Gull Fareen is a resident of Hattar area District Haripur. She is married and has a three years old son. Her Husband is barber and getting meager earning out of it. Gull Fareen’s parents died of TB when she was very young. Before diagnosed with TB she was living in joint family with her in-laws.

Gull Fareen was married happily and was living a healthy life but soon after her TB was diagnosed the scenario of her life changed completely. The relationships changed and so did their behaviors. She became a dejected figure at home and out side as well. However, among all these odd behaviors her only ray of hope was her husband - who stood steadfast with her.

Gull Fareen had cough since long and she contacted many private doctors but they were unable to diagnose the disease. The prescriptions of these doctors proved ineffective as she didn’t get any relief. Upon the query, how she came to know about TB? She said “Once bajis (TAF Team) arranged a programme on TB in our neighborhood. I also participated in the programme where I came to know about TB and the hospital where TB can be diagnosed. As my symptoms were like the one discussed, I feared that I might have TB. I visited Kot hospital and there they took my sputum for test. When my test results came doctor sahib told me that I had TB”.

She told her husband and then her mother in law and rest of in-laws got the information about her TB. The news of Gull Fareen’s disease spread in her neighborhood and every one distanced from her, because of fear that they will also get the disease.

Gull Fareen was bed ridden and was unable to do household chores, but nobody was bothered about it. Her room floor was not cemented and the grass grew there because she was unable to clean it.

Meanwhile I gave birth to son but due to my insufficient food intake he was so weak that he was not getting proper feed from me. As a result he died.

All these atrocities couldn’t deter her courage and she was following regular treatment. Slowly and gradually she started feeling better and was regaining health. Upon seeing her improving health her in-laws also started coming to her home and so did her neighbors. Now everything is ok .She has completed treatment and has started a healthy life. “I can do all my household chores. I am feeling better and happy. Now I will be advising other TB patient to start treatment from Kot (diagnostic center) – as it’s free of cost and quality one”.

Mr. Khalid Khan is an NGO Activist from district Swabi. He is living in a joint family along with his brothers and sisters. He has a beautiful wife and two loving children. He is a committed professional at work, a caring brother, a compassionate father and above all a loving husband at home.

Few months back his wife “Fatima” had successfully completed TB treatment. Like many other TB patients her disease was diagnosed late. This was primarily due to her negligence of TB symptoms which resulted in trying various doctors in private sector. She was suffering form severe cough and temperature but her disease was misdiagnosed. Her husband was very worried about her as her condition was deteriorating day by day. On one fateful day her husband participated in TAF (The Asia Foundation: NTP Partner) awareness session on TB where he came to know about TB symptoms that resembled a lot of her wife illness. Furthermore, he also got information about the diagnostic centers and free of cost TB diagnosis and treatment services. As a result, on the very next day he took his wife to the diagnostic center Swabi where she underwent sputum tests. The results worried him because his doubt was now a reality.

Visualizing the condition of his wife and the attitude of his family towards her, he decided not to disclose his wife’s disease. Even he kept it secret from his wife.

Upon asking why you didn’t tell your wife. He said ”she is very young and weak therefore I don’t want to disturb her because I knew that by getting this news she will undergo the stress which I don’t want.”

He started treatment of his wife by regularly giving medicines to her - till the completion of treatment. His wife was oblivious of the fact that she is suffering from TB.

His sister who is living in his home says” Once my niece came and she told me that aunty might be suffering from TB you should distance yourself from her. When I asked from my brother he replied that i have confirmed from doctor she is having chest problem not the TB”

Slowly and gradually Fatima condition started improving and she completed her eight months treatment. Khalid felt elated when he got her final sputum results, they were clear. After completion of eight months treatment Khalid told his wife and his family that Fatima was having TB and she is cured now. However his wife was not prepared for this shock and she got worried and depressed but Khalid satisfied her by saying “show these results to any expert in this world he will confirm to you that your TB is cured now” with this she felt satisfied as she believed him.

Khalid’s contribution to TB support did not end up here. He approached TAF for getting TB project for his organization (NGO where he works). So far his organization has referred 1099 TB suspect to Yaar Hussein Hospital out of it 78 were confirmed. Among these 78 TB patients 23 are SS Positive while 55 are SS Negative.

