How shortage of specialists aggravates TB complications

It’s a reality that remains largely unspoken in many parts of Kenya: patients silently battling complications that linger long after tuberculosis (TB) treatment ends.

In a country where specialised care has for decades remained centralised in the capital, many Kenyans living far from Nairobi are left undiagnosed, untreated, and misunderstood.

“Specialised care has not been spread out. It has been centralised in this country for a long period of time,” says Dr Robert Sadia, a cardiothoracic and vascular surgeon at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kisumu. “So if a patient walks into a hospital where you don’t have specialists who encounter these kinds of conditions, most people would not recognise it.”

Dr Sadia explains that what many patients experience after recovering from TB are post-TB sequelae, a group of conditions that arise when the infection leaves permanent damage to the lungs.

“TB is still a prevalent condition in Kenya,” he notes. “The World Health Organisation continues to rank us among the countries where TB remains quite common. And because of the HIV pandemic, which tends to coexist with TB, we continue to see many patients affected by both.”

He adds that even after completing full TB treatment, some patients develop complications caused by lung destruction during infection. “The damage caused by TB can give rise to other conditions like aspergilloma,” Dr Sadia says. “Many patients present with coughing up blood, difficulty in breathing, or shortness of breath, especially when doing simple tasks like walking or climbing stairs.”

These are the patients doctors often evaluate for possible surgical intervention procedures that could significantly improve their quality of life.

Although aspergilloma is common, there is limited data to show how widespread it is in Kenya. “We don’t have studies that give exact figures for aspergilloma in the country,” Dr Sadia admits. “But it keeps a lot of chest surgery units busy. In training hospitals, it’s one of the most common reasons for performing lung surgeries such as lobectomy or pneumonectomy.”

He explains that a lobectomy involves removing a section (lobe) of the lung, while a pneumonectomy removes an entire lung. “The right lung has three lobes and the left has two. The most common reason we remove lobes or lungs in Kenya is aspergilloma, a post-TB infection complication,” he says.

Despite progress in TB control, stigma and delayed healthcare-seeking behaviour remain barriers. “Every disease has its special kind of stigma,” Dr Sadia says. “When people start coughing up blood, they often feel hopeless. Many think they can’t be helped, and since few people understand what’s happening, they shy away from hospitals — especially if the first time they seek care, they get no answers.”

This stigma contributes to patients staying at home for days, sometimes months, worsening their conditions.

However, Dr Sadia acknowledges that Kenya has made progress in expanding access to TB treatment. “These days, most hospitals have TB-specific clinics. That means more people are getting care earlier. And TB, if treated fully for six months, often doesn’t progress to these complications,” he says. “But when treatment is incomplete or the immune response is weak, that’s when post-TB complications develop and surgery becomes necessary.”

The biggest challenge, Dr Sadia stresses, is that specialised care has remained concentrated in Nairobi. “Sub-specialities like cardiothoracic surgery are few. At the moment, we have around 28 cardiothoracic surgeons in the entire country and more than 20 are based in Nairobi,” he explains.

This leaves patients in regions such as Nyanza and Western Kenya with little to no access to expert diagnosis or treatment. “If someone in Western Kenya develops a serious chest complication, most hospitals around won’t know exactly what’s going on,” he says. “And you can’t just board a bus to Nairobi when you’re that sick. Even then, there’s a long waiting list because the specialists there are serving the whole country.”

He prefers not to call it “misdiagnosis,” but rather underdiagnosis or under-referral. “You can’t diagnose what you don’t encounter often,” he explains. “Physicians in the counties mean well, but they may not recognise certain rare post-TB complications because it’s not their area of speciality.”

Dr Sadia emphasises that patients must continue seeking care and not be weighed down by stigma or hopelessness. “The most important thing is to seek care and keep seeking it,” he advises. “Don’t give up. Ask questions, push for investigations, and ask for a diagnosis. If your doctor can’t provide one, they can refer you or consult their colleagues.”

With more specialists being trained and hospitals like JOOTRH expanding their thoracic and vascular units, the future looks promising for patients in Nyanza, Western Kenya, and beyond. But until specialised care is fully devolved, many will continue to suffer silently.