Nurses And Covid-19

Jordan Kelly is a nurse who has passed on in the line of duty due to Covid-19. Even as we mourn this loss, we can honor him by protecting the entire Nursing profession .

Many have suggested that nurses are the backbone of any given health facility. I find that line cliche and exhaustively tiring. It lacks the zest that the users intend and it falls just a punctuation mark of sarcasm. Being a nurse morphed from being a call; thanks to Catholic nuns of eons ago, into being a profession; thanks to the modern theorists of the nursing profession.

When the world is grappling with the demon that is Covid-19, nurses can not afford to panic. They can’t afford a second to sit back and wonder what their next move should be. Like ambushed soldiers in the battlefield, they have to figure it out while donning the armour of service to all mankind.

With trepidation nurses from across the globe have decried lack of proper personal protective equipment. Many might say I am biased towards nurses and God knows I am. A nurse spends the most hours in contact with patients exhibiting signs and symptoms of Coronavirus. Nurses are also the first people to interact with these patients. The level of exposure therefore, is undoubtedly greater amongst nurses of all levels.

This is especially so in my country Kenya and other third world countries where we do not necessarily have carers to work alongside us.

Equip the Nurses

Indeed nurses took the Florence Nightingale path and swore to do no harm. This is not a prerogative for committing suicide. Suicide is used loosely here to refer to working in precarious situations with the necessary personal protective equipment. Nurses need to he trained on the use of the same as well. There is a well packaged load of Covid-19 in and around Nurse’s workplacwa.

It ia futile to clap for us and call us amazing heroes of healthcare if you won’t provide PPEs. That is an empty song whose void tunes assault the listeners. Nurses must be equipped. Without this vital move, we can be sure that other efforts against Covid-19 will be self-defeating.

An exposed nurse will easily transmit the disease to many patients within the hospital and carry some of the virus with her to her household. Then waves upon waves of new infections will continue to be witnessed. We must break the chain of transmission by ensuring the right gear is with the right folks.

Unions and associations of nurses keep pushing governments to ensure that gloves, gowns, face shields and proper masks are provided. This is not the time to play superiority games. It is a time to save the nurse as they save humanity from possible annihilation.

Train The Nurse

I must applaud the Training of Trainers ( TOTS) rolled out by the Kenyan Ministry of Health. However the timing is wrong. What we lack as a country is disaster preparedness. When the first case was reported in other parts of the world, this was a golden opportunity for nurses to be trained on what to do in the event Covid-19 hits Kenya.

Case definitions and identification cycles should have been distributed to all the six levels of healthcare in Kenya by now. What we are currently doing is playing catch up while we already have one death from Coronavirus.

We have very few critical care nurses in Kenya. Majority of the ones that work in such set ups especially in private hospitals are not properly trained to execute the roles of a critical care nurse. This is a time where we need rapid response initiatives. I implore the government through the capable Ministry of Health to not only focus on prevention training but also management.

Nurses need refresher courses on use of the available ventilators and maintenance of negative pressure rooms ( if we have any!)

When doctors are busy shuffling between one critically Ill patient to the other, it is the nurse who is left to man an entire shift at any particular point. We need to make sure that we have a standardised way of response. This is possible through retraining.

We must eliminate gaps and make sure that what a Covid-19 patient is getting in terms of management at Kenyatta National Hospital in the ICU is replicated in Kilifi County ICU. That gives us a standard operating system which even allows for proper consultation and follow up.

We can not hide our heads in the sand and assume that everyone working in the ICU is good to go. Just because we can incubate and extubate does not mean we are qualified as critical care nurses.

I know it is a desperate time which calls for desperate measures. Part of that is immediately training nurses in all departments on use of ventilators, monitors and a thousand other equipment in an ICU set up. We may have started late but last I checked, Kenya is a running country and we sure as the blue sky above can catch up.

Protect The Nurse

With nostalgia I remember the last strike nurses held. It was in 2017 and politically heated. Nurses kept asking for a review of Risk allowance. I will always recall the headline that screamed that Nurses were dancing on the graves of patients. For some reason I took a picture of that headline and sometimes I refer to it when I want to remind myself how bad editing can damage a profession.

It is immoral to award some healthcare workers a risk allowance of Kes 20,000 and casually throw Kes3,850 to nurses. This is sacrilegious. An insult. A strategy made by the devil’s advocates. Nurses take shifts as most other healthcare providers take calls. Nurses do not even enjoy the huge medical cover benefits accorded other cadres. It is therefore sick to call nurses heroes while throwing them under the bus with the greatest risk of crushing.

Protect nurses as they continue protecting us. If not for them, then for their children who they keep exposing to Covid-19 after every exhausting shift. Other counties resorted to contracting nurses on short term contracts. This is a time to give the nurses a permanent and pensionable slot with all benefits awarded other healthcare professionals.

Even as the government rolls out plans to employ more nurses to beat Covid-19, it behooves all counties to ensure no nurse is on a temporary contract. We will need the additional workforce even post Covid-19. That calls for the government to ensure that the new nurses to be employed won’t be given shoddy contracts but pulled into the payroll under permanent and pensionable terms.

We can go back to hating the nurses we are presently calling godsend later. We can resort to disrespecting them and calling them expensive derogatory terms after this crisis. As for now, all efforts must be geared towards protecting this vulnerable group.

As you were!

CORONAVIRUS; A CRY FROM OUR PUBLIC HOSPITALS

Sometimes we all are but little children. Sitting on the floor gazing at the backside of a canvas being painted. It looks ugly. Senseless and downright boring. We can’t wait to go to the other side and see the whole picture. At the core of it is a special thread that holds the entire canvas in place. Without it, the painting crumbles. It becomes a mishmash of wet and thick liquids.

That is the situation Covid-19 has presented to the Kenyan masses. For the longest time, healthcare workers have gone on strike to decry, in part, deplorable working conditions. I remember my colleagues at Kerugoya Referral hospital refusing to work because of horrible conditions. They were sacked. Some even contracted Hepatitis B.

Not here to lament though , believe me I would like to. However I’d hate for pain and grief to be my most prized possession. Today, Kenyans are listening thanks to the Covid-19 pandemic. I love good opportunities. Actually, I take advantage of opportunities; their nature notwithstanding.

I will hope to God that you do get the courage to take a leap with me into the murky waters that are our current public healthcare system in Kenya. Hold my hand.

