Beliefs, culture hinder treating of TB in Kwale

Our interview is disrupted every few minutes by a child’s shrill cry.

Mohammed Hussein, a one-year, nine-month-old boy, seems uncomfortable as his mother, Asha Mohammed, narrates to us the suffering they have gone through for the past 21 months.

Most of the children his age walk and run around, but Hussein still crawls on the floor. He looks so disturbed and would cling to his mother for attention and comfort.

Asha, a 32-year-old mother of four, says when she delivered Hussein, her lastborn son, about two years ago, she noticed that the child had difficulty in breathing and always had a very high body temperature.

“From those early days, I knew something was wrong with my son. I wondered why his elder siblings did not exhibit such symptoms when they were young,” she says.

At home, the young boy would cry the whole night, and after one week, they had to go back to the hospital to try and seek some medical advice.

“We were just given some Piritons and some other painkillers. I went home with my child, but the medication did not help at all,” she adds.

The child’s grandmother said the boy might have been bewitched, and that was the beginning of all their troubles.

Her husband, who stays in Mombasa’s Likoni area, told her to travel with the young boy to go see a woman in Mombasa who would help them cast off the evil spirits.

“I went straight to my mother’s place in Kisauni and the following morning, we took my child to a traditional healer in Kisauni,” she says.

“Your child has been bewitched and we should immediately place him on black magic medication,” the traditional healer told them.

The baby was smeared with a powder then bathed in cold water.

Asha says despite her son’s chest pains, he was thrown into a basin of cold water and thrown into the air several times. The traditional healer asked them to administer the black powder to the child for a whole week, and if they do not see any changes, they should come back.

ANOTHER TRADITIONAL DOCTOR

After one week, Asha’s mother advised her to take the child to Coast General Teaching and Referral Hospital after it became evident that the ‘black magic’ was not helpful.

However, her husband opposed it, saying they should give it (black magic) more time before they go to the hospital.

They were then directed to another traditional healer called ‘Mzee Try’ in Kisauni.

“Your child has been really affected by ‘Chira’. If I give you my medication, your son should be healed within a week. He will be very healthy,” Mzee Try told them.

Chira is a belief among the coastal communities that a child would become terribly sick if one partner engages in extramarital sexual affairs.

Asha's sister, who stays in Mwapala in Shimba Hills in Kwale county, called to ask how the child was faring.

“We told her he was still sick and in pain, and she said she knows of yet another renowned healer in Shimba Hills who could help us. The healer told us my child has been possessed by evil spirits. He will never walk or talk,” Asha said.

The traditional healer asked them to bring two cocks: a red one and a black one.

“I did not have the hens with me at that time. He administered some traditional ‘first aid’ and asked for Sh900,” she says.

“We went back after a day with the cocks. He yet again asked for three kilogrammes of rice and gave me some oil to be used for seven days. We stayed at the house of the traditional healer for a whole week. Nothing changed.”

After three attempts to visit traditional healers, Asha decided to visit Lunga Lunga Subcounty Hospital for medical attention, and the doctors referred her to Msambweni County Referral Hospital for X-rays.

“Before the xX-ray results were out, we were referred to yet another traditional healer in Mwangulo. This healer was my husband’s aunt,” she says.

The relative told them her son was possessed by seven jinis, adding that they would have to dance for a whole night to oust them.

“We were required to buy three special clothes. She asked for eight hens: one of the hens should be ‘disabled’, either without a leg, wing or eye. One should be a white cock, a black one and a red one,” she says.

Four hens were for the traditional healer and four were to be slaughtered as sacrifices.

“The healer also asked for a black goat and Sh7,540 cash money. We danced from 3pm throughout the whole night, while my child was being bathed in cold water,” Asha says.

Once back home, however, nothing changed. The situation became worse and the child stopped breastfeeding for two weeks. He was very sick.

She went back to Lunga Lunga Subcounty Hospital and was advised to go to the tuberculosis clinic. The doctors asked for the child to be admitted before they could collect the samples for testing.

The young boy was diagnosed with TB and immediately placed on medication in August.

It is now three months since Hussein started his medication and his health has really improved. He now crawls and tries to stand on his own.

TOTALLY MISLED

Kwekwe Rau, a 38-year-old mother of seven kids, has an almost similar experience to Asha's after her lastborn daughter developed sickness just a few weeks after birth.

Husna Mbeyu is now one year old, but she has been in and out of hospital and to several traditional healers in Kwale county because of her unending ailments.

“Few weeks after birth, my child was sick every now and then. I took her to several clinics and health facilities in the locality but nothing changed.  I was advised to seek the services of a traditional healer,” Rau says.

At the first traditional healer, they were surprised to be told that, “Mtoto wako amechukuliwa nongo,” which loosely translates to, “Your child’s shadow has been taken away.”

They were given some traditional medication, but before they could finish the dose, they were advised to seek help from yet another traditional healer.

“The second herbalist told us my daughter has asthma,” she says.

After a few weeks without any changes, they took the child to Lunga Lunga Subcounty Hospital, where she was diagnosed with malaria and pneumonia. She was placed on medication but the condition did not improve much.

