CORONAVIRUS; A CRY FROM OUR PUBLIC HOSPITALS

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

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

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

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

Underfunding

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dishonesty

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

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

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

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

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

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

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

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

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

Tattered ethoes

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

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

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

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

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

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

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

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

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

Political Goodwill

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

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

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

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

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

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

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

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

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

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

GREATLY UNINSPIRING

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

THESE TABLETS

you are about to exceed the limits of my medication

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

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

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

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

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

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

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

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

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

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

Learn to ask because there are always safer options.

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

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

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

Thank you for passing by.

THE DISEASE BURDEN

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

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

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

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

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

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

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

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

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

Let us go back to our topic…

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

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

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

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

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

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

As always, having you read is my honor.

CARING FOR DIALYSIS CARERS

When you say it, it stops being as dangerous as it sounded in your head.

#TeamPhoenix,these past few weeks have seen me tackle a little about acute kidney injury. I want us to have a look however at hemodialysis.This is what is common in Kenya and maybe what we are used to.

There is an aspect of care I want to delve into–The families of the patient. I wonder who takes care of them. Let me expound.End stage renal disease means that we are staring at end of life.It takes a toll on any family.

Taking care of a patient is tasking. Even more demanding is a patient with a terminal illness. The reality of renal disease,however,is that progression can be deterred if we actively engage kidney replacement therapies. Hemodialysis is more often than not where our people start.

The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) recommends preemptive kidney transplantation for suitable patients. See,that is not possible in Kenya. I would hate to write for you things here which I know that you will most likely not see be practiced. Unless you have some serious cash flow.Cash flow for majority of our people is not anywhere near serious. If anything,like a pendulum,income keeps swinging to the poverty line and back under.

What that body of regulators say is that as soon as we diagnose end stage renal disease, a kidney transplant should occur without having to go through dialysis. Do you understand it now? That is common in First world countries.

Ideally, patients should dialyse thrice a week. Due to the intimidating cost and general limitations of resources, patients in Kenya dialyse twice weekly. That is unless in special circumstances where we dialyse them thrice weekly or more frequent depending on the condition. All factors constant, however, chronic hemodialysis occurs twice weekly.

We are yet to get to a point of accessible renal units in every village and town. This means patients travel far and beyond their county borders in search of dialysis–a lifesaving treatment.

More often than not, a family member must accompany them to the unit. That means not only one person, but two (sometimes three or four) will have to be divorced from their daily duties to visit the renal unit. Dialysis is not only time consuming but emotionally and spiritually exhausting.

Once Rosie asked me why we had no family support center in our renal unit. Rosie is a daughter to one of our patients. She went ahead to share with me deep concerns which she feels could be addressed in such a centre.

I thought about the other patients and their families. I realized they all underwent similar agony!

1 ) Time management

That someone must stop their activities to attend to one person perpetually is draining. Carers suffer from burnout and they may come off as aggressive if we the healthcare workers do not pay attention. Dialysis costs money and time is money. This is especially felt for patients who are old, children or too weak to go to the renal unit by themselves.

#TeamPhoenix, that is why I advocate for talking sessions. Identify a staff you can discuss the whole challenge of time management with. Nobody should guilt-trip you for feeling like you spend a lot of time on one person.

You should not feel guilty for wanting time off. Believe you me we all need time out. Your wanting to take a break from caring should not be misconstrued for neglect. Not by you or anyone else. It does not matter if the patient is your spouse, parent or child, it gets deeply draining. Take a break. Rest. Allow others to take care of your patient even if it is for a day or two. Let them be taken to the renal unit by someone else .That allows you time to rejuvenate and catch up with other things. Manage your time by letting others help. Ask for help too if none offers it readily.

2)Fear of the unknown

Dialysis takes four hours if everything runs smoothly. However machines fail (they are ALWAYS failing in the unit I work at), emergencies happen, vascular access fails and generally complications occur. What started out as a straightforward procedure becomes life threatening and you can’t help but feel confused. If nobody is offering any explanation, you are constantly on edge. In some cases, your loved one wastes away on your very sight and you are unsure of the effectiveness of dialysis.

A nagging uncertainty stares at you like a looming mount and dares you to climb. Lack of a solid plan for kidney transplant make it even worse.

