Imagine a world without meat. A cruel world in which you’d never savour that scrumptious nyama choma, that golden-brown deep-fried chicken or mouth-watering fried pork.
Isn’t it almost unimaginable? These are delicacies we have known all our lives. In fact, so deep is Kenyans’ love for meat that each person eats 14kg of beef per year. A Kenyan man or woman eats 38g of beef daily, according to the 2018 Economic Survey. The same data shows an individual takes seven grammes of poultry a day, which totals to 2.6kg annually. About 250g of milk and its products, such as cheese, are taken daily by one person. According to this data, in 2018, 2.8 million cows were slaughtered, a 7.3 per cent increase from 2017.
While more sheep and goats were slaughtered — 10.2 million sheep and goats slaughtered, an 11.3 per cent rise from the 9.2 million — beef was still the most consumed.
Unfortunately, if recent reports are anything to go by, a world without meat will soon exist. The cow will be the first to go if we don’t change our ways. Our misuse of antibiotics has moved from humans to livestock.
This misuse has now created a crisis. Our cows, chickens, goats, sheep and pigs are no longer responding to drugs.
If a cow contracted deadly mastitis, for instance, the cure was simple and the animal healed well. This is no longer the case. Due to antimicrobial resistance, a result of abuse of antibiotics, a cow will die of pus-filled udders from mastitis. If a cow is operated on, it will not heal and its wounds will become fatally septic.
BOW TO PRESSURE
Antimicrobial resistance is an overworked term used to describe the loss of ability of drugs to fight dangerous infections that affect humans and animals.
Samuel Kariuki, a professor of microbiology at Kenya Medical Research Institute (Kemri), tells HealthyNation abuse occurs when farmers give healthy cows antibiotics to treat “anticipated diseases”. It also occurs because farmers are fattening cattle by lacing their feed with antibiotics.
When Alexander Fleming was receiving his Nobel Prize in 1945 for discovering penicillin — an antibiotic — he warned the world that under-dosing would expose microbes to non-lethal quantities of the drug and make them resistant.
Prof Kariuki explains how this occurs in the cow as in the human: the bacterium is a cunning creature which existed way before mankind. Through the centuries, man bowed to the pressures of changing climate and other threats such as genocides, but the microscopic creature survived. Over time, it has recorded in its DNA the knowledge of what is happening around it such as the many methods used to try and wipe it out whenever it causes an illness. Armed with this knowledge, it gains new tactics to fight drugs. “When you expose bacteria to subtle doses of drugs, doses not strong enough to kill them, they learn the attacking style of that drug and change themselves for the next attack,” he says.
For instance, some antibiotics work by breaking down the cell walls of bacteria to kill the microbes. Therefore, if a dose is not strong enough to kill the bacteria, they change their cell walls to overcome that or produce enzymes to disable antibiotics.
One example of a bacteria that has learnt how to ‘defend’ itself from drugs is E coli.
The fast-growing bacterium, that causes mastitis, replicates itself every 20 seconds. Whenever E coli is under attack from antibiotics, it marshals the knowledge it has gathered over the years to withstand that attack.
“The bacteria may develop ‘pumps’ to flush out the drugs or grow a thicker layer against the drug, such that the next time medicine is given to fight illness, the bacteria will just scoff at the drug,” says Prof Kariuki.
This is already happening.
The cow, and all the animals that people consume for food, contribute immensely to this drug resistance, but strangely animals have been missing in the public discourse on controlling antimicrobial resistance.
TRACES OF ANTIBIOTICS
A 2018 research by International Livestock Research Institute (Ilri) scientists found a multidrug-resistant pathogen responsible for mastitis in milk samples in Isiolo and Marsabit counties. Dr Delia Grace, a researcher from Ilri, reported in 2015 that 22 per cent of cattle are dying annually of preventable and curable diseases.
If only the cow was dying alone. Unfortunately, it will take with it millions of people in this antimicrobial resistance crisis. This is a global public health threat even the United Nations is getting jittery about.
A report released in April 2019 by the World Health Organisation (WHO) estimated that as the cows are dying, stubborn human infections refusing to go away due to drug resistance kill 700,000 annually. Another 230,000 deaths occur from drug-resistant tuberculosis. If nothing happens, it would kill more than 10 million people annually by 2050.
There are many ways through which the resistance in cows spells doom for people.
A 2016 survey commissioned by Nation Media Group and conducted by University of Nairobi in shops in Thika and Gatundu, found that samples of poultry, beef, eggs and milk tested positive for traces of commonly used antibiotics. Poor handling of the animals when they are being slaughtered, lands these traces of antibiotics on the plates of many Kenyans. Consuming meat with traces of antibiotics, exposes people to lifelong health complications, including cancer and fuels resistance to medicine.
Prof Eric Fevre, a researcher of veterinary infectious diseases at Institute of Infection and Global Health at University of Liverpool and Ilri in Nairobi, heads a research called the Urban Zoo project. In a previous interview, Prof Fevre said abattoirs rarely observe hygiene guidelines such as preventing the meat from coming into contact with the contents of the animals’ gut — the place where all the resistant bacteria live.
