A new lease of life after MDR-TB “When the doctor informed me they had finally diagnosed my illness, I was so relieved. It felt like I was getting a second chance on life.”
“I was still coughing, experiencing chest pains as well as unexplained extreme fatigue. I had lost so much weight that everyone around me kept wondering what was amiss. Then, I was still going to school and even attending to my classes,” he explained adding, “I had lost my appetite and all food tasted bad and I would occasionally vomit.”
These are the words of Peter Otieno, 50, who was diagnosed with multi-drug resistant tuberculosis (MDR-TB) after eight years of misdiagnosis. According to the 2015 National Tuberculosis, Leprosy and Lung Disease Program (NTLD) report, MDR-TB cases in Kenya rose from 112 in 2010 to 433 in 2015, a 50 percent increase compared to 288 cases in 2014. The growing cases of MDR-TB is a problem that has continued to plague the Kenyan public health system with a treatment cost of at least Sh 2 million per person. Otieno’s journey with TB began in 2009 when he was first misdiagnosed. At that time, he thought it was another respiratory disease, likely pneumonia. “At the time, I assumed it was the motorbike I was using to ride to and from school that was affecting my health. Little did I know that my assumption would one day end up with a TB diagnosis” said Otieno a teacher at Nyamoma Primary School in Migori County. Otieno was placed under medication for eight months and was eventually declared TB free. It was not long after that before the chest pains and the coughs began again. Having been declared TB free, the last thing on his mind was a recurrence of the disease. “Four months down the line I was again paying visits to different private hospitals and sometimes even self-medicating. The clinicians treating me diagnosed that I was suffering from pneumonia and at times I would be treated for malaria,” narrated Otieno. Despite being constantly under
Peter Otieno, a survivor of MDR-TB. Photo: PATH/Christine Ogutu
medication Otieno’s health kept deteriorating. Everyone was worried for him since he was on treatment and did not seem to be getting better. Eventually, in July this year, he took the advice from a worried fellow teacher and decided to visit Migori District Hospital to seek a second opinion from the government owned facility. At the facility, the first doctor he came into contact with could not tell exactly what he was ailing from even though he had explained that he had a history with TB. A week later, his sputum was tested for TB. “The second time I was visiting Migori District Hospital, the GeneXpert machine was still unavailable. Again in all the smear tests done, the results were negative but even with that, the doctor placed me under TB medication which was ineffective,” explained Otieno. In 2012 Kenya adopted the use of the GeneXpert machine which is a sensitive method for rapid diagnosis of TB. Despite the country being listed as a high endemic area for TB, the technology has only been devolved to the county hospitals. Sub-county level hospitals still depend on microscopy for TB diagnosis — which in most cases has proven to be ineffective in smear negative cases like Otieno’s.
Otieno, a father of eight, decided to consult doctors again. This time he saw a different doctor at the facility who advised that he undergoes the more advanced screening for TB. This meant that his blood sample would be taken to Kisumu County Hospital for screening where the GeneXpert machines were already available. “A few agonizing days went by and then the doctor called me back to the hospital. I was so reluctant to heed his calls and so I demanded an explanation why I was being recalled. He told me that I was using the wrong drugs which might have really affected my hormones. He insisted that I report to the hospital immediately,” recalled Otieno. “I had spent my mornings and nights praying that the doctors would finally diagnose my illness. I was diagnosed with multi-drug resistant TB. Though the results were scaring, I was very happy to finally know my ailment and more so that it could be cured,” added Otieno. In May this year, WHO recommended a new drug regime that shortens the treatment for MDR-TB from two years to nine months. Unfortunately MDR-TB patients like Otieno still have to go through the tedious 18-25 months of treatment regime since Kenya is yet to adopt the WHO recommendations. Some patients enrolled in MDR-TB treatment find it very hard to adhere to the rigorous schedule. They run the risk of defaulting treatment and are
A new lease of life after MDR-TB susceptible to recurrence of the disease or even the more serious XDR-TB. In Kenya, patients who have defaulted from such treatments have in the past been confined in jail since there are no isolation facilities. This has raised concerns on the rights of the highly infectious patients vis a vis public interest.
everyone in my environment was going to be safe and thus I have not missed any of my medication.”
that once he is cured he can resume work.