Basmeen, an unmarried girl from Yar Hussein, Swabi narrates her story of being a TB patient still living with the desires and hope for a new life – A TB free life. She is illiterate and belongs to a poor family and has no means to earn. She and her mother are dependent upon her brother who is married and having a large family. Being a poverty ridden family there are two TB patients in her family i.e. her mother and nephew. Her mother is having bone TB and is under treatment while, her nephew suffered from Lymph nodes TB and has successfully completed his treatment.

Basmeen was suffering from Chest problem, severe cough and blood in sputum. Unaware of the nature of her disease she tried various health care providers i.e. Hakeem, Private Doctors etc but in vain. Private Doctor diagnosed her TB but due to her financial condition she left the treatment incomplete.

Information about the government free TB diagnosis and treatment services provided by the National TB Programme were a blessing for her, as half worries of financial burden was relieved with it. Unfortunately, she was diagnosed twice with TB and got treatment from Mardan and Swabi diagnostic centers but her symptoms remained persistent with her. These are not only the symptoms of her disease but also the causes of her rejection, depression and agonies which she is facing every day. She clearly remembers initial days of her treatment when her sister in law completely sidelined her. As her utensils were separated and was not allowed to meet her brother’s kids.

Her sister-in-law was always in search of finding excuses of how to get rid of her and finally she succeeded in it. Once she fought with her and separated Basmeen and her mother by putting up a wall inside the house.

When she lost all her hopes and went into disparity, the TAF team arranged session on TB in their neighbor wherein the TAF got information about her. The team approached her brother and after long deliberation succeeded in convincing him. Furthermore, they took comprehensive session with her sister in law on TB, which worked well and she feel embarrassed on what she did to her. Now they are living together with her. It was not only her sister in law who was giving her mental agony but her relatives also did the same. They were cursing her of being a TB patient and even were unwilling to talk to her.

The fear of repetition of her disease had so much engulfed in her that she had lost her hope of getting married and even when she was getting some proposal she was rejecting it with the fear that she will not be able to manage her home. Secondly she was not agreeing with her family views of hiding her disease from the people who were proposing her.

Basmeen’s life is the mosaic of sufferings, deprivations and grief. But in the midst of all these helplessness the only asset she has is her hope of getting cured which is giving her a hope to live and face all these odd situations with courage, patience and determination. She hopes the Day will Come when she will get cured and she will be back into life. Her hope has made her distinguished and outstanding from those who instead of bringing change in their lives are living with difficulties.

Does TB still exist? The most frequently asked question of the policy makers - who decide people’s fate at district level. It is an indicator of lack of information of the policy makers toward such a critically important public health issue, which if not addressed timely can play havoc with lives of the poor. Moreover, it also shows the commitment towards TB and TB patients on their ladder of priorities. So where to fix the blame? We as health care providers who failed to highlight the magnitude of problem or the district government who are unfamiliar to the problems of their masses. Looking through the lens of Manager, our vision should be on how to mould such a situation in our favor so that we could maximize our gains out of it.

Sometimes our perceptions about certain segment of society is also a hindrance in our way to move ahead, for example politicians - often we look at them as self centered, disinterested and careless about the well being of their masses. But going through the case study of Mr. Gohar Saifullah, District Nazim Kohat will dispel most of our these impressions.

Mr. Gohar Saifullah working as district Nazim has displayed strong commitment to social sector particularly health and specially TB control. He is the one who approved the dispensary for Rukwan, a far flung and neglected area of district Kohat, and managing a trust named Saifullah Trust.

Mr. Saifullah along with his colleagues made a visit to TB diagnostic centre to observe the procedure of management of TB patients. It is pertinent to mention that in the history of TB Control Programme, the first ever District Top Executive paid visit to a TB center. The commitments of Nazim do not end here, he directed all concerned departments to shoulder the responsibilities of awareness raising with TB Control Programme. As a result EDO Education, Social Welfare Department, Literacy for All Programme and Information Department endorsed the idea of incorporating TB in their sphere of work.

Any developmental Programme that strives for ameliorating the conditions of down trodden society can’t achieve its best if it fails to look after their sustainability and it is only possible by exploring and exploiting indigenous resources. Believing on this vision Provincial TB Control Programme NWFP initiated a process of resource mobilization from district Kohat. When the team approached District Nazim his first question was Does TB still exist? The question didn’t prove shocking and unexpected as team was aware that TB is placed on the back seat of political commitment at district level not because politician don’t want to support the programme but because we failed to broaden our vision in understanding the role of district governments. In response to the question by Mr. Gohar Saifullah, the team apprised him of TB, efforts of Health department in tackling TB problem and the challenges faced by the Programme at district Kohat.

