By Susan Anyangu-Amu –NAIROBI (IPS) – When a doctor instructs a patient to take one tablet three times a day, she often has no way to ensure the instructions are followed.
Many stop taking their medication once they feel they have regained their strength – specially when the course of treatment lasts for months. When the medicine is for a highly infectious disease like tuberculosis, defaulting on treatment can have serious consequences.
Daniel Ngetich and Patrick Kipngetich are presently cooling their heels in a government of Kenya prison; unless a court orders otherwise, they will remain there for eight months until they finish their TB treatment.
Henry Ngetich, who was also arrested for defaulting on his treatment, was lucky enough to end up in hospital because he is in critical condition.
The move by the Kenyan government to arrest and incarcerate TB sufferers has been castigated by human rights organisations who term it a violation of their rights.
“Everyone has a right to quality medical care and this must be provided with dignity and respect,” said Pascaline Kang’ethe the national coordinator, rights to health and HIV/AIDS at ActionAid International Kenya. “This is a case of discrimination and the move is bound to cause others in need of treatment to shy away fearing arrest.”
Nelson Otwoma, the chief executive officer of Network of Persons Living with HIV/AIDS, said the two men are being held in prison in deplorable conditions and do not have access to the proper nutrition that is required for TB treatment.
“When we visited, we found them being held in the same room as other prisoners. They were not in isolation. To make matters worse they are being treated like common criminals and are handcuffed and under armed guard,” Otwoma said.
Speaking to IPS, the head of the National Leprosy and TB control programme, Joseph Sitienei defended the government’s action, saying they had acted to safeguard the interest of others after receiving complaints from family members.
“The public health officer in that region acted within law under the public health Act section 27 – which authorises him to take necessary action including detaining infectious patients to prevent the spread of a disease,” Sitienei said.
A 2008 World Health Organisation estimate is that 5,000 people around the world die from TB every day.
Several other countries have also considered incarceration to control the spread of TB. When research uncovered the presence of a highly-fatal extremely-drug resistant TB in South Africa’s KwaZulu-Natal Province, health authorities
In 1994, Israeli health authorities initiated legal proceedings seeking compulsory isolation of a homeless person with infectious MDR-TB who was failing to take medication.
In South Africa in 2007, the discovery of highly-fatal and extremely-drug resistant (XDR) TB in prompted debate over compulsory isolation. The decision was taken to quarantine drug-resistant TB sufferers at facilities like Cape Town’s Brooklyn Chest Hospital.
“There are challenges without answers,” Simon Moeti, medical superintendent of the facility told the South African Press Agency. “There are people who are refusing treatment, people who want to abscond.”
Otwoma said the incarceration of the two men in Kenya’s Rift Valley has sent the wrong message and caused panic among other TB patients who have stopped taking their medicine.
“In fact when we visited the home of Daniel… his wife indicated that their last-born child has been coughing however, she is afraid to go for tests fearing she will be incarcerated alongside the child to facilitate treatment,” he said.
Under the public health act, safeguarding the safety of others supersedes an individual’s right to comfort. Patients who are found to have infectious diseases may be isolated to prevent spreading and this should essentially be in specific wards in government hospitals.
But Allan Ragi, the executive director of Kenya AIDS NGOs Consortium, says government hospitals do not have such facilities.
“Under the round five of the Global Fund, Kenya got $19 million to construct an isolation ward at Kenyatta National Hospital. Five years down the line, this is yet to be completed,” Ragi said.
He said rather than concentrate on arresting defaulters, the government should invest in creating awareness about tuberculosis and its treatment.
“This country is at risk of a multi-drug resistant TB epidemic because we do not have the capacity to test everyone and follow up on treatment. The government should invest in awareness creation and train TB champions who will work in the community to educate others on the fact that TB is curable but one must adhere to treatment,” Ragi said.
The government has indicated that the two who have been incarcerated have drug-resistant TB, but this is refuted by human rights activists who say tests to confirm have not been conducted.
At the close of 2009 Kenya had 110,065 cases of TB. The default rate on treatment is at five percent and the government is working to reduce this to three percent.
By 2009 Kenya had 500 cases of MDR-TB. Oonly 117 are on treatment. MDR-TB is resistant to two of the most powerful first-line anti-TB drugs. It can, however, be cured with long treatments of costly second-line drugs, which have more adverse effects. Treating a single case calls for drugs worth more than $16,250. Kenya is 13th on the UN World Health Organisation’s list of high-burden TB countries.