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Practical Approach to Diabetes Mellitus

November 14th is recognized as World Diabates Day. I pay particular attention to Diabetes Mellitus as it is one of the two leading causes of chronic kidney disease. Further, it is responsible for many complications chief of which touch on the heart leading to premature deaths.
Diabetes is thought of as a sugar problem. However, that viewpoint maybe a little skewed as the meaning gets lost in the interpretation. According to various health journals and groups like World Health Organisation, Diabetes is primarily an insulin problem. Insulin is a hormone produced by the pancreas.
This hormone helps our body cells to absorb sugar in its simplest form (glucose). Insulin is the engine that must be present for our bodies to utilise the fuel that is glucose. Understanding this therefore helps us to understand how to manage and handle Diabetes Mellitus. It forms a foundational framework for any further reading. It is the bedrock upon which further understanding is based.
Because we need insulin to absorb glucose, its lack means that our body cells stay hungry while the bloodstream is full of glucose. Talk of being too close yet too far. We eat, digest the food and break it down to glucose which is now in the bloodstream but it can’t be utilized by the body cells. That causes cellular starvation.
Starvation of cells causes many problems including loss of consciousness. The other issue is that blood cells can only accommodate high glucose levels only to a certain degree. Beyond that, they get affected and stop working as they should. For example, white blood cells become less effective in their ability to protect the body from infections.
On the other hand, the pancreas may release enough insulin but the body cells become resistant to it. This is the bane of today’s blogpost.
Insulin And Fat cells
Ignorance, I have had to admit to myself, is not as blissful as previously advertised. I came to that conclusion when my endocrinologist looked at me and told me I was overweight and it would make management of some condition I was dealing with even more difficult.
I was in denial for a while. Because I have been overweight all my life. It doesn’t show because it comes wrapped up in all the right places. A curve here and a corner there. However it was not until I started paying close attention to Diabetes that I realized that I was preaching water while drowning in a pool of wine.
A high Body Mass Index (BMI)has been credited with the risk of developing Diabetes. BMI is calculated in relation to one’s height. What I do not understand is whether we have values for particular ethnic groups. Is it just me or do Africans and some Asians tend to be shorter than their Caucasian counterparts? Is it why they say ‘American height’ at the runways? We will never know.
Fat cells with time become resistant to insulin. That by itself is enough for the insulin produced by the pancreas to be rendered useless. Let me explain this concept further.
When one is overweight, it simply means they have more fat tissues. These fats decide to surround internal body organs. They are the shock absorbers par excellence. My colleague recently joked that he has a chiseled six-pack only that he protects it using one thick layer of fat. You get the drift, yes?
When we have excess fat layers surrounding the body organs, it becomes difficult for insulin to reach the targeted cells of those organs. Picture this, insulin is a fire engine that needs to get to town on time. But this is Nairobi city where the traffic menace is in itself a tourist attraction site. Our fire engine will try all it can but chances are, it won’t get to town on time.
That may not have been a very accurate analogy but it directs you to what happens with insulin resistance. We may not change the fact that we are from certain descents and families which may predispose us to developing Diabetes; but we can change the aspect of being overweight.
If anything, it shows the universe that we aware of our surroundings and we are willing to do something about it. I hear that the universe responds to what we give it. Weight loss should however not be a do or die matter. Not a critical deadline issue. On a personal level I am horrible with too much pressure. I however like deadlines. I like the sound they make as they fly past me. Ha ha. Weight loss is a lifestyle change.
Diabetes especially type 2, is mainly a lifestyle disease. It then follows that if we can modify at least one aspect of our lifestyle, we are keeping it at bay. This one lifestyle choice is healthy living.
Healthy living besides pointing to a healthy weight sustenance involves physical activity too. The caveat here is that being physically inactive is as risky as being overweight. Inactivity simply increases the level of low density lipoproteins (bad cholesterol) in the body which in turn increase the risk of developing Diabetes and heart diseases. What I encourage us to do is be physically active.
We do not have to kill ourselves in the gym to be able to flash some muscles for the Gram for likes and commens. We can realize that we are doing it as part of our new chosen way of life. That explains my new habit of taking a walk or a jog in the outskirts of Edinburgh city. And boy, Edinburgh looks splendid in the cover of dawn or dusk.
Some people take up cycling. Others swimming. Others simply dance their hearts away. My GP (General Physician in the UK and Doctor everywhere else in the world) tells me that the trick is to deliberately increase my heart rate. I think he emphasized on deliberately because he knows there are various unhealthy ways I can decide to increase my heart rate. Cute.
Physical activity also makes the brain release good hormones that stabilise our mood. The next time you and I are tempted to stress-eat, we might want to get out of the house and talk a walk. Probably by the time we come back home we will have found new ways to address the situation. Better ways than a bag of more fries.
What I am doing with these anecdotes, is steer you towards better living without the pressure of social media. The day we start living for ourselves, then we start living. Living sounds like a very good thing to do so let’s do it together.
It is costly to manage Diabetes especially for our Kenyan society where good quality healthcare costs an arm, a leg and a pound of flesh. We are better off keeping it at bay if we can.
As we gear up to acknowledge 14th November as World Diabetes Day, it would be a good thing to be pragmatic about weight loss management. Targeted physical activity simply shows an appreciation to our pancreas for the work it does. It sends a candid message that we see her and we recognize her. I think this is where I put a wink emoji.

The Kidneys and your medicines

There is medication for your need for medication
Many things happen when we take any form of drug. Be it prescription drugs like antibiotics or common medicstions like painkillers. The processes through which these substances get broken down may vary but the end result invariably touches on the kidneys.
My promise to you has remained to break down medical information to help you absorb it. Let us talk about these many drugs and substances.
Your body and drugs
For the sake of this blogpost, the words ‘medication’, ‘medicine’ and ‘drug’ will be used interchangeably. That does not mean they mean the same thing chemically speaking.
When you take a medicine for example Paracetamol for headache, it must be broken down to a manner that is able to be absorbed by the body. The blood will then need to transport it to wherever the pain is so that it can stop the perception of pain.
Breaking down this paracetamol down is called metabolism. It is just a fancy word medics use to communicate in that complicated language of theirs. Ha ha.
Drug metabolism takes place in many organs and sites in the body but chief among them is the liver. In fact, almost everything we swallow will be fully metabolized in the liver. From food to alcohol and other recreational substances. The problem with paracetamol and other drugs is that some of their end products are substances which are harmful to the body. That is where your kidneys come in.
These harmful products will need to leave the body system and pronto. Please note that some drugs become useful and able to do what they were meant to do in the form of their end products. However even then, the products of that process of metabolism will need to leave the body immediately.
They are transported to the kidneys for elimination by the blood. This happens by being added to urine. Kidneys are the fundamental organs of excretion. That is why when they want to find out if athletes have used any illegal substances, they do a urine test. Well, not just athletes.
In fact, you may have noted that some medications make your urine smell a certain way or change colour. That just goes to show you that indeed, elimination of that drug (or its products) after it has done what it was supposed to do in the body happens through the kidneys.
Having many medications (prescribed and/or unprescribed) at the same time does not only overwhelm the liver but also the kidneys. Whatever goes to the liver will most likely come to the kidneys.
There is a close relationship between these two organs and pressure in one directly or indirectly leads to pressure in the other. Toxic waste build-up from failed kidneys will eventually lead to a failed liver. Excess waste production by the liver will overwhelm the kidneys.
That is why you hear people undergoing dialysis after alcohol poisoning making you wonder what could have happened to the kidneys; while we are always told that alcohol damages the liver.
Taking many medications is common in the elderly or people that take medications for various diseases. For instance, it is not uncommon to find a patient suffering chronic kidney disease being on treatment for both Diabetes and High Blood Pressure.
Further, if they have other issues for example nerve disturbances, chances are they will have even more medicines. Add that to the fact that we are all embracing alternative therapies including herbal medicine. All these chemicals will be metabolized in the liver and the waste products will have to be eliminated by the kidneys.
What happens then is a build up of noxious wastes. Kidneys become overwhelmed because the rate at which you are feeding the liver with “junk” is higher than the rate the kidneys are removing the said “junk.”
Majority of Over-The-Counter (OTC) medications have a direct negative effect on the kidney cells. A good example is the good old Ibuprofen. It is even more sad to find that renal patients still manage to purchase Ibuprofen and other painkillers in the same class as Ibuprofen yet they damage the kidneys even further.
The net effect of continued injury to the kidneys is a decrease in their filtering capacity. This leads to kidney failure in different degrees depending on what you have exposed them to and for how long. For a kidney disease patient, the ugly becomes hideous.
Reconciliation
It is prudent to be transparent with the doctor about medicines which you are using at any given time. This helps them to do something called drug reconciliation. This involves the doctor going through all your current medicines and deciding which ones need combining and which ones need to be removed or added.
Some medications have the same effect, or are composed of the same active ingredient but are sold under different names. That is why it is vital to tell the doctor about everything you are on currently. This includes herbal remedies.
Some herbal supplements and drugs like Mwarubaini (Neem) and all her products interact with some antibiotics and can be fatal if taken together. Some concoctions we dearly call dawa directly insult the kidney cells and should be avoided.
I don’t know who told some of us Kenyans that whatever is bitter and sold by some guy wearing traditional clothes is therapeutic. Some herbal remedies work and I’m not overruling them. I am just wondering who said everything that is sold by some guy in a maasai shuka is indeed beneficial to the body. It remains a mystery. It is up there in the list of mysteries together with the disappearance of one sock. I even have a drawer for them but somehow one sock gets lost.
Toxic overload for the liver is toxic overload for the kidneys. Help us to protect you by being open about what you are on at any particular time.
If the clinician does not ask, please ask the clinician whether it is alright to continue taking whatever you have been taking on top of what he or she has prescribed. That gives you a chance to know and do the right thing. Being forewarned is being forearmed.
Our role
Doctors, clinical officers, pharmacists and anyone else with prescribing authority must actively ask patients what other substances they are on. This is especially important in Kenya where I’m sorry to say that we do not have very robust prescribing laws. Anyone can pop in to any chemist and buy whatever medication they read about on Generous Google or Fancy Facebook.
They can source the most expensive antibiotics including Third generation Cephalosporins. No wonder we are struggling with super bugs due to drug resistance. This is how we are having to deal with unnecessary acute kidney injury.
It is important to be aware that in our setup, by the time a patient comes to you as the clinician, they have tried other things. By the time you prescribe those medications for high blood pressure, they have tried aspirin-containing medications (for example mara moja), Piriton amongst other medications. They will not tell you if you do not ask. They will assume it is alright to top “your” prescription to “their” OTCs.
Harmonizing the list of drugs a patient is on does not only help the kidneys but also improves compliance. It is stressful enough for our patients to have to take medications but it is even worse when the prescription runs from Tunis to Cape town.
I can’t emphasize enough the need for adequate hydration when taking medications. This increases the amount of fluid in the blood hence flushes the urinary system. By so doing, we encourage kidneys to eliminate as many end products of these medications as possible.
That goes for other substances like alcohol as well. We agreed that even alcohol will be metabolized in the liver. The end product will be removed from the body through urine. The more water you take, the better your clearance is of alcoholic end products.
In addition, alcohol itself makes you urinate more so drinking copious amounts of water helps to replace the water you lose through excessive urination.
The fact is that we have very limited number of dialysis machines in Kenya. The demand surpasses the supply in huge proportions. If we can avoid acute kidney injury caused by medicine poisoning, then by God we should! We can then leave the few machines available for the unavoidable cases. That now, ladies and gentlemen, is public partnership in healthcare delivery.

Nurse Musings

They look okay but deep down they want a nap and a foot rub.
I have been staring at my nursing license. I seem to be doing a lot of staring lately. Where nursing is concerned, my eyeballs have unmatched propensity to pop out of their sockets. As a matter of fact, I might end this blogpost by staring once again at my license. That is not the story.
The story is, I wanted it to speak to me. To answer my questions. To positively say something that would make me happy to be a nurse. I grew up without any nurse role models or mentors. I didn’t even think nursing was a career. It was a preserve for the nuns according to my green brain and there are many things I would have killed to be; a nun wasn’t one of them.
Talking of which, my maternal grandfather, a skilled hunter and beekeeper; held a firm belief that one of us, his naughty grandchildren would be a priest or a nun. By the time I was eight, my truancy and hard headedness had safely eliminated me from the equation. That left my elder sister, Shii and my cousins.
I can’t speak so much for my cousins .My elder sister however, would never make a good nun. She likes watching over my back. Nuns are supposed to be watching over the back of some holy saint. Nuns can’t spend all their life wondering what their baby sisters are upto.
I have no idea what ran through my cousins’ minds. Take Bobo for example. Do you know right now as we speak she is a nun? True story. Right this moment, as Nairobi’s traffic slowly becomes spaghetti, Bobo my first cousin is a nun. I think my late grandpa smiles down from heaven and pats his shiny bald-head with self contentment.
The Good Lord heard his prayer. Bobo is a happy nun. A nun that told me she wanted to be a nurse just like me. See how close my grandfather’s dreams keep coming at me! Not today gramps, not ever. That plus I miss the scoops of honey from you…
Back to nursing. It felt like I was in a one sided love relationship with this profession. Try as I might to give it my best, it just never loved me back. Falling out of love with it was fairly uncomplicated. Unrequited love, said a writer somewhere, is a bore.
In these times of self-doubt and pseudo imposter syndrome, I sought answers from my license. I wonder whether “saving lives” is worth the pressure, misunderstanding, resentment, constant back pains and mysterious stains on my uniform and shoes that accompany nursing all over the world. What lives do we really save? Is it not more of “prolonging life” than actually “saving” it?
The Kenyan license states back at me. My UK PIN eyeballs me. There is a stalemate. Both daring me to walk away. Perhaps knowing I’m in too deep to let go. Nursing is home albeit in a profound, almost comical manner. I have been initiated into this. The adrenaline rush and sugar crashes are all part of the caffeinated entanglement of this profession that neither sleeps, nor slumbers.

They came, they nursed, they documented it.
Nursing is one of the oldest professions even before Florence Nightingale and Mary Seacole. About Mary Seacole, I had to research about her. History denied us a golden opportunity to celebrate a Black person as a foundress of nursing. When we talk about Florence Nightingale and the Crimean war, we never mention Mary Seacole yet this British-Jamaican Nurse was there making lives bearable for the soldiers injured in the war.
But that is a Black Asian and Minorities (BAME) conversation we are not willing to have at the moment. We are too busy dealing with the second wave of Covid-19 and if you’re in Great Britain, prepare for another round of rainbow paintings and claps for your service.
I had a lengthy wordless conversation with my license. In that impenetrable quietude, nursing became clearer. It stopped being limited to the (un)sterile corridors of the hospital. Nursing, like a determined baby dragon, broke from her eggshell and emerged to show herself to the world.
She went into theaters to make films and write plays. She became the screenwriter Safina Iqbal from Kenya. Nursing struck the shells and he went into politics. He wanted to make it count. He became Mheshimiwa David Ole Sankok from Kenya. Nursing wasn’t done, she leapt off the pages of my diary and formed paragraphs in the heart of the author of Nurse on a run; Christine from Kenya.
Nursing went into the modelling industry to show the world what beauty with brains looks like. You should have seen her sashay her petite hips on the runway. You should have seen her match with a stethoscope around her slender neck. Oh you should have seen her tell them that she is proudly a nurse.
He went into sales and marketing and became a gem in notable pharmaceutical companies. He managed winning teams and innovative teams. He became a clinical research nurse. He started working with research institutes.
The timid dragon took off into the great unknown and became a clinical specialist and an advanced practitioner. He started playing in the same league with other medical professions. No longer unbowed. No longer intimidated. No longer silenced. Untamed.
She became a teacher to teach the public and others about their health. They all mistook her for a doctor. With practiced patience, she reminded them all that she wasnt a doctor. She was a nurse.
And because once is not enough, she studied aesthetic nursing and started performing minor plastic surgeries and cosmetology. She went to the United Kingdom/America to study this precious course. She never once forgot who she was. In fact, she became everything she could be because of who she was; a nurse.
She solved the problem of desertion of the frail and old and terminally ill by society through creation of Chesed Home Health care. This agency specialises in home based nursing in Kenya. She started from a scratch.
As my eyes watered from staring so hard, nursing smiled at me and showed me how great he actually is in private and public partnerships in health. He showed me Alfred Obengo,president of the National Nurses Association of Kenya and his diligent agitation for nurse representation in the table of public health decision making. About partnerships with banks to raise the profile of the Kenyan nurse.
Nursing pointed me to Nancy Wang’ombe, president of Kenya Nephrology Nurses Association and her peer reviewed articles on kidney transplantation in International Journals of Nephrology. As I started to put my license away, I saw Nurse H, my mentor in the United Kingdom and she who has produced protocols and competencies for nurses in the dialysis unit. She who is quoted by nurses new and old in the profession.
At that moment, nursing was elevated to a sacrament. Ah, I was content. Thoroughly satiated that what looked so bleak held so much promise.
I will look at my license again, this time not to seek answers but to marvel at the solutions already given.
To every nurse reading this, wewe ni shujaa (You are a hero).

