Rabies

Raise your hand if you have ever been bitten by a dog.
Raise your other hand if this dog that bit you has never been vaccinated against rabies.

Move to the left if the dog that bit you was a strange dog…..

A small boy, about six or seven lay in the hospital isolation room, with saliva drooling down the side of his mouth. Occasionally, he suffered a strong seizure that made his whole body tense and shake at the same time, before slipping into episodes of apparent calm. His mother sat by his side, with hands supporting her cheeks. Occasionally, she would stand and pace the room, raise her hands and place them over her head before finally walking back and taking her place beside her son. He later slipped into a coma, and as we all know, this story doesn’t end well. When he had shown up in their house one evening three months earlier with bite marks and scratch marks thanks to a neighborhood dog, they decided the bite was too small and just ignored it. Three months later, he presented with full blown rabies. (This is a true story).

September 28th is rabies awareness day. Incidentally, yesterday I saw a woman who had been bitten by a dog two days before she presented to the hospital. She was admitted for reasons other than the dog bite. But I had to bring up that “small matter” of a dog bite. She didn’t have money to buy the anti-rabies, she promised to look for the money. Meanwhile, we will just sit back and pray that she gets the money….before it is too late because rabies is real.

Rabies is a viral disease that affects the central nervous system (brain), usually transmitted through a bite by a rabid animal.
Rabies is transmitted through a bite by a rabid animal, usually a dog. In my village, they are called t-nine, or mbwa wa kichaa. Other animals that can transmit rabies include monkeys, skunks, cats, wolves et cetera.
In the unfortunate event that an unvaccinated or a strange dog bites you, please make sure that you seek medical help. Go to the hospital and have the wound cleaned, get an anti- tetanus shot and get a dose of the anti- rabies vaccine. Now ideally, you should get five shots of the vaccine. The day you are bitten is the first time you get the vaccine. That is day zero. Then you should get a repeat shot on day three, day seven, day fourteen and day twenty-eight.

Of course most people rarely get the anti-rabies. The few who get it get a single dose on day zero and never return for the remaining doses. The issue is money constraints. The anti- rabies vaccine costs an average of one thousand five hundred shillings. Public hospitals almost always never stock it and most medical insurances don’t cater for it. So most people who present to the hospital end up skipping it altogether. The question is, if a dog bit you today, would you afford the anti- rabies vaccine right this moment? Maybe we should remind the forty seven county governments that they need to stock anti- rabies …

As a young girl growing up in the village, once in a while, we used to have mass vaccinations. A community vaccination of all domestic animals. I haven’t heard about them for a long time now. People are too broke vaccinating their domestic animals is the last thing on their mind.
Maybe the reason why we are a third world country is because we are still killed by diseases like rabies. Of all diseases that should kill us, rabies shouldn’t be one of them. But it is.

NB; on day zero, rabies immune globulin is administered together with the anti- rabies vaccine.

NIGHT SHIFT

3:00 hours.
The extension phone in theatre rings once. The theatre nurse stirs, but continues resting her head on the table. Her breaths are coming out in shallow regular spurts. She looks peaceful, comfortable even. The extension phone rings again. This time, the ringing is continuous. The harsh krr, krr, krr of the phone jolts her awake. She lifts her head. She is disoriented for a minute or two. she looks around, yawns, stretches her arms then stifles another yawn as she picks the receiver and places it next to her right ear.

“Theatre”, she croaks into the phone, then listens. “Okay”, she says and replaces the receiver. She has an operation to prepare for. She walks into the operation room and taps the other nurse. He is seated on a theatre stool, head resting against a wall. She taps him on the shoulder. He wakes up immediately. They start preparing the operation room for surgery. Then the extension phone on the nursing station starts ringing again. He goes to receive the call. He comes back just as the surgeon walks in. the anesthetist also walks into the changing room soon after the surgeon.