Breathe. Just breathe. Done? Let us talk. In the simplest of that sentence, let us talk. Knowing a disease and its progress and what to look out for as a carer helps you take an active role in management of the patient.

Involve your renal nurse, renal counselor or nephrologist in charge of your patient. Talk about it. Share your fears. You might be surprised that whatever you are so antsy about has the simplest of explanations. I like informing relatives that no two patients are alike. Refrain from using one patient’s experience and expecting it to apply to whoever you are taking care of. You will really mess it up and interfere with the management.

By the way that explains why people keep moving from one specialist to another and another. There is something they want to hear and they are hoping the next consultant will say it. Medical nomads. Information pastoralists.

3)Nutrition

The typical renal diet is a mix and match of carefully selected foods. Now, from a family that can barely afford three daily meals, how do we expect them to afford special food preparation? Potassium, Phosphorous, Sodium and strict fluid restrictions make most foods off the menu of a renal patient. If they remain, they require extra preparation and the cost of fuel. If there is nobody to help, or they can’t do it themselves, renal patients end up eating the same diet as people with healthy kidneys.

That results in acute complications of high potassium levels and fluid overload in the lungs. It is vital to have a chat with a renal nutritionist. Please note the difference. Not your day to day nutritionist. We need a renal dietician or nutritionist. That is because they have extensive know-how in our local cuisine and will advise on what to eat and how to prepare it.

All renal units should have a renal nutritionist or dietician. These professionals are integral players in the renal team. Without them we work in futility.

4) Cost

National Hospital Insurance Fund (NHIF) has made great strides in ensuring renal patients get twice weekly chronic hemodialysis. However, the cost of serial imaging and blood tests still remain uncatered for by NHIF. This has increased the cost of hemodialysis. Furthermore, the fact that NHIF does not pay for anti-rejection medication post transplant is a factor that makes many of our people shy away from transplant.

Before introduction of a dialysis package in NHIF, many passed away for lack of funds to pay for the life-saving treatment. I believe more can be done if we are to achieve excellent health of the renal patients.

The above are just a few things carers battle with in the journey of taking care of a patient on dialysis. We need to talk about it and help them because they can not do this alone. If indeed it takes a village to raise a child, surely it must take the same to heal one?

As always, feel free to contact me here or elsewhere for any of these or other concerns you have as a carer. Talking is always the first step towards a solution. We are grateful for the dedicated work you do of taking care of our patients.

It has been a pleasure having you.

#KidneyWednesday

A SLOW RUN

A good slow run is better than a bad stand.

Two Secondary Schools sent me an admission letter after my Kenya Certificate of Primary Education (KCPE). Karoti Girls’ High School and Ngiriambu Girls.I loved them.I had seen them perform at the music festivals when I was at Rukanga Primary School in Mwea Division,Kirinyaga county. The students were so confident.They spoke English and Swahili.Two languages that I adored. Especially English.How could they speak English in English? I had all along believed English was Kikuyu with an ‘s’!

I wanted to be them.Those girls with chests strapped in traditional brassiere.Those girls with hips wide as the river ocean. Hips that shook and gyrated to the beats of the African drums as the adjudicators nodded their heads in judgement.Those girls with skin smoother than pebbles.Oh how I wanted to be them!

I do not even know how to properly direct you to my primary school.They dissected our pishori-producing division into West and East and I have no idea where my ancestral home should be. All I know is on an earth-road towards Boto area in Rukanga Village,my placenta was buried. I was born by the roadside.

I have a point stop rolling your eyes. If I do not tell you,my mother and father will tell you so as to embarrass me and have a good laugh about it. So I have beaten them to it. Take that parents! here is where I smile…

My village does not produce rice.We are not near the irrigation schemes.We therefore planted other things and slyly,like hungry foxes, produced another product;chang’aa. We were good with that stuff. Not not us as in my mum and dad,no. Us as in the villagers. My father’s brother for example was a connoisseur. Dad worked in the big city of Nairobi as mum hopped from one shamba to the next breaking her back through tilling people’s lands for a little money.

She threatened to divorce Papa if he let her brew Chang’aa. I think that is how we were spared. Women and threats! lol.

My sister and I perfected the art of rice farming by walking about ten kilometers to Mwea Tebere irrigation schemes to weed the rice farms. Or plant in the bilharzia-infested flooded farms or to harvest with sickles during school holidays for a nickel and a dime.

