2. THE FORMATIVE YEARS
2.3 Work done during the period
2.3.2. Other Experiments
Bangalore district was selected to conduct smaller studies
simultaneously. These provided the necessary training to different categories
of staff, for major studies which were constantly being planned. For e.g.
a pilot “Awareness study” was carried out in randomly selected
villages of Bangalore district. The objectives of the study besides training
of social workers and formulating interviewing techniques were:
A TragedyThe Kirangur camp where the field teams were stationed was situated in a secluded wooded part on the banks of the river Cauvery, about 3 kms from Srirangapatna. Everyone, from Piot, Banerji, Muthusubramanian, to the cook stayed in the camp. One day, as was the usual practice before breakfast, Verghese, XT went in for a swim in the river. Unfortunately, he got into the turbulence and before anyone could guess what was happening, drowned and never came up. Verghese was a very friendly person and had joined only recently. His body was retrieved by local fishermen by afternoon. After hectic parleying, necessary approval to transport the body to Kerala, his home town, was obtained avoiding postmortem. By late evening, the body was taken to the NTI. As ill luck would have it, the director was away and no one had the authority to use the government vehicle to transport the body to Kerala. The urgency was such that the senior most available officer, Banerji, took the decision. Nobody raised audit objection later! The teams were back to work 7.00 a.m. next morning. |
1) To obtain a preliminary picture of the level of awareness
of TB and
2) To compare the results of interviewing on symptoms before X-ray survey
(in some villages) and after X-ray survey (in different villages).
In fact, at that time, very little information was available in the field of ‘medical sociology’. With Dr Banerji and Mr Andersen in the lead, the main theme, of understanding the sociological aspects related to health of the people; to feel their pulse and identify ways of enlisting their cooperation, gained centre-stage. They discussed extensively and constantly revised opinions based on new information coming as a feedback from the field teams. They were joined by Dr Piot who had considerable field experience; Drs Raj Narain, Bordia, Geser, Mahler and Mr Jambunathan. Their collective wisdom would not yield to unqualified acceptance of highly attractive sociological techniques in vogue in western countries. Instead they looked at the problems and formulated plausible questions. For e.g., Are people aware of symptoms of pulmonary TB? How many of the active cases found were aware of their symptoms attributable to TB? Can we find potential TB cases by questioning people? Can we design statistically applicable interview techniques to yield quality data? Would this data form a basis for case finding tools? Would these tools be applicable in different epidemiological situations36?
 Sociology Interrogation |
They also battled with another different, but equally important area of investigation: ‘action taking’ pattern. How much sickness, suffering, any other distress signal or what criteria prompt or impel people to take action? What will they do? Where will they go? What other influences play their parts in taking any decision? Yet another was the “acceptability” pattern. When diagnosed and informed “you have TB”, how many would accept the diagnosis and take action? An important variable is the individual’s impulsive behaviour which is indeed difficult to determine. Understandably, the behaviour would be influenced by financial, emotional, educational and religious factors34 Those battling with the above questions at the NTI, knew that despite these obvious quandaries, there would emerge a broad pattern amenable to scientific computation. The difficulty was to quantify them on a scientific basis. The purpose of doing this research was to feed the information to develop a socially applicable TB programme which could offer the best possible returns from the available resources.
The tasks set before the epidemiology section (EPS) were slightly different but yet vital. It had to obtain information on the size, extent and nature of the TB problem in the community. The information obtained should yield precise estimates of the disease burden. Thus, the work was not just the study of distribution and determinants of TB but where, which and how much the various factors attributable to TB are distributed, and interrelated. It had also to develop through systematic studies, a comprehensive picture or model into which the various determinants of TB problems are fitted and available for immediate use.
Field work was extremely labour intensive and physically exhausting. Both accuracy and high coverage for all examinations were the basis of standard scientific epidemiological investigations. The staff had to be trained to carry out different types of skilled tasks e.g., tuberculin testing, reading, X-ray examination. The tasks changed from study to study in accordance with the needs. Each item of data, therefore, was considered specific. So, both the trainers and the trainees met frequently and had long improvisation sessions. During these endeavours, both had first-hand experience of mass contact, and of ways of getting adequate cooperation of the community. Desk planning methodologies were perfected. In the process, they developed research manuals (RM), for census taking (RM/1), tuberculin testing and reading (RM/2), XT (RM/3) and LT (RM/4). These manuals were extensively used while training. In addition, variations between different workers doing the same task and different workers doing different tasks e.g., tuberculin testing, reading, enumeration, symptom questioning, etc., were kept to the minimum by constant statistical monitoring. At the end of training, the performance of staff trained in these aspects was compared and best were selected for the field work.
As data began pouring, the Statistics Section (STAT) got busier by the day. In fact, the pressure was so much it could only concentrate on receiving and checking the large quantities of data pouring in from different field activities, arranging them to be punched, after random scrutiny. There was hardly any time even for preparing tables and preliminary analysis work. There was pressure on the NTI to concentrate on planning different studies which would yield the necessary and relevant data for the proposed nationally applicable TB control programme. These studies would be carried out in Tumkur district34.
 Old X-ray unit |
 New X-ray unit |