ABNORMALLY NORMAL

I have a painfully incurable trait at replying to people’s messages on Whatsapp. That explains many unopened messages wishing me a better new year or something to that effect. I have progressed downwards in my lack of etiquette especially after I went public with the divorce. I saw a friend’s message a few days ago. He wrote, ”you did not deserve what you went through.” That message got me thinking. Did I not deserve it? Who would I rather have had to feel the pain of half baked dreams and aspirations? If God gave me a chance to choose ,who would I single out as the most befitting mortal to be torn to pieces by what they once called the zenith of self actualization?

I have come to the conclusion that I do not wish it on anyone. I also know that nobody deserves pain. Maybe we do because we are smart asses who play with fate but when all is said and done,we want to be happy.

A broken marriage is the last thing anyone wants to associate with;especially an African woman. We know that we should leave. That alone is the most interesting thing about abusive relationships. The victim knows that they should leave. However the fear of leaving overcomes the fear of staying. One day however,when the fear of dying will overcome the fear of staying,they will leave.

When you grow up believing in everyone else but yourself,you become conditioned to believe you are a terrible person. You believe that any person,man or woman who will love you will be doing you a favor. I became so detached with my femininity that I thought my husband was doing me great charity by staying with me.

I would even apologize for things that were just not my fault. If he never loved me I took that as a cue to work on myself. Domesticate myself to fit in.I took the pressure from our families to make the marriage work.

I was doing everything to keep the ship afloat. That included taking counseling to work on my anger issues. Before marriage, I kept asking why victims stay with their abusers. I have learnt over time that the greatest prison is in our minds. The abuser perfects the art of manipulation that the victim learns that there is no other man or woman better in the world than the man they are with. He breaks your self esteem. He throws away your confidence. He snuffs out any candles of hope within your soul. He freezes your voice under the heat of this breath. Eventually you stumble in the dark,blind and with a cold voice stuck in your throat. Your tune he took and snapped the strings that played your heart’s music. It becomes an icy world.

The problem is that this mess becomes your new normal.Interestingly others see it but you just can’t.

I remember Jozef his friend telling me that he was the worst I could marry but because love,I told my husband that his friend was not wishing him well.I did not take Jozef’s words seriously even after finding a message from my dear husband telling Jozef, ”…wacha kunichomea kwa Cate I also don’t tell Halima (Jozef’s wife) about your escapades.”

No sooner had I walked out than Jozef texted me, ”Cate I told you so”

Needless to say, Jozef remains blocked in all social media and mainstream media channels. Ha ha, you should not remind me the obvious.I know it is petty but I speak petty fluently.

I tried to change.I tried to speak softer,closed my mouth more,became more homely.I even tried to be less volatile but I could feel him traveling away from me in his dreams. I removed the jewels from my crown for him to be able to carry. Even then,it was too much for him.

One day,I got tired of trying to make my sparkly star-shaped self into society’s square holes. I chose to embrace the glorious mess that I was and shine like a morning star.

There is a direct relationship between how you see yourself and the men you end up with. Or women for that matter. Playboys are attracted to mommy types. We become infatuated with each other’s broken souls. As I begged him to ,”please stop doing this to me” I knew what I needed was closure.

I demanded closure as if life is put together as neatly as a novel but it is not. Life is a messy sentence, ending too early or in the middle. But we have to love it,poor grammar and typos,it is a beautiful thing—life.

I had a deep-seated Savior Syndrome. I wanted to save people and especially men. This is a sad character I have seen in many career women. Furthermore,people who grew up in untold hardships and have done everything to be where they are today more often than not invest in men with half a brain.

How to not do it is to realize early enough that you are vulnerable. I wish I had taken stock of the men I ever dated. I could have seen a worrying trend and sought help to break the chain. I saw it later in life and I can confidently say I am now one notch less sad.

A day in the life of a Matatu tout in the Eastlands of Nairobi is full of shouting, name calling and running battles with cops. It is chaotic to you and I who do not work as touts but it is very normal for the Matatu industry. See,when Jogoo road is as spiky clean and clear as spring waters, the tout and driver are very cautious and attribute it to police ‘operation.’

