SOCIAL BEHAVIOR OF KENYANS REGARDING COVID-19

The fear of contracting Covid-19 and dying actually first became tangible in Kenya after the first case was reported on 12TH March 2019. But even then, every Kenyan hoped the situation would remain contained. But then as more people continued jetting into the country and movement remained un restricted, the one case soon became two, then sixteen and soon enough we were talking about hundreds of positive cases per day, some people we knew and soon enough, ourselves.

Slowly, overtime, to protect ourselves and loved ones, we had to change from life as we knew it to a new normal that ensured we were protected.

Here are some of the things we have had to change;

  1. Handshakes and hugs;

While hugging is seen as a behavior copied from the west, handshakes have been regarded as the oldest form of greeting in our society. It was initially extremely difficult. But slowly Kenyans have embraced the no handshake greetings.

These days, a simple nod, clasping of your own hands and verbal greetings are acceptable in our society.

  1. Burial practices

These have changed significantly. From holding wakes for long days, to reducing mourning times and changing burials from open casket burials to closed casket methods.

These days, bodies of people who have died of covid-19, though regarded as potentially infectious, the stigma has reduced significantly and they no longer require police escort or presence during burial.

  1. Worship

Though worship places have now been opened to the public, for a long time people were content with online worship.

The church had done away with the need for shaking hands during ‘the peace time”. Also the elderly and very young are still expected to stay away due to their fragile immune systems.

  1. House parties

Now that numbers are regulated and curfews are still in place, Kenyans have moved from club parties to house parties.

  1. Home going husbands

One of the greatest positives for Covid-19 was the curfew that was put in place. This has ensured that husbands are now able to sleep at home with their families as opposed to before when they could black out in drinking dens

  1. Matatu culture

Pre- covid-19, matatus used to overload passengers. It was common to find a public service vehicle over loaded with many more people hanging from the doors, two people sharing one seat etc.

In an effort to increase the distance from one passenger to another, the carrying capacity of a single vehicle was reduced to half its capacity.

This resulted in an increase in commuter fee but also increases the comfort during travelling

  1. Hygiene

For the first time in forever, we are having Kenyans coughing into tissue papers and into their elbows as opposed to coughing into each other

The hand washing campaigns and hand washing points have increased the frequency of washing up

  1. Visiting relatives

There is reduction due to the fear of transmitting covid-19 or contacting from relatives

  1. Health seeking behavior

Has increased for cough and related illnesses.

Covid-19 Precautions

Covid-19 Precautions

Although Covid-19 was first reported in china in December of 2019, it wasn’t until 12th March 2020 that the first case was reported in Kenya. Until this time, we had all somehow thought, and hoped that it was a disease of the Chinese, or the West at worst. So it was scary and surprising to learn that the melanin we had hoped would be protective was not protective after all! It is a disease that had shaken bigger economies and claimed lives in countries with a seemingly organized, well-funded and equipped health care compared to that of our country. So the fear after this one positive case was understandable.

Covid-19 is an acute respiratory illness in humans caused by corona virus.

Transmission of the disease is by:

  1. Respiratory droplets
  2. b) Contact with respiratory secretions and saliva
  3. Aerosol particles

Since spread appears to happen from person to person, here are the precautions one must take to reduce or minimize the spread

Social distance

To reduce spread during coughing, sneezing or talking stay at least one metre or six feet away from each other.

In trying to implement social distance, the government implemented some of the following measures, most of which are still in place, a few have been modified over time;

  1. Learning institutions were closed and online classes introduced.
  2. Social and religious gatherings were banned. For the first time in history, the doors to churches, mosques and bars were closed

The conduct of funerals was also changed significantly; overnight wakes were banned, and the number of people allowed per funeral was also reduced.

Funerals for people who had died of Covid-19 had to be conducted following a set of rules as per the ministry of health guidelines.

  1. For the first time in history, public service vehicles would carry at less than full capacity. Up to date, there has to be an empty seat in between two passengers.

Wearing masks

It became compulsory to wear masks when out in the public.

Masks are believed to reduce transmission from person to person by trapping particles that are produced during talking, sneezing, or coughing.

Though initially there was a severe shortage of surgical and N95 masks. They are now available and at a less than prohibitive cost.

