“I thought I was going mad. I drank a lot of alcohol at the time and so thought that I was ill because of my drinking, even when I was vomiting blood. During this time I lost a lot of weight – people told me I looked as if I was nearly dying.”
It is hard to believe that Ben Nyaigo Mochama, a 36-year-old tuberculosis (TB) patient, is the same person speaking to me today at Iyabe district hospital in Kisii, Kenya, which is supported by international medical charity Merlin.
Although still on medication he looks in perfect health and tells me that after struggling with TB since 2006 life is finally back to normal.
Perhaps even more dangerous than the disease itself, which is curable, is a lack of understanding of TB and the fact that it kills when untreated.
Ben was diagnosed with TB after having been ill for a few months, but defaulted on his medication – still struggling with alcohol he did not believe that his doctors were telling him the truth. Fortunately, as the result of an initiative to trace defaulters – one of the areas in which Merlin supports the Ministry of Health in Kenya - he started treatment again last year and is now back to work as a farmer.
The situation is complicated further by the fact that the major factor responsible for Kenya’s significant TB burden – currently the 13th highest in the world – is weakening of the immune system due to HIV.
The two concurrent epidemics – with 44 per cent of new TB cases between 2006 and 2010 being co-infected - make diagnosis and treatment of TB a major challenge, not least because stigma and discrimination still remains.
For example, those suffering from early symptoms of TB often hold back from seeking treatment for fear of finding out that they are HIV positive.
Redemptor Arusa, 35, suffered for a year before being diagnosed with TB – one of the reasons being that at first she had assumed her illness was simply due to her HIV positive status.
During this time she was unable to walk and her mother and husband had to take over looking after her children. But once she received the correct medication she immediately began to gain strength. She completed a course of drugs last week and is here today for a test to confirm that she has been cured.
In partnership with CARE International and the Centre for Disease Control, Merlin provides integrated services to tackle TB and HIV in Nyanza province, where HIV prevalence is double the national average.
This includes educating communities about the initial symptoms of TB and the fact that the disease is curable – even for those who are HIV positive – using community health workers and traditional music and theatre groups as a vital link.
Merlin supports health facilities like Iyabe by ensuring that free TB and antiretroviral drugs are available and training health workers and peers with new skills such as tracing defaulters and providing counselling for patients struggling with medication or discrimination because of their status.
For patients like John Miruka Marita, this forms a vital part of recovery. The 43-year-old initially reacted badly to his TB medication, which caused him to vomit. “I began to lose hope in life but kept being encouraged by other people on treatment to continue coming to the clinic.”
Today he is here as a peer educator, providing the same counselling to new patients.
Although Kenya has made considerable progress in tackling TB, this momentum needs to be sustained if the Millennium Development Goal of halving TB prevalence and deaths by 2015 is to be met. Nonadherence to drugs is increasingly leading to a new strain of drug resistant TB - which with an estimated 2,000 cases in Kenya was declared by the Ministry of Health to be “the biggest challenge we are likely to face in the future.”
But it is surely encouraging to know that just spreading what might sound like a simple message - that TB is curable - has the potential to save hundreds, if not thousands of lives.