A Healthy Nation

When hospital beds spill to the corridors without a pandemic or a crisis, it is time to rethink our whole system.
My brains were recently picked in another forum. This was in relation to the mega drama Kenyan netizens witnessed a while back at Pumwani Maternity hospital. Because one is never enough, we saw women politicians holding mock protests against the same government they are in.
Perhaps even demonize the healthcare workers. That is what we always do as a people. It is always the fault of the healthcare workers especially nurses.
As I press the keys on my keyboard to write this, Kenyan Healthcare workers in most counties continue to work at home because they are yet to get paid salaries for the months of August and September. Yet these are uncomfortable conversations we are not willing to have.
I may not know the ultimate solution to our public health but I know failure to make politicians use these facilities is a hole in the ship. If a health commission as envisaged in the BBI draft will solve this, then it is welcome.
If all it (proposed Health Commission) does is regurgitate old words using new ink hoping for different results, then we are better off with our familiar mess. Failure to make politicians consume the same decisions they enact is but a bullet in our gas tank. We will collectively explode.
Given my immutable campaign for changes in the public health sector mashed with a diminished capability for pessimism about our future as a nation, find the link to the blogpost below.
https://viewpoints.co.ke/proposed-commission-https://viewpoints.co.ke/proposed-commission-likely-to-restore-health-in-our-hospitals/likely-to-restore-health-in-our-hospitals/

Born With a Smile

If I should ever leave you whom I love, to go along silent way, grieve not nor talk to me with tears. But laugh and talk of me, as if I was beside you there. ~~Isla Paschal Richardson
In one of my many posts on Facebook, I talked about end of life. I challenged the African approach to end of life. I advocated for better management of the terminally and chronically ill in our society.
Just like any creative non fiction writer, I hit raw nerves. I shook trees at their roots. I shook them in their forests. I upset a lot of hearts. One of my readers reached out to me on Messanger. I read all messages and decide which ones to reply to. This one I had to.
She was gutted. She was not amused that I had discussed end of life that plainly. I needed to walk a mile in her moccasins and feel where it pinched.
It didn’t pinch my toes though. It shredded my heart into mince and made pulp out of it. Dinah had never talked about her baby’s death since July 29th 2020. Her husband never talked about it either. Sylvia, as the baby was dearly named, remained an untouched subject. Too raw to approach, too real to bear. Dinah didn’t want to talk but she wanted me to stop talking about end of life.
Yet the memory of Sylvia stood there. Stubbornly refusing to leave. It was as if she was still part of the family yet hiding from it. As if she was still alive but lived in her own shadow. Present but only felt through the whispering pines and seen through the setting skies.
It may be easy to deal with end of life for the chronically ill. Perhaps even expect it a little. Nonetheless painfully devastating. What happens though, when babies die? What happens when a one month and three day’s’ old baby stops fighting and simply crosses over to the other side? How do parents then fill the void left in the shape of the baby’slittle heart?
Dinah wanted to talk about Sylvia so I let her. With her permission I have shared this story. She has asked me not to edit the names. She wants Sylvia’s name immortalized. I wish mine was indelible ink. I gladly would.
****
Sylvia was sweet and calm. She was beautiful. In my own eyes at least. Every mother thinks that their babies are the most gorgeous anyway. Her smile lit up the room. And my family’s life.
She was named Sylvia after my great maternal grandma. And Kwamboka after my mother in law. I loved to call her by her first name, Sylvia.
A month before I gave birth I was sitting at work, and a thought crossed my mind.(I am a pharmtech. My husband too). I thought to myself, ” I don’t know why, but I think I’m going to have a very difficult delivery.”
But then I had the easiest delivery of all three. Shortest labour of all time. From when it started at 0413hrs, I delivered at 0645hrs. I was elated. I did not even get an episiotomy like in the previous deliveries. I was ecstatic.
I have two other children both under 10 years and I had delivered them in untold agony. Sylvia’s birth was rather fast and easy for lack of a better word. She brought scintillating joy in my life as a mother. She was just a beauty! Sylvia was born with a smile.
A month later, my baby fell ill with pneumonia. Hubby and I took her to Machakos Level 5 hospital. While on our way, I noticed she was becoming very weak. She had refused to breastfeed. She was too sick to suckle. My baby was too sick to suckle and this tears me to pieces even now
I called her once. She tried opening her eyes, only the left one opened, somehow I think she was bidding me goodbye at that moment because after that she didn’t open her eyes again.
I have so many unanswered questions you know. Hubby and I are medics and we couldn’t save our own. How fair is that? When she passed on on that cold July night, they removed the big needle they had put in her shin just below the knee.
She bled so much. I saw her soul flow with the blood. My baby left me. She had had that needle because the nurses and doctors couldn’t find a vein to insert a cannula. They tried 32 times. I counted Cate, I counted. She had given up. She was not crying. She was not fighting. She kept gasping for breath and let the medics have her tiny little body.
She didn’t even flinch when they scratched her airways to do a Covid-19 swab test. It turned out negative.
Hubby was with me through all that, he was devastated. But at least he was there when it all happened, he supported me and I didn’t have to break the news to him. I have no idea how I would have.

I remember one nurse however who fought for my baby. My Sylvia. I forgot her name. When my baby died, she was unable to tell me. When I asked her whether it was confirmed, she looked at me, nodded and shed tears then quickly left the room.
That gesture has never left me. I saw how much she gave for the sake of my baby. When the doctor gave up looking for a vein, this nurse didn’t give up. She told me three words,”I will be here.” She was until the very end.
She later came to the room as hubby and I cried into each other’s shoulders. She took a blanket and wrapped my baby as if she were still alive and feeling cold. She never let me see me see her eyes but I could tell she was crying. I pray for her you know. I pray for her. She is a brilliant nurse. She is a kind nurse and we don’t get those often in public hospitals in Kenya Cate.
I refused to go home though. I didn’t know how to face my two children. I didn’t know what to tell them. Hear me out Cate.
When I was pregnant, they kept saying I’m delaying them, they should have fed the coming baby already. You should have seen them selecting baby clothes for their sister. We are blessed to have such good children. They even had a pink bow to go with pink baby shoes.
When I went to the hospital for delivery, they kept calling me to check on me through hubby’s phone. I have never felt so much love in my life. My family was there and this brightened my life. When I brought Sylvia home they were over the moon. Sylvia fitted in like the last piece in a jigsaw puzzle. She was a bundle of love being welcomed into an ocean of more love.
Any time I suggested changing the diapers, they’d rush to get me a fresh diaper, baby wipes, baby powder and baby oil. Then they would hand them to me.
When we took her to the hospital, they both asked me what was wrong with Sylvia. I told them we would go to the doctor and say she was not breastfeeding as she should. That the doctor would do something to help her suckle. They cried. Especially because they could not feed her the same food I served them. I had reassured them that everything was going to be alright. I promised.
Here I was though, with no baby. No sylvia and yet I had to go home. I felt like a failure to my own children. I felt like I had let them down. I failed to keep my promise.
But they are sweet little children. I told them Sylvia has rested, that when Jesus comes back, she will rise again and we will continue from where we stopped. We will change her diapers. We will carry her. And they understood.
In retrospect though, I think I was saying that more to myself than to them, reassuring myself that one day I will see my baby again.
They’re okay now. Occasionally they tell me they miss Sylvia, I tell them pole, I miss her too. Hubby misses her deeply though he never talks about it. I wish I knew how to help him through this pain. He misses her smile. Such an innocent smile. I know he feels what I feel; like our baby was a gift that was taken from us even before unwrapping.
*****
I read this with tears rolling down my face. I remembered my own brother who passed on at one month old. Just like Sylvia, Simon was born in a June and passed on in a July. I said a silent prayer, that our Simon will meet her Sylvia in heaven and that they will be friends. Everyone is friends with everyone in heaven. Isn’t it?

A Story From Poland

Nursing in another country has confirmed what I always knew; we all bleed the same.
I have given up pronouncing his name right. It is written as Szymon. Whatever Z is doing after S I’ll have to take a holiday to Poland to find out. The interesting thing is that everyone calls him Simon. He attends dialysis at the new hospital I work at thrice a week. On these days, there is another patient called Simon who comes as well. Whenever a senior nurse sends me to “Simon” I have to ask “which one?”
It has been a few weeks since I was signed off on my Hemodialysis competencies. That means I no longer have to work under direct supervision of a mentor. I get to handle patients with minimal support from the very busy and incredibly experienced senior renal nurses.
The first time we met we immediately hit it off. He has a funny bone in him and he told me his arteriovenous fistula was just an overgrown tattoo.
An arterio-Venous Fistula is a vein which has been surgically joined to an artery on the arm and allows us to draw blood from the body, to the artificial kidney during dialysis and back to the patient. This is with the help of pumps in the dialysis machines.
I was mortified under my face mask and didn’t know how to react to that. He burst out laughing and I felt the humor ooze from him like colours from a rainbow. I call him Simon with the Z. He chuckles himself silly to that. He said he liked it. He says he knows someone from Kenya. A neighbour in his apartment is Kenyan. I am not sure I believe him. When you live in the UK you get to learn how to accommodate everybody.
You don’t act surprised when someone mentions a country in Africa for example; even if you think Africa is one huge country. And China is representative of Asia. Don’t let them know you don’t even know where Nepal is on the map. Do not say you don’t know that Egypt and Morocco are actually in Africa. Act along. Play along.
You just make sure you get the name of the country and then say you know someone (most likely imaginary) who comes from that same country. Or say you know someone who looks like that person but is from Zimbabwe.
Mention Zimbabwe a lot. Zimbabwe is easier to pronounce than Kenya and Namibia. And hey Brits and the rest of the world, it is Namibia not Nambia. President Trump was just having a bad day when he called it Nambia. Nambia is as real as Wakanda is, forever.
Nursing allows me to interact with different people. A dynamic place like the dialysis unit, however, does not give nurses time to bond and have lengthy impromptu conversations. Especially not in Great Britain where everyone believes in timely appointments. In Kenya, appointments, just like traffic rules, are there as suggestions.
Working as a nurse here makes me want to take the juice of British culture and pour it in a clear bottle, add the extract of the Kenyan culture; gently mix them and pour a dash of the fluid to both countries. Great Britain could do with a little bit of what mother Kenya has. Kenya could do with a little bit of what Her Majesty the Queen’s land has. And I am the greedy mammal that does with a little of both worlds.
Simon with the Z wasn’t as chatty as usual. He sounded subdued. Even forlorn. After every patient had been connected to their dialysis machines, I went back to him to catch up about the weekend and hear what he had planned. This is always an icebreaker in Britain. It is in the top of the food chain together with the weather.
If you don’t know what to say in any of the four countries that make up The United Kingdom, say something as innocent as ,”It is a beautiful day today, right?” Or “The weather is horrible today.” Let that sentence hang in the air. Like abandoned roses post Valentine’s, do not pick it up. Your audience will always fall for it hook, line and sinker.
If that sounds cliche, like it did on this Saturday evening, try ,” anything nice planned for the weekend/afternoon/later?”
Everyone and their pets will respond. These are the unwritten rules in this castle. The Brits have unwritten social interaction rules. You just have to know them. When anyone asks about your weekend, they don’t really care. They want to talk. Those are filler words. Whatever you do with them is your business. They are what otherwise? Is to a Kenyan in any spoken speech.
Sometimes I imagine going to Kenya with my new friend Janine. I dream about introducing her to my friends in Nairobi and going for a night out where she would be bombarded with a lot of “otherwise?” The English girl in her would drop down with exasperation. Ha ha.
To those asking, we use otherwise? In Kenya as a filler word. It is an invitation to continue or change the topic. Basically tell us more. Or less. Or hiss . Or meow. Or whatever your type of animal does. Just don’t ask us to explain it. We also don’t understand it very well.
But I didn’t want to fill words with Simon with the Z. I did want to talk.
I tweedled with his dialysis machine for no good reason and made small talk about his weekend and the weather. An avalanche of cliches. Byword onslaught. He took it up.
In a heavy Polish accent, he lamented how he had been advised that the hospital he had been dialysing at before coming to our unit was ready to receive him. He did not want to go back. He had to because it was near his flat and the NHS was not going to keep providing him with a taxi to and from our unit which was about 20 miles away from his flat.
He worked as a checkout officer at Asda Supermarket. He had for 5 years now and the employers let him work only when he was not having his dialysis sessions. He had stopped counting his sick days and the management had stopped counting either.
He had been referred to our unit (it is the Headquarter of Renal Diseases and Management in this part of Scotland) due to social issues. Further, he had been on the Kidney Transplant Waiting list since January 2020. Covid-19 happened and now at 36 years, he felt his hope for a new kidney plummet.
He told me the team from the previous hospital did not accommodate his frequent trips back to Poland. He had had to go to Poland every week for the last six months. There are existing protocols and policies to be followed after a patient returns from another country. It is tedious. It is lengthy. It is expensive for the NHS.It is important. It is life saving.
Having to do it weekly for the same patient may have raised some red flags about compliance to therapy.
Simon with a Z was not being difficult. He was having issues with his Polish passport. For the longest time, citizens from the European Union could live and work in Britain without a problem. Brexit happened and the reality of it all is hitting differently for patients like Simon with a Z who rely on the NHS for their dialysis. They are now required to apply for a right to live and work in the UK which is impossible without a passport.
Poland officials, like any other country in the world, took their sweet time to process his papers so he kept going back and forth.
Poland prides herself in highly advanced dialysis centres. The cost of a session is your entire household and their breadwinner. That is how expensive one session is. Healthcare isn’t funded by the government through taxes like in the UK. Rather, it is purely capitalistic just like her counterpart in Kenya. Same script, different players.
He needed someone to explain to Marion, the coordinator in the other hospital that until he got his passport from Poland, he had to keep flying between the two countries. His manager at Asda knew it. Marion needed to know it too. Szymon was not being petulant or inconsiderate.
My responsibility was passing this to the charge nurse who certainly informed Marion. In the cacophony of task completion and role performance, Szymon’s voice had been buried. His fears and anxieties unrevealed. It took an idle talk about a weekend to get him listened to.
Which makes me sad.
Outpatient dialysis unit is one of the most homely units in the entire nursing profession. Yet it is one of the most short staffed. Not only in Kenya but also within the NHS of the UK. Having worked with a rather smaller team of patients in Kenya, I had gotten used to finding out what each and every one of our patients were dealing with and liaising with different teams to address the issues.
Simon with the Z awakened two issues in my heart. The need for governments all over the world to adopt a publicly funded healthcare system, and the need for NHS to employ more renal nurses.
Our vision shouldn’t be rigidly focused on the disease a patient has. It must go to how that disease is affecting the patient. How that disease or condition has eroded the fabric of his or her coping mechanism. Now that is nursing. That is painting 2020 as the Year of the Nurse and Midwife in colours bold and bright.

End Of Life Care : A Kenyan Approach

It isn’t the days of our lives that count; it is the life in our days.
Death is a vital topic yet enveloped in thick layers of superstition and myths. We discuss end of life in hushed tones and sombre whispers. Under the blanket of the night sky or in nameless street corners: like drug peddlers. You know they are there but you don’t even know any by name. In common Kenyan argot,”mtu hujua pedi wake .” Perhaps the same for end of life.
Death for the longest time in Africa and Kenya to be precise has been an arena of curiosity. Yet it is a part of us; separate from us but also a part of us. Waiting for us but also hiding from us. Our tribal and religious leaders have come up with (un)helpful cliches to sell to anyone dealing with bereavement, if they are willing to buy.
Whether the above works or does not is not a bone of contention. The elephant in the room is that every human being has a right to proper medical care until their end of life. Especially for patients who are terminally ill. Though we pray and fast for them to recover and cling onto hope that they will, it behooves us now more than ever to prepare for end of life.
The average hospital setup caters for acute medicine. Conditions like dementia associated with old age, Alzheimer’s disease or even end stage renal failure do not get space in the hospital setting. Granted, hemodialysis remains an option for kidney failure. That does not negate the fact that in itself, end stage renal disease is a terminal illness.
Oftentimes patients dealing with terminal illnesses land in the hands of family members who are busy with their own lives or simply do not know what to do. The duty of care is hence left to any charismatic person who genuinely do their best. This best is not always safe either for the patient or for the carer.
There exists a gap deeper than the roots of any corruption scandal in Kenya between acute and chronic medicine. That includes the knowledge base for our healthcare providers too.
It is seen as a taboo for a doctor to disclose to the patient that they have a terminal illness. Either that or the doctor simply plays it down and sells a mountain of hope to the patient and his or her loved one. The brave ones do not talk about it and pass it on to the nurses who have no legal power in Kenya for medical diagnoses. The patient is left in a wide limbo of misinformation or no information.
Hope is a necessary ingredient in our dish of healing. However, having medical facts in a humane manner does help one process the shock and start an important conversation regarding the kind of care they wish to receive when the inevitable happens. Whether that takes a month or a hundred years is for the Giver of life to determine.
In the absence of nursing homes, home-based Nursing services in Kenya is the unnoticed guest. The idea of a service to take care of both the aged and terminally(or chronically in some cases) ill initially interested me when I started working in care homes in the UK. Then inspired me, captured me and now it is imprisoned in my mind. I am overcome with a need to bridge the rift in care in my motherland.
Nurses, patient care attendants and by extension doctors, are part of the calming team of companionship to every family struggling with a loved one suffering a terminal illness or frailty associated with old age. Teaching hospitals have taken up the role of training patient care attendants who become equipped with basic caring concepts. These become handy even when family teaching is concerned.
As much as the future is female, it is also aged and in desperate need of a helping hand. Which reminds me, have you noted how the female life is all about patchwork and maintenance? Is it just me or other females out there undergo patchwork? My nails for instance, they need constant repair lest I look like I live in a rabbit hole (which I probably do).
Talking of which, I decided to be a beautiful nurse and applied some shellac paint on my nails. It was a light mix of pink and glittery things. I paid an arm, a leg and a pound of my flesh to Angel a Chinese (or Korean) nail artist down in West Pilton street.
I was certain they would serve me for a month. The nails not the artist. It came as a stab to my heart when my mentor at my new workplace broke the news that nurses shouldn’t have paint on their nails. I had to get rid of them. I’m yet to recover. I need a self help group or something. If I ever quit nursing, it will be because I want to paint my nails. Sob. Sob.
More maintenance is needed to my hair which is actually funny because half of it is left at the salon (silent sob). My hairline needs repair lest my forehead extends to my neck. And my toes! Please let us not discuss my toes.
Either I’m paying too much attention to myself or the female life involves needles and threads, screws, nuts and bolts, stick ons and different types of glue.
This alleged feminine future equally needs maintenance. However it has no permanent people staying in the village with our elderly parents and grandparents or even the sick. They all are chasing after tax money and better education in the big cities.
The traditional African village has been replaced by the hustle and bustle of the modern day life. Traditionally, the sick and aged would have been taken care of by the children or anyone else because the vulnerable were a collective community responsibility. That has morphed. We need to adapt to the vicissitudes of the seasons.
It is not just enough to visit the Accident and Emergency department. It is no longer sufficient to get discharged after acute care. Life moves on and on forever after these stages. We need to accept it. We need to realize this screaming need in the society with regards to management of terminal illnesses.
If we can’t have proper care homes, then let us fully embrace home-based nursing services. It is not only cheaper in the long run for the family, it is also less distressing to the patient. There is a certain peace in being taken care of in a familiar environment.
A conversation touching on end of life needs to permeate through our deeply anchored superstitions. Talking about death does not make it come sooner. In fact, it does not make it less a reality than it already is. It allows us to be on the same page with regards to management of symptoms that come with whatever underlying condition is in question.
It empowers the doctors to think about medications to relieve unwarranted pain, respiratory secretions and anxiety that accompany end of life. It allows family to be aware and take part in the management of the care of their loved one. It gives power to palliative care nurses and geriatric care nurses to expand their roles outside the hopls
In this dynamic world, it is reassuring to know you’ve entrusted your loved one to the hands of a trained professional. That they know what to do and how to do it. That they know what they are looking for and how to mitigate it. Now that is peace personified.
CateMimi Lifestyle Leave a comment September 16, 2020 5 MinutesEdit”End Of Life Care : A Kenyan Approach”
Caring for carers
You’re the only place you’ll ever live in. Prioritize you too.
With tears hanging loosely under her lower lashes she heaved. Stretching out her back against the rather hard arm chair, she fluttered her eyes , looked to the uninspiring hospital ceiling and forced a nervous laugh.
We had been talking for ten minutes, it felt like ten hours. Sheila had been caring for her mother for three years now. Her mother had been diagnosed with end stage renal disease and she was our patient at Hekima Renal unit. She dialysed twice a day. We ran two shifts at Hekima. Morning and evening. Each lasted four hours minimum.
I was an unofficial coordinator of the said shifts. Unofficial because I’ve always had a stubborn streak that made me abhor leadership responsibilities. Let’s hope I’ve outgrown it for my own sake. Sheila asked me if we could please move her mum to a morning session as opposed to the evening one.
In my life as a nurse, I always seek to answer one of Richard Kipling’s research questions;WHY? That makes me either a very social nurse or a very slow nurse. Take your pick. Her bodily cues made me invite her to the charge nurse’s office which also doubled up as an archive for old patient’s notes. It smelt of treated and missed opportunities.
My charge nurse rarely occupied this office unless when crafting the duty rota. Sheila had lost her job three years ago after her mother fell sick. She had been working at an accounting firm which laid her off after numerous sick days. She and her tep elder brothers were single handedly brought up by their ailing mum. Her two brothers were doing well in Nairobi city.
To cut costs, they had decided that Sheila should stay at home and take care of their mother. After all, they would pay her rent and food. This is on top of Sheila’s own two children. Her partner walked out on her the moment her mum became a “burden.”
For three years now, she was her mum’s carer, a parent to her children and the coordinator of everything regarding her mum’s treatment. From sourcing for a taxi twice weekly, running to different chemists for the very expensive medications her mum was on, honouring clinic appointments, special renal food preparation and also normal food for her own family…the list was endless. She was at the end of her tether.
Life had been unbearable for a while now since her two brothers had seemingly forgotten she had no job to sustain her needs. She felt burnt out. She wanted to take a job in a local hotel where she would work evening shifts. That informed her need for a change of the dialysis timings.
“Sister do you think I’m being selfish for wanting a break?” She queried, almost pleadingly. I honestly didn’t think she was. In fact, she had given so much of herself for so long that her 32 years of age seemed to have tripled down on her.
Is it selfish to want a break from caring for those you love? Is it selfish to want to go out for a pint and a laugh with your friends and leave your sick loved one at home? Is it right? Should you do it?

