Covid-19 Precautions

Although Covid-19 was first reported in China in December of 2019, it wasn’t until 12th March 2020 when 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 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.

Photo by Prasesh Shiwakoti (Lomash)

Transmission of the disease is by:

  1. Respiratory droplets
  2. 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 were
  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 of 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. To contain spread to other counties, the government initially announced a cessation of movement into and out of these regions on April 6 ,2020.

Quarantine is a restriction of movement of people, intended to prevent the 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 a 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 curfew was put in place to reduce movement of people to help with containing people in one place

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

 

 

 

 

 

 

 

 

 

 

 

 

 

Traditional and Home-made Remedies for COVID-19

Though most home remedies have unproven effects on the course of diseases in general and Covid-19 in particular, the following are some of the traditional remedies that have been tried and have proven beneficial in one way or another.

Image result for garlic concoction

    1. Ginger

Used as a spice for meals and for medicinal purposes

Ginger is a natural anti-inflammatory and anti-oxidant

It also helps remove toxins from the respiratory tract.

    1. Garlic

Has anti-viral and anti-inflammatory properties

For a long time, it has been used as a spice in most households and when frequently mixed with ginger, and lemon, the resultant mixture is used for common cold.

It reduced airway inflammation.

    1. Lemon

A good source of vitamin c which helps immune cells to work properly.

Most treatment regimens for Covid-19 include vitamin C.

Lemon is a good source of naturally occurring vitamin C.

Its use in treatment regimens for Covid-19 has seen this fruit become scarce and hence increase in price to exorbitant levels.

    1. Honey

Works well for a cough

Attenuates acute inflammation through encouraging immune responses.

Honey has limited virucidal ( ability to kill viruses) effects against viruses like herpes.

    1. Turmeric

A spice with anti-inflammatory, anti-oxidant, antimicrobial and wound healing properties.

It has limited anti-viral properties.

Due to its anti-inflammatory effects, it has been suggested in the use against Covid-19.

    1. Chicken soup

Chicken soup doesn’t only make the stomach feel better, it may also clear nasal congestion and ease cold symptoms!

Chicken contains tryptophan which helps the body produce serotonin which can enhance the mood.

    1. Green tea

Powerful anti-oxidants protect your cells from damage and helps fight diseases.

    1. Keto-diet

This is a low carbohydrate high protein diet.

Ketone bodies inhibit infammasome activation in response to viral infections and could thus prevent hyper inflammatory reaction associated with the cytokine storm in severe critical Covid-19.

    1. Hot bath

This helps blood flow easier and can relieve symptoms of cold and flu

Note:

Patients with mild symptoms of Covid-19 are encouraged to recuperate at home and using some or all the home remedies known is okay. But should your symptoms worsen, it is best to seek treatment and care in the hospitals.

Also, even though most of these home remedies are good, none of them is proven to directly have an effect against Covid-19.

THE PLIGHT OF THE FRONTLINE WORKERS ESPECIALLY DOCTOTRS AND NURSES

This is a difficult story for me to write. I am a doctor who works in the accident and emergency department of a busy hospital and while I would say I am lucky to be well and hope to get vaccinated soon, it is not the same story for my colleagues who have lost their lives to Covid-19.

There are over fifteen doctors in different stages of their careers who have lost their lives in the line of duty, there are several nurses and clinical officers too. That is unfortunately the price that we, as health workers have had to pay; death.

Here are some of the things that health workers have had to struggle with amidst fighting Covid-19:

  1. Unsafe working environments.

Nurses and doctors working in isolation units where Covid-19 patients were being admitted have found themselves in a situation where they work with no proper protective gears.

Initially, they were required to work with minimal protection because there was a global shortage of all protective gear from the hazmat suits, N-95 masks, protective goggles, boots et cetera.

Also there is the issue of the government availing poor quality protective equipment like masks whose strings snap in the midst of a procedure, hazmat suits and aprons that are not water proof, oversize or under size hazmat suits et cetera.

Most of the isolation units were being run by junior doctors and nurses and a majority of them were ill trained to handle Covid-19.

Some hospitals also lack running water.

  1. Lack of compensation or proper remuneration

Working in the hospital comes with its own set of challenges and dangers. There is the constant danger of getting infected with diseases such as hepatitis and tuberculosis.

Working in the hospitals in the era of Covid-19 obviously puts one in a higher risk of contracting Covid-19 than the general population. This is bad enough.

It is worse when the risk doesn’t come with a financial cushion.

Doctors who were recruited to work in Covid-19 centers for example had to stay for a period of six months before receiving their salaries can you imagine that?

  1. Lack of good medical covers

Hospital workers who contract Covid-19 in line of duty have found themselves unable to cater for the cost of treatment which is not covered by the insurance covers provided by the government.

This is unfortunate and hence most of them have had to resort to fund raisings to cater for a disease they contracted in line of duty!

  1. Overworking and burn out.

Most public and private hospitals were severely understaffed even before the Covid-19 pandemic.

With Covid-19. Most healthcare workers found themselves working longer hours and under more pressure due to the increased influx of patients to the hospitals.

In 2020, most healthcare workers’ leaves were put on hold. In addition to working longer than expected, most of them could not take their annual leaves also!