Underfunding

Working in the Renal unit at one public hospital in Kenya last year was a blessing to me. I had an opportunity to learn the challenges we face as nurses and the entire renal team. On this particular Thursday, we had no food to serve our patients on dialysis. Many may identify with this situation. Hemodialysis is one of the most energy intensive procedures a patient will ever have to undergo.

Going without a meal was beyond me. I remember having a chat with the powers that be (many know me as a salient activist especially where injustice prevails). I posed questions whose answers came in choked bits and pieces.

The Hospital, a level V one, had not received funding for about six months and it was in enormous debts to her suppliers. All suppliers had stopped supplying us with food items and now it was all man for themselves.

It pained me when my colleagues and I had to tell patients to bring food items in advance from home. This situation was replicated in the general wards. For patients whose relatives didn’t visit often, they were left at the mercy of other patients if not nurses. I lost count of the many times some of my fellow nurses brought packed food if not went to the shops to buy food for patients.

When one is quarantined at Mbagathi, the most unselfish thing for her or his folks to do is to NOT visit them. What was kind to do yesterday is unfortunately very irresponsible to do today. Covid-19 pandemic has turned our values inside out. Our socialization challenged.

Patients are expected to have relatively comfortable lives for the period of the isolation. These are the same wards that should provide enough food, toiletries, hygiene products and beddings to name but a few of the required consumables.

Fellow Kenyans, when you strangle funds to reach public hospitals, the result is a malnourished public healthcare system. You must contend with limited supply of services at the same Hospital you despise.

Understandably, everyone loves quality healthcare. That has informed the upsurge of medical insurance targeting private hospitals. Private hospitals are never lacking in commodities. They are always offering decent meals and nurses and doctors wear ever present smiles for your pain. Friends, a pandemic is not insurable.

You might have to find yourself in that public facility that you have treated like dog poop for all this while. You will have to be served by the same healthcare workers who you have time and again labelled selfish when they strike to seek better terms and conditions of work.

If the government and you the entire citizenry actually cared, public hospitals would never lack funds to run her operations . Suppliers would be timely paid. Machines would be promptly repaired. Casual workers and cleaners would never go a month without their wages. We would be proud of our public hospitals.

Covid-19 is exposing our underbelly as a nation and unless we have an honest conversation geared towards efficiency and effectiveness in the public healthcare system, then this exposure will be for nothing.

There is nothing as bland as passing through pain and not learning a thing from it. Time and again Afya House has been embroiled in scandals. Scandals which have been sanitized if not swept under red carpets. We lose funds in the most ingenious ways.

Funds meant for the sick and lonely. Funds meant to finance public Hospital operations. We stopped caring as a leadership in Kenya because we can afford the notable private Hospital charges. If that fails, we can grab the next flight to London or India and get our broken bodies fixed. Unfortunately our spirits are left in irreparable shreds. Covid-19 however has allowed nobody to travel to seek treatment. We perish or stand together.

I am a firm believer of our public healthcare. If you invested in us in the public healthcare sector, perhaps you would not have to feel so edgy at the prospect of being quarantined in an emaciated ward, would you?

Dishonesty

I thrive in veracity. No matter how hurtful it is, I desire the truth. I love more when I am confronted with hard truths than when I am cushioned with soothing lies.

We have used public healthcare as a campaign tool for eons. That is decrepit by now. Kenyans need to ditch the mediocrity bubble they have been accustomed to. We need to be awake to the fact that proper healthcare is not a favor but a RIGHT enshrined in our constitution.

We must be honest when we demand better services. On one hand, we treat nurses and doctors and other healthcare professionals as the enemy while the actual enemy is your political leader who expects these professionals to work around the clock with little if any, resources.

Honesty comes in the form of candid discussion where I get to tell you the challenges I face. That the radiographer machine is not working since three months ago and no, the clinic you will go to is not run by myself. That we do not have gloves and masks and therefore I want you to come with some at your expected date of delivery. That I have no linen in store and so I will humbly ask your relatives to bring some blankets for you to shield you from the cold.

When mothers are forced to share beds after delivery, caesarean or normal, I ask you to please make room for the next patient. That should make you very pissed. Not at me, because Jesus help me, I have no bed I can add to that ward, but at the right people.

That should infuriate you. That should incense you. Light up a fire that you direct to your governor or national government. It should make you dial the HOTLINE numbers that you otherwise dial when you suspect negligence at service delivery.

It should spring you into action by calling media houses. The same way you call them to say nurses have ‘allowed a mom to deliver on the floor.’

See, you are a dishonest populace that expect us to run on bare minimums and still deliver excellent care standards. My worry is, we hardly survive on a normal day, how will we survive with this pandemic?

However this is a conversation we do not want to touch as a people. We want to continue swallowing campaign promises year in year out. Therefore, for the deplorable conditions that our isolation wards will soon enter into, we have nobody but ourselves to blame. I do not expect you to change because I can count on you as long as I can count on a politician’s promise in an election year.

Tattered ethoes

By either default or design, healthcare workers got sucked up into an unforgiving system and they became better students than the master. Most of the healthcare workers have perfected the art of survival by rendering what I call shitty services in public hospitals while offering the same services; only this time ‘above excellent’ is the term I will use– in private hospitals.

This is how it works. Some doctors and independent practitioners hold two jobs if not three. This makes sure that they attend rounds at a public hospital for say an hour then ask the entire lot of waiting patients to return in a week’s time so that they can spend the rest of the afternoon minting tax free money at private Hospitals.

Nurses have more than once been at loggerheads with this clout of doctors. Our ethics as professional healthcare workers have been sacrificed at the altar of greed and we are damned. A radiographer will take his sweet time to come to a public hospital where he is employed and on the government’s payroll because he is hidden in another radiography unit in a private facility making quick bucks. Our moral fabric silently tears apart.

The oaths we took at graduation are no longer binding. They are just empty chants with no hold on our conscience.

It almost looks like a favor we are rendering patients when we treat them or serve them well in public hospitals. As if they must beg us to do what we are employed to do.

Granted, we have excellent doctors, nurses and other healthcare professionals in public hospitals. However, the few ( debatable I know) rotten eggs make the whole crate smell like Satan’s broth.

Indeed the infrastructure is there. Many times the system fail us but I will be lying if I say that we are not sometimes part and parcel of the failure.

This is a call for us to understand that Covid-19 is and will affect us as healthcare workers. It will be very dramatic to see yourself being treated as a child of a lesser god just because you seek services at a public Hospital.

