SCRATCH THE SURFACE

I held the sun in my hand,
but it felt cold.
Not like the flaming ball of Orange in the sky
but like a globe of ice.

It is a little past noon and the meeting has just been called to order. Scott is the facilitator.  We do not know his surname. Nobody knows anyone’s surname here.  I even doubt his name is Scott. People are comfortable not knowing much about one another in this group. It is my third time here and everyone is looking expectantly at me. I had to attend this group therapy because my supervisor said I either attend it or I face the sack. I do not want to be jobless so here I am.

“Hello, I am Catherine and I am an angry person,” I unreservedly declare.

“Hi Catherine,’’ the six people in the humid room reply in a boring monotone.

They are; three almost-gentlemen whose names I can’t recall, two ladies and a ferret. The animal is owned by Scott. He says it helps him focus. I think he just loves animals but won’t admit it. He excitedly talks about anger. He is not angry. I am confusion itself.

He starts preaching about how antisocial we are. Not because of the anger but because we are too passionate. What a paradox. We have always been that way even before the discovery of the global village. Hello mother, I am not angry, I am very passionate. Ha ha.

Everyone nods in agreement but I couldn’t be bothered. I am pissed off. I miss my phone and a strong Wi-Fi connection. I want to tell my hundreds of followers how boring this meeting is. I am not ready to form friendships or any real life connections as Scottie is suggesting. I call him Scottie. Not to his face but on my mind he is Scottie the Ferretie.

I hate when I have to talk about my feelings. I am a bubbly person but below the surface that Scottie and his band of feel-Happy artists want to scratch is a cauldron of smoldering anger. And a deep desire for release.

There are many things I am angry about. Today, I am mad at Mary and her malicious self. Mary is a girl I should not have called. But I did. Follow me.

It had been a normal Friday evening. The traffic in Nairobi city coughed like and sputtered. The touts slapped the thighs of the loud Matatus and Facebook was still Instagram for old people. I am old-ish. As I scrolled through photos of extremely good-looking men on Facebook, my notifications badge blinked red with a message. I have always replied to them and so I decided why not.

It was a lady asking for my phone number because well, she had something very important to tell me. I encouraged her to share in my inbox but I think she thought I am part of those Russian spies or something. She wouldn’t. She was adamant too that all it took was her talking to me on the phone. She graciously gave me her number.

A few days later, after twiddling and doodling with the number, I decided to give it a buzz. A buzz. Mm, I admire people who speak like that.

“Yo Boris, give me a buzz later. Cheers.”

“Cheers, mate”, Johnson tells Boris.

So I buzzed. I was ready with a wise-ass line. I wanted to tell the owner of the meek “Hello” at the end of the line that it still wasn’t safe to talk. That we could go to the heart of Chalbi desert with my eyes blindfolded and after using three planes, one rickety Chevy and a camel to throw off anyone keen enough to follow me.

That or maybe, it is time we met in a Library on the same aisle and talk to each other while reading different books and never eyeing each other because spies might be listening in on our little chat. We may have to run for our lives soon.

I did not do it. After introductions and her vote of thanks for my auspicious call to her, she dropped the bombshell. Literally.

“How is Jim? Do you think I can trust him?” She eagerly waited.

Now, Jim and I had been married for a while before I realized the trouble I was enshrouded in and walked away. This was when I was waiting and praying to the gods of marriages to touch my husband and return him to me.

It was one of my most vulnerable points in life. Maybe not quite because no good deed goes unpunished but this was it. I was hurting and a new girl was asking me how to handle my soon to be ex-husband. Satan is not short of surprises and innuendos.

Mary laughed in my silence. She giggled. I realized the meek voice was meant to throw me off-balance because instead of a bird learning to fly, I heard the chirp of a vulture used to the hunt.

“Catherine, I want you to know I came to your wedding and I have your man. He has even visited me and I love him very much,” She cheerfully announced. After the dark angel on my left shoulder finished laughing at the white angel on my right shoulder, I replied in the most honorable ways.

“Jim is a great man and you can trust him. Also thanks for letting me know about your plans. If there is nothing else, I wish you a good day.” I hung up before that maniacal laugh from Mary the hunky dory got the better of me. I needed to hung up and block her on all platforms. It was nauseating.

