Dalvin Modore walked as if there was a broken glass under his feet, stomping heavily, his frail shoulders predicted pain. His pants were so loose that he had to hold him as he inched around his small farm in western Kenya.
Modore has tuberculosis. He is a tall man at 40 years old and has lost 110 pounds. He coughs, coughing, and sometimes vomits blood. He fears that the illness will kill him and is eager to be taking medicine to treat it.
Modore is one of thousands of Kenyans and hundreds of thousands of people worldwide, and has become tuberculosis, where the Trump administration has cut foreign aid and lost access to treatment and testing within weeks of withdrawing funds for health programs around the world.
Many, like Mr. Modore, have become quite sick. They are walking around and waiting for life, and they are spreading the illness to others, including their own family, their communities and more.
The entire system of tuberculosis detection, diagnosis and treatment – can kill more people worldwide than any other infectious disease – It has collapsed in dozens of countries in Africa and Asia since President Trump ordered aid freeze on January 20th, in his inauguration.
The US last year donated about half of its international donor funds to TB, and here in Kenya, paid everything from nurses to laboratory equipment. Trump administration officials say other countries should contribute a significant share to their global health programs. They say the administration is evaluating foreign aid contracts to determine whether they are in the US national interests.
Some of the TB programmes may ultimately survive, but no one has received the money for months.
Families of infected people are not being given preventive therapy. The infected adults share rooms in a crowded Nairobi tenement house, and the infected children sleep four of them in bed with their siblings. Parents who were tested with sick children the day before Trump took office are still waiting to hear if their child has tuberculosis. And those with meticulously resistant tuberculosis forms are not treated.
Modore shares his cousin, his home and bed with four other relatives. They all have seen him get sick and fade, fearing his health.
Despite being fully curable, tuberculosis killed 1.25 million people in 2023. This was last year when data is available.
New diagnosis and treatment testing, major tuberculosis research efforts have concluded. Global tuberculosis drug procurement agencies have lost funds and are said to have led to them being regained, but that's not the case yet. TB, a global consortium of government and patient groups that coordinate tuberculosis tracing and treatment, has been suspended, and fired, but has yet to receive funds.
The US did not pay for all of Kenya's TB care, but funded a critical portion. And when they were frozen it was enough to shut down the entire system.
The US paid motorcycle drivers. Motorcycle drivers made about a dollar for transporting samples from people with presumed infectious diseases to the lab and transporting them to the lab to test for tuberculosis. The driver was fired on the first day of the funding cuts, causing the sample to halt.
The US paid for several experimental equipment used to process the test. Processing has stopped in many places.
The US has paid for an internet connection through advocates from the local community known as the TB Champions, where many test sites can send results back to distant patients. So, even if patients found a way to send samples to the working lab, notification of results was stopped.
Families cannot begin preventive therapy without a test to see if a person is infected or what type of tuberculosis they have.
The US paid for half the dozen tests patients needed before starting treatment for multiple resistant tuberculosis, allowing their bodies to withstand harsh drugs. These tests can cost over $80 out of reach of many patients. Without tests, clinicians don't know what drugs prescribe very sick patients. The prescription has stopped.
The US moved drugs to ports and paid for ships and trucks that moved them to warehouses and clinics. Shipping has stopped.
The US paid for a data management agreement that provided a national dashboard of data on cases, treatments and deaths. The tracking has stopped.
Kibuchi, the national coordinator for the Kenya suspension TB partnership, predicted it would take just three months for infections to rise. “But we don't even know about new deaths, as all data collection was supported by USAID,” she said.
The US also paid the salary (about $35 a month) of community health workers and TB champions who lost small paychecks that believe in their important role. Research shows that tuberculosis treatment often involves miserable side effects, often accompanied by disastrous side effects, making patients far more likely to get cured when someone finishes their course of medication and checks regularly, cheering and seeing lapse.
But across Kenya, community advocates continue to work unpaid, covering the costs of trying to reach patients and providing a diagnosis from their own pocket.
Modore's constant cough caught the attention of his neighbours in January. Doreen Kikuyu, the regional tuberculosis champion from his, came and collected sput samples from him and sent them for diagnosis using the bike system.
By the time his results were back, the Trump administration had frozen the system. Kikuyu couldn't get the funds for the bike to take her home to let him know. “But I couldn't leave him without knowing the answer,” she said. “That's why I started walking.”
She also explained that lab analysis did not provide information on whether he has a drug-resistant form and therefore further testing is necessary before starting the appropriate drug. However, he has to pay $1,000 in Kenyan Shilling (about $8) to send the sample to a local laboratory where the test can be performed. To pay for it, they may need to sell chicken, one of the few assets. They discussed what to do when the day was carved.
