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

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.

Living With Lupus

Lupus or SLE is short for systemic lupus erythematosus, a chronic autoimmune disease in which, your immune system fights your healthy body cells! The result is, literally every part of your body, from your skin, your kidneys, heart, lungs, etc are affected. Seal, the Grammy Award winning singer and song writer suffered from discoid lupus, a type that affects the skin, which left his face scarred. Nick Cannon, the AGT host experienced kidney failure due to complications from lupus. There is an estimated five million people in the world with some form of lupus. Despite this, not many governments have dedicated any meaningful relations towards funding lupus. The month of May is dedicated towards raising awareness about lupus.

Once a person is diagnosed with lupus, there is never being free of it. Your life is characterized by periods of flares and remissions during which the symptoms wax and wane. During a flare, your life takes a back seat as the auto antibodies wreck a havoc in your body. Remissions is the time when you take your drugs and suffer the side effects of those drugs, live your life and wait for a flare because it is always coming!
Aside from the physical manifestations of the disease, lupus, like all other chronic illnesses will affect your life financially, socially, and emotionally.
Lupus is an expensive affair! Apart from having to buy drugs that cost an arm and a leg and doing a zillion tests, you also have to pay doctor’s consultation fees on a monthly or two monthly basis. Then there is the cost of moving from home to hospital and numerous other miscellaneous expenditures that don’t apply to persons who are well enough. It is important for me to mention that as much as we encourage all persons to take a medical cover, most people with lupus have to pay for drugs out of pocket because most regular pharmacies and hospitals do not stock these drugs.

Most people are diagnosed with lupus at the prime of their lives; late teenage to twenties, while they are busy trying to be alive and wrapping their minds around the fact that they will be sick for life, their colleagues are making a nark for themselves in the career world! The result is, they give up on their dreams, become under- employed or unemployed. For those who are diagnosed later in life when they are gainfully employed, they may not be able to stay employed because of being constantly absent. Though there are laws that protect employees, some employers will retrench, or sack you at the slightest provocation!
Chronic illnesses always have their effect on marriages and family life. Those that come early in life have a way of separating the sick from their soul mates and lupus is no difference. Love may be strong but not stronger than the constant fear of losing a loved one. One of the consequences of lupus is habitual pregnancy loss and this in itself worsens the already bad situation.

People with lupus may have less friends because they are almost always missing in action. Today they are okay but tomorrow morning they are too tired they can’t move a finger to scratch their scalp! And so they have to cancel a dinner on the eleventh hour and some friends can’t understand that! They miss a baby shower because they convulsed at night and they don’t want to ruin it by convulsing right in the middle of the photo shoot, and also baby showers remind them of their own babies who came out as clotted blood.

Being constantly sick, relying on meds for life, the strain to get enough money for your illness, having very few people who understand your sickness and the lupus itself have an adverse effect on mood. It is therefore uncommon for people with lupus to suffer from mood disorders such as depression! Caregivers and primary doctors should therefore be able to screen for any signs of depression and refer these patients to psychiatrists on time.

It is now possible for people with chronic illnesses like HIV and TB to get drugs at no cost. People with lupus should also be able to get their drugs and tests for free or at a subsided cost. This will go a long way into improving their survival rates and quality of life, because with the proper treatment they can be productive people who will contribute immensely to the growth of this nation. If you see Nick Cannon hosting AGT, you wouldn’t think that he has lupus; a chronic illness that can be debilitating at times.

SEX; FOR PLEASURE OR REPRODUCTION?

A man will pour millions of sperms into a woman’s birth canal, turn on his left side, sleep for hours, wake up, pour another round of five hundred million or so sperms, and sleep like a baby. He will wake up a third time, pour another millions of sperms, then fall asleep and wake up three hours later to leave. And when this time comes, he will leave with hands in his pockets, chest puffed out and a stupid grin on his face. Another one will be whistling contentedly with hands in his pockets while his feet kick every pebble on the way (his way of telling the world he just had unprotected sex).