Carers’ Guilt

Fill your cup
These questions stem from a deep desire to be there for those that are suffering. In the African set up, the sick and/or aged in the family belong to the family. We are obliged to take care of them. This in part contributes to carer’s guilt. You feel as if you must be there 24/7 365 days of the year.
It took a lengthy chat for Sheila to admit that her life had stopped when she started living with her mum. It took courage on her side to accept that she was also as sick as her mum; just not physically. She had allowed her mum’s terminal illness to dictate how she lived her own life.
This is the dilemma most carers find themselves in. You want to give your best but you also want to live your life. You go have fun with your friends then feel guilty for being happy. It has been described as a cyclic feedback loop from hades.
Empathy is feeling with someone’s heart without becoming them. It is not synonymous to sympathy. Sympathy is when I refuse to perform incision and drainage on an abscess because I’m feeling sorry that you’ll experience pain. Empathy is when I acknowledge that you’ll hurt a beauty but go ahead to cut and drain it because we need it to heal.
Carers are called to be empathetic. No matter the blood relations, it is important to take care of yourself. You can only give from your overflow. If you’re running empty you’ll give half baked versions of your care.
This is why we cannot over emphasize the need for professional patient care attendants and home-based nursing. These individuals take care of your loved one during the times that you can’t be able to do it. Kenya is yet to fully embrace nursing homes so home based care is the cog that connects hospitals and families.
If care of the terminally ill must be provided by family members, rotation of roles is important. That way nobody suffers burn out and the burden of care is evenly distributed.
It is irresponsible and heavily selfish of some siblings to relegate the duty of care to other siblings. Just because you provide monetary needs does not mean everything is taken care of. We need you to visit and take care of the ones taking care of your loved one. Pass by and let them know you care. You want them to be well.
Take time and rejuvenate. Caring isn’t a call for misery. Fill your cup of wellness to overflow then let us drink from the saucer. That is the only way you’ll give quality as opposed to quantity. That is when caring becomes a joy as opposed to a duty to be accomplished.
We managed to play around with the shift and Sheila’s mum got a morning session. Further, we reached out to her elder brother who was perturbed that Sheila needed help this much but did not ask.
We need to develop a culture of asking for help. It is not because you’re weak or uncaring. It is because you too deserve a break to regrow your spirit. You’ll be surprised how much people would be willing to lend a hand.
In the African context, a child belongs to the community. I believe this should apply even in sickness. Religious groups, chamas, Rotary clubs, nyumba kumi and such informal and formal groups should be at the forefront to take care of the terminally ill in their membership. Service to mankind and above self does not stop with monthly contributions. It must extend to where the rubber meets the road.
Talk however, is cheap especially when everything is alright. The real test is when we are in the valley and we need someone to hold the hand of the carers. To nurse the nurses.
Where possible, carers need support groups even if it is on online platforms like WhatsApp. That is a good channel to share ideas and find common ground. That is also a great avenue to talk and be listened to by people with different yet similar challenges and how to approach them.
Perhaps having benefited from psychotherapy myself, I will always want people to form purposeful groups to help one another. If we deplete the energy of our carers , we will not have anyone to nurse the world back to health.

The story of Jepkosgei

The ripples she caused in my world will never die away.
I never enjoyed Midwifery lessons in basic nursing college. I tolerated them. I was supposed to pass the gruelling Paper Two of the qualifying exams. Inexcelled. I swore to never work in a Maternity set up. I meant it.
Then I didn’t. The nun that ran the mission hospital I trained in hired me straight from college and graciously posted me in Maternity ward. Dark humor. Back then, a post in Maternity ward was deemed as punishment.
There used to be a charge nurse that ran the unit with an iron fist and a pitch black soul. Her motto must have been : of it doesn’t hurt it isn’t worth it. Patients and staffs feared and respected her in equal measure. Maybe she was an undercover agent for the Black Ops.
A few moons and some change, I found myself in yet another Maternity ward of a public hospital. I would work here for a while here until one day my love for kidneys was born. It is the day I met Jepkosgei. Jep, we will call her.
Just Another Admission
It was a normal Sunday mid-morning in July. Rain fell in scattered drops as it does every other July in Kenya and the temperature in Limuru town fell by a few more degrees. I was the nurse in charge of admissions for the day. Sundays were slow. Like the finance guy who takes a holiday to Kainuk when we all want his signature for our salary to be processed. Snail slow.
She wore an ocean-blue maxi dress that had seen better days. Black crocs were visible on her stout feet which she dragged along the cabro corridor like last year’s sins. She looked like she didn’t want to be here. Yes, she didn’t want to be here. I might have concurred but for the well-rounded protrusion of a pregnancy on her abdomen.
My eyes landed on her abdomen. When you’re a nurse-midwife, the abdomen of any lady attracts you. When you’re a ward nurse, the sight of a (wo)man with visible veins in the bus makes you want to say hello. Paediatric nurses fall for other peoples’ children and they want to find out why that one there won’t stop crying. You get the gist don’t you?
My attention seemed to alert her to the existence of the pregnancy. She parted it in one deliberate motion, gave her carrier bag to the lady that accompanied her and took shy steps towards the nurse’s station. Something in me wanted to make her comfortable. To reach out to her and make her feel at home. I did.
The lady accompanying her was her employer. This elegant lady who commanded the same cabro corridor to rise and meet her manicured feet. She dangled car keys and smelt of affluence. Probably in her early fifties, she took quick steps to catch up with the pregnant woman and came to the nurse’s station as well.
Jep and Mrs.Finch. Jep was her house girl. They had two days ago, returned from a holiday in the heart of Rift Valley. Mrs. Finch had learnt today that Jep was pregnant. She was not very happy. She couldn’t let her suffer either so she brought her to the hospital. The chief complaints were a mild headache and a heartburn. Jep couldn’t keep any food down without feeling intense heartburn. On physical examination, I found slightly swollen feet. No she hadn’t noticed but yes her shoes felt tight that’s why she wore crocs today.
She was not sure how old the pregnancy was. She never once attended antenatal clinics. She was hiding the pregnancy from Mrs.Finch. It was 34 weeks by palpation. She had been hiding it from Mrs.Finch because she didn’t want to lose her job. The responsible boyfriend had denied her three times before the cock crowed twice. I don’t know you! He had said, I don’t know you!
This tasteless Sunday was her first antenatal care. And only because her head hurt a little and the heartburn was distressing her. I was supposed to do everything that shouldhave been done in an antenatalclinic. In conjunction with Dr.E, we did our best apart from one thing; an abdominal scan.
We needed one because neither the doctor nor myself could hear the heartbeat of the fetus through the fetoscope. It was scheduled for Monday morning because welcome to public hospitals in Kenya; we do not do ultrasounds on Sundays.

A midwife’s best friend.

I went home after my shift only to return on Tuesday morning and find my new friend missing. She wasn’t in the antenatal ward where I had admitted her into. She wasn’t in the labor room. She was not in the postnatal or post Caesarean section room either.
I always follow up where my patients go to after I handle them. You could say I’m looking for closure. Jep had been referred to Kenyatta National hospital on Monday evening where she had succumbed to acute renal failure.
Acute renal failure. A finality. A new phrase. An ominous harbinger. New not because I had never heard of it but alien since I had never handled it. What changed between her admission and the referral? What did I miss? What did the doctor miss? One thing the public doesn’t know is that every death weighs heavily on healthcare workers. Especially nurses and doctors as they are in direct contact with the patient.
Dr. E was on shift as well and together we went through her file. Jep had suffered one convulsion episode on Monday morning which had led to a diagnosis of Eclampsia even before the planned ultrasound. I will never forget her blood pressure reading on admission; 124/82mmhg.
Kidneys and pregnancy
We ask you to attend antenatal clinic not only for the life you carry but for your own. We need to establish a baseline for your observations especially blood pressure. To everyone, Jep was not hypertensive. That reading (124/82mmhg) was an okay blood pressure. However, we did not have any baseline to compare it with. At eighteen, Jep lost her kidneys;and two lives.
Pre-Eclampsia is a life threatening condition only present in pregnancy. From the word you can tell it is a precursor to something. Pre means ‘before.’ We can rarely tell who will get it and who won’t. It is characterized by elevated blood pressure, proteins in urine and sometimes severe headache. Eclampsia occurs when a patient fits (convulses). It is one of the leading causes of maternal mortality. It shuts down kidneys as fast as a morning run. It shuts down the heart and the liver with total abandon.
You want to have your antenatal clinic as soon as you discover your pregnancy. You want to encourage women in your circle to seek antenatal care if only to have baseline observations established. You do not want to take pregnancy casually. It isn’t. Please attend your clinic appointment.
Our kidneys contain tiny micro filters that allow certain things to pass into urine and others not to. Red blood cells and proteins are not allowed to pass through the kidneys. If red cells pass through, urine appears like some Coke soda.
If proteins pass through in large amounts, the urine appears foamy. One of the nurses on shift on Monday had written that Jep reported deep-coloured urine a few hours before the fit. This had been attributed to dehydration and patient encouraged to drink more fluids. Maybe I would have thought and done the same.
Acute Kidney Injury happens when bad chemicals in this condition called Pre- Eclampsia are deposited in the kidneys clogging the filters we talked about. This leads to shut down of the kidneys. If our kidneys go to sleep, then we cannot be able to remove wastes from our bodies.
These waste products therefore get reabsorbed into the body and they get packed in all vital organs where they cause untold misery. That is where early recognition and intervention is paramount. Eclampsia happens when the body can’t take the toxic waste load anymore.
In Jep’s case, the progression from mild symptoms to a cardiac arrest was abrupt. Perhaps, if we had handled her in previous occasions; had she attended even one single antenatal clinic, we may have found out a huge discrepancy. Still, I wonder what the doctor and I missed on admission.Everything on paper looked great given our resources but I still wonder…still.
This calls for active management of pregnancy. The mere act of carrying another human being puts immense strain on our hearts, kidneys, blood itself and blood vessels to mention but a few.
I carried the pain with me. I wrapped it in the garment of my heart. Every day I handled a pregnant mom, the hem of the garment broke loose. The fabric was giving way in places it shouldn’t have.

Let me tell your story. Not Academic writing please. Just speeches. Thank you.
I still see her. In that once blue maxi dress I see her. I feel her breath down my arms; forming rounded frosty puffs that swirl into the fog of my mind. I wish I knew then what I know now. I wish many things. I wish she was still around.
We are heavily advised against forming attachments in our job. I couldn’t help it. Every time I see laboratory results of kidney function tests, I feel her looking down my shoulder to interpret with me. I hope we get it right Jep. I hope we do.
The kidneys, I’ve learnt, will always find a way to be related to every organ in your body. That includes those that you may host for a while.

Kidney Disease and the Bones

Fragile; handle with care
I had dearly missed renal nursing. I was dying back to go back to the field . Time and again I looked at my papers and gazed at my previous work station and wondered when the sun would shine. It did and I got an opportunity to be in a renal department.
In Kenya, Nephrology/Renal nursing is comprehensive. It involves all facets of renal care to incorporate acute kidney injury and chronic kidney disease. Renal nurses get trained in all therapies or renal replacement. Understandably, we do not practice all of them. The most common ones are kidney transplant and hemodialysis.
That is why I was exhilarated to be placed in a dialysis unit at the new work station. I am getting impressed on a daily basis by the modalities of care some of which I only learnt in books. Care of the failing kidneys is one of the most fulfilling roles a nurse can ever take up.
After such a long break from renal nursing, it was pure serendipity to have one of my Facebook followers ask me what was wrong with his uncle because he has been getting bone problems while on dialysis.
It took me back to one of my patients in Nairobi. He had started hemodialysis at some decrepit private unit for an year before transferring to our newly established renal unit. He had since suffered poor mobility and couldn’t walk without crutches.
The relationship between our kidneys and the bones is an interesting one. Bones have many components top of which is Calcium. That is why the commercial taunts milk and other products as being a source of calcium for strong bones and teeth. That doesn’t mean strengthening teeth and bones are the only roles of calcium.
Without calcium, however, we get brittle bones which easily fracture. Our bodies absorb calcium from the small intestines. This is one source of calcium for our body cells. It is dependent on having sufficient calcium in our food which will be absorbed if we have sufficient blood flow in the gut.
However, this calcium cannot be absorbed without the presence of Vitamin D. Vitamin D from our diet must be in an active form for it to help in this role. The kidneys activate this Vitamin D. I hope I have not lost you.
When we have end stage kidney disease (where we are already on dialysis) this vital function of the kidneys is diminished. That means we do not have an active form of Vitamin D which will encourage our gut to absorb calcium to take to the kidneys.
Further, there is a close knit fellowship between Phosphate and Calcium. They have an opposite relationship. Let me explain. Over 85% of Phosphate is found in bones. It is important in different roles in the body part of which is making muscles contract together with other minerals.
The problem is that if Phosphate is too high in the body, it forms deposits in the body organs. It also causes bone and muscle problems. Now, kidneys regulate this balance of phosphate by secreting them in urine. That way we do not have too little or too high levels of this element.
In end stage renal disease, the kidneys do not make much urine and in other cases they do not make any urine at all. That leaves our levels of Phosphate at dangerously high levels. Our risk for heart attacks and strokes are increased. Our bones become even weaker.
I hope you can see that in this case we already have two mechanisms which are causing bone problems. That takes me to the third one.
There are four tiny weeny glands the size of a grain of rice on your neck. They are behind the big butterfly-shaped one called the thyroid gland. We all know something about the thyroid gland I suppose. If you have come across the word ‘goitre’ then you have surely handled the thyroid gland.
Let’s try something. Go to the mirror. Expose your beck if you have a scarf on. Do you see the voice box? Okay you may not if your neck is as well fed as mine. Ha ha. If you are a man, your thyroid gland is just below the Adam’s apple.
Which reminds me; men that have visible Adam’s apple are God’s gift to the universe. Favourite sons of the creator. Movers and shakers of my all things female. An Adam’s apple invites me to touch it or simply nibble at it. Yes I need prayers thank you.

I’m advertising this my other side. Folks, we start charging in mid-September. Also note it is NOT academic writing. Just speeches.
On the front part of your windpipe is where the thyroid gland is. It is shaped like a butterfly with two lobes. We will call them wings because yes we can.

Show me your butterfly

On the reverse side of this important gland, on every tip of the wings, we have other even smaller glands called the Parathyroid glands. As you can see from the diagram above, we have four tips of the thyroid gland. I mean, each of the two wings has two tips. One for the upper part and another for the lower part. That is for each wing. So we end up with four tips. Ask me to explain if this isn’t clear.
On the reverse side, each tip has a parathyroid gland embedded onto it. When we discuss Calcium and Phosphate, we must pay maximum respect to these four glands.

