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PAKISTAN: TB-Afflicted Women Struggle to Overcome Social Stigma

Ashfaq Yusufzai

PESHAWAR, Pakistan, May 17 2010 (IPS) - Abdul Wahid’s wife had been unwell for two years, showing symptoms of a chronic infectious disease such as prolonged coughing, before she finally decided to see a doctor.

By then it was too late. Her illness had developed into full-blown tuberculosis (TB). “Her doctors said she needed to undergo prolonged and expensive treatment for her tuberculosis,” said Wahid, a shopkeeper in Mardan, one of the 24 districts of the Khyber Pakhtunkhwa province in Pakistan.

He admitted that his wife, Jamila Begum, 24, did not seek immediate treatment for lack of female doctors and for fear of being ostracised by her community should she confirm her suspicions that she was suffering from TB.

The Khyber Pakhtunkhwa province has a total of 800 female doctors serving an estimated 14 million women.

“Usually, we don’t allow women to be seen by male doctors. Women visiting male doctors are looked down upon by society,” admitted the 33-year-old Wajid.

According to the World Health Organization, (WHO) Pakistan ranks sixth among TB-burdened countries in the world. Some 300,000 new cases of TB are recorded in the South Asian country every year, with female patients outnumbering the males by a ratio of 52:48.

Of an estimated 40,000 TB patients who registered with 214 government-run diagnostic and 1,029 treatment centres across the Khyber Pakhtunkhwa province last year, more than half, numbering 22,000, were women.

Jamila, 24, is “not the only woman who became afflicted with TB for failing to visit a doctor at the onset stage of her disease,” Dr Suleman Ahmed, her attending physician, told IPS. Others afflicted with the otherwise curable infectious disease also had to bear the brunt of ostracism by their communities, Dr Suleman said.

Amina Batool, who lives in Nowshera district, adjacent to Peshawar, the provincial capital of Khyber Pakhtunkhwa, could not see a doctor immediately despite her fear that she was showing signs of the dreaded disease.

“I had coughs, mild chest pains and evening fever, but my in-laws didn’t allow me to go to a hospital,” Batool told IPS. It was only when she became bed-ridden that she was finally brought to a hospital in Peshawar, where she learned she had chronic TB, Batool recounted as she lay in her hospital bed. Women with TB are often diagnosed late compared to men due to the former’s limited access to healthcare, preference for non-traditional healthcare and the stigma attached to the disease, especially among women, says WHO.

The social stigma is not only depriving women of treatment but is also causing more individuals to become infected with the disease, says the United Nations health agency. A patient, if left untreated, can infect 10 to 15 people in his or her close environment per year, says WHO.

“There are hundreds other [women afflicted with TB] in Khyber Pakhtunkhwa province and the Federally Administered Tribal Area (FATA), who are looked down upon,” said Dr Suleman Ahmed.

In 2009, about 258 women died of TB in the Khyber Pakhtunkhwa and FATA, which lies between the province and Afghanistan.

TB is the third leading cause of death among women of reproductive age, aged 15–44 years, in low-income countries and worldwide. It ranks fifth worldwide among women aged 20–59 years, says WHO.

Medical experts say that because of the stigma attached to the disease, patients avoid visiting public hospitals, fearing disclosure of their illness.

Bakht Meena, 21, who lives in a remote village in militancy-plagued Swat, said she had been undergoing treatment at home using traditional medicines for several months before she visited a male doctor, there being no female one available in her area, along with her husband.

In a phone interview with IPS, the mother of two said her health condition began to improve after taking the medication prescribed by her doctor. “My husband regrets not having brought me to a doctor earlier on,” said Meena.

She hastened to add that her fear of being rejected by society continues to haunt. “Some of our close relatives have stopped seeing us,” she said.

Unlike Meena, Nargis Bibi, 50, who developed TB late last year and is currently undergoing treatment, said she is not bothered by the negative social consequences associated with the disease.

“People in our home and neighborhood started to hate me from the day I was diagnosed (with TB),” Bibi told IPS during a telephone interview. Unfazed by the stigma, she vowed to “complete my treatment until I get healed.”

But Bibi’s concern goes beyond her own condition, saying she is now trying to raise awareness of the disease and to push for increased access to treatment for all TB-afflicted women in Pakistan.

She has been actively involved in the anti-TB campaigns of the provincial government’s health department, which include the conduct of seminars intended to raise awareness of the disease.

“I have taken it as a personal advocacy to raise awareness about the disease and remove the stigma attached to it,” she said. Said Dr Abdul Lateef, head of the Khyber Pakhtunkhwa TB Control Programme: “We have been vigorously campaigning to raise awareness that TB is curable and the patients, especially the womenfolk, should not be stigmatised and must receive the full support of family and community.”

Thus the government has begun airing dramas and talk shows on television, encouraging the women to see a doctor in case they manifest any of the symptoms of TB.

Until the stigma and other factors driving the disease are eliminated, TB will continue to be a critical burden for women.