Before March 24, 2016, tuberculosis patients in Kenya who interrupted their medication were confined in prison by the government for up to eight months. But that changed when the High Court of Kenya declared such confinement unlawful and unconstitutional.
The ruling was a victory not just to Kelin, a civil society organisation, which filed a petition arguing that congested prison facilities subject sickly people to poor nutrition and hygiene, putting them at a more risk of additional infections — but more so TB patients.
“The Public Health Act then authorised public health officers to take whatever action they deemed necessary, including detaining infected patients, to prevent spread of the disease,” said Solonka Nombaek, head of the clinical TB control unit at the Kajiado County Hospital.
The court further directed the Ministry of Health to ensure that isolation of patients can only be at a health facility where infection control would ensure patients adhere to the course of treatment for their own interest and that of the public.
It is this directive that is at play at Kenyatta National Hospital (KNH), where seven TB patients occupy an isolated ward with restricted access. This ward is not located on the main 10-floor story building of the hospital, but on a separate building away from the main hospital complex.
The other two isolation wards in Kenya can be found at Homa Bay Hospital in Nyanza region and Moi Teaching and Referral Hospital in the Rift Valley region.
The TB patients here are those that are extremely sick from TB and need intensive care.
They suffer either multidrug resistant tuberculosis (MDR-TB), extensively drug-resistant tuberculosis (XDR TB) or normal TB infection but have been defaulting on their treatment and have become a risk to the public.
Samuel Misoi, assistant director public health of the national tuberculosis, leprosy and lung disease programme, says that in Kenya, TB is among the notifiable diseases under the Public Health Act Cap 242.
He says the policy of isolating TB patients is ready and will be launched on World TB Day on March 24. The policy will provide a framework within which TB patients may be isolated in a manner that respects their human rights.
“It will serve the public health purpose of protecting the public while using a patient-centered and rights-based approach to TB prevention, treatment and management,” said Dr Misoi.
The policy outlines voluntary and involuntary isolation. It specifies that isolation should never be implemented as a form of punishment and should always be implemented in an ethical, non-discriminatory way that respects the patients’ human rights.
“Patients who decline treatment and who pose a risk to others should be made aware in advance that their continued refusal may result in compulsory isolation. An individual that is deemed to require isolation should also have the right to appeal the decision in an appropriate setting, including before an administrative, judicial or quasi-judicial body,” says the policy.
“Patients in isolation should receive treatment and all the clinical and social support necessary to minimise the burden of isolation in their lives to the greatest extent possible. If isolated patients refuse treatment, their informed refusal should be respected, as they no longer present a public health risk.”
The World Health Organisation suggests that interfering with freedom of movement when instituting quarantine or isolation for a communicable disease such as TB could be legitimate.
According to Andrew Owuor, a medical specialist at the Respiratory and Infectious Diseases Unit at KNH, the patients are isolated for between three to six months before being discharged. TB treatment in all Kenyan public hospitals is free.
Only authorised health workers and a close relative are allowed access to the patients. The health workers here — two nurses and the doctor on duty have to take personal precautions by wearing protective gear (gloves, gown and mask) every time they visit the ward.