The second phone call is from maternity ward. They have two emergencies; two cases of fetal distress. The theatre nurse informs the surgeon about the maternity cases and the surgeon knows that his patient will have to wait and probably lose one testicle in the process. He has reviewed this particular patient. An eighteen-year old male with scrotal swelling and severe scrotal pain, admitted about an hour ago, a condition called testicular torsion. It is a surgical emergency. The earlier the operation is done, the higher the chances of saving the testicle.
At the entrance to theatre, the patient from maternity and the young male patient arrive at the same time, both wheeled in by nurses. they are both wailing in pain. One from labor, the other from a rotated testicle. Both of them have emergency conditions. But because there is only one theatre bed, only one of them can be saved first; the pregnant lady. She is carrying a life. So she gets in as the young man is wheeled back to the ward. He will be taken to surgery alright, but then he will lose his testicle. Because the longer the time taken to operate on a testicular torsion, the higher the chances of losing that testes.

Because of severe shortage of theatre staff and equipment, doctors every day have to make tough decisions. Every time you get three pregnant women in need of emergency cesarean sections, you have to decide who to take in first amongst the three. You are therefore indirectly deciding whose child to save now and whose to save later, something that doesn’t always work well. When you have done your best assessment, you might as well save all of them. But sometimes, “shit happens”. If you have a mother in labor who requires a c- section and a young man with a rotated testicle that needs to be fixed urgently, you will of course decide to save the mother and the baby and lose the testicle! Doctors are always playing god, not only on which patient who gets admitted into an intensive care unit, but also on who to be saved and who to deal with consequences.

You Must Not Lie To Your Doctor

When I caught my patient sipping some mysterious-looking fluid from a plastic bottle just three minutes before being wheeled to theatre, I remained motionless for a second or two. Then I casually walked towards him. He had to hide whatever it was that he was trying to drink. As I stood by his bed waiting for the nurses to wheel him to theatre, I couldn’t stop myself from asking him, “George, ulikula mara ya mwisho saa ngapi?“ “Jana usiku, kitu saa sita hivi”, came his reply. I chuckled. He looked up at me with the most innocent eyes I have ever seen. I was about to ask him another question but then the nurses had already arrived by his bedside, ready to wheel him to theatre.

Once on the operation table, the anesthetist asked him the same question, “boss, ulikula mara ya mwisho saa ngapi?” and he gave the same answer. But because anesthetists are anesthetists, he asked another question, “hata maji haujakunywa? “and he said no. I had to walk out of the operation room and wipe the grin off my face before the anesthetists could see it and demand for some explanation. You see, I knew George was lying, but I chose to say nothing. I had done the exact same thing George was doing now some six years ago. I had been scheduled to go to theatre at seven in the morning. The doctor’s instructions were; to take nothing by mouth beyond midnight, when I became a doctor, I learnt a fancy term for “do not eat anything” it is called being nil per oral! So I didn’t take anything. Then in the morning as I was being prepared for the operation, my parents asked for five minutes so they could pray with me (back then, going for surgery was euphemism for dying/going to die/about to die). They were granted the five minutes. And they prayed for me. Then they made me take a sip of some herbs from a bottle. And I sipped and I was taken to theatre and when asked the last time I had eaten, I said midnight. I didn’t even die.

Patients set to undergo surgery are routinely starved for about four to six hours, as a precautionary measure to prevent aspiration of stomach contents into the lungs. This could happen during general anesthesia. Doctors rarely explain the reasons for starving patients before surgery or the real dangers of eating just before surgery. That is why patients are always outsmarting doctors, like the way George and I did! We were just lucky though. The next time your doctor tells you not to feed before surgery, please don’t. Or if you happened to succumb to a little bit of temptation and had to take a slice of ugali and nyama choma, just let your doctor, or at least the anesthetist to know! If you want an uneventful surgery, you can’t afford to keep such things away from the theatre team!