I was angry. Angry that my dear husband had gone to such great extents to make sure that I was not only hurt but shattered.

I should have shared with the group. I should have told them how agonizing It felt to be replaced that fast. But I did not. I kept telling myself stories as the group members spilled their guts out. All I wanted to do was sign the attendance register then grab my phone and start interacting with hollow profile holders on social media.

My new found drug was sunshine laced posts and comments on social media. I liked how it used to numb the pain.

This meeting was outliving its usefulness. Scottie the Ferretie wanted us to recite the 12 steps heavily borrowed from Alcoholic Anonymous. I was not amused. Nothing in this room was a source of amusement apart from that brown ferret with piercing eyes.

I have been thinking lately about why women hurt other women. I have asked myself that question a million and one times. I have been wondering what Mary hoped to achieve or did achieve by hitting below the belt with me. Was it all worth it at the end? I would be disappointed for her sake if it wasn’t.

I have learnt to sell nothing short of happiness in spite of a cloud of dark. My journey, like that of many other men and women may have been scribbled with the right amount of agony but we triumphed. We faced our fears and did something anyway. Scared of the rising sun but opening the curtains nonetheless.

People, in a nutshell, will always do whatever they want to do and there is nothing we can do to stop them. I could hate people if I wanted to. Maybe label them in colorful words It is in your best interest to know that sometimes when it rains it pours. You may think you have seen it all and then boom! It gets worse. But It gets better too. It does. As soon as the storm passes, we will safely anchor the ship and have a party.

IT HURTS STILL

Light at the end of the tunnel can simply mean an oncoming train.

Life will not always make sense. It is there to be lived either way. Not the chirping of the birds or the aroma of good food will have hidden meaning. It is all part of this maze we live in. Life, painful as it may be for some or pleasurable for the others, is not what you make it as some would want us to believe. Life just is. It does not care about your perspective. It will happen because that is what life does–happen.

I would love to stand in front of an eager crowd and feed them hope. I would love to stand and punch the air with fists of victory over every little and big fight I have allegedly won in my life. Maybe be this iron lady who prances like a foal in a paddock because she was there,saw and conquered. Probably sing songs of freedom to a wild audience that will sway to my tune like a tribe of over-caffeinated monkeys.

However I will not because I am not a very good liar. I suffer short term memory loss and I would have to write down every lie I bellow through the microphones so that I may remember them all.

Truth is, it still hurts. It hurts that I invested so much of my time and resources trying to build a marriage that was authored on some sinking sand. It breaks my heart. Every. Single. Day. Well, there is a hint of hyperbole there but it is the truth nonetheless. It may not bother me all the time because I am busy being a nurse and a semi-manager of some sorts. You do get what I mean, however,don’t you?

Time and again I hate myself. I look at all I may have done had I not willingly entered a pit that I knew was too deep for me to climb out of. I knew it. That is the problem with most abusive relationships. The victim always, always know what the perpetrator is capable of but they somehow go ahead with it.

It is what I constantly call the impeccable art of self-destruction. My issues, to bore you, were not to do with my marriage per se. I like that phrase “per se.” It is a very Kenyan phrase. We use it in all situations and subsequently murder the Queen’s language. We are amazing. Not amazing Per se but… ha ha see what I did there? You are welcome!

I am deflecting , thank you for stating that. My issues stemmed from anger against those who took my childhood away from me. That was the most simple, perhaps too simple, an explanation I got from my shrink when I asked her why I was so good at screwing myself. I chose a man who I knew would hurt me so that I could continue with my incessant fights with this thing called life. I have always had to fight for things and I thought, albeit unconsciously, that even with marriage, I could fight and change, ergo, my man. When that did not work as I had envisioned, I had to go back to the drawing board.

Some people tell me I was extremely lucky to walk away and finalize the divorce. Others say I was very lucky to move on. These are opinions of people who are not me so allow me to tell you what I think. Fortunate to not have had a baby. By default or by design.

It is all well-preserved hogwash. Balderdash. Shut up world.

