In Kenya’s sprawling Kawangware slums lives 32-year-old Elizabeth Wambui Nthumbi. She is a jobless, mother of four who is currently bedridden because she is suffering from extra-pulmonary tuberculosis (TB).
This is the second time TB has recurred in Elizabeth. The first time, Elizabeth says she strictly adhered to her treament routine and successfully completed it. But she admits that, whenever she got the opportunity, she binge on alcohol.
According to Elizabeth, on finishing her treatment she had every reason to celebrate. She says she continued her drinking sprees to make up for lost time at the expense of her family and children, stealing from her boyfriend, the father of her two small children, to pay for her favorite pastime. Her boyfriend’s pleas to stop drinking went unheeded, causing in him taking their children to his mother’s home in a rural area, in the hope that Elizabeth would quit alcohol.
In the grip of her alcohol addiction Elizabeth abandoned her infant children to her mother in-law and came back to the city where she continued with her drinking, ‘stress free’ life. Her youngest was barely a few months old.
But her desire for an endless party-life was short lived when TB returned. Currently, Elizabeth has been put on treatment for the second time. She has just finished her injections, yet she is getting worse by the day. She cannot walk, sit, stand, take care of herself or do basic things. Besides this, she has been hallucinating and is confused and delusional. She now relies on a community health worker, a cousin and neighbors to help carry out basics tasks.
She lives with her sister and brother. But both are also known alcohol abusers and are able to offer little assistance with Elizabeth’s own alcohol dependence. Her children are also struggling. Her eldest daughter, who was in Form Two at St Martin Girls High School in Kibagare, has dropped out despite being sponsored by a local Catholic Church. Her son has run away from home and is currently on the street, his exact whereabouts unknown.
I visited Elizabeth at her one-roomed house at Gishagi in Kangemi. On entering you are welcomed by the pungent smell of ammonia due to the fact she sometimes relieves herself on her bed because she is bedridden.
“Ni vile tu hawezi kutembea lakini angepata nafasi angekuwa kwa pombe” (It’s only because she cannot move otherwise she would have been out drinking) says Grace Waithira, her cousin.
At first glance you would mistakenly confuse Elizabeth for someone who is in the fourth and final stage of HIV because her body displays the HIV wasting syndrome. But Elizabeth is HIV negative. What she is suffering from is arguably worse than HIV or any other disease; she has an alcohol problem.
People with alcohol disorders not only face an increased risk of acquiring diseases, ithey are more likely to become seriously ill or die from diseases such as TB because alcohol can suppress the immune system. Alcohol can also complicate TB treatment as people with drinking problems are less likely to adhere to treatment routines.
According to Evelyn Kibuchi, Advocacy Manager at the Kenyan AIDS NGO Consortium (KANCO), people who are addicted to drugs including alcohol should recieve counseling before being initiated into TB treatment to ensure they understand the effect the drugs they are using will have on the efficacy of their treatment.
“Alcohol should be discouraged when one is on TB treatment because it increases the frequency of urination thus making drugs pass out in the urine before they are absorbed,” she adds.
Dr Joseph Sitienei, head of TB Division, echoes this sentiment. He said: “Alcohol and TB do not go together. A person should not compromise because the two are can potentially be toxic to the liver.”
For someone like Elizabeth, who suffers from a potentially fatal and highly contagious disease, alcohol addiction can lead to drug resistant TB. According to studies carried out by scholars from the World Health Organization’s Stop TB Department, people who have an alcohol disorder are at greater risk of active TB. Theses studies show that there is an association between alcohol use and the risk of TB, although these findings do not establish the extent of this association. The increased risk could be due to the increased risk of infection related to specific social mixing patterns associated with alcohol use, as well as alcohol’s influence on the immune system alongside other alcohol- related conditions.
Suffering from alcoholism and chronic medical illness further contributes to a cycle of poverty, displacement and socio economic disempowerment that often makes recovery unattainable, even for the most motivated patients. The question is: what is the government, civil society, and those bodies set up to address issues surrounding TB and drugs, doing about people like Elizabeth?