They look like mustard seeds don’t they? And so the Good Book says,” if you have faith the size of a mustard seed…”
Parathyroid glands produce a hormone called parathormone abbreviated as PTH. PTH is crucial for the regulation of calcium in our body. When calcium levels are low, PTH is secreted (released) by our parathyroid glands.
What PTH does is encourage bones to release the stored Calcium in form of calcium ions into the bloodstream. This, friends and family is the second source of Calcium. One is by our diet where the calcium is absorbed in the gut. The other is from bones under the influence of PTH. We could loosely say bones are our banks. They hold Calcium for us like banks hold money, and dish it to us in small doses should we need it.
When we talk about Vitamin D activation in the kidneys, there are two chemical steps involved. The first one is under the influence of this hormone we are calling PTH.
Excretion (removal from the body) of both calcium and phosphate is through urine and also being deposited (stored) in the bones. It is a cycle I know. Release, absorb, excrete, absorb. Repeat. Most body processes are cycles. This is because we must get things under control. Not too high and not too low. Just like the baby’s chair in Goldilocks’ story, we need everything to be just right.
When kidneys fail, we need to find a way to replace these metabolic and regulatory roles. We do so by administering Calcium and activated forms of Vitamin D supplements. We have medications that come as a combination of both to eliminate the need for multiple tablets.
The patient we had handled was never given these vital supplements and that explained his bone issues.As aforementioned in end stage kidney disease, there tends to be low calcium levels. What happens is that parathyroid glands continue to secrete PTH which draws calcium from the bones to the bloodstream.
Our tiny weeny glands do not know that the kidneys have failed. They sense a low Calcium in the blood and tell themselves that we need Calcium in the blood so we must release PTH to tell the bones to release the Calcium it has in store.
Remember we need calcium for other things not just healthy bones. This function ends up making already weak bones even weaker. A recent calcium supplement contains activated Vitamin D, calcium, and also prevents the parathyroid gland from releasing PTH.
That way we not only get free ions of Calcium in the blood to act on heart muscles and other cells, but also maintain the bound calcium in our bones. That is a win-win for the bloodstream and the bones.
We must look for a mechanism that will ensure that the body does not absorb too much phosphorus from the diet. This is where Phosphate binders come in. These tablets swallowed with food or snacks take ahold of the phosphorus found in our food and prevent it from being absorbed by the body. That way we do not end up with hyperphosphatemia (too much Phosphate in the blood).
Hemodialysis itself is another explanation for weak bones. When a patient’s blood is going through the artificial kidney (dialyser) it can easily clot. That would mean losing a lot of blood. Normally our bodies contain numerous substances to ensure that blood does not clot as it flows through our blood vessels.
One of the most important body’s natural anticoagulant is heparin. This substance is produced by the liver and stored in many cells of the body. It ensures that blood does not clot. What renal nurses do therefore is inject artificial heparin into the blood tubes on the dialysis machine to make sure that blood does not clot.
One of the side effects of this artificial heparin is weakening of bones or what we call osteoporosis. That is why advanced countries have migrated from the good old heparin and adopted a low molecular weight heparin form.
The latter ensures that heparin is administered but not continuously throughout the session of dialysis. That way we achieve anticoagulation without increasing the risk of osteoporosis.
We can improve the outcomes of patients with end stage renal disease by giving appropriate supplements. This goes hand in hand with monitoring laboratory values of the blood. Further, for everyone else whose kidneys are functional, I hope this will make you want to take better care of your kidneys. Stay hydrated.

Flying in Covid-19 Era

The difference between safety and none
It is 1316hrs and I’m headed to Edinburgh airport. It feels like a million years ago when I was last at the airport. Back when we were cave people and shaking hands was kind.The Coronavirus crisis has curtailed everyone’s movement. I badly want to see how flying has changed.
Just as the Airport Link Bus approached the final stop, I remembered I didn’t have on me one important document; my passport. I thought I carried it but the image of the blue- covered piece of legality lying peacefully on my bedroom locker taunted me. I had to go back.
A taxi from the airport to my flat and back cost me slightly above thirty pounds. How expensive improper planning is! My flight was scheduled for 1715hrs but I knew I needed to get there early. There were many changes with regards to physical distancing as Easyjet had suggested when sending my boarding pass.

The new normal
Which takes me to the first time I came to the UK. It was also the first time I flew anywhere outside Kenya. I had never even been to JKIA. This is the largest international airport in Nairobi. Never needed to be there. Nobody in my family had ever left the country or returned to give me an excuse to go to the airport to pick them up. We didn’t even have friends overseas.
When the agent I dealt with sent me my ticket, I was supposed to Check in and print a Boarding pass. That language was new to me. As far as I was concerned, aeroplanes operated like Mat za Githu. All I had to do was hop in and hop out. It was not to be.
My best friend, Flo, looked at me with unconcealed wonder. Catherine, a twedi something, seemingly exposed girl who hadn’t a clue about planes and flying. She ended up doing the check in and boarding pass printing for me. She was to also take me through the whole process of flying and what to expect. I had a checklist.
To avoid being a nuisance, I didn’t ask her what a boarding pass was. I asked another friend; Maggie. She is like a mum to me so she wouldn’t deny her daughter some education on boarding passes. Ha ha. I met her at a school where she works and she patiently explained about boarding passes and gates and terminals. Boy , haven’t I come from far!
I thought about this in the backseat of the taxi as I came back to the airport. I was on time. My passport and my tiny purple cabin bag with me. I chose the mini suitcase for her colour at the shop;purple. Purple screams royalty. I am in the Queen’s land so there you go.
She also stands out in the school of other suitcases. You will always notice her toned behind as she waltzes down the carousel without a care in the world. Many times I’m tempted to let her make another round before picking her up. She strikes me as one who loves the attention she gets. Some would call it a vanity, I call it confidence. I like confident suitcases.
A lady’s voice is reminding everyone over the PA systems about wearing face masks and social distancing. We are trying even as the security checks prevail. Cute masks, smiley masks, oversized masks, tribal masks. It is a sea of face masks and sweat. Especially sweat.
The temperature is somewhere near 20 degrees Celsius and that is very hot for any city in Scotland. I think I’m melting under my clothes. I have been trying to lose weight for a while now and melting sounds like an excellent way to achieve my body goals. Melt away chubby bum bum melt away…
1650hrs and the beautiful Easyjet flight attendants are explaining about security protocols inflight. This time I listen. I had forgotten where my safety jacket is supposed to be. The plane is half empty. I notice this as my attention drifts away from the two flight attendants who are wearing Snow White face masks.
My seat is 14A and it is near the window. I do not know if it is supposed to be that way though. Until now, I can’t tell whether A is the aisle seat or the window one. I usually wait for other passengers to come and claim their seat but today this plane is half empty. I get to keep the window seat. 1655hrs and there is a plane packed at the airport screaming HOP! In dark blue letters. Sounds like graffiti I’d find back in Nairobi on a Matatu. Yes I miss Matatus big time.
Save for the passengers travelling as a family (read couple) , everyone else is encouraged to seat by themselves. I like the way these flight attendants are smiling with their eyes. I am seated across a missus and her pink earphones. I momentarily look at her then focus on my flight details.
We are one heartbeat away from take off. The captain fluidly begins to taxi away. This is my favourite part. I notice another plane crying HOP! take off before us. She starts out like a giant eagle, lifts her wheels then kisses the clouds nose first and becomes a baby sparrow. Then it is our turn.
I enjoy the moment when the captain accelerates just before ascent. I love it. Speed thrills me. Is it such a bad idea to have a race rally using planes? I have been thinking about writing that to airlines. They need to factor it in their future Olympics or something. The adrenaline packed mini rally is my starter juice. I live for this moment. I fly for take offs.
The tiny flaps on the wings of the plane open and close. They open and close. Like a baby’s mouth they open and close. We are airborne and she hides her legs into the fuselage. Gate 18 and 17 of Edinburgh airport fade in the distance as does the aeroplane parking lot that is the entire airport. All I see are dots and spots of buildings. We tilt on one side and I know we are headed to the windmills.
I see them. Three of them. They look like angry three-armed women flailing their hands in the wind. Unstoppable. The pilot does whatever pilots do with those windmills (can anyone explain to me, thank you) then we are South-bound to London.
I marvel at nature below until the plane disappears into the clouds and all I see is layers of clouds. Some still, others moving. They look like heaps of cotton wool left in the skies by a creative God. Whenever I fly, Juu Angani plays in my head and now it is. It is a Swahili song by Ambassadors of Christ Choir in Rwanda. For some reason I do not read the novel I am holding. I am too distracted.
I focus on Pinkie. She has been coughing for a while now. Short little bouts of cough. Sporting a once white pair of hot pants exposing her sufficiently tanned lanky legs and a black top, she embodies dietary discipline. She coughs under the pink face mask. The nurse in me hopes she is alright. She smiles with her eyes probably to indicate that all is well. She then places her immaculately sculptured legs on the seat and filed her nails away.
She was bewitchingly gorgeous and she knew it. She opened her pink purse and removed some fake nails and started gluing them to her own. So effortless. She removed her face mask for a while to take a selfie. Instagram influencer, I told myself. She buttressed the photo with a short video where she fluttered her fake lashes exposing her pink eyeshadow and Cleopatra eyes.
Just then a flight attendant passed by and asked her to put her legs back on the floor and wear her face mask. She was however free to remove the mask, eat then wear it again. Pinkie frowned. Perhaps at the suggestion of eating. Girls with such bodies don’t eat. They smell food. They feed on the aroma of meals and they are satiated. Girls like me however, gain weight just by looking at pictures of foods.
The clouds outside are breathing and the air is flowing in tiny wisps atop each batch. The gentleman on seat 13A in front of me is singing to some music from his headphones. I miss listening to music in Matatus. Shouldn’t they play music in planes too? Safety and security reasons you say? Ah , alright mother. Alright.
50 minutes later, the captain’s voice resonates through the cabin and announces our imminent arrival at London Luton Airport. The descent begins. My ears start hurting. I chew my gum like my life depends on it.
I didn’t know about decompression syndrome until that maiden flight outside Kenya last year. As the Etihad Airbus descended towards Abu Dhabi International airport, my eardrums almost burst open. I was sure I would die. Either that or have cerebrospinal fluid rush out of my ears. What is a person without their brain juice?
I couldn’t hear myself think leave alone others speak. The only remedy that has so far worked for me is chewing gum. I chew gum with unmatched vigor. I chew gum like it hurt me. Probably to squeeze life out of it as I save my own.
Being UK, I wasn’t surprised to find it raining in London and my host stuck in traffic. The vicissitudes of UK weather pattern makes one blush. A climate for books. Geographical books.
Though changes have come with Covid-19 pandemic, getting a chance to travel is still a blessing. What we aren’t sure of still is, when will this end? Will it ever end anyway? Until then, safe skies everyone.

Nursing A Dying Profession

In loving memory of all the nurses we have lost and keep losing to Covid-19.
There is a protest organized by one of the most vocal Nurse’s association in the United Kingdom. Its aim is to decry the segregation of nurses when the Tories government decided to raise pay for senior doctors and teachers. This was as a sign of appreciation during the almost ending first bout of Covid-19 pandemic.
Since the Crimean War birthed Florence Nightingale, nursing has continued to be viewed as merely a vocation and not a true profession. They coined the “it is a calling” slogan, whipped it with enough gaslighting and fed it down the throats of professional nurses. It is nurses, not nuns. A profession, not a calling. But who is listening.
Nurses in the United Kingdom are sort of fed up with claps for their effort and slaps for their pay. Below-inflation raises is what they got the last time a pay was discussed. Perhaps even the threads that hold the prim, proper and highly cultured fabric of the British persona are getting loose. When a Brit protests, then things are not just bad but horrible.
Still there are ways of raising concerns. There are protocols that are in place and the upcoming protest is one of the ways to register displeasure. God speed fellow UKRNs.
Let’s Go to Kenya
Nurses are struggling to get quality personal protective equipment. So far, Kenya has lost at least four nurses to the Covid-19 and all we hear is a loud defeaning silence. When one of the doctors passed on (may she rest in peace) , the airwaves came to a standstill. In fact, my president, during his last address was kind enough to pass a word of condolences.
At the same , we had already lost two nurses. Clifford Manyara Mburia was a 58 year old Nurse anaesthetist at Kitengela Medical Centre. Covid-19 snatched him away from us.
Moses Gitonga Ringera was a 49 year old clinical nurse at the University of Nairobi. Two gentlemen with souls of pure gold. Two nurses who paid the ultimate sacrifice; with their lives. Yet in the heat of the moment, we have chosen to forget their names. When the dailies report on their deaths, their cadre gets lost in the blanket of healthcare workers. We have a name. We are nurses. Say our names.
We ignore the plight of nurses. When they complain, we hastily christen it as dancing on the graves of patients. Yet before those words left my mouth, we have a fresh grave of Nurse Marian Adumbo. The sun and the moon haven’t even shone on the chilling memory of her demise but we badly want to move on as a nation.
Let us talk about Nurse Marian

Marian, as she was fondly called by those dear and near attended the prestigious Asumbi girls high school. She was to later join Lwak girls and study Nursing in Nyabondo. Being a people’s person, Marian pursued a Bachelor of Science in Public Health at JKUAT university. She never confined herself to clinical nursing. Like an eagle, she spread her wings and flew high in the sky.
Marian was pregnant when Covid-19 struck. She should have been able to shield from work if the presidential orders were respected at hospital levels.
She gave her work all she had and eventually contracted Covid-19. It took enormous effort from fellow nurses to get physicians to attend to her properly. Marian held on even when the oxygen saturation in her blood kept fluctuating. She clung onto dear life to bring to the world a beautiful baby boy.
We sighed with relief as we heard reports of her recuperation postnatally. It therefore came as a sharp sword to the nursing backbone when she breathed her last. One baby left without a mum. One more nurse taken by the tentacles of Covid-19.
Shall we talk about risks?
The risks nurses undergo almost always become fatal. By it’s very nature, nursing has a truckload of occupational hazards. If you are not being spat on and slapped and called names by patients and their relatives, you are being given substandard personal protective equipment by the government. Or harangued by camera-happy politicians to work under inhumane conditions.
Perhaps that knowledge informed the decision to include a risk allowance in the pay of all healthcare workers. However, it is a cesspool of lies laced with a deeply set conspiracy theory to pay nurses Kes.3,850 every month as a risk allowance. Hear me out.
A pay of Kes.3850 is not even enough to cover all the vaccinations a nurse should ideally get before working in the clinical setting. On top of that, the NHIF cover does not recognize nurses as civil servants. This is so if they are of a job group lower than L. They end up providing for services that they themselves can’t afford. Other civil servants get comprehensive medical insurance but nurses do not. That is the extent to which we have diminished the nursing profession.
We treat nurses like a post script of medicine. Never the core of the system. They are an appendix of healthcare. Until Covid-19 happens and then we call them heroes. The difference between the betrayal of nurses in UK and Kenya is that UK waited for the pandemic to wane down before sticking sharp shards of glass to the souls of nurses. Kenya is doing it smack in the middle of the pandemic. A bold display of unregulated, gut wrenching ignominy. The gospel of the untouchables.
It therefore comes as no surprise that nurses may get such quality education in Kenya, get the requisite experience then pack their bags and leave for foreign countries.
Betrayal, friends of God, tastes better when served by strangers and like slimy undercooked mushrooms when served by family. I’d rather be hurt by the systems in UK , Canada, America or even Australia to name but a few, which I may or may not understand than watch in horror as the place I call home throws me to the dogs. No offense to dogs.
It is a mental workout to be a nurse in Kenya. A constant emotional cardio exercise. Probably all over the world but more so in my motherland. It sears like the edges of six serrated knives. All to the gut.
Nursing is not a profession of administering medication. Any person can hold a syringe and needle. Anyone can pop tablets and give them to patients. Nurses undergo intensive training to understand the human body. Not only do they aim to restore the physiological processes that go haywire when illness strike, but they also target to restore the emotional, psychological well being.
In fact, a definition of health by WHO that I like is; ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity ‘(WHO 1948)
Show me a person that upholds that and I will confidently show you a nurse. Nurses are not asking for promotion into doctorate positions. They can do that by themselves. They have studied and are studying towards that. All nurses are asking for is for space at the table of health equality. Some semblance of recognition if the fact that they are human before they are nurses.
The nurses that have died so far are friends to people, they are mothers and mothers, sisters and brothers, wives and husbands and children of loving parents. Protecting us is protecting the world. Paying us some sort of appropriate dues is respect to the work we do. We are here to nurse the world back to health. We will not do it in atmospheres rife with malice and disdainful scorn.
The world was comfortable with doctors until Florence Nightingale showed up in the war with nothing but a cap on her head and a lamp on her hand to nurse soldiers back to health. The world will remain comfortable until she realizes that she needs a nurse. You will never do without a nurse. You may hold on but you’ll break. This is that one time in history we are asking , in the name of everything you consider holy, to protect nurses.
All nurses with underlying medical conditions must be allowed to shield and be fully paid. Stop recalling retired Intensive Care Nurses when we have young and healthy unemployed nurses. Is it that hard to do the Math? Suspend all contracts that make nurses slaves of paycheck. Absorb them into permanent and pensionable terms. That way they have no reason to risk their lives.
To the nurse managers, it is your responsibility to protect nurses that are under you. One day that office you occupy will be occupied by someone else. What you want is for the nurses to never forget what you made them feel. Your role is especially critical during Covid-19 pandemic. Inspect the personal protective equipment as they get delivered and should they fail the required standards, please return to sender.
John Lewis (may he rest in peace) left us with an admonition that if we see something is wrong we surely must say something about it; we owe it to the world to DO something about it. That is what we are called to do as nurses. Do things to make others right.
Marian’s promotion to glory is a call for all nurses to remember our own vulnerability. To be here for one another and in a thunderous cry, say enough is just about enough. Expressing our opinion will not alter the flow of water in the high seas but will cause ripples in the ponds and tributaries that feed into the ocean.
The following is a song we call the Nurses Anthem.
There is a candle, in every soul,some brightly burning, some dark and cold
There is a Spirit who brings a fire
Ignites a candle and makes His home
Carry your candle, run to the darkness
Seek out the helpless, confused and torn
And hold out your candle for all to see it
Take your candle, and go light your world
Take your candle, and go light your world
Frustrated brother, see how he’s tried to
Light his own candle some other way
See now your sister, she’s been robbed and lied to
Still holds a candle without a flame
So carry your candle, run to the darkness
Seek out the lonely, the tired and worn
And hold out your candle for all to see it
Take your candle, and go light your world
Take your candle, and go light your world
‘Cause we are a family whose hearts are blazing
So let’s raise our candles and light up the sky
Praying to our Father, in the name of Jesus
Make us a beacon in darkest times
Carry your candle, run to the darkness
Seek out the hopeless, deceived and poor
Hold out your candle for all to see it
Take your candle, and go light your world
Take your candle, and go light your world
Hold out your candle for all to see it
Take your candle, and go light your world
Take your candle, and go light your world
Take your candle, and go light your world

