TB time-bomb ticks as State runs out of cash

• Patients only wear masks at clinic and are allowed to mingle freely in public areas

Patients with a dangerous and contagious strain of tuberculosis are either not receiving treatment or have been allowed out of hospitals because the government does not have the money to isolate and treat them.

Of the 300 Kenyans diagnosed with drug-resistant TB, only 45 are receiving some form of treatment in hospitals — 35 at the Kenyatta National Hospital and 10 at the Moi Referral Hospital in Eldoret.

That leaves 255 patients who are not on any structured treatment.

But even those who are being seen by doctors are not happy with the care they receive. Some of the patients with the deadly disease being seen at KNH complain that treatment is sporadic while in Eldoret the patients are getting home-based care from community workers.

The government policy states that anybody with the multi-drug resistance Tuberculosis (MDR-TB) must be treated by medical staff who have had formal training in treating TB.

According to Dr Joseph Sitienei, head of the Division of Leprosy, Tuberculosis and Lung Diseases in the Ministry of Health, the government has asked donors for help.

Asked whether they have considered isolating the patients to minimise transmission of the deadly strain to other people, Dr Sitienei said this could raise serious human rights issues.

The strain, which is spread usually from person to person by breathing infected air during close contact, is highly infectious and if not promptly and effectively treated can lead to the development of yet another variant called Extensively Drug Resistant Tuberculosis (XDR-TB), which is nearly impossible to treat. Those with low immunity are more prone to infection.

MDR-TB most commonly develops in the course of treatment for ordinary TB. It is mostly a result of doctors giving inappropriate treatment, or patients missing doses, failing to complete their treatment or getting substandard drugs.

While the daily, two-year treatment of the 300 would cost about Sh400 million, at Sh1.3 for each case, not treating them would be much more expensive because of its capacity to spread fast, especially among the poor.

The country, according to a 2005 government report on TB, does not have enough trained and experienced staff to deal with the emerging strains.

Because of staff shortage, the 35 patients attending Kenyatta Hospital are asked to go home with injections on weekends because there is no one to attend to them on those days.

Ideally, the 35 on the treatment programme should be isolated, but according to Dr Henderson Munene Irimu, the head of HIV/Care and Treatment at KNH, this is not possible because the hospital does not have the space and facilities.

Talking to the Nation at the hospital on Friday, Dr Irimu, said KNH has an isolation ward for only 15 patients and the rest are allowed to go home and commute to the hospital daily for treatment. The available space, he said, is only for very serious cases.

Since most of the sick are poor, the hospital, with assistance from donors, has been giving the commuting patients Sh300 a day for fare in an effort to make sure they attend the clinics every day.

In most countries, patients with this type of TB are usually isolated as a way of controlling the spread of the strain. But in Kenya patients walk around unaware of the danger they pose to others.

Ironically, at KNH, in the secluded field where the clinic is situated, both patients and doctors must wear masks. But when they leave the clinic and go into crowded matatus and other public places, they are allowed to interact freely.

According to one patient, who cannot be named because of the stigma associated with disease, wearing protective clothing in the clinic does not make sense since he does not wear a mask at home or when in public places.

“If the doctors think we are that dangerous, why do they allow us to walk around?” he asked.

The drugs, taken daily to treat this condition are very strong and sometimes have serious side-effects, which keep patients out of jobs.

If patients miss their medicines or the treatment protocol is disrupted, then they are at high risk of developing the even more dangerous XDR-TB.

The situation in Moi Teaching and Referral Hospital is a little different. There are 10 patients currently on treatment and according to Dr Lameck Diero, head of the Department of Medicine at the hospital, the patients are treated at home.

Cannot access

The hospital works together with local health centres where the patients can go for injections and drugs. Those who cannot access a health centre are attended to in their homes by community workers.

Dr Diero said that the patients are provided with masks and advised on how to reduce the chances of infecting others, but he admitted that “the risk of infection is still there”.

According to Dr Irimu, the situation could get out of hand if the government does not act fast to treat all MDR patients.

Under Vision 2030, the Ministry of State for Planning, National Development recognises the need to manage MDR-TB.