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

I Have Three Failed Kidneys

Selena Gomez & Francia Raisaa

When people ask me how it started, they almost always expect me to say it started with either diabetes or hypertension. That is normally the story for almost everyone. But diabetes and hypertension didn’t have anything to do with my kidney failure. My kidneys failed because of just a malarial infection. I recovered from the malaria, but my. The doctors were confident it would be for a while, a short one, six months at most. At the end of six months however, my kidneys hadn’t improved. I was on dialysis for like three years, two times every week for three years. It became too much for a lot of people; myself, my family and my employer. I lost my job, I lost friends, I lost most of my family.

Kidney failure may not kill you fast, thanks to dialysis, but it sufficiently reduces your quality of life. The dialysis keeps you alive alright. But you are literally tied down to a life of oscillating between home and the hospital. Every little plan you make about your life has to actually fit in with your dialysis sessions. Dialysis becomes the main point of your existence and everything else becomes secondary.

My brother gave my life back to me. He gave me his left kidney. I was able to go back to work for five days a week from eight in the morning to five in the evening like every normal person. I travelled a little. I was able to become a full time mother again. But that was short lived (sadly) the immune suppressants (the drugs that prevent your body from destroying the donated kidney) became too expensive for me I couldn’t afford them. So I started missing my drugs. Initially just once in a week after I had paid school fees for my children. Then it became two times in two months, then more consistently. My body began becoming puffy; again! So I went in for the tests; and they found that the other kidney, my third kidney had also failed, this time around because of my own immunity.

So I am back on this journey of dialysis two times a week again. Though I have an insurance scheme paying for the dialysis sessions, it is still tough. Sometimes even going to the hospital becomes an uphill task. Before I became sick, I didn’t know I could lack two hundred shillings for bus fare. But then when you have sickness competing with the little money you make, even a ten shilling coin can become rare in your house. You find yourself having to make a choice between putting food on the table for your children and your own health. So you train your body to put up with all the toxins so that your babies can have a meal. It is not healthy but I am a mother and I have to do it.

Angelica Hale
Angelica Hale

PS;
If you watch America Has Got Talent, then I am sure you know Angelica Hale, an eleven year old contestant who is a singer. At the age of four, she contracted sepsis and suffered kidney failure. She was on dialysis for a year and a half. She received her kidney at the age of six from her mother Eva. Five years on, she is healthy, singing her life into money and fame.

Selena Gomez & Francia Raisaa
Selena Gomez & Francia Raisaa

Selena Gomez an award winning record artist suffered kidney failure secondary to lupus. She received her life saving kidney from her friend Francia Raisa in 2017. Almost two years later, she is doing well, great even.

Preventing Birth Defects

As she walked out of the new born unit, my mind drifted back to the phone call I had heard her make…”it is just a small swelling on her back. Something that will definitely close on its own ….” her words kept going round and round in a circle in my mind; just small swelling on her back, something that will definitely close on its own, just a small swelling on her back, something that will close on its own, just a…. I had spent at least one hour explaining to her that her baby girl had spina bifida, a neural tube defect that would need surgery. I had told her that even after surgery, her child would still have problems with movement, and bladder and bowel continence. I had thought she had understood but when I heard her making that phone call, I kept wondering; if she was she still in shock or she had chosen to be overly optimistic, or if she was just trying to re-assure another person, or if she was just being a mother and thinking best thoughts for her child.

No woman carries a pregnancy to term expecting to give birth to a less than perfect child. The shock that normally comes with realizing that your child is ‘not perfect’, that your child has a birth defect is therefore understandable. Being that January is “the National Birth Defects Prevention month”, I would be happy if you took some time off to read a little about preventable birth defects.

Here are some of the causes of preventable birth defects:
 ALCOHOL-
No amount of alcohol is safe to drink while pregnant.
Drinking alcohol while pregnant may result in; FETAL ALCOHOL SPECTRUM, a disorder characterized by; 1. Facial anomalies; small head circumference, small eye opening, flat upper lip
2. Intra-uterine growth restriction and poor weight and height gain after birth and
3. Learning or behavioral abnormalities.
People who are planning to conceive should therefore refrain from drinking and stay alcohol free throughout the pregnancy.

 FOLIC ACID DEFICIENCY
Pregnant women are usually given folic acid supplements throughout pregnancy.
Folic acid deficiency may lead to neural tube defects such as spina bifida and anencephaly
Ideally, women who are planning to conceive should prepare for conception by starting to take their folic acid tablets at least three months prior to conception.
The problem about our society is that, people ‘find’ themselves pregnant, most pregnancies are never really planned. In this case then, you should start taking your folic acid tablets as soon as you find yourself pregnant and not wait till the pregnancy is advanced like the way most people do.