I do not feel lucky. I did not, for Chrissake, walk down the aisle so that I could walk right up. We all accept that marriages end but no girl wishes hers to be the one that does. So yes, I may not feel as jammy as I get labelled.

Do not get this twisted, given another chance, I would definitely get that divorce and sooner than I did. I would still look at the man I once called mine and say enough is enough. I am alluding to the fact that fortunate is not how I see myself. Stories of picture-perfect couples I call friends do not help the matter. It is not strange to find myself sad at weddings and crying at christenings. I remember what I do not have. I must say it. Oh I am sorry if you expected a shell of a woman. No. I see things. I think about them and I definitely wish many things would not be or would be and such other self-tormenting thoughts.

Turns out I still succeed at breaking my own heart. I should now get an award . ha ha.

The truth still, is that I let all these feelings of unfulfilled wishes wash over me. I let every dark emotion course through my veins like the poison it is. I have allowed hard times to weigh me down properly until they can’t anymore.

As a matter of fact I remember crying the other day and naming every drop of tear that fell from my eyes. I called one strength, the other wisdom, another compassion, understanding, one more discernment. I had a love tear, a hope tear and a better-day tear. I also allowed the river of anger to stream freely from my eyes . Anger pulled with it fear and fear balanced its legs on my lower eyelids before making small rivulets down my chubby cheeks. The session lasted shorter than I had hoped for.

if you try to gloss over the truth or massage it, more often than not you arrive at erroneous conclusions. That is my truth. I have learnt to wear my unspoken with aplomb. I have learnt that I will hurt even years from today. I will hurt even when IO get married again and even if that marriage will turn out to be what God authored, hurt I will.

Hurting will not escape me when friends seem to be so happy in their marriages, whether on camera or privately. Pain, Like a ghost in the night, will visit me when I remember some four years I spent teaching a fish how to climb a tree. Misery will engulf me when friends post photos of their babies and I am left to wonder kwani what did I do wrong? Yeah, I will ask God many questions too. God and myself.

Mostly myself because well, Papa God answers to no man.

I will want to deactivate all my social media accounts or perhaps go and live in the heart of China where social media is rumors and suggestions. I will feel all these and more.

However, I will still chart my way forward. I will believe that I am human and to not make dumb moves is to be robotic. I am not. To be low is human as Christ had a moment where He too wished to not drink from the cup that was his shameful death by crucifixion. this is where most of us go wrong. The journey to love is both pain and pleasure. You have no choice but to take them both.

We must learn to accept that life does not owe us happiness.

If that is so then, we must allow life to happen and appreciate the good with the bad. God, after creating people, He handed everyone their own small hell to handle. You will never outrun your hell. You will not out-smoke or out-drink or out-whatever-terrible-things-you-do. In fact, you won’t out-sex your hell.

Have fun with it. Embrace it because that is the only way to be human. You will appreciate your journey once you have faced that little piece of pain and risen in spite of it. Like demons, which i will address in the next Lifestyle topic, create a circus for your pain and join in. Control the strings and let the pain dance to your tune.

You own the pain. It does not own you.

Thank you for passing by.

WHY KIDNEYS MATTER

The heart may Stop, The brain may sleep but the kidneys never give up. However when the kidneys give up, not even the heart can stand it.

I may have touched on the work of these two bean-shaped organs in our bodies but I will go back to them yet again. I have received diversified questions and I thought if I took you all back to some basic physiology class we may be able to answer these (un)asked questions.

The kidneys are located towards the back of your body.They are on each side on the lower aspect of your ribcage. This is as far as I can make it sound non-medical. We agreed that these articles will not be written in medical jargon,no? Wait,you did not attend that meeting? Surely you had a representative? hehe.

Kidneys contain millions of tiny sieve like cells called nephrons. These small,intricate systems are key in filtering wastes and excess water from the blood.Waste in this case includes in part Urea and Creatinine. Urea is an end product of protein metabolism. It needs to be taken out of the body because excess content interferes with the normal working of the other systems in the body. Actually we get the word ‘urine’ in part from Urea.Creatinine is as a result of muscle breakdown. So, ladies will have less Creatinine in blood than men, got it ?