This is one time that we must blot out those stubborn stains within our personalities. We need to treat our jobs as a gift; whether we come out successful will be dependent on our interpretation of this pandemic.

Political Goodwill

It is no longer enough to say you dislike politics. Good politics translate into a good life while bad politics brew the opposite. Policies and regulations made at different levels of the government need the willingness of the political class to enact. Our political elite must face the truth that indeed it is no longer enough to just write down policies. They must be translated into small actionable deeds. These directly affect the consumer who is people like you and I. People that rely solely on public healthcare to survive.

Covid-19 is a pandemic that does not respect social strata or kickbacks from private health facilities. It is a time of reckoning I daresay.

You have become the proverbial ogre. Passing laws that seemingly protect universal healthcare but also passing others that prioritise private health facilities.

It is sad the limited number of Intensive Care Units (ICU) beds we have in public hospitals half a century later after independence. Covid-19, if you did not know, at its severest is causing acute severe pneumonia which necessitates an ICU.

My question is, how many patients do you think we can accommodate in our ICUs across the country? Let me save you the trouble, we have less than 500 ICU beds in public hospitals in the entire country. To get one in a private facility, you will have to pay a deposit of roughly Kshs.100,000.

We have complained of this little fact for the longest time but as usual, our voices were lost in the din of better problems.

I dread the day that we will need to make a decision on who to save and who not to. It is happening in Italy, a country that has fairly stable public healthcare facilities. I hate to think what would happen in Kenya. I hate to even imagine it. But here we are, playing Candy Crush and eating Mukombero because well, that is not our problem, is it? Until it is…

Going back to that canvas which we were painting, perhaps if it was turned and the painter chose to move his paintbrush delicately as we watched, maybe we would appreciate the entire meaning of what he has been trying to day all along.

Covid-19 is that hidden canvas. We are only seeing the back of this tapestry and it initially isn’t making sense. Soon it will and we may not like what we see.

Mine is a voice calling out in the desert of the skeleton of public healthcare, is anybody listening?

KIDNEY HEALTH FOR EVERYONE

There is something eerily familiar with World Day anything. It is usually a congregation of dehydrated people ready to march along the streets of the city in the sun, screaming their lungs out about one cause or the other. When I was seventeen or thereabout, my father asked me to compose a poem towards World Aids Day. Grab a water bottle and a chair, this will be lengthy.

See, dad has worked at Nairobi’s Wakulima Market since eons ago. He calls himself a farmer of sorts. I keep telling him he can barely bend with a Jembe in hand which cracks him up revealing a set of near-white teeth and a cavity. If you can ever see dad’s cavity when he laughs, then you are a damn good joker. I am child, I am.

He is a member of one Chama that had organized a day of awareness with regards to HIV/AIDS. It was International AIDS Day. The theme involved protection so I had to compose and recite a poem on prevention of HIV. Looking back, dad had too much faith in me. He also missed out an opportunity to discuss safe sex with me. No I was not sexually active by then but still, we should have talked ,yes?

Suffice it to say that we talked in the infamous African parents’ design.

Dad: ( one evening in a drunken mood) You! (pointing at my elder sister and I, mostly myself because I was the black sheep of the family) Go ahead and ruin your lives with men.

Me : (In my head) What the hell have I done?

Dad : Continue ignoring me and you will get pregnant and get diseases and then you die and make my enemies happy.

End. Of. Threat.

Also end of sex education.

When I was diving into the outlines of the World Kidney Day 2020, I wanted to find out what was going to be different this time. Why do we mark this day every other March but still keep diagnosing and losing people to various forms of Kidney disease?

STATISTICS

Kidney disease as a non-communicable disease currently affects around 850 million people worldwide. One in ten adults has chronic kidney disease (CKD) . The costs of dialysis and transplantation consume 2–3% of the annual healthcare budget in high-income countries according to British renal society. In Kenya, our patients either do not get timely dialysis and transplantation or simply never get to know they are suffering from chronic kidney disease.

THEME

March 12th 2020 calls for Kidney health for everyone everywhere. This means that we are not only concerned with managing kidney disease but our aim is to prevent it from occurring and also from progression.

SO WHAT NOW?

You will have to agree with me that one of the most expensive diseases to manage in Kenya is Kidney Disease. Time and again charitable fund organisers have rallied behind one if not many a Kidney Disease patients. I have personally heralded these calls and asked you to chip in in one or many ways. I have written articles on #KidneyWednesday even going ahead to show you practical ways of supporting patients and families afflicted with a case of kidney ailment.

In a solemn decree we must agree that the disease burden is fast approaching emergency levels. My mantra as a nurse has always been ,’an informed patient is an excellent patient.’ That self-theory has been echoed by the National Kidney Foundation who are advocating for kidney health education for everyone. #TeamPhoenix, I will keep strumming the strings of this #KidneyWednesday guitar until you hear me out.

Prevention further entails the elimination of chances of chronic kidney disease. Management of high blood pressure, diabetes and structural malformations of the urinary system are among ways we can slow the chances of kidney disease presence.

For patients already on dialysis or on the way to transplantation, cardiovascular disease prevention is top of the nephrology team concerns. That with maintaining a life close to normal as possible is essential.

#TeamPhoenix, it would be vital to note that though Kenya offers twice weekly dialysis sessions to her chronic kidney patients, world-wide practice is thrice weekly. That is more effective in clearing as much toxic waste from the blood as possible.

Unfortunately, we can not be able to reach that standard owing to inadequate machines and poor uptakes (if any) of kidney transplantion, among other factors. What we therefore can do is salvage the remaining renal functions in an individual and maximise on that. Kidney disease can be prevented and progression to end-stage kidney disease can be delayed with appropriate access to basic diagnostics and early treatment.

My reciting a moving poem at Wakulima market on use of Condoms did not deter the transmission of HIV. Similarly, empty rhetoric on the need for ‘more’ with regards to Kidney disease won’t bear much fruit.

What we need a s a Sub Saharan Country is policies directed at education of not only the public but healthcare professionals. I think that is what they call Multi-service training. We desperately need it. This ensures not only consistency of care but also continuity. That means a Consultant at Doctor’s plaza will not eternally treat his patient for ‘stomach ulcers’ while indeed the patient has early stages of kidney disease. That will mean Nurses in the Maternity wing will take urine and blood pressure monitoring of mothers within the journey of antenatal to post-partum as serious as life and death because that is the clearest indicator of not only an infection but also kidneys’ well being.

