Amina’s struggle with mother’s sickness mirrors the horror Kenya faces over TB challenge

By Henry Neondo

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

Apiyo is just one of the many nurses charged to man TB patients in one of the numerous clinics in Kenya in a government strategy that has seen TB services decentralised down to the community level.

Working under strenuous conditions that include thin funding from the Treasury, lack of protective working gear to frontline staff, low personnel, a not convincing drug supply level and poor buildings in the name of clinics, it takes personal initiatives by nurses like that of Apiyo to have the programme record success in a country classified by the WHO as tenth in 22 most TB burdened countries globally.

To begin with, the clinic is housed in an old building and squeezed in a corner that would best be described as a home’s tiny food store.

There are no benches outside on which sick patients could sit on as they wait for their turn to be attended to and for a hospital receiving 600 TB patients weekly in this City’s densely populated estate, the waiting is no fun.

Fatuma herself is on que waiting for her turn and she is patched somewhere under the shadows of a hedge of shrubs that makes the fence that shields the hospital from not so a secure neighbourhood.

But just to show the enthusiasm with which the brave Kenyan medics have taken the decentralisation of the TB programme, Apiyo dedicatedly begins her work with what she calls a "health education" where she encourages both the sick and the guardians who bring them to the clinic like Amina, about management of the disease.

For example, Amina says that through the health education, she together with three of her other siblings have been taught how to live with their sick mother in their (10 by 10) square metre room.

Asked what she has learnt over time, Amina says that Apiyo has taught them to always have their one room’s window open, allow 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 short course (DOTS), a WHO strategy to ensure adherence to treatment that currently runs for eight months in Kenya, be fed with some fruits to balance her diet and ensure that she is brought to the clinic.

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

To go round the problems, Apiyo makes use of the guardians and community elders to translate her health lessons in as many languages that are spoken in the area.
In a programme that has won global accolade, Kenya’s TB programme has now been decentralised to the Community from referral hospitals in a bid to stop a disease that has long been considered finished in 1980’s.

But thanks to the emergency of the HIV and AIDS, TB has re-emerged in a fury and is now considered the most opportunistic of the opportunistic diseases that actually kill people whose immunity have been compromised by the 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 portend a deadly challenge to health care services in what Dr Sitienei calls "unholy marriage" and annually, 24, 000 Kenyans get infected with TB.

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 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 all people to work together in putting the plan to stop TB into action in order to stop one of the oldest and most lethal diseases known to humanity.