In a Garment Factory
Khadiza Begum left the paddies and bamboo houses of her native village for the whirring garment factories of Chittagong, Bangladesh’s second most populous city and the country’s busiest seaport. Soon after getting a job as a packer in a factory that churns out polo shirts for Western brands, she developed a cough. When she finally decided to visit the factory’s hospital, she learned she had tuberculosis. “I had a cough for months, but I did not know what tuberculosis was. I thought it was only a bad cough,” said Khadiza, a petite, light-boned woman of 23. “When I went to see the nurses at the factory’s hospital I learned about the disease,” she said, speaking softly through a purple surgical mask, her head covered with a red cloth printed with flowers. “I feel stronger since taking my medication. The nurse makes sure I take my pills and after my day off I need to show her the empty tablet.”
With the support of a Global Fund program in partnership with the government of Bangladesh and civil society organizations, poor garment workers like Khadiza are receiving prevention, treatment and care for TB. Bangladesh ranks within the top 10 of the 22 countries considered to be “high burden” by the World Health Organisation, with 340,000 new cases of TB per year. Because TB is generally transmitted in crowded indoor spaces, factory workers are considered a high-risk group, particularly in Bangladesh, a country of 150 million people. The hospital at the Chittagong Export Processing Zone, a sprawling manufacturing compound where 184,000 textile and manufacturing workers are employed, has a center for DOTS treatment and staff made up of doctors, nurses and lab technicians. It also provides outreach TB and HIV awareness workshops for workers and factory managers. “Tuberculosis is a serious problem in Bangladesh so this program is critical,” said Dr. Abu Taslim, chief health administrator at the industrial zone’s hospital. “Many workers come from poor rural areas with high illiteracy rates so it is important to educate them about TB. When a worker has symptoms they can come to the clinic, get tested and treated and continue having a job.”
The TB program is made possible thanks to the close partnership between the Bangladeshi government’s National Tuberculosis Program and BRAC, the oldest and largest non-governmental organization in Bangladesh. The NTP has played a leading role in the expansion of DOTs program all over Bangladesh. “One of the most important things about fighting TB is to make sure that the patient adheres to treatment,” said Dr. Shayla Islam, senior TB program specialist for BRAC. “The treatment is long and hard, so our trained health providers make sure the patients are following the treatment and getting the right care.” Khadiza and millions like her have helped Bangladesh turn into an export powerhouse. The booming garment industry is the economic engine of Bangladesh, which has made significant progress in recent years in a number of areas including maternal mortality, women’s literacy and life expectancy. Eighty percent of the country’s garment workers are women, from rural areas. With one of the lowest minimum wages in the world, Bangladesh attracts billions of dollars in orders from Western brands and retailers such as Benetton, Gap, Inditex and Walmart. To stimulate economic growth and job creation, the Bangladeshi government created a network of export zones, luring foreign investment with tax incentives and other benefits. Wages are higher and conditions are better in the export zones.
The death of more than 1,000 people after an illegally constructed factory building collapsed earlier this year in an area outside an export zone in the outskirts of the capital, Dhaka, has brought heightened scrutiny of workplace conditions in Bangladesh. The accident has intensified pressure on global apparel companies to improve worker safety in the factories they use in Bangladesh. Kamrul Islam, manager of Bangladesh Spinners & Knitters Ltd., a factory that manufactures clothing for Lacoste and Marks & Spencer, said the TB programs are helping factories and managers in Bangladesh shoulder their share of corporate social responsibility. His factory has staff nurses and the medication they use is provided through Global Fund grants. Khadiza was given a three-month sick leave with pay, he said. “We are very grateful to the DOTS program. Thanks to it our workers are healthier,” said Islam. “Our workers are our best assets. When a worker is sick the business loses out too. Healthy people make healthy products.”
As a late-afternoon orange haze fell over Chittagong, Khadiza, who makes US$55 a month, was about to make her way home through the din of cars and rickshaws that congest the city’s streets. Now that she feels stronger, she can go to work and help support her family instead of staying home, she said. The ships at the port outside the export zone are busy being loaded with appliances and garments, some of which have passed through Khadiza’s hands, before they sail out into the dusky glow of the Bay of Bengal.