That is the kind of life I led in my short stint at marriage. It was chaotic through and through but I loved it. It may be abnormal but it was my normal. The signs are there. The writing on the wall is candid but well, we are stubborn little girls. Just like one stumbles looking for light in a pitch black pit ,so do victims. Society expects you to know it all and have a marriage that is working. Society makes all the rules and like a good girl, you must conform. I conformed until my back bent. I could no longer do it.

It does not mean the chatter has died down. If anything, it has only begun. Sometimes when i have too much time to do nothing, I tell myself that had I had power, I could turn back the hand of time and call off the wedding.

People, it has been three years, do you think you would still be talking about me? I doubt it. There have been other perfect scandals in our nation worth your bile-coated tongues.

Our community will never be kind to women. It has never been and never will be. As an African lady, you are screwed if you do and screwed if you don’t. If a man is irresponsible and a total mess, they all blame it on you. If you make wise investments and the man appears to succeed,they claim the man is very hard working. Quintessential patriarchy.

Child, if you stay in an abusive relationship they suggest you leave but if you do they label you a home wrecker. If you give birth before marriage they call you a whore and if you give birth in marriage then walk out they call you  a lazy single mother. If you have a beautiful marriage they say mtaachana tu.When you do not achana,they employ tactics to make sure that you and your marriage are blown into smithereens.

We have mutated into a sad group of people in a dark corner waiting to celebrate people’s misfortunes at life.We attack people whose journey’s we do not understand.We do this behind our keypads dressed in torn underwear while eating cat food.

It makes us feel a little more successful if we succeed at bringing each other down.We feel justified if evil befalls those we deem higher on whatever SI unit of success we use. We abhor those that have guts to show society the longest finger. We hate those who are able to know they deserve better and better they look for. How dare they challenge our comfort bubble of mediocrity?

That is when I start laughing and smiling as if I own the universe.Why because when you suddenly raise your standards,the universe will meet you there.This universe has an uncanny ability to adjust.

ACUTE CAN GET CHRONIC

As I had outlined,this is a #KidneyWednesday post because I won’t have the time to post on Wednesday owing to other commitments.Reports trailing to my desk indicate that I owe you a story.

A rather hot afternoon of August 2017 found me at Kenyatta National Hospital (KNH) in the Renal unit.I was a student Nephrology nurse thirsting and hungering for Renal Know-how.

If you have been at KNH you will agree with me that it is forever a beehive of activities.The renal unit has not been spared from the same.

It teems with patients coming in and out ,others waiting for the very few Hemodialysis machines,relatives too tired do sleeping on the cold benches at the waiting bay;Doctors and other medics coming in and out ,their white lab coats hot on their trail.

Nurses and nursing students crammed in the not-large unit all grappling for knowledge.Other nurses wheeling patients from the wards for a dialysis session.Othersfrom the next door Intensive Care unit (ICU) accompanying their patient who has tubes sticking in and out of them.Suffering personified.

It was in this cacophony of work that I heard ,”Sister was Jumuia,” called out from one of the dialysis beds.

Jumuia is the hospital I used to work in as a Nurse-Midwife before coming back to KNH school of Nursing to specialize in Nephrology Nursing.

I knew with certainty that it had to be me.I searched fervently for the origin of the voice and that’s when I saw her.

Buried deep in the once-White hospital beds,Ruth looked like she had been sewn into the bed.Her eyes swollen and her outstretched arm fat at the wrists which made it look like a small rungu ya Maasai.

I grasped the arm in a greeting,flashed a smile and started a small talk.Her mother was towering above her trying to arrange the dialysis consumables atop the machine labeled ‘Ruth.’

Ruth had been a patient at Jumuia and she remembered me.She remembered how I attended to her when she was in labor.Usually we forget your faces and names as soon as you leave the ward unless there is something specific about you.

There was something about Ruth.When I was the nurse processing her discharge with her new born baby girl,I asked her to delay going home so that we may monitor her blood pressure.