“I really want to start taking medicine, but I'm just wondering what's going to happen,” Modore said, sitting in the shadow of a wooden stand outside his house recently afternoon.
Ultimately, the brave Kikuyu managed to cut down on the money by gathering contributions from other healthcare workers and neighbors in the now-founded community. She sent the samples to the lab. The good news is back: Mr. Modore was not drug resistant and could take standard medication.
But no one prescribed them. Clinic staff were paid from the US and have now been fired. Kikuyu had succumbed to her wit, knowing that Modore was desperately ill.
She called, used the airtime to buy herself, and bagged a local government TB staff member who was a clinician who met her at the hospital and prescribed and issued medications from a clinic sheltered that was closed. She rubbed more money to take Mr. Modore to the clinic on her bike. She saw him smirk and taking his first medicine, and she felt a flood of relief.
But soon she faced new worries. Neighbors close to his family had to start preventive therapy to prevent around 12 people from getting sick. The clinic is closed. If she can find a clinician who prescribes drugs for adults, then at least she can deliver them. (TB drugs for children are complicated and require doctor supervision.) However, she has no money to return to Modore's house. She walks to the other patient's house waiting for a test, waiting for results, waiting for drugs.
“That's a problem,” she said tiredly. “But we have to go to that family.”
For tuberculosis treatment to work, patients must take medication daily for several months without interruption.
Barak Odima, a 38-year-old mechanic from Nairobi, is in the form of the most deadly disease and is resistant to most treatments. Last fall he began a rare drug combination, but when he went to pick up the medicine two weeks ago, clinic staff told him that one of the medications hadn't been restocked and that he had nothing.
“If we don't get this drug that we're lacking, how will we cure it?” Odima said.
A week later, the clinic received a small amount of medication. The clinician and pharmacist had been fired, so the TB champion gave him the medicine, but he couldn't tell him what he might receive more pills.
While he is taking the medication, Odima is supposed to perform monthly examinations of his blood, liver and kidneys to make sure his body tolerate them. This costs around $80, previously covered by US grants, and since the funding freeze, he has not been tested. Odima's wife and five children are due to be reaffirmed this month due to the illness. X-ray payments require all his savings.
In an interview in the clinic's treatment room with stickers and posters promoting USAID support, Odima thanked the US for supporting him in his treatment, but said he was confused by the state's cut off help. Of course, he said his own government should provide such care. “But we are a country we depend on,” he said. “And since Kenya cannot support the program, all people with these illnesses can be cured.”
In fact, Kenya's tuberculosis treatment system was not robust before the US elicited support. Last year, the country had nearly 90,000 new infections. Labs lacked supplies to perform molecular testing, and people were often misdiagnosed.
The TB champions stopped by to check in anyone who heard of a persistent cough, and were meant as a low-budget, shocking strategy to change it. Since the aid was frozen, they have taken on something very important. In Busia, a champion named Agnes Ocourse, a Western Kenyan town, is using the money he earns from the snack stalls to fund a trip to the village. Since late January, she has provided a diagnosis and has collected sput samples in a jar of plastic samples.
“I am a survivor of tuberculosis myself. I can't just leave you with a dying,” she said. “Whatever the little money we can find, we're using it.”
This cut in aid has crippled a network of clinics established across Africa 20 years ago by President George W. Bush's AIDS Relief emergency plan. These clinics bypassed the frail, bureaucratic, transplanted health systems in countries fighting tuberculosis and H.IV. And quickly put patients in life-saving medication. Twenty years later, they were still partially or completely separated in most places, with US payment staff.
Currently, African health officials are in a hurry to absorb these patients into the regular health system. This is an already overgrown facility, with a 40% increase in caretakers. The Kenya central government says it is working on the plan, but did not provide details on how it would fill the gap in yoning funding.
However, since all cases of tuberculosis and HIV have been in separate clinics for many years, clinicians at major facilities are unaware of drug protocols, side effects, or signs of treatment failure.
“There are healthcare workers who have never seen TB cases. Dr. Timothy Malica, who oversees Kenya County's TB Program, said Dr. Timothy Malica, who oversees one of the highest TB infection rates in Kenya.
Abigael Wanga, who lives in a village in Busia County, has five children. The two have been undergoing tuberculosis treatment for a year. However, one day, two children, Philemon, and his stubborn sister Desuma (3), who want to become a pilot, are still suffering from chest pain and coughing, and have no appetite.
Okose fears they are drug resistant. She collected sput samples from them and their three brothers the day before inauguration. The test is frozen and all five children continue to sleep under one blanket at night.
