Getting Tuberculosis (TB) can be as cheap as being close to someone who coughs carelessly, but treating the disease can be so costly, especially if you get infected with the drug-resistant type.
To treat the normal TB, you simply walk into any government health facility, get tested and if found positive, treatment is free.
But that is not the case with treating or managing the drug-resistance type of TB.
Fourty-eight years old Ignatius Okech knows this only too well. Early last year, he began to experience bouts of weakness, loss of appetite and night sweats. For two months, he went to the hospital before he was diagnosed with multi-drug resistant TB (MDR-TB).
Multi-drug-resistant TB is resistant to the two main TB antibiotics (rifampicin (R) and isoniazid (H). This type of TB strain requires treatment for two years with at least six months of injections. This makes it more difficult and expensive to treat. Compared to six months’ treatment for a typical TB case, MDR-TB treatment is 100 times more expensive.
Indeed, treating the disease has been a tough battle and a costly affair for Ignatius.
After he was diagnosed with MDR-TB, he stayed for another two months before he could start his treatment.
According to Evelyne Kibuchi, Senior TB Advocacy Manager at Kenya AIDS NGOs Consortium (KANCO), to treat one patient with MDR-TB costs Ksh. 2 million for drugs alone. An MDR-TB patient takes drugs for 24 months, and an injection every day for the first six months. She says treating MDR-TB takes a heavy toll on families’ resources, and comes with enormous socio-economic consequences for families.
“A hundred percent of those who suffer from the disease lose their jobs because of the rigorous treatment process,” she says.
For majority of Kenyans who live on less than a dollar a day, getting infected with MDR-TB can be fatal.
When he was first diagnosed with TB in late 90s, Ignatious left his job at Kenya Railways, because he had to go home to Busia to seek for treatment at the Centre for Infectious and Parasitic Diseases Control Research (CIPDCR), in Alupe, Busia County. Last year, when he was found to be infected with MDR-TB, Ignatius again had to stop working as a night guard with a small security firm in Nairobi.
“I had Ksh. 34,000 in my account, I have spent all that…I have nothing else even if I have to go for x-ray, I am not able…I have no money for fare to hospital…I leave my fate in doctor’s hands,” he says.
He is unable to provide for family
He is unable to provide for his small family that lives in Kawangware, Nairobi. His family was kicked out of their house early this year because he could not pay the house rent. At the time I was talking with him, he had been locked out of his house again for defaulting on rent.
KANCO came to his rescue the first time. They raised some money to enable him clear the arrears that were outstanding, before the landlord could allow Ignatious, his wife and four children to get back to the house. This second time, he could only raise Ksh. 2,000, hoping that the landlord would take that and allow them to continue staying in the house.
But that is not all; Ignatius says that his children have had to go to school without uniform, shoes, and they take only one meal a day because he cannot afford to provide them with a square meal every day. His wife washes clothes for other women to help put food on the table.
And that is not all; since he has to use a protective covering (surgical mask) over his mouth to avoid infecting other people, this too comes with social stigma. He uses the surgical mask, which is cheaper, because he cannot afford the N95 mask, which he should be using.
“Every time you will find me isolated,” he says.
Ms. Kibuchi says all this is happening yet every MDR-TB patient is entitled to an allowance of Ksh. 6,000, which the government is yet to give Ignatious despite donors having released the money to the government.
Dr. Kamene Kimenyi, the National Drug Resistance TB Coordinator, National TB, Leprosy and Lung Disease Unit, says delay to give support to MDR-TB patients was caused by reason of one of the donors withdrawing in mid-2012.
“So, the whole of 2013 we had a problem giving patient support, because we (government) ran out of money,” she says.
Initially, each MDR-TB got Ksh. 15,000 per month, but this has come down to Ksh. 6,000. The government settled on that amount (Ksh. 6,000), which is close to the government’s minimum wage level of Ksh. 7,000. The government says the amount is feasible, considering that different donors give different amounts for the programme.
The amount is supposed to cater for the patient’s food and transport to be able to visit the health facility where they get their treatment. The government recognizes that many of these people may not be able to work again once they start the 2-year treatment process. This is barely enough to meet a family’s needs.
TB on the increase
Statistics from the World Health Organisation show that cases of MDR-TB have been on the increase in the country.
The WHO Global TB Report (2013), released last year shows that 3.6 % of newly diagnosed and 20.2 % of retreatment cases of TB had MDR-TB. The report states that an estimated 450,000 people developed MDR-TB and 170,000 died from the disease in 2012, worldwide. It also reveals that less than one-third of the people estimated to have MDR-TB were detected in 2012.
“MDR-TB is a real and present threat to global health”, says José Luis Castro, Interim Executive Director of The Union. “It puts a greater burden on health systems and budgets, as well as the obvious harm it causes to MDR-TB patients and their families. Cases are found all over the world, irrespective of a country’s overall level of TB prevalence. We all have an urgent and vested interest in identifying MDR-TB and controlling its spread”.
Drug resistance can arise due to improper use of antibiotics in drug-susceptible TB patients; administration of improper treatment regimens and failure to ensure that patients complete the whole course of treatment. A patient who is sick with a drug-resistant TB strain can transmit this form of TB to other individuals.
The WHO admits that progress towards targets for diagnosis and treatment of MDR-TB is far off-track. Experts say that in high MDR-TB burden countries, increased capacity to diagnose MDR-TB will have to be matched with supplies of quality drugs and scaled-up country-capacity to deliver effective treatment and care. This will require more collaboration among partners, including drug regulatory authorities, donor and technical agencies, civil society and the pharmaceutical industry.
Previously, MDR-TB patients had to be isolated in a health facility for treatment. But this is now not the case, says Dr. Kamene, since treating them from home gives better results. Once a person has been found to have the disease, health workers visit the family, counsel them and also screen the family members. After that, depending on the patient’s condition, a nurse will visit the home every day, or they visit the health facility every day. Dr. Kamene says that only patients with serious side effects are hospitalized.
“It is estimated we have around 3,400 MDR-TB cases in Kenya, we have been able to diagnose slightly over 1,000, we have treated 850 patients with MDR-TB, with good outcomes, with a treatment success rate of around 78%,” says Dr. Kamene.
MDR-TB treatment success rate good, but more needs to be done
Even though the MDR-TB treatment success rate is good news for the country, a lot still needs to be done to ensure that the disease is eradicated and that new infections don’t occur, and that affected individuals and families, like Ignatious’, get support at the right time.
Ignatious, who is also HIV-positive, is skeptical about the government’s support since he has been receiving empty promises since last year at the health facility he goes to at Riruta Satellite in Nairobi. He says the government needs to ensure that the support reaches the intended people.
Worldwide, it is estimated that 9 million get infected with TB, a third of who (3 million) are “missed” by public health systems. Many of these “missed” people live in the world’s poorest, most vulnerable communities and include groups such as migrants, miners, drug users and sex workers.
TB is said to be a poverty disease, since it is mostly found in households with poor hygiene. In Kenya, it is mostly found in urban slums in cities like Nairobi, Mombasa and Kisumu.
As the world celebrates World TB day this year, the goal is to reach the unreached 3 million and ensure that everyone suffering from TB has access to adequate TB care, including diagnosis, treatment and cure.