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

It Could Be Depression

There was a time when reading used to make everything better for you. From fixing your broken heart, shortening a lengthy day, cooling your nerves just before an important interview and even uplifting your lowly moods. Those days, you could be passing through hell and not even realize it because books offered you a nice escape, to beautiful shores, Rocky Mountains, deserts whose air was laden with too much dust you wanted to cover your eyes with your hands by just reading about them. These days, you hardly enjoy a book. As a matter of fact, you are finding it increasingly hard to pick a book and start reading. Every time you talk yourself into reading one, you barely go through the first ten pages before the over powering urge to stop comes again. There are ten books all book marked at page ten that you have started to read in this past week alone but couldn’t go beyond the tenth page. You don’t get the kick you used to get from reading anymore. You have tried movies but realized every time you start watching one, your thoughts wander. The movie plays on till the end only for you to realize you have no idea what the movie was even about.

You can’t read, you can’t watch a movie, and as if this is not enough, you can’t seem to fall asleep at night. On those nights when you fall asleep, you can’t stay asleep for more than two hours. And on those days (which is every day by the way) you have nothing to keep you company apart from your own thoughts. You realize you would give anything just to run away from this hopelessness that has descended upon your world.
Three quarters of the time you are lying in your bed turning, tossing and even then, you don’t want to get out of that very bed where you lie gazing into space. Every time you push yourself to get up, the farthest you get is to the bathroom. Just to empty your bowels and pee, take a really quick shower on the day when you feel it is absolutely necessary, serve yourself a mountain of food and sit on the bed that you last made two weeks ago, and eat all that food. You have added a few inches to your waist, the clothes hug your body more, three skirts are threatening to burst at the seams. You know you are headed for obesity but that is the least of your worries now.

You know you are supposed to feel better in the morning but all days are the same old and dull to you. You feel as lonely on Friday nights as you feel every Monday morning. Your friends no longer call. They are tired of the lack of enthusiasm on your voice when you finally choose to answer their calls. You have missed friendship re unions with no explanation and they are tired of trying to pull you down from your high horse. Your mother has made peace with the fact that you are going to call home once in a blue moon. She is okay if you are okay. You don’t care about social media any more. You are tired of running into your ex everywhere in these streets of face book. You are tired of trying to tell yourself that he doesn’t deserve you. Probably you are the one who doesn’t deserve him with your body looking like a roto tank with all the eating you have been doing.

You feel so empty; you have a pain that you can’t even describe. You slap yourself. You want to feel physical pain. You wish for someone to come and beat you up. Or even for a matatu to run over you, break a limb, break something in your body, leave you in a coma where you will lie and wake up and scream over a physical pain.

You know whatever is happening to you is not even normal. You are in a place to the extreme left of sadness. If you could walk even a little bit, then walk yourself to the bus station and ask them to drop you at a hospital gate. Because you are depressed and if it is going to get worse, you will commit suicide…

Most of your friends aren’t even going to realize that you are depressed. If anything, they will accuse you of all sorts of things. Maybe we can’t blame them. We live in a society that has taught us that it is okay to be unhappy. That we don’t even deserve too much happiness. That we can’t blame anything in our lives for the feelings that we feel.

Suicide takes considerable courage

They tell you that suicide is selfish, that it is cowardice, and that it is wrong. That suicide is no way to die. What they don’t know is that it takes courage to tie a noose, put your neck in and grit your teeth, shit your pants, clasp and unclasp your hands as you wait for the rope to cut deeper into your flesh. Honestly speaking, it takes courage to swallow a liter of sulphuric acid, let it burn its way down your throat, down through the esophagus and wreck havoc as it settles down your stomach. Tell me what is the cowardice in swallowing triatix? I mean you all know how bad it smells even the ticks can’t stand it. There is absolutely no cowardice in choosing to die via a bullet let loose by your own hands. Suicide is many things but it is not cowardice! David Mitchell says that; cowardice has nothing to do with it- suicide takes considerable courage.

Most people would rather not talk about suicide. It is a taboo amongst most African cultures. (Ever attended a funeral of someone who committed suicide? Then you know what I am saying) in the church setting, it is a murder which is a violation of the commandments. Suicide and attempted suicide is viewed as a curse in most communities. Most people will go Iraq and Iran on victims of attempted suicide. They will rush them to the hospital alright but they often receive an uncalled for tongue-lashing. There is this grown man who had drank a whole bottle of a pesticide and his brothers rushed him to the hospital. While he was retching and clutching his stomach in pain, a brother of his who happened to be a teacher kept glaring at him and reminding him that he is the one who had chosen the pain. Needless to say, he passed away hours later. A mother of four drowned a bottle of triatix. Her husband and good Kenyans rushed her to the hospital only for them to chide her for being so stupid. She died after a two day stay in hospital, because her husband didn’t have money to buy her drugs that could reduce the side effects of the poison!