That will allow my Paediatrician bestie to feel free to refer children to a nephrologist at the earliest opportunity without feeling condemned by her superiors. Her diagnosis investigated not castigated.

These efforts will jointly allow the medical team to speak a similar language as far as screening for and managing Kidney disease goes. In a nutshell,there is a desperate need to increase the awareness of the importance of preventive measures throughout populations, professionals and policy makers. Without these, the World Kidney Health Day will always be something to look forward to and to swiftly classify as a blurred memory year in, year out.

Take advantage of the free health screening that will happen in different hospitals next week in Kenya. Go have your blood glucose checked. Go have your blood pressure monitored. However do me a favour and take the advise you will receive seriously. Act on it. It is important.

Where will I be? I am glad you asked. I have a feeling I will join fellow Renal Nurses at Kenyatta National Hospital Grounds to mark this auspicious Day. Please say you will come. If not for anything, I can at least show you where your kidneys are located. Yes? Thank you!

Now friends, place your right hand on your chest or breast and repeat after me,”Kidney health for everyone, everywhere.”

My Black-ish Wedding

The inability bybmen and women to deal with their mistakes is what causes so deep a heartbreak.

I was going through my wedding photos and I came across my solo photo. I looked heavenly. Sleeveless gown bedecked with fake silver pearls on the bosom. Cinderella waist out-flowing to meet the short train of the gown made me a sight for sore eyes. My smile caught the sun rays and it made my eyes shimmer with astounding glory. Then the eyes. Wide open with glee. Fake lashes giving more diameter to my lenses. A photo so beautiful it breaks my heart again and again. It was highlighted with black as deep as the pit in abyss. I still feel it sometimes.

There is divorce when you are in your forties with a few babies and a cat, then there is divorce when you are in your twenties, no babies and definitely no cats. Not because you do not like cats but because you really do not care about pets. You have no home plant either. You take care of everyone but pets and humourless house plants. You do not hate them. You just feel nothing for them and that makes people think you are a monster. Maybe you are.

It confuses people. Not the lack of pets you Wiseman, the divorce. It flabbergasted me for a while. Not a while; more than just a while. I hid the fact that I was ever married. Divorce in my world, represented sad women narrating their gory life histories over cups of morose coffee. Women with motivational quotes all bordering on men being four -legged animals. I would hate to be identified with that clout of misery.

When I went for the Divorce care Counselling, the first words I ever uttered were, ‘ I do not want to be here.’ I meant it. Who wants to be in a class of grown ups sobbing about the unfairness of life, not me! I was mistaken.

See, I always had my life figured out—or so I thought. At 26, I knew I wanted to have my first born. I even had a name for her because God help me, it was going to be a girl. Looking back I think that was pretty naïve. I am not famous for my brilliance though.

At 26, I walked down the aisle with who I believed was my life partner. When I tell my best friend that I wanted to run away the same day I walked down the aisle, he laughs his lungs out. He feels I am the most melodramatic girl he has ever met. That is a coveted title I humbly accept. That , friends of God, is a crown I wear with as much pride as Aladdin’s genie at the three wishes.

I walked up the aisle (surely the opposite of walking down the aisle is walking up,no?) an year and a suicidal ideation later with nothing but the pieces of my broken heart. If I listen hard enough, I can still hear my heart shatter on the cold concrete floor. If I stay still enough, legs closed in the famous Lotus posture, inhaling a concoction of brutalist fumes from elderly candles, I will hear the veins of my heart burst open. If I stay without blinking for thirty seconds, muscles of my eyes trained on a big black circle, I will see the trickle of hot blood from the heart that hung on shards of glass.

I do not want to go into the details of the events that led to the famous fallout. Partly because it is depressing and majorly because the outlines are clear but they fade at the edges leaving blurs and smudges, after that, everything is dark. Darkness is one struggle I choose not to have.

A legally divorced, gorgeous (I just complimented myself go hang) and baby-less lady in her twenties attracts all sorts of mysteries around you. It started with speculations that lack of a baby was the reason why that union collapsed. It morphed into many theories which I gave up refuting. There is nothing that screams GUILTY as attempts to deny a story. So I let it go on. The noise was however too much and I had to excuse myself for a while. It served the purpose of allowing my former partner to spin his web of lies in my absence. I never bothered correct him.

What was even more infuriating was his dismissal of the court proceedings. He chose not to attend or contest the divorce or even face me in court. He chose lies, more lies and even more lies told to willing and listening ears. It broke me into smithereens.

That helped not because men generally assume I am in some sort of emotional limbo. Women on the other hand assume I am living in denial. When I tell girls in the twenties like myself that I look forward to love and marriage, they shudder with awe. Men on the other hand keep assuming I am desperate to get laid.

I encounter men who ,much to my chagrin, imply that coming to my house is a cute way to start a friendship. I will never understand that concept. It takes a man a few days of infatuation to suggest I need him in my house. The idea of a woman having her wits about her and still be single is foreign to many. There is one who actually told me I am at the age where I should read signs and interpret them wisely because the years are moving and soon I may not have a baby. Soon, went on the Great Seer and Interpreter of Women’s Ovarian Cycles, I will get too old to get married. I should, he summarised his speech, lower my standards and get on with him as he is available and learn to love him on the way. I was galled. Miffed. Stupefied and in a catatonic stupor as he spewed his version of wisdom.

The problem with this type of thinking is one. I have been there, done that. I know how grave getting into a union for the sake of it is to me as a person. I know how dangerous it is. I have lived and held it. The poison has coursed through my blood and hit every vital organ. I have known pain from such a myopic perception.

Such notion come from men who are used to treating women wrong and women letting them get away with it. We are so used to being mishandled as women that we consider it our normal. Chaotic relationships have become our new way of living and we do not expect anything more.

Men on the other hand have gotten used to the idea that they are God’s gift to women and so women should keel backwards and let them pass. Unquestioned, unchallenged, masterpiece. I was so damaged that I thought everything he did against me I deserved. I was so hurt and broken in ways I can barely outline that I felt he was doing me a favour by loving and staying with me.

Time however, taught me the beauty of damaged people—they know they can survive. I did.

