Peter*, a lab technologist at a government-run health facility in the Kenyan capital, Nairobi, recently took the last dose of his six-month course of tuberculosis medicine; he is fairly sure he contracted the disease at work.
"This is a big facility and we come into contact with many patients infected with TB - it is by no accident that I got infected," he told IRIN. "As health workers, we can't escape coming into contact with people with highly infectious diseases like TB because it is our work to help them."
Kenya ranks 13th on the UN World Health Organization's (WHO) list of 22 high-burden TB countries globally, and has the fifth-highest burden in Africa. According to WHO, the country has more than 130,000 new TB cases every year.
Safety equipment - including protective masks and proper waste disposal facilities - are rarely available in rural centres, something health workers say must be addressed urgently.
According to Victor Were, a clinical officer in western Kenya's Mumias town, over-crowded and poorly ventilated clinics pose a big risk to health workers.
"We don't have protective gear and only one hospital in Mumias has proper waste disposal facilities where they incinerate their medical waste," he said. "We have about 40 TB health workers in Mumias - we don't regularly screen them for TB, but last year four who presented with signs of the disease were tested and treated."
Were said the government urgently needed to address the issues of training health workers on risk reduction, provision of masks and ensure proper ventilation or even outdoor clinics to reduce the risk of infection.
"Many health workers are bogged down by heavy workloads and therefore even those who are infected [with TB] stay for long without treating themselves and by the time they do, they might have infected quite a number of people, including their colleagues," said Andrew Suleh, medical superintendent of Nairobi's Mbagathi District Hospital.
Supply chain problems
Government officials say problems with the supply chain and funding shortages are the main reason for the lack of protective gear.
"Health personnel cannot stop treating or offering services to patients even without these [safety] commodities and during that time, they risk getting infected by the very patients they treat, so it is [down to] us as the government to ensure facilities don't run out - at times stock-outs do occur and this is due to procurement challenges, which makes it hard to expedite the delivery of these commodities to health facilities," said Joseph Sitienei, head of the National Leprosy and TB Control Programme. "Sometimes health facilities delay in requesting these much-needed materials and only do so when they completely run out.
"One cannot ignore the financial challenges faced at times and they do lead to stock-outs, but we have seen increased funding to the health sector recently and I hope this will soon change for the better," he added. "What we have started doing is to make waiting areas in health facilities well ventilated, making the consultation rooms more spacious, and of course providing protective masks... the government is streamlining procurement and supply of commodities including protective gear to health facilities."
|More on TB|
|Risking TB in Nyanza's gold mines|
|Stepping up paediatric TB diagnosis|
|HEALTH: What's new in TB technology?|
|ETHIOPIA: Reducing TB risk in Addis Ababa|
According to local NGOs, corruption within the health system is also to blame for the haphazard availability of medical supplies, with drugs often 'disappearing' from government health facilities and sold to private pharmacies by government pharmacists.
Sitienei noted that the risk of TB infection ran both ways between patient and health worker, and the government encouraged "frontline" staff such as nurses and lab technologists to regularly test for TB and if found positive, to seek treatment immediately.
"Also, availability does not always translate to use - we have to constantly sensitize personnel on the need to use the protective gear," he said. "To reduce stigma, it is also important - we have done this - to sensitize patients too on why those attending to them must have a mask, for example."
He said that to reduce health facility-related infection, isolation wards were being established in health centres that attended to large numbers of TB patients.
In November 2010, WHO, UNAIDS and the International Labour Organization launched international guidelines to protect health workers against HIV and TB. Among the recommendations were development and implementation of free regular TB and HIV screening, free HIV and TB treatment for infected health workers and the incorporation of training for all health workers on HIV and TB prevention, treatment, care and support into existing training programmes.
*Not his real name