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Nepal - foothills of democracy Friday, 6 November, 1998, 18:16 GMT
Nepal wages war on TB
Nepal's countryside
90% of Nepalis live in rural poverty - where TB thrives
South Asia Correspondent Daniel Lak reports

Medical experts are warning of the threat of a tuberculosis epidemic in Nepal as the sex trade in South Asia helps fuel the spread of diseases.

The poverty and cramped living conditions of much of rural Nepal means a disease that the developed world thought had been conquered is, in fact, thriving.

Bishnu and mother
Bishnu caught TB from her mother
Tens of thousands of Nepalis die from TB every year - despite countrywide efforts to spread awareness and treatment.

Three-year-old Bishnu Maya caught tuberculosis from her mother.

She says: "We thought she was going to die when she first got sick. She had this horrible swelling on the side of her neck and she was coughing a lot. Now she'll be alright - she's going to be cured."

Now Bishnu and other TB patients make the daily half-hour walk to a clinic where they get treatment.

The little girl is given a daily cocktail of drugs to bring the disease under control.

TB becomes resistant to treatment if all the medicine is not taken so a local health worker watches to make sure that Bishnu competes the whole course.

Potential disaster

It is safe to say that Nepal has declared war on tuberculosis, and the battle is well under way.

But Dr Ian Smith of the World Health Organisation says there is still the potential for disaster:

"Over half the people in Nepal have been infected with TB - in other words they have the potential to go on and develop the active disease.

Clinics make sure patients take all the medicine
"We estimate that over 100,000 people in the country, at this moment, have TB. Half of them have infectious TB - transmitting the disease on to other people. So the potential for a huge epidemic of TB exists."

About 90% of Nepal's people live in remote rural areas and villages. But the cities are where the TB problem has become most acute.

Many of those who live in the countryside will some day move away to find work in Kathmandu - or even in India - and that migration has added a chilling new factor to the already disturbing epidemic of tuberculosis.

Sex slaves carry disease

For years women from Nepal have been kidnapped or lured away to become prostitutes in Bombay's infamous red light area.

Many come back infected with HIV which makes it almost certain they will get tuberculosis and pass it on.

Abserra is two - she has TB and is HIV-positive.

Child who is HIV+ and has TB
Abserra lives in the shelter where her mother died
Her mother died from Aids a few months ago - still mourned by the other women who lived and worked with her in a shelter in Kathmandu.

Aids and HIV infection are common here - largely due to the years these women spent as sex slaves in Bombay.

They live at the shelter because they are not welcome in their villages. But their deteriorating health is already part of an HIV-fuelled wave of new TB infections in Nepal.

"We were at the brothel one night and the police raided and took me away. They sent me back to Nepal. I started having chest pains when I was in India but in Nepal I was coughing up blood - I was really sick," one told me.

Nepal's only hope comes with keeping their children healthy - and that means keeping them separate from infectious TB sufferers. It is essential across Nepali society as a whole for the health of an entire generation.

BBC News
Daniel Lak: Migration adds a chilling new factor to the TB epidemic
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18 Oct 98 | South Asia
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