“I was asked to visit Msambweni County Hospital for X-ray services. It was confirmed that the young girl has TB and she was immediately placed on medication,” Rau says.

That was in August and they started medication in September. Her child’s health has since improved.

Tunu Hamza, a TB clinician at Lunga Lunga Subcounty Hospital, says TB is now common among children because they have weak immune systems and, therefore, can easily get exposed.

“You will find that the child has TB but both parents and close contacts are negative,” she says.

“Therefore, the child might have been exposed far away from home, either during weddings, funerals or baraza gatherings, which are common in this region.”

She adds that parents who take their children to herbalists or religious leaders do so because of a lack of information.

Hamza says because of high levels of stigma, most patients who contract TB will rush to test for HIV-Aids first.

“If they turn out to be negative, they automatically think they are bewitched and will either run to a pastor or a traditional healer,” she explains.

PRAYERS, 'JUJU' MIX

At Perani village of Kwale, 67-year-old Jimmy Muli is under TB medication for a second time after he developed Multi-Drug Resistant TB.

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Muli says when he first contracted TB in 2018, he was placed under medication for six months and declared TB free after finishing his dose.

After five months, he started engaging in hard labour again, he said.

Around June this year, while he was busy on his farm, he felt the urge to cough. He spew some blood and had to rush to the hospital.

“I was immediately diagnosed with TB and placed on medication for one year,” he says.

Around November, he was advised to seek spiritual healing from a local pastor in Mrima area of Lunga Lunga.

Muli says the pastor advised him to put on heavy clothes because “he was suffering from cold.”

The father of nine explains that he felt better after the prayers. He parted away with Sh300 at the pastor’s place as an offering.

“After a week, I was not feeling any better and I was advised to go see a traditional doctor because there are people who are jealous of my hard work,” he narrates.

The distance from his home to the herbalist costs Sh1, 200 on a motorbike.

“I was asked to pay yet another Sh3, 800 to the traditional healer. I spent a total of Sh5, 000, but nothing changed. I wasted my money. I shouldn’t have gone to those places in the first place,” he says.

Peter Jilani, the Lunga Lunga Sub County TB and Leprosy Coordinator, explains that before devolution, most of the rural residents used to mistake TB for witchcraft due to lack of information.

 “However, the number of those who associate TB with witchcraft is slowly coming down due to the campaigns we have been doing at the grassroots,” says Jilani.

He says at Lunga Lunga Sub County Hospital they are now handling more and more TB patients as locals come for testing.

“We handle TB clients from within Kwale and even from neighbouring Tanzania. I’m happy to note that we have had increased diagnosis of TB because people come for testing regularly,” he says.

Two years ago, the Lunga Lunga Sub County Hospital facility was dependent on AFB Smear Microscopy for testing of TB, which is not as sensitive as the modern technology used in diagnosis, explains Jilani.

Recently, the facility received the Truenat TB testing machine, which is a new molecular testing machine that diagnoses TB within one hour.

“We received this new machine courtesy of USAID. It has higher sensitivity compared to AFB microscopy and we have so far managed to improve our diagnostic rate,” says Jilani.

Initially, Lunga Lunga Sub County Hospital used to record about six cases of TB every month, but since they started using the Truenat TB testing machine, they have been able to double the number to 12 patients per month for the past three months.

We have increased the cases from an average of 36 cases per quarter to 48 cases every three months. This quarter of October to December we expected to have over 50 cases,” explains Jilani.

According to the TB expert, before the onset of devolution in 2013, the cases of locals associating TB with witchcraft were very rampant in Kwale County.

However, they have been carrying out regular sensitization forums to enlighten the community to understand what TB is all about.

“What we have tried so much to do is to give information at the community level down to the household level using the community health volunteers,” says Jilani.

“That aspect of constant health education has been able to curb the stereotype.”

Sylvia Ayon, Senior Policy Manager at Kenya Aids NGOs Consortium (Kanco), explains that they work with communities in Kwale and Mombasa counties to enlighten locals on TB through the support from Global Fund.

Kanco has over 50 Community Health Workers who work to assist in treating, monitoring and tracing TB patients in Mombasa and Kwale counties.

Ayon explains that people in rural areas tend to rush to the elders or religious leaders for advice whenever they have a problem.

In most cases, these elders, religious leaders and traditional healers might mislead their followers for lack of information.

Ayon says Kanco some years back decided to ensure that the community leaders, traditional healers and pastors are enlightened on TB.

“We took them through training. They will call for a community health volunteer or health worker to take a person local who has shown symptoms of TB to a health facility,” explains Ayon.

Ayon said a lot of community work was done to sensitize these herbalists and they went ahead to the extent of mapping those who were so prominent within their locality.

According to Ayon, another reason that forces locals to seek help from religious leaders and traditional healers is because of financial problems.

“They (locals) think they will spend a lot of money at a health facility compared to a traditional healer. We want to sensitize the community that the TB services are offered freely in public health hospitals,” she says.