the DOTS clinic in-charge and urban health volunteers were oriented about the need and process of psychosocial counselling and nutritional support activities. Secondly, field supervisor along with the support of the health care workers assessed the psychosocial and nutritional needs of the TB patients through consented face to face interviews. On the basis of these findings the TB patients were provided with psychosocial counselling which included coping strategies for distress, fear, anxiety, stigma and discrimination. Furthermore, the poor and vulnerable patients were supported with foods for nutritional support. The eligibility criteria to receive nutritional support included daily wage labor, patients with no other economically active family member, single women/old age, vulnerable groups like key populations living in slums, migrated, disadvantages, factory workers, school children. During the project period, a totalof84 TB patients received nutritional support.
Kanchi Shrestha,48 years female(name changed)residing at Balaju, Kathmandu was diagnosed with Gland TB.TB treatment was started at the urban health clinic of ward no. 16, Kathmandu. The patients lives with her husband who is paralyzed on pretext of being injured during 2015earthquake. The family lives in a temporary settlement made of tin as the original house was completely destroyed during the earthquake. The patient has two daughters, both of them are married and live with their respective families.
The patient was illiterate and lacked awareness regarding TB before being diagnosed with the disease. The patient earns through daily wage labor and has not gone to work since being diagnosed with TB. She said in her own words “ I feel isolated and nobody is ready to help me”. She said that “when I was healthy, I earned some money to eat, now it has been very difficult.” I feel that my husband and I might not survive for long .” She further added “I have no dream of making a house, I just want to get cured and take care of my husband.” This reveals that TB does not only affect the physical health of the patient, but also affects the mental health by increasing distress, feeling of hopelessness and fear of dying. She said “ I have not shared my TB status to anyone if they know I will not be called to work.” This indicates persistence of limited knowledge, stigma and discrimination associated with TB along with fear of social exclusion. Despite socioeconomic & psychological distress the patient has been regularly taking TB medicine on DOTS since her enrollment in the treatment. “Hari sir-(DOTS incharge of ward no.16) has told me I am doing well” She believes in herself that she will be cured and will be able to go to work and take care of her husband. However, she complained that after the initiation of the treatment she has been more affected by the gastritis problems.