“During that time, when the doctor informed me of my TB diagnosis and explained the need for medication, acceptance wasn’t difficult,\u201d Emily said during the interview.<\/p>\n\n\n\n
She said that her active involvement in an HIV support group, provided the necessary support to navigate the subsequent stages of her HIV\/TB coinfection<\/a>.<\/p>\n\n\n\n After successful treatment, Emily was declared free from TB and assumed the role of TB Champion.<\/p>\n\n\n\n In 2014, complications in her urinary system emerged, causing infections and discomfort in her abdomen.<\/p>\n\n\n\n “The doctor kept noticing that I would get one infection after another, and even after treatment, they just kept coming back,” Emily said. “I used to wonder, what kind of infection is this?”<\/p>\n\n\n\n Despite continuous medical attention, the underlying issue remained unidentified.<\/p>\n\n\n\n Emily said that her visits to the hospital continued for several years until the end of 2018 when she became critically ill, to the point of developing high blood pressure.<\/p>\n\n\n\n “It was during this time that the doctor I had been seeing for years became concerned and decided to refer me to a medical consultant here in Kajiado county,” she said.<\/p>\n\n\n\n During this consultation, the new doctor closely examined Emily’s medical history, focusing on her persistent urinary complications.<\/p>\n\n\n\n “After the check-up, the doctor told me that the problem is with my urinal system,” Emily said. “So, he sent me to Lancet in Nairobi city for more tests.”<\/p>\n\n\n\n Following the urinal test at Lancet, a diagnostic, monitoring, and screening laboratory with pathologists, she was diagnosed with Urogenital Tuberculosis.<\/p>\n\n\n\n The aftermath of a delayed diagnosis of Urogenital TB can be profound, leading to complications such as urinary incontinence<\/a> \u2014a reality that Emily is living with.<\/p>\n\n\n\n “I have to use adult diapers now because I lost control of my bladder,” Emily said with a shaky voice. <\/p>\n\n\n\n Emily lives in Kajiado, a rural area where small hospitals with minimal facilities are, and service delivery for complicated diagnosis like extra pulmonary Tuberculosis, often go unnoticed. She is one of about 20% of the global Tuberculosis patients diagnosed with Extra pulmonary TB<\/a>, considered a rare form of TB.<\/p>\n\n\n\n Impact of delayed diagnosis <\/strong><\/p>\n\n\n\n Now, concerns are mounting over the battle against this disease in Kenya, attributed to delays in diagnosis, which create a gap between the onset of symptoms and the confirmation of TB, during which patients might unknowingly transmit the disease to others.<\/p>\n\n\n\n \u201cThis diagnostic delay issue is particularly significant for Kenya given its high ranking among the 30 countries contributing to 80% of the global TB burden<\/a>.\u201d said Nkirote Mwiringi, the National Coordinator for Public-Private Collaborations, Human Rights, and Gender at the National TB Program, Ministry of Health, Kenya.<\/p>\n\n\n\n She said that one of the government’s significant challenges in addressing TB is that a substantial portion of cases seeking care does not receive timely attention during their initial contact with healthcare providers.<\/p>\n\n\n\n “This becomes a problem, considering TB ranks as the fourth leading cause of death in the country,” Mwiringi said.<\/p>\n\n\n\n According to the 2023 Global tuberculosis report by World Health Organization,<\/a>1.3 million people worldwide succumbed to TB in 2022. An estimated 10.6 million people fell ill with tuberculosis (TB) worldwide, including 5.8 million men, 3.5 million women and 1.3 million children.<\/p>\n\n\n\n \u201cThis infectious disease requires early identification and treatment to prevent complications and long-term health effects,” said Dr. Jeremiah Chakaya Muhwa, a pulmonologist and founding member of the Respiratory Society of Kenya (ReSoK). <\/p>\n\n\n\n However, he noted that the diagnosis of extra-pulmonary TB is challenging, and delays might occur due to nonspecific symptoms.<\/p>\n\n\n\n “The difficulty intensifies in areas with limited diagnostic capacities, often requiring the referral of patients to higher-level facilities for appropriate testing,” Chakaya said.<\/p>\n\n\n\n The impact of delayed diagnosis on Emily’s daily life is palpable. <\/p>\n\n\n\n “When the doctors told me it was Urogenital TB, they started me on TB treatment, and within 6 months, I was cured,” Emily shared. “But, during that time, we didn’t realize that the TB had already spread to my bladder and kidneys.”<\/p>\n\n\n\n After being declared TB-free for the second time in her life, Emily’s health challenges persisted. She continued to experience pain, and her blood pressure remained high. Her second doctor recommended consulting a urologist for a more in-depth examination.<\/p>\n\n\n\n “The urologist sent me for a scan, and it showed that my kidneys were affected. As the doctor tried to figure out the best way to address my kidney issues, I started having uncontrollable urine flow,” she said.<\/p>\n\n\n\n Emily underwent a procedure to insert a ureteral stent<\/a> \u2014 a small tube placed in the ureter, to connect the kidney to the bladder. This stent helps maintain the flow of urine from the kidney to the bladder and is often used to address issues such as blockages or obstructions.