In addition, the medicines we take need to be removed from the body after they have done what they were meant to do in the body. Majority of these drug metabolites are excreted through the kidneys. #TeamPhoenix, some drugs get converted into inactive forms in the liver and we need to get this ‘inactive’ metabolite out.

Sometimes it is the poisons we ingest in the name of fun. Alcohol is a good example. Alcohol exits the body largely through the kidneys and that explains (albeit vaguely) the numerous trips you take to the washroom after your second beer or so. Imbibe on alcohol and you overload not only the liver but the kidneys too. By and by a hepatorenal syndrome with subsequent kidney failure will be apropos to you.

Kidneys also regulate the amount of salts and electrolytes in the body. We need these salts and electrolytes for muscle coordination, brain cell excitation, heart contraction to highlight but a few of the functions. Kidneys keep these elements within the normal range so that the internal working system of the body stays in some equilibrium.

Potassium is a cation worth mentioning because of its high relevance to renal patients. While normally we evade any catastrophes whether the Potassium in our diet is present or not, renal patients do not afford such a luxury. Kidneys retain and remove potassium from the blood with surgical precision. Too low or too high potassium is enough to cause a cardiac arrhythmia (heart beating abnormally). That explains the stringent dietary Potassium restrictions that renal patients have.

The blood’s PH is neither acidic nor basic and must be maintained within that range of 7.35-7.45. This happens via an acid-base mechanism that primarily is the role of the kidneys. Hormones and blood cells get denatured and destroyed if the PH is altered. This will manifest in various ways.

Kidneys produce an important hormone called Erythropoietin. This hormone stimulates the production of red blood cells in the bone marrow. That is why, when kidney failure sets in, one of the manifestation is anemia which means low blood levels. This hormone is so important that we inject it to the patients on dialysis. Dialysis attempts to replace the functions of the kidneys but this is one function that it can not replace–yet; because who knows the future?

Kidneys also control blood pressure. That means very high or very low blood pressure will have detrimental effects to the kidneys. Note too that high blood pressure can also be as a result of damage to the kidneys from other factors. I hope I have not lost you there.

It automatically follows then that any elevation or decrease in blood pressure is worth looking into. The kidneys play a vital role in activation of vitamin D which we need for strong, healthy bones. Talking of bones, the kidneys maintain Calcium metabolism,a key element in maintaining healthy bones.

In a nut shell, urine is of immense value as it tells us how your kidney health is. Urine is a mixture of excess water, electrolytes, Salts and a horde other waste materials. When other substances like glucose are present in urine, It guides the physician towards a correct diagnosis and management.

I hope these functions are palatable to your non-medical taste buds.

Till next week,cheers.

KIDNEY HEALTH DISCUSSION

More powerful than the best artillery is information in the hands of those who want to use it.

Despite it being among the top ten non-communicable disease killer in our country, kidney disease has continued to receive a wide berth as far as resource allocations go. There is so much the government, present and future could do to make sure that this is rectified. However I believe that the steering wheel of your health, #TeamPhoenix is not one you carelessly leave to other people. It must be your vehicle, your wheel.

The goal of many of these #KidneyWednesday articles are to make you feel empowered enough to approach Kidney Disease from a point of some sort of know-how. There is a need to perceive Kidney Disease as a primary ailment rather than a cause-effect phenomenon. That means we can talk about kidney disease and the disparaging misery it has brought to many households. That means we can now include Urine analysis as a mandatory baseline test for anyone visiting our health facilities.

#TeamPhoenix, my desire is for you to be informed. Shall we start some information therefore?

Basics

I know I have said it before but shall I repeat anyway. There is a major difference between Acute Kidney Injury and Chronic Kidney Disease. Now, the former is easily reversed if the right measures are put in place and I have a thousand and one words to say on this topic on my Facebook Wall before we gave birth to this blog. Most of the patients we handle , however, are suffering chronic kidney disease and unfortunately are in the fifth stage of the illness called End Stage Renal (Kidney) Disease.