I have met ladies who have been separated 0r divorced and they all felt a certain closeness with me. Because someone understood them or their stories. We however almost always fall out with them. #TeamPhoenix, when one undergoes untold pain and subsequent loss of a marriage, fear grips them to hellish extremes. That coupled with anxiety makes for a beautifully bitter woman. Bitter with men, bitter with society, bitter with self.

Separation and divorce makes one nurse feelings of anger and hatred which will make you sing the men are dogs chorus for the rest of your spartan living. I refused to be that woman.

I refused to be the girl who tells others how unforgiving marriage is. I was unsupported, unloved, abused and misused and my love disused. That is the truth. However how I interpret my truth is a struggle. I chose to make a lovely struggle.

I make deliberate efforts every single day to view marriage as a beautiful story. I have enough reasons not to. Believe me I do. I strive to view love as a butterfly that won’t leave my tummy. This is my way of doing it. If this makes me unreal then I am as guilty as charged. I am not blind to abusive relationships. I am as woke as woke can be. However I refused to let my past define my future. That would be giving him too much power over me and last I checked, dude wasn’t worth squat.

Peace with myself, happiness with myself is the thing I never gave myself for 26 years. It took four wrong years for me to realise how utterly selfish I have been to myself. Now that a couple of years have passed, I look back with appreciation of my short stint at marriage. I do not think I would have known myself as I do today had I not been thrown against the rocks of my turbulent marriage episode.

I however wish I did not have to undergo such a calamitous moment for me to appreciate myself. It was unnecessary and an overkill. But I did and it will always be my choice how I deal with that. I have loved me in ways that I can not explain. That sounds like a line from the motivational speakers club. Ha ha.

No, I do not say so to pep talk myself. I mean it. I have learnt my blind spots and in certain flashbacks I wonder how that son of my former mother in law dealt with my emotional volatility. Well, he did not.

Self- love is the ability to realise that you suck at most things in life and actually doing something about it. It is the looking of self through Rose-tinted spectacles and yet see the logs of wood that impede your sight.

In the Divorce Care program, I met men who had undergone hell and that may have opened my eyes into the fact that people are people and their being nice or nasty is not related to their gender.

By the time I was done with 12 weeks of counselling, I was able to say yes, I was once married and yes, I look forward to marriage again in future. I was able to forgive all my mistakes and those of my former partner. I was able to say with a finality that the marriage should not even have happened in the first place. I made peace with that. It was just a glamorous waste of everyone’s time. Oh, but people love a good waste of time, don’t they? That coupled with a beautiful wedding gown and classy photos is a nice way to spend a Saturday afternoon isn’t it? Yes I am laughing…

I will not sit down and perpetuate fear of love. If anything love does take away fear. That does not mean I am desperate for a man. I was at 26 and it landed me in a place I was not supposed to be. I was and it made me make stupid decisions which I have had to seek help to accept and live with.

That is how I confidently say no to the few that imagine coming to my house is a thing. I still believe proper men exist. Chivalrous even. Men who respect women. Men unthreatened by strong women. Men capable of being men without leaning on anything else. Men able to make peace with their demons and still smile and laugh from the belly. It may make me simplistic in my opinion but well, it is my opinion.

I say a few more Nos to anyone and everyone hell-bent on psychoanalysing me. Hell-bent on explaining my past, explaining my present and definitely out to make me feel under pressure. Love, I have learnt, includes a mutual friendship and understanding. It is not self seeking. It is the small things we choose to do or not do that define a marriage.

Therefore if you see me smiling like the moon gazes at me every night, let me for I have learnt what it is to lose a smile. Let me because I have known days when the tears never dry. I have felt pain in my heart in more ways than one. My story has been distorted to fit the other person’s narrative. I have watched as friends and enemies talked about me as if I was not in the room. Oh I have felt it all. The betrayal and disrespect. I have held it in my trembling hands.

God though, held my hand through my murky waters. He made me get away from toxic situations and let me go many miles away from those that wished me harm. He said I am His daughter and He has my life figured out . All I needed to do was follow Him. I have experienced that peace that surpasses human understanding. I have experienced calm in a storm.

As for now, I remain the villain and superhero in my post divorce period.

PERITONEAL DIALYSIS

I’d really appreciate your kidneys.

I recall with trepidation my peritoneal dialysis assessment at Kenyatta National Hospital. To be fair, practical exams always freaked me out. They still do. No idea how I pass. I am a fairly stable nurse in practice but the idea of following all rules while a towering mount of an assessor is on my neck sends shock waves down my already stiff spine. If that assessor is as thorough and committed as the one we had for peritoneal dialysis, you are bound to swallow your tongue.

Madam O (as we will call her here) together with my mentor Madam R (hail myself, queen of creativity) had drilled to our heads that all that stood between us and the title of Nephrology Nurses was peritonitis. That is infection of the sheet or membrane that surrounds all abdominal organs.

We therefore washed hands. Disinfected them. Washed. Disinfected. If my hands were an emotion, harassed would befittingly describe them. My skin thin as a whisper. We learnt of sterilizing hands. We became connoisseurs at hand wash. Befitting champions. It was needed. It was life-saving.

Imagine my horror then when I recently walked into a room at the far end of our unit’s wide corridor to find a man busy doing a bag exchange! What’s more? He had all the products I struggled to understand back at Renal Nursing School. His hands shimmered with lack of microbes. Kirk (the man) is my mentor in the Renal Unit. I have been a volunteer for a while now and I work under his able guidance. Fellow nurse, suffering end stage renal disease, on peritoneal dialysis. Let. That. Sink. In.

SO WHAT IS THAT?

#TeamPhoenix, the internal organs of the body are covered by a double folded layer of membrane (sheet) called a peritoneum. It is so large that it allows all organs in the abdomen to be invaginated inside it. Invaginated, big word, yes? Ha ha.

Dialysis as a term simply refers to “cleaning of blood”. Some processes apply and the easiest is osmosis. This is a fairly easy term. Okay, shall we revise your primary science lesson? Do you remember your science teacher asking you to scoop out some flesh of a potato and put sugar inside it?

Mr.Mbui (my Class 6 Science teacher nicknamed Mnyama wa porini) went further to talk about a semi-permeable membrane. He outlined how this membrane of my potato allowed water to escape into my sugar overnight. He said, with voice as hard as the canes he used to rain on my cracked feet, that semi meant ‘partially’ while permeable meant ‘to pass.’