Dad had a vision taller than his legs. The vision was to rescue his daughters from the prospects of an early marriage and ultimate chang’aa large scale production to offer them a better chance in life.

Karoti and Ngiriambu,though I really wanted to be there,were unaffordable to my poorer-than-the-poor parents. Dad brought us to Soweto,Kayole where we joined Bahati Community Centre Secondary School with only 200 shillings that dad could afford for registration.

I received an admission letter to pursue my Honor’s degree at a local university in the recent past. It is a bittersweet feeling. Most girls and boys my age are done with their Masters. I am pursuing my first degree. It is funny because others have told me I have done well but if you are an education junkie like me you must surely know the ouch feeling.

True heroism I believe comes from gulping pain and making sure that others do not experience it. I do not want students to be as confused and clueless as I was when I joined and left high school. I want to give opportunities to them. Better than I had.

When Affecto was born and fronted to me,I knew I will always be a part of it. This foundation is doing what most of us would like to do but lack the means to–help a student in school.

As a beneficiary of sponsorship in my Nursing Education,I know it is painful to have your school fees paid yet you have no money to do any shopping. Also to be able to focus while you are certain that your siblings, Mom and Dad do not even have a meal for the night. That is where many lose it. Affecto has sealed this loophole by ensuring that a student’s personal needs are addressed as well as their tuition fee.

Affecto flys on the wings of the all giving Kenyan spirit. I have tried to hold a neighbor’s child through high school by myself and I failed miserably. That is because I did it from my own salary which can barely suffice my own needs. That plus the many bills I keep paying for different purposes. My story is actually a replica of your story and many others who are willing to help but do not know if the little they have can even cover themselves leave alone others.

This initiative borne out of necessity promises to join all our little and big contributions towards a complete financial grooming of at least one student through high school.

Having attended a mentorship day at Karima Girls where two students are Affecto stars,I couldn’t help but feel a little envious of them. I mean,if only I had had a chance to attend such a prestigious school..if only I had had someone to hold my hand through the schools I had qualified for..I remember emphasizing to the students that they were thoroughly blessed to be where they were. I looked at Ndung’u Nyoro (The brain behind Affecto) again and wondered where he was when I was desperate for high school.

I smiled knowing that at least,many girls and boys in my shoes won’t have to take long detours towards their dreams. The challenge of a full sponsorship are as many as the stars in the sky.

Affecto has hit icebergs that have threatened to tear the ship into pieces of precariously hanging screws and wood. This explains the gala that has been planned at the exquisite Villa Rosa Kempinski on 22nd November 2019.

Not money,not favors,just give me an education.

That is why I plan to attend the gala. That is why I will spare 5,000kshs to go have dinner at Kempinski. Who knows,I might even eat from the same place that President Barack Obama ate from. I may even feel like I have made it in life for that one night. That plus take selfies and strike a few poses to brag about.

Villa Rosa Kempinski will have the coolest spot in heaven with their own Garden of Eden. They will host all parties in heaven with waitresses as gorgeous as Vashti and waiters as muscular as Goliath but with the hearts of King David . The choir of heaven will practice their oohs and aahs at the coffee garden of Villa Rosa Kempinski. A restaurant that offers its presidential services for 5,000kshs to common Kenyans like myself must surely be written in the book of life,right?

I will even go to Gikomba market in advance and get myself a camera-camera dress and some chunky heels to don that evening. Kariokor market and Dubois Street will see me buying cheap accessories to compliment my look. Njeri wa salon will have a field day that afternoon making sure I look like I stepped from the moon. I might even comb my hair,who knows.Ha ha. You better run away from your social media accounts because 22nd November 2019 is the day I ruin your online lives with pride.

We are not depending on outsiders to come and save us. We will start saving ourselves and whoever joins us is a major bonus.

So folks,cheers to influencing care,right?

ACUTE IN THE HOSPITAL

The old Proverb is true;Prevention surpasses cure.

Today I may sound a little technical with a lot of English friends but bear with me.I will reset I along the way. Statistics display that 10-20% of emergency hospital admissions in the United Kingdom are related to Acute kidney injury and tagged onto this is a poor prognosis.(Selby NM et al defining the cause of death in hospitalized patients with acute kidney injury 2012;7(11).

