As Regional Director for The Union’s South-East Asia office (USEA), Dr Jamhoih (Jamie) Tonsing oversees a region that presents some of the world’s most pressing public health issues.
Dr Jamie Tonsing, Regional Director, The Union SE Asia, and The Union's 'Achiever' profile for February.
As Regional Director for The Union’s South-East Asia office (USEA), Dr Jamhoih (Jamie) Tonsing oversees a region that presents some of the world’s most pressing public health issues, not least in tuberculosis (TB), where cases are at epidemic proportions.
In the World Health Organization’s (WHO) Global Tuberculosis Report 2017, India topped the list of the seven countries that account for a massive 64 percent of the total 10 million new TB cases worldwide. The report also stated that, out of 490,000 multidrug-resistant-TB (MDR-TB) cases, half of those were in India, China and the Russian Federation combined.
“India has the highest number of TB cases in the world which makes it the frontline of the fight to eliminate the disease,” says Jamie. “Unless the disease is eliminated in India, global efforts to end the disease by 2030 will remain a pipedream.”
Jamie joined USEA as Director in October 2014, after seven years attending The Union World Conference as a participant, presenter and chair of the major symposiums.
Her background did not always signal this as an obvious career move. Trained as a psychiatrist, Jamie had worked in Bangalore on the clinical management of psychiatric illnesses, which focused on interventions for substance abuse, including alcohol and drug dependence.
But in 2000, with a move to the Ministry of Health’s Central TB Division to work on India’s Revised National TB Control Programme (RNTCP), Jamie changed focus and was subsequently introduced to the work of The Union:
“The Union’s focus on scientific rigour is what makes the organisation a leader in the field. The people at The Union are pioneers and technical experts in their specific area of interest, whether that be operational research, multidrug-resistant-TB, childhood TB, or training provision. As a person interested in TB, the opportunity to work with the best was something I could not pass up.”
Today, USEA works closely with major global funders and leads on some of the region’s most extensive and ambitious projects, including TB outreach efforts, TB awareness raising, the management of tobacco control grants, and an extensive programme of operational research and training.
Jamie says, “My main role is to lead the strategic development of The Union’s programmes in the region, manage and develop the regional office and staff, and provide overall leadership to USEA office in the development and implementation of public health programmes.”
One of those flagship programmes is Project Axshya, an innovative civil society initiative funded by The Global Fund to Fight AIDS, Tuberculosis and Malaria, and designed to improve access to TB diagnosis and treatment. This was an issue highlighted in the WHO Global TB Report as being particularly relevant to countries, like India, with large unregulated private sectors and weak health systems, which ultimately impact on the under-reporting and under-diagnosis of TB cases.
Given the challenges outlined in the WHO report, the achievements of Project Axshya are even more impressive. To date, the project has reached over 17 million households with TB information and services and identified and facilitated the testing of over 220,000 presumptive TB patients that have resulted in the treatment and diagnosis of over 25,000 people with TB.
“We have established ourselves as a trusted and reliable partner in India,” says Jamie. “We are called upon by the central and state government for assistance, the biggest donors for TB and tobacco control (the Global Fund, USAID and Bloomberg Philanthropies) fund our work and other organisations look for opportunities to work with us.”
USEA is the lead partner of USAID’s Challenge TB project in India, through which the office is supporting the RNTCP’s Bedaquiline conditional access programme in six major hospitals. Through the Call to Action for TB Free India campaign, USEA has mobilised 17 corporate partnerships in under 12 months, some of which have already translated into projects; engaged both the media and notable celebrities to talk about TB; and launched the India TB Caucus in New Delhi in 2017, which had over 25 members of parliament signing up to commitments to end TB in India.
Jamie confirms the impact of the project: “The Call to Action campaign has advocacy at its core and, through innovative campaigning, has contributed to the noise around TB in India and the political commitment we are now seeing.”
Just one example of this was the TB-Free India Summit, held in Dharamshala in 2017. It brought together government officials, members of parliament and Indian celebrities to raise awareness of TB and increase the momentum to actively fight the disease. The Summit concluded with a cricket match, where India’s celebrities and politicians competed to symbolically ‘bowl TB out of India’.
Jamie is clear on the impact of turning household names into ambassadors. “We wanted to demonstrate how harnessing leadership and celebrity – personalities that the public know and identify with – is so integral to combatting TB and addressing some of the associated issues that are prevalent in the region, such as discrimination and stigma. These issues can prevent TB-affected persons seeking the help and support they desperately need, out of fear of being penalised for it.”
Famed Bollywood actor, TB survivor and campaigner, Amitabh Bachchan, has been a prolific and very visible ambassador for highlighting these issues. Jamie is under no doubt as to the impact of his involvement. “His commitment has enabled us to demonstrate that anyone can get TB. So when TB does not discriminate, TB stigma makes no sense. Mr Bachchan gives credibility and impact to this message, because he has himself experienced TB.”
She adds, “One of The Union’s strengths in India has been to convene support beyond the TB community. Also, our staff tend to stay with The Union, turnover is low and people join us even when we are unable to match the higher salary packages offered by other organisations.”
With a region demonstrating so many issues in lung health, Jamie is aware of the challenges that go hand-in-hand with trying to make a difference.
“The private health sector is providing healthcare to as much as half the populations in countries like India, Bangladesh and Indonesia. So we struggle with questions such as how do national public health programmes work with them to ensure standards are complied with in terms of patient-care? How can we ensure that necessary public health functions, such as ensuring adherence to treatment and notifying TB cases to public authorities, are undertaken and guaranteed? How can we reduce the high out-of-pocket expenses incurred by patients, particularly when seeking care in the private sector? These are all issues that we continually debate and are mindful of.”
With the United Nations’ first-ever High Level Meeting on TB scheduled for later this year, Jamie believes that these are also issues that are vital for its agenda.
Meanwhile, Jamie’s hopes for the future of the USEA office are “that we become self-reliant and independent, so we can pursue our responses to the immediate needs of those we help and can deliver what we are best at. And that we can continue to attract the best talent to our cause and build our reputation as the thought leader and expert in our area of work.”
She also hopes that her family continue to stoically bear the commitments that come from a career in public health “They deal with numerous late-night calls at home and my frequent absences with the travel. With their support, I fly in the face of what is acceptable from a ‘good’ Indian mother,” she jokes.