How to wear your mask:

  • Clean your hands before you put it on, after taking it off and anytime you touch it
  • Cover the nose, mouth and chin
  • When you take off the surgical mask, dispose in the bin immediately, clothe masks should be cleaned
  • Don’t wear masks with valves

Good hygiene

  1. Clean hands with soap and water or alcohol based hand rubs.

Through government institutions, non-government organizations and private businesses, hand washing points have been set up and strategically distributed throughout the country in major towns, outside government offices, hospitals, schools, churches, markets, et cetera.

  1. Cough hygiene.

Cover nose with elbow or handkerchief when sneezing or coughing. Through health campaigns and advertisements, everyone is slowly learning the right practice.

  1. Clean and disinfect surfaces

QUARANTINE

The first Covid-19 case in Kenya was first reported in Nairobi, Kenya’s capital. The spread was initially high in Nairobi, then followed by Mombasa, kilifi and Kwale counties. In an effort to contain spread to other counties, the government initially announced a cessation of movement into and out of these regions on April 6th 2020.

Quarantine is a restriction of movement of people, intended to prevent spread of disease. Its use is intended to restrict people who may have been in contact with people from moving into healthy populations and further spreading the disease.

 

 

 

 

 

ISOLATION

Separation of ill persons with contagious disease (Covid-19), from people who are not.

Early in the outbreak and with confirmation of the first cases in the country, all sick persons were admitted into isolation wards in the hospitals. But as the number of cases has increased rendering our facilities overwhelmed, so many people especially those with mild disease are isolating themselves at home.

Home isolation is encouraged for mild disease. However in case of worsening symptoms, a patient should check into a health facility.

CURFEW

Dawn to dusk curfews put in place to reduce movement of people were to help with containing people in one place

Also ensured social places like clubs and pubs remained closed hence reducing crowding and hence transmissions.

 

I AM AND I WILL

About a year ago, I was unfortunate enough to break it to a twenty seven year old that he had cancer. He had just walked to the hospital with anemia. When we first asked for an OGD, we were just doing it as a routine test to rule out the underlying cause of the anemia. I had expected that the OGD would turn out normal; except it didn’t. He had a small tumor in the duodenum and a biopsy had been taken. It turned out to be an adenocarcinoma, with metastases to the liver which meant curative surgery wasn’t an option for him. As we sat with the oncologist to draw out his chemotherapy regimen and to just talk to him, I couldn’t help feel extremely sad for him. I was twenty seven and I hadn’t even started living. He had graduated from a teacher’s training college and he was yet to get a job (you know how hopeless our country is in this front). In the face of illness, his joblessness would fade into nothingness. Now he had to devote his life into fighting cancer.
2019 was particularly a bad year for Kenya. We lost a lot of people to Kenyan, in addition to all the “faceless” Kenyans we lost to cancer, there was Ken Okoth who succumbed to colorectal cancer, Bob Collymore who had acute myeloid leukemia and former Bomet governor Joyce Laboso.
Today is world cancer day and in line with the theme, I want to do my own share of building the nation by sharing something on breast cancer screening.
Screening is defined as the tests and exams used to find a disease in people who don’t have symptoms.
The purpose of screening is to enable earlier intervention and management and in the case of cancer, to achieve cure
Breast cancer screening
The goal is to find it before it causes symptoms
For women at average risk of breast cancer, they should be screened as follows:
1.Start a screening mammogram between age 40 and 44 every year
2.Women 45 to 54 should get mammograms every year
3.Women 55 and older can switch to a mammogram every other year or continue yearly mammograms

Women at high risk for breast cancer should get a breast MRI and a mammogram every year starting at the age of 30
You are at a high risk for breast cancer if you have any of the following:
1.History of breast cancer previously
2.Genetic mutations such as BRCA1/2
3.History of radiation therapy to the chest in childhood
Clinical breast exams are not recommended for breast cancer screening among average risk women at any age
It is important to aspire to prevent cancer and if this is not possible, then early detection is the next best shot if we are aiming at cure.