Diabetes Mellitus and Hypertension are the two leading causes of this disease and I can’t overemphasize that point. There is however, a rather little known disease called Polycystic Kidney Disease. More often than not this is discovered while one is being treated for a totally different condition. It is a situation where the kidneys develop cysts (water -filled growths). These tiny little monsters compress the normal tissue of the kidneys. The result is reduced surface area for the kidneys to do their work. That increases the blood pressure in the kidneys and the general systemic circulation leading to a further damage to the kidneys.

A feedback cycle from hell you could call it.

That usually presents in the early thirties. I must say I never thought much about it until I went to the Renal Clinic at Kenyatta National Hospital during my training. I encountered so many young people on management for Polycystic Kidney disease, the reality was staggering for me.

It presents with very high blood pressure. Time and again a patient can be mismanaged–albeit genuinely, as having a migraine. Wait, now that I have written that down, I think I need to make some calls…funny how real things appear when one writes them down!

Where were we?

Polycystic kidney disease detected early is managed and the disease progression slowed. We may do little to reverse it as it has everything to do with our genetic make up. The reason I am highlighting this is to make you realize the need for this conversation surrounding Kidney failure.

We need early screening and staging of the disease so as to inform management. Last time I told you a story of a Patient we are dialysing who we shouldn’t be, at least not yet, had the attending consultant identified the staging early enough and referred the patient to a Nephrologist.

See, there is a culture of indomitability within medics circles, and Kenya has not been spared, that really needs to come to an end. This is where a consultant or doctor or another medic delays a referral to specialists in the name of figuring it out. I daresay medicine is dynamic and nobody will have all the answers. What you do is put these patients at risk as you focus on what to do or not do. As you become too afraid to be labelled incompetent just because you referred a patient. This is why we have so many cases of terminally ill patients whose stories look like they were scripted by the same writer.

That is how patients start dialysis and they tell us that they have been undergoing treatment for stomach ulcers, Malaria, Typhoid and a horde of other illnesses which if we take a proper history, were all related to the failing kidneys. The Chronic nature of this type of kidney disease means that it does not befall us as a thief in the night. Surely there are signs.

If your patient isn’t responding to particular management after a set timeline, why on God’s green earth do you want to keep treating them for that same condition till Jesus comes? What happened to effective referrals being part and parcel of management?

Sigh…

#TeamPhoenix, do find out the type of Kidney disease you are dealing with. I always say sometimes you do not know because you do not ask. Please ask the medical team handling your loved one, you or a friend or a neighbor what type of Kidney disease they are dealing with.

If it is Chronic, I want you to be part of the team that supports these families. Please encourage them to attend dialysis sessions because if the kidneys are failing, we are accumulating wastes in the blood and excess water which by and by will lead to complications.

Drop them at the renal unit, provide some eggs for them, ask about their next session, talk about the need for kidney transplant, link them to people who have undergone transplant and are doing well. Link them to people who have been on dialysis for a couple of years. Be there. Be available. If a village brings up a child, then the village should indeed help one to be well again. Let us put to action those community values we boast of as an African village.

It doesn’t need a title but here we are

Let us have conversations about Kidneys and how to keep them healthy. As well as how to manage the disease if it comes to that. End stage renal disease is a terminal illness in itself but it should not be the way life comes to an abrupt halt.

People can dialyse and still attend school, work and be productive. People can undergo kidney transplant and change the whole ballgame altogether. However this is a multi-pronged team effort. I keep saying that the most important player of the medical team is you, #TeamPhoenix–the patient/client.

Ask questions. Seek simple explanations. If not for anything else, for the sake of your consultation fees. That is what you pay for, right? Consultation. Then by all means , Consult.

Next week , we shall talk about functions of the kidneys. I know we had talked about it on my Facebook wall but I have this unsettling need of going through them again.

It has been a pleasure having you today.

GREATLY UNINSPIRING

No sassy quote can describe the sound of loneliness as it carries your heart.

This is the last time I am typing this paragraph. I have offered burnt offerings to the gods of my forefathers hoping that just this once, I write half a page. Writing is supposed to be meteoric for me but lately it has been a constant skid in the mud and a painful drag on earthen floor. As earthen as my grandma’s hut.