I’m not Good at Goodbyes

They must change, who would be constant in happiness and wisdom ~Anon
There are many things I’m terrible at. Among them is twerking and saying goodbye. I have no idea when my backside married my waist but they sure are stuck at the hip. I was never invited to the marriage. When good music blast the air waves, I spring to my feet with dire temptation to twerk and shake the bright future behind me. I end up doing what I can call a duck’s waddle and that is being kind.
Goodbyes break my heart. That is why I prefer leaving without preamble. That says a lot about my past relationships. Sometimes I feel like calling for a meeting of my ex partners and offering them a collective apology for leaving without notice. But that would send wrong signals so hold that thought.
The last time I left a workplace, it hurt. I had worked at J hospital when I was a student pursuing Nephrology nursing. J Hospital is one of the best rated maternity hospitals in Kenya. I joined them as a bank staff nurse. That is for the sake of my British readers. To the rest of the world, I was a locum nurse.
What I knew about them was that they did not recruit anyone into their pool of locum nurses unless you had been a permanent staff at some point. However I applied. See, working and studying at the same time is not easy. Though I was given a study leave by my permanent employer, I still needed tuition fee. Bills needed to be paid and a bank loan I had unwittingly taken still needed financing.
My payslip was as dull as Marasmus illusionist like smoke and mirrors. My best friend took one look at it and declared,” Catherine you’re bleeding financially and you need to make it stop or you risk never ending the poverty in your family.”
That is why I jeeded an extra source of income. J Hospital employed me even without having worked with me previously. God’s favour, I have come to realise, respects no boundaries. When God decides to bless you, it is beyond human comprehension. So I gave up trying to explain.
For the entire year of my studies, I worked with them and put my best foot forward. I also put the other not best foot forward in school. Perhaps the feet were both great because I excelled at both my studies and I learnt a lot in the hospital.
Time came to say goodbye and I remember sitting with nurse managers K and M. I told them from the deepest parts of my heart how grateful I was to serve with them. I was not being polite. I just meant every syllable and punctuation mark. When time neared for me to leave Kenya, I went back and with a tiny piece of cake, I reiterated the same to the entire staff.
They did not understand why. For the longest part of my life, nursing was just a happenstance. J Hospital reaffirmed me as a nurse. I worked mostly on night shifts and the weekends because of school but even then, professionalism in nursing screamed out like catchy headlines.
My interviewer was Director F. She was brutal at the interview but she still recruited me. I hope to one day ask her why she chose me. I know she does not even remember me. All I know is nursing started making sense during that period. I remember telling her I never wanted to be a nurse. I was sure I flopped at the interview. She said I was interesting. The rest is history.
As tears rolled down my chubby cheeks, I waved goodbye through the purple gates of J Hospital. It was time to leave for the UK.
This scene was replayed last week when I had to say yet another goodbye to my colleagues at NM care home in Edinburgh, United Kingdom.
I was convinced, after the first few months in the UK, that I was not wanted or needed as a nurse. In fact, I was ready to book the next flight to Jomo Kenyatta International Airport (JKIA). Transferring from the initial work station to NM was a blessing. Here I was accepted. My blackness never mattered. Here, I was a nurse and not, “that new African nurse,” said with a scowl and a scoff.
It has not been easy. I expected to work in the nursing unit but I found myself in the dementia unit. Why I never complained is actually a mystery to me. I look back and ask myself why I never once approached the manager for a move to the general nursing unit. Perhaps it is because deep within my heart I came to adore mental health nursing.
I came to fall in love with that one aspect of nursing that I always let be in total abeyance. I was protective of my residents even when they made me feel so helpless and powerless. Not once did I wake up in the middle of the night to wonder if resident X was being restless because he was somehow in pain.
The Abbey Pain score tool may be straightforward on paper but it is hard to implement on a patient with advanced dementia. Some of the scores overlap with every day mannerisms of the patient. It becomes hard to tell if they are in pain or are just having an abnormal normal day.
Nursing changes her meaning when it comes to mental health. The balance is but a slither. A tongue of merit of a procedure against the potential harm. It seems like the only choice I ever made in my nursing career is actually Renal/Nephrology nursing. The rest have sort of landed on my lap.
Take for example my experience as a midwife. In basic nursing school, midwifery intimidated me. I however liked the tutor and I aspired to be her in many ways. She was always cool, calm and collected. Even when forcing you to redo a procedure, tutor G as we called her never lost her serenity. She was the meniscus that allowed a needle to float on water. Unshakable.
When I graduated, I told my classmates that I would never ever work as a midwife. Because God has a sense of humor, my first posting was in the Maternity ward. The second one in the County government of Kiambu was to a Maternity department as well.
I was convinced I’ll never leave the Maternity environment until we lost a 21 year old to acute kidney injury. That is when my love for Renal nursing was born. It still hurts to have lost her when I’m the one that admitted her to the antenatal ward. Anyway, that is a different story altogether.
Allow me to take you through this journey. I will mention a few people that have impacted my stay at the care home.

I’m shamelessly using my blogpost to advertise my side business of speech writing. Feel free to contact me.
NM nursing home enabled me to face myself. I especially had to learn a few things on conflict management. It reached a point where my team and I couldn’t coexist in harmony. Being who I am, I’m used to running away from conflicts and never once addressing them.
What I did that evening still surprises me. I asked the team to have a sit down with me and talk about their issue and I talk about mine. By the time the manager came to ask me about the argument we had had the previous evening, the case was solved. We had evaluated and planned for the future. Suffice it to say I will miss my team. They forced me to face conflicts as a point for growth.
I have been under the mentorship of mental health nurses. They have specialised in this field and I always ran to them for support. Case in point is nurse A who is a night shift nurse. Time and again I wrote nursing care plans which I wasn’t even sure of. Due to the Covid-19 pandemic, I never had a chance to undergo preceptorship so I have majorly been stumbling in the dark with writing of care plans.
Nurse A always checked them and in a melodious voice she would day,”stop doubting yourself my lovely, this care plan is great!” Much to my relief.
K is a mental health nurse who says that she is in her fifties. She does not look a day past 30! Being a Gemini like myself probably pulled me to her. She called my signature a ‘souvenir’ whenever we administered controlled drugs. She had the most subtle sarcasm and I think she is the only one that identified with my wicked sense of humor.
My 12 hour shift was shorter with her in the next-door unit. I knew if I ever got stuck, she would come running. Oh she can run! She ran when a resident in my unit had a chest infection and the hospital was delaying his admission.
She ran when I was unsure whether to phone for the ambulance myself or trust that the ambulance would show up after the doctor called for it one hour earlier. She infused large doses of confidence in me as a nurse.
She saw through my indecisiveness and fear. She consistently empowered my strong points and gently led me to a final decision on a matter. If I ever make a good clinical nurse, I will attribute it to K. There is something about her vast experience that is both intriguing and awesome.
Deputy home manager P is another soul I will never forget. He was always ready to help. He knows the company’s policies by heart. He knows every resident by the beat of his heart. He took me under the wing of his brilliant care and mentored me.
I remember one day sending him a message to ask if there was a problem with my skills as a nurse. This was after being fed cow turf about some nurse asking about my qualifications. I felt so insulted, so belittled. I asked P if he knew about any issues. He didn’t. He has been my sturdy bedrock of reassurance.
Tasha is a health care assistant. When I told her I’m moving to the Renal ward at the hospital, she cuddled me and quipped,” you deserve it. You need an environment that will let you be who you are” those words warmed my soul.
When I contracted Covid-19, nurse R the home manager came to my apartment to bring me supplies for the period of my self isolation. She was accompanied by the ever happy administrator H. This was the first time an employer went out of their way for me.
She asked me for a shopping list. She even looked for my preferred drink maziwa Mala known as Kefir here in the UK. R has been integral in my growth and development. Whenever I had issues and approached her, she never once unceremoniously pushed me aside. Even when I was very disturbed when someone questioned my qualifications, I asked her about it and she told me to treat those words as malice and attach contempt to them.
When I handed her my notice of resignation, she embraced it. She elicited how I needed to grow as a nurse. That a care home did not offer me enough challenges seeing that my career goals were very different. She was very helpful. I will miss working with her.
She also was happy to allow me keep swapping my shifts to suit my university lectures. Yes I am pursuing a Bachelor of Science in Nursing here in the UK too. Thank you for the clapping. Ha ha.
The icing on the cake was to hear the regional manager T and also my boss’s boss say,” Catherine I wish you the very best with NHS. However, should that not work out, please pick up the phone and call me. We will be happy to have you back.”
Wasn’t it for Covid-19 guidelines, I’d have hugged her and wet her flowery top with chunky rolls of tears of happiness.
Friends, sometimes we do not know how much people appreciate our presence until it is time to leave. I feel this has been it for me. As I look to the future with expectant longing, I nostalgically revel in the immediate past. I see favor in everything about my life.
Many have lost jobs during the pandemic but I have not only maintained one but also got another with my speciality as a Renal nurse. There are many factors that people may use to explain that. I choose God’s favor as the explanation.
Nancy is my spiritual helper and a staunch Christian. She has a habit of discussing my life with my best friend. She once told my best friend ,”does Catherine understand that God has decided to show off His might with her life?”
I believe her. I really do.
I had promised myself to be strong. I however broke down when I saw the multicolored balloons and good luck messages strapped onto a dining table all for me. I half-cried, half-laughed when I saw a pink bow for my hair as one of the farewell gifts.

Oh no! Can’t we go to page one and do it all over again? ~Winnie the Pooh
The Activities’ planner B and my team of health care assistants had made sure to get it for me. They even added white chocolates because that is my favourite flavour.
I love my hair bows. Maybe I still am a little girl at heart. I suspect myself to believe in unicorns and fairies too. In my defense, Scotland’s national animal is a unicorn. You should see my natural, kinky hair in a bow. I live for those moments. I am a happy nurse when I have a wee bow. I noticed that my residents liked it too.
I am thankful for a whole year of service with this company. I am smiling as I recall the small and big moments we have shared together.
I bid farewell to not only a care home, but MY home in Edinburgh. Thank you for allowing me to be part of your family.
CateMimi Uncategorized 3 Comments July 29, 2020 10 MinutesEdit”I’m not Good at Goodbyes”

A castle and a rock

She is not just royalty. She is a marriage of a rock and a castle. Edinburgh castle is perfect witchcraft
I remember the first time I saw her. Like nobility she was draped in purple. The hem of her garment spotted frills that brought hypnosis to life. Shifting lights of the night shone on her and she reflected these beams with sexy abandon. Alluring without trying to be. She oozed confidence with so much ease that she took my breath away.
I knew she would love me back even if it was the beginning of a wintry night. She held so much promise. Edinburgh, the capital city of Scotland in the UK was my new found best friend.
Malea and I had left Belfast for Aberdeen through Edinburgh. The flights from Belfast to Aberdeen were not until the following morning and we could do with a visit to this enigmatic city. We spent a night at a travel hotel just a stone throw away from Edinburgh Airport. Google had so much to say about Edinburgh and we couldn’t wait to have a preview.

With my village hood I posed in front of her
Our journey back to Aberdeen was by train later in the afternoon. In the meantime, Travel Lodge hotel welcomed us with a full English breakfast. It was self service. I was blonde at the components of a proper English breakfast. Malea is a nurse from the Philippines and going by her ease of using cutlery and pronouncing the names of the dishes, she was well exposed. Catherine on the other hand, was as exposed as a dead dodo.
I followed her lead in serving the breakfast. I copied everything including putting baked beans next to my toast. Dear Britain, who taught you this outrageous combo? And while you are at it, is there a white pudding to complement the black pudding? Just random Africannesse in me. Black pudding is mutura for cool kids.
Minutes later we hailed a black-bodied taxi to Waverly Train station. The plan was to wander about Edinburgh but within the radius of the train station. Missing the train was not in the to do list. The short detour was short and sweet.
Boasting of a majestic Castle on the hill Edinburgh attracts the mind and the heart. Within the walls of the vast and resplendent castle lies a wee room where Mary Queen of the Scots gave birth to King James VI of Scotland and I of England. So stately is the castle that it is build atop sturdy ancient and medieval rocks. Some call it the rock and the castle. I couldn’t agree more.
The city of Edinburgh sits among seven hills. It is surrounded by antiquated and romantic Victorian and Georgian buildings. Separating it into Old and New towns is the almighty Princes street. A beehive of trade. The epicenter of activity. An ocean of people moving in all directions from all over the world. Malea and I had the pleasure of loitering in a garden park just next to Princes street. The deliberate efforts of going green from the Edinburgh city council have paid off since this park was teeming with all sorts of summer flowers, cooing pigeons and silly seagulls.
Oh the seagulls. They cawed and boldly posed atop street lights and the Scot monument. The monument is coloured in streaks of dried, drying and fresh poop from the naughty birds.
Dressed in a kilt and hugging his bagpipes, a traditional Scot belted out tunes after tunes from them with reckless abandon. I was both mesmerized and amused. This was the first time I saw a man in a skirt! Okay, kilt.

Fun Fact: Men ideally wear no underwear under the kilt.
Months later after transferring to this ancient and portentous city, I have enjoyed every bit of it. Waverly has become my Afya Center. My friend and I designated it as such after numerous episodes of getting lost. Afya Centre is a famous building in Nairobi where all people wait to meet to avoid getting lost. Afya Centre is the True North of the city in the sun. So is Waverly for Edinburgh.
Rural Huntly with her unwelcoming aura felt like sipping water from a fire hose while Edinburgh was a gentle breeze on a summer night. I was received with open arms at the new work station. Strikingly dissimilar from the previous work station, this one had people of all colours. I was not the only African and this gave me a sense of comradeship. The staffs had interacted with people from all over the world and I quickly became part of the team.
I didn’t have to remember that I was African. Here I was me. Catherine, a UKRN. For the first time since coming to the UK, I took part in a staffs’ night out. I may have stayed out until half past ten but those few hours meant the world to me. It is in our nature to want to belong. To be accepted. To be in a group.
I gained confidence in my nursing skills just because I felt at home here. I was able to make and execute decisions as a nurse because I was part of the big painting on the canvas.
The weather in Europe has been described as the most outrageous in the world. Perhaps with keen interest in Scotland where it rains in winter and rains in summer. A saying goes that there is nothing as bad weather, just bad clothes. Edinburgh embodies this.
A few months ago Malea visited me. She settled in the city of Aberdeen but couldn’t wait to have a slice of my city. This was in the coming to birth of winter of last year. As we trotted from a Mexican hotel whose tacos were a stroke of genius, splattering rain interrupted the otherwise sunny afternoon.
Five minutes later little hail stones fell on her long silky dark hair. As if that was not enough, some snowflakes fell too and this was while the sun stood still. It all stopped as soon as it had begun. We experienced all seasons in one day. The work of an amusing god.
Twelve-hour shifts breeze away when I recall that I am working and living in Edinburgh. My first impression on that first night several moons ago has but grown in new depths and expanded my vistas. It is as cosmopolitan as London. Only without the haste in London. London reminds me so much of Nairobi. Where is everyone going to in such a hurry? Why the serious faces huh? Who hurt everyone? My city, my Edinburgh is home to good natured fellows. A smile here and a “hiya” there.
The Scottish accent however is another tall tale. We do not cross our t’s in Scotland; we swallow them. We annihilate them from the sentence. We pretend they do not exist. Water is not water until it is wo-a. Butter will not be on the toast unless it is ba-a. I never thought much of the accent until one of my trainers taught us at a class in Belfast. That is when I realized just how heavy the Scottish accent is.
I have been trying to teach the carers I work with the Kenyan accent. It is not working. They have been trying to teach me the Scottish accent. Proud to report that I fail spectacularly. It is even worse when I try to communicate with a resident. A particular one always says to me,”I don’t what you’re saying! ” in total exasperation.
It pays to have a super team at work. I can time and again approach my colleagues to ask them to interpret what in God’s green earth was just said to me. Not once or twice have I laughed to jokes told while I had no clue as to what the speaker said. Smile and laughter are universal languages that save me all the time.
Yesterday my friend and I went for a stroll in the shimmering lights of the summer evening. Mouth and nose fully concealed under a face mask, I waited to board a double-decker bus to my Afya Centre. An elderly man stared at me for some minutes at the bus stop before telling me something to do with face masks and smiling. I could relate. He however went on to talk about something else and the best I could say was “Aye”…..”Aye” and one more “Aye”
He must have thought I am a woman of few words. Probably thought I was wise. Truth is, I still have no clue as to what he told me.
But whatever he said in the name of good ol’ Edinburgh, AYE!

Mild Covid-19, Or Is It?