Among the challenges the focus of the Programme was on creating community awareness, earmarking separate budget for awareness raising and designing a comprehensive response to TB by line departments. The deliberation proved effective as Mr. Saifullah realized the importance to tackle TB on priority and also that the district government could play a pivotal role in addressing this challenge. After series of meetings with district government the conclusion was that the District Government will financially support TB Control Programme in arranging awareness sessions at every union council of district Kohat.

The support of District Leadership has provided a policy impetus to TB Control Programme in the context that if district leadership is approached and informed about TB and its related challenges, their support can be channelized into meaningful inputs.

Tor Dand - a far flung village of District Karak and abode of Mrs. Jamshed Begum, a TB patient who has successfully completed her treatment. Mrs. Jamshed is married to an aged person and has three kids. She is the second wife of her husband (as from the first wife her husband had no kids therefore he married Jamshed who is much younger than him).

TB was not new to Jamshed, as her father too suffered from it. He took treatment from Dadar Sanatorium and now is leading a healthy life. Jamshed developed symptoms of TB at an early age. She, from time to time took treatment from various private doctors but due to poverty she couldn’t afford complete treatment which resulted into non-compliance. The avoidable suffering which she faced due to the fact that she could not understand the gravity of the problem resulted into a chain of problems after marriage.

Her negligence, compulsions and bad luck followed her till the door of her in-laws. She got TB, when she was pregnant. Her symptoms i.e. temperature, severe cough with blood stained sputum disclosed the disease to her in-laws. When the news of TB reached to her husband he broke all marital relationships. Ironically, her in-laws too were not cooperative and they treated her as untouchable.

"My mother in-law was not allowing me to take water from the well as it would get contaminated with my germs. Moreover, I was told to separate my utensils and not join them in meal. Sometime I was getting bored with my routine food and wanted to have something else but nobody paid heed to my desire - they were only concerned about the household work which I had to accomplish at any cost", Jamshed remembers sorrowfully.

During all these odd days the only happiness she got was the birth of a child. But unfortunately this happiness did not last long. Her husband’s first wife took her child, with the pretext that he would get TB.

"All the day I was crying for my child as I was missing him. May Allah not render a bird issueless let alone the human being as its very painful for the mother when her child is taken away from her", mourns Jamshed.

Slowly and gradually the days were passing and she was looking forward for the moment when her sufferings would come to an end and that’s happened when Aurat Foundation arranged awareness Programme on TB at Karak, which was attended by Ms Nasreen who was Jamshed’s neighbor as well as Aurat Foundation focal group member. The comprehensive session on TB changed Nasreen’s mind and she recalled the plight of Jamshed. Upon her return she took Jamshed to the diagnostic centre where her TB got confirmed and treatment started.

"When I came to know about the availibity of free treatment I absolutely agreed to carry on my complete treatment as I wanted to have a healthy and happy life with my kids", says Jamshed.

Jamshed started treatment from the TB Control Programme when she was the mother of three kids. She was regularly following advice of the doctor till the completion of her treatment and finally she was declared cured. During the treatment her husband’s first wife created a lot of hindrances for her but she continued with her treatment. Nasreen was subjected to criticism by Jamshed’s family but she ignored all these criticisms and stood fast with her treatment till completion.

Nasreen recalls, "Whenever I was looking at Jamshed I was feeling sorry for her because she was not getting support from anywhere; neither from her in-laws nor from her parents. First wife of Jamshed's husband put accusation on me and were telling neighbors that they are going for outing not for treatment".

During the treatment her husband brought cattle home and Jamshed was made responsible for its care and feed.

Jamshed says, "I was suffering from temperature. Whenever my situation deteriorated I was taking pain killer and again started to work but I was happy that at least my treatment had started and I would be having a healthy life. My treatment completed and the results are visible. Now I am eating together with my family and well received by my parents who deserted me when I needed help".

Jamshed is the emblem of fortitude courage and endurance who ceaselessly wrestled the obstacles coming between her disease and getting cured. The journey from the TB patient to the healthy life is not smooth; one has to face a lot of challenges, which are baseless and unreasonable. She had been through all these challenges and instead of hiding behind these challenges she faced them boldly. Her devotion has transformed these challenges into an opportunity for her which she seized for changing the impression of her family members regarding TB.