Part 2: Q&A with GARP-Kenya Coordinator Eveline Wesangula

CDDEP: How did you first become involved with GARP-Kenya?

Eveline Wesangula: I saw an advertisement for an antimicrobial resistance group coordinator, and I have training in infectious diseases. One of my interests was in chemotherapy and malaria and the use of ACTs [artemisinin combination therapies], and antibiotic resistance seemed like interesting and important work. So I applied and was offered the position.  It turned out to be a good decision.  The working group is great. I think we’ve seen a lot of growth at this point.

CDDEP: How has it grown in that time? What have been GARP’s key successes?

EW: Vital to GARP’s success has been the interdisciplinary, multi-sectoral approach that we have taken with CDDEP’s direction. We’ve had a mix of professionals from both human and veterinary medicine working together—from hospital practitioners to academics doing research to representatives from the pharmaceutical companies, in our meetings for GARP. The government has been included since the beginning, but this year it came together with a key partnership with the Ministry of Health.

CDDEP: What would you say are the biggest challenges for the working group?

EW: Gathering data and conducting surveillance on resistance. This is largely due to the lack of infrastructure and microbiological capacity of the hospitals to carry out surveillance, but it’s also about a lack of personnel. We don’t have microbiologists in all of the regional hospitals. So that becomes a challenge in collecting data that will be useful for developing guidelines—and not just any data but reliable and accurate data.

CDDEP: Are there big differences between hospitals across Kenya in their ability to generate antibiotic resistance data?

EW: There are differences, yes. First of all, we’ve got both public and private providers. Most of the private systems have good microbiological capacity; they are able to carry out tests and document the resistance trends within their hospitals. But the public sector, unfortunately, doesn’t have many microbiologists in their facilities, so they can’t carry out surveillance and report adequately on resistance and sensitivity patterns. And the pathogens in the private hospitals might not be the same as in the public hospitals, so we can’t use just their data and assume it applies to the whole country. We need to strike a balance and get data that can be used for the general population.

CDDEP: Is the new Ministry of Health partnership important for expanding data gathering and surveillance?

EW: Yes, because the government gives direction to virtually everything. We cannot implement guidelines if the government doesn’t buy in. The MoH controls policy development—if we make strategic plans without them, they’ll just be plans. But with their help, they can be plans that are implemented.

CDDEP: Does the MoH have sway in policies for both public and private hospitals?

EW: Private, not as much, but yes they control public hospitals. On the national advisory board, though, we do have representation from the private hospitals. And most of the people in the private hospitals with good AMR programs have been appointed as members of the advisory board. So we hope they can also influence practices in the private sector.

CDDEP: Could you talk a bit about how GARP-Kenya has worked with veterinarians on antibiotic use and resistance?

EW: We’ve been working with veterinarians in several ways. First, within the GARP working group we have representation from the University of Nairobi School of Veterinary Medicine—two professors from the University sit on our working group. We also have representation from the Ministry of Agriculture, Livestock and Development Department of Veterinary Services who attend our meetings. They understand how AMR issues really cross over into both the human and animal health aspects. We are constantly in touch with them. And our newly developed protocol for knowledge, attitudes and practices is not just for human health, but has a big component that will evaluate the use of antibiotics in livestock as well—we developed it jointly with the veterinary community.  And although he now works in human health, it doesn’t hurt that the working group chair, Sam Kariuki, was a veterinarian before he got his PhD in microbiology!

CDDEP: How much are antibiotics used in animals and farming? Is it a big problem?

EW: It’s a big problem. It’s the only challenge we can’t quantify. We can tell the quantity of antibiotics consumed by human beings, but we have not had a study to be able to determine animal use in quantitative terms. We’re thinking that this is an opportunity for us to carry out a study of that kind.

CDDEP: Where would you like to see GARP’s work going in the next few years?
EW: I think I would like to see GARP taking a lead role in advising the Ministry of Health—they’ve already been doing that, but in a way that is more recognized, as a standing partner in all the activities of AMR in the country. We’d like to be working on the development of the policy and guidelines and also supporting implementation of the activities the MoH decides to have. And of course we’ve been working towards being independent, and clarifying exactly what GARP is other than just a project. We’d like to move from just being a project to being a legal entity that can be recognized by everyone—an organization that everyone knows where to find you, to have a physical address and be independent and interdependent at the same time.

CDDEP: Certainly. We wish you the best of luck with those goals, and thank you so much for taking time to talk with today.

EW: We’re very grateful for the support we’ve gotten from CDDEP and look forward to the relationship growing and prospering.