Mr.Mbui was the type of teachers who punished you not for getting less than half marks in your Science exam, but for dropping the marks. He kept a record and woe unto you if you ever got 100% at a CAT, you better maintain it till the end of the year. Lest you discover the true meaning of a good deed never goes unpunished.

And I miss him. I miss Mr. Mbui. Who knows of his whereabouts? I know he retired but man oh man, did he not make me love anything scientific! Well, until I discovered literature in high school and decided to be more art than science.

I digress.

The same principle applies with this God-given membrane. It allows for some substances to pass from the blood. All we need is to make sure there is another solution to exchange these substances with.

WHAT HAPPENS?

Peritoneal dialysis involves the surgical creation of a tiny hole in the abdomen near the belly button to access the peritoneal space. Now, remember I mentioned it to be a double fold? Imagine that space between the fold. That is what the surgeon wants to access. They then put a small tube called a catheter. This is the one that we shall use in peritoneal dialysis.  A special fluid (water) is put through that catheter into the peritoneal space. It is allowed to rest for some hours.

Si even the potato was allowed to rest overnight? During his period of rest, the water is in close contact with this semi-permeable membrane which has very many blood vessels on either side to allow for exchange of waste products from the blood to the fluid that we already put inside.

Let me make it palatable. The water acts like the ‘sugar’ in the potato. It pulls out excess fluid, urea and other toxins from the blood and allows it to be manually removed. This removing (draining) of the dirty water in exchange for fresh fluid is what we call a bag exchange. That is what I found Kirk meticulously doing in his special room.

I believe that is better.

HOW NOW?

The fluid we use is commercially produced hence we must buy it from the shops. It is so hard to get it in Kenya that sometimes patients have to wait hours no end to have it imported from India, UK among other nations that are practicing this life changing procedure. The good thing is that anyone can do this procedure if well taught. For my mentor Kirk, he had to be taken through it, despite being a nurse, by the Community Dialysis nurses in this region. End stage renal disease spurred his interest in becoming a renal nurse. It has been three years and he is finally on the way to transplantation after a long wait for a suitable donor.

WHY DO WE NOT DO IT IN KENYA?

#TeamPhoenix, when one talks of dialysis in our setup here in Kenya, we automatically expect it to be hemodialysis. As a matter of fact, many do not even associate the term dialysis with anything else apart from one machine, many tubes and a laborious four hours to boot.

This narrative has been whipped properly by the government’s initiative to install a Renal Unit in each county in Kenya. That has shot with enough steroids to down a horse by the mushrooming of private centers that conduct hemodialysis as long as you have an insurance cover. Or a well-layered wallet. Or both.

Like I have come to appreciate, renal units are not complete unless they are tackling all aspects of the renal replacement therapies. We have largely ignored peritoneal dialysis in Kenya for reasons best known to the powers that be.

We carry peritoneal dialysis out on children who are unfit for hemodialysis. This goes for infants and like my dearly departed friend before he was old enough to be strapped onto the hemodialysis machine (see his story on the previous #KidneyWednesday blog post). Do not get me wrong, children and indeed infants do undergo hemodialysis but not in Kenya. I am yet to see it happen. So in cases of renal failure, we go for the available mode—peritoneal dialysis.

My problem is with the uptake of peritoneal dialysis among the adult population. We can teach adults to properly perform peritoneal dialysis on themselves or their loved ones. We can free up the hemodialysis machines and stop keeping patients on wait for a chance at dialysis by simply teaching them how to do it. Must we sentence people, working people, school going people and their relatives to twice weekly visits to the unit to have hemodialysis? What happened to individualized care?

If we have patients on peritoneal dialysis, we might even lower the cost of the peritoneal dialysis fluid. An adult uses about 8 bags a day and given the average cost of each bag to be 2,000 Kes, I doubt anyone would afford it.

I say this given the socioeconomic dynamics of almost all our patients. National Hospital Fund and other insurance providers could then encourage patients to take up peritoneal dialysis by taking care of the cost of this fluid. This is the beauty of Universal Health Coverage envisioned in the Sustainable development goals and reflected by President Uhuru’s Big Four Agenda for Kenya’s development.

A demand for peritoneal fluid will force our chemists to locally produce this fluid to lower the price of one bag. Surely we have learned industrial pharmacists and chemists? Is Manufacturing not a part of the big Four agenda? We only think cotton, milk and sugar whenever manufacturing is mentioned yet this is a beautiful way of diversification?

#TeamPhoenix, if one is able to understand their illness and manage it, then they become great partners at healthcare. I do my best to give you the knowledge because I believe in empowerment of my audience. Do not approach illness with a nonchalant attitude. It only gives room for exploitation and misinformation. Take an active role in health education especially management of end stage renal disease.

In a country where the rate of kidney transplant is grossly unproportional to the rate of demand, we cannot afford to be apathetic with peritoneal dialysis. In a country where the hemodialysis units mushroom in the name of profit, we really can’t feign ignorance. We must ask and agitate for peritoneal dialysis to be reintroduced in Kenya. Patients can then wait for a transplant (if feasible for one) while on peritoneal dialysis.

I do not understand how Zambia, Tanzania and Malawi are practicing it while we hide in the cocoon of peritonitis.

Granted, peritonitis (infection of the peritoneum) is one of the most life threatening concern with peritoneal dialysis. However, home inspection, rigorous hand hygiene among other factors are considered even before initiation of this procedure.

End stage renal disease is already a terminal illness. We should not make it even worse by choosing for patients the mode of renal replacement therapy. The current ‘one fits all’ approach is an atrocious representation of facts. Each case of end stage renal disease should be examined with merit and patients told about peritoneal dialysis because it is a choice and it is pragmatic.

Yes there are a myriad of hurdles but have we at least tried? What about trying again? And again until something gives?

Thank you for passing by.

IN LOVING MEMORY OF MY FRIEND

Death leaves a heartache nobody can heal and love leaves a memory nobody will steal.

These past few weeks have been heavy. Not only for me but for all those knew and interacted with Eric, my little best friend who passed on after battling kidney failure. He was twelve years confidently and surely. Though the misery of poverty and illness had died a thousand deaths in his spirit, the reality of Alport Syndrome lingered on in his little body like a vengeful zombie. For him and other children, let us demystify this rare and genetic disease called ALPORT SYNDROME.