Cover your nose and mouth to cover the world.
I woke up before the others. Before the birds, before the sun. I woke up to post some tiny squiggles I call sentences on this blog. Out of habit, I checked the trend of Covid-19 in different parts of the world. I look out for new information. This virus is as dynamic as it is complicated. I must stay updated.
I then happened upon one of the public speakers in Nairobi. He shared his story on contracting Covid-19 and being admitted at a well-to-do private hospital in the city. What appalled me was the lackluster approach my countrymen adopted. My stomach knotted in several different spots.
I have battled what they call a mild form of Covid-19 yet there is nothing mild in it. Weeks after recovery, the journey has been a roller coaster of symptoms. It starts or ends with an episodic continuous cough. A cough so wheezy and hacking that you’d be forgiven to think I’ll drop down dead the next minute. I will say nothing about the muscle aches and absolutely unexplainable bouts of sadness.
[Read about Richard Quest’s experience on https://www.cnn.com/2020/07/07/health/richard-quest-covid-wellness-intl/index.html%5D
The good public speaker who we will call RB (I am so good at keeping things anonymous haha) wore a baseball cap and had oxygen being delivered through his nostrils as he went live on Facebook.
My people, being the ever light hearted fellows diagnosed him as a sympathy and attention seeker. It squeezed the remaining drops of life in me. Living and getting used to such low standards of public health care has blinded most netizens from the fact that oxygen administration isn’t a life and death situation.
That oxygen therapy is available even in some people’s houses. That oxygen cylinders are available for people to walk around with if they require long term administration of oxygen due to various medical conditions.
Interestingly, when Covid-19 hit New York city, a Kenyan in the US posted a video of herself using the same oxygen cannulae in a hospital. She was vocal in letting everyone see the seriousness of the illness. She received no bashing. When RB speaks about the same, he has become the bad guy.
Fact is that the cases of Covid-19 are on a sure and steady rise in Kenya. Nairobi especially is hanging on the precipice of tipping over. The curve of infection is on a sure way up. More than fighting the virus, my colleagues on the frontline will have to battle pure unadulterated ignorance from online personas.
These are people who have swallowed the narrative that Covid-19 is just a flu line hook and sinker. A tangled web of faulty beliefs, selfish impulses and desperation. Irresponsible and irredeemable. These are people whose sense of responsibility is as common as rain in the Sahara.
Pretending Covid-19 is just a bad flu will not make it one. That is a bias we are adopting to protect our fragile egos. A special kind of delusion. I am scared that now that the lockdown restrictions have been eased, most Kenyans will resort to factory settings. No social distancing, no hand washing and definitely no masks. And if they do wear them, they will be relegated to being chin guards and dangling ear pieces.
When you receive such hatred online after admitting that you have contracted Covid-19, how will other people manage to speak out? We must be woke that Covid-19 is here with us and is at local transmission. We will protect ourselves and those we love by being bold enough to go for tests and making them know that we are going to be self isolating due to the viral infection.
Contact tracing and tracking has been documented as being an effective mode of handling Covid-19. Consistently doing so will save us from potential annihilation as a country. When we discover cases early, we are able to isolate and treat them early when they are still contagious.
See friends, it is not your fault that you contracted Covid-19. It is nobody’s fault. Even the best laid plans go haywire. The least we can do besides protecting ourselves is supporting those that contract it.
Covid-19 is not HIV where you hide your status even from your family. We are at a very critical point in Kenya and many will get infected. If we receive them with the hostility we have directed at RB , then they will not reveal that they have been infected. These people may be your colleagues or even employees or a domestic manager. They will not tell you because nobody enjoys having their dignity stripped off them.
My appeal to the ministry of health in Kenya is to demystify contracting Covid-19. It is scary enough to gerrit but it is even worse to keep silent about it. When we lie about it or keep quiet, we waste precious time that may have been used to track and trace contacts for effective isolation and early initiation of supportive treatment.
There is power in speaking out. It gives courage to others in similar situations to know that they are not alone. However when those that speak out are pelted with keyboard stones, nobody speaks up, everyone gets infected and soon we start mourning our loved ones. Please desist from trashing people’s stories. It is an inspiration from hell and you are the Devil’s right hand person.
The lack of knowledge coupled with blatant flounting of rules from most government officials have made it look like one big joke. Like we can create memes and move on. If anyone speaks about their interaction with Covid-19 then they are seeking attention.
How twisted your brain must be if your way of getting attention is claiming to be suffering from a novel virus? I do not know who will make us realise that we are courting danger. Flirting with mortal disaster.
Do not be mistaken by the phrase mild Covid-19 infection. There is nothing mild in the after effects. There is nothing mild in the utter fatigue and mental ditches that one suffers after the fact.
Further, it is crystal now that the viral DNA remnants remain in the body for as long as 8 weeks (or more) in some people. These are not infectious and have served their time. However, who is to tell what damage those remnants could be doing in the body before they finally get eradicated? Research is still ongoing and believe me it is not fast enough.
Personal responsibility means that we are on our own. The government has done so much and now, in spectacular Obama style, they have dropped the microphone. We have reopened the country for the sake of the lost livelihoods, not because it is safe to do so.
Social media is informational. Part of that set of information is that oxygen delivery is not tantamount to intensive care admission. Is it about time Kenyans volunteered in hospitals and learnt a few things on the same? Perhaps then they will understand healthcare and own it.
We are used to seeing oxygen be given to people gasping for air. We never thought it can be administered while someone is able to talk and still eat and interact with their environment. And what is wrong with the baseball cap? Should RB have smeared ash on his face and worn a sack cloth for us to believe he is in the hospital battling Covid-19?
Fellow Kenyans, there is nothing as beautiful as our creative streak but sometimes we take the joke too far. This is why many people on your News Feed will never come out to say they contracted Covid-19. Because you will call them a few names before dismissing them.
I am struggling to understand post Covid-19 syndrome. I have been looking for people who have healed from Covid-19 for us to compare notes on life after Covid-19. Your judgemental behaviour is prohibiting them from speaking out.
To RB, there is a time you classified friends and said some should never be invited to the kitchen. It is time to classify Kenyans on social media. We die while laughing. We bash everyone and everything. May this episode of our malice not dampen your spirits. From a girl that recovered and is still recovering, get well soon.
PS : To anyone of African descent reading this and has healed from mild to moderate Covid-19. Please write to me on mainacate2013@yahoo.com. Tell me about life after Covid-19. Listen to your body. Let us compare notes.

Covid-19 in a Dementia Unit

Always remember, a dementia patient is not giving you a hard time; he is having a hard time
~Bob DeMarco
He always picked on me. Graeme M. Frank* always did. At 6″2 tall, he towered over me like a mighty Goliath. He didn’t do it on purpose though. Alzheimer’s had robbed him of the joys of human interaction. Infrequently however, divine light illuminates his mind and his best sides strikes through like a bolt of lightning.
But he still picked on me. We could be attending to him with one of the carers and he would choose me as the target of his clenched fists. “You will get it!” he’d threaten but forget about it as soon as he said it. A lion’s roar.
I work in an advanced dementia unit hence Alzheimer’s disease is one of the challenging illnesses I’ve had to deal with. As intimated before, mental health nursing is not one of my strengths. I time and again rely on those I work with to hold me together.
I am the team leader of a very capable team. At any given time, I have N* and J* as my health care assistants. I focus on the nursing aspect as they focus on the intimate caring bit. That is what the papers say. However, we essentially team up every second of every 12-hour shift to offer the highest attainable quality nursing care for all our residents.
They know I identify too much with my residents. N is the chief whip of the unit. She demands thick skin from me. I try. God, how I try. Occasionally I feel so helpless as a nurse I have to go to J for cuddles. J stabilises the team. I couldn’t ask for better carers!
Take for example this fluffy Friday afternoon. Fresh as a sunny day in winter, time dragged on and Graeme did what Graeme did best; wander with purpose.
It is a phrase we use to describe patients who move from place to place. At face value, it looks aimless but the truth is, their thought process indicates that they have a purpose to the movements. It gives them something to do. You can safely encourage this in a nursing home. Quite the opposite if you’re nursing this patient at home. They may get lost.
I heard a scuffle and rushed out of the treatment room to the corridor. Greame was very agitated and pushing Hillary* away. Graeme jealously protects his territory. Hillary loves being with other people. We had not noticed Hillary walk towards Greame and hold his hand. Graeme wasn’t very pleased. Neither was Hillary. It broke my heart.
As Hillary tightly clasped my hand and walked in tandem with me to the dining room, I unsuccessfully hid the tears welling up in my eyes. N, being the hawk-eyed of the two carers wasn’t fooled.
“Catherine why are you crying?” She enquired.
I’m not sure what I said but it bordered on my feeling sorry that Graeme didn’t know why Hillary wanted to hold hands and Hillary not understanding why Graeme didn’t want to go for a walk together! I may as have well spoken in tongues.
N and J both held me in a five stars embrace. Just what the doctor prescribed. A therapeutic hug. A hug that went to a private school and had access to private tutors growing up. Hugs, friends, hugs should taste like this. I wanted to freeze this moment right here and put it in a mirrored column pedestal or in gilt-edged frames. Priceless.

Hugs are the words we utter when our mouths can’t speak.
See, both carers have considerable experience working in dementia units. You could say they have seen it all. Well, yours truly hasn’t and I’m not sure she ever will.
Graeme, apart from being ferociously territorial, picks on strangers. Especially strangers of the female gender. I was a stranger and a female; a typical low hanging fruit. It took a few months for him to get acquainted to both my face and voice. I am no longer threatening to him. In fact, he drawls a “hiya!” in a heavy Scottish accent whenever I pass him by.
Brian*, his son, nostalgically remembers his father as a family man. A true Scot. Before being admitted at this care home, he had taken care of his agarophobic wife and autistic daughter. He always looked out for them. He defended them and shielded them from the world.
With the straps of his boots, trudging from the Scotrail company to his home every other day, he looked out for them. It came as a shock to the family when the tentacles of Alzheimer’s disease started eating at their beloved dad’s mind.
Alzheimer’s is a debilitating illness. It threatens to steal the person from themselves and from those around them. The decline in mental capacity is not only slow but sure. Medications oftentimes only slow the progress of the disease but not reverse it.
It starts differently for everyone. Forgetfulness being a classic symptom. Then a total inability to make independent day to day choices. It is a traumatic experience to watch someone you hold dear and near become a shadow of their former selves mentally speaking.
I have been here for a while now and every day I walk a mile in the shoes of my residents, it hurts my toes in several different spots.
When Graeme left for the nursing home, a void in the shape of his heart was left in that palatial home in Falkirk, Edinburgh. A void that shows in the frequency of visits from Graeme’s immediate and extended family. A void that is filled with silent understanding of what’s best at this point. A silence I could cut into and serve a chunk for breakfast.
The light in his eyes shine every time a family member visits. Everything changed with the dawn of the Covid-19 pandemic. Families had to stay away. Staffs wore Personal Protective Equipment (PPEs) and the familiar faces were buried in masks and visors. I was worried sick that his anxiety would be heightened.
To worsen a bad situation, Graeme contracted Covid-19. For a resident who moves unhindered from place to place, this was a major challenge for us. He was asymptomatic. Not even a cough. He had been diagnosed on a routine examination of all residents after one contracted it.
How they managed to get a throat and nasal swab from the able and mighty Graeme is a mystery I’m yet to unravel.
With a right-sided stoop due to scoliosis, Graeme shuffled along the unit without a care in the world. Nothing changed for him. Not even the novel Coronavirus was enough to dampen his spirits. Still he purposely rearranged furniture from one end of the corridor to the other. Still he transferred the cherry blossom-colored throw pillows from the Day Lounge to different bedrooms if they were open. Still he made a big fuss at personal care. That was our Graeme. Unbowed.
With Covid-19 restrictions, it has been a while since he last saw his family. Especially Brian, his son. Whenever he calls to find out about his Papa, we tell Graeme that Brian was on the phone for him. ” Oh aye!” He offers again in that exquisite Scottish drawl.
Last weekend however, Brian and his daughter brought toiletries and assorted chocolates for the staffs and residents in my unit. We encouraged Graeme to stand on the balcony so that they could see him.
He stood at the balcony, looked at the two and just when we thought he might actually register some recognition, he turned to a stuffed bunny that lay unattended on the couch. He picked it and went back to the Day Lounge. The perfect organiser. Always fixing everything to its place.
The memories and moments created with his family have fallen into the sofa cushions of time. So have the numberless conversations and the belly laughs together. There they all lie, in time, cataloguing the past and hopefully mapping out the future.
Time, I have learnt, does not offer any consolation to the declining mental capacity for dementia patients. Time for them is a vacuum filled with bits and pieces of a past that seems so long ago and a present that is held together in shaky ribbons and shoe strings.
I was afraid he would pick on me again. He didn’t. My soft voice, though wrapped up in a 3-ply face mask he still recognised. My eyes though hidden under a visor, still held his gaze and silently reassured him that we all were there for him.
The unforseen challenge was protecting other residents while still encouraging his ‘moving with purpose .’ How do you enforce isolation in an advanced dementia unit? What is the color of the sky in isolation and barrier nursing within Dementia Units?
N and J in my shift were integral in containing the spread of the virus. Every 30 minutes they’d walk up and down the corridor with bottles of disinfectant wiping down all surfaces. Every nook and cranny of the unit got cleaned a million and one times over. Happiness Unit*, though unhappy from semi-isolation from the other units in the care home,was not only spotless but germ-free.
It has been a while now since he tested negative. We are still working with the two metres physical distancing rule. Not for him though. Patients with declining mental capacity do not have the ability to comprehend the restrictions. The onus falls on the staffs to do it for them. For everyone’s sake.
Yesterday was special nonetheless. I was seated in a corner of the dining room nimbly working on my nursing notes. He stood at the door, gingerly holding the doorknob of the dining room where I sat (many metres away) and looked at me. He raised those bushy eyebrows as he held my gaze. I offered a smile. No reaction. I offered another. Then another one.
“Nice teeth,” he declared as he doubled up and shuffled back to the corridor. Pardon me if I’m smiling too much today. I just have to show you my nice set of teeth.
* Names of people and places have been changed to protect the identity of individuals and places. This is for confidentiality purposes.

Moving House

Home is where the heart is even if you can’t remember which box you packed it in ~Anon
The thing they never told me about abroad was that there were no bodabodas and no mtu wa mkokoteni. And people generally minded their own businesses.
My move from Huntly where nothing ever happened to legendary was filled with potholesthe size of an adults and hiccupsas loud as God’s thunder. It was a Wednesday. Wednesdays are supposed to be lively. This wasn’t. There was no life in my soul. Though I had passed the OSCE exam and I was now a UKRN, I still felt inadequate. I badly wanted to leave and go to a city. Any city.
I had experienced subtle micro aggression and hidden racism that I was just about done. Done with having to realize that I’m black. Done with feeling like an executive pariah. I have always preferred open rebuke to passive aggressive comments. Those made my red blood boil.
The transfer couldn’t come at a better time.
TIP : If you want to work in the UK, I propose you tell your recruitment agency that your like to be in a city or a major town. Small rural towns will suffocate you.
I packed my few belongings and hired a taxi to Aberdeen city. I had to do with the curious looks from my flatmates. Talking of whom, they had accused me of every evil under the sun. I had stayed with two couples. One Polish, the other a blend of Scottish and Litvia. The latter had their own en suite room, the Polish shared a bathroom with me.
This is where I came face to face with the glaring differences between housing options back home and in the United Kingdom. In Kenya, multiple occupancy houses are not a thing!
We had a duty rota to clean the common areas. The stairwell, the living room (which I never used), kitchen and in my case the bathroom I shared with the next door couple. This is where I had to learn to use a vacuum cleaner and a washing machine. A girl from my kind of background in Kenya had understandably never used either of the two.
As a matter of fact, they come in so many variations that I’m still learning how to operate them. I remember an impatient knock on my bedroom door one day after my night shift. It was Mrs.Mazur from next door.
She spoke in the most heavily Polish-accented English. From the tidbits I could gather, the bathroom needed to be scrubbed clean and I was being insensitive by sleeping during the day when the poor little bathroom was dirty. It was malicious to sleep when baby bathroom needed cuddles and a lullaby from mama. How could I!
I knew that it was not my turn to clean but either hers or her serial smoking husband. She gesticulated in angry frustration at me. Partly for achieving little communication because of the language barrier and partly because I looked unperturbed by her mannerisms.
Striding past her, I bounced down the stairs to the announcement board and brought her the tiny piece of paper that we called a duty rota. Calligraphically hand written there was today’s date and her name against it. She grabbed the rota from me and furiously returned to her room. I could hear her murmuring to her husband.
Poor man, I thought; that woman will kill him before the cigarettes do. She has a carcinogenic fiery tongue. Had I been my former self, mine would have clashed with hers and lit a fire. But this was a new me. Jesus had the wheel–and my tongue.
It takes an hour or so on the train from Huntly to Aberdeen city. It takes three decades and a prayer on the taxi. My cab driver was a chap who’d seen better days. He however knew a little about the world and over the staccato of the BBC Radio 2, we had a chat.
Cab Driver: Wherabouts yu’ from?
Me: Kenya
CD: Oh nice lassie yu’ run?
Me: (Giggling) Yes, for my life.
CD : (Laughing with me) That’s fine. We all run for our lives.
He noticed the luggage and the move and asked where I was headed to. At 70 years, he highly recommended the move. He said and I quote, ” this area has more sheep than people. A wee lassie need people.”
We can’t argue with our elders, can we?
The taxi rank is in the East side of Aberdeen bus station next to the busy train station. I needed to go to the West side where the bus station is. He could not help me any further without risking significant fines. I was therefore on my own. Just me, three boxes of baggage the size of a teenager and a backpack carefully strapped on my back.
This is where I missed watu wa mkokoteni. They make life easier. They help you carry everything and if you’re nice, they can carry you. Especially when it rains and Nairobi morphs into one big swimming pool. My father has been a porter for many years. He carries goods (not people Ha ha) in Wakulima market in Nairobi.
I missed him and his buddies. I wanted him to refer a good person to me to help me carry my burden from East to West. But this was Aberdeen. The glittering city in summer. I had to tough it up and solve my dilemma.
The Megabus I had booked was to leave for Edinburgh in an hour’s time. I had enough time. There was one problem though. The trolley I got from the train station had crooked, locked front wheels. It could also accommodate only two boxes at a time.
I had to leave one behind. However this is the UK. If a box or bag is left unattended for long, people will call the police and it may be taken away and treated as you’d treat a bomb. See something, say something is the slogan here.
I had horror images of being led away by mean looking Scotland Yard officers. Screaming at the top of my lungs that all I did was move house. Then I’d be sentenced to prison for causing public security concern. Then because I wasn’t built for a cage, I’d die, be buried and then my epitaph would read : She died for her baggage.
Thinking was not going to help me. I took a leap of faith and dragged the trolley. My blood alone propelled it forwards. Across a sea of people of all colours I pushed my evil trolley. I packed my boxes near the bus terminus. Luckily the people had “seen something and done something ” as the security messages blared from the different announcement boards.
The something they had seen was a struggling girl. And the something they did was leave her alone. I made a second trip and a third one to return the trolley. I was knackered. Why was I the only one moving house? Someone is always moving house in Nairobi. I missed seeing people move house!
The bus sauntered into Edinburgh bus station a few minutes shy of one O’clock. I was in contact with the owner of the Airbnb where I had booked a short stay.
I was only 15 minutes away going by the Google maps. I missed our Kenyan bodabodas. The rider would have lifted my luggage onto his boda, then somehow fitted me onto the same boda and off we would have left for the Airbnb. Ah the small joys of Kenya!
If it can’t fit onto a bodaboda, it can’t fit anywhere else.
I needed a taxi. Again. Edinburgh Cabs is the recommended taxi operator. I phoned and asked for a black taxi. A black taxi is not only black in color but also bigger. Can carry me and my sins.
Unfortunately for me, the taxis are not allowed to enter the bus station. One must access them from across the road where they have a cabstand. My driver called to let me know he had arrived. I had no trolleys. I was alone, again. My three boxes helplessly looked at me from the ground. Like a firstborn that knew his mum had hit below the rock bottom.
People walked around me into different directions and some gave me deserved look-at-this-poor-girl looks. Just what I needed. I approached a black bus station attendant and asked him for a trolley. He had been staring at me for a while now.
He smiled and in the most beautiful West African accent, he informed me they had no need for trolleys at the station. The baritone intonation of his voice sounded like the beats of Burna boy. Or Wizkid. Okay Pick any West African musician you know. My phone wouldn’t stop ringing. The taxi driver had the patience of a hungry infant.
He excused himself and helped me carry every last piece of luggage to the taxi. He is from Gambia he informed me. Getting a helping hand for the first time was golden. I half cried. He was the shining star in my dark skies. I tried giving him a token of appreciation. He politely declined. He just wanted to help me he said. I should have hugged him.
The cab driver was nasty. He shamelessly asked if I was carrying my life’s savings in those boxes. Retrospectively, that was hilarious! I didn’t however understand his whining. I had clearly informed the operator that I was moving luggage. There was no need for Mr.Cab to be salty with me.
He complained for the entire 15 minutes and I was too jubilant for that Gambian gentleman to be annoyed. The charge was seven pounds but I gave him a twenty and told him to keep the (insert a profanity) change.
My host was Russian. The tallest man I’ve ever seen. His girlfriend was petite. A lovely combination. I have blurry recollection of his name but I know it had a slav at the end. Somebodyslav from Moscow, Russia. In Edinburgh for 10 years and now virtually a Brit. He missed Mother Russia and hoped to take his girlfriend to see his parents soon.
I rated him a clean five stars on Airbnb. He was warm, his girlfriend a perfect host. She showed me how to use an oven to cook and warm meals. The closest I had been to an oven all my life was while watching Let’s Cook program on TV back home. Back in Huntly, my flatmates expected me to know. After all, the earth is flat and we all come from similar backgrounds, yes?Ha ha
I was not even aware cans of beans and fish could be opened using a can opener. First, we didn’t use canned foods back home and second, if we ever needed it opened, we could always use knives to piece the edges at the top of the can.
She showed me places to shop and even recommended an African shop around. Compared to the reception I’d had at Huntly, this was incomparable. It was life giving.
It would take me a week and a half to get new accommodation. There are no signs indicating houses as ‘VACANT’ like I was used to back home.
I had to use my phone to download different applications where tenants meet landlords . I missed waltzing into a building and asking ” huku kuna vacant?” Translation: is there a vacant here? A vacant is a loose word we use to denote an empty house for rent.
I reminisced how even if there was no vacant in that particular building, the tenants would guide me to available vacants within the area. Again, the joys of Kenya that I took for granted!
Recently I went to the African shop that was recommended. I needed plantains. I saw the Airbnb from across Gorgie road, Edinburgh. I felt like passing by and saying a massive hello to Somebodyslav and her girlfriend.

