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.

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

Source: LyricFind

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.

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.