Tuberculosis takes its toll: 410 people in Tower Hamlets, Newham and Hackney are suffering fron TB. An estimated 4,000 EastEnders are 'carriers'. Esther Oxford reports

In the kitchen of a council flat on the Isle of Dogs lies a boy swathed in rags: dirty, smelly, thin, sick.

Jo-Ann Pinney, a liaison nurse at the London Chest Hospital, Bethnal Green, is sitting by his side. She talks softly, soothingly, but the boy can hardly respond. Yes, he whispers, he is taking his antibiotics. Yes, he wishes his mother could get a visa to come over and live, but in the meantime he has his brother. And he is getting stronger everyday.

Outside, children are playing. But the Pakistani boy rarely ventures outside. Thirty or forty years ago, people in east London would finger their collars for luck whenever a dead tuberculosis victim was carried by. Nowadays TB carriers are more likely to be confronted with abuse.

Tuberculosis, according to Dr Nabil Jarad, a lecturer at the London Chest Hopsital, is a growing problem in Tower Hamlets. The number of people who have the disease is ten times the national average.

More than two thirds of those attending Dr Jarad's TB clinic are from

ethnic minorities. Most pick up the infection in Pakistan or India and bring it back to London, he says.

Between 10 per cent and 15 per cent of the 'strains' are resistant to the antibiotic chemotherapy used in Britian to treat the disease. 'In some parts of South-East Asia up to 25 per cent of patients will not respond to conventional treatment,' Dr Jarad says.

But when arriving passengers are filtered through customs at Heathrow, few are identified as infectious. 'Non-medically qualified immigration officers are given the job of identifying ill-looking patients at Heathrow,'

says Jarad. 'As a result, only 10 per cent of new immigrants are screened.'

Most asymptomatic carriers walk straight back into the community and into their TB-conducive dwellings: overcrowded, often unhygienic council flats.

Miss Pinney works in the Tower Hamlets area. Her job is to visit sick patients and to 'contact trace' friends and relatives who have been in close proximity (shared a lavatory or a bath) with a TB-infected person.

She says that 96 per cent of infectious patients are caught in the local authority 'notification net' within a year of arriving in the country.

But those immigrants carrying a dormant infection are near impossible to identify until the bacteria becomes active. 'We don't know who they are and how many there are,' Miss Pinney says, fustration edging into her voice.

That morning, there had been reports from Hong Kong and the United States that aircraft passengers who boarded in India would be screened for pneumonic plague symptoms before being allowed to enter the country.

The official story at Heathrow was that immigration officers were taking 'appropriate measures' to treat new arrivals suspected of carrying the plague.

Miss Pinney welcomed the initiative but said that 'host' local authorities should follow Tower Hamlet's example and take an active interest in the health of new immigrants at all times.

'In Tower Hamlets every single new entrant receives an introductory letter written in their own language telling them how to get access to the health

services and how to register with a GP. Anyone with an infectious disease cannot help but be spotted,' she says.

In a quiet area of Shadwell, the Singh family were waiting for a visit from Miss Pinney. They have a 14-year-old son with tuberculosis at the Royal London Hospital, Whitechapel.

The boy showed the first signs of tuberculosis on a trip to India four months ago. He had a fever, chest pains and was coughing up blood. His father took him to a doctor immediately; since then he has shown little sign of improvement.

Mr Singh misses his son: 'When will he come home? My children are asking for him,' he says, smiling worriedly, his arms wrapped protectively around his little girl.

'Soon, soon,' Miss Pinney soothes. 'As soon as he is better.'

In the past month the whole family has been screened as part of the Tower Hamlets initative. All have been given a skin test and follow-up consultations.

As yet none have tested positive - although the (pregnant) mother is showing signs of malnutrition and has a barking cough. The negative results are a surprise: the family is large, the flat squashed and stifling. There is no play area for the children outside, so the toddlers have to make do with the huge plastic car and a rocking horse parked in the centre of the lounge.

Tuberculosis has a real stigma, Miss Pinney explains later. Home visits by health workers need to be kept discreet: if families believed that screening or treatment might attract unwanted or hostile attention, many would be reluctant to come forward.

'Much of the stigma is left over from twenty or thirty years ago when children were brought up to fear TB, and to wash their hands,not chew their pens,not use public lavatories accordingly,' she says.

But some people have tried to revive the stigma by fanning fears of an epidemic. Rumours have been spread and leaflets distributed, warning people not to approach (Bangladeshi) neighbours because 'everyone who spits has got TB'. 'Tuberculosis is being used as a weapon to drive people out,' Dr Jarad says. 'The fly posters and door-to-door handouts are being used by racists to scapegoat Indians and Pakistanis as the spreaders of the disease.'

Miss Pinney agrees. 'People like to blame someone. Bangladeshis are an easy target.

'I've had people turn up at housing association meetings and tell me that 80,000 residents in Tower Hamlets have got TB and that it is all the fault

of the Bengalis.

'I just say: 'Well, how often do you mix with your Bangladeshi neighbours?' The usual reply is 'Rarely'. 'Well, what is your worry then?' I ask.'

At the moment a rigorous campaign is in place to try and control the spread of tuberculosis: all newborn babies in Tower Hamlets are vaccinated at birth; school children who miss the BCG vaccination at school are given follow-up appointments; contact tracing is diligently pursued and an educational health promotion is about to swing into action.

Still, says Dr Jarad, this is not enough. Most crucial is the need to check immigrants as they arrive in Britain.

The boy in the kitchen, at the flat on the Isle Of Dogs, is one of those who slipped through the net. He was only identified as a TB victim when his weight plummeted below six stone. By that time he was so sick he spent the next three months in bed at the Royal London Hospital. He was discharged several months ago but is still too weak to leave his flat.

On the fridge, 3ft away from the plastic sofa, is a photograph in a gold coloured frame. It is a picture of his mother, in traditional dress, her arms around three children. The boy misses his mother: he has no-one to comfort him, encourge him and bully him into taking his tablets.

No-one except Miss Pinney.

(Photographs omitted)

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