 PRESCRIPTION DRUGS
Drugs that cause birth defects are known as teratogenic drugs in the medical world.
Women who have chronic illnesses and are on drugs should first discuss with their doctors and have their drugs changed to safer ones before they get pregnant.
Pregnant women should also avoid buying drugs over the counter because they may not know if a particular drug is safe for their unborn children.

Some of the commonest teratogenic drugs include;
1. Drugs used in the treatment of epilepsy- carbamazepine{tegretol}, phenobarbitone and phenytoin[epilim].
2. Some drugs used to treat hypertension- eg enalarpril, lisinopril etc
3. Some antibiotics like amikacin, gentamycin, may cause deafness
4. Drugs used in the treatment of cancer, like thalidomide may result in phocomelia, a disorder where someone is born without limbs
5. Some ARVS like Dolutegravir-has a potential risk for spina bifida

 MATERNAL OBESITY
Having a body mass index (BMI) of more than thirty percent is associated with a risk of heart defects in your child.
Women intending to become pregnant should therefore try and lose weight before becoming pregnant to reduce the chances of getting a child with heart defects

 INFECTIONS
Pregnant women should be screened and treated for the following infections; toxoplasmosis, rubella, cytomegalovirus, herpes simplex,
All pregnant women should routinely be screened and if found to be infected, they should be treated.
If untreated, cytomegalovirus may cause anomalies such as hearing loss, vision loss or mental disability.
Toxoplasmosis may result hearing loss, or even visual impairment in a newborn.

Cervical Cancer

Assuming that we all remembered to include; “taking my healthcare more seriously” in our 2019 resolutions or plans, it is my duty then to impart you with the knowledge that you will need to help you stay healthy.

According to the 2019 WELLNESS AWARENESS calendar, January is the world cervical cancer awareness month. Now cervical cancer is one of the most treatable cancers but sadly our people continue dying from its complications. It is the second leading cause of cancer deaths among women after breast cancer according to the Kenya Network of Cancer Organizations. This is mainly because of the fact that they present to the hospital when it is already in advanced stages, when the doctor cannot do much except just make them comfortable while they await death.
This doesn’t have to be case. We can decide to do better as patients, as a society.

Here is what we need to know about cervical cancer;

The cervix, also known as the uterine cervix is the lower part of the uterus, normally cylindrical in shape, and about one inch long. This is the part that is normally affected by the cancer, before the cancer cells move to the other parts of the body in a process called metastasis.
Unlike other cancers whose causes are still unknown, cervical cancer has almost always been associated with the infection with human papilloma virus (HPV) especially sub types 16 and 18.

HPV IS SEXUALLY TRANSMITTED.

It appears to be common in women who have multiple sexual partners, women who smoke, women with a low immunity (HIV positive), and also women who start sexual relations at a younger age, and those with promiscuous male partners.

After infection with the human papilloma virus, it usually takes about ten to twenty years before the cancer develops. This is good news because it means that if a woman presents at this time to the hospital, then something can be done before the actual cancer develops.
Prevention of cervical cancer;

Well we obviously have to reduce the risk factors; don’t smoke or stop if you already started, reduce the number of sexual partners to one (it is possible right?), dump promiscuous sex partners.

VACCINATION AND SCREENING
If we have any plans as a country to eliminate cervical cancer like the way most countries in the West have, then we need to embrace vaccination and screening as the strategies. If the government is very serious about the delivery of Universal Health Care, then we can do what other countries have done; develop a system of vaccinating our young girls against HPV.
The government could also incorporate screening services and a system to refer patients who have positive pap smears in services provided in government facilities.

VACCINATION:
Cervarix and Gerdasil are vaccines that are available locally and are used against the human papilloma virus which is the causative agent of cervical cancer.
Girls from the age of nine to thirteen are eligible for these vaccines.
Cervarix
Is active against HPV 16 and 18
It is administered in three doses at 0, 6 and 12 months intervals
Can be given to girls aged between eleven and twelve

Gardasil
Active against HPV 6, 16 and 18
Administered in three injections six months apart
Can be given to girls aged between nine to thirteen.

SCREENING
The most common screening method is the PAP SMEARS.

PAP SMEARS
When did you last have your pap smear?
Have you ever had a pap smear?
Do you know what a pap smear is?
Papanicolaou smear or just pap smear is a screening method used to identify pre cancerous cells in women.
Women below 21 years of age do not need screening.
Women aged between 21-29 years will require pap smears every three years.
Women aged between 30-65b years of age, who have had negative pap smears will requitre to go for pap smears every five years.
Women who are HIV negative though require yearly pap smears or as directed by their doctors.