Doctors Should Stick With Their Bad Handwriting

When Gabriel walks into the gynecology clinic, I am expecting that his wife will follow him into the consultation room. But he closes the door behind him and takes a seat . And no, he doesn’t have any problem really, just a small question though; “daktari, they say that my wife has an incompetent cervix“, he begins tentatively. So I look up at him and wait for him to ask his question. He regards me for a moment then goes on, “tell me daktari, how can a cervix be incompetent?’ I look at him closely for the first time, he looks like one of those men who go to beauty parlors for a facial. He has the smoothest face south of Sahara, and for a minute, I almost pass a hand over my own face. “cervical incompetence’, I begin, “means that during pregnancy, the cervix dilates and becomes thin before the pregnancy reaches term. The effect of this is pregnancy loss or a miscarriage”. He exhales visibly and I almost chuckle. I mean what did he think after seeing the diagnosis? I want to explain further but he is ready to take his leave. He extends his hand and I shake him while he mutters his thank yous then quickly leaves closing the door behind him. I try to imagine what he saw written on his wife’s consultation card. The correct term is “cervical incompetence” how did it become incompetent cervix? As the next patient walks in, I decide doctors should just stick with bad hand writing. Writing in a legible hand writing that patients and their relatives can easily read might give someone a heart attack soon. Imagine that man seeing incompetent cervix as his wife’s diagnosis? What was the first thing that came to his mind? Now imagine if that man decided to be unreasonable, arrived at his own conclusions and confronted his wife about it? Maybe he might have included it in his list of abuses; good for nothing woman, lazy, incompetent cervix, idiot.

NB; always ask your doctor to explain everything, you can’t form an opinion based on what you see. Sometimes, a list of words written side by side don’t mean what you think. Adios

APRIL; AUTISM MONTH #LIGHTITUPBLUE#

I bet we all remember Susan Boyle; a Scottish singer who first came to international attention in 2009 after appearing as a contestant on Britain’s Got Talent. She stood before an audience in “Clyde Auditorium” and said that she was trying to become a professional singer (at forty) and that she hoped to be as successful as Elaine Paige (The audience smirked at her on hearing this). She performed the song “I dreamt a dream” so beautifully and so powerfully, everyone including the judges was surprised. They hadn’t expected much from her. She finished second in the contest, losing to the dance troop ‘Diversity’. Every time I am in need of inspiration, I go to you tube and watch her performing “I dreamt a dream”, while ignoring all the people in the congregation who were waiting for her to falter so they can burst out laughing. Susan Boyle was diagnosed with Asperger’s syndrome (now autism spectrum disorder) in 2012. She made her diagnosis public in 2013. Now, autism is a developmental disorder that is characterized by; difficulty in social interaction, challenges in communication and restricted repetitive behavior. World Autism Awareness Day is marked every second day of April as a way to raise the awareness of autism. April is autism awareness month. Autistic children and adults live in our world, amongst us; hence, we cannot afford to be ignorant about autism!

Parents and guardians will first notice symptoms in their children during the second and third years of life. Symptoms vary depending on the age of the patient and severity of the disease. Here are the “defining” symptoms of autism:
speech
1. Delay or lack of development of spoken language. This is often the reason why parents will seek for help.
2. Those who are able to speak are unable to start or sustain a conversation with others
Many children exhibit echolalia i.e repeat phrases and words they hear.
Impaired social interaction-

1. They lack emotional reciprocity
2. John Elder Robinson, said; ‘and I know it is perfectly natural for me not to look at someone when I talk. Those of us with Asperger’s are not comfortable doing it. In fact, I don’t know why it is considered normal to stare at someone’s eyeballs”
Autistics lack non-verbal cues; they are unable to maintain eye contact, unable to understand and use gestures, lack facial expressions and other forms of non-verbal communication.
3. They are unable to adjust behavior to suit social contexts. Hence they are unable to develop, maintain and understand relationships!

Restricted, repetitive patterns of behavior, interests, or activities,
1. They insist on sameness and adhere to routine in an inflexible way.
They may have to sit in a particular chair, dress in a particular way, or eat particular foods every single day.
They become quite distressed if a routine is disrupted.

2.Insensitive to pain or temperature, light or noise.
They are prone to injury since they can withstand extreme pain and temperature.

3.Stereotyped or repetitive motor movements, use of objects, or speech –

simple motor stereotypes, lining up of toys, flipping of objects, echolalia, idiosyncratic phrases
4 they have highly restricted and fixated interests.
They become fascinated with parts of an object for example the wheels of a car.
5.though some will have intellectual disability, others have normal intelligence. Some have very specific talents or abilities especially in music and mathematics. Susan Boyle?

