Raju has TB and AIDS and lives on the street


While Mumbai prepares to sleep, Raju the masseur goes out to look for work. He is a pavement dweller, 40 years old and emaciated, partly from alcohol and drug addiction. He also has tuberculosis and AIDS. Despite the pain of his condition, Raju has to work in order to eat well enough to go through another day of heavy medication. If taken on an empty stomach, the high-potency TB drugs - which are provided free of charge by the municipal corporation - could produce side-effects of weakness, giddiness, nausea or fever. Raju looks for clients every night in the hope that he can earn the 60 rupees that would just about get him two meals.

Raju came to Mumbai, like thousands of others from rural India, in search of a job. He worked as a domestic servant, a bootlegger and a vegetable chopper before becoming a masseur. In the 25 years since he came, he has never visited his home in Katni, a village in the central state of Madhya Pradesh.

"With what face can I go back? How can I explain to my parents what I have been doing all these years? I want to go back with something to show for the years I have been away," says Raju with visible pain. "I have fallen in my own eyes," he says.

A year ago, Raju realized that his persistent cough and rapid loss of weight could mean serious problems. So he turned to the state-run J J Hospital, which provides free or subsidized treatment for poor patients. He had to stand in a queue for two hours to register as a patient. An X-ray and blood test later, he was diagnosed as having TB and AIDS. "The doctor told me that I would die, that the drugs are very expensive, that if I have more difficulty I could come back. They gave me two types of pills for four days and nothing more," he recalls.

Raju turned to the corporation-run Nair Hospital for help. Here he had to wait three hours. They did some tests, gave him a packet of biscuits, the same message, and a month's supply of medicines. "I did not eat those yellow and white capsules because I got fever after a couple of doses. Moreover, a friend, who is partly educated, said these were not TB medicines, so I threw them away," says Raju.

Miserable and debilitated, Raju then heard about Sankalp, a nongovernmental organization (NGO) that helped poor patients overcome drug addiction. Raju enrolled for Sankalp's de-addiction programme. He was sent to the Seewri TB Hospital, the main TB referral centre in Mumbai, where he got some relief.

After his discharge, Raju was referred to the government-run TB dispensary for the DOTS programme in his locality, a facility he had not known about before. The treatment included a course of 60 injections, but the dispensary did not have syringes. Raju now had the additional expense of a disposable syringe every day.

"I stopped going to that centre for a combination of reasons... the long queues, the indifferent staff, their irregular hours. But, also I could not afford to buy those syringes. And, although they never said anything, I felt the staff did not like me because I had AIDS, and because I was poor and lived on the pavement," said Raju.

However, the doctor at Sankalp persuaded him to resume treatment at another DOTS centre closer to the NGO's office. The one-month break in treatment meant that it had to be started from the beginning again. Sankalp monitors his treatment, counsels him daily, and lets him use its day-care centre. But the indifference of the staff at the TB centre continues to bother Raju.

However, thanks to the support of Sankalp, Raju's craving for alcohol has subsided. All his energy is focused on earning money to buy food so that the medicines can flush the TB out of his system. Unfortunately, the only food he sure of getting is sub-standard grain and rotting vegetables. The only encouraging thing about his case is that he wants to survive and is trying to.

Rupa Chinai, Mumbai

World Health Organization Genebra - Genebra - Switzerland
E-mail: bulletin@who.int