If you are new to these #KidneyWednesday sections, let me welcome you. The message on health and particularly Kidney health is one I do my very best to speak of in the simplest of terms. My target audience is not the specialists but every other Kenyan without any form of medical knowledge. I hope to speak to you in a language that you can identify with. However, some terms will be highly technical and if you do not understand I really encourage you to interact with me in the comments section. Feel free to contact me on www.facebook.com/catemimi and let me know your concern. @catemimi1772 is another way to talk to me on Twitter.

I do not have all the answers. You letting me know your concerns and questions will help me to seek for the answers from the great nurses that mentor me and doctors and other professionals. In return I will package that information in the simplest terms possible. Deal? Thank you.

ALPORT SYNDROME

This is a genetic condition characterized by kidney disease, hearing loss and eye anomalies. That means the patient will present with some degree of eyesight loss, some degree of deafness and some degree of kidney failure. These symptoms occur in childhood or adolescence for most of the patients. Alport syndrome being genetic means you are born with it. Not everyone gets it though. Let me explain a bit. Alport syndrome is inherited through the X-linked recessive pattern. Wachana na hiyo kiasi…Anyone up for a biology refresher course? Ha ha

X’s AND Y’s.

Males have an X and a Y sex Chromosome while females have an X and another X as their sex Chromosomes. That tells you all Kenyan men, it is not that your wife isn’t giving you sons; it is you who has the chromosome that can result to a son and you need to research more on how to make a baby boy. I digress.

Mutations (changes) of specific genes in the X chromosome lead to manifestation of this disease. There are specific materials needed to make each and every tissue in our body. All the information is contained in genes. There are genes for every part of our body. That explains why my cheeks and those of my siblings will always be full. It is because our parents’ genes decided to carry that information and use it while manufacturing our chubby cheeks. That is why your nose is the way it is. What I don’t know is whether genes are to also blame for my never growing hair.

It has been ten years now and every girl and their cat have long hair. Mine arrived came to the land of menopause and fell in love with the place. Oh the pains of kinky curls!

To filter urine, kidneys are comprised of millions of small structures called nephrons. Within the nephrons, there is a sieve-like membrane that allows waste products to pass through and come out as urine. We already said what urine contains. Right? Eti left? Hehehe you are funny. This membrane is interspersed with a fine network capillaries and together we call it the glomerulus. That is singular. Plural is glomeruli. I would go further and discuss the glomerular basement membrane but we are not here to get medical. We are here to at least get the basics.

Think of a regular kitchen sieve and a handle. The sieve is your glomerulus and the handle is your tube which will allow urine to pass through. Fair enough.

There is a specific protein that is needed in the formation of this glomeruli. This is the type IV collagen protein. Mutations in the genes specific in making type IV collagen cause abnormalities in the glomeruli and subsequent inability of kidneys to properly filter the blood. Type IV collagen is also needed in the making of Organ of Corti in the inner ear. This is an epithelium (membrane or lining) involved in the transformation of sound into nerve impulses for the brain to interpret.

Therefore, abnormalities in type IV collagen will cause hearing loss. Okay medics, it will cause sensorineural hearing loss. Sijawasahau hehehe.

Type IV collagen helps maintain shape of the lens and cells of the retina of the eye. That tells you changes in how this protein looks like will mean changes in the eye lens and retina. The retina is where we find the cells of sight and this will mean different degrees of blindness.

I am now biting my nails in the corner of my room eating last night’s disappointments hoping to my ancestors that you #TeamPhoenix do understand the three relationships. That is, this is not witchcraft like I saw some of you allude to in Eric’s case or a curse from the gods. That it is a genetic condition and the village witches had nothing to do with it. Sorry you alumni of Hogwarts school of witchcraft and wizardry, this isn’t on you.

INHERITANCE

The genes needed to make type IV collagen are within the X sex chromosome. It follows then that women will most likely pass the disease to their offspring while themselves are not affected.

Hold that thought please.

If a man has the mutations in these particular genes in the X chromosome. He too will pass it along and most likely he will already be exhibiting the signs and symptoms we have discussed. This is because, again, women have two X sex chromosomes while men have an X and a Y as their sex chromosomes.

 Dear God, show me a sign that kinaeleweka…

In males (XY) who have one altered copy of COL4A5 (the gene in question) in each cell, it is enough to cause kidney failure and other severe symptoms. In females (XX) who have a mutation in only one copy of the COL4A5 gene, it usually only results in hematuria.

However in some cases, it is inherited in an autosomal recessive pattern. Simply put, parents of this individual have one copy each of the mutated gene (carriers). In this case males and females are affected alike.

DIAGNOSIS

I would be very happy to write text book procedures. However, that would reduce this blog to a site of plagiarism with intelligent insults. See, in the Kenyan set up, such diseases get diagnosed by accident. It means that the parents have time and again presented the child to the hospital with either blood in urine, hearing loss or blindness. These are usually picked by the teachers who notice change of behavior with a child more intimately than parents do.

Sometimes the child will start speaking loudly and saying too many ‘repeat what you said.’

That is just but a clue to what could be happening. Thinking about the above, so many reasons can be attributed to them. It goes to show you that there is no walk in the bright sunny park as far as diagnosis of Alport Syndrome goes. It may take a few months if not years for the doctors to know what they are dealing with. By this time the kidneys will be damaged beyond repair.

A kidney biopsy will indeed detect the scarring of the glomeruli. Specifically it allows for testing of type IV collagen which will be absent in people with Alport syndrome. Genetic testing will confirm the diagnosis and help in determining the inheritance pattern so as to help other family members.

TREATMENT OR IS IT?

You will not treat Alport Syndrome. I wish we could. What management involves is monitoring and deterring progression of the disease as well as supporting the individual in different life skills. Patients will need hearing aids and in the case of blindness, ophthalmic support.

With regards to the inevitable end stage renal failure, dialysis and Kidney transplantation is the way to go.

PREVENTION

It really would be grand if we had some sort of genetic counseling centers in Kenya. That would allow us to seek information regarding our different health conditions. That would inform our decisions on what to do or not do. This is a tentative area pregnant with misinformation so I will shamelessly let it hang in the air like unclaimed Valentine’s roses.

Alport syndrome when detected early will be slowed down in its progression. Management of high blood pressure will be key. There are a wide range of drugs safe in the management of high blood pressure. There is, specifically, a cluster of medications concerned with preventing proteins from leaking through the glomeruli into the urine. These are the ones that the nephrologist will go for.

OUTRO

Funds were available through numerous fund drives for Eric to undergo kidney transplant but he passed on before that could be actualized.