Parents whose children have been diagnosed with autism live in constant fear. They worry their children will hurt themselves, they worry they will grow too fast and the world will hurt them, they worry they will have to face the world someday alone, and the world will not know how to handle them! These are all genuine worries. The good news is that there are others who have done it! I know that most of us have heard about Susan Boyle, but maybe we haven’t heard of other autists like John Elder Robinson, who grew up knowing he was different and was only diagnosed with autism(Asperger’s) at the age of forty by his therapist friend. He taught himself about electric circuits and sound waves and used the self- taught knowledge to design guitars and toys. Then there is Temple Grandin a professor of animal science, consultant to the livestock industry on animal behavior and autism spokesperson and there is Kerry Magro who was diagnosed with autism at four but went on to beat all the odds and became a professional speaker and a best-selling author. These are just but a few of autists who have gone on to become great despite having autism. And who tells you that your child cannot become as great if not greater?

There was a time Temple Grandin wouldn’t talk! “I can remember the frustration of not being able to talk. I knew what I wanted to say, but I could not get the words out, so I would just scream.

FEAR KILLS

I have been seated across from this woman for four or five minutes now. I have been wording and re-wording the sentences I will say to her in my mind. It is an incredibly cold morning. Been raining all cats and dogs, and still, the skies are heavily laden with dark clouds. It is windless outside, but the relative calm is punctuated with the sound of thunderstorm from time to time. I can’t stop thinking that ‘I am cooking a storm’ for the young lady seated before me. She looks older than her thirty eight years. Must be the doings of cancer. Her once beautiful face is now just bones covered in a thin sheet of muscle and skin, with minimal fat.

She looks at me for the first time our eyes meet. I have been hoping that she will somehow read my mind, pre-empt my thoughts and save me from having to open my mouth and utter the very words. But there are no signs this will happen. So I clear my throat and look in the general direction of her face. She avoids my eyes and looks right past me to a point on the wall behind me. “It is stage four (b)”, I say. She sighs and focuses her eyes on mine. She frowns and I count five lines on her forehead. “surgery?”, she asks. “No”, I reply. Before I explain further, she stands up, unties her wrapper and re-ties it. She walks to the door then walks back to her sit and lowers her little self onto it. Today is one of her good days; she can actually walk without feeling dizzy, thanks to the multiple transfusions she has had.

There is a knock on the door as I lean foward to tell her more. Whoever is on the door shouldn’t have cared to knock in the first place. she lets herself in even before I let her in. Turns out it is the counsellor from the palliative clinic. I had been waiting for her. I am over- joyed. I quickly forget her bad manners and offer her my chair. I had briefed her about this lady. She will definitely do a better job than I have been trying to do. I leave her to it and quickly close the door behind me without as much as glancing behind me.

I let out air from my lungs once I step out. Didn’t know I had been holding my breath all this while. As I walk away, I can’t stop thinking about this lady. She will be lucky if she lives to forty. Cervical cancer stage four (b). It means it is no longer a local disease. The cancer cells have spread to the liver, and the spleen. The only option we have is to palliate her (add quality to her remaining days, not quantity). Send her for radiotherapy to reduce the local disease, take care of her pain and do serial blood transfusions. Sad, right? It is actually sadder when you think about her children who will remain mother-less thanks to a highly preventable and treatable disease like cervical cancer.

It is sad because women will experience symptoms up to one year, others two years before finally walking to a hospital. And why is that? You ask, it is because of fear. While some fear discussing ‘embarassing’ topics like vaginas, breasts, and sex, others fear being tested and diagnosed with illnesses like cancer, HIV and AIDS, and other sexually transmitted diseases. We all know a person or two who would rather die than be diagnosed with cancer. These are people who will never show up for voluntary screening and testing. For some weird reasons, they believe knowing they have a certain terminal illness will kill them faster. What they forget is that, the earlier some of these conditions are caught, the better for them.

Take cervical cancer for example, stage one is a totally treatable condition. Stage four is un treatable. The difference between stage one and four is just time. A person will be stuck in stage one cancer for a while before the disease becomes stage two, then three, then eventually four. While a few are lucky to be diagnosed with stage one disease, majority will show up three years too late when there is virtually nothing that can be done. Those who show up late will tell you that they feared coming early. And fear will be the cause of their death.

