Silver lining in a dark cloud: Community DR-TB at work in Kano State
Maikudi was one of the most boisterous young men in his village, and although not opportune to have acquired any significant formal education, he still transcended above this limitation to engage in small businesses which generated considerable income. At a young age of 24, he travelled to far away Abuja in search of profitable businesses mostly dealing in electronics and often returns home with enough money to cater for his family. He loves his mum and relatives adore him because of his kind nature.
After an unusually prolonged cough in 2012, Maikudi visited Utai Primary Healthcare Center (PHC) where he was screened for tuberculosis and subsequently treated. He successfully completed a six month course of CAT1 anti-TB drugs with full resolution of symptoms. During the evaluation, he was also diagnosed with HIV but ignored the result because his friends said he couldn’t be positive! He went on to continue his business until August 2013 when he started coughing again. He initially assumed it was just flu until he started noticing weight loss and night sweats. Maikudi went about his normal business but noticed a gradual decline in energy. He took a bold step to visit the primary health clinic in his village and was quickly referred to Wudil General Hospital where a GeneXpert was requested. He was placed on CAT2 drugs while awaiting his test results. Shortly afterwards, his health status took a rapid down turn. He was now completely unable to carry on with his trade and normal daily chores. He was in a continuous dilemma wondering what was happening to him as he wasn’t noticing any improvement in his condition despite the CAT2 medications. Furthermore he had commenced Anti-Retroviral Drugs but with little or no improvement. GeneXpert result later revealed that Maikudi had DR-TB. He was immediately placed on the DR TB treatment waiting list but couldn’t be admitted immediately as admissions are done based on cohorts.
He progressively declined to a state whereby he could no longer get out of bed. Maikudi was bedridden almost 100% of the day. He could no longer eat, stand, and had lost so much weight to an extent that only his skin and bones were visible to the eye. The occasional breathlessness was distressing and the inability to eat or drink even when he could feel the sensation of hunger was a torture not befitting for any human being. He was only hanging by a thread and relatives knew that death was already lurking by the corner. He continually asked the DOT provider in his village if he was going to die.
Hope came when a team from the USAID funded FHI360 supported TB project visited in company of the State TB Control Program Officer, with information that he could be commenced on treatment for DR-TB right at home if he was ready to comply with medication adherence standards. On January 14, 2014 Maikudi commenced CAT4 treatment with close supervision by a DOTS Provider in his community and fully supported by FHI360 DR-TB technical team. After 28 days on treatment, the remarkable improvement seen could only be described by him as a miracle. He was elated by the fact that he can now get out of bed and walk to the front door of his room all by himself. He could eat by himself and has gained 10 kilogram during this period.
Although he was just beginning a long course of daily medications, he can now see that “silver lining in the cloud”, that the resonates with the hope of him earning a living again and caring for his mum.