Where We Work

An unsafe injection leads to community awareness of injection safety in Kenya

Jane Kirumbi was a happy newlywed 30 years ago when she fell into a coma after receiving an unsafe injection. She had gone to the community healer complaining of chest pain, and although she was skeptical about receiving an injection directly to her chest, she had little alternative in her rural community of Kiambu, 20 kilometers from Kenya’s capitol, Nairobi.

Jane Kirumbi encourages her family, friends and neighbors to discuss treatment options before accepting an injection after receiving training from the Making Medical Injections Safer Project.

“My husband told me that I was unconscious for four days,” Kirumbi said. After she regained consciousness, the doctors at the hospital told her she should not have received an injection directly to her chest. She decided that from that day forward she would only accept an injection if medically necessary and has opted for oral medications over injectable ones for over 30 years.

 This is a choice rarely made by Kenyans, according to the country's high patient demand for injections and doctors’ tendency to prescribe them even when oral alternatives are available. While some conditions warrant injectable medications, research indicates that a significant portion of injections given in developing countries are unjustifiable from a medical standpoint and in some cases like Kirumbi’s, may be dangerous. In countries with high HIV prevalence, many of the patients in the health care system may be HIV positive, creating a risk of transmission of through contaminated needles.

According to the World Health Organization, in some situations, as many as nine out of ten patients presenting to a primary health care provider receive an injection, of which over 70% are unnecessary or could be given in an oral formulation. Patients prefer injections because they believe them to be stronger and faster medications. They also believe that doctors regard injections to be the best treatment. In turn doctors over-prescribe injections because they believe that this best satisfies patients, even though patients are often open to alternatives. In some cases doctors choose injectable medication because the profits associated with injections are higher than that of oral treatments.

So when the PEPFAR-funded Making Medical Injection Safer (MMIS) Project, implemented by JSI in Kenya between 2004 and 2010, began to offer community workshops on injection safety and how to reduce the demand for unnecessary injections, Kirumbi was eager to share her story and participate in the community gatherings organized to create awareness of the risks associated with unsafe and unnecessary injections. To educate community members about the rational use of injections, the MMIS project in Kenya organized 100 community performances with injection safety messages reaching over 25,000 people that teach participants what makes an injection safe or unsafe and how to request alternative treatment from their health care provider. Training participants then share the information with their families, neighbors and friends in the hopes of lowering the demand for injections.

“I was so happy when I met people who were talking about how the injections are not always good and (how) you have to remember about the other (oral) medicines,” Kirumbi said. “Anytime I meet people, I tell them about what I learned.”

Changing the attitudes of patients and doctors to reduce unnecessary injections is an important component to promoting injection safety because each injection not administered represents not only savings in terms of unused supplies and equipment, but also saved time for health care workers and one less opportunity for the transmission of bloodborne diseases, like HIV and hepatitis. Ideally, the savings on syringes and needles can be reallocated to other health programs to maximize impact. In addition to the behavior change component targeting both health care providers and community members, the 5-year MMIS project also focuses its interventions on procurement of injection safety syringes, training and capacity building of health care providers in their use, and proper waste management for contaminated syringes, needles and other medical waste.

Kirumbi said she meets regularly with two women’s groups who are family leaders to talk about the importance of injection safety and how to advocate for a safe injection. She says that many of the people she talks to are skeptical at first, saying that they are in the hands of the doctor and should accept what they are given. However, through the community workshops, Kirumbi has learned how to discuss her treatment options with her health care provider rather than blindly accepting what they prescribe. “I was very happy when the doctors at Kiambu taught me the dangers of unsafe injections and how to respond when a doctor offers an unnecessary injection.” she said.

In addition to sharing what she learned with the other family leaders in her community, Kirumbi said that she also informs people she sees waiting for the doctor at the health post in her neighborhood that it is okay to ask for alternative treatment because sometimes the doctor assumes they want an injection. She speaks at her church and other community gatherings about the importance of injection safety, as well.

While MMIS works to prevent unsafe injections and discourage unnecessary ones, the project’s trainers are careful not discourage injections altogether since, in some cases, injections are the best form of treatment. To achieve this, the trainings focus on alternatives to injections and what makes necessary injections safe--namely that the syringe and needle come from a new, unopened packet, contains the correct medication and dosage and are disposed of properly. “I usual explain to them (community and family members) the difference between a good injection and a bad injection,” says Kirumbi.

Kirumbi’s status as an elderly community leader and her personal experience with unsafe injections makes her an ideal advocate for injection safety. As she and others in her in community become confident in discussing their treatment options with their doctors, they can break the cycle that promotes irrational use of injections and reduce the chances of medical transmission of bloodborne disease in the health care system.