TB carers in Kenya
"MOST OF THE PATIENTS THAT HAVE BEEN TO BIG TOWNS ARE LIKELY TO BE HIV POSTITIVE. ALTHOUGH WE CAN FULLY TEST THEIR STATUS HERE, OUR HANDS ARE TIED, AS CONSENT MUST BE SOUGHT FROM THE PATIENT."
In a remote centre in Kenya called Loitoktok live the Maasai, a nomadic pastoralist group. The Loitoktok sub-district covers an area of over 6000 square kilometres and has a population of about 100,000 people. The majority live in small, dark, humid huts with poor ventilation.
Dr Samuel Solonka Pilipili, together with two nurses, runs a donor-funded project also supported by the Kenya government. He has adopted the World Health Organization’s Daily Observed Treatment Short-Course (DOTS) regime in this mission. This clinic, called Manyatta, was set up in 1996 and consists of 15 huts supposed to host five people each. At the moment, however, the huts are overstretched with 106 patients. They are 260 km from Nairobi, an eight hour trip by a dirt road that is impassable in the wet season.
A heart-rending story in the Manyatta is that of a family of five. Ngina and her three children owe their lives to a good samaritan who was alerted by neighbours of the sick family. Ngina had a 9 month old baby who succumbed to tuberculosis a few days after arriving at the Manyatta Clinic.
She tells her story; "It started with a flu-like illness with a cough from one of my sons who was treated for pneumonia in a nearby clinic. Nothing improved and soon all of us were coughing. My husband started coughing too but was not keen on having us seek treatment elsewhere since he had not appreciated the gravity of the matter,” says Ngina.
Ngina continues: "When our neighbours noticed we were not coming out they asked a businessman who had come around to buy skins to bring us here (Manyatta, 80 kilometres away). When we tested positive for TB, we were asked to remain here for treatment. My baby died after a few days," she says sobbing, "Dr Pilipili sent for my husband who was also infected by TB. He went home today to bring maize flour so that we can make porridge for the children to subsidise the ration we get here," she adds.
According to Dr Pilipili, Ngina's story illustrates the difficulties almost all his patients go through to reach the clinic. "A woman might complain of sickness, but the man will just postpone or send for paracetamol from the shop. It's only when things get worse, like a patient coughing blood, that a man agrees to take his wife to hospital," says the doctor.
Next door to this family's hut is another couple with their two-year-old daughter. The man, James, used to work at a tourist hotel in Kenya's coastal town of Malindi. When he became sick, he was told at a dispensary there that he was suffering from the effects of the ocean breeze since he was a night watchman. This was in November 2001. He was later diagnosed with TB and was put on treatment (not in Manyatta), which he says he completed. When he came home, the sickness seemed to recur, and meanwhile his wife became infected, along with their daughter. They have now been at the Manyatta for three weeks and he says; "I am feeling much better now. I had started dreaming about death." Dr Pilipili says "Once a member of the family becomes infected, it is almost natural that all the others will too,” adding that he tests all family members once he detects one among them has contracted TB.
Sadly for James his story may not end there. Dr Pilipili says his diagnosis may not just be TB. "Most of the patients that have been to big towns are likely to be HIV positive. Although we can fully test their status here, our hands are tied, as consent must be sought from the patient."
So far James has declined to be tested although he has gone through mandatory counselling which all TB patients are put through to prepare them for post-HIV-test eventualities. Dr Pilipili says there is a strong link between TB and HIV/AIDS.
According to Dr Pilipili, the stigma attached to TB, unlike in the days gone by, is no longer a problem. "Previously, this disease has been associated with witchcraft and therefore nobody sought medication or even admitted they had it. It was just like the stigma currently faced by those who are HIV positive. I am happy however that the community is now a bit enlightened and actually acts as a watchdog,” says Dr Pilipili.
He is quick to add, however, that illiteracy is still the biggest hindrance to achieving 100 per cent result in dealing with TB. He says DOTS helps a lot since patients are monitored closely and interact with one another. "After four months here, they realise their case is not unique. When we release them and explain in their mother tongue (Maasai) how they are to continue with their medication for the remaining three months, they faithfully adhere," he says.
Since the project is funded by foreign agencies through the government, cases of the facility going without medicine are very rare. “We normally have a six-month buffer stock and apart from some little logistical problems to do with transport once in a while, the mission is running well,” says Dr Pilipili.