I have been an average female who has refused to let go of what defined her when she was still starting in her career. I have refused to move on. Moving on is a sexy idea. What with feminists preaching self-love and the internet saying how cool it is to be a new person. New mindset and if you please, a new wardrobe. Unfortunately, what I lack in flexibility I cannot even compensate in fashion. I am as old as a cat. Why a cat? I think cats don’t have nine lives. They are just old.

I finally received the complete judgment of the judge who laid a final verdict on my marriage. She wrote in such exaggerated legal jargon that I wondered if that was my story summarized in a few words. The words cut through the blackest of spaces. And I am very black to be fair.

As much as possible, I am supposed to be happy and relieved. Happy or relieved.Both.However there is an unceasing gnaw of ache in my spirit. I keep going back in my mind to days I spent as a happily married girl-or what I imagined was happy. I especially keep rewinding the month of August before I walked down the aisle in September. Sometimes the voices in my head suggest time travel.

I recall days the choir of lassies invaded my privacy and candidly reminded me that I was a means to some end. I ignored them and labelled them envious. In positively glowing ways exactly as I would have loved to see them in hell at that time.

All signs indicated that getting married to my then fiancé was a terrible idea. For starters, he was yet to make peace with his demons. Talking of which, you can’t escape your demons. I enrolled mine in a circus and we are having the time of our life. They are the eye of the fire in my life. I stare at it and no, it won’t blink.

There is a certain shame one feels when they realize that the castle they built was made of eggshells. There is an undeniable loss when one realizes every dream they had was actually a dream. I have been wanting to scream and shout at the son of my former mother in law. I swear I had a few wonderfully crafted things to tell him. Words that cut across me like a network of dry riverbeds. I wanted to talk to him on a bright dawn just before the sun slit through the curtains.

It was the suggestion of the Demon-In-Chief in my head to remind him that he was the first tree in my forest yet he burnt it.The Deputy Demon said he burnt it down because it was never his forest.It was my uncanny ability to make terrible decisions. I had to choose whether to wallow in the cesspit of pity or learn the lesson and hope to make more creative mistakes in future.

I have not stopped to preach to myself that I will be alright someday. I have not lied to the girl in me that someday it won’t hurt. I know that it will hurt. Especially when I look at the judgment and the Decree from the court. There is abusive marriage and there is something about seeing the details on paper.

I asked my lawyer if he was sure that that was my story. He sadly reminded me the day I went to make an Initial statement. You see, divorce must be factual. You must be able to prove to the law that you have grounds for it.That was when I hated my life a little bit. Do not get me wrong, I am grand. However I can be a wee bit daft too.

I typed the exact things that had been happening in my otherwise perfect home and I broke down staring at the screen. As the cursor left space after space after every diabolic atrocity nobody should do to another human being; especially a human being they walked with down the aisle, my heart ripped open. Small rivulets of thirsty blood spilled out. Small tributaries of anguish welled up and overflowed in the form of tears. Unhappy tears that dripped drop after drop on the desk of my solicitor. I asked for a lawyer, not a therapist. It seemed like I needed both.

So with the inevitable sheet of pain lying idly on my desk, I had to choose.

I made the choice to embrace that part of my story. To stare at it and wink sometimes. To hug it to my warm bosom and then throw it off a cliff. There is no prison greater as the one in one’s mind. The moment we break the chains and set sail towards Island Freedom, no gates of captivity can contain us.

It pays to be at perfect harmony with the ghosts of one’s mistakes. The heart may be fragile and coated with a thin layer of hurt but it is all we have sometimes. Much as I hated looking at the full judgment, I had to surrender myself to the emotions it brings.

I decided to give in to the pain and brokenness this particular writing would bring me.To dive into the darkness emanating from a strike of the pen and a dropping of the gavel. To actually take a walk into the bottom pit. It is only by going dark can one see the rays of light. When we hit the rock bottom of desperation, anxiety and foreboding, we can see so many pathways to the top.

I have become good at feeling bad. I have allowed negativity to latch and suck onto my soul like a baby unquenched at the mother’s breast. That is how I am able to walk into positivity. Not because I believed in myself but because I did not. I do not win at self-motivation and maybe that is what someone wants to hear. That they are perfectly fine feeling terrible. That they are perfectly dandy even if hours and hours of psychotherapy have not helped to ease the pain.

