NAIROBI, Kenya – Four days after my toddler's turn was worse, his tiny body fluttering with fever, diarrhea and vomiting, Sharon Mbone decided that it was time to try another medicine.
Looking at the doctor, she took him to a local pharmacy kiosk, a corrugated hut near her home in Cyber, stretching out in Nairobi. Store owner John Otieno listened to how she described the symptoms of her 22-month-old son and bounced off the pharmacological buffet that he had given her over the past two weeks. None of them, including four types of antibiotics, did not work, she said in despair.
"Look, if these works," he said, handing him 1,500 shillings for both, about $ 15.
Antibiotics, miracle Preparations that save tens of millions of people have never been more accessible to the poor in the world, largely due to the mass production of generics in China and India. In most developing countries, it costs only a few dollars to buy medications such as amoxicillin, an antibiotic of the first line that can be used against a wide range of infections, from bacterial pneumonia and chlamydia to salmonella, streptococcal throat and Lyme disease. 19659006] The inhabitants of the cyberspace are huge consumers of antibiotics. One study found that 90% of Cyber households used antibiotics in the previous year, compared with about 17% for the typical American family.
But the increase in the availability of antibiotics has accelerated the worrying disadvantage: losing the ability to kill the microbes that they created to defeat. Many bacteria have evolved to outwit medicines
And since these mutant bacteria are mixed with other pathogens in sewerage channels, hospital departments and animal animals, they can share their genetic properties, making other microorganisms resistant to antibiotics.
Antibiotic resistance is a global threat, but it is often viewed as a problem in rich countries, where comfortable insured patients are in a hurry to seek prescription medications with the slightest hint of cough or cold.
In fact, urban poverty is a huge and largely undervalued driver of resistance. Thus, the growth of persistent microbes has a disproportionate impact on poor countries, where poor and overcrowded living conditions, poor control of antibiotics and a lack of affordable medical care help to spread infections that are increasingly not responding to drugs.
"We can not effectively mumble on the growing problem of antibiotic resistance without working with places like Kybert," says Dr. Guy Palmer, a researcher at the University of Washington who is studying resistance in Africa. "There is one billion people living in similar situations, and as long as they do not receive clean water and basic sanitation, we are all at risk."
Worldwide, persistent pathogens each year take 700 thousand lives, according to one British study. The resistance here in Kenya is not just a potential disaster for future generations: the lack of effective treatment already confirms thousands of lives every year, many of them small children whose immune systems are not yet fully developed, according to government figures. Kariuki, a researcher at the Kenyan Medical Research Institute, who studied resistance over two decades, said that nearly 70 percent of Salmonella infections in Kenya stopped responding to the most widely available antibiotics, compared with 45 percent in the early 2000s.
"Salmonella kills about 45,000 Kenyan children every year, or nearly every third who suffers from it," he said. In the United States, mortality is approaching zero.
"We quickly exhaust the treatment options," said Professor Kariuki. "If we do not solve this problem, I'm afraid of the future."
In some cases, sellers sell counterfeit antibiotics that do not contain the active ingredient, or so little that they accelerate resistance. Even when these drugs are authentic, many poor Kenyans try to save money by buying only a few pills instead of a full course – not enough to defeat the infection, but enough to make the bacteria mutate and resist.
40-year-old Lena Ohhba, the owner of a kiosk in Kiberi, who receives most of her income by selling antibiotics, often three or four pills at a time – an amount that is one-third or less of the recommended value. Usually for most antibiotics. "Even when I manage to sell the entire box, my customers rarely take them all because they believe it's too much of a pill."
Bad sanitation, irrepressible illness
There are no human waste in Kiberi. It flows from small hand-made cesspit toilets, pools into chips and, finally, flows into a black river.
At night, plastic bags with feces are thrown out of the roof by those who are afraid to go out into the street. Residents call them flying toilets. Mbone and her husband got used to the spectacle and the smell of untreated sewage flowing in front of their one-room hut. With no other place to play, their son, Shane and his 3-year-old sister sometimes end up angry. "They are children, they will always go out into the street to play," Ms. Mbonne said, 19. "How can you stop them?"
A plastic bucket filled with medicines purchased in stores is evidence of the diseases that haunted Shane for most of her short life. Born prematurely, he spent his first few weeks in the clinic, and then in the hospital. Even with allowance for subsidized care, medical accounts were approximately $ 200 equivalent to the 10-month salary that Mrs. Mbonne's husband earns as a port carrier for the bus station. She has since been reluctant to bring Shane to a doctor. "I'm worried if I go to a bigger hospital and this bill will be bigger," she said. Mbono is not convinced that the unsanitary conditions are responsible for the health problems of Shane. Other children play at Kyberi drainage ditches, she said, while some of them suffered from permanent diarrhea that affects her son.
But epidemiologists and health experts who studied Cyber say there is a direct relationship between poor community hygiene and infection that persists for almost every seven years. Harmful bacteria in feces that are allowed to leak into the surrounding soil can survive for months, and in densely populated settlements such as cyber streams feeding on soil trails, they easily find their way to food and water, often from residents who are unknown to carry pathogens in their homes on shoes or unwashed hands.
According to the study of the Center for the Control and Prevention of Diseases in 2012, cases of typhoid fever among children in Kibera were 15 times higher than those living in rural areas west of capital; Infections in cybercrats were even higher in low-lying areas where sewage tends to be a bullet. The study also found that 75 percent of typhoid strains showed resistance to publicly available antibiotics.
"Lack of sanitation leads to more diseases, which leads to greater use of antibiotics, which leads to greater stability," Mark said. Alan Windowson, Senior Vice President of the Global Health Care CDC in Kenya, who has been conducting surveillance work since 1979 in Cibere. "This is a vicious circle".
