 2017 Global TB Report, every year, more than 10 million people contract TB globally and India accounts for more than one-fourth of the cases. In 2016, 480,000 people succumbed to the disease and the country also has the second highest number of estimated HIV-associated TB in the world.  Nearly 30 % of the deaths are among the working age group (15 to 54).

It is time to challenge TB on a war footing. At the recent Delhi ‘End TB Summit’ held in March 2018, an emphatic commitment to this mission came from Prime Minister Narendra Modi. He launched the TB Free India Campaign and said, “India is determined to address the challenge of TB in a mission mode. A target has been set to end TB globally by 2030. I would like to announce that we have set an aim to eradicate it from India by 2025.”

  A road map is required to reach out to workers. The ILO’s role in this regard can be transformative.” says Dr Raghuram Rao from the Central TB Division (CTD). CTD is actively working with the Ministry of Labour and Employment (MoLE) and the ILO to devise a workplace policy and programme on TB.

During the monthly follow-ups at the Mumbai Central Bus Depot Dispensary and Investigation centre, Dr Anil Singal, Chief Medical Officer (CMO), BEST, and his team take time out to counsel TB patients who are often accompanied by a family member. ©ILO/A.Bishnoi 2018 
“The world of work can play a critical role in ending TB in India by promoting early diagnosis, quality treatment, and extending the support,” says Dagmar Walter, Director of the ILO Decent Work Team for South Asia. “Employers can be supportive of workers who are affected by this curable disease. Employers should ensure that there is no discrimination, workers would not lose their jobs, and that they would be looked after. Employees should be empowered to cope with TB and return to their jobs.”

The ILO has supported development of a national policy framework to address TB and HIV in the world of work in India. It worked in collaboration with the International Union against Tuberculosis and Lung Disease (The Union) under USAID’s Challenge TB Project. “We have existing partnerships on HIV and AIDS with large corporate houses in the country. This model, fully-owned by companies and implemented at their own cost, can be adapted to include TB as well,” says Walter.

Wellness and the workplace

Pradeep Khandomane is an electrician with BEST’s transport division. Like Sawant, he too survived a case of extreme-drug resistance TB. The financial support of his employer helped him undergo the treatment.

“BEST provides certain essential facilities to TB patients like me. We are linked with our local DOTS centre that offers free hospitalization. Family members too receive counselling. I am now fully-recovered from mouth cancer, a lung removal surgery and TB. Thanks to these provisions getting treatment was relatively easier.”

Surendrakumar Bagde, General Manager at BEST, says, “To reduce TB-related morbidity and mortality, among our 40,000 employees, we strongly advocate for an early detection and diagnosis. We also advise appropriate treatment for an adequate duration with extraordinary benefits.”

Dr Singal says, “We have interventions like awareness-building, stress management activities, and access to high-protein subsidized meals at the office cafeteria. We also have a monthly three-tier follow-up process to prevent treatment defaults. In three years we haven’t had even a single default reported.”

India’s largest coal producer — Coal India Limited (CIL) — employing over 300,000 people invests strongly in its healthcare policy. Dr Bidyut Guha from Eastern Coalfields Ltd (ECL), a subsidiary of CIL, says, “Healthcare is free for our employees. Our hospitals and dispensaries provide the full course of TB treatment and link the patients with nearest DOTS centres.”

Dr Abhijit Bhattacharya, medial supervisor, assesses an x-ray of a TB patient. At the central hospital an in-house diagnostic facility is available. ©ILO/A.Bishnoi 2018
“Miners are vulnerable to TB as they are working in cramped spaces with constant exposure to coal dust.  When we launch awareness campaigns and undertake prevention strategies, we make sure to link our patients with DOTS services” says Dr Abhijit Bhattacharya, medical supervisor with ECL’s hospital.

Tapan Adhikary, a ward assistant at the hospital, was diagnosed with TB in 2013. He underwent a rigorous eight-month treatment. “For a working person his/her job matters. I knew everyone was waiting for me to resume my duty at my workplace. I had the full support of my colleagues which boosted my confidence,” he says.

Following ILO’s policy guidelines of reasonable accommodation, both BEST and ECL reassign duties to another employee when a worker takes sick due to TB or HIV. A good workplace policy on TB has multiple benefits. It can help keep the worker on the job, which in turn helps in treatment adherence and reducing stigma.

TB in India

  • 1 in 3 Indians is a carrier of the TB infection, active or latent
  • India accounts for more than one-fourth of TB cases globally
  • In 2016, TB cases in India were predominantly diagnosed among people  aged between 35 and 44, followed by those between 25 to 34
  • In 2016, 480,000 Indians succumbed to TB. This roughly accounts for 1,400 fatalities a day, or one every minute
  • India has the highest burden of MDR-TB cases worldwide. Annually, there are an estimated 1.3 lakh MDR-TB patients
  • India has the second highest number of HIV-associated TB in the world – an estimated 1.1 lakh HIV-associated TB occurred in 2015, and around 37,000 succumbed to the co-infection
  • Around 30 per cent of deaths due to TB were among people aged between 15-54
Sources: WHO Global TB Report 2016 and 2017; WHO-STOP TB Partnership-2007
This article was written by the ILO under the project ‘Strengthening world of work response to TB and HIV’, supported by the International Union Against TB and Lung Diseases, under the USAID-funded Challenge TB project.