Three months into her residency at Chogoria Mission Hospital ten years ago, Angela Migowa watched a child battle Lupus and die.
Lupus – a disease where the body's immune system attacks its own tissues and organs – is not fatal in most cases. In fact, most people live a normal life span after early diagnosis and following a proper treatment plan.
In an interview with The Star Health &Science on Saturday, she retraced her journey to becoming Kenya's first female paediatric rheumatologist. Rheumatologists specialise in disorders that affect the joints, muscles, bones, and immune system. Dr Migowa’s current focus is arthritis in children in Kenya. Arthritis is a disease that causes damage in the joints– the places where two bones meet.
There is a misconception that this disease only affects the elderly. “Yet, the reality for children living with arthritis is a daily struggle with pain, disability, and the social stigma that comes with it,” she told The Star. “We estimate that between 200,000 and 300,000 children could be living with arthritis in Kenya.”
Dr Migowa currently works as a Paediatric Rheumatologist at Aga Khan University Hospital Nairobi. She later founded the Hope Arthritis Foundation, based in Nairobi, to promote awareness about the plight of children with this disease, properly known as juvenile idiopathic arthritis (JIA).
“When a child complains of pain in a joint, please before we label the child as pretending, let us do due diligence and have the child examined. The pain of arthritis is very interesting because the pain is worse in the morning and improves as the day goes by, and it improves with activity. As the child runs and plays, the pain gets better,” she explained.
JIA in children is more aggressive compared to arthritis in elderly individuals because their bones have not yet achieved full growth. Secondly, JIA consists of seven types of arthritis, each with unique features. A child suffering from a disease that affects growing bones runs the risk of a lifelong disability, Migowa said.
This can also impact their education, emotional well-being, and future economic prospects, creating a vicious cycle of poverty and chronic illness. Early diagnosis relies on thorough history-taking and physical exams, which are critical since testing accounts for only 20 per cent of the diagnosis. Arthritis in children can be genetic, but the impact of pollution on the environment, temperature change, diet, and infections plays a big role in triggering someone to tip over from a genetic risk to the actual disease.
“All these things come together in synergy to impact the development of the disease,” she said. Historically, healthcare priorities in Kenya focused on diseases like malaria, pneumonia, and HIV, but noncommunicable diseases are emerging as major issues. Some of the JIA symptoms parents are advised to look out for are swollen joints, reduced daily activity in the morning, children crawling using their elbows instead of wrists, and sudden refusal to put their legs down if they had already started walking.
“Most children crawl on their wrists and their knees. If you notice the child is not crawling on the elbow, you have to ask yourself, what has happened to the wrist,” she said. Anna, a mother whose name has been changed, initially thought her son had allergies or had a bad fall when he began limping and dragging his feet.
“It took us three years to receive a proper diagnosis and learn that our child had arthritis, due to the rarity of JIA and the lack of awareness about it,” Dr Migowa said. The revelation was both surprising and devastating to Anna and her husband. Managing the disease has been emotionally and financially challenging.
Dr Angela Migowa is also the president of the Paediatric Society of the African League Against Rheumatism (PAFLAR)Their son, who is now eight years old, has to undergo
physiotherapy and physical activities like swimming to help manage the
condition. Other recommended activities are cycling and walking, which help
alleviate the pain.
On
Saturday, the foundation launched its strategic plan for 2025–2029 to promote awareness, prevention, early
detection, and management of childhood arthritis and rheumatic diseases through
education, research, and collaboration with healthcare professionals and
stakeholders.