Did isolating (jailing) TB patients in Kenya helped public health?

When Kenyan activist Nelson Otwoma went to see the three TB patients who were put in isolation (in the prison) in August 2010 for forcible TB treatment – he was shocked. They weren’t isolated rather they were sharing the prison chamber with other inmates defeating the very public health argument for isolation, and of course further worsening the human rights situation in prison for all – the three TB patients, other inmates, prison staff and prison warden who was supposed to be the 'DOTS provider.' Nelson was speaking at the 41st Union World Conference on Lung Health, in Berlin, Germany (11-15 November 2010). Read more

The 'Kapsabet case' when three TB patients were isolated during mid-August 2010, in compliance with the Kenyan Public Health Act (PHA), Chapter 242, Section 27 which reads as follows: "Isolation of persons who have been exposed to infection: Where in the opinion of the medical officer of health, any person has recently been exposed to the infection and may be in the incubation stage, of any notifiable infectious disease and is not accommodated in such manner as adequately to guard against the spread of the disease, such person may on a certificate signed by the medical officer be isolated…"

The Section 28 of the PHA further says that: If you knowingly violate PHA or knowingly go out infecting people then you are liable for prosecution or fine as judge may deem fit.

The official statement of the public health officer (PHO) stated that "three TB patients are dangerous as they expose the pubic to life threatening disease knowingly and in fact one has infected six family members."

When Nelson and other community activists verified this claim of PHO, they found that no family member or community member had been screened for TB. None was diagnosed to date, said Nelson.

The official PHO statement stated that "three TB patients have defaulted many times and may now be having multi-drug resistant (MDR-TB)."

When Nelson and other community activists verified this claim of PHO, none of the three TB patients had been diagnosed with MDR-TB so far. Due to official PHO statement, the media kept referring to the three TB patients as having MDR-TB when it was not true.

The official PHO statement stated that “three TB patients have only been arrested and two imprisoned for isolation purposes. Isolation is an approved strategy for TB infection control and thus can be done upon the recommendation by medical authority.”

When Nelson and other community activists verified this claim of PHO, three TB patients were not isolated, were sharing room and other prison facilities with other inmates, and other inmates were not made aware of what brought them to the prison. No prison inmate was screened for TB, "do other prison inmates have human rights too?"

Prison officials said to community activists that they cannot tell other inmates about why three TB patients were brought here because of the risk of them getting killed in the night by other inmates. Nelson said that one of TB patients was forced to say that he had a family trouble with his father for which he was brought here to the prison.

The official statement also highlighted "advantages of prison" said Nelson. It stated that:
- Prison provides free and good nutrition and keeps the inmates away from alcohol
- Prison wardens will monitor adherence

When Nelson and other community activists verified the claim of 'advantages of being in a prison' they found that there was no special diet for the TB patients, which was also violating the Prison Act of Kenya.

As both print and electronic media was repeatedly referring to these three TB patients as having MDR-TB, they had to hold sessions with the media, said Nelson.

The National Empowerment Network of People living with HIV/AIDS in Kenya (NEPHAK) members in Nandi (Kapsabet) had to organize meetings and mobilize communities to take out a public procession to sensitize people living with HIV (PLHIV) on TB issues. NEPHAK leadership called for immediate release of the isolated (jailed) TB inmates.

"Does isolation of person with infectious disease as listed in the PHA justify imprisonment?" asked Nelson. The above example of how isolating (jailing) three TB patients could be dangerous for public health and above all, counterproductive for social justice, clearly illustrates that radical changes in how we approach public health and human rights are required.

Nelson also asked whether "knowingly exposing others and the public to danger is the same thing as knowingly infecting others and the public. What about those TB patients who refuse isolation?"

What does the Kenya Prisons Act say on health? Prison Act says "prisons will not deal with special medical conditions and will refer such inmates to health facilities" said Nelson.

Nelson appreciated the role of noted health activist Case Gordon (World Care Council) in supporting the growing civil society movement in Kenya in a timely and strategic manner. There were many bilateral, multilateral agencies or International NGOs that take considerable time to respond to such emergencies, said Nelson. After the three TB patients were isolated (jailed), there were other examples like in MWEA and Sotik, where other TB patients were being harassed and threatened. The need for a loud and clear civil society voice to demand change towards social justice was and is compelling.

On 30th September 2010, honourable Judge Eldoret ordered the release of the isolated (jailed) TB patients in Kenya and called for continued treatment at home.

The honourable Judge failed to understand the earlier order and explained it is an extreme application of PHA.

Issues such as consent, privacy, confidentiality, right to disclosure, and right to treatment, rarely, applies to TB, said Nelson.

"Imprisonment intensifies TB-related stigma and defeat the very purpose of the public health it is supposed to promote" said Nelson.

Broadening treatment literacy (for increasing adherence) and combining it with the rights literacy are the key learning for Kenyan activists.

Hope Kenya has not forgotten that the WHO Stop TB Strategy has the Patients' Charter for TB Care, as an integral component which provides a rights and responsibilities based framework for a community-centric response to TB care and control.

Before I conclude, I did find it interesting that when Kenyan health activist Nelson was presenting the case of human rights violations in Kenya and civil society led response to bring in a change the national TB programme manager Dr Joseph Sitinei was speaking in an adjoining session hall on preventing infection control - makes me wonder whether jailing TB patients in Kenya was a good way for infection control?

Bobby Ramakant - CNS