That it was not meant to work like some pixie dust. It was meant to be grilling and as long as they are putting in the work, we shall all be alright. Probably not fully but we will not sit and stare at our wounds forever.

Getting out of bed and doing something other than count the number of tiles in the room, going to work and actually loving it, waking up to meet some much needed friends and going out in the bright sunshine or wintry night; these have become my absolute tiny victories. I have found solace in the written word. It is funny how it leaves me when it is out there. It is hellishly liberating.

Words are the sauce with which to serve a perfectly ruined lunch.

THESE TABLETS

you are about to exceed the limits of my medication

Linda is an 88 year old lady with a hump on her back. I initially stared when she first was brought by Rose, her daughter, to our Renal unit. I know I should not have stared I know but these my eyes! Humped she might be but her humor was as straight as a roundabout. She joked that what God denied her in shape compensated in her buttery mouth.

Linda had been attending a medical outpatient clinic somewhere in the leafy suburbs of Nairobi. The consultant she had been seeing had declared her to have a myriad of age-related problems. These are Rose’s words not mine. Hypertension to Diabetes to Arthritis and an array of others that I have forgotten to remember.

The events leading to their visit on that sunny Thursday afternoon was a more recent hospitalization at yet another well-to-do private hospital. Interestingly, the same consultant saw her at this hospital with a severe case of headache, irretractable vomiting and diagnosed her with End Stage Renal Disease and acute hemodialysis was started.

Later, Rose and her mother were to learn that that was just the beginning to a lifelong visit to renal unit. Given the close proximity of our Unit to the interior parts of central Kenya where this family lives, they came to book a slot for this fine lady. Linda had a prescription of about fifteen medications and supplements most of which counteracted with each other. I remember calling Doctor K with palpable anguish in my voice.

He is our renal pharmacist. He has become a darling to all the patients on hemodialysis. He has helped many manage their medications with a rationale behind each and every tablet. He came and I could see the look of dismay as he went through the prescription that dear old Linda was on.

Mom and daughter were initially skeptical seeing that it is a consultant who had been dealing with them in a major private hospital but here we were, in a government owned facility, with some young-ish lad wearing a white lab coat telling them that we had to get rid of some of these impossibly expensive drugs. It has been five months and the blood parameters of Linda have greatly improved painting a vivid picture of adequate dialysis. A fete impossible to achieve if the medication regime is a display of rumors and suggestions.

#TeamPhoenix that brings me to the gist of our #KidneyWednesday today. In our Kenyan setup, rarely does End Stage Renal Disease happen overnight. Moreso in the elderly, and those with Diabetes Mellitus and/or hypertension, End Stage Renal Disease does not come upon us like a thief in the night. Linda did not suddenly develop renal failure. It was a case of omission from the doctor attending her. He had omitted telling her that she was in the early stages of renal disease and therefore refer her to a nephrologist early enough.

The medications that a renal patient uses must be carefully examined by a clinical renal pharmacist. Most of the drugs used to treat hypertension will more often than not raise Potassium levels . Now ,in a Patient with end stage renal disease, high Potassium levels is the last thing you want to deal with. Some of them will cause fluid retention in the body. In end stage renal disease, fluid retention in the lungs, heart and other areas of the body is the last thing you want to handle.

Renal Pharmacology is a very ignored area as far as management of renal patients go. That coupled with our lack of regulation of public chemists place our patients at dire risks of renal emergencies and deterioration of the disease. #TeamPhoenix, We learnt that the only thing we can do with chronic kidney disease is slow its progression, right? Please tell me you remember that lesson…

In our endevour to slow the disease progression, we alleviate the sting of complications and help the patients live lives that are as close to normal as possible. Unless we do not really mean what we say, these tablets must be evaluated to give them a clean bill of health. These tablets must come with renal instructions. Pharmacists at the chemist must at least ask the customer about their kidney health. You as the mwananchi must learn to ask the pharmacist if the drug you want to buy is safe for you or someone suffering kidney disease.