Condoms: Male condoms and female condoms

Most of us buy our contraceptives directly from pharmacies based on the knowledge we gather from interacting with our peers mis-informed and from social media. The unfortunate thing about this information we get from social media and friends is mostly wrong. Either because of poverty or because we don’t think of birth control as a serious issue, only a very small percentage of us see doctors before settling on a suitable method of birth control to use.
Choosing a method of birth control is as serious as taking your blood pressure medication or keeping fit. That is why I am taking this opportunity to talk about contraception.
Contraception or birth control is a device that is used to prevent a pregnancy.
There are different types of birth control methods and these include;
1.Barrier methods.
2.Hormonal contraceptives.
3.Sterilization.
4.Periodic abstinence.
5.Intrauterine devices.
6.Emergency post coital contraception.
BARRIER METHODS
Raise your hand if you have seen a female condom? Keep your hand up if you have used one…
I know there is a group of humans out there who don’t know that a female condom exists. As a matter of fact, I didn’t know there was one until I went to medical school so you are not alone.
The most commonly used barrier method is; a male condom, then there is a female condom that is not very popular, then we have the diaphragm and the cervical cap.
Male condom
This is thin sheath made from latex that is placed over an erect penis before a sexual encounter.
It is one of the most popular mechanical barrier.
Advantages include; protection from sexually transmitted illnesses.
Cheap- in fact the government supplies free condoms.
Disadvantages
Some people are allergic to latex
Single use hence hectic
May decrease enjoyment of sex
Female condom
It can be inserted up to eight hours before sex.
HOW TO USE A FEMALE CONDOM
1.Check the cover to make sure it is not past its expiry date.
2.Take it out of the packet.
3.Sit, lie or squat, squeeze the smaller ring at the closed end of the condom and insert it into your vagina as far in as possible. The larger ring at the end of the condom will cover the area around the vaginal opening.
4.During sex, you should guide the penis to enter into the condom and not between the condom and the side of the vagina
5.After sex, twist the large ring to prevent semen from leaking and pull it out.
Double protection with both a female and a male condom is not recommended as this may increase the chances of condom burst due to friction.
Condoms with all their disadvantages should be encouraged among young teenagers, people in long distance relationships where trust is an issue, in commercial sex, and between discordant couples as they reduce the chances of sexually transmitted diseases.
CONDOM BURST
In case a condom breaks during sex;
1.Withdraw the penis immediately.
2.Avoid douching
3.Use emergency contraceptive pills as soon as is possible
4.Asses the need for post exposure prophylaxis against HIV.

MEDICAL FORMS

MEDICAL FORMS
Eight years ago when I was joining campus, I was required to fill a medical form. While I don’t remember all the exact details in that medical form, I remember there was a part where I was required to fill if I had undergone any surgeries. I remember that part because I answered ‘no’: a lie. I had had a surgery about a year before but because my father, felt like I would be discriminated against if I said the truth, I had to lie. Thank God it wasn’t some kind of chronic illness that required long term monitoring I had lied about because the result may have been fatal.
Form ones all over the country are reporting to high school. For most, this is the first time they will be away from their homes hence the need to fill that form and list down any chronic ailments that the school should be aware about. Being a doctor, I have had to fill a lot of forms this past week and I have noticed that; apart from most of them being poorly constructed, most parents and their children tend to lie or deliberately omit necessary information.
We are talking about parents who won’t mention anything about their sons or daughters being asthmatics, or epileptic, being HIV positive etc. And this, this actually is a matter of life or death. Then there are those who lie about allergies against popular high school meals like githeri, beans and sukuma wiki..
Lying about being allergic to the most commonly eaten meals in high school isn’t as bad as lying about having a chronic illness. But why would someone who is asthmatic wanna lie that she is not? Here are some of the reasons;
1.Fear of being bullied or discriminated against
2.Fear of being excluded from their favorite sports
I saw a young girl today, who has been asthmatic for about four years now deny the asthma and the inhalers she has been using, except she had conjunctivitis and as I questioned her about her red eyes, she eventually told me the truth. Patients lie to us every time. I mean I have had a twenty something year olds swear to me that she is a virgin even after a positive pregnancy test and an ultrasound confirming a pregnancy. Or a chain-smoker swear that he stopped smoking several years ago even though his breath is reeking tobacco smoke. This young girl lied to me because she loves foot ball and she thinks that she will never make it to the school team if she said the truth.
But is it true that if you are asthmatic you can never be an athlete? Everyone knows David Beckham; the great footballer. But did you also know that he has sufferered from asthma since his childhood? He was even photographed using his inhaler during LA Galaxy’s 5-4 defeat on penalties by Real Salt lake in Major League soccer’s championship game in Seattle in 2009.
Having asthma doesn’t mean that you can’t pursue your dreams about playing football or being any kind of athletes because there are others who have done it despite the asthma. People like Jackie- Joyner Kersee and Paula Radcliffe.
Then there is epilepsy, another chronic illness that a lot of people are ashamed to be diagnosed with. Most people who are diagnosed with epilepsy tend to keep their diagnosis a secret and will even skip their medication just so that other people don’t discover that they are epileptic. But you can live a totally normal life as long as you take your medicine right. Take for example Prince. Remember Prince of Purple Rain? If you haven’t listened to Purple rain then you need to go to you tube right after you are done reading this and watch that piece of beautiful music. Prince was epileptic since his childhood. But that didn’t stop him from being a great musician. The 26th president of the United States of America: Theodre Roosevelt was also epileptic same to very many other people who have achieved so much in life. People like the singer Susan Boyle; we know her from Britain’s Got Talent. Harriet Tubman the famous activist suffered from temporal lobe epilepsy. There are so many great people, people we try to emulate, people whose lives inspire us that suffer from epilepsy but they have been able to live their best lives and offer the world their best.

