QUETTA , 23 April 2007 (IRIN) - QUETTA , 23 April 2007 (IRIN) - Ayeda Kulsoom, 17, had been coughing up blood for several weeks before her mother brought her to a health centre in Quetta, the dusty provincial capital of Pakistan's vast, south-western Balochistan province.

"We were shocked when doctors said she has tuberculosis [TB]. Everyone says that is an incurable sickness," Rahima Bibi, Ayeda's mother, said as she sat next to her painfully thin daughter, the teenager's shawl failing to hide her frailty or her laboured breathing.

But despite her family's fears, doctors at Quetta's Jinnah General and Chest Hospital - the city's leading facility for the treatment of TB - have assured Ayeda and her parents that, with proper treatment, she will be cured.

"They say it will take time and I must take medicines regularly for many months, but I will get well," Ayeda said.

In addition to the disease itself, the family must fight the stigma that comes with a sickness associated with over-crowded living conditions and poverty; a disease that takes thousands of lives every year.

Despite official campaigns over the past few decades, the disease is perceived as being incurable and its infectious nature means the sufferer is often shunned.

Ayeda's parents fear that if it becomes known she suffers from TB, it may prove impossible to find a husband for her.

Such is the stigma that close relatives of Atiqa Bibi, 60, and her husband who has TB had stopped visiting them since they learnt of his condition.

Among infectious diseases, TB remains the leading cause of death by infectious disease in Pakistan. Each year, according to the World Health Organization (WHO), 250,000 more people across the country contract the disease.

Most of those afflicted are never diagnosed, due to limited awareness, a lack of healthcare facilities and abject poverty, which keeps people away from clinics and hospitals because of the costs involved, specialists say.

Tuberculosis is spread by inhaling droplets spread by an infected person when he or she coughs. The sickness usually affects the lungs, but if untreated it spreads to other parts of the body, including the bones.

Poverty is endemic

The problem of diagnosis and treatment is especially acute in the under-developed Balochistan province, spread over 350,000 sq km and with a population of about 12,000,000 - 565,000 of which live in Quetta. Poverty is endemic, literacy rates less than 40 percent (only 20 percent for women) and health facilities extremely poor.

"Many people in Balochistan, through their lives, never come into contact with a doctor or anyone else from the medical profession," Farooq Ahmed, a social activist currently working on a project to track educational needs, told IRIN.

According to the WHO's Global TB report for 2006, Pakistan ranks seventh among the 22 countries of the world with a high burden of TB. There has also been growing concern over the rise of drug-resistant TB, which does not respond to standard treatments.

"This comes about mainly when drugs, such as antibiotics, are either wrongly prescribed or patients do not complete courses of treatment, either because they feel better or the costs of the medication is too high," said Dr Ameena Pervaiz, a physician, who works in Quetta with a charitable organisation.

Special programmes to manage TB have been run since 1995 in Balochistan by Pakistan's health ministry. "At least 13,500 patients have been treated over the past three years in the province, and we now have 65 diagnostic centres and 107 treatment centres which are functioning in 28 districts of Balochistan," said Dr Baseer Khan Achakzai, provincial manager of Tubercolosis Control Programme, Balochistan.

He also emphasised that the government was making "full efforts" to ensure testing facilities, medicines and other medical supplies were available, wherever needed.

However, despite how far the health ministry has come in tackling TB, it still has a long way to go. "Where my family lives, conditions are just terrible," said Ghulam Nabi, 40, who works as a clerk in Quetta but lives in Jaffarabad district, to the east of Balochistan along its border with the Punjab province. "There are no health facilities, and even those who are very gravely ill often never reach a doctor," he added.

These issues, aggravated in Balochistan because of the immense distances between towns and limited road or rail transport facilities, makes TB particularly hard to manage. The fact that childhood immunisation against the disease, as well as other infectious illnesses, is still not universal, makes the challenge even harder.

"I've now been asked to get my five younger children vaccinated against TB," Ayeda's mother, Raheema Bibi, said. "I wish I'd known about the vaccination earlier, when my daughter was born 17 years ago, so I could have saved her from this curse."

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