Fighting TB in Kenya's community clinics

By HDN Key Correspondent, Kenya

KENYA--For the last four months, Amina, 15, has religiously escorted her mother to the nearby tuberculosis clinic in Eastleigh North, Nairobi. According to Amina, her mother, Fatuma 48, is lucky to be alive.

She attributes this to the clinic’s nurse in charge of TB, Mrs Magdaline Apiyo.

Apiyo is just one of the many nurses charged with providing treatment and care for TB patients in the numerous local clinics in Kenya, as part of a government strategy that has seen TB services decentralised to the community level.

Working under strenuous conditions that include sparse funding from the Treasury, lack of protective working gear for frontline staff, shortages of personnel, an unreliable drug supply and poor buildings in the name of clinics, it takes personal initiatives by nurses like Apiyo to make the programme a success, in a country classified by the WHO as tenth out of the 22 countries with the highest TB burden.

The clinic is housed in an old building, squeezed into a corner that would best suited for a home's food store. There are no benches outside on which sick patients could sit as they wait for their turn, and for a hospital receiving 600 TB patients a week, in this densely populated estate, the waiting is no fun at all.

Fatuma herself is in the queue, waiting for her turn, somewhere in the shade of the hedge around the hospital.

Showing the enthusiasm with which the brave Kenyan medics have embraced the decentralisation of the TB programme, Apiyo dedicatedly begins her work with what she calls 'health education', where she teaches both the sick and the carers who bring them to the clinic, like Amina, about management of the disease.

Amina says that through the health education, she and three of her other siblings have been taught how to live with their sick mother in their ten square metre room. Amina says that Apiyo has taught them to always have their room's one window open, allowing sunlight to penetrate the room and not to share utensils with their sickly mother.

Apiyo has also emphasised the need for them to ensure that their mother gets to the clinic daily for directly observed treatment (DOTS), a WHO strategy to ensure adherence to treatment that currently runs for eight months in Kenya. They have also learned to make sure that their mother is fed some fruit to balance her diet.

Compounding Apiyo's problems is the fact that Eastleigh is an estate in Nairobi populated with people from all over Eastern African, including Eritrea, Ethiopia, Sudan, Somalia, Uganda and Tanzania, few of whom can comprehend and communicate in either English or Kiswahili, Kenya's national languages.

To get around these obstacles, Apiyo makes use of the carers and community elders to translate her health lessons into as many languages as are spoken in the area.

In a programme that has won global accolades, Kenya's TB programme has now been decentralised to the community from referral hospitals in a bid to stop a disease that was considered finished in the 1980's.

Thanks to the HIV/AIDS epidemic, TB has re-emerged in a fury and is now considered the most deadly of the opportunistic infections that actually kill people whose immunity has been compromised by HIV.

In Kenya, Dr J. Sitienei, the National TB-HIV Coordinator says a third of all AIDS-related deaths are due to TB. Together, TB and HIV have combined to create a deadly challenge to health care services in what Dr Sitienei calls an 'unholy marriage'.

Thanks to decentralisation, Nairobi province alone now has a combined 135 diagnostic and treatment centres set aside to manage TB. This is a much improved scenario from the days when the entire 3 million Nairobi residents had only Mbagathi Infectious Disease Hospital for TB treatment. In addition, thanks to the Stop TB partnership that brings together over 400 partners, TB treatment is now free countrywide.

Eastleigh North, Apiyo's clinic, typifies the Stop TB Partnership's call to bring everyone to work together in putting into action the plan to stop TB - one of the oldest and most lethal diseases known to humanity.

Source: Partners-Zimbabwe eForum