Learn to ask because there are always safer options.

As the Nephrology nurses, we can only do so much in terms of dialysis. We need a robust support from the Pharmacists and the general medicine-buying-culture in Kenya to achieve some sort of milestones in our ardent fight against Chronic Kidney Disease. There are many classes of anti hypertensives and not all are to be used in a patient on dialysis. The same applies to anti-diabetics. I must say I am proud of Doctor K. He manages to explain to the patients the WHY before changing the drugs for the patients. That is a character lacking in many of our doctors and nurses in Kenya.

Not many medics teach before treating. That to a great extent, explain the huge percentage of non-compliance to treatment modalities. It is futile to tell people to follow some way without explaining why they need to follow it. I am an avid advocate of public health education so this touches my heart.

It is your health and that of your loved ones. Please ask questions as far as medications go.

Thank you for passing by.

THE DISEASE BURDEN

“I am a prime example of the way kidney disease strikes silently,” Sean Elliot

Despite being one of the top ten common claimers of life,chronic kidney disease still struggles to receive visibility in Kenya.It is worthwhile to note hat the poverty of statistical data has not stopped the Global Burden of Disease (2015) study from ruling that5-10 million people die annually due to kidney disease.”The common lack of awareness and frequently poor access to laboratory services ,such numbers underestimate the true burden posed by kidney disease,”concludes WHO.

Mine is not to bore you with lengthy academic papers.Let us make that a little digestible to us.When we talk of disease burden especially with End stage renal disease,we need to be awake to some of the struggles of daily living in the life of a patient.

What I have had to grapple with and most renal nurses I am sure is the constant poly-pharmacy. A renal patient of dialysis will most likely have medicine to lower their Phosphorous level while adding their Calcium level,medicine to add the level of blood,medicine to lower the blood pressure,medicine to regulate blood sugar ,medicine for the heart,medicine for nerves and the list can’t be exhausted.The problem is the utter intimidating nature of all these tablets one person is expected to take and remember to take.

It is overwhelming even to think about it. I am a nurse and the idea of swallowing medication or receiving it in any other form makes me cringe. The families are faced with the constant fact of buying these drugs month in month out and it is not a wonder to see most of our patients going without them.

Just like the infamous American heath system,the Kenyan one is perpetually making a patient choose between treatment and food. Between taking children to school and proper healthcare.This should never be the case in a country that indeed loves her people.

The good old NHIF can and should pay for these essential drugs but the drugs are always conveniently missing from the hospital pharmacy.Maybe I need to say it again. There is a mismatched relationship between low income status in Kenya and the prevalence of end stage renal disease. Perhaps because the rich are able to deter the progression of the illness at its early stages.

Perhaps because the haves can access better and timely medical care as compared to the have nots. It has become a death wish to be below the poverty line in Kenya.It is a rich man’s country.

I can’t stop the activist in me now,can I?

Let us go back to our topic…

I implore you as #TeamPhoenix to be so kind as to check on those among us with kidney disease and are on dialysis. They too are part of this daunting team. It is financially and emotionally exhausting. This is compounded by the fact that they may not ask for your help for fear of being a constant bother. Most die in silence if not saying all is well.

All is not well.It is not when someone has to prepare two meals at every mealtime. One for the rest of the family and one for the patient. It is especially difficult when that meal is not easy to come by.

Yet they have drugs to buy and laboratory tests to take and a dialysis session to attend to.

That is where I advocate for a renal counselors and social services care contact persons in every renal unit.We need a safe place where the caregivers and the patients can express their challenges.The nephrology nurses can only do so many dialysis sessions.We need help. I believe there is help out there. If not for anything else,for availability of all these medicines without which the quality and length of time of patients on dialysis is reduced. Let us stop unnecessary and premature deaths.

And to you my #TeamPhoenix,do not expect a sufferer of kidney disease to ask you for help. Offer it anyway. Please help. That is the only way we can beat the burden of end stage renal disease. It does not matter what you do. Probably buy a week supply of drugs, maybe find out their dietary needs and provide that for a day or two, there is something all of us can do.

This Nephrology nurse will keep writing to tell you about it.

As always, having you read is my honor.