This is a country that has embraced research and accurate data entry. If the same situation were transplanted in Kenya, the figures are worse if not close. This is occasioned partly due to lack of know-how on kidney disease and majorly due to ignorance of both the patient and the healthcare provider on this ravaging disease.

Acute kidney injury (AKI) happens in almost all long term patients in our wards. The causes are many and varying. The commonest sign is an acute dehydration attributable to the underlying co-morbidities.0.5mls/kg/hr of urine is what the National Kidney Foundation identifies as the cut off for an adult; all factors constant.

Hospitalized patients develop AKI because their illness—the primary cause of the admission—has robbed them of the ability to drink fluids as they normally would.

That explains the frequent ‘monitor input/output’ clinicians write in the patient’s record of care. The interesting thing with our set up is that as far as it involves urine, most of us deem it too ‘lowly’ and demeaning.It is even hard enough to get the patient to understand the rationale of regular fluid balance checks if we do not understand it ourselves.

Acute kidney injury has a good prognosis if detected early enough. The reality however is that more than 50% of cases are diagnosed in the most advanced stages of the disease. Recuperation maybe great but it leaves the patient with some degree of diminished renal function.

It is imperative that we take kidney disease with the seriousness it deserves. You as the client needs to take care of your kidneys. They really are the most vital organs if you think about it.The kidneys maintain our electrolytes, our minerals, our blood pressure among many other functions. I am sure we have covered them in previous #KidneyWednesday series.

Watch the color of your urine too. Urine should be amber in color. Amber sasa ni rangi gani… bamboo-straw maybe? Straw-colored? I need to borrow some English from people. Any creditors?

As clear as pure water means you have taken too much fluid hence diluting your urine. That or you have an underlying medical condition which I don’t intend to cover today. Too concentrated and it means you are dehydrated.Folks, anything that is reducing the fluid content in your blood will ultimately make you have concentrated urine. That or you have underlying medical condition which I have no solid plan to delve into either.

#TeamPhoenix, take a day to walk in the shoes of patients suffering kidney disease. You probably would understand why I am all for prevention. We have acute shortage of hemodialysis machines in Kenya.The available ones are excellent at regular mechanical breakdowns yet the number of patients on the waiting list is growing exponentially.

We refused to practice peritoneal dialysis in adults (because we are generally a selfish people) and kidney transplantation is taking a whole century to take place on at least one eligible candidate.

What’s more, the hefty cost of anti- rejection medication post-transplant discourages many a patient from undertaking this life saving operation. Preventing acute kidney injury and intervening at its earliest onset is the way to make sure that we do not continue condemning more and more patients on chronic hemodialysis.

My hope is that nurses being the first point of contact with all patients are empowered to recognize signs of deteriorating kidney function and do something about it.We do not need to wait until the situation is dire for us to act. This is why we need nephrology nurses at every point of contact. That is the role the new scope of practice is aiming to introduce –clinical nurse specialists.

In a community set up, in nursing homes, in maternity departments, in new born units, prevention of acute kidney injury is multi-agency. A good referral system ensures that whatever is reversible is reversed and we maintain some healthy kidneys.

It is important to note however that patients with chronic kidney disease can and will suffer acute kidney injury. If we miss this we end up worsening an already bad situation. With this in mind therefore, acute reduction in urine production should alert you and me on the state of the kidneys. That coupled with a few cheap tests are enough to help us correctly identify at-risk patients.

I can’t overemphasize how vulnerable all hospitalized patients are. It does not matter what initiated the admission but as far as we have altered that person’s normal routine, we have positioned them on the path to acute kidney injury and subsequent sequelae.

However, some of the problems we face in the quest to maintain adequate fluid volume in our patients are self-inflicted. It will be very foolhardy to initiate the patient on fluid intake and output monitoring without their knowledge.

Just let the patient know what you are doing and why. That is the one of the strategies I have always seen to work with even the most difficult of patients.

Explain in the simplest language you can afford. Unless they start Google-name-dropping on you. If they do that, by the powers vested in me by nobody in particular, unleash all pathophysiology on their souls. Hahaha.

To the general public, whenever you are hospitalized, your intake of fluids is acutely reduced. It is hence vital for whoever is taking care of you to encourage you to drink more water if only to reduce the formidable statistics.

Sigh…

Is it too late to hope Kenyans will be proactive in matters kidney health?