Key Correspondent Sidi Sarro returns to visit Elizabeth, a 32-year-old from Kenya’s Kawangware slum who was close to death with TB six-months-ago
We find her busy making chapattis with the help of her daughter and nephew. She does not look anything like the woman we met when we visited her six months ago (see One foot in the grave, July 2011). The only thing that has not changed about her is her bright and welcoming smile. She is Elizabeth Wambui Nthumbi, a 32-year-old from Kenya’s Kawangware slum who barely a year ago had one foot in the grave and was wondering why death was not knocking in her door despite the fact that she was ready for it.
Elizabeth, 32, is a living testimony that tuberculosis (TB) can be cured if you properly adhere to treatment. She had been suffering from extra-pulmonary tuberculosis and had twice defaulted on her treatment, which led to the re-occurrence of the disease. She was also an acute alcoholic who drank cheap local brews in the many Kangemi dens. She was jobless at that time and she was at times forced to steal from her boyfriend to sustain her habit. She continued her drinking sprees at the expense of her family and children.
The second time her TB reoccurred, community health workers and TB supporters from Kangemi put their feet down and made sure that she adhered to her treatment religiously.
Elizabeth was delusional and could not walk the second time TB attacked her and was completely bedridden. So the community workers, led by Joyce Wambui, began delivering TB medication to her and even engaged a nurse who would give her the daily injections that are mandatory for a re-treatment case. Her cousin, Grace Waithira, never left her side and, whenever she could, would bring her food and take care of her personal hygiene. Besides this health workers made sure she was enrolled for food supplements that are normally prescribed for people whose immunity is compromised.
At the time, Elizabeth could have been mistaken for someone in the fourth and final stage of HIV as her body was displaying the HIV wasting syndrome but she was and is not living with HIV. Rather she had extra pulmonary TB of the bones, an infection caused when TB bacteria spreads beyond the lungs. Just like pulmonary TB, extra pulmonary TB is usually treated with a combination of four medicines for six months but in the case of a re-treatment the period of taking drugs extends a further two months thus making it to eight months in total. Extra pulmonary TB occurs less commonly than pulmonary TB. According to a 2010 Kenyan ministry of health report, Kenya of all recorded TB cases in the country, just 16% were cases of extra pulmonary TB.
Health workers supervising Elizabeth’s medication ensured that alcohol was not sneaked in to her by siblings and friends. Like all other medication TB drugs and alcohol do not mix. Alcohol abuse not only place individuals at increased risk of acquiring a number of diseases it also places those with these diseases at higher risk of poor outcome and death as it suppresses the immune system. Alcohol can also complicate treatment, since people with drinking problems are less likely to be able to adhere to medication regimes.
According to Evelyn Kibuchi, the KANCO TB Advocacy Manager, people who are addicted to drugs should be well counseled before being initiated to TB treatment in order to understand the affect the drugs they are using will have on the efficacy of their treatment.
“Alcohol should be discouraged when one is on TB treatment because it increases the frequency of urination thus making drugs pass out in the urine before they are absorbed,” she adds.
Echoing this sentiment, Dr Joseph Sitienei, the head of TB Division, said: “Alcohol and TB do not go together and a person should not compromise because the two are can potentially be toxic to the liver.”
The doctor also emphasized how important it is for anyone with TB to adhere to treatment, adding that this is paramount to avoiding further complications and the emergence of multi drug resistance TB.
In TB management, as with the management of other long term illnesses, adherence to treatment is a problem. However, TB treatment presents particular challenges for adherence because the treatment is long and involves taking a number of medications. Side effects are also common and the patient feels better long before treatment has been completed.
TB patients are expected to adhere to 90% of treatment for it to be a success and cure them of TB. Failure not only increases the risk of development of drug resistant strains it also increases the change that TB will spread in the community, which in turn increases the burden of TB in the country.
Kenya currently ranks 13th among the high burden countries. Any further increases in the burden of TB would overstretch the health system, which his already laden with TB patients. The problem will be worse with the multi-drug (MDR) and extensively drug resistance (X-DR) TB cases, which are likely to develop with non-adherence, and are difficult and expensive to treat.
Elizabeth, who finished her treatment on the 10 January 2012, has not touched alcohol since starting her re-treatment and vows never to even go near it again. She thanks God that she is alive and hopes that God will give her the strength to do something better and meaningful in her life. She plans on becoming a TB advocate who will sensitize people about TB and issues related to it.
See Sidi’s KC profile for more stories on Kenya.