By Martha Nyambura
In his Iruru village in Kapsabet town, Daniel Ngetich’s name rests easy on the lips of villagers, like those of athletics champions Bernard Lagat, Robert Cheruiyot, Wilfred Bungei and Pamela Jelimo.
They are all the sons and daughters of the village but for this 38 year old farmer, it is neither his prowess on the athletic tracks nor his ability in farming that has brought him to the limelight amongst his kinsmen.
Miles away in Kangaita village in Kerugoya County is Simon Maregwa, whom Mr. Ngetich shares the fame that they were propelled into by the most unlikely of circumstance: defaulting on their TB medication, an act that would take them behind bars.
The 54 year old Mr Maregwa, is a father of two who earns his living by weaving baskets. His is an ordinary life. His Kerugoya district hardly makes headlines; it is not endowed with athletic prowess neither are songs of their farming skills making it to the charts but recent events surrounding him has made Kenyans take notice of his Kangaita village tucked in the slopes of Mount Kenya.
It all began in August last year. Usually, this is the time when the view of the Rift Valley escarpment comes to life; the maize crops trades in their green colour for a brownish one in anticipation of harvest. Farmers are abuzz preparing their barns to carry the bumper harvest.
On one August morning, Mr Ngetich was in his farm getting his crops ready for harvest when policemen came calling. In full view of his kith and kin, he was arrested ostensibly for failing to finish his dose of TB medicines.
“These drugs are not like the malaria ones, this one make you drunk than the normal beer,” he recalls of the medication.
In the case of Mr Maregwa, he was arrested at the Kerugoya District Hospital where he had been called in for routine checkup. When the nurse noticed that his TB medications were not all utilized, policemen were called in.
“If you have a stomach problem or headache,” argues Mr Maregwa, “and you take medications for a few days and feel better, you stop taking the drugs. I thought this is the case with the TB medicines, I took them for a while and felt better.”
This marked the beginning of the two men’s time in the limelight that would see them hog newspaper space and television airtime. Overnight, they became the talk of the country.
They were later handed an eight months jail sentence when the case was concluded. However, they did not serve the full sentence as intervention from human rights advocate earned them freedom midway.
It is their plight that recently brought together health rights’ advocates at a Nairobi hotel to campaign for a humane approach to the treatment of TB patients.
Kenya’s TB burden is the fifth highest in Africa and Kenya is ranked 13 on the list of 22 countries that bear the highest burden of the disease in the world, according to the Global TB Report of 2009 by the World Health Organization (WHO).
Figures from WHO indicate that the country records 132,000 new TB cases every year. It has over 500 confirmed cases of multi drug resistant TB (MDR-TB) , according to the ministry of public health’s division of leprosy, TB and lung disease but WHO estimates this number to be in its thousands.
Dr. James Gachengo, coordinator of DR-TB at the division of leprosy, TB and lung disease says that defaulting on TB medication threaten gains the country has made in combating the disease.
He notes that those who default on treatment are likely to develop resistance. This means that they are likely to infect others with MDR-TB, which costs over 1.5 million shillings to treat a single case.
However, the activists are against locking up defaulters. Imprisonment has contributed to stigma against many people who may have TB, fearing to come out in the open, says Anne Rono of National Empowerment Network of People living with HIV in Kenya- NEPHAK in Nandi County.
Ms Rono says there is need to come up with creative ways of ensuring that TB patients have the right support from their families and the community to ensure they finish the dose.
In fact, there is concern that this could lead to spread of the disease in prison when the defaulters are incarcerated.
Kenya’s prison capacity stands at 22, 000 and currently there are over 49,000 prisoners, which means that the prison setting may in the long run contribute to the spread of TB since most prison cells do not have isolation wards.
Poor information on TB management and stigma; with TB linked to HIV infection lead many to shy away from accessing treatment, says Nelson Otuoma of NEPHAK.
The TB medications require that many patients have balanced meals while taking the drugs but poverty often makes this difficult, adds Mr Otuoma.
There are examples within Africa, where human rights based approach to treatment is being used. South Africa is amongst them. It has developed policy guidelines on the treatment of TB, the decentralized policy for MDR-TB treatment and care that uses, says Agneeszka Wlodarski an attorney at section 27- a provision in South Africa’s constitution that advocates for the right to access health.
The policy is based on the successful pilot project that incorporated a decentralized treatment that involved the community in treating MDR-TB, which saw more patients getting treatment and adherence to medicines was high.
“TB patients should not be punished for having the disease but we need to examine the reason behind the defaulting to try and stop infection, prison cells are ill- equipped to guarantee quality of care and adherence,” notes Ms. Wlodarski.
The TB advocates are calling on a more pragmatic approach to effectively deal with TB at community level, that involves community sensitization, investments in education and information to help patients choose to complete treatment themselves and develop health systems that respond to patient’s needs.
The Kenyan government is currently conducting training programs in 12 regions in a move to train 25 health care workers after realizing that most lack information on the management of MDR-TB, says Dr. Gachengo.
The training is meant to form clinical teams in the health centers to deal with the management of MDR-TB as per new requirements on TB care.
The teams will work on bringing down defaulting cases, through enhancing follow ups and managing side effects resulting from the TB medications.
The clinical teams will also have social workers who will carry out follow up and health education to ensure that even before patients are put on treatment they are advised on what to expect while on TB treatment.
(This article was first Published in the MESHA website in Sept 2011)
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