The woman will toss and turn, then wake up and rush to the chemist for the emergency pill, or she will wake up to count the number of used condoms on the bed side table and try to recall how many rounds you both went, or she will wake up, retrieve her oral contraceptives and confirm that she didn’t by any chance miss her pill yesterday. While she checks her calendar to reassure herself that it is not yet three months since she last had her shot of depo, he will be “hi fiving” and receiving pats on his back for being able to bed that “girl”. While the man goes on with his life without a care in the world, she will be waiting for her period anxiously. That is the only way she can know she is not pregnant for sure.

The same man will tend to react in three ways if by some ill luck that girl gets pregnant; one, he will deny that stomach, “everyone knows you are a hoe or ho, just go find the father of your child.” Two, he will accuse the girl of trapping her “you did this on purpose, kwani you were not on the pill?” Three, he will try to get the girl to abort, give them that little speech of I am not ready and neither are you, raise ten thousand shillings and lead them to some nasty back street clinic, have your baby yanked out of her womb and then avoid them forever. A few however accept and I have to give them that though it leads to unplanned parenthood but hey, the world is too full of dead beats we will take any who is ready to man up and admit that it was one out of the billions of sperms that fertilized that ova.

If there is a chance for men to decide when to have children and when not, by all means they should. If they won’t ‘wear’ the condom, then they can have that pill. Or better still, go for the safest of them all, vasectomy.

Vasectomy is a family planning method that is not for small boys. It is for men who have had their desired family size. During vasectomy, the vas deferens on both side are ligated and tied (done under anesthesia of course!!). This prevents sperms from entering the seminal stream.

Pregnancy is still possible shortly after vasectomy and therefore couples are advised to continue with another complementary family planning method until a semen analysis is done in which zero sperms are found on semen.

A man undergoing vasectomy

It is important to remember that vasectomy will not protect you from sexually transmitted diseases. It doesn’t affect your sex drive also! And the first human vasectomy was done in 1924!

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.

Without Consent, It Is Rape

If your hand or arm is going to “accidentally” brush against my ample bosom once, I will turn my eyes the other way and let you be. While I agree that accidents will always happen no matter what; I will not be looking forward to similar accidents from you ever. Which is why I am taking time off to inform you that accidents that involve you touching my body parts are not going to be forgiven twice. And since there is no way I am going to shrink my bosom, please learn to keep your distance, your roving eyes and arms slash hands to your space.

Dear colleague, note that I prefer shaking hands than hugging, for the simple reason that hugging is informal and is preserved for my close friends and relatives not colleagues. But if you ever find me crying and feel the urge to hug me as a way of comforting me ( we all have those moments when all we need is a hug), please don’t press your body so much into mine, because well, then you will not be hugging me but trying to squeeze air from my lungs! A hug doesn’t have to be full body to work. The Cambridge dictionary defines hug as to hold someone close to your body with your arms to show that you like, love or value them. Please put emphasis on “hold” and ignore the rest of the definition from love onwards.

Dear colleague, on behalf of those colleagues who are well endowed posteriorly, butt groping will never ever be treated as an accident! As a matter of fact, butt groping is a form of sexual assault. So don’t go grabbing buttocks that you have no right over and think you are better than rapists. If you are going to grab buttocks or thighs for fun, then you can wait and go to be sorry in court because there is no way in hell I am going to stand and wait for you to apologize to me for “accidentally” feeling my ass or thighs or any part of my body for that matter!

And finally colleagues, when it comes to sex, there is no such a thing as implied consent. We have far too many bosses assuming that a worker who stays late in the office is sending them some message. How they assume it is sexual, I am yet to find out. Someone cannot work late and have peace, dear colleagues. The moment some of you discover a colleague is staying late, you start staying late too, time your toilet breaks with theirs, somehow find yourselves in their offices for no intelligent reasons at all and before long, your thrusting your hands into places you should never touch in the first place. And you will think of yourself differently from a rapist, accuse your victim as a pretender and of passing mixed signals. Mixed signals my left foot! Why on earth don’t you just man up or woman up and ask for sex.

If you are going to have sex with someone, the least you need is a consent. Sneaking up to your colleagues and assuming that given your familiarity with them you can try grabbing their breast then hopefully end up laying them doesn’t make you any different from a rapist. Rape isn’t having sex with an unfamiliar person, it is having sex with someone who has not consented!