Thank you all of you that empathized with his story and to all the parents, guardians and families and friends dealing with this horrendous illness, from my heart is a warmth of understanding, love and unconditional support.

Till we meet again Eric, Rest in peace.

COLORLESS VIOLENCE

We have no future as a people if we do not stop having violence (paraphrased from Edward Bond)

There are many things I have believed all my life. Like If it rains while still sunny, monkeys and hyenas are getting married in a beautiful jungle wedding.  If you cross the outstretched legs of your elders as they warm around the fireplace, you will never give birth. They are truths I held dear until I grew up and realized my clan and their clans played me. I however hold grudges against my elder sister Immaculate. That lassie told me that I have large-sized feet because I hated washing them. Who lies to their baby sisters like that? I am yet to execute a revenge.

I have been enlisting the services of the committee of experts in my head for most of my adulting and they are yet to give me a befitting course of action. I called her out to my whole family in the last get together. I wanted them to realize that behind that calm demeanor lay a not-so-immaculate wicked heart. They did not. They all burst out in peals of laughter that would put excited teenagers to shame. Labelled her creative. She even told dad that she had said so to help me love water because for most part of my childhood, bathing and I were sworn enemies.

I will tell ogre stories to her children you wait and see. They will hear it from me.

When dating and love and the whatnots of restless hearts came in, we were told that there are certain calibers of men that treated their women well. We were not taught to find them or to be found by them on the basis of their characters, no. We were to base this elusive gold through tribes, sub tribes, clans and race.

Stereotypes were painted in our hearts and agile minds that a man was indeed as good as their surname or lack thereof. Coupled with happily-ever-after-infused telenovelas, the reality of pain and pleasure of love was lost on us.

I had been mulling over how untrue all these things have been when I knocked on the Duty Room’s door to meet Mildred*. Mildred is a nurse in my new work station. It was New Year’s Day and normal people were either making resolutions or having their time with families. Nursing is not a job that allows anyone to be normal. We were therefore being on duty.

I had spent the New Year’s Eve at a street party and there ensued a stampede which saw my ankle half sprained. I wanted Mildred to please take my shift as I went home to cool my heels down.

That is when I saw her. Her milky white skin was flushed on both cheeks. Her lower eyelids colored in tiny dark streaks of the mascara she wore. Her lips smudged and minute traces of purple lipstick clung on. Her eyes, though winning at a smile were worn out like a tired headline. Verdict; she has been crying. In comes Catherine, deducer of the obvious and master of apparent observations.

Tenderly placing the stethoscope I held in my hand on the table, I asked Mildred what was happening. She ignored me and went back to furiously write a letter she was engrossed on. I felt pity for that piece of paper because the strength with which she wrote made me conclude, again that that paper had hurt her.

After realizing I was not going anywhere, she looked at me and said, “Catherine I can’t take your shift because I must go home to see my children before something happens to them.”

She said it with such a finality that my curiosity was piqued. She opened up.

Mildred has been living with her partner and father of her children for the past five years. He has been beating the living lights out of her as well as being an emotional, sexual and the in-betweens abuser. He is the most charismatic man to the rest of the world but a jerk at home. He makes her go on diets to be plump or slim depending on his present fantasy. This man had been arrested and charged over five times in the period they stayed together due to battery in its different forms. Restraining orders had been broken time and again. Twice he has been in remand but Mildred went and bailed him out. You read that right. He beat her, got arrested, she bails him out. That has been the cycle she had been through.

Why you ask? Because of the same reason every victim defends their abusers –control.

She showed me copies of doctor’s assessments after she was sexually abused by this same guy. She hoped, with time, that she will make herself good enough for him but in the meantime she wanted time off to go be with her children. She was drafting a letter, therefore, to the manager asking for an emergency leave.

I was perplexed. Not because she had bailed him out but because she is a White woman in a White country which is thousand degrees up on the civilization thermometer. With coercive control being a crime in this country of the Queen, I was appalled by the presence of such inhumane treatment and silenced intimate partner violence. Gobsmacked because my truth of White men treat women betterthan my African brothers was shattered right there in my eyes.

My truth that White men only mistreat Black women was ripped at the centre. She showed me scars on her back from whips this man has used on her when he felt that she needed ‘disciplining.’ A cold chill that had nothing to do with the wintry weather outside made its way down my back.

That first day of 2020 taught me how tasteless and utterly colorless violence against intimate partners is. I went back to the many taunts from a few friends that I am better off marrying a Mzungu as they treat people well. How ignorant that statement is.

Treating your partner right, respecting them, wishing them well has nothing to do with race. Take that and run with it. Race is what we see on the outside. Perhaps the westernization of most of our television love stories has made us assume that the rain of abuse only pours in Africa. N to the O.

Violence is a torrential storm sweeping across all colors, shapes and forms. Violence knows not your surname. Abuse does not respect melanin or lack of it. At this juncture, Mildred is just another sister girl going through the patches I have had to go through. Mildred is a girl held mentally captive by her abuser just like many victims are. She is a girl not taught and not able to be taught by her current system, how to value herself and move out of a potentially fatal situation. I cry for her. Not because he will be back in her life but because she will let him in.

She is a girl whose story stings my heart in different new ways. It is not about where one comes from ethnically speaking. This is all about one’s virtues as a level-headed human being. An evil person is evil whether they come deeply spiced and tenderly marinated from an island in the Caribbean or Canada. A good person is good whether Taiwanese or Togolese. Goodness and evil transverse the globe in varying shades of melanin. It is your happy day to accept this plain truth. Actually, use this as your New Year’s entrance song. Wrap it on your elegant neck. Cuddle it to sleep. That, #TeamPhoenix is all the motivation speech I will throw at you this year. No promises though. Ha ha.

 I no longer wonder why victims stick with their abusers. The element of control by the perpetrators is played with surgical precision. Abuse, essentially, is not so much the physical as the mental hemisphere from which it emanates. Violence is about control. The battery, insults and assaults serve to buttress the emotional and mental regime of captivity.

There must be something more than the physical walking out of an abusive relationship. If not there, one tends to keep stumbling over the same outgrowths of misery then blame it on life being thoroughly unfair to them.

Like Mark Manson I pose, how special do you think you are that life suddenly decides to focus on making you sad all the time?

#TeamPhoenix, Tweni tweni has not even had a cuppa tea so here is my Beautiful New Year Wishes to you!