Antenatally, Ruth had demonstrated a mild elevation in blood pressure according to the Antenatal clinic record she presented.

All through labor her blood pressure was not alarming at all.The obstetrician had not put her on any medication either adopting a Wait-and-See approach.

A quick urine test demonstrated mild protein level in her urine.I escalated this to the doctor on call who had referred her to the obstetrician–again.

That was an year or so before this meeting at the renal unit.I remember her being discharged a day later ,much to my chagrin, through the Obstetrician clinic.I made the mistake of challenging a colleague on why Ruth was being discharged without medication.My colleague quickly dismissed me by letting me know that when I WILL get pregnant,I will understand that raised blood pressure can happen because of the stress of delivery and childbirth.

Children of God,such ancient wisdom isn’t to be engaged any further.

I listened as Ruth narrated to me how even after going home she did not think it was a big deal to have a, “… Little raised blood pressure because even the nurse who discharged me told me it would reduce by itself.I never went to the clinic until after a month,” she paused to scratch the dressing on her shoulder which covered her subclavian Central catheter.

Ruth went to the clinic after experiencing an untold throbbing headache which was unresponsive to paracetamol or Ibuprofen.The Obstetrician admonished her but sent her for a few blood works.

Ruth was in Acute kidney Injury.Dialysis was not recommended because according to what she told me,the attending doctor told her as long as she was passing urine (she was) , everything would be alright.

It wasn’t.

Within an year of our meeting she had undergone all the stages of Chronic Kidney disease and as her file would tell me later,she was in End Stage Renal Disease.

This is a classic example of how ignorant we all are in matters Kidney Disease.

I say this with a lot of understanding that most medics genuinely mismanage patients with some form of Kidney disease leading to Chronic Kidney Disease.

Specialist doctors do the injustice of delayed referrals to fellow specialists.None wants to appear to not know it all.Yet this is what medicine is–dynamic!

If only Ruth,a 32 year-old gleaming with life had received the necessary management I do not think we could have met as we met.

I never saw her again.I am yet to find out if she finally got a kidney transplant.I feel very embarrassed as a nurse who handled her in the initial stages where probably I should have been more assertive in advocating for her timely referral system.

Eve,my classmate,found me crying that day in the linen cupboard and couldn’t help but ask what was wrong.

I explained how a patient I once nurses is lying on the dialysis bed because someone somewhere (probably me) did not play their part in preventing end stage renal disease.

A few hugs did the trick and I was able to sail through the rest of the shift.

Well,Kidney Disease management is multidisciplinary.We can not leave it to one person to manage it.We need all stakeholders on board.

I write so that you as a patient or client may be informed about this highly ignored ,high mortality indiseade in Kenya.I write so that we medics can take more keenness in prevention of Kidney disease whether acute or chronic hence lessen the burden on everyone.

I wrote to challenge doctors and clinicians to not ignore renal function tests.These are important.Let them appeal to your gut when you’re dealing with your patient.You do not treat the results,you treat the patient .

To all team members of the Maternity wing especially in public hospitals,an elevated blood pressure with proteinuria isn’t stress associated with childbirth.

It doesn’t matter how many pregnancies you yourself have had.

Till next week people, enjoy this #KidneyWednesday come early.

BROKEN RINGS

my fault was falling in love,
and forgetting to pack a parachute

“I do not want another group therapy!” I barked to Leila. She is the coordinator of Divorce care program at my new church. The church had been announcing these feel-good-it-was-not-your-fault meetings for all divorced or separated people in the congregation.

One Sunday afternoon I had written my phone number and name as an expression of interest. I changed my mind immediately but the list had gone back to the ushers. I was too embarrassed to recall it. Leila called after I missed the first and second introductory meetings. I escaped by being very rash and telling her what I had been thinking about for long-death.

It beat me how a loving God could allow His creation (me) to suffer in the hands of others. Had I not done everything to be a good girl?

Well, I know my browsing history was questionable but then again, that wasn’t a mortal sin or was it? The Ten Commandments from the good old Moses had not expressly prohibited me from watching interesting videos you know. That plus when you want to do wrong you will always find a way to justify it.