If for some reason you had your uterus removed; complete hysterectomy, then you don’t need to go for pap smears at all.

 

Merry Christmas

HAPPINESS EVERYWHERE….
It is that time of the year when we celebrate the birth of Jesus and the festive mood is present everywhere! Television and radio stations are playing Christmas carols, supermarkets and shopping malls are all decorated in bright colored balloons and glittery lights. There are Christmas trees everywhere, decorated with bright lights that keep winking at us as we walk around, reminding us that it is Christmas.
As everyone else travels to the village to celebrate with their relatives, he (let us call him Mark), Mark lies in the hospital bed unaware and uncaring about what is going on beyond his field of vision. It is two or three months since he was allowed to go home. And for these three months, he has been lying in his bed, trapped in his own body, unable to move any part of his body from his waist downwards.

The doctors found tuberculosis in his spine and put him on medication. But he is yet to get better, and it may be too early to hope for anything because he is supposed to take them for twelve months; yes, one whole year of his life, dedicated to swallowing tablets. For three months he has lain in that hospital bed and waited. Initially, the problem was the hospital bill. But his hospital bill was waived and his family didn’t have to pay for anything. Still, no one came to get him. And so he has been lying on that bed day in, day out. Every time he wakes up and opens his eyes, the first thing he sees is the roof over head. His eyes land on the same spot overhead and he can see it clearly even in the eye of his mind with both of his eyes closed.

Each day is the same in the hospital they are served the same watery tea and three pieces of poor quality bread at seven in the morning. Then the nurses pass around from bed to bed making their beds. At his bed, they pause, change his diapers first, then change his beddings. They also remember to turn him then. If he is lucky, he receives a bad bath once in a while and a change of clothes. Then the doctors pass round and when they reach at his bed, greet him. There is really nothing more they can do. He is already on anti- TBs. They remind the nurses to turn him every two hours and they remind him to feed well. Recently, they add anti-depressants to his treatment. He is depressed. It shows in his face, in his refusal to talk and his poor appetite. And they will call the plastic surgeon to come and look at his bed sores. He has developed large ugly bed sores on virtually every pressure point on his body; over the sacrum, the hips, the heels, the elbows, the cranium; everywhere a pressure ulcer can develop. Sad right?

And today, amongst all these cheer and happiness, I can’t just push his emaciated body off my mind. He keeps popping up and I can’t stop imagining what he was before he became para-plegic; he definitely was a man with goals and dreams of his own. Dreams he has been forced to forget about because well, he is in the hospital and he doesn’t know how to get out. Because what he needs is not just money but someone, people; friends and family. Maybe they will give him a reason to fight, to start feeding and maybe to turn him as frequently as he may need to be turned.

Like Mark, so many patients find themselves trapped in almost ‘useless’ bodies. Either as a result of brain injury from one cause or another, or even spinal cord injuries either due to disease or accidents. You can only pray to never find yourself in that situation. Meanwhile, how about we think about how these people’s lives can be made better? As things stand, we will never have enough nurses to turn these patients every two hours, at least not in the next ten years. But maybe we can buy them a ripple mattress. A ripple mattress is actually a device that can be used to prevent bed sores in patients who are bed ridden. The ripple mattress is sold with an external pump that alternates the pressures in the different compartments of the mattress, allowing for pressure to alternate on the skin.

If you are looking to gift anyone this Christmas season, you can gift a public hospital near you with a ripple mattress…..there could be someone there who could use one.

Ripple Mattress

Merry Christmas!!!

Nyumba Ya Wazee (Part One)

Old patients who have suffered debilitating strokes are the hardest to take care of. These ones need round the clock nursing. After suffering a stroke, most old people never recover fully. They are forced to live with the residual effects of the stroke. These people, will, most of them for the rest of their lives, need help in carrying out virtually every activity of daily living. They will need help with getting to bed, turning, feeding, urinating, pooping, showering, dressing, brushing their teeth et cetera. Most of these people will also need at least two weekly visit to a physiotherapist and regular check-ups by a doctor.

Now most of us have terribly failed our ailing parents and grand-parents. Because we are perpetually busy looking for money to buy food, property, pay hospital bills and repay the Chinese people their loans, we rarely are able to be there to provide this kind of care to them. A few of us try. We employ house-helps to stay with them and do all things on our behalf. But the house-helps soon get overwhelmed. And the fact that old people are stubborn doesn’t help make matters any better. So our old relatives end up staying alone. They sleep on one side for enough days till we are able to squeeze a few minutes in our busy routines to turn them. The result is the big ugly bed sores that almost each one of them has. Some skip meals and their drugs, and physiotherapy.

