Photo:Ruhul, 27, who has regained his health after battling undiagnosed TB for six months and John Keats, who died of tuberculosis in 1821 aged 25.

Emily Brontë. DH Lawrence. John Keats. The list of great writers who had their lives cut short by tuberculosis goes on. During the Romantic era, the disease was seen as requisite to creative genius. Those affected by the illness known as ‘consumption’ or ‘the white plague’ had slender figures, rosy cheeks and porcelain complexions; physical attributes considered highly fashionable as they came to denote intellect and poetic sensitivity.

Bangladesh's biggest killer

There is nothing desirable about the tuberculosis epidemic in Bangladesh, where over 80,000 people die from TB every year. There are a multitude of reasons for Bangladesh being the 6th most endemic country in the world - high population density, environmental pollution, poor living conditions and a lack of knowledge about the disease being just a few.

Bangladesh is extremely low-lying and flat, and as a result is subject to frequent flooding. The large rivers and hundreds of tributaries are both a giver and destroyer of life; flooding replenishes the fertile soil enabling agriculture and livelihoods to flourish, but also causes widespread devastation and hardship.

Although Bangladesh is one of the most densely populated countries in the world, many people still live in remote, rural communities. When the floods hit, communities living on sandbank islands (known as chars) become even more cut off from health care facilities than during the dry season. Compounding this, there are cultural values still prevalent which prioritise traditional healing methods over modern medicine, leading to late or no diagnosis of TB.

Many cases of TB go undetected

In remote communities it is estimated that two thirds of TB cases are missed. Given that a single infected person can infect a further 15-20 people in a year, TB detection and treatment is vital for these communities for whom TB results in 3-4 months of work time lost annually, and a 20-30% loss of earnings.

The impact of TB on income, when combined with an insecure livelihood constantly at the mercy of the weather, means remote communities are pushed further into extreme poverty.

Remote communities are neglected by health systems

Our work with remote communities focuses on increasing detection and facilitating access to treatment. An initial survey we carried out in north-west Bangladesh revealed that although 92% of respondents knew that TB is curable, only 15% knew the cause, 53% knew the signs and symptoms and only 49% knew where to go for treatment.

Within a few months of the survey we trained 200 volunteers, who have reached around 10,000 people who can now recognise the symptoms of TB and know where to go for treatment. This has resulted in earlier detection and diagnosis of cases, thus reducing the spread of the disease. 

The World Health Organisation’s slogan for World TB Day 2014 is “Reach the 3 million”, which aims to help the vast number of people who do not get the treatment they need.  The remote communities of north-west Bangladesh undoubtedly form part of the 3 million who are missed by health systems.

There were 8,751 detected cases of TB in the UK in 2012, however the WHO estimated that the actual total was 9,400. In stark contrast, there were 173,619 detected cases in Bangladesh, whilst the WHO estimated a total of a staggering 350,000.

This clearly demonstrates gaps and inequities in global health systems which need addressing as a matter of urgency - or the world will incur the devestating cost, both human and economic, of multidrug-resistant TB. 

Savithri and her daughter Vani both endured a gruelling regime of medication to cure them of multidrug- resistant tuberculosis.