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Daniel Ng’etich retells the traumatic experience, whose impact  exposed them to stigma cost his brother’s life. 

Harriet James @harriet86jim

One day in 2010, Daniel Ng’etich went for a checkup after experiencing a persistent cough for two weeks.

His cold body also worried him. Upon visiting Kapsabet Hospital, he was given medication and doctors discovered he had pulmonary tuberculosis (TB). 

“They gave me medication that would last a week. They gave me an injection and tablets,” he says. 

What he didn’t know was that earlier on, his brother, Henry Tirop, was also diagnosed with the same disease and given the same prescription. 

Later on, while they were at home, going about their business, two chiefs, the chief public health officer and police officers raided their home.

At first, they told them to go to the dispensary at Kiropet and take medicine but changed their mind and arrested them and their neighbour.  

The public health officer made an application seeking the imprisonment of Daniel and Henry at the Kapsabet Prison for a period of eight months on grounds they had defaulted on taking their prescribed TB medication, and that such default had “exposed the general public of Kapsabet area and their immediate families to the risk of TB infection”.

 “They just gave us the medication without explaining to us their use. We were taken to the police cell, beaten and later on arraigned in court,” Daniel recalls.

“Later on, they said we were supposed to take the medication for eight months, but they hadn’t told us this when giving us the medicine. They just gave us medication for just a week, once a day.” 

They stayed in police remand for two months and one month in prison, before a lawyer took up their case. During this time, his brother became very sick and was taken to the hospital for two months, chained to the bed. 

According to the National Tuberculosis Programme, it is estimated approximately 150,000 people are diagnosed with TB every year in Kenya and about 60 per cent of those are diagnosed and put on treatment. 

In 2019, an estimated 147,000 people fell ill with Tuberculosis, yet only 86,385 people were diagnosed, treated and notified to the Programme.

The rest of the diagnosis is missed largely due to poor health seeking behavior and some are missed by the health system.

Timothy Wafula, Acting Programme Manager, HIV, TB and Key Populations Thematic Area at KELIN notes that this practice was widespread and the organisation has dealt with several similar cases. 

“This widespread practice of imprisonment of TB patients made KELIN to file a constitutional petition (Petition 329 of 2014) to challenge the unlawful and unconstitutional incarceration of TB Patients. TB is not a crime.

KELIN argued that the manner and conditions of incarceration endangered patients’ health and that of prison population. Prison conditions, being overcrowded and congested, are ideal for rapid transmission of TB.

Further, Kenyan prisons do not have isolation or medical facilities where proper care and treatment of patients can be provided,” argues Timothy.

 He adds that in a judgment delivered on March 24, 2016, the High Court declared the practice of confining TB patients in prison for treatment a violation of the Constitution and unlawful.

The Court ordered the government to issue a circular to public health officers not to confine TB patients in prisons.

The government was also directed to commence the process of developing a policy on involuntary confinement of persons suffering from infectious diseases (TB included), which should be in line with international standards.

The policy adopts a patient centered and rights-based approach and aims at ensuring rights of TB patients are protected and to encourage their continuation of treatment in an appropriate medical setting; ensures the spread of TB disease is contained by application of infection control measures; and outlines structural requirement of designing, renovating and constructing isolation facility.

“The policy states the isolation of people affected with TB for treatment purposes should be voluntary.

It also states that TB patients should be counselled, given adequate information and support.

It adds that it is a violation of human rights to arrest and jail in prison a person affected with TB,” says Timothy.

 The use of isolation should be strictly limited to the infectious period. Once patients are on effective treatment and are no longer infectious, there is no need for isolation.

Fortunately things have changed in recent times. 

“People are no longer arrested, but offered proper adherence counselling and education during course of treatment.

In certain instances the programme has advocated for counties to have isolation centres.

For extreme cases, we encourage treatment supervision,” explains Aiban Ronoh, head of monitoring, Evaluation and Research, National TB Programme.

He adds that the programme has adopted WHO guidelines for diagnosis and treatment. 

Guidelines

“We carry out regular sensitisation on guidelines and provide tailor-made trainings for all cadres of health workforce from clinicians, lab officers and also community health volunteers,” he says.

However, the main challenge for the programme is missing people with TB.

“If we manage to get everyone and put them on treatment then transmission in the community is going to reduce.

A number of patients still miss their appointments in hospitals posing a risk of treatment failure and development of more deadly strain of TB known as drug resistant TB,” says Ronoh. 

Another challenge is that some patients present late for treatment, reducing the chance of recovery, especially given challenges of HIV and malnutrition. 

As for Daniel and his brother, once they came out of prison in 2011, they were  given medicatiion in form of injection and tablets, which they took for eight months that year. 

Unfortunately, they had to deal with stigma from villagers, who shunned them.  Some even thought they had HIV.

They, however, began sensitising villagers on the disease, something that went far in their acceptance, with some villagers assisting them with food.

But one thing that saddens him is the loss of his brother due to depression. 

“We recovered from TB but my brother’s wife ran away with their children because she couldn’t handle the rumours in the village. He was lonely and felt that people hated him,” he says.  The burden was too much for his brother, who died by suicide.

Consequently, Daniel has made it a mission to sensitise the locals on TB and also ensure that none of the villagers is stigmatised like they were.

His wife, who had run away as well,  came back together with his five children. 

“She was gone for four years and I also was depressed because of this since I thought that she was not coming back,” he says in conclusion.