No Students in Class

I’m trying to be the person I was too lazy to be yesterday.
Shifted and subsequently broken. That was the state my heart was in when the airbus kissed the skies away from Kenyan airspace and dauntingly tilted towards Abu Dhabi.
I told myself that I wanted to go anywhere. Anywhere but home. I wanted to be away. To rethink, re-strategize and reboot. I was unsure of many things but one; I needed to go back to school. I needed my Bachelor’s Degree in Nursing. Now I have to tell you a story.
Little Red Riding Hood…
Once upon a time, the Nursing Council of Kenya ( NCK) decided to have a conflicting educational system for nurses in the country. NCK, which is the Regulatory body for Nurses in Kenya, felt that it was the most beautiful thing to train nurses as Certificate holders, Diploma holders and then Degree holders.
To garnish the uninspiring system, NCK trained diploma Registered Nurses for an entire 3.5 years, taught them the same thing they taught degree holders for 4 years in University, and then refused to have a scope of practice.
The employers, government and otherwise, then went to the job market in search for nurses. They found degree holders but felt they couldn’t pay them for their high and mighty papers. So they shopped for diploma and certificate holders who could equally do what the degree nurses would do.
After all, the market was flooded with nurses. And any nurse is a nurse as long as they do what nurses should do. I do not know what that means leave me alone. NCK did not learn even after multiple attempts from professional bodies and unions to try cushion the future of the Nursing profession in Kenya.
“Let us train them all,” NCK reasoned. ” It has always been like that,” they chorused like well-fed baby yodas. “The employer can decide whether to employ the certificate holder or the degree holder,” they justified.
The brains behind degree nursing had had a dream. A dream where the value of the profession extended beyond Kenyan borders to global standards. A dream that students in high school would someday want to become nurses by enrolling for degree courses. That nursing would regain her lost glory and stop being viewed as a course of last resort.
A dream that nursing in Kenya wouldn’t be viewed as a subordinate branch of medicine but an equal player. That dream was in part transitioning the education system of the nurse. But NCK, just like the big bad wolf never changed.
Just like the big bad wolf, in the 20th Century, NCK won’t scrap off Certificate nursing training whose requirement is a D (or something similar) in KCSE and won’t create opportunities for employers to prefer nurses with advanced education. Baby Yoda belched with satisfaction at the confusion he created.
Then along strutted Little Red Riding Hood. She failed to understand the malignant injustice in the Nursing education system in Kenya. She especially felt that higher education should reflect in a wider scope of practice and a more defined scheme of service.
Higher education, she surmised, brought massive shifts in the world of possibilities. It was exhilarating. She saw a future whose direction she’d love to be part of. This borderline orgasmic determination scared some and inspired hope in others.
The science and art of caring for the sick was an empty clanging cymbal if it couldn’t work for the benefit of not only patients, but the nurses themselves. Laws that break the very backs of the taunted frontline workers are antithesis of what nursing embodies.
Little Red Riding Hood got an opportunity to test her theory. She enrolled for her BsN by God’s grace somewhere in the United Kingdom. This was in the year of our Lord 2020. Covid-19 was the king and social distancing the new gig. She was me. I was her. The End.
To the present…
I have been to numerous classes thanks to my interesting educational journey. What I have never considered is online learning. That is what Covid-19 has shoved down my throat. Perhaps it should be easy because I’m a qualified and registered nurse already but hand to Jesus and the choir of heaven, it is not.
It is even more convoluted when you’re as tech-ignorant as I am. I pride myself in having a fairly stable memory. I should remember my Computer classes not so many moons ago. However, the outlines are clear but they fade at the edges leaving blurs and smudges. Everything gets dark after that.

I need an IT boyfriend . It is urgent. Do you have a tech-savvy boyfriend? I need him. Sharing should be caring or something like that. This is where girl power comes in Mother Teresa. Loan me your geek boyfriend for the period I’m in school. Ha ha. I got you.
Two days ago I submitted my assignment and instead of posting it in the board where my lecturers can see it, I posted it in the Frequently Asked Questions’ section. It is only the patience of the lecturers holding me together. Like raggedy pieces of duct tape and a shoestring, they daintly keep me in place.
Blessings is my virtual learning classmate and she keeps asking where the assignment section is located. Ollie wants to formulate and answer his own questions. A certain Olayinka won’t fix his microphone during live class sessions.
The live sessions have become my favourite. They are gorgeous. See, we have two lead lecturers. M and Dr. P. For the entire semester of Summer 2020, if they say jump I must ask how high.
The time is 1200hrs BST ( 1400hrs EAT). M introduces the lesson and everyone has their mic on. She has a hard time getting the class to order. Everyone wants to say “hi everyone .” Daniel, who has joined us three minutes after the start of live recording also wants to chant ,”hi everyone.”
M and Dr.P briefly outline the learning objectives then M takes the lead. M is in Surrey and Dr.P is in London.I don’t know whether they know but their students are there just not there.
Solomon’s hand has been up for the last several minutes and M keeps asking him if he has a question but he won’t talk. He will not put his hand down either. We have to learn to live with him.
M is saying something about Harvard referencing style. She talks about sending us a link to learn how to cite them right. Charles has his microphone on. He is murmuring to some femeo that ,”aha, I can see them now.” Okay Charles we would like to see you too please turn the camera on.
M : Charles could you please turn your microphone off? I will allow time for Q and A at the end of the session.
Charles: ( To femeo) ahaa, now it looks good.
M: I’m sorry class let me mute all microphones.
I have forgotten what she was saying. Did she say the author’s name and the year of publication must be within brackets or was it just the year? I hope to catch up.
M goes on. She asks Dr.P if the screen she is sharing is legible. Dr.P rightly tells her that it is not and we would all benefit if the text was enlarged. Here comes graduated trouble.
M is as naive with technology as I am. Dr.P’s silence is too loud. Apart from Emmanuel who saves the day, we are technologically as tasty as plagiarism. Emmanuel reminds me of a classmate I had in my renal nursing program, Bundi.
Bundi was the genius of technology. He helped set up Power Point presentations, linked them to wondrous YouTube videos and still managed to screen in and screen out presentations. Emmanuel is my new Bundi.
Some child is crying in the background and I can’t tell whose baby it is. Neither can M. M just wants the microphone off. That happens. Almost immediately, the cursor on my screen moves and there is someone doodling on the screen. They are drawing tiny blue circles on the screen and M is ten milliseconds away from holding her forehead in exasperation. She doesn’t.
M : Please class note that we all can see things happening on the screen. Please do not touch your screen when on live session. Please try to not play with your mouse pads.
Ha ha M. I miss real classrooms. Where I would sit at the back and pass wiseass notes to my classmates as the lecturer talked. Whoever is drawing is officially my desk mate.
Eventually we get it and the lesson is halfway over. We pause for a quick Q and A. A girl is asking a question about some activities in Unit 7. People of God, Unit seven is not until three weeks from today. Pray tell me how did we get here?
Though she gets her answer, Dr.P is a quintessential Brit who tells her without telling her to calm her heels down. Oh you should have seen the smirk on P’s face. It froze the sun.
I have been dying to ask about word count. I am horrible at word counts. I always get it wrong. Dr.P is guiding me but all I hear is stuccato because someone’s cup is filling with water (or alcohol) somewhere. Children of Papa God, how hard is it to turn your microphone off though?
I have to ask Dr.P to say it again. This time, I am the one that interrupts it. There is a flying beetle that’s found it’s way into my living room. I left the window half open to let in some light. The early summer beetles have been dying to have a cuppa coffee with me.
A cuppa when in the middle of a lesson sounded like a beautiful idea so it buzzed its way into my living room. Wings tiny as a baby’s finger, he fluttered on in front of my face and I used my hand to swat him away.
That movement somehow touched my mouse-pad and the camera came on. P had to pause and watch me fight my monsters with the microphone off. What a spectacle!
Veronica wants to ask questions and “seek clarification ” on everything. She also wants to “clarify” what M and Dr.P have already said. My brain has taken a walk and I want to follow it. There is something about a teacher’s voice that just takes the pain and grind of life away.
A teacher’s voice is the blood running through the vessels of peace, love and harmony. The intonation of the teacher’s voice; as s/he explains a concept is a melodious tune to our hearts. A teacher’s voice cannot be ignored. It is also a cajoling lullaby. So I doze off somewhere along the lesson.
I’m startled when my earphones fall off and for some reason I am thinking about Samuel L. Jackson. I think he would be a badass teacher.This is why they record these lessons. Samuel L. Jackson would record them too.
We must access them if we are to pass the module. By the time we chant ” bye everyone,” Ollie still isn’t convinced that his answers are not related to the questions asked in the assignment.
Charles and his femeo left the session at the 47th minute and Solomon’s hand is still up. He says nothing. Seen. Not heard. Does his voice sound like Samuel L.Jackson’s? Is his voice the love song of the nightingale and the lark who we can’t hear anymore?
Why is his hand up? I wish he could type his thoughts in the chatroom. He doesn’t. Like a sleuth he wanders in our online presence. He sees us but we can’t see him. His virtual hand however, remains up. I must go back to that recording.

The Golden Girl From Swansea

Being happy never goes out of style
–Anon
The Germans say that a person has learned much who has learnt how to die. In my line of work as a nurse, death is one dull dreary experience and I have interacted with it several times. My colleagues and I are always fighting it on behalf of our patients. The statistics have so far been overwhelming in our favour. Sometimes however, the thin curtain between life and the other side gets lifted and it is bye bye.
Never before in my career had death become all too familiar as when I started working with residents. The beauty of a close knit care home is the homely atmosphere. Everyone knows everyone. Some residents know the team and they can tell who didn’t come to work when. It is also very hard not to have some degree of emotional attachments with them.
Good nursing practice says to empathize with clients. This calls for walking a mile in their moccasins for a nurse to offer quality care. I wore pair of Maddy’s* snub-nosed blue shoes and they fit snugly. I didn’t didn’ttake a mile in them. I completed the whole race track and loved it. This 98-year old golden girl from Swansea leapt off the page like a catchy headline.
She had been living in the advanced dementia unit I worked in for an year before I was transferred there. I do not understand my nursing journey oftimes and I gave up trying. I had hoped to work in the special nursing unit but by some twist of fate, I was posted in the advanced dementia unit.
Mental health nursing, psychology and indeed psychiatry never tickled my fancy in nursing school. The memories I have are of my team and I at Mathari Mental Hospital in ward 6B where I had a glimpse of what diminished mental faculties can do to someone. It weighed heavily on my spirit like a little baby elephant and I eliminated mental health nursing as a career.
Indulge me a little. On our first day at the aforementioned ward in Mathari mental and referral hospital in Nairobi, Kenya, we met Ndung’u*. Thin as a string with eyes that could light up a room, he tried to be invisible most of the times. Ndung’u had perfected the art of being inconspicuous. In a populace of all types of mental illnesses, it paid to not be visible for the others. Whether this was a mannerism from him or an adaptation, we will never know.
He however chewed his tongue whenever he was not eating or talkingto the voices in his clean shavenhead. You could hear him chew his tongue. The whole world could hear him chew the tongue. Ndung’u approached Mary*, one of my group mates and said ,”sister nipee.” We were greenhorn student nurses wondering who we had wronged for us to be thrust in to a such a ward.
Perhaps having seen the scene that was about to be created a few times too many, the nurses on duty smiled as Ndung’u asked for this mysterious object from Mary.
We didn’t even know how to communicate with mentally ill patients leave alone give them stuff. In Kenya, mental illness is frowned upon. Schizophrenia to be specific is not even a mental illness; it is the result of witchcraft. Either that or the good ol’ mama and papa pastors will attribute it to a few episodes where the patient forgot to tithe.
This is the culture we were coming from. Theory in class had dispelled a slither of that belief but this is a reality that even the most learned need to grow into.
Ndung’u was adamant that Mary needed to give him something. With open palms that revealed dark undergrowth under the fingernails, head hung expectantly on his side and those pleading big black eyes, he paused from chewing his tongue and took his voice a decibel higher.
“Sister nipee, Sister nipee, Sister nipee!”he impatiently exclaimed. Mary asked Ndung’u what it is that he wanted as the rest of us tried to be cowardly strong behind Mary. We had heard tales of students getting beaten by the patients and nobody wanted to provoke anyone. Silent lambs in a lion’s den.
Ndung’u quipped like a baby by its mum ,” nipee kanyonyo kamoja. Niwekee hapa (pointing to his palm) nifinye.” Fellow patients laughed. We laughed. The nurses laughed. Ndung’u didn’t.
That awkward moment made me abhor mental health as a future area of speciality. Finding myself therefore in an advanced dementia unit was not going to be fun. Maddy changed it. At 98 she still believed in exercises. She liked stretching in her bed though it was almost impossible for her to do so. Age and other short stories.
It was my role to encourage her and help her complete her morning ritual.This was followed with a ,”cuppa nice, cold water.” Which she hungrily downed as the folds of saggy, wrinkled skin on her Caucasian face danced to every gulp. Maddy , though weak, used her Zimmer frame to use the toilet. She knew when she wanted to go and she was the most helpful resident I’ve ever met.
On this particular day, after administering medications, her alert-mat buzzer went off and I knew she had woken up.Maddy woke up every day at 9.30am. She was a clockwork. The mixed type of dementia had not taken that away from her.
The carers, N* and J* were with another resident and Maddy couldn’t wait. She was a high falls’ risk and that explains the alert-mat buzzer system. This alerted everyone that she was up ready to rock then roll.
“Good morning Maddy,” I pleasantly greeted.
“I want to wee-wee” she replied. She always said that whenever she wanted to have a short call.
Pushing the alert mat under the low profile bed, I silenced the alarm and stabilized her onto the Zimmer frame as we trudged to her toilet. She had partial sensorineural hearing loss and it was hard sometimes for her to hear what anyone was saying. She was too sweet however, that she always filled in the gaps the way she wanted; to fit the context.
Either that or my accent betrayed me. Ha ha. “Are you from Swansea?” She asked when we were having a shower. “No Maddy I am from Nairobi, Kenya” I reassured.
Maddy: Oh Swansea near the church? I am from Swansea too.
Me: No Maddy. Nairobi. Kenya. Africa.
Maddy : You should take me for the mass today. They sing good music. What’s the name of your husband? I might have seen him at the church in Swansea.
Me: Maddy (increasing the cadence of my voice, somehow adopting a British accent) I am not married. Do you know of a good man around? (I teased)
Her sunken ash grey eyes lit up. She must have managed to hear what I said. She looked at me long and hard as I oiled her lanky legs and declared, ” you have a medium bum you should get a good man.”
I know I’m not supposed to laugh but that sent me rolling on the floor. She joined me in the laughter and started a sing song ” medium bum, medium bum, you have a medium bum”
Maddy : Margaret has a medium bum.
Me : My name is Catherine not Margaret.
Maddy : Margaret has a medium bum, medium bum…
Oh well, you can’t say I didn’t try, right?
Maddy spent days in the lounge or in the garden or simply lying on her bed. She enquired frequently about the days of the week and no matter what you said, it was always a Tuesday two seconds later.
Tuesdays were pension days and she loved going to the post office to collect her pension.
Even having lived with mixed dementia for a few years, she never lost her bourgeoisie. She wore well-pressed attire complete with matching shoes. Her daughter Sheila* always provided these. She would never leave her room without her white pearls dangling from her slender, furrowed neck. This would be accesorised with a hand bag which she called a carrier bag and a pocket of disposable tissues slipped under the sleeve of her sweater of the day. Our prim and proper Maddy from Swansea.