Living on the edge

Suicide is common. Attempted suicide is commoner. Approximately seven hundred thousand people take their own lives annually. Most of these are young people between the age of thirteen and thirty five. Quite unfortunate that people who have literally a life- time before them are the very ones who do not see the need to live. You ask yourself “why?” why is it that someone will literally fight for their dear lives in intensive care units, why is it that a patient with stage four lung cancer would cling to life so much while a seemingly ‘whole’ person would jump in front of a an over-speeding car. Why would someone be that cruel to themselves? Why would someone not give a hoot about life?

No one is born not wanting to live. Most of the times, life becomes too much. Sadly, in the world of face book, twitter, and Instagram no one realizes another person’s struggles. Everybody is busy and when it happens, everyone runs to social media with questions like” why man why? “Really now?” “Did you have to do it?” everyone is apt to call you selfish after you kill yourself but David Mitchell writes that ‘what’s selfish is to demand another to endure an intolerable existence, just to spare families, friends and enemies a bit of soul-searching.’

People commit suicide for reasons bigger than cowardice, and fear. They commit suicide because;

  1. THEY are DEPRESSED

Over half of all attempted suicides are as a result of depression.

Depression is sadness multiplied infinite times. It is darkness, pain, hopelessness, and anhedonia all inhabiting the same person.

  1. DRUGS

Case on spot here is the seemingly “ harmless” alcohol

Most depressed people tend to lose themselves in alcohol in an attempt to escape their persistent pathological melancholy.

It works for some time, helps them forget themselves for some time, puts a song in their lips and gets them newer friends. But with time, it ceases to comfort them.

Alcohol leads to loss of whatever little self control was left and that is how a person is found hanging from his roof reeking alcohol.

  1. DISAPPOINTMENT and LOSS

Divorce, death, break-ups, this world is so full of disappointments and when people can’t deal with them, they remove themselves from them permanently

  1. PERSONALITY ABNORMALITIES

Then there are those who are kind of impulsive. They will fallout with girl-friends, threaten to kill themselves and they do. This is common among teenagers

Sometimes, a person will commit suicide out of the blues. They will be alright, and then the next minute they will be found dangling from a tree, lifeless. Most suicidal individuals however will behave in a certain way for sometime before they kill themselves.

Here is how to tell if someone is suicidal;

  1. They focus on the gone past- they dwell on past losses and defeats.
  2. They anticipate no future- some might say the world will be a better place without
  3. They are distracted and lack humor
  4. They are pre-occupied with death
  5. Some are dominated by hopelessness and helplessness
  6. Some will let you know that they are intending to kill themselves- take it seriously

A person preparing to die will visit family and friends to say good bye, some will write a suicide note therefore checking their rooms would be prudent. Some will write a will and others will purchase a means to their end, a rope, a gun……

If you suspect that a person close to you might commit suicide, here is what to do;

  1. Ensure he/she is not left alone. A determined person commits suicide when there is no one to stop them. Don’t let them sleep alone. Don’t let them take a walk alone.
  2. Remove anything that they may use. These are many and varied. Some use knives to open a vein, stab self, guns, pesticides and herbicides, ropes, guns
  3. Commit such a person to a safe secure and supervised facility-hospital
  4. Treat underlying psychiatric illness- depression, alcohol dependence, schizophrenia….

Here is a list of patients who should not be ignored;

  1. A person who has attempted suicide before. Some people try suicide as a way of seeking for attention. Their initial intention is never to die. Others try a first time and fail, learn from their mistake, try harder a second time and succeed. Anyone who has attempted suicide should be reviewed by a psychiatrist for this reason
  2. Patients who engage in activities that indicate they are leaving life ( writing a will, visiting friends and making funeral plans)
  3. Patients with a family history of suicide. They tend to commit suicide at around the same age their relatives committed suicide or during their death anniversaries
  4. Patients recently discharged from psychiatric hospitals. The time after discharge is usually very tough as they try to get back into the normal life
  5. Depressed patients who often see death as the only way out of their pathological sadness
  6. Patients with command hallucinations- these will often respond to the voices in their minds telling them to kill themselves

A suicide can only be prevented. It can never be treated and no matter how much we talk about the way it should never have happened, once it is done it cannot be un-done.

Depressed or just sad?