HDN Key Correspondent Team
Email: correspondents@hdnet.org
(April 2005)
In a remote centre in Kenya called Loitoktok live the Maasai, a nomadic pastoralist group. The Loitoktok sub-district covers an area of over 6000 square kilometres and has a population of about 100,000 people. The majority live in small, dark, humid huts with poor ventilation.
Dr Samuel Solonka Pilipili, together with two nurses, runs a donor-funded project also supported by the Kenya government. He has adopted the World Health Organization’s Daily Observed Treatment Short-Course (DOTS) regime in this mission. This clinic, called Manyatta, was set up in 1996 and consists of 15 huts supposed to host five people each. At the moment, however, the huts are overstretched with 106 patients. They are 260 km from Nairobi, an eight hour trip by a dirt road that is impassable in the wet season.
A heart-rending story in the Manyatta is that of a family of five. Ngina and her three children owe their lives to a good samaritan who was alerted by neighbours of the sick family. Ngina had a 9 month old baby who succumbed to tuberculosis a few days after arriving at the Manyatta Clinic.
She tells her story; "It started with a flu-like illness with a cough from one of my sons who was treated for pneumonia in a nearby clinic. Nothing improved and soon all of us were coughing. My husband started coughing too but was not keen on having us seek treatment elsewhere since he had not appreciated the gravity of the matter,” says Ngina.
Ngina continues: "When our neighbours noticed we were not coming out they asked a businessman who had come around to buy skins to bring us here (Manyatta, 80 kilometres away). When we tested positive for TB, we were asked to remain here for treatment. My baby died after a few days," she says sobbing, "Dr Pilipili sent for my husband who was also infected by TB. He went home today to bring maize flour so that we can make porridge for the children to subsidise the ration we get here," she adds.
According to Dr Pilipili, Ngina's story illustrates the difficulties almost all his patients go through to reach the clinic. "A woman might complain of sickness, but the man will just postpone or send for paracetamol from the shop. It's only when things get worse, like a patient coughing blood, that a man agrees to take his wife to hospital," says the doctor.
Next door to this family's hut is another couple with their two-year-old daughter. The man, James, used to work at a tourist hotel in Kenya's coastal town of Malindi. When he became sick, he was told at a dispensary there that he was suffering from the effects of the ocean breeze since he was a night watchman. This was in November 2001. He was later diagnosed with TB and was put on treatment (not in Manyatta), which he says he completed. When he came home, the sickness seemed to recur, and meanwhile his wife became infected, along with their daughter. They have now been at the Manyatta for three weeks and he says; "I am feeling much better now. I had started dreaming about death." Dr Pilipili says "Once a member of the family becomes infected, it is almost natural that all the others will too,” adding that he tests all family members once he detects one among them has contracted TB.
Sadly for James his story may not end there. Dr Pilipili says his diagnosis may not just be TB. "Most of the patients that have been to big towns are likely to be HIV positive. Although we can fully test their status here, our hands are tied, as consent must be sought from the patient."
So far James has declined to be tested although he has gone through mandatory counselling which all TB patients are put through to prepare them for post-HIV-test eventualities. Dr Pilipili says there is a strong link between TB and HIV/AIDS.
According to Dr Pilipili, the stigma attached to TB, unlike in the days gone by, is no longer a problem. "Previously, this disease has been associated with witchcraft and therefore nobody sought medication or even admitted they had it. It was just like the stigma currently faced by those who are HIV positive. I am happy however that the community is now a bit enlightened and actually acts as a watchdog,” says Dr Pilipili.
He is quick to add, however, that illiteracy is still the biggest hindrance to achieving 100 per cent result in dealing with TB. He says DOTS helps a lot since patients are monitored closely and interact with one another. "After four months here, they realise their case is not unique. When we release them and explain in their mother tongue (Maasai) how they are to continue with their medication for the remaining three months, they faithfully adhere," he says.
Since the project is funded by foreign agencies through the government, cases of the facility going without medicine are very rare. “We normally have a six-month buffer stock and apart from some little logistical problems to do with transport once in a while, the mission is running well,” says Dr Pilipili.
HDN Key Correspondent Team
Email: correspondents@hdnet.org
(April 2005)
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