By Benedict Wachira
Tuberculosis (TB) is one of the biggest killer diseases in Kenya. It is even a deadlier opportunistic disease for those with underlying conditions like HIV/AIDS.
Even though TB is caused by a different germ from Covid 19, and even though the two diseases are different in many ways, TB and Covid 19 share many similarities. Both can cause death, both are airborne and highly infectious, both can exist latently, both require mass testing for effective control, both are costly and tiresome to cure/manage, both are transmitted more by young people, both are exacerbated by poverty etc.
Proper hygiene, proper ventilation, proper coughing method, physical distancing and wearing of face masks are recommended for both diseases. TB and now Covid 19 are public health headaches. If the CS for health chose to announce the number of TB infections and deaths on a daily basis, then this Country would go into an enhanced panic mode.
In spite of the gravity of TB (of the lungs), and in spite of our weak healthcare system that is as a result of the promotion of neoliberal capitalism instead of socialism, Kenya has comparatively done a very good job in managing and containing TB over the last 15 years. The Government has done and is doing a great job in destigmatising it and in explaining the disease to the people. Even though TB kills, many Kenyans today know that it is treatable and they actually seek treatment when symptoms arise/persist. As a result of successful public health campaigns, it is for example not rare for a commuter to open the matatu window when another commuter coughs suspiciously.
TREATMENT OF TB IN KENYA
There are three main ways by which TB is treated in Kenya. Patients with severe TB are admitted in hospitals where they are treated in more or less isolation circumstances. Patients with ordinary TB illness are treated in an outpatient fashion, under close supervision of healthcare officials. This type of treatment forms the bulk of TB patient management. Several tests are conducted, the patient is counselled on the length of treatment, the side effects of the medication, issues of hygiene, aeration, protection of family members and other people among other issues. Patients are then issued with the medication on a weekly basis or more frequently as the case may be, for a period of six to eight months. Both the healthcare provider and the patient monitor the treatment process. The consequences of not adhering to the medication are also explained to the patient.
Even though the treatment of TB is lengthy and is difficult especially for alcohol drinkers, smokers and Miraa consumers since they are required to abstain from indulging for the pendency of the treatment, majority of the patients stick to the instructions and most are eventually cured.
TB treatment is very expensive, but in Kenya it is offered for free, and is highly decentralised. The seriousness of the disease both in terms of its consequences and ease of spread have contributed to its treatment being offered for free in spite of Kenya’s capitalist orientation. Also, failure to deal with ordinary TB properly usually leads to drug-resistant type of TB which is even more expensive to treat, yet as easily spread. It was because of this that a third method of treatment of TB was practiced in Kenya until it was declared unconstitutional in 2016; treatment by jail term.
TREATMENT BY JAIL TERM
Prior to this declaration by Justice Mumbi Ngugi, that reiterated and expanded Justice Mwilu’s decision in a related case, TB patients who refused to adhere to the treatment would be jailed for 8 months, where they would be forced to take the medication under the supervision of prison warders. On paper, this made sense because of the obvious danger that such hard-headed patients caused to people that they interacted with and also to themselves. However, there were four issues that defeated this concept of jailing the ‘defaulters’.
First, whereas the intention was to limit the spread of the disease, these patients would be crammed up in police cells with healthy people pending arraignment, then they would be arraigned in stuffy court rooms with healthy judicial officers and court attendees, and they would later upon conviction, be confined with healthy prisoners in extremely unhygienic cells where social distancing was a myth. In other words, the unintended consequence was worse than what was being cured. (this not including the other consequence of introducing non-criminals to convicted criminals!).
The other problem was that the nutrition in the prisons was so poor, yet these patients needed better food for them to be treated successfully. Some would also sleep with completely worn out mattresses and with worn out blankets, thereby putting them into more risk of either dying, or developing and spreading the drug resistant TB.
The third problem was that the law required that a medical health officer sign a certificate approving the committal to confinement, and this never used to happen.
Lastly, the Public Health Act had been misinterpreted all along, as it provided for involuntary confinement for the purposes of treatment, and not for imprisonment for the purposes of punishment-cum-treatment. This means that an infected person should be confined in a health facility, until they are cured, and this can only happen as an act of final resort.
(of course the course of action is different for those who know that they are infected and they knowingly and intentionally spread infectious diseases, which is another story altogether.)
COVID 19 LESSONS FROM TB MANAGEMENT
In light of the current Pandemic, one would wonder, why is the Government of Kenya being so reckless in how it is handling the Covid 19 situation, yet it has done an excellent job with a similar disease in recent times? Why isn’t the country building on its own experience and improving its lessons?
Two days ago, the CS for health declared that those who flouted curfew rules, irrespective of the circumstances, would be arrested and sent into what they refer to as mandatory quarantine, and at their own cost. The CS then proudly announced that over 400 people had already been arrested in one night.
We have seen the conditions in which many of those in these quarantine facilities live in. They are basically confined in elevated prisons.
Four years ago, the courts resolved that the basis for involuntary confinement would be scientific. The Government of the day is now resorting to the most unscientific methods of confining people, that is, being found outside your house during curfew hours!
Four years ago, the courts found out, and the Attorney General agreed that arresting and confining people with notifiable infectious diseases in police cells and in prisons would only worsen the risk of spread of the disease since the healthy tend to mix with the sick. Today, the same is being done in the police vehicles, police cells and the newly established prisons that are erroneously called quarantine centres.
Many more years ago, the Government realised that the best way to deal with a dangerous and highly infectious disease was to offer the treatment of the disease for free, to decentralise the treatment, and for mild cases, to develop ways in which people can be treated, under close monitoring and counselling, from home. At worst, the Government would confine patients with the highest risk of spreading the disease at its own cost.
Why then is the Jubilee government charging people for lodging in the new prisons? Why is it introducing money between the people and the containment of a pandemic?
Over 20 years ago, the Government learnt that scaring people about an infectious disease was far less effective in combating the disease, while it was far more useful to destigmatise the disease, and at the same time educating people about the seriousness of the disease and more importantly encouraging them to protect themselves and to look for treatment if they get the symptoms.
Why is the Government reverting back to the same failed methods that were used in combating HIV/AIDS in the 90s?
Kenyans do not like hospitals, but they still go there. No one likes to be admitted in an hospital, but people still understand why they should be admitted. But looking at how this Government is mishandling this disease by using threats, using it to defraud the population, using it to further spread the disease, using it to traumatise people through strange burials, using it to kill and maim people, using it to extort money from people, using it to criminalise lateness, using it to confine people in the new prisons and so on and so forth, I doubt whether people will trust the Government enough to accept voluntary treatment now and in the future. People will get the symptoms and go to those hospitals when they are about to die and they have spread the disease to enough people.
Occasionally, people run away from hospitals so as not to pay the bills. Yesterday, people escaped from the KMTC prison both because of the bills, but more because they felt that they did not deserve to be in that prison. Indeed, every Kenyan has a constitutional duty to oppose, resist and ran away from illegal detentions. . A disease confinement centre should be secured, but should still resemble a health centre, and not a prison. The recklessness of the Jubilee Government will end up costing so many lives.
The truth is, the Corona Virus will be with us for a very long time. The other truth is that life must and will continue. Eventually, whether Uhuru Kenyatta or Mutahi Kagwe like it or not, air travel will resume, schools will re-open, restaurants and bars will re-open, and 24-hour life will return.
How the State treats the people today henceforth will have a great impact on whether Covid 19 will be contained in the future. We should build on what we’ve learnt, rather than destroy everything through infantile show of might, and greed.