<\/p>\n\n\n\n After the procedure, a follow-up for a second round of insertion was scheduled two months later. <\/p>\n\n\n\n “On the second try, the stent insertion on my left Kidney gave some trouble, so they did more tests. As a result, my urologist referred me to Kenyatta Hospital,” she said.<\/p>\n\n\n\n This referral by her third doctor marked the moment when Emily transitioned from local county-level doctors to specialists at Kenyatta National Hospital, a public tertiary referral hospital under the Ministry of Health.<\/p>\n\n\n\n Emily said she was shocked to learn that her left kidney had become non-functional. Though it remains in place for now, doctors at Kenyatta Hospital continue to monitor her right kidney.<\/p>\n\n\n\n According to Dr. Leyla Abdulahi, a practicing epidemiologist and research scientist at the African Institute for Development Policy (AFIDEP), there is a gap between the intended capacity for TB care in the country and the actual number of clinics actively offering these services.<\/p>\n\n\n\n \u201cRecent data indicates that, out of the theoretically designated 10,000 clinics for TB care across six levels of health facilities, only approximately 6,000 are actively providing TB services,\u201d said Dr. Abdulahi.<\/p>\n\n\n\n She said that this statistics demonstrates limitations in the healthcare system’s ability to provide comprehensive TB care.<\/p>\n\n\n\n The Silent Spread of Urogenital Tuberculosis<\/strong><\/p>\n\n\n\n Urogenital tuberculosis is a type of tuberculosis (TB) that affects the parts of our body responsible for urine and reproduction.<\/p>\n\n\n\n A study published by Nature Reviews<\/a> indicates that, \u2018A substantial proportion of patients presenting with extrapulmonary TB have urogenital TB (UG-TB), which can easily be overlooked owing to non-specific symptoms, chronic and cryptic protean clinical manifestations and lack of clinician awareness of the possibility of TB.\u2019<\/em><\/p>\n\n\n\n “We find that Urogenital TB is more frequently observed in women than in men,” said Duncan Barkebo, a clinical provider and mentor specializing in Tuberculosis (TB) at the Center for Health Solutions in Kenya.<\/p>\n\n\n\n Barkebo said that the primary concern associated with Urogenital TB is infertility. This not only impacts the individual but also extends to their family and the wider community, noting that, in some instances, the condition might be mistakenly attributed to other reproductive issues, such as fibroids or blocked tubes.<\/p>\n\n\n\n Emily said that this disease presents other unique challenges for women, especially dealing with the stigma it carries.<\/p>\n\n\n\n “The stigma is there. As an adult buying diapers, and also looking at my role as a community health volunteer, I’m wary of people knowing the full extent of my condition. I don’t want them to view me differently, judging me because I have to wear diapers. That’s why I choose to conceal my identity,” she said, adding that the situation has taken a toll on her mental well-being. <\/p>\n\n\n\n \u201cI don’t feel comfortable as a woman anymore. Wearing diapers all the time diminishes the family aspect,” she said. “There are things I have been wanting to do, but this disease makes me feel like my hands are tied, and I can’t pursue my aspirations.\u201d<\/p>\n\n\n\n Emily notes that for the few people who know her situation, she can see how they look at her with pity, and that makes her uncomfortable too.<\/p>\n\n\n\n \u201cI avoid visiting people, and if I do, I only stay for a few minutes and leave. Because of my situation, I don’t want to excuse myself to go and change. I don’t feel comfortable, so this disease makes you feel so lonely.\u201d She said.<\/p>\n\n\n\n \u201cIt’s crucial to recognize the unique challenges women face, particularly in societies where women often bear the primary responsibility for home management.\u201d Dr. Chakaya said, \u201cIf a woman is affected by TB, it can have significant consequences for the entire household, affecting children, neighbors, and the woman herself and perpetuating stigma. This adds to the disproportionate impact of TB on women.\u201d<\/p>\n\n\n\n The Cost Implication<\/strong><\/p>\n\n\n\n \u201cFor the adult diapers, it costs KES150; there is no cheaper alternative, and I have to use them day and night, every day,\u201d said Emily, while looking at the tangible cost of Urogenital TB. \u201cYou cannot go a day without them; you will soil yourself, and that brings about stigma.\u201d<\/p>\n\n\n\n Emily said that she always needs to have money in her pocket due to frequent travel from Kajiado county to Nairobi, where Kenyatta Hospital, the only facility capable of addressing her complication, is located. <\/p>\n\n\n\n This movement from a rural area to the city center for medical care incurs additional costs.<\/p>\n\n\n\n \u201cYes, I do have the National Health Insurance Fund (NHIF), but the cover doesn’t cater for everything, even at the public hospital.\u201d Emily said, adding that, \u201cI have had to sell things in the house, rely on friends, well-wishers, family members, and that is a problem. I am straining.\u201d<\/p>\n\n\n\n Despite her low income, these are necessities she must bear to cope with the aftermath of delayed TB diagnosis.<\/p>\n\n\n\n![\"\"](\"https:\/\/kassfm.co.ke\/digital\/wp-content\/uploads\/2023\/12\/Untitled-design-61-1-1024x576.png\")
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