Anyway God and I were sort of in the middle of a fight. I wanted him to kill me just like he had killed my marriage. He was having none of that.

How do you explain being married at 26, being separated at 27 and divorced at 28? Where do you even start? When they talk of a group therapy for divorced folks, what I visualized was a group of bitter middle-aged women (never men) crying about their half-assed exes, passing some scrunched up wet tissues around and pretending to love each other.

A group of unbelievably irritating women whose husbands had irritated them unbelievably.

I imagined a divorced and very bitter facilitator who’d swing her sore neck towards the crowd and remind them of the theme of the group.

Facilitator: Who are we?

Members: Divorcees!

Facilitator: What do we know?

Members: All men are the same!

Then she would smile sadistically at the gullible listeners and lift a cup to her dry lips. Inside the cup would be a few splashes of coffee cold as her soul.

I did not want that. I did not want anybody to tell me how to handle my loss. Or was it a loss really? How do you lose what you never had? So I had resorted to identifying myself as just a single girl.

There is nothing like erasing that part of your life. The dangerous D word will always hover around you like an un-avenged spirit. You may be as successful in life as Oprah but you’re divorced. You may even be a president but Missy, you are divorced. You may get married again and be very happy in the new marriage but people will always remember the divorce.

If you let it, it can define everything. Divorce can be you if you allow it.It can become a slice of anger in the pie of your brain.

When you die, they will write your eulogy mentioning that you were divorced at some point in your life. They won’t let us forget. It is a cancer that scourges our very spirits. Divorce feels like eating your own heart.

The group therapy turned out to be the trampoline upon which I sprung my emotional life upwards. The pillar upon which my emotions finally stood. Finally I could confidently say yeah,it was well worth it.

Men and women of all ages shared horrific stories of their sour marriages. Men cried like little babies. I remember telling God how he has a wicked sense of humor. Why did these apparently great guys date sisters of Jezebel? Why did myself, a moderately sane girl marry Cain’s distant cousin? Where were they when I was looking for a life partner? Where was I when they were looking?

But Thanos once said we are villains in somebody else’s story. The exes were the villains. We, the model Christians were the superheroes without capes. Many told me how sad they were at me having to leave the marriage that fast.Others called it brave. Some said the fact that there were no children involved was a blessing in disguise. I felt confused. Too much noise for me, too much.

Twenty eight isn’t like the worst I could do with myself. I had done other things before twenty eight and I have a feeling they will count someday. The facilitator said the earlier the better.

I could not care how early or late it was. All I knew is no sooner had I walked down the aisle than I wanted to walk right up. But it was too late and my parents and everybody looked so goddamned merry. Partly that and partly because I was hungry too and wanted to hurry up to go eat the nice smelling pilau they had cooked for the occasion.

Pilau for the bride…yummy!

I also wanted to see the African-themed cake I had chosen from Mrs.Muigai.I badly wanted to see how it turned out (perfect friends, perfect). I wanted to see the decoration in the reception field. Douglass was the one in charge of decorations. I remember asking him to particularly erect white pillars and have a climbing plastic flower on each. I wanted to make sure the said flower was in place.

Stop laughing.

Eleven weeks of therapy and finally I knew with a very deep certainty that I authored the marriage. I was ready to be a wife to somebody who wasn’t even able to define husband. I was ready to be a mother too but I had not envisioned mothering a full-bearded man.

I was a broken girl too marrying to get fixed. I was not at peace with myself and I sought peace in marriage. I was not happy with myself and I wanted somebody else to make me happy.

I could not face rejection. I could not admit like his friends had admitted that the relationship was running on my very blood. I saw what I wanted to see. I saw a family with two tiny weeny babies and nothing was going to stand in the way.

I wanted to fix my husband. I wanted to solve his problems. I am still paying for that in the form of a bank loan. I wanted to make him stop drinking, stop cheating, stop lying, be responsible, love me even. God, how I wanted him to love me!

