Unsung Hero: Education and social mobilization: The keys against TB in a Kenyan slum
(For the last two years, Dr. Nyamato has worked at one of a few tuberculosis (TB) and human immunodeficiency virus (HIV) clinics in Nairobi's Mathare slums. The Blue House clinic is run by Medecins Sans Frontieres (MSF). He has learnt two things: that TB is one of the treatable diseases yet it continues to kill many Kenyans and that there are many innovative ways to educate the public and get them tested and treated. He shares his story with HDN)
HDN: Do all your patients come from Mathare slums?
DR Nyamato: No, being one of the small number of TB-HIV specialist clinics in Kenya, we get referrals from other hospitals such as Mbagathi hospital. Others come to our clinic first and are then transferred to other centres but 60% of our patients come from Mathare.
HDN: What challenges do you face working with patients?
Dr Nyamato: The main challenge I face is convincing TB patients to get tested for HIV, it is a fact that 50% of the TB patients attending our clinic are HIV positive but one risks jeopardizing the whole programme if one insists on testing. I would like a situation where the patients get themselves tested and if they turn out to be positive, they can access care and treatment early, but they are likely to share their experiences about testing with others and new patients may hesitate to come. The majority of our clientele is from the slums which are a closely knit society and word travels fast.
There is also the challenge of divorcing TB from HIV. Yes, TB is the number one cause of death among HIV patients but we would want everyone who has signs of TB to get tested without fear regardless of what they think or fear their HIV status might be. This is again a matter of information and education. Just like in malaria, if people in the villages notice signs of malaria, they are able to run and seek treatment. We want it to be known that TB, like Malaria, is preventable and treatable.
HDN: What motivates you?
Dr Nyamato: My relatives have died or suffered from TB and I want to play a social mobilization role in my society. I want everyone to be in a position to seek medical attention.
HDN: How do you involve people with TB?
Dr Nyamato: Granted that 60% of our patients come from Mathare slums, we have close follow-up with the network of Community Health Workers (CHW). We ensure that each patient is attached to a CHW and he or she is closely followed up.
At the MSF clinic, we like trusting the patient with their own medication, we ensure they follow the direct observed treatment short course (DOTS) during the first two months but after that, we give weekly doses. Nevertheless we monitor the situation carefully. The patients are assigned counselors who keep in touch with them and ensure that each week they pick up their dosages. They are expected to bring the empty foils at the time of their next visit. In case of default, the counselors visit the patients in their homes to find out why they have not visited the clinic. This way, the patients have a say in their own health development because they are responsible for ensuring the medicine is taken on time every day.
Every morning, our counsellers and community health workers sit together to review the situation. Thus we are able to identify those patients who are defaulting and those adhering to medication. The community health workers also update on the education campaigns and identify people or areas in the slums that need to be targeted.
HDN: What is your vision?
Dr Nyamato: I would like to see a situation where in Kenya, treatment for tuberculosis is available at village level. Yes, the hospital infrastructure may not be so good, but if we maximize on what we have and continually train our medical and paramedical personnel, I believe this is possible. Like now, many of the nurses in government hospitals may not be well versed with modes of testing for TB. They still test the sputum only, but TB (especially in late stages of HIV infection) can manifest itself in the liver, stomach or bones etc or can be sputum negative.
I would like an improvement in the medical staff's ability to perform tests and an enhancement in the quality of the laboratory services. Right now, the treatment centres in Mbagathi hospital, Kenyatta National hospital and other centers are doing their best to cope with the rush of patients. But there is need for more centres and facilities just in case the number of patients rises. You see, the HIV-AIDS pandemic caught us unprepared so we have to work backwards, trying to design mechanisms that we should have worked out much earlier.
In this regard, I would like to see a district or local hospital where all patients, whether they have TB, HIV and/or malaria are treated together. Specialist clinics are good but to minimize stigma. I believe we will have to all work together and design such coping mechanisms.
HDN Key Correspondent Team
Email: correspondents@hdnet.org
Source: Stop-TB eForum, join-stop-tb@eforums.healthdev.org
HDN: Do all your patients come from Mathare slums?
DR Nyamato: No, being one of the small number of TB-HIV specialist clinics in Kenya, we get referrals from other hospitals such as Mbagathi hospital. Others come to our clinic first and are then transferred to other centres but 60% of our patients come from Mathare.
HDN: What challenges do you face working with patients?
Dr Nyamato: The main challenge I face is convincing TB patients to get tested for HIV, it is a fact that 50% of the TB patients attending our clinic are HIV positive but one risks jeopardizing the whole programme if one insists on testing. I would like a situation where the patients get themselves tested and if they turn out to be positive, they can access care and treatment early, but they are likely to share their experiences about testing with others and new patients may hesitate to come. The majority of our clientele is from the slums which are a closely knit society and word travels fast.
There is also the challenge of divorcing TB from HIV. Yes, TB is the number one cause of death among HIV patients but we would want everyone who has signs of TB to get tested without fear regardless of what they think or fear their HIV status might be. This is again a matter of information and education. Just like in malaria, if people in the villages notice signs of malaria, they are able to run and seek treatment. We want it to be known that TB, like Malaria, is preventable and treatable.
HDN: What motivates you?
Dr Nyamato: My relatives have died or suffered from TB and I want to play a social mobilization role in my society. I want everyone to be in a position to seek medical attention.
HDN: How do you involve people with TB?
Dr Nyamato: Granted that 60% of our patients come from Mathare slums, we have close follow-up with the network of Community Health Workers (CHW). We ensure that each patient is attached to a CHW and he or she is closely followed up.
At the MSF clinic, we like trusting the patient with their own medication, we ensure they follow the direct observed treatment short course (DOTS) during the first two months but after that, we give weekly doses. Nevertheless we monitor the situation carefully. The patients are assigned counselors who keep in touch with them and ensure that each week they pick up their dosages. They are expected to bring the empty foils at the time of their next visit. In case of default, the counselors visit the patients in their homes to find out why they have not visited the clinic. This way, the patients have a say in their own health development because they are responsible for ensuring the medicine is taken on time every day.
Every morning, our counsellers and community health workers sit together to review the situation. Thus we are able to identify those patients who are defaulting and those adhering to medication. The community health workers also update on the education campaigns and identify people or areas in the slums that need to be targeted.
HDN: What is your vision?
Dr Nyamato: I would like to see a situation where in Kenya, treatment for tuberculosis is available at village level. Yes, the hospital infrastructure may not be so good, but if we maximize on what we have and continually train our medical and paramedical personnel, I believe this is possible. Like now, many of the nurses in government hospitals may not be well versed with modes of testing for TB. They still test the sputum only, but TB (especially in late stages of HIV infection) can manifest itself in the liver, stomach or bones etc or can be sputum negative.
I would like an improvement in the medical staff's ability to perform tests and an enhancement in the quality of the laboratory services. Right now, the treatment centres in Mbagathi hospital, Kenyatta National hospital and other centers are doing their best to cope with the rush of patients. But there is need for more centres and facilities just in case the number of patients rises. You see, the HIV-AIDS pandemic caught us unprepared so we have to work backwards, trying to design mechanisms that we should have worked out much earlier.
In this regard, I would like to see a district or local hospital where all patients, whether they have TB, HIV and/or malaria are treated together. Specialist clinics are good but to minimize stigma. I believe we will have to all work together and design such coping mechanisms.
HDN Key Correspondent Team
Email: correspondents@hdnet.org
Source: Stop-TB eForum, join-stop-tb@eforums.healthdev.org
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