Romantic heartbreaks, death of loved ones, illnesses, accidents and many more unfortunate events are inevitable as long as one lives, and so is sadness. Sadness is the normal reaction to these constant pains of life.

A sad person will have disturbed sleep, lack of appetite, and ruminations on sad thoughts and feelings, but a depressed person will also experience these symptoms. So what really is the difference between sadness and depression?
Unlike sadness, depression tends to last longer. And in addition to these symptoms, depressed person experience the inability to experience pleasure (anhedonia), hopelessness, and the inability to feel a mood uplift in response to something positive( loss of mood reactivity), which doesn’t happen in normal sadness.

Are you depressed or just sad?

So how do you know if you are depressed? Here are some of the symptoms of depression;

1. Depressed mood most of the day
For Children and adolescents, look out for an irritable mood
2. Diminished interest or pleasure in all or most activities ( previously enjoyable activities become boring)
3. Over eating or under eating or weight loss or gain when not dieting

4. Lack of sleep or excessive sleeping
5. Restlessness or being slowed down observable by others
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive inappropriate guilt
(Reduced selfesteem.)
8. Reduced ability to think or concentrate, or indecisiveness
9. Recurrent thoughts of death, recurrent suicidal ideation, a suicide attempt or a specific plan for committing suicide.

Other persons will not experience the classical symptoms of depression. They will instead experience multiple pains and body discomfort. These are people who move from doctor to doctor and have been treated for all manner of illnesses, but with no improvement.
Here are some of the symptoms they present with,
– frequent headaches
-pressure/fullness in head, – GI fullness/gas, noise, nausea
-palpitations
-amenorrhea,
– low libido
-low back pain
Who gets depressed?
No person is immune to depression. Anyone can be depressed, but some people are more predisposed than others.
Here are those who are likelier to be depressed:
– Women more than men
Some careers- doctors, nurses, military personnel
-the unemployed
The youth, the old
Depressed so?
Depression is a disease like any other. It is treatable.
The first step towards healing is to accept that you are indeed depressed, and that you need help.
So once you suspect that you are depressed, see your psychiatrist asap.
A psychiatrist will know how to help. If you don’t have a psychiatrist, see any doctor who will then link you up with a psychiatrist.
Be a different African. Refuse to accept sadness as a part of life. Its not normal
GET TREATMENT FOR DEPRESSION

At the far end

At the far end of the hospital,

Is a structure or a building if you may like. It stands solo, away from other buildings. Its walls are high, higher than those of Babylon. They are made of concrete. Where the concrete ends are pieces of broken bottle sticking out like the spines of a porcupine. The doors to its insides are always kept closed. We knock at the door, a face peeps through the open window. There is a shuffle, then a hand and a bunch of keys sticks out through the same window. I take the keys and try opening the padlock. It opens at the tenth trial. There are a bunch of boys and girls behind us; they too are in white coats. I leave the door open. They will close it.

Inside…

Men and women in white and blue stripped uniforms that make them look like prisoners are up and about. There is a gate separating the women section from the male section, a uniformed tall, lean and tough looking man stands by the gate. He lets us in to the women section.

The sun’s rays are already falling into the compound albeit weakly. A nicely dressed young woman in her late twenties or early thirties sees us and runs to hug Ahmed. He is a staunch Muslim, he prays five times a day and never gets into close proximity to women let alone shaking hands. He recently transferred to our school and hadn’t rotated in the psychiatry ward. The lady, she is beautiful by all means, her chocolate face is spotlessly smooth. Her long black hair is tied neatly in a push back. She is wearing a yellow dress that ends just below the fold of her buttocks. The dress, it’s tightly clung to her body, outlining her disproportionately large hips. She must be a wife of someone this one. She maybe mad but she is too beautiful.

The others stare at us, or them, Ahmed and his new found friend. She already thinks he is in love with her. “My husband is not with me anymore”, she says. “He left me because I have madness” she quickly adds. “But you won’t leave me right? “She implores. Ahmed is dumbstruck. He only moves when the lady moves and is looking at me with pleading eyes. “What is your name? “ I ask her. She looks at me from head to toe then looks over me and turns to Ahmed. “You don’t want to tell me she is your girlfriend?’ She lifts her left eyebrow and sneers. “She has no supporting documents, “she says. “ I mean, look at her, she is all bone no meat, no fat” before I know it. Her hand is over in my chest, palpating and declaring that I should be a tenant, that I have two flats in my chest. She wants to show Ahmed what she is got, she lets go his hand and pulls over her dress.

