Kenyatta nurses fear slayer TB patient

May 22, 2009 12:00 am

, NAIROBI, Kenya, May 22 – Nurses at the Kenyatta National Hospital (KNH) taking care of a patient with a severe type of Tuberculosis (TB) who has refused to take his medication, are now fearing for their lives due to the high risk of exposure from the patient.

The man, who is suffering from Multi Drug Resistant TB, has refused to take his medication and instead turns violent on anyone who goes near him.

A senior Nursing Officer said on Thursday that the patient had even resorted to deliberately smearing sputum on the wall and floor, frustrating the efforts of the health workers.

“This becomes a bit too much and even the other staff who do the cleaning feel they are also exposed, despite the fact that we use disinfectant,” the senior official told Capital News.

“If he was complying, we could have no issues taking care of him. But because of his behaviour, we feel that is quite a constraint on our part,” he further said.
KNH Chief Executive Officer Dr Jotham Micheni said that the patient risked developing complications that could lead to death if he continued without medication.

“Some tissues may rot and just simply become a cavity. When that happens it is likely that this cavity could erode into major organs – in the lungs, it could erode in the vessel, arteries and veins and he could cough to death,” Dr Micheni explained.

“He could just bleed and die. He could get TB of the brain, we call it TB meningitis,” he added.

Dr Micheni said that the hospital management was still consulting with the government to know what should be done with the patient, who is also a remandee.

The patient, admitted at the referral hospital in October 2007, initially took his medication but later developed an aggression where he refused to swallow medicine even under supervision.

“In view of this the doctors in the ward felt that the patient could easily get into an XDR (extremely drug resistant TB) so we decided to withdraw the drugs completely so that we do another sputum culture,” the senior nursing official said.

The nursing officer explained that the main reason the remandee patient was behaving that way was because he wanted to use it as a bargaining tool for the prison authorities to speed up his case.

“He may be feeling he needs to be taken to court, sentenced so that he can know his fate. That was the initial reason. But so far nothing has been forthcoming from the prisons department because they say they don’t have an isolation facility.”

He said that despite going through counselling sessions, the patient seemed not to understand the magnitude of the effects of his behaviour and the risk he exposed to other patients as well.

“He belongs to the prison, not Kenyatta. Our part is to take care of his health that is if he is willing to have it, but if he is not we feel our hands are tied,” the hospital official said.

The prison warders, who are also in fear, must also be involved when the patient needs to be served with food or given water to take a bath.

The nurses and everyone who has to come into contact with the patient is using protective gear like the N95 masks, which have the capability to filter out some of the germs, gloves and other protective wear.

“But this is not good enough because you are not sure how much you are protecting yourself,” said the nursing official.

“You should try to minimise the exposure and if the hospital had the negative pressures, like the ultraviolet light which would kill some of these bacteria, the environment would be better and safer,” he added.

Dr Micheni on the other hand said that the hospital was considering discharging him if the prison authorities refuse to take him back.

“We have only two patients with MDR-TB but this country has way over 100 cases so where are the other 98 or so, they are in the society. Secondly we must educate society to understand not to stigmatise,” he said.



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