Stigma Blots Kenya’s COVID-19 War – Some Patients Fearful Of Seeking Treatment
Kenyan banker Peter Karagu ,alias Kanyenyaini Kangema, in his hospital bed in Nairobi. He spent 22 days under COVID-19 treatment and openly spoke about his illness with the hope of fighting stigma associated with the illness.

Nairobi, Kenya – While banker Peter Karagu is one of the over 35,000 people who have contracted COVID-19 disease in Kenya over the past 6 months, he cannot in any way be described as an ordinary victim of the respiratory illness.

Throughout his 22 days confined at an isolation ward at Kenyatta University Teaching Research and Referral Hospital in the capital Nairobi, he would update his social media followers with hilarious experiences at the hospital. You would think being hospitalised with COVID-19 was fun, had it not for days pushed him to the brink.

Sadly his rib-tickling posts on his Facebook page, where he uses the name Kanyenyaini Kangema, did little to fight stigma associated with the illness, one of the things he intended the updates to achieve, as he came to discover only a day after he left the treatment facility. 

He had developed a problem of high blood sugar during the course of treatment, just like many fellow patients at the hospital, making it necessary for him to visit a neighbourhood pharmacy to have his sugar levels checked.

However, as soon as he stepped into the shop, the terrified and panicky owner declined to attend to him, and hurriedly shut the doors before embarking on the process of spray-fumigating the pharmacy.

“The reaction surprised me, the pharmacy owner knew me, so he had heard that I had been diagnosed with the disease. What really shocked me more is the fact that he and his workers were not just ordinary Kenyans, but medical professionals who should have known better,” Karagu told Health Policy Watch.

Peter Karagu recuperates at home

Stigma Leaves Patients Alone & Fearful

Stigma associated with the disease is often leaving patients and their families more traumatised than disease itself. As a result Kenya’s Health Ministry is appealing to citizens to help fight the trend, realising that the race to conquer COVID-19 won’t be won unless the vice is tamed.

“It will not be easy winning this war if we do not all fight stigma, we must learn to accept that anybody can fall victim to this disease as it does not discriminate, so do not discriminate against those who get it,” said Director General Patrick Amoth.

Stigma was hindering efforts against the disease as community transmissions accelerated, he observed. The problem was pronounced in rural areas and making some people refuse to submit for testing, in some cases nearly derailing Kenya’s targeted testing strategy.

Stigma could also be blamed for the recorded low number of patients turning up in hospital for treatment of other diseases since the outbreak hit Kenya in March, added Dr Amoth.

“We are worried over the low numbers of patients seeking treatment in our health facilities, we think the reason for this is that people fear being tested for COVID-19 due the kind of stigmatisation those diagnosed with the disease and their kin have been subjected to,” the official noted in an August 27 press briefing.

The World Health Organisation (WHO) protocols for burying victims have not helped matters, according to Amoth. Burials are hurried compared to usual burials. Only a few people attend, and bodies are handled by health workers in very brief ceremonies. In normal times, burials are huge, elaborate affairs attended by hundreds of mourners.

In fact, it is out of the fear of his young family being treated as outcasts by neighbours that made Karagu ask his wife to drive him to hospital when results came out that he had the disease. He was afraid that ‘screaming’ ambulances sent to pick him from home, with medics “dressed like astronauts” would also traumatise the children. 

Stigma Slows Efforts To Contain The Pandemic

Ngoy Nsenga, WHO Africa COVID-19 Incident Manager

The WHO acknowledges that stigma is a major problem and has been slowing efforts to contain the pandemic in Kenya and across Africa.

“Stigma in the community is a distracting factor hindering interventions to contain the spread. People might hide for fear or refuse seeking treatment even when they have coronavirus-like symptoms, endangering themselves and others,” said Ngoy Nsenga, WHO-Africa COVID -19 incident manager.

One way of fighting the problem he says is by bringing in the community as allies, educating them and making them partners in ending it.