Prince Rogers Nelson
Prince Rogers Nelson

AFTER BEING DIAGNOSED WITH BREAST CANCER..

January 6th2020

I am seated in one of the consultation rooms in the surgical outpatient clinic, it is a busy morning; the first surgical outpatient clinic in the New Year and the human traffic is overwhelming. Looking at all the people waiting to be seen makes you realize that the world has so many sick people it is scary.

At eleven forty two, a lady walks into my office. I remember the time because at exactly that time, the alarm in my phone goes off and I am startled because a) alarms always startle me and b) I don’t remember setting it…. I mean why would I set an alarm at such an odd hour? Nothing happens at eleven forty two, tea break happens earlier and lunch comes later. I switch the alarm off just as she settles into the chair.

‘So, why are you on follow-up?’ I ask her. It is a question I like asking every patient I encounter who is on long term follow-up. It helps me gauge if the patient understands half of what is going on in their bodies, the mode of treatment they are put on and if they understand their role as patients. (Fun fact- most patients, can’t name the diseases they suffer from, don’t know the names of the drugs they use and don’t carry them to their routine hospital visits because they assume the doctor is supposed to know whatever drugs they are on. Those who have had surgery can’t tell you what the surgery was all about).

Back to my patient, she is here because of her breast….she has had an obvious lump in her breast with skin changes and nipple retraction for the past four months. In that same period, she has only managed to do a mammogram. No biopsy has been taken, no staging images have been done, no counseling, no one has discussed the modalities of treatment with her. we have lost three precious months, why? I don’t know. Meanwhile the tumor has been growing in size (because that is what tumors do, they grow, and spread…

So what was she supposed to do? Most of our patients present a little late because screening is not one thing that we have taken up seriously as a country. Most patients will present with lumps big enough that they can be felt through palpation of the breast. Depending on their ages, they will either be sent for a mammogram or an ultrasound of the breast. Ultrasound if they are less than thirty five, mammogram if they are thirty five or older. After having a suggestive mammogram or ultrasound, here is what you need to do:

1. Tell someone in your family; your husband, your mother, your grown up child or even friend.

2. Get a medical cover if you don’t have one already. The bills that come from having cancer can’t possibly be covered by cash. Medical insurance even though it doesn’t cover everything goes a long way into easing the financial burden that comes with suffering from cancer.

For breast lumps, the next step for your doctor to take after either a suggestive mammogram or breast ultrasound, is to get a histological diagnosis. This is where biopsy comes in.

1. BIOPSY

A piece of tissue is surgically taken from the lump or breast lesion. It is then subjected to histology to confirm the diagnosis of cancer, show the cell types and the hormone status.

2. STAGING

This is done to determine the extent of the disease. Here, the size of the tumor is determined, the organs involved and how far it has spread.

This is done by imaging. In breast cancer, a chest CT scan and an abdominal CT scan or ultrasound are done and reported by a qualified radiologist.

