Publication Date
September 10, 2012
KAPSABET, NANDI DISTRICT, KENYA – For 50 days, Kenyan brothers Daniel Negtich, 38, and Patrick Kipng’etich, 28, slept on the floor of a tiny, cold jail cell in Kapsabet Prison in the western region of Kenya.
Negtich and Kipng’etich, both tuberculosis, TB, patients, were arrested in late August after they failed to pick up their prescribed TB medication. The local magistrate sentenced the brothers to eight months in jail for failing to take their medication, calling it a crime against the Public Health Act.
Zacharia Maina Bett, a public health officer in Kenya’s Nandi Central District, swore to an affidavit that allowed the local magistrate court to order the confinement and imprisonment of Negtich and Kipng’etich to force their TB treatments.
The brothers were released last Monday after a High Court Judge, Philomena Mwilu, rescinded their eight-month sentence amidst a chorus of local and international human rights fury over their imprisonment.
According to the medical humanitarian organization, Médecins Sans Frontières, detaining patients with infectious diseases only increases stigmatization and “will harm rather than help the fight against the infectious disease,” the organization wrote in a statement.
But as the threat of TB grows in Kenya, in the last 20 years the rate has more than quadrupled, public health officials are struggling to find a meaningful way to create awareness about the disease.
An estimated 132,000 Kenyans are infected with TB, giving Kenya the 13th highest TB population in the world. With more than 2.2 million Kenyans also living with HIV/AIDS, TB is particularly dangerous. According to the World Health Organization, WHO, TB is the leading cause of death among the world’s HIV positive population.
With more than 800 new HIV infections assumed every day in Kenya, Beth Mugo, minister for public health and sanitation, says 200 more Kenyans die every day from TB.
Mugo says the Ministry has recognized this problem and taken important steps to increase the capacity of the health system to test and treat patients. Since 2008, the government has offered free testing and treatment.
But consistency in treatment has become a major issue. A patient diagnosed with TB typically requires at least four different drugs and at least six months of supervised care, known as directly observed therapy. If TB treatment regimens are stopped short, the bacteria can mutate into a tougher strain, requiring longer treatment and more expensive drugs. Over the last three years, the number of Kenyans infected with multi-drug resistant TB has increased from 82 in 2007 to 150 in 2010.
As several other governments in Africa have begun to create new programs that treat TB patients in their home communities by training local health workers to visit patients to help them take their medication and provide food and transportation help, Kenya’s plan for treating TB patients – isolation -- is now being widely criticized.
Nelson Otwoma, the national coordinator for Kenya’s Network of People Living with HIV in Kenya, NEPHAK, says while the Public Health Act does have a provision for isolating patients who fail to take precautions against spreading their infectious illness, the act does not indicate that those who fail to keep current with their medications should be sent to prison.
The Global Fund to Fight AIDS, Tuberculosis and Malaria, Kenya’s main funder for TB care, gave Kenya $19 million for the construction of an isolation facility for TB patients in 2005. Today, the facility remains incomplete and the government has applied for additional funds. But until the medical isolation facility is complete, advocates fear that TB patients will continue to be thrown in jail as a means of isolation.
“The country has made great progress in addressing TB,” Otwoma says. “But the jailing of these patients is real concern.”
David Njuguna, chairman of NEPHAK and a survivor of TB, says, “Defaulters are supposed to be taken to health facility not prison because they put other people in danger.”
During sentencing, the magistrate judge ordered that Negtich and Kipng’etich have no visitors and not be allowed to intermingle with the other prisoners. Their only contact was supposed to be the prison warden, who would deliver their food and pills each day.
However, the attorney representing the brothers confirmed that they were put in cells with the other inmates, likely due to overcrowding. The number of inmates potentially exposed to TB is unknown.
Since their release last week, Negtich and Kipng’etich, who were not available for comment, have been taking their medications regularly according to NEPHAK, the body now responsible for monitoring their medication intake.
Otwoma says defaulting on treatment is likely a result of a lack of education. “Most TB patients will follow with their treatment as long as the patients are educated about the disease,” he says. “When patients default from treatment the blame should not be placed entirely on the patients,” he says adding that the health care system need to take social, economic and mental illness issues into account when penalizing people for missing treatments.
Otwoma says many people in the brother’s home community have been shaken by their arrest. “The criminalization of these patients by subjecting them to prison has sparked a lot of fear, anxiety and panic among the general Kenyan population particularly in the Kiropket and Kapsabet Districts,” he says.