Acknowledging that stigma is normal at the beginning of any pandemic, Dr Nsenga says that no outbreak can be fought without community engagement, hence their importance.

“We have to make communities partners in order to win against this disease, we have to work and with and within communities to tame and stem the stigma”, he asserts.

While daily cases in Kenya seem to be dropping since the end of August, particularly in the major cities of Nairobi and Mombasa, which have been the disease epicentres, cases seem to be rising in rural areas. 

Coronavirus Cases and Fatalities as of 8 September 2020, according to the Kenyan Ministry of Health

Kenya’s Contact Tracing System Under Pressure – Community Health Workers Recruited 

And as transmission trends shift to the countryside, the strained health system has all but abandoned tracing of contacts.

Instead Kenya is undertaking targeted contact-tracing, Nsenga told Health Policy Watch in an interview.  This is advised by WHO in such scenarios, so as to trace and quarantine those who are at higher risk of contracting the disease, or at becoming seriously ill. 

“This should include those in the same household as the victim, vulnerable people such as the elderly and the sick, and health workers should they have been in contact with the case,” the official said.

“As the numbers overwhelm, we also advise authorities to consider deploying technologies including phone apps which is easy where internet coverage is good”, he added.

Some eight out of ten of the infected are turning out to be asymptomatic, or only showing mild symptoms. As a result, Kenya has also enlisted its network of Community Health Workers (CHWs) to help monitor and actualise home-based care and isolation of the patients.

Monitoring such cases for at least ten days is recommended, according to Dr Nsenga. It’s important so that they can quickly be given treatment should they develop severe disease, something he says happens to about five percent of those in this category.

“Being able to detect and net many asymptomatic patients is not necessarily a bad thing; it is actually a sign that testing is wide enough for it to be able to net those with no symptoms,” he noted. “It helped in preventing the cases from developing into severe disease.”

Many of the CHWs so far deployed by county governments in rural areas have not been received any form of compensation, according to a health official based in Kirinyaga County of Central Kenya. Yet their support has proven invaluable. 

The CHWs have been helpful in enforcing protocols for  home-based care, despite not “being facilitated to perform the tasks, and are being an important part of community participation” in fighting the epidemic, said a Public Health Officer who spoke on condition of anonymity.

CHWs and health promotion officers help educate the community about the coronavirus.

Deploying the CHWs was a good thing in home-based care situations as long the volunteers are properly trained, notes Dr Nsenga. And of course, he added, so long as they are given proper protective clothing so that they do not get infected or infect others.

Kenya’s Current Coronavirus Testing Situation

Over the past 3 weeks Kenya’s testing capacity has gone down from a high of 4,500 tests a day in July to a low of under 3,000 tests a day in September. Health Minister Mutahi Kagwe blames the low testing capacity on a shortage of reagents. 

However, while numbers of tests administered have declined, so have numbers of positive cases, suggest data provided by the volunteer tracking website, CoronaTracker.  From a high of 688 daily cases confirmed by 4,522 tests on 18 July – a positivity rate of 15 percent, numbers have fallen to 102 confirmed cases out of 2,668 tests on 7 September –a positivity rate of under four percent. As a result, there could be a further easing of restrictions in the coming few weeks.

Overall total deaths stood at 599 as at Monday this week, while a total of 35,205 of positive cases had been recorded since March. Some 21,310 people had recovered from the disease and according to the Health ministry Kenya’s death rate was at 1.7 percent.

Kenya’s Coronavirus Cases and Fatalities, 8 Sept 2020. Numbers change rapidly.

Part of a series of stories about how the coronavirus response is playing out in different parts of Africa. For more on this, see our stories on South Africa, Ibadan, Nigeria, and Kampala, Uganda

Image Credits: WHO Africa, Peter Karagu, WHO Africa, Twitter: MOH_Kenya, CoronaTracker.

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