Men are worse off than women. First off, they are poor healthcare seekers. That coupled with the fear of the unknown will make them shy away from hospitals. That is why most of them will hide at home with their big prostates and only show up in hospital accident and emergency department in the wee hours of the morning when they can’t ignore the burning pain in their bellies thanks to retained urine.

I believe it is time we all took our health a little more seriously. Let us make use of all available screening tools. Let us have annual health check-ups. Let us make those decisions to lose a breast than a life early enough. Let us give up those problematic prostates. Because when we are dead, we won’t even need the breasts that we so refuse to part with in life. Or the prostates for that matter.

Motion Sickness

There are people who will get in a matatu, with groundnuts on one hand, fries on their laps and a container of milk on the other. For them, the process of travelling is as simple as eating their fries slowly, washing them down with a sip of milk and occasionally confusing their digestive juices with a ground nut or two. Others will get in a matatu and sleep as soon as they are in motion. They will sleep through bumps and rough patches in the road. Then there are those who will get in a matatu and head for a seat by the window roll down the window, rummage through their luggage for a black polythene bag and keep it close. Once the vehicle is in motion, their stomachs churn and they retch and retch. Most will throw up the bitter acid from their stomach and food from a day ago. The other passengers will of course look at them and wonder why people eat too much just before they travel. Bad conductors will bark nasty stuff like having to clean the matatu and self-control and stuff like that.

Well, what most people don’t know is that, throwing up when travelling is a disease! Motion sickness is a disease just like malaria. And no, you can’t fight the urge to vomit.

So what is motion sickness?

Also called car sickness or sea-sickness, is the feeling you get when the motion you sense with your inner ear is different from the motion you visualize

Symptoms of motion sickness begin as soon as a car is in motion. These include;

  1. Uneasiness
  2. Cold sweat
  3. Dizziness
  4. Hyper salivation
  5. Headache
  6. Fatigue
  7. Nausea
  8. Vomiting

There are people who will get in a matatu and travel for fun. There are those of us who try as much as possible to avoid travelling. For those of us who suffer from motion sickness, travelling is an awful experience that will be punctuated by retching, vomiting and awful glances from fellow passengers.

Motion sickness is an awful experience that for some reason is commoner in women and young children. Those prone to this condition will avoid travelling as much as is possible. But they will more often than find themselves in a matatu, clutching a black polythene bag travelling to school, to their places of job or to the country-side.

The good news is, motion sickness can be prevented. Here is how;

  1. Avoid fatty meals 24 hours before traveling
  2. During Car travel- sit in the front seat if possible- this helps to visualize the motion that you will perceive
  3. Avoid smoking- cigarettes are not only bad to your lungs apparently! (Of course you know this).

You can also take some anti-emetic (drugs that prevent vomiting) before travelling. Here are some that can be used;

  1. promethazine- these tiny tablets work wonders.

They will prevent nausea and vomiting but they will make you very sleepy, you will miss the scenery and if you are too unlucky, You might get robbed ( God forbid)

  1. Cyclizine- can be bought over the counter. Take 30 minutes before travelling.
  2. Scopolamine- this is administered as an injection.
  3. scopolamine- may also be used.

So next time you are seated to a bored young lady who won’t accept your roasted maize in a matatu, don’t be quick to call her proud. She might be suffering from motion sickness.

If you are among the lucky majority, here is how you can make life a little better for the unlucky minority;

  1. Let them have the window seat- you can always look at the scenery on the return journey.
  2. If you must eat, please avoid njugu karanga, roasted maize and fries. The smell from this food stuff worsens the nausea!
  3. Avoid strong perfumes and body sprays!
  4. Don’t remove your shoes in the matatu ( PLEASE)
  5. Don’t drink and travel ( ha-ha).
  6. Fill your petrol tanks before passengers board( DRIVERS and CONDUCTORS)
  7. Travel clean- with brushed teeth!
  8. You have a right to be disgusted but remember everybody hates vomiting. Be kind!