Sylvia Adhiambo Omulo, researcher at Washington State University The Global Health Program, which has been studying resistance to antimicrobials in cyber biology over the last few years, said she was struck by the widespread nature of resistant pathogens such as E. coli.
Hands of adults and children, "she once said, when she pulled through the muddy Kierberi hiking trails, dodging children, stray dogs and sometimes chickens. "It's not surprising that people here are constantly ill."
When people feel unwell, they often turn to people like Mr Otieno, a drug supplier on the sidewalk, wearing a white laboratory robe and holding a lamp that is sleeping late at night. Mbon counts on him for affordable medications, but also for a cute ear and casual cash loan. "These chemists are my neighbors," she said. "I trust their councils."
A hard man with sharp features and a gentle manner, 32-year-old Mr. Otieno, is a permanent resident of Cyber. He could not find a full job after high school, he spent several years helping another chemist in the neighborhood until he had accumulated enough money for his store.
With his baby blue interiors, medical wall posters and cabinet-filled cushions, Mr. Otieno's canister can be taken for a clinic. Despite his lack of training, he said that many years of practical experience reported his appointment decisions, and he knows that antibiotics do not work because they often do not cure the people who buy them.
resistance here, "he said. That's why people are constantly coming back to get different antibiotics.
After cycles of antibiotics, limited variants
If Ntihinyuirwa Thade was conscious, doctors at Kijabe mission hospitals would be asked about his medical history, including the list of antibiotics he has taken in recent years. But Mr. Teid, a 25-year-old migrant from Rwanda, was on the fan and unconscious, fell from the top floor of the building. He did not wear a hard hat and suffered a serious head injury.
A week after the accident, he faced a more direct threat: the Klebsiella pneumonia infection blossoms in the lungs. The condition of Mr. Teida did not respond to the three antibiotics that were already in his veins, so his doctor George Otieno (who had nothing to do with Mr Otieno, the owner of the pharmacy kiosk), was preparing for the last drug in his limited arsenal. relatively expensive antibiotic, called meropenem. "If this does not work …", he said, his voice retreats.
Clebsell's bacteria are ubiquitous in the environment – in the soil and in the intestines – but they can become lethal for people with weakened immunities. 19659002] Dr. Otieno acknowledged that Mr Teide most likely bought him through a plastic breathing tube that kept him alive.
Many leading medical institutions in the world are struggling with persistent microbes, and Kidzhab is one of the best clinics in Kenya. ] Located in a green valley close to Nairobi, it boasts first-rate equipment and a combination of Kenyan and foreign doctors that attract patients from all over the country. But being a referral physician is a drawback: many people come quite sick and are already rotated because of the many antibiotics. "Often, they took every drug that is publicly available," says Dr. Evelin Mbugua, a therapist. Teid was one of several patients who tried to overcome persistent mistakes. In a pediatric ward, a one-month-old child, blessing Karangi, fought with an anxious blood infection, and another place in the hospital, 65-year-old nurse Grace Mutiga returned with a resistant respiratory infection.
Taking different antibiotics over the past few weeks – Drugs purchased at a local drug store – Ms. Mutiga has exhausted her options. "We will have to see if we can get an antibiotic from Nairobi," the doctor said, when Ms. Mutiga tried to hold her breath.
In Kenya and other developing countries, the most effective antibiotics are not always available or available. Loice Achieng, a doctor-infectious disease at the Kenyatta National Hospital, shook her head, recalling one recent patient, a 65-year-old recurrent kidney transplant recipient infected with Pseudomonas aeruginosa, a bacterial disease that is often bought in hospitals.
The patient took Kenya all the necessary antibiotics, Dr. Acheng said to seven, that the only hope was Avicase, a four-year American drug. There were obstacles, including the dismissal of Kenyan customs officers and 10 thousand dollars in 10 days. After several days his children managed to raise the necessary funds, but it was too late.
"I do not believe that we will solve it"
Kenya has officially adopted what health experts call antimicrobial surveillance, efforts to hold back resistance by reducing excessive use of antibiotics, promoting vaccination and promoting better hygiene among hospital workers. Over the past two years, many government medical institutions have established management committees. Wall hand disinfectants have become commonplace in hospital corridors and waiting areas for patients.
But the government did not succeed in complying with laws that require prescriptions for the purchase of antibiotics, nor have they done much to curb the flow of drugs. it sheds across the border of Somalia to 400 miles.
"It turns out to be more difficult than we thought," said Dr. Waddowson of CDC, who advised the government. Theeida's condition became sharper. When the nurses were preparing him for another X-ray study, Dr. Otienne spoke about the problems of addressing the problem of drug resistance.
A passionate man with wide, expressive eyes, Dr. Otienne, 36, is the driving force behind the newly established hospital. antimicrobial program. But he was disappointed by the lack of progress in describing overwhelmed nurses who reluctantly perceive complex hygiene protocols and their own pharmacy for the hospital, which he said continues to rewrite antibiotics.
I have faith that we will solve it. I do not think our government thinks this is a big problem, "he said, when the lame body of Mr. Teide was raised to the wheel.
"I worry about my country, but also about my family. One day I could go home and infect my children with one of these dangerous mistakes. "
In the following days, Mr. Teide's condition was sufficiently stabilized that he was taken out of an intensive care unit. Despite the fact that his injuries did not allow him to go, he came to consciousness and seems to have recovered, said his doctors, but the infection was alive and did not give grounds for meropenem, the best antibiotic in the hospital's arsenal. Three months after the infection spread to his blood, Mr Teide died alone in his bed and away from home. "God will give him a soul," said Dr. Otieno.