Kenya: Teamwork is key to fighting TB
TB is a highly contagious disease which causes damage to the lungs. It is one of the leading causes of death worldwide. Gordon works at an MSF clinic in Kenya which is aiming to fight the disease. He introduces us to his job...
My name is Gordon Oyugi, I am the clinical nurse working with MSF in the Green House Tuberculosis clinic here in Nairobi.
It is a clinic dedicated to treating drug-resistant tuberculosis (DR-TB) - forms of TB which can't be treated with the usual antibiotics.
I have been with MSF for around three years. 
As a clinical nurse what I usually do most is screen people to see if they have TB.
My main aim is to identify as many drug-resistant TB cases as possible, so that we might initiate patients onto treatment; to diagnose as much as possible and render them to the health facilities that belong to the government.

Testing patients


One of the things that we do here is cough induction. This is for patients who have signs of TB, but are not producing sputum that can be tested.

When we want to evaluate a patient for sputum induction, you have to ascertain that the patient does not have any other symptoms that may complicate the situation during the process.

Gordon! Photo credit: Wairimu Gitau/MSF.

So, the number one thing that you always look for and assess is the level of oxygen saturation. We usually check this using the sputum saturation machine.
Another thing that we always check is for any underlying heart conditions. There are some drugs that we use, for instance salbutamol, that can really increase the heart rate, causing abnormal heart rhythm to patients who have an underlying condition - so for these ones we look for other avenues.
When the patient has qualified for the process, the machine is set up. 

Cough Induction Machine

The machine itself is called Cough Induction Machine.
While preparing the patient, I will have to explain the procedure very well to them and ensure they understand every bit. This is because this process relies on the maximum cooperation from the patient.
Usually, we do it in a very quiet, highly ventilated room because TB is an airborne disease that can really be contagious; this really requires a lot of efficient teamwork.


So, teamwork starts with the receptionist, who then refers this patient to the nurse for screening.
The patient will then be referred from the nurse to the lab technician with a request form.
This request form allows the lab technician to give sputum containers for the patient, so they can cough up a sputum sample for testing.
In the event that there is no cough, that is no productive cough only a dry one, then the patient is returned back to me. I will assess them as a clinical nurse to check their eligibility.
Gordon with the cough induction machine.

Gordon with the cough induction machine. Photo: Wairimu Gitau/MSF.

So, you can see this cycle of movements, if there is any interruption, we are sure we are going to miss something and that is very key in the management.
If this chain is interrupted anywhere or if there is misinformation somewhere then this process is not going to work.
And then for the cases of infection prevention purposes, the room where sputum induction is done, has to be cleaned. So, the hygiene officers have to be involved and I also have to ensure that I render this place very non-infectious to the extent that I close it for one hour before anyone gets in so that I prevent any infection of my colleagues.

"I am very satisfied with the kind of work I do now"

I can tell you I am very much satisfied with my job here, even though there's always improvement needed because medical practice is dynamic… a lot of things come up and a lot of things phase out; so what I know is that I am very satisfied with the kind of work that I do now.
I think I am the only nurse who does sputum induction in Kenya because apart from MSF there is nowhere with such procedures.