Fatuma Abdalla, a recovering extensively drug resistant TB patient sorting out chaff from rice outside her daughter’s house in Likoni, Mombasa County.
Fatuma Abdalla, 70 years old, was a farmer in her village Mwalulamba, in Kwale County until April 2017 when she fell ill. What started as a normal cough progressed to a chronic cough accompanied by chills, night sweats and loss of appetite prompting her to visit a local private health centre.
“At the private facility they diagnosed me with pneumonia where I got injections for seven straight days on top of a cocktail of drugs,” Fatuma shares.
“Even after enduring those painful injections my mother’s condition was not improving, rather it was getting worse. Every time I called her to check how she was fairing on, we had to cut short our conversations to allow her to cough as well as take a breath. My once energetic and active mother was now a feeble person who spent most of the time indoors sitting in her bed, as laying down was a problem due to the frequent coughs,” Rukia, her daughter, interjects.
With no respite in sight and disturbed by her mother’s deteriorating health condition and inexplicably weight loss, Rukia invited her mother to her home in Likoni, Mombasa. It is here that Fatuma was taken to Likoni Sub-County Hospital. Upon cross examination by a clinician and a sputum test, it was confirmed that she had pulmonary tuberculosis, a common form of TB affecting the lungs.
“The words of the doctor mentioning I had TB struck me to the nerves. I could not believe I was going to die of the same disease that had killed my husband and son a few years ago. I was only relieved after she sat me down and counselled me that the disease is treatable and curable if only I adhere to the medication as guided. And truly looking back my husband and son could have passed on due to non-adherence as I had seen them skip their medication,” Fatuma recalls.
After the counselling Fatuma was put on treatment. By the end of the first week she had stopped coughing and the other symptoms had disappeared. She went back to the facility every two weeks to pick her medication and every month for sputum collection for culture test to monitor her response to the medication.
“Though the symptoms had disappeared, I always remained steadfast with the medication. The thought of losing my life and leaving my daughter and grandkids behind gave me the motivation to keep pressing on,” Fatuma says.
Fatuma was progressing on well until the fifth month when she began coughing again. Unfortunately, when the sixth month culture test was taken, the same month she was to complete the medication, it showed she had developed resistance to rifampicin, one of the first line drugs used to treat TB. She now had to start on a new nine-month regimen for drug resistance TB again.
“Unlike in the first treatment, this was a tough one. Apart from the tablets that I was swallowing, I also received daily injections that left my body aching. Despite all this, my determination to get cured was still alive. The support from my family and medics at the facility kept me going. Like when I lost appetite and began urinating blood like urine, the doctor advised me to take a lot of water as well as to eat a lot of vegetables and fruits, and when I did this the side effects disappeared,” Fatuma says.
A collaboration between the USAID funded Tuberculosis Accelerated Response and Care activity (TB ARC) with the National TB program early 2018 saw the enrolment of Fatuma to the National Health Insurance Fund (NHIF) to cover some of the non-related TB tests as TB treatment is free in all government run facilities in Kenya.
“Apart from being enrolled to NHIF, I was also given a monthly financial support of Kshs. 6000 as well as nutritional supplements to boast my weak immune system. The stiped covered for my daily transport to the facility to receive the injections and other drugs as well as support my daughter in purchasing food for me,” Fatuma recounts.
Unfortunately, she began having a hearing problem in the fourth month of the second regime leading her to stop taking one drug as advised by her doctor. By the fifth month, the TB in her body had become resistance to two more drugs; isoniazid and fluoroquinolone, making her an extensively drug resistant TB patient.
Being the first case in the facility, it took the intervention of the Tuberculosis Accelerated Response and Care II activity (TB ARC II), Coast Region Officer, Godana Mamo, who developed an individualised regimen for Fatuma. The regimen was sent to the National TB Program in Nairobi. After a few days the National TB Program sent a drug kit to Likoni Sub County Hospital for Fatuma to begin her medication.
According to the attending nurse, Saumu Ibrahim, “Since Mama Fatuma began the treatment for the extensively drug resistance TB, she has been responding well to it which is clearly evidenced to her activeness as well as weight gain which is increasing by day having improved from 30 kilograms to 58 kilograms at the time of the interview.”
Nurse Saumu describes Fatuma as a lady who has been following the medication religiously without causing any trouble to her family and the health care providers.
“Not even a single day have I had a complaint with Mama Fatuma. She is one of the best patients. She comes to pick her medicines here when required even now that she has to come here every morning. While waiting for her turn to get in, you will hear her giving hope to other patients not to worry as they will get cured as well as the importance of adhering to treatment,” Nurse Saumu says.
Having been counselled on the risks of spreading the bacteria to others, Fatuma’s household comprising of her daughter and grandchildren are screened for TB periodically and the young ones have been put on isoniazid preventive therapy to prevent them from contracting the disease.
The USAID funded Centre for Health Solutions – Kenya, TB ARC II implemented activity is working with the National TB Program to reduce incidence and number of deaths due to TB in Kenya. This is by strengthening health care providers and facility performance in TB management through didactic classroom sessions, Extension for Community Healthcare Outcomes (ECHO) sessions, and facility based continuous medical education sessions trainings.
Additionally, TB ARC II is also expanding and strengthening TB diagnostic network to increase timely use of quality TB and drug resistant TB treatment to patients as well as ensuring proximal access to laboratory tests for all DR-TB patients like Fatuma. TB ARC II is; bundling 189 GeneXpert machines countrywide in public facilities on monthly basis for patient results to reach the clinicians and sub-county TB coordinators on time for patient management; supporting 48 GeneXpert machines super users for basic equipment maintenance in improving functionality of the machines hence enabling results flow in and processing on time in 223 Genexpert machines sites; and by supporting sample referral of all TB patients culture to the National TB Reference Laboratory and KEMRI – Kisian Laboratory, and DR-TB patients sample referral to Lancet Laboratories for baseline and routine haematological and biochemical laboratory investigations to evaluate potential adverse drug effects in line with National TB Program guidelines.