3. TREATMENT

Deciding the modality of treatment depends on the type of the cancer, and the size of the primary tumor and then the stage.

The commonest modalities of treatment include surgery, chemotherapy or radiotherapy.

Whether to start with chemotherapy or radiotherapy or surgery depends on a number of factors; and from here, the team that is involved in your treatment should sit down and discuss how to go about your treatment

The most important thing to note is that it is a race against time and that any time lost may shorten the survival time.

What is Cervical Incompetence?

McDonald Cervical Cerclage

[vc_row][vc_column][vc_column_text]A few weeks ago, a friend rang me up and told me that her doctor had just called her cervix incompetent. Here is how our conversation went.

Friend: Hello?

Me: Long time I have missed you.

Friend: (Sounding bored) Well, yeah, been busy

Me: Are you okay?

Friend: Actually, the doctor I am seeing just called my cervix incompetent

Me: Oooh, I um…..

Friend: I will sue him. How can he talk like that? Is that even professional?

Me: Haha haa haaaa

Friend: ( Hangs up).

An incompetent cervix is one that opens prematurely under the pressure of the growing fetus and results in early second trimester miscarriages.

Causes of cervical incompetence include:

1. Genetic weakness of the cervix

2. Severe laceration during previous pregnancies

3. Multiple gestation (twin, triplet, etc)

People with cervical incompetence normally experience multiple pregnancy losses all which occur in the second trimester of pregnancy.

The treatment usually involves placement of a cervical stitch (MC Donald’s stitch) that closes the cervix and prevents it from opening usually from the 12th to the 16th weeks of pregnancy

Your doctor will need you to abstain from sex if you have a MC Donald’s stitch in place till delivery.

People with MC stitch can still deliver vaginally except, the stitch will need to be removed before delivery or any time after the 37th week of pregnancy.[/vc_column_text][/vc_column][/vc_row]

These are The Times of Cholera

cholera

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Fifty-six minutes later, i was still seated on the toilet seat, there were no signs the diarrhea was about to stop. I called reception with news that i was “a little unwell”. A member of the support staff showed up in my room, dressed in his work coveralls and boots. Thanks to him, i was bundled into the hotel van, and rushed to the Nairobi Hospital. “It must be botulism”, i remember telling the attending doctors in the accident and emergency. We had been served cold rice (yeah they serve cold rice in big hotels too), and i was certain it was botulism. A doctor mentioned cholera, but i brushed him off. It never occurred to me that i could get cholera, not from such a big hotel. That a hotel would promise so much and deliver cholera instead? But then i had overestimated it. After they deposited me and my stuff in the hospital, they washed their hands clean. They even refused to refund the money for the days i didn’t spend in the hotel.

The doctor performed a random diagnostic test for cholera (bless his soul!) The test turned positive! I was stunned! I thought i was dreaming. I had read about cholera, handled a case or two, now i was suffering from it. I would have discounted the test results. But my stool was the classical rice water stool of cholera; water with flecks of stool.

I was started on intravenous fluids and antibiotics. I remember calling my husband in the middle of it all. He had just received news that his father was very ill and there i was with news that i had cholera! I can still hear the shock in his voice as he asked me if i was in the hospital already. I can imagine how deeply it hurt him. Lying in the hospital miles away, i could see him pacing the house wondering how to be in two places at the same time. I have never known what lie he had to say to our children.

The Nairobi county executive commissioner ministry of health officials visited at a time when almost thirty three of us; doctors, nurses, and community healthcare workers had been admitted to various hospitals in Nairobi county. We had been attending a conference on lung diseases in a hotel in Nairobi. They were sympathetic, at the verge of tears, they promised to get to the bottom‘of the matter’, to do “something”. It broke my heart when they would later go to national television and rubbish the whole issue, deny the possibility of a cholera outbreak, call what we were suffering from ‘mere food poisoning’ and suggest that it was food we eaten in unconventional places that was responsible. In other words, we had been careless. That stung. Lying in bed with stool leaking out of my rear on its own accord, I remember asking myself why anyone who had seen me in that state would lie without even blinking.

