The painful truth sunk in when they were given a prescription by the hospital to buy drugs worthy Sh 40,000 every month for a period of two years if the TB super strains were to be effectively managed.

At this rate, they were expected to spend Sh 1.2 million by the time the patient completed the dose.

Yet, the family had no otherwise but to respond immediately because one of Gakii’s lungs had collapsed.

TB experts say the collapse of the lung is one of the key features of Multi Drug Resistance Tuberculosis (MDR-TB), which can only be managed by surgery or a cocktail of powerful drugs.

Although TB drugs are free in government hospitals and health centres, the government does not have a programme in place for isolating and treating patients who have MDR-TB.

Such patients are left to die if they cannot afford the over one millions shillings required to purchase the drugs used to manage these strains.

At the KNH hospital, the revelations that Gakii was resistant to TB drugs send panic even among some of the medical staff.

They did not know what to do with her because the hospital has no special isolation units for MDR-TB patients.

Initially, Gakii’s aunt, Speranza Wanjohi Nkuene, says when she was admitted, the doctors put her together with other patients because they did not know she had resistant TB. But when they realized this, they started pondering on how to handle her. Without an alternative special unit to place her in, they decided to hold her in a room that Gakii’s family says was not designed for patients. Horizon managed to trace the room in ward 8C with the words Procedure Room 8.71 written on the door.

Speranza Wanjohi Nkuene who has been taking care of her niece, Loice Gakii.

Inside, there were buckets, sweeping brooms and a bed, with all signs indicating that it was not meant to hold a patient. Gakii was kept in this room for nine days from 16th December 2005 until her death on 24th December of the same month.

“The moment I found her in that room, I knew her fate was sealed. She had been condemned to die,” recalls a sobbing Nkuene, who had taken care of Gakii since the time she was diagnosed with the disease.

The hospital’s Head of Respiratory and Infectious Diseases, Dr Munene Irimu, admitted that they do not have special TB wards for patients with MDR-TB. They have to improvise whatever they have to manage such a patient.

“The first instinct when we have such a patient is to separate him or her from other patients using any available space we have,” says Dr Irimu.

Whatever we do, is our best intervention to handle an issue under the difficult circumstances we are operating in, he adds.

Other medical personnel at the institution who talked to Horizon said even if the MDR-TB patient is isolated, they would still fear attending to them because they are not receiving treatment.

Studies show that TB patients who are not on treatment are more likely to infect other people.

And with those with the super strain too poor to afford the drugs and the national TB programme not catering for them, medical staff fear getting into conduct with them. The only option they have is to immediately discharge such a patient.

Statistics from the KNH indicate that the country might be sitting on a time-bomb that might explode sooner than later if urgent interventions are not put in place.

In a recent proposal to Global Fund for HIV/AIDS, Tuberculosis and Malaria, doctors at the hospital say they see between three and four MDR-TB patients every month. In the year 2003 alone, 20 cases were seen in the hospital’s TB clinic.

Without treatment, these patients are likely to infect the hospital staff, their families and other members of the public.

Panicking about these developments and lack of special TB units, the hospital has appealed to the Fund through the ministry of health, for financial support towards the construction of such special units.

Last year, senior officials at the Ministry of Health in one of their internal communications indicated that a national referral and isolation unit for TB patients was going to be build at Kenyatta National Hospital.

The unit was to be used to cater for patients isolated from the rest of the population for treatment purposes.

These patients were going to be held in this unit for about three months to see if they are cooperating with the treatment requirements and can tolerate the drug regimen which is known to be very toxic.

The unit is yet to be established even statistics showing that the country has had over 400 MDR TB cases since 2001.

For now, some medical personnel interviewed by Horizon claimed that some government hospitals are discharging these patients very fast without even asking for payments once they are diagnosed as MDR-TB candidates.

Meanwhile, in attempt to save Gakii’s life, her family went out, desperately trying to organize a fundraising to get Sh 40,000 to buy the first dose of the drugs.

But it was never to be. On 20th December 2005, Gakii passed away exactly one week from the time the prescription was issued and even before the drugs were bought.

One chapter in the life of an MDR-TB patient was closed, and another one was opened with many questions.

Gakii’s death and her family’s experience with the disease brings out not only an urgent need to put in place interventions to manage the disease, but also tells a story of what MDR-TB patients go through.

A first born in a family of two, Gakii’s disease started with a simple cough, which was treated at Chogoria Mission Hospital as such.

Without improvements, the family took her to St Mary’s Hospital where an x-ray was done. She was found to have TB. The hospital referred her to Mbagathi District Hospital for further treatment.

Here, she was put on TB medication for a period of eight months, but she later lapsed in taking the medication. Research shows that one of the ways in which MDR-TB develops is either by the patient lapsing on treatment, under-dosing or using ineffective medication.

By the time Nkuene was taking Gakii back to Mbagathi Hospital in May last year, she had defaulted for several months and the TB had done a lot of damage.

Mbagathi put her again on TB treatment for another eight months, but this time around she was to also receive 60 anti-TB injections, one each day.

When another examination was done after she had completed the 60 injections, it again showed no improvement.

This prompted the hospital to put her again on another 30 injections to see if they could make any difference.

Still, nothing much happened, and so around June, 2005, the hospital decided to undertake further diagnosis at the Ministry of Health’s TB National Reference Laboratory where culture tests, which is a definitive way to establish which drugs a TB patient is resistant to, were done.

The results of the tests from this Laboratory brought out the news that changed her life and that of her family forever: she was an MDR-TB patient.

Horizon established that the results of culture tests at the laboratory that were released on 6/5/05 under culture number 327, showed that Gakii was resistant to three of the four anti-TB drugs- Isoniazid, Rifampicin (Rifampin), and Streptomycin – a classic case of MDR-TB.

The test indicated that only one drug, Ethambutol, could work for her. This meant the adoption of a rapid and an expensive treatment intervention was the only option.

“What continues to pain us is that when they found out that she had MDR-TB, nobody educated or counseled us how to live with her,” recalls Nkuene.

“At this point, we feared isolating her from the rest of the family who she had been interacting with all the time she was sick.”

Worried about what would happen to them, Nkuene took her entire family for TB examination. Although they were found be free from TB, they are hoping second tests in future will give them a clean bill of health.

While this was happening, Nkuene says Mbagathi hospital referred Gakii to KNH for further medical assistance, but doctors here were too lost on what to do with her as they had no drugs or units for MDR-TB patients.

After pondering over the issue, one of the doctors advised Gakii to go to Kibong’oto National Tuberculosis Hospital in Tanzania, which was believed to have free drugs for MDR-TB patients.

Her family pooled together Sh 20,000, and send her to the Tanzania hospital, where she stayed for one week before returning to her rural home in Meru.

The Tanzania hospital gave her a one month dose, which she was to take upon her return to Kenya.

Still, this did not make much difference, and her condition deteriorated only three weeks upon her return home. She started having immense difficulties with her breathing.

Immediately arrangements were made and for the second time, she was brought to KNH, where it was confirmed that one of her lungs had collapsed. She died at the hospital after nine days of intense pain.