MDR-TB in Mobile Populations: Omar Guleed’s Story

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Multi-Drug Resistant TB*Omar Guleed stepped on the brakes of his truck.

 

He had to do it today. The cough had persisted for more than two weeks, and he felt a sharp pain in his chest whenever he breathed. He had to have it checked. A seasoned long distance truck driver, Omar expertly packed his burgundy coloured 18-wheeler truck and walked into Kisumu District Hospital.

One hour later, Omar had given his sputum, tested for TB and started on a six month TB treatment regimen. The health care workers at the hospital were especially kind and patient with him as he was unable to understand both English and Swahili.

Through a translator, Beatrice Ooko, Kisumu East Sub-county TB and Leprosy Coordinator (SCTLC), did her best to explain to Omar the importance of adhering to his treatment. Beatrice also explained that Omar’s close contacts needed to be screened for TB something that Omar strongly objected to. He was too afraid to let anyone in his family or at work know that he was sick. His boss, who was actually his cousin’s husband, would not be too pleased if his star truck driver was sickly and on long-term medication.

“Taking the medicine can not be too hard, ” Omar thought as he walked out of the hospital.

A few days after starting his medication, Omar was off to Sudan via Uganda against the advice of Beatrice and other health care workers in Kisumu. After about one month, he had fallen behind in his medication and was completely unreachable. After three months of non-responsiveness, Omar was declared an out-of-control client to the disappointment of Beatrice and the health care workers in Kisumu East. Four months later, a sickly Omar resurfaced at the hospital.

He had lost so much weight and his cough was worse. Beatrice requested for another sputum test, which confirmed that Omar still had Tuberculosis. This time, Beatrice brought in a community health volunteer who was fluent in Omar’s native language for intensive adherence counselling after which Omar was put on a re-treatment regimen. Part of the counselling required for Omar’s relatives to be informed of his condition in order to support him through his treatment. To Omar’s shock, his cousin was indifferent and disdainful.

“Does he have HIV?” the cousin asked.

“Has he been immoral and contracted HIV/AIDS?” she asked

Can he infect us with HIV and TB if he stays with us?” she asked

Omar was hurt but because of the intensive counselling he agreed to continue with the medication. His cousin also reluctantly agreed to accommodate him in a small separate room as he continued with his treatment. In a short while, Omar was feeling better and soon got into his beloved truck and resumed his long distance travels.

He had however interrupted the continuation phase of his retreatment regimen. It did not take long for Omar to show up in the system again. He was now very ill and sought treatment at a neighbouring facility. Beatrice however traced him back and Omar was eventually diagnosed with MDR TB.

A team consisting of the TB Clinic Nurse, a community health volunteer and the Kisumu East SCTLC once again counselled Omar and his family emphasising the need for him to stay in one place as he took his medicine. Timothy Malika, the Kisumu County TB and Leprosy Coordinator also stepped in to support Beatrice and encourage Omar to complete his treatment. After a series of arrests and increased stigma from fellow truck drivers, Omar subsequently finished his medication with great support from Beatrice, Mr Malika and the DOT nurse assigned to him.

MDR- and XDR-TB are a growing concern in Kenya. In 2011, 166 MDR-TB and two XDR-TB cases were notified. In the same year, it was estimated that 3.1% and 10% of new TB cases and retreatment cases respectively had MDR-TB, translating to about 2400 and 1000 cases among new and retreatment cases respectively, suggesting low MDR-TB case finding.

The USAID funded Tuberculosis Accelerated Response and Care (TB ARC) Activity is mandated to provide transport and nutritional support to MDR TB patients like Omar to help them successfully complete their treatment. TB ARC also supports support for health care workers to facilitate home based Directly Observed Treatment that was instrumental in helping Omar complete his treatment.

“Omar is a different man today. He has gained weight and tested negative for TB. I think he is an excellent MDR TB champion and TB ambassador for truck drivers,” said Beatrice Ooko.

“His story represents how MDR TB clients struggle with their treatment and how stigma can negatively affect a patient’s outcome. We are all looking forward to getting Omar’s final culture results to confirm that he is fully cured of MDR TB. It will be such a triumph for him and all of us, “ she added.

**Names changed to protect the identity of the MDR TB Client

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