TB Screening Beyond Status- Jitoni Community Medical Clinic

Jitoni medical clinic is a private facility owned by a registered community health nurse-Victor Abayo. The facility has been operational since 2010. It’s a medium size facility, located in Jitoni, of Jomvu Sub-County in Mombasa. The facility offers basic primary health care services and is recognized by the county government department of health. The facility has a total of 5 qualified employees, operates on a 12 hours basis though they sometimes extend due to workload. The facility is licensed by the Kenya Medical Dentist Board and has a valid facility license. All the clinical staff offering clinical services are. The facility offers various outpatient services which include; curative, laboratory services, counseling, TB screening & linkage.
When public private mix (PPM) imitative was introduced in the region through the support of PS-Kenya, Jitoni medical was one of the facilities that was mapped and later successfully enrolled into the program and later signed partnership agreement to participate in active TB case finding as per the MOH guidelines.

On 10/5/2020, the provider took a self-initiative of attending to a mentally challenged man who was routinely passing by the facility. The man was coughing and no one had thought of assisting him to seek medical treatment since he was mentally challenged. In normal circumstances, no one takes care of the mentally challenged people as they are left to take care of themselves. Little did they know that this man was potentially a risk in the community as he was coughing and spreading the TB bacilli.
Mr. Maxwell (clinician) approached ‘Sammy’ (the mentally challenged man) greeted him and suggested that he would attend to him in his medical facility since he was coughing so much. ‘Sammy’ stood and followed Maxwell to the facility. He carried with him all his rugs to the facility and sat pensively waiting to be attended. Some of the patient waiting at the reception opted to go out as they could not stand him. After examination he was given a falcon tube to produce sputum. He did and gave a good sample of the right quantity which was given a first priority and transported to the Gene Expert hub immediately by the motor rider. Maxwell called the hub to process the sample and be on the top list bearing in mind the sensitivity of the case.
When the results were out, it was a shock to everyone, it was MTB positive. As it was his tradition, he passed by his usual route and Maxwell called him and tried to discuss the results with him. After several attempt to try and explain about his health, ‘Sammy’ accepted to take medication. The challenge was how to ensure adherence to treatment owing to his mental status. The facility after discussion with the Sub County TB coordinator decided to act as DOT to support the patient through Mr. Maxwell’s lead. The facility was offered a TB patient pack to support the patient on DOT daily.
‘Sammy’ has routinely been visiting the facility and taking his TB medication on daily basis without fail and has found friendship in Jitoni medical staff. He is currently at his fourth month of treatment. Sputum smear after intensive phase of treatment was negative hence started on continuation phase. It is a challenge to deal with a mentally challenge patient as sometimes he disappears giving the provider difficult time to start looking for him. This was a good initiative and everyone commends the facility for going beyond status in finding missing people with tuberculosis.

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