I was moved into isolation unit on Friday morning. I had never put myself in the shoes of someone in isolation unit until i  found myself in there, this time not as a doctor but as a patient. If I say isolation was lonely, i would be understating it. But then the English language doesn’t have a better word for ‘the state of being alone in a room with just your thoughts to keep you company’.

Visits to your room are minimized and each time anyone shows up, they come dressed from head to toe in a protective gear that is designed to make them close enough to you, yet as further away from you as is possible.When they walk in, all you see is just their eyes blinking from behind protective goggles. When they talk, their voices, coming from behind a face mask comes out filtered of emotion. The only touch that you get is from hands that are gloved. Keeping people in isolation is a great way of ensuring diseases don’t spread but it is also a sure way of making someone get depressed. Being in there was hurting. It was painful, and all these months later, i just don’t know how to put all that pain in words!

Saturday was my worst day in the hospital. First off, i woke up hungry. I was getting my appetite back, but i couldn’t get anyone to bring me food. Nairobi Hospital is understaffed too! I remember calling for a nurse so many times that i gave up. I was made to understand later that they were all busy attending to emergencies. That got me thinking; no one, not even we the middle class withour insurances are safe. I mean i was in Nairobi Hospital paying an arm and a leg for staying in the isolation unit (my insurance doesn’t cover isolation so i had to pay out of my pocket). I expected to have at least one nurse assigned to me. But there was none to spare. That is why we need to speak up when public hospitals close for months on end. We need to make some noise because when they are shut, those without money don’t get help. We need to make some noise because we pay taxes.

Cholera is not something you can wish on anyone. Not even your worst enemy. No human deserves all that pain. Having diarrhea is bad enough. Having continuous diarrhea punctuated with vomiting is worse The worst thing is not even the diarrhea, it is that you are not in control. When you feel like passing stool, then you get just seconds before the sphincters relax. Cholera will make you run to the toilet but you will poop on yourself just before you sit on the toilet seat.

When i look back at that time, i shudder. At some point i thought i wouldn’t make it out alive. I thought about my children who had learnt about my illness from their friends who had seen, me on TV, speaking from the hospital bed. The ministry had insisted though that it was just an acute diarrheal disease. In fact, we never got the confirmatory stool test results from the hospital which is wrong. As a patient, i am entitled to know what was found in my stool. The country also deserved to know. We need to stop denying these truths. We need to accept that Weston, no matter who owns it, once served us cholera!

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Epilepsy

Prince Rogers Nelson

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Sunday morning, it is quiet outside. Even the road feels quiet, nothing like the usual matatu and boda boda madness. This happens every Sunday morning. The whole world slows down. Faithfuls go to church to unburden themselves and to also get blessings for the week ahead. I search for Prince’s “purple rain” in my play list and switch my speakers’ volume to full blast.

Purple rain, purple rain
Purple rain, purple rain
Purple rain, purple rain
I only wanted to see you
Bathing in the purple rain

A lot of us have heard ‘Purple Rain, most of us know its lyrics by heart. It is one of those songs that keep the memory of Prince Rogers Nelson alive among us. The younger generation know about Prince just because of this song; Purple Rain. But Prince sung and performed other songs too. One such song that caught my attention is; The sacrifice of a Victor.
Here are the lyrics from ‘The sacrifice of a Victor’;

I was born on a blood stained table
Cord wrapped around my neck
Epileptic till age of seven
I was sure heaven marked the Deck

This song, the Sacrifice of a Victor is one of the most courageous songs I have ever heard. In the song, Prince confesses that he was epileptic as a child.

Epilepsy is a neurological disorder caused by excessive electrical discharges from the brain resulting in seizures or convulsions. In our set up, most communities treat it as a taboo disease that afflicts the lowly, the cursed, and the ungodly.

While it is possible to lead a relatively normal life with epilepsy, a lot of men and women who suffer from epilepsy lead a less than normal life due to the huge stigma that surrounds epilepsy. Most people believe it is brought about by witch craft, curses, disobedience etc.

Lil Wayne
Epilepsy is a disease that affects normal sometimes highly performing people, Lil Wayne for example suffers from epilepsy (did you know that?). Lil Wayne has suffered from convulsions since he was a young boy. Here is what he told MTV correspondent Sway Calloway about his seizures ; ‘no warning, no nothing, I don’t feel sick, I get headaches real bad.’ What we know for sure is that, the rapper has suffered a number of seizures even in his prominence as an award winning rapper. He has had two emergency landings due to seizures and he nearly died in 2013 due to seizures.