Roars of laughter fill the scene as the other mad women laugh at her. From the other side, the male side, necks crane over as eyes open wider to feed in the new free x-rated video. An elderly mad fellow orders her to dress, then another talkative woman dresses her by force as a nurse walks in. this is when I realize that Ahmed has left. I look around and my eyes meet his. He is standing on the other side of the gate, the male side.

 

In the male side, those who had stood to watch the naked woman have gone back to sit. They are chatting excitedly, laughing doing high fives. Most are married men whose wives have left. It must have been long since they had sex.

There is a bathroom at the end of their dormitory and water is running. Two uniformed nursing students are standing outside the bathroom, watching as an old man, old enough to be their father takes a bath. He is slow and reluctant, the one with a cane keeps threatening him, and the other one only coaxes him. He is bathing yes, but he might finish tomorrow. “Why don’t you want to shower”, it’s Ahmed. He looks at him briefly. He wants to ignore him but he decides to answer, because, there are men teasing me. “How?” I ask. He regards me briefly and continues staring at the running tap and the yellow basin before him. One of the students tells me he doesn’t talk to anything with hips and breasts. “How?” Ahmed asks. “They keep talking, saying what I do, when I scrub my back, they say, “Now he is scrubbing his back, now he is washing between the buttocks, now he is holding the balls, and the shaft.” They are not good this men.

There are three unknowns, all are male. Two years ago, when I first came to this ward, there was only one unknown. He is still there. He still sits at his favorite corner, and he hasn’t stopped chewing at his clothes. He hasn’t grown either; he is still the height of a walking stick. His face is still hairless, and he hasn’t learned how to sit with his legs together (he is a man anyway). He is wearing a purple robe (it’s more of a dress). He never talks this man; commonly known as brownie (he is brown). He wakes up each morning, pees and poops, showers, takes breakfast then sits at one spot. He listens to other mad people talk. He smiles at their stories, but he has never opened his mouth. I walk towards him and he puts a hand over his face. He remains like that, and then he removes it at and looks at me. I am still looking at him, so he closes his eyes. His thoughts are those of a two year old, if I can’t see you, you are not there. I love the way he thinks like a baby. I wonder how he found himself here. He was probably abandoned in one of the casualty benches like many others. Maybe he was found by the roadside and brought here by good Samaritans. He never talks, so no one knows his name, or his mother. He will remain here forever. He will grow old and die here. Even his body will never be claimed, so he will be donated to a medical school. In his death he will be useful, he will make a difference, he will make his contribution to the nation, and he will be used as a cadaver in the study of human anatomy.

There is a man who has been talking about his meeting with the ministers and how he will fire most of them, he has delusions of grandiosity. He is the president apparently, and his governance sounds Hitler-like. His trouser has no elastic and he walks while pulling at. He is euphoric, he is mad yes, but he is happier than a king.

In the single rooms, a man keeps shouting and hitting the door mercilessly; the other madmen are looking and laughing, driving his anger to evaporation point. Mad people laugh at madness too. Ha ha ha.

The psychiatrist has arrived with his suitcase; the anesthetists are done fixing branulas. Ten patients are lined for electroconvulsive therapy. We walk to the room and witness as the first patient gets a seizure, induced seizures are like dugs, they heal depression and delusions and other psychoses.

My mind goes back to Kabibi. I know her from when I was little. When I used to poop behind our house. She hasn’t changed. That woman hasn’t even grown old. Her breasts are still full. They still slap each other when she runs. She always runs to the river, and she likes balancing her five liter jerry can on her head. Little boys like teasing her, they tell her that she smells (true), and that she doesn’t shower (true). If the maize hasn’t flowered, she will not talk to the boys. She will just fetch her water and go home. She has had babies and babies. If you ask her who fathered her most recent child, she will tell you it’s your father (this is not funny). If you ask her where her child is, she will tell you her grandmother ate it (she sells them).

When the maize brings forth flowers, Kabibi stops going to the river. She stops answering questions. She goes to Birongo market and picks bananas and avocados and anything she wishes. If you deny her anything, she bites you, or says that she is your co-wife, because it’s your husband that fathered her last child. Whenever she sees a man, she gathers large stones and they run away.

The last day I saw her was two years ago. I was going to the market, she was walking before me. She was stark naked except for the boots she was wearing. She seemed to be conversing with herself as she kept throwing up her hands in the air like the mad woman she was. She kept walking then suddenly bent to pick something. The cleft between her buttocks became apparent and then she suddenly decided to push. I didn’t wait to see what would come out, I turned and left, I would go to the market after the maize had been harvested I decided.

I wonder where she went to, whether she still lives. I wonder why they build psychiatry wards at the far end of the hospitals.