“It has been over a month since I commenced treatment. The journey has Karina Opiyo, a clinical officer attached to been far from easy. I have experienced the Uriri health facility said that after deafness, dizziness and joint pains. The Otieno’s enrollment into treatment, the drugs are also very powerful, I become next step was to screen the people he had weak after taking them and I have to rest come into contact with. for two hours or more before I can regain Due to the long process and the cost of strength,” Otieno said. “As his clinician, I accompanied the treating MDR-TB, Otieno was referred to regional TB Coordinator, the area Chief Otieno adds that when he broke the news Uriri Sub-county Hospital to enable him and a Community Health Worker (CHW) to his wife that he had been diagnosed with have his treatment within the village where to his home to have the whole family MDR-TB, she was very worried. She he resides. From his past experience, he screened. We first had to give them health became inquisitive and advised that I be did not have confidence that he would get education on MDR-TB and the preventive tested for HIV. good service at a sub-county health measures after “I assured her that the doctors had already facility. which we took the done all the screenings. After an extensive “I was reluctant to sputum samples talk with her, she committed to supporting accept even though that were taken to me. She is the one who has been preparing the facility was the GeneXpert porridge and reminding me to take my nearer. I had site,” said Mrs medicine. I am happy that through the confidence that the Opiyo. challenges, she has been very supportive,” hospitals in Migori town would be better At the school where Otieno teaches, they he said. placed to treat me. The doctor explained had to engage the headteacher before He added that he has been very vocal about that commuting to and from Migori on a conducting the extensive screenings. his status around his community and at the daily basis would be very expensive “We told her that one of her teachers had school where he teaches. He believes that considering the 25 months of treatment,” been diagnosed with MDR-TB and there through his experience others can learn he said. was a need for an immediate screening of more about the existence of MDR-TB. Uriri Sub-county Hospital is one of the both pupils and teachers. Otieno could “I could have lost my life if I did not go to facilities supported by APHIAplus have transmitted it to the pupils as he the public health facility but now I want to Western project in Migori County. Under taught since the disease is transmitted bring more awareness of TB. I am the auspices of the project, an additional through saliva droplets. Again the sputum encouraged to keep going because I know I clinical officer has been trained and samples were collected and taken to will get healthy and I will resume teaching designated to the TB unit to deal with the Kisumu for the GeneXpert test,” she said. once again,” said Otieno. influx of TB patients from the area. Since August 4, Otieno has been getting Migori County ranks second in HIV Thanks to the available treatments and his second line medications and daily jabs prevalence in Kenya and TB –HIV dedicated health workers Otieno, sole at the Uriri Sub-county Hospital. Through coinfection rate stands at 50 percent. breadwinner to his family, is looking the aid of Mrs Opiyo he was initiated into forward to completing his treatment and “The medical staff would not accept my the ‘Direct Observed Therapy (DOT) Plus’ resuming teaching. plea [to be treated at home] and I had to program which puts every MDR-TB commit by way of writing that I would “I feel like I have just got a second chance patient under treatment on direct adhere to treatment,” said Otieno. at life’ he says offering a smile. observation by a trained health officer.
“I feel like I have just got a second chance at life.”
He added: “Enrolling for treatment meant that my family and the people I had come into contact with, including the entire school where I teach, were to be screened. I welcomed any health processes provided
Due to the intensive nature of treatment and the adverse effects, Otieno has since Article by Christine Ogutu, PATH/ taken some time off teaching. He has been Communications assured by the Teacher’s Service Commission, which employs all teachers,