While epilepsy has no definitive treatment currently, anti-convulasants can be used to effectively prevent the convulsions from occurring. Anti convulsants are drugs that are usually administered to prevent convulsions from occurring. They are prescription drugs that are normally prescribed by a physician. The type and number of drugs that one epileptic person receives normally depends on their age, severity of symptoms and whether they are pregnant or not.

When anticonvulsants are used correctly, one is able to lead a normal life with very few or no seizures. Other high achieving people with epilepsy include, Susan Boyle the famous Britain has got talent contestant, Neil Young, a musician and song writer and Theodre Roosevelt who was the 26th president of USA. This list no doubt contains immensely talented people who throughout their lives achieved more than those without epilepsy.

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Pre-Conception Care

Pre-Conception Care

Well before each baby is conceived, the two parents involved should actually decide to conceive the baby (as opposed to find yourself pregnant), carry the pregnancy to term and give birth to a healthy baby, while ensuring the mother is healthy throughout the pregnancy and during the post delivery period. During the preparation phase of conception, the two parents to be should undergo pre- conception care.

Pre- conception care is the care given to both men and women who are planning to conceive, with the aim of increasing chances of conception, and reducing the risk of death during pregnancy, with an aim of giving birth to a healthy baby.

It offers patients an opportunity to discuss risk factors that can be minimized before and during pregnancy to ensure a healthy outcome for the mother, father and the baby. The issues to be discussed and addressed include;

Contraception
Couples on contraception who wish to get pregnant should discuss it with their obstetrician and gynecologists. Those on implants and intra-uterine devices should have them removed. Those on three monthly injections should be counselled on the possibility of a delay in the return to fertility for about three or so months.


Maternal chronic diseases

Before pregnancy, women who suffer from chronic diseases like diabetes, hypertension, epilepsy, HIV should be seen by their gynecologists. They should be treated to a level where their diseases or the drugs they take won’t affect the well being of the baby.

    Diabetic women

should have their sugars well controlled before they become pregnant. They should also have their medicines changed from oral tablets which have teratogenic potential to insulin injections.

Pre-Conception Care
Pre-Conception Care

    Hypertensive women

should have their pressures well controlled before pregnancy. They should also discuss the potential to have their drugs changed to drugs that have no teratogenic potential.

    Epilepsy

– women with epilepsy and who are on medications should not ideally get pregnant without discussing it with their doctors. Most of the anti-epileptic drugs they use may cause birth defects such as spina bifida. They are therefore supposed to be started on a course of folic acid supplementation several months before they become pregnant. They should also have their drugs changed to drugs that don’t cause fetal defects.

    HIV positive women

should be put on anti-retrovirals till their viral load is undetectable so as to reduce the possibility of mother to child transmission.

    Hyperthyroidism

– women using anti-thyroid drugs should be seen by their doctors and advised if at all getting pregnant is safe at all. They should also have their drugs changed to drugs that don’t cross the blood placental barrier hence causing fetal defects.

Mental illnesses
Such as depression and anxiety disorders should be screened and treated before pregnancy. Women who are on continuous treatment for mental illnesses should be put on medications that are safe for the child who is about to be conceived.

Nutrition
All women desiring pregnancy should have their nutrition assessed. They should start feeding on folic acid rich foods and taking folic acid supplements if need be. Folic acid prevents against neural tube defects.

Obesity
Women with a body mass index (BMI) of 30 and above should be advised to lose some weight. Obesity is a risk factor for infertility among women. It is also a risk factor for other pregnancy complications like deep venous thrombi i.e clots.

Sexually transmitted diseases
Both parents should be screened and treated for sexually transmitted illnesses such as syphilis so as to eliminate the risk of transmitting it to the unborn baby.

Family and Genetic history
Assess pregnancy risks on the basis of maternal age, maternal and paternal health, obstetric history and family history. Possibility of passing genetic defects like sickle cell to the unborn baby should be discussed.

Advanced maternal age and the risk of getting babies with Down syndrome should also be discussed.

Images courtesy of Citizen Kenya & Lune Magazine