With no money to see a doctor, she carried him to the local pharmacy stall, a corrugated shack near her home in Kibera, a sprawling impoverished community here in Nairobi.
The shop’s owner, John Otieno, listened as she described her 22-month-old son’s symptoms and rattled off the pharmacological buffet of medicines he had dispensed to her over the previous two weeks.
None of them, including four types of antibiotics, were working, she said in despair.
Like most of the small shopkeepers who provide on-the-spot diagnosis and treatment here and across Africa and Asia, Otieno does not have a pharmacist’s degree or any medical training at all.
Still, he confidently reached for two antibiotics that he had yet to sell to Mbone.
“See if these work,” he said as she handed him 1,500 shillings for both, about $15.
Antibiotics, the miracle drugs credited with saving tens of millions of lives, have never been more accessible to the world’s poor, thanks in large part to the mass production of generics in China and India.
Ms Mbone having breakfast with her son, Shane, who has been ill and taking antibiotics. Source: Andrew Renneisen for The New York Times
Across much of the developing world, it costs just a few dollars to buy drugs such as amoxicillin, a first-line antibiotic that can be used against a broad range of infections, from bacterial pneumonia and chlamydia to salmonella, strep throat and Lyme disease.
Kibera residents are prodigious consumers of antibiotics. One study found that 90 per cent of households in Kibera had used antibiotics in the previous year, compared with about 17 per cent for the typical American family.
But the increasing availability of antibiotics has accelerated an alarming downside: The drugs are losing their ability to kill the germs they were created to conquer. Hard-wired to survive, many bacteria have evolved to outsmart the medications.
And as these mutant bacteria commingle with other pathogens in sewage canals, hospital wards and livestock pens, they can share their genetic resistance traits, making other microorganisms impervious to antibiotics.
The lobby of Tabitha Medical Clinic in Kibera. One study found that 90 percent of households in the neighborhood had used antibiotics in the previous year. Source: Andrew Renneisen for The New York Times
Antibiotic resistance is a global threat, but it is often viewed as a problem in rich countries, where comfortably insured patients rush to the doctor to demand prescriptions at the slightest hint of a cough or cold.
In fact, urban poverty is a huge and largely unappreciated driver of resistance. And so, the rise of resistant microbes is having a disproportionate effect on poor countries, where squalid and crowded living conditions, lax oversight of antibiotic use and a scarcity of affordable medical care are fueling the spread of infections increasingly unresponsive to drugs.
“We can’t effectively mitigate the growing problem of antibiotic resistance without dealing with places like Kibera,” Dr Guy Palmer said, a researcher at Washington State University who studies resistance in Africa.
“There are a billion people living in similar situations, and as long as they aren’t getting clean water and basic sanitation, all of us are at risk.”
Worldwide, resistant pathogens already claim 700,000 lives each year, according to one British study. Resistance here in Kenya is not just a potential calamity for future generations: Lack of effective treatment is already claiming thousands of lives each year, many of them young children whose immune systems have yet to fully develop, according to government figures.
Sam Kariuki, a researcher at the Kenya Medical Research Institute who has been studying resistance for two decades, said nearly 70 per cent of salmonella infections in Kenya had stopped responding to the most widely available antibiotics, up from 45 per cent in the early 2000s.
In a hospital in Kijabe, Ntihinyuirwa Thade was taken to have his chest X-rayed. Source: Andrew Renneisen for The New York Times
Salmonella kills roughly 45,000 Kenyan children every year, or nearly 1 in 3 who fall severely ill with it, he said. In the United States, the mortality rate is close to zero.
“We are quickly running out of treatment options,” Kariuki said. “If we don’t get a handle on the problem, I fear for the future.”
In some cases, vendors sell counterfeit antibiotics that contain none of the active ingredient, or so little that they accelerate resistance. Even when the drugs are authentic, many poor Kenyans try to save money by buying just a few tablets instead of the full course - not enough to vanquish an infection but enough to allow bacteria to mutate and gain resistance.
“Who am I to deny them what they want?” asked Lena Ochomba, 40, a pharmacy stall owner in Kibera who earns most of her income selling antibiotics, often three or four pills at a time - an amount that is one-third or less of the recommended course for most antibiotics.
Washing clothes in a stream polluted with sewage. Human waste is unavoidable in Kibera. Source: Andrew Renneisen for The New York Times
“Even when I manage to sell the whole box, my customers rarely take them all because they think it’s just too many pills.”
By Andrew Jacobs and Matt Richtel © 2019 The New York Times