The researcher is studying the social and economic circumstances under which resistance occurs. He believes the close interaction between animals and people in Kenya, coupled with poor sanitation and farming methods worsen the situation.
Farmers, who are clueless about the effect of improper use of antibiotics, use the drugs as growth promoters or to prevent diseases in livestock and fail to adhere to proper veterinary procedures.
In Nakuru, Dr Peter Lamuka, a lecturer at University of Nairobi, tested milk samples in Ndundori and Olenguruone, some of the county’s major suppliers of the commodity. He found that 47 per cent of the milk had antibiotic residues higher than the recommended levels. Dr Lamuka said when he visited the farmers, he was surprised they were not withdrawing their livestock from drugs before either milking or slaughtering them as is recommended.
Experts advise that farmers should not sell or consume milk from a cow that has been on medication for at least three days. With these subtle doses in the human body, the pathogens that make people ill also develop resistance.
Ramanan Laxminarayan, the director of Centre for Disease Dynamics Economics and Policy in the US, conducted the first global analysis of this troubling matter involving 228 countries. The study, published in the Proceedings of the National Academy of Sciences, forecast that the rampant use of antibiotics especially in livestock was accelerating the crisis.
Joseph Omega, an animal science researcher and lecturer at University of Eldoret, places the blame on quacks in the veterinary profession for the abuse of antibiotics.
People without clinical training, Dr Omega says, take advantage of farmers who depend on cattle for livelihood and have no access to proper veterinary services.
Dr Omega explains: “There are broad spectrum antibiotics that treat several diseases and this is what the quack will use to inject the cow because as long as it is a bacterial disease, chances of the cow getting well are high and then they will be known as the ‘doctor who treated my cow’ by the farmers.”
The problem with this, he says, is when the disease is viral and should, therefore, not be treated by antibiotics or it is bacterial and not showing signs such as acute mastitis. Administering the antibiotic will not help.
In rural areas, quacks are the only hope that farmers have. In Ligodho village of Ndhiwa, Homa Bay County, small-scale farmer and teacher Joseph Opiyo talks of how his heart went out to his only cow when he was certain it had mastitis. He called a “vet” who he knew had not completed his high school education, but had “treated” another dying cow in the neighbouring village.
Jo Blek, as they are fondly known in the village, went to his home and injected the cow, a service for which he paid Sh200. “The cow died the following day,” he says.
Dr Omega says a novel antibiotic, Gentamycin, has been abused in this way and is gradually becoming resistant.
But, what has the farmer to do in the absence of trained veterinary officers to offer extension services?
Dr Naphtali Mwanziki, the head of the Directorate of Veterinary Services, traces the dilemma farmers face to a historical decision. Dr Mwanziki tells HealthyNation in the 1980s veterinary drugs and services were supplied to farmers for free by the government through his department. However, the Structural Adjustment Programmes imposed in Kenya, as the country was going through a financial crisis, privatised veterinary services farmers now have to pay for.
Dr Samuel Kahariri, the Kenya Veterinary Association chairman, says his experience with farmers from arid and semi-arid regions has persuaded him that private veterinary services would never work in Kenya.
Most of the cows are in the hands of small-scale farmers. The UN’s Food and Agriculture Organisation (FAO) estimates that 70 per cent of Kenya’s food supply comes from small-scale farmers.
“These farmers do not want to part with an extra coin, so they would rather buy the medication and inject their cows themselves,” says Dr Kahariri.
Quackery is not only in animal “doctors”, but also those working in human drug stores. A recent study by Dr Dishon Muloi from Ilri on the knowledge and attitudes of people operating pharmacies and veterinary drug stores, revealed some ghastly statistics: 10 per cent of pharmacies and 26 per cent of agrovets in Nairobi are run by people who have not attended any medical or veterinary training, or even formal education.
Dr Muloi tells HealthyNation: “I asked one whether they have antibiotics and he said ‘yes, we have a lot of Panadol’.” Panadol is not an antibiotic.
Nearly 100 per cent of the veterinary stores, Dr Muloi’s study showed, did not ask farmers for any prescription when they went to buy medication. “A total of 50 per cent of the human drug stores said they require prescription for the drugs they sell, but while I was seated there I saw people come in and buy the medication without any prescription,” he says.
A spot check by HealthyNation on pharmacies and agrovets in Kisumu, Kakamega, Webuye, Kitale, Migori, Homa Bay and Nairobi revealed that pharmacies only restricted purchase of medication meant for mental health, but not antibiotics such as Augmentin. The agrovets did not ask for prescription.
The law does not help this situation either. Kenyan farmers are aided by quacks in abusing a last-resort antibiotic called Colistin. Colistin is a very old antibiotic. Doctors stopped using it in the 70s because of its harsh side effects especially on the kidneys, but it was brought back to clinical care as other antibiotics began losing their effectiveness.
It is often used to manage hard-to-treat bacteria that resist one of the last lines of defence, antibiotics called carbapenems.
Dr John Kiiru, a microbiologist from Kemri, says if a disease becomes resistant to Colistin, doctors will have run out of options and the patient will most likely die.