At a dispensary in Siaya County, a cheerful Margaret confidently walked towards me looking all excited. She was eager to meet me just like I was to meet her. She was ready to share her experience once again explaining that she has occasionally shared the story publicly. This is a practice she finds renewing adding that she shared it during the 2017 World TB Day commemoration in Siaya County. This is the story of Margaret, a great fighter of both TB and Diabetes, making her story uncommon.
Margaret’s story is unique in that many of us know of a close family member or relative who has either suffered TB or Diabetes in separate cases. However, not many know of someone who has suffered both concurrently. The 47-year-old’s plight started one ordinary morning in 2013 when she collapsed while routinely brushing her teeth. Before this, the mother of three had had a clean health record. Her husband found her unconscious and rushed her to the county hospital. Several tests were done and one turned positive; her sugar levels were high confirming that she had diabetes. She was put on medication, which she religiously adhered to day-in-day-out while observing a healthy diet as advised.
Later on, in the same year, she developed a persistent cough. She was taken to the hospital and was advised to cut her uvula – back tongue – as it was presumed to be the cause of her irritating cough. She obliged and had it cut. However, the cough did not go away. At this point, she had lost a considerable amount of body weight and appeared frail. She was also sweating profusely at night.
This time, she visited the sub-county dispensary hospital with a longer list of symptoms. Upon carrying out several tests including TB and HIV, she tested positive for TB. She felt disheartened, uncertain of how she would manage both TB and Diabetes. She shared her predicament with her family who dismissed the diagnosis as inaccurate since it was done at a dispensary. The family persuaded her not to take the TB medication. She followed her family’s advice and her condition got worse. Two weeks, later she was taken to the county hospital where an x-ray was done and again, she was diagnosed with TB. It was a devastating blow to her. She was put on eight months’ TB treatment, which including 60 injections.
To her surprise, she was referred to the facility near her home, which happened to be the same dispensary where she had been diagnosed with TB the first time. The walk from her home to the dispensary took her one hour. She found this distressing, prompting her to quit treatment as she often felt fatigued walking to the facility daily to receive the prescribed injections. She could also not bear the embarrassment and stigma from many in her village as they thought she had HIV as the TB clinic was housed within the Comprehensive Care Centre (CCC).
After some time, she realised that the treatment was done separately and TB patients would often get treated early and then released to go home. This realization elevated her confidence and she went back for treatment. On the other hand, her medical expenses had become too heavy to a point where she contemplated quitting the diabetes treatment.
This was not all, she faced rejection and isolation at home. Her cups, plates, spoons were labelled and stored separately from the others. However, this did not last long as with time, she improved and her family members started accepting her back. The other great challenge she faced was swallowing the large TB tablets with an unpleasant smell.
Margaret successfully completed her TB treatment and is now left to battle diabetes. Her family is supportive of her and often exempts her from heavy and hazardous chores that could get her injured as injuries and wounds suffered by diabetic patients take longer to heal. She eats healthy foods and now understands that the reason why she contracted TB was due to the low immunity caused by diabetes. This is equally common among patients with other chronic diseases like HIV, hypertension, sickle-cell anaemia, epilepsy and even cancer.
She thanks the Community Health Volunteer (CHV) who encouraged her to take the TB medicine and would make weekly home visits. The CHV also had all her contacts regularly screened for TB.
Having experienced this and many other similar TB co-infection challenges in the county, the County TB and Leprosy Coordinator (CTLC) has not taken active case finding to chance. She and other healthcare workers have redeveloped the outpatient card to include TB screening questions. If a patient presents with one of the symptoms, they are asked to produce sputum for examination using GeneXpert technology. “We have proudly embraced this strategy; however, the only challenge we face is a stretched workforce due to the increased number of sputum samples at the lab,” says CTLC Mary Wambura.
According to the World Health Organisation, diabetes is a serious, chronic disease that occurs either when the pancreas does not produce enough insulin (a hormone that regulates blood glucose), or when the body cannot effectively use the insulin it produces. Globally, an estimated 422 million adults were living with diabetes in 2014, compared to 108 million in 1980. This means that diabetes is on the rise, most markedly in the world’s middle-income countries. This reflects an increase in associated risk factors such as an increase in the co-infection rates.
People with a weak immune system, because of chronic diseases such as diabetes, are at a higher risk of progressing from latent to active TB. People with diabetes have 2-3 times higher risk of TB compared to people without diabetes. Early detection can help improve care and control of both.