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Kenya: The “Blue House” in the slum district Mathare helps people with HIV/AIDS and tuberculosis – but to survive they need more than just medicines. Mathare has 300,000 inhabitants and that makes it one of the biggest slums in Nairobi, the capital of Kenya. Médecins Sans Frontières (MSF) runs a clinic here in which patients can receive antiretroviral HIV/AIDS drugs that can prolong their lives, and also tuberculosis treatment. Rebecca Gathu, a Kenyan head nurse, explains what the “Blue House” does for its poverty-stricken patients. Why are there so many people with HIV/AIDS and tuberculosis (TB) in Mathare? The people here are very poor and live in very cramped conditions. Alcohol and injected drugs play a big part. You can also find hard drugs because some of the people work as dealers. The population lives from hand to mouth – besides small shops, prostitution is an important source of income. The inhabitants of Mathare are exposed to a way of life in which they easily come into contact with diseases such as HIV/AIDS. HIV weakens the immune system, which often leads to tuberculosis. How many patients have HIV/AIDS, how many have TB and how many are suffering from TB as a so-called opportunistic infection due to HIV/AIDS? On average, we register 100 patients per month here at the Blue House who have been diagnosed with HIV/AIDS. In addition, we take on about 50 patients with TB every month, and in about 75% of those cases we find that the TB is a so-called opportunistic infection which means that TB appears in those patients because their immune system has been weakened by HIV and they are therefore more vulnerable to illnesses. Owing to the close connection between HIV/AIDS and TB, we ask every tuberculosis patient to undergo an HIV test so that he or she can receive the right therapy from an early stage. What treatments do the patients receive? Patients who have been diagnosed as HIV-positive are initially given drugs aimed at preventing the outbreak of opportunistic infections. Afterwards, we carry out a test to determine whether their immune system has been weakened to such an extent that we should begin life-prolonging antiretroviral therapy. If a patient has been diagnosed with TB, he or she also receives appropriate TB-medication for six to nine months. Those patients who have both HIV/AIDS and tuberculosis are usually treated for TB first. However, if they are already in such a poor condition that the AIDS treatment must begin immediately, then we often have to adapt their drugs-regimen aimed at minimising the incompatibility reactions due to the simultaneous intake of different medications. What are the challenges you face in diagnosis and treatment? TB is harder to diagnose in patients who have HIV/AIDS because the microscopic examination of the sputum coughed up by the patient – the sputum test – is even more difficult than in normal cases. Even x-rays will often not give us a clear outcome in HIV positive patients. We also provide financial assistance if a patient cannot pay for this. Examinations, laboratory tests and medicines in the Blue House itself are free of charge. Another challenge is that we sometimes lose patients. Most of the people who live in Mathare come from the countryside. Some arrived years ago, others only recently. When we start treating a patient when he or she is very ill and bedridden, the relatives often want to take them home, back to the countryside. But that means the treatment is interrupted because we can no longer reach them. Discontinuing the treatment can easily lead to resistance; and it is very difficult for us to help patients with resistance to TB medication. The therapy is protracted, very expensive and the outcome not always successful. In a slum like Mathare, is it possible to save lives purely through medical intervention? In this kind of situation an all-embracing approach is required. We also have to deal with the social needs of our patients and give them extra attention when they need shelter and food. Assistance provided by social and community workers is very important in our project. Read other articles on HIV/AIDS
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