Tuberculosis in Bombay: new insights from poor urban patients

This study explores the health seeking behaviour of poor male and female tuberculosis patients in Bombay, and examines their perceptions of the causes and effects of the disease on their personal lives. Sixteen patients who attended an NGO's tuberculosis clinic were interviewed in-depth. Almost equal numbers of respondents stated 'germs' and 'worry' as the cause of tuberculosis. Men worried about loss of wages, financial difficulties, reduced capacity for work, poor job performance, and the consequences of long absence from work. Women were concerned about rejection by husband, harassment by in-laws, and the reduced chances of marriage (for single women), in addition to their concerns about dismissal from work. During the first two months of symptoms most patients either did nothing or took home remedies. When symptoms continued, private practitioners were the first source of allopathic treatment; they were generally unable to correctly diagnose the disease. Respondents shifted to municipal and NGO health services when private treatment became unaffordable. Respondents shifted again to NGO-based services because of the poor quality of municipal tuberculosis control services. The wage-earning capacity of both men and women was affected, but women feared loss of employment whereas men, being self-employed, lost wages but not employment. Married men and single women perceived a greater level of family support to initiate and complete treatment. Married women tried, often unsuccessfully, to hide their disease condition for fear of desertion, rejection or blame for bringing the disease. Women dropped out from treatment because of the pressure of housework, and the strain of keeping their condition secret particularly when the reasons for their movements outside the home were routinely questioned. Health programmes will have to be sensitive to the different needs and concerns of urban men and women with tuberculosis; in the case of women, health care providers will have to make particular efforts to identify and treat married women with tuberculosis completely.