But I did…
Staffs new and old adored her. She had a kind or funny thing to say about anyone or anything. A carer could be tucking her in bed at night and she would enquire when the carer was going to bed themselves. She would offer us to sit and eat with her at meal times. She didn’t understand why we kept walking about and helping other people eat!
On the day she complained of rigors, I had spent a few hours of my day with her. Palms feathery and mild as the clouds, I lifted them to my masked cheeks and reassured her that we were doing everything in our power for her to be alright.
Earlier in the day we had had a loving conversation.
Maddy : I wish it was summer already
Me: Summer is here Maddy and I’d love to take you to the garden.
Maddy : (at the top of her lungs) There’s a tiger in the garden!
Since December last year her health had significantly deteriorated. The dementia robbing her of what magic of life was still within. Her ability to perform a few of her own duties totally impaired. She couldn’t stay in the day lounge with other residents without falling asleep ten seconds later. I believe as we age, so do we want to take naps.
She sometimes would manage to break through the fogginess of this abysmal cloud of mental decline and express herself. Our Maddy was still in there somewhere.
This was one such day and I’m glad I held her hands in my gloved palms and listened to her. I still feel the heat of her palms piercing through my face mask. She pushed away her teddy and clutched her baby pink soft blanket and told me just how cold it was. This was the only time I saw her in tears. It ate at my heart and I couldn’t wait to have the antibiotics Dr.Jill* had prescribed over the phone ( thanks to the fear and restrictions surrounding Covid-19 pandemic) ; and have Maddy start on them.
The paracetamol I had already given her was yet to kick in and she was having it very rough. Maddy was coming down with a chest infection and I had proved it through a set of vital signs and a phlegmy cough that I had not witnessed all day until now. Until now when the sun was hauntingly lingering in the British summer skies daring man and beast to move. It harshly bounced off the walls of the care home and flatteringly kissed the petals of the snowdrops that shyly looked to the ground.
Though on End of Life Pathway, Maddy’s demise broke my heart in a million little pieces. I never got to be there with her as she passed on. She transitioned to the other side on the very same day I got my Covid-19 positive results.
Yesterday I went back to our unit’s gallery. I saw her. She held her teddy and with cheeks as bright as her soul, she smiled. From her heart, she smiled. I fingered this photo of hers with immense nostalgia. I caught a tear that threatened to ruin the lapel of my uniform. I missed her once more.
It is a habit that photos of deceased residents get discarded after a while but I don’t see Maddy’s going anywhere. She was loved by staffs and relatives alike. She was loved for her nimble thoughts when they happened. She was loved for her witty sing songs.
She was loved even when the fangs of dementia clutched her brain and rained painful hallucinations on her. This golden girl from Swansea was loved even when this dying and jaded cold stare of Covid-19 robbed us of the little time we had left with Maddy.
* Names have been changed to protect identity of the mentioned people. This is for confidentiality purposes.

Through My Covid-19 Eyes

I think more than anything, I wanted some form of positive vibrations.
I didn’t plan to be a nurse. It is a fact I never shy away from. In fact, my mother had earlier in life written me off in any medical course. I had been an angry, impatient and particularly rebellious little girl.
Mother dear couldn’t wrap her head around my lack of manners. She kept moaning in tired resignation, ” you’ll never be a nurse or a doctor. Because if a patient presents with a headache you’ll inject medicine into their heads.”
Years later I’d discover that she wanted to be a nurse herself so I’m here living her best life. Parents!
This noble profession prepared me for several things in life. It especially taught me to be flexible and accommodating. It is gloriously refreshing when I can swap my shifts with a colleague and get an extra day off. I did exactly that on that fateful Wednesday the 13th of May 2020.
As I stepped from my apartment, the late spring freshness wafted into my nostrils like fresh roses. I closed my eyes and took a deep breath and held it in for a precious few seconds smiling to myself. Gingerly, I made my way across the road and onto a lean concrete pavement that wound itself across the sleeping Dalry Cemetery in Edinburgh city heading off to my workplace.
Instinctively, I stopped near a once white tombstone and gazed towards an imposing Scottish spire. Its gothic stained glassy top shone in a beautiful spectre of a million dazzling rainbow lights behind the burning golden ball of the morning sunrise. In childlike wonderment my eyes glistened as iridiscent rays stretched over this tombstone. Whoever lay here must be a happy soul. He attracts the morning sky.
I shook myself from this unending, stupefying reverie and reminded myself that at this rate, I was going to be late for work. Determinedly, I trudged forward and a sense of foreboding suddenly gripped my heart. Just as fast, it left me. Momentarily, this got me very puzzled. Perhaps it was because everyone else is fighting Covid-19 one way or the other. Perhaps because like many other frontline workers, I am very nervous.
I consoled myself knowing that we didn’t have any Covid-19 positive case at the care home I worked in.
I spent the day with two health care assistants who are wonderful at what they do. For the period I’ve worked in care homes, I have enjoyed the magic of team spirit. Being a team leader during a crisis needs you to believe in your team. To have an outsized sense of possibility whipped together with a diminished capability for pessimism. We had to pull through our 12 hour shift.
But even the best laid plans go haywire, don’t they?
I had a day off on Thursday and Friday, I was meant to go back to work on the weekend. I woke up feeling lethargic on Thursday morning. Through my Covid-19 eyes, this is my zero day.
Day Zero
After the shower, my neck itched. Either I’m suddenly allergic to my shower gel or something is wrong with my towel. I decide the towel is guilty without letting it have its side of the story. I popped it immediately into the dirty linen basket. I would get to it later. I do not know why my throat is so dry. My lips are cracking and the Vaseline lip moisturizer isn’t helping. I think I’m coming down with a sore throat. I can’t stop clearing my throat.
Day One
It is my hair wash day. Oh I love washing my kinky curls. I have a certain unhealthy obsession with washing my hair. I relish the scent of my deep conditioning cream. I savor with orgasmic delight the different fumes of the flowers and oils that make up the natural hair moisturizer. Just that today I can’t smell it. It surely isn’t expired? I check again. Expiry date is sometimes in 2022. That’s odd. I tell myself. I can’t stop clearing my throat either. And is it me or is this place getting hot by the minute?
My appetite is almost non existent. It is now 1307 hours BST (1507hrs EAT). I have not had anything to eat. I make a cheese omelette and it miraculously has no smell. I am at peace with that because I like eggs just not how they smell. However, they are tasteless! Whatever games my body is playing on me they have to stop. My neck continues to itch. I apply some antihistamine cream and make a mental note to pass by Lidl to buy some skin-friendly detergents.
By 1900hours the itch is gone. The constant clearing of my parched throat has been replaced by a deep hacking cough. I feel cold alternating with hotness of body. It is officially a ping pong. Hot cold. Hot. Cold. Cold. Hot. I have this aura of darkness around me.
Day Two
I wake up at 2.30 am covered in buckets of disturbingly drab sweat. I do not sweat easily. My Zumba instructor, before the Covid-19 pandemic, kept pushing me harder than everyone else because he thought I was not giving it my all. I did. I always do. My sweat glands are just too fussy and they play hard to get. You can’t easily excite them. Until tonight.
Perhaps it is because of the dream I’ve just had. In this dream I’m strapped onto a ventilator and I keep trying to ask the attending nurse to let me see my heart’s rhythm on the cardiac monitor. The nurse is busy splitting tubes to use on the next patient. Come on, I silently pray, I need to see that rhythm. I am not very good with cardiology so I want to ask my Critical Care Nurse instructor ( mentor) what in the world that rhythm is. But the nurse is very busy and I wake up.
There are smouldering embers in my throat and someone is intentionally fanning them to life. I suddenly cough again and this time it hurts like broken promises. I go to the kitchen and get some warm water from my mini flask. It soothes the throat albeit temporarily.
I had to change pillows because the one I laid my hot head on was drenched in sweat. I love pillows. My bed has six pillows at any given time. Yes I need to hold something (until someone shows up) as I sleep come beat me. Some girls have boyfriends and husbands or partners. I have pillows.
I am working today. I head to the carehome with heart in my hand. Even the sun seems to have left my skies. It is ominously sulky. I don’t care how much workload I have today. All I know is I’m tired and my legs feel like pins and needles. From the calf muscles to the soles of my feet it feels like some fire ants are having a post lockdown party. I try stretching and running as I go to work but I’m as uninspired as a politician after elections.
The News
Just after washing my hands, on my way to my locker to get changed, the manager summons me to the office. She stands two metres away and tells me one of the residents had turned Covid-19 positive. This is the resident I had been worried about (she had read my documentation and reports and everything a nurse should write in case of concerns) on Wednesday.
Residents refer to the people being cared for in a care home. I am saying this for the sake of Dr.Mary, my close friend who thinks a resident is a doctor undergoing his or her residency program in a hospital. It is a homonym Doc. Tembea dunia Mary, tembea ha ha.
I immediately tell Nurse manager R what I’ve been feeling. She makes the right call and tells me to go back home, self-isolate and phone NHS 24. Now, fellow Kenyans, NHS 24 is a phone service for the national health service of United Kingdom. You get to consult a doctor on phone and you may be advised to go to the hospital or something like that.
The Phonecall
It took about 5minutes for the doctor to get back to me. I explained my symptoms and she dropped the bombshell unapologetically. “All your symptoms are suggestive of Covid-19 infection especially now that you’ve been caring for someone who has turned positive.” She goes ahead to outline things I should do including a test to confirm but I’m not listening. Suddenly I can’t breathe through my nose because it feels congested. She keeps asking if I’m there . I am there. Just not there.
The Test
I didn’t handle it well. I didn’t handle it well at all. It feels like scratching your brain through the nose. It feels like being forced to gag on your tongue. When they trained me how to collect the swab for Covid-19, they didn’t mention it would make me squeamish too.
There is a beautiful aspect nonetheless. We have a Drive thru testing centre. It is for key workers and healthcare professionals exposed to Covid-19 in need of testing. You get swabbed while in the taxi. The Council (government) organises for your transport from your house and back. Therefore swabs are taken whilst in the car.
But Satan had other plans. The taxi never showed up in my case. They only offered half-hearted apologies an hour after I had already undergone the test! I booked my own Uber and was careful to stay masked and come straight to the house after the test.
I keep praying that I didn’t expose the two Uber drivers I used that day. I didn’t even know where the test centre was. I got lost and kept circling it until a kind missus directed me. Story for another day.
Day Three
Self isolation ongoing. I feel very tired. My joints ache including these tiny finger joints. The pins and needles feeling intensify on my legs. I was too tired to exercise. I slept for ages. I struggle to breathe through my nose. It is blocked. My brain automatically wants me to use my mouth. However I know if I do so I may never get better.
I keep saying to myself: the nose is for breathing and the mouth is for talking. This is the mantra that saves me. I repeated it the entire duration of my isolation. I wasn’t having this virus change things.
I know I have Covid-19 even if the results are not yet out. This is no normal flu or cold. I confide in Dr.Mary. She tells me I’m overthinking though I know she is playing safe. On one hand she is my friend and her unwritten job description is to make me feel sweet in this unforgiving world. On the other hand, she is a paediatrician and she knows better. Gotcha Mary make up your mind! Doctor or friend? Haha
I also confide in another friend who’s like a big brother. He prays for me and tells me to stop imagining things. I guess friends generally don’t want to help us in our journeys of overthinking. They just want us to be calm and see the best in everything.
However, these two friends were wrong and I think they knew it. They just didn’t want to confront their fears. After all, they hadn’t met anyone close to them who’s Covid-19 positive. They sure didn’t want pretty lil Cate to be the first one! But I have done them the honors.
Day Four
I still teach Hypertension on Facebook. I pretend all is well. I can’t allow this to stop me from writing. Honestly if there is one thing God gave me as a gift, not only to the world but to myself, is writing. Writing keeps me from going nuts. Writing helps me go nuts safely. Writing saves me from myself. Writing calms down the voices that would otherwise be too loud inside me. Informative writing aimed at sharing knowledge is borderline orgasmic to me.

The Results

That is when the birds sung but I couldn’t hear them.

Aftermath
I didn’t handle it well either. I posted on Facebook right when most of my Kenyan friends were rubbishing the Ministry of Health’s daily briefings. They said and I quote, “I’m yet to see or hear of anyone who’s Covid-19 positive. Kwani where is the government getting all these numbers from?”
I posted that to, one, make people know Covid-19 is not an imagination and two, help myself process it.
I had to pull it down. The curiosity was from outer space. The ignorance in how people handled it too much for me to bear. More than the toll the virus has on everyone, the fear and stigma and generalized doom will be the end of us.
I remember listening to Chris Cuomo (CNN Prime time News Anchor and brother to New York City Governor Andrew Cuomo) when he had the virus.
He had intimated that the virus wants you to sleep and lie down for it to thrive. So he had to move and work out no matter how he felt. He had to do deep breathing exercises no matter the resistance in the airways. I decided to be Chris Cuomo. Just the female version. Without the money and definitely without the experience.
I ChrisCuomod my body. I even managed to do push ups. Two and a half and now I want an Olympic medal. Or a Head of State Commendation or a Medal of Honor, come on folks, get me a medal will you? The fact that the second one is done while I’m half alive doesn’t count. The baseline is that it gets done and I manage the remaining half by collasping on this old grey carpet that needs vacuuming asap. I danced Zumba. I also tried jumping jacks. Youtube became my darling. Thank God for accessible and affordable internet in the UK.
You should have seen me arms raised high above my head, neck straight like an experienced swan; balancing on the balls of my feet as I deeply breathed in and out. In then out. Then cough like the world was coming to an end. Cough some more. Consistency is the key here, so I coughed my lungs out.
I’ve done more series of exercises in my period of isolation than I’d ever done before. This was purposeful. The possibility of deterioration and death were lingering at the back of my mind. More ChrisCuomo to me yay!
I had lengthy talks with the virus. I reminded it that my body is a temple of the Holy Spirit and that it can’t accommodate both light and darkness– my body, not the virus Karen. So I gave it an ultimatum. I told it to push me down for the period I am in isolation because that’s all it had. It responded by giving me more rigors. I shook like a twig in the wind. I was as hot as I was cold.
It sent me a memo in the form of blinding headaches, constipation with zero appetite. It fired off messages in the shape of deeper and more frequent bouts of continuous cough. It sent me to my knees with crushing joint pains. Everything that can hurt hurt.
The virus cackled maniacally and intensified pain in my throat. My nose suddenly had a river of life that never ran dry. My disposable tissues had nothing on it. I wrote ‘more tissues’ as what I needed most when manager R asked me for a shopping list. She brought boxes upon boxes of them. These babies should last me till eternity. Hehehe. The virus was deciding how I lived my life.
I had moments of extreme sadness. I wanted my mother. I also wanted to sleep and be told I’m going to be alright. I hated being alone in a foreign country. I wanted my neighbors. Why am I single? I wondered. I felt ugly. I hated my dry lips. I wanted people to talk to me but I also didn’t want to talk. The mental torment of this monster is beyond description.
I was grateful albeit begrudgingly to be single and live alone. I didn’t think I’d handle the thought of exposing other people. Glad I was to be away from my mum and dad who I’d expose to this virus. Happy my siblings were away from me.
I missed the sun. As if on cue, it dutifully rose every morning before half past five. It peeped through my bedroom window, mocking my sadness. I opened the curtains to allow it in. I badly needed to see the sun, my flaming ball of orange every spring morning. I wanted to gaze at the feathery blue skies. I wanted to see other people.
I used paracetamol 6-8hourly because of the fever and rigors as advised. I also bought a mouthwash which I used to gargle and this greatly eased the pain and discomfort in my throat.
I had to rehydrate too. I downed numberless gallons of lemon,ginger and honey concoction. Being a renal nurse only complicated matters for me. I started a fluid balance chart for myself. Stop laughing…I recorded my input and output. I watched the color of my pee and panicked one morning when it was deeply saturated. The only thing I lacked was a urine measuring jug. Okay, now I am laughing.
Today, I watched the rising sun again. I paused again at the same spot –that tombstone. There was no foreboding. Just a deep gratitude that the sun has kept shining.

Never before had the morning sun’s kiss felt so life-giving.
Tantalisingly, it curled beneath the rustling birch trees casting shadows so replescendent and gratifying that my heart melted. I almost touched it. The magic after a mirthful winter, the sweet smelling flowers along this path that permeates the air with warmth like that of a hug from a dear friend.