Originally published in Village Life Magazine, October/November 2006
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In a country where an estimated 1.3 million people are living with HIV/AIDS, the Blue House stands like an oasis of hope, diagnosing and treating thousands with both HIV and tuberculosis. Situated in Nairobi's Mathare slum, one of the largest slums in Africa with a population of 300 000, the Blue House is operated by the French section of Medecins Sans Frontieres (Doctors Without Borders) and epitomises the global fight against HIV that MSF and many other NGO's are involved in. MSF originally started with a primary health care dispensary in 1996, however, by 2000 found that a specific centre for HIV and TB treatment was needed and the Blue House was opened in 2001. The urban prevalence rate for HIV in Kenya is 17-18%; Mathare is closer to 25-30%. While this is an alarming statistic, it is the prevalence of TB in Mathare that has the MSF staff concerned. 'TB is considered a 19th century disease and largely ignored,' said MSF's James Lorenz in Nairobi. 'However, conditions within areas like Mathare make it very prevalent and it's these secondary "opportunistic infections" like TB that are so dangerous to HIV patients.' Christine Genevier, MSF's Head of Mission in Nairobi, backed up this concern: 'This (TB) is the number one opportunistic disease,' she said. 'If we get a TB patient we have to convince them to accept an HIV test because at least 60% of TB patients are also found to be HIV positive.' Mathare itself lacks basic requirements and is therefore a perfect breeding ground for a disease like TB. There is very little access to water and electricity, drainage and sewage are virtually non-existent and there is on average one toilet per 400 people. As they are pay toilets, most don't bother to use them. The two rivers flowing through Mathare are more like open sewers and used as a dumping ground. As an example of the many health risks associated with living in Mathare, heavy rain in 1997 that overflowed the rivers and turned the slum into a swamp resulted in a massive cholera outbreak. The residents themselves are generally unemployed or low-income earners; more than half are single mothers living on less than a dollar a day. Access to health care, in most cases, is impossible. Medecins Sans Frontieres treat over 6000 patients in Mathare. On average, 100 patients visit the Blue House each day for primary health care (including 'emergency' cases), TB and HIV diagnosis and initial and follow up treatment. The Blue House also boasts a lab where TB screening via sputum slide microscopy and HIV blood tests to determine the stage of the HIV virus, are conducted. |
 TB is a hard disease to detect at the best of times and is especially hard in HIV patients where the sputum tests show to be negative and chest x-rays appear clear. 'TB presents in many different ways,' said Laboratory Technician Andrew Mwangi-Chege. 'We take three sputum samples from suspected patients over a period of time to increase our chance of finding the TB bacillus,' he said. 'In Mathare, if the patient has the clinical symptoms and we are very suspicious, even if the sputum is negative and even if the chest x-ray is normal, we still put them on treatment,' said Dr Liesbet Ohler, one of the two doctors working in the Blue House. 'TB is a very big problem in Mathare and we now have five MDR patients (multi drug resistant) that we cannot cure with our drugs. Normally you have to isolate those patients but here in Nairobi there is no hospital with a good isolation room so I have been making a protocol to treat those patients unilaterally.' A major component of MSF's work in the Blue House is education. A survey conducted in October 2005 showed that 30 out of 61 patients didn't recognise or understand the importance of keeping follow-up appointments or adhering to their medication. That importance is developing resistance to the medication, be it for TB or HIV. 'The risk in developing resistance is exponential with the number of times you forget to take your medicine,' said Christine Genevier. 'That is why, in this program, we have a big number of counsellors and such an input into the counselling of the patients to see that they are adhering to the treatment.' The concern is trying to keep as many patients on the generic-based and subsequently cheaper 'first line' treatment for both HIV and TB without having to switch to the more expensive, and non-generic, second line treatment. 'We started the ARV (antiretroviral) program in 2001. At that time the cost of one year's treatment with generics was around $300-400 US dollars, two years before that it $15 000. The generics have brought a huge difference. Now it is below $200. A move to second line treatment is a minimum of $700-800 but closer to $2000,' Christine said. |
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