Photo courtesy/ nation.co.ke

The only thing that we try to do is take them to the hospital when their clinic days are due. But no one stays around to turn them two hourly, to change their beddings, to help them wash up or even to administer their drugs. But when their clinic days are due, we show up in our cars, wash them up and bundle them into the back seats. We march to their clinics and demand to see the doctors, make a lot of noise about delays, demand for lots of tests, get the medication and drop them off in their miserable homes.

Some of us even walk to the hospital and demand that our parents be hospitalized in the best possible sections of the wards. Because we can’t take care of them at home. We want nurses and doctors to keep our old in the hospital and do everything in the hospital. Maybe this works, in private hospitals. Public hospitals are however no place to dump our old. Those places are teeming with humanity and disease causing organisms thrive in the hospital air.

That is why we need to have this conversation about homes for the old and sickly. Instead of pretending to be nice African children, we need to embrace anything that would make our lives easier. How about we admit these old people in professional homes where there are people to take care of them around the clock? How about we admit them there and never worry about them missing their drugs, or overdosing, under dosing or worse still, being found dead alone? We could let them go there then try and visit them as often as is possible.

Homes for the old might not be popular in these sides of the world but we can make them friendly. Have qualified people to see to the needs of these old people. Design nice games for them to play. Arrange road trips for them et cetera.

Health Is Now Devolved

Photo source: The Sun Nigeria.

A twenty-year old walks to the County referral hospital with the dignity of a married woman, tummy protruding before her, she is walking with her legs slightly apart, thanks to her protruding belly. She is in the company of three women; her mother in law, her own sister and an elderly neighbor. Every twenty or so minutes, she pauses, puts her hands on her waist and takes long purifying breaths as a strong contraction starts at the fundus of her uterus and radiates down, causing indescribable pain. The long, slow breathing, she has realized helps. She is hopeful that everything will be fine, she is not worried about anything. The most important thing to her is that she is married. This child is not a bastard. He (she hopes it will be a son) has a father and hence a future.

At the entrance to the wards, she is allowed in without delay. The security people don’t keep women with protruding bellies and dancing feet waiting. She is ushered into the maternity ward. The admitting doctor gets her details. She is a first time mother. She doesn’t remember when she got her last period, like ninety percent of all the women admitted into maternity. Currently she has low abdominal pain, that begun about sixteen hours before she presented to the hospital. Her baby is kicking just fine but her water hasn’t broken. The admitting doctor notes that. She asks for the antenatal clinic book. She is handed a purple booklet which, except for the name, is essentially blank. ”Mama ulienda clinic?” She asks. The patient answers in the affirmative. How many times? Once. The reason why no test was ever done is because she was unable to go back a second, third and fourth time. The county health care workers were all on strike over unpaid salaries. She couldn’t afford the private hospitals because she has no insurance cover. And she couldn’t go to the next county hospital either because she had no bus fare.

The doctor performs her examination and realizes she is carrying twins. Her cervix is five centimeters dilated. She hastily draws blood, to check her hemoglobin level and do other basic tests like HIV testing, blood grouping, et cetera. Her HIV sero-status comes out positive, her hemoglobin level a mere seven. The doctor summarizes the patient’s condition; “a first time mother, who is anemic and HIV positive, carrying twins, never been on ARVs.” This is definitely a recipe for post-partum hemorrhage and other chaos.

She decides to look for blood for her just in case she develops post-partum hemorrhage. When she goes to the lab, the fridge is opened so that she can see for herself that there is no blood. Because seeing is believing. So the doctor goes back to the ward just to consider her options; take out her prayer beads and say a continuous prayer for the poor clue-less woman. Pray that she delivers safely. Pray that she doesn’t bleed excessively after delivery, or refer her to the next county hospital. Her cervix is now nine centimeters dilated. The first baby will be born about one hour from now. The next county hospital is one hour thirty minutes away. So referral is clearly out of question. but she still calls the hospital for the sake of it. But the person on the other end is so sorry they also don’t have blood. So the doctor goes back and sits in the maternity ward and waits for a miracle, the miracle of safe delivery, good health to the mother and the babies. Because she can’t have a maternal mortality. Mothers shouldn’t die when bringing a new life to earth. And also mothers shouldn’t die because maternity care is “free” paid for by the government. Our dear government!