  1. Anxiety, depression and other mental health challenges.

Though depression is common among healthcare workers, Covid-19 may have worsened the already bad situation.

Most healthcare workers found themselves depressed from working very long hours, not being able to see their families’ due to the need to self-isolate, and from seeing their colleagues contract covid-19 and die.

Reading stories and statistics from the west drove some of my friends into completing their Wills and preparing for any eventuality, death included!

 

The Plight of Front-line Workers

This is a difficult story for me to write. I am a doctor who works in the accident and emergency department of a busy hospital and while I would say I am lucky to be well and hope to get vaccinated soon, it is not the same story for my colleagues who have lost their lives to Covid-19.

There are over fifteen doctors in different stages of their careers who have lost their lives in the line of duty, there are several nurses and clinical officers too. That is unfortunately the price that we, as health workers have had to pay; death.
Here are some of the things that health workers have had to struggle with amidst fighting Covid-19:

Unsafe working environments.

Nurses and doctors working in isolation units where Covid-19 patients were being admitted have found themselves in a situation where they work with no proper protective gears.
Initially, they were required to work with minimal protection because there was a global shortage of all protective gear from the hazmat suits, N-95 masks, protective goggles, boots et cetera.
Also, there is the issue of the government availing poor quality protective equipment like masks whose strings snap in the midst of a procedure, hazmat suits and aprons that are not waterproof, oversize or undersize hazmat suits et cetera.
Most of the isolation units were being run by junior doctors and nurses and a majority of them were ill-trained to handle Covid-19.
Some hospitals also lack running water.

Lack of compensation or proper remuneration

Working in the hospital comes with its own set of challenges and dangers. There is the constant danger of getting infected with diseases such as hepatitis and tuberculosis.
Working in the hospitals in the era of Covid-19 obviously puts one in a higher risk of contracting Covid-19 than the general population. This is bad enough.
It is worse when the risk doesn’t come with a financial cushion.
Doctors who were recruited to work in Covid-19 centres for example had to stay for a period of six months before receiving their salaries can you imagine that?

Lack of good medical covers

Hospital workers who contract Covid-19 in line of duty have found themselves unable to cater for the cost of treatment which is not covered by the insurance covers provided by the government.
This is unfortunate and hence most of them have had to resort to fundraisings to cater for a disease they contracted in line of duty!

Overworking and burn out

Most public and private hospitals were severely understaffed even before the Covid-19 pandemic.
With Covid-19. Most healthcare workers found themselves working longer hours and under more pressure due to the increased influx of patients to the hospitals.
In 2020, most healthcare workers’ leaves were put on hold. In addition to working longer than expected, most of them could not take their annual leaves also.

Anxiety, depression and other mental health challenges

Though depression is common among healthcare workers, Covid-19 may have worsened the already bad situation.
Most healthcare workers found themselves depressed from working very long hours, not being able to see their families’ due to the need to self-isolate, and from seeing their colleagues contract covid-19 and die.
Reading stories and statistics from the west drove some of my friends into completing their wills and preparing for any eventuality, death included!

THE JOURNEY THE COUNTRY GETTING COVID 19 VACCINNES

It’s been a long while of face masks, face shields, sanitizers and social distancing. Covid-19 has not only changed our way of life but our fortunes too. The sad reality that remains is that, there is still no one established cure hence the need for a vaccine.

Vaccines work by training and preparing the bodies’ immune system to recognize and fight off viruses and bacteria they target.

While developing new drugs and vaccines takes several years (about ten years) it was essential to find a lasting solution to Covid-19 soon enough due to the continued large toll of death due to the virus and its high transmission rate.

Here are the stages to vaccine development;

  1. Pre-clinical stage

Research intensive phase that usually takes up to four years

Its aim is to find natural or synthetic antigens that trigger the same reaction as a bacteria or virus

  1. Safety and the right dose testing

Phase 1 testing-the first time a vaccine is tested in a small group of adults to evaluate safety and measure the immune response generated

Phase 2a – To determine the most effective dose and to expand the vaccine’s safety profile.

Phase 1 and 2a last several months to a year.

Phase 2b and 3 trials increase the number of people receiving the vaccine

  1. Effectiveness trial

More volunteers receive the vaccine to check its effectiveness

Before volunteers are vaccinated, they are tested to ensure they are Covid-19 negative.

Half of the study sample is given the vaccine while the other half receives a placebo.

Both are then followed up for a while to see if they develop Covid-19 symptoms.

  1. Regulatory approval and licensing

After a successful phase 3, manufacturers submit an application to bodies like FDA for approval

  1. Then manufacture on large scale, and international distribution is commenced.

NB; The manufacture of Covid-19 vaccine seems hurried, but all the necessary steps and protocols were observed by doing some steps concurrently.

Approved for manufacture and international distribution are the two vaccines by Atrazeneca and Moderna.

Mutahi Kagwe, the minister for health assured Kenyans that they would receive the vaccine for free once it becomes available

Once available to African countries and Kenya specifically, the plan is to have it incorporated in our vaccination program and ensure every person gets it.

With some countries in the west receiving the vaccine, our greatest hope as a country is that soon enough, we will be among the vaccinated.

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.

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.