A Brave Initiative-Facilitating Early Detection and Diagnosis of NCDs in Tea Gardens by ACCF during COVID19 Pandemic

  • Approximately 8000 tea garden population screened in the ongoing health camps

Until recently it was believed that the major chunk of NCDs is common only in urban sectors. However, unlike the belief, the burden of the NCDs is increasing in rural areas, thus reducing the Urban Rural healthcare divide. People are affected dearly with the long-standing consequences on their health and economy. For this, Assam Cancer Care Foundation (ACCF) through its multiple initiatives has been organizing several healthcare programmes at different locations across Assam in collaboration with departmental health authorities, state NCD officers and various agencies. On similar lines, it has also collaborated with Amalgamated Plantations Private Limited (APPL) for facilitating the awareness and screening programme for their employees at the tea gardens. The initiative has been able to make significant progress towards awareness and benefits of early detection of the prevalent NCDs.  A 51 years old female staff   has said – “I am thankful for the opportunity and have done my screening for breast and cervical cancers. I have never heard of these examinations before. The doctors and nurses at the camp were very helpful and explained the importance of screening. I will also send my relatives and family to this programme.”

Tea garden workers are susceptible to unique occupational health problems at their workplaces due to physical, biological, chemical, environmental, lack of awareness and psychosocial factors.  Occupational cancer in agricultural workers can present as a delayed complication of certain causative factors. However, this can be detected early through screening at regular intervals and can be cured completely in early stages. APPL has twenty-one gardens under its aegis across Assam, comprising a population of approximately 86000 people. Of these, the eligible population as per the Government of India guidelines is 31762 (37% - age 30 – 65 years).  The aim of the programme is to reduce the morbidity and mortality caused due to common NCDs – common cancers, diabetes, cardiovascular diseases and cerebrovascular strokes through awareness amongst the tea garden people by engaging the welfare teams, and community healthcare volunteers, and organizing opportunistic screening, treatment and follow up of people reporting at such camps.

The screening programme initiative commenced in November 2019 at Chubwa Tea Estate of Dibrugarh. The programme continued till March 2020 and thereafter ceased due to COVID19 pandemic restrictions. During this period, ACCF team completed awareness and screening programme at Chabua Tea Garden and almost fifty percent of total eligible population at Nahartoli Tea Garden. There have been 3351 participants from both the gardens so far.

While commenting on the initiative Dr. Umesh Gupta – Medical Officer, Lamabari Tea Hospital said – “This is a very good initiative. I feel good looking at the response from the people about the NCD screening camp. The ACCF team is very hardworking and determined. My gratitude to all the team members.”

Tobacco is one of the most common causative factor for Oral cancers in addition to other diseases such as Hypertension, Lung cancer and coronary heart diseases. According to Global Adult Tobacco Survey 2016-17 (GATS-2) 13.5 lakh people die every year in India from Tobacco related diseases.  As per GATS, the prevalence of tobacco usage is far higher in North Eastern states especially Assam, as compared to the national average. While its prevalence in India in the last five years has decreased from 34.6% to 28.6%, the prevalence in Assam has increased from 39.3% to 48.2%.  Consumption of tobacco in any form – smoke or smokeless, have equal risk for many respiratory infections and increases the severity of respiratory diseases.

Besides tobacco consumption and other intoxicants, hygiene and sanitation, nutritional habits, and potable water conditions are some of the prime reasons why tea garden population of Assam is susceptible to NCDs. A study* shows that general living conditions of the people in tea gardens are low in terms of sanitation facilities and the labourers are still using open space for defecation, which in turn enhances the risk of water borne diseases.

Dietary habits, especially high intake of salt is a common practice which increases the risk of hypertension and other related ailments amongst the populace.

Use of pesticides for effective pest control and artificial agrochemicals used for higher growth rate of tea production has generated a lot of concern relating to public health and environmental pollution like water. If Arsenic content in water is found to be above the permissible limit (0.01 ppm) of WHO guideline value for drinking water, prolonged use of this water can lead to cancer and other chronic diseases. It is a matter of concern that amidst the pandemic, many other treatable but life threatening ailments are being overlooked.  People are avoiding visit to the healthcare centres in fear of getting infected with COVID19, and many are living without being diagnosed or treated for any ailment.

To address this issue for the tea garden workers, both APPL and ACCF management decided to resume awareness and common NCDs - Oral Cancer, Breast Cancer, Cervical Cancer, Hypertension and Diabetes screening programme in the tea gardens while following all the COVID19 protocols strictly issued by the state health authorities.  Four teams were placed at Namrup TE - Dibrugarh, Bhelaguri TE - Jorhat, Letekujan TE - Golaghat, and Lamabari TE – Udalguri in the last week of June.  Till August 23, three teams completed the awareness and screening programme at Namrup TE, Lamabari TE and Bhelaguri TE. The fourth team is continuing with the screening at Letekujan TE. After completion at these gardens, the teams have moved to other tea gardens at Naharkutea TE in Dibrugarh district and Hatigarh TE in Udalguri district. ACCF's healthcare workers are presently camped in these locations and are conducting door to door visits for creating awareness on corona virus, cancers, and Government schemes for availing cashless treatment.

ACCF team has adapted a seamless follow-up mechanism for the suspected cases of non-communicable diseases and continuously guide them through the process of treatment. Suspected cases are sent for diagnosis and for further investigations to the nearest Medical College Hospital. Patient Navigators are placed at all Medical College Hospitals for navigating, counselling and follow-up of suspected cases.  If found positive, they are further referred for treatment and if required also directed to palliative care centres. After resumption of programme at these tea estates, ACCF team has screened approximately 4600 beneficiaries from these gardens.

After completion of screening at these locations, ACCF team will move to other APPL tea gardens and continue with this selfless service.

*International Research Journal of Social Sciences ISSN 2319–3565 Int. Res. J. Social Sci.