I knew I would support my man in all ways but I had not counted on being the one to pay for everything every time.I was ready to accommodate my partner but I had not dreamt of accommodating cheating, emotional manipulation and humiliation.Those,I had not factored In the equation.

I knew I am a good communicator but I did not know I had to shout and apologize for seeking explanations. I did not plan on being a detective but I eventually graduated from the Cheating Husbands School of Detectives. I spied. I found things out.

And when I did, I could not stop. That is the problem with finding out. You can’t help but keep doing it again and again and again. It is a feedback loop from hell. You take that phone to check what mischief he’s up to.Your gut tells you that it will be just like last time but you can’t help but go right ahead to confirm.

A sick obsession.Voyeurism to some extent. You found nudes of a woman who wasn’t you last week and you broke a few glasses which were a gift at the wedding.

There are so many of those—glasses. Kenyans have a glassy place in their hearts as far as wedding gifts go.

He said he was just being a good guy by appreciating other people. He even accused you of not wanting him to have friends. He said you have anger issues. You apologized and sucked his cock.Bobbing your tired head up and down his manhood as he scrolled up and down his phone to the rhythm.

You hoped to show him that you suck better than Maria or was it Mary?

He did not care. Oh, he cared for the head, just not yours.

Today you are holding that phone again, yours this time because you already know how to hack his Whatsapp account. All his messages come to your phone too. You can see more text messages of a new girl praising his bed skills.

A sting of jealousy hits you like a nauseous wave from the trench. You can’t remember the last day he touched leave alone made love to you. It is always you initiating the half-hearted lovemaking. You were degraded to begging for sex.Just like in food,the main course always disappointed.Normal married people have sex.At least they should. The pastor said it in the premarital counseling sessions.

You cry and call him to ask him why he is doing this to you. Are you not a good wife? What are you doing wrong? Does he want you to walk away? He listens, never says a word and hangs up. You now have to spend the rest of the afternoon sulking at your classmates and crying because the tall guy chose to sit in front of you and he’s blocking your view of the presentation!

Yet you keep finding out. The beginning of the end is when you’ve degraded yourself so much from finding that there’s nothing left to find out but walk away.

Because you are very Proverbs 31,you one day enroll for counseling sessions to fix yourself and be a better wife to, ‘the best man in the whole world.’ One day the fight is so bad that you get physical and almost kill him.

There is a meeting between the two of you and his parents. His mum, the sweetest mother in law any lady could ask for, looks at you with eyes filled with a silent understanding.

Later when you finally dissolve the marriage, you remember cryptic words that that woman had shared with you one Sunday afternoon.

This was the second time you were having a meeting. The Sunday was the color of pigeons. Just lacking in the tranquility. “Sometimes the best thing is to be apart for people to think about what they really need.” I have come to accept that parents want their children happy. They rarely think about the other parents’ child. This one did.

The thing about a divorce is that it bruises you. Even if it turns out to have a healthy afterlife, you remain tainted by the experience. How you react afterwards is entirely your responsibility. I realized I was married but not married. I chose to wear my scars as remembrance beads of my bracelet on my hand.Every time I look at them I see their transformation.

Each experience, they say is an opportunity to learn. I wish that were true. You do not need pain to learn. I did not need it.I could have done without it.However some of us are Balaams, unless the Biblical donkey speaks, we don’t trust angels. My donkey spoke.

People say time heals. I think that is not entirely true. God healed me by force. He had to set my head right this time.I made peace with my past. I confronted my fears of rejection and failure. I faced my worries of who to be without being Mrs. Him. I faced the pain of loving and losing. I had to separate myself from the chaos that had defined my life away from the common populace.

Sometimes we get attached to our misery. I was. What would I do without arguing with him? What would I do if I was not hurting from one thing or the other? Counseling and group therapy helped me find a new normal. I had to start loving peace, tender love and understanding.

I had to appreciate good people and let bad people be. My mission on earth isn’t to mend fraying fabrics, I deserve complete outfits.

ACUTE KIDNEY FAILURE

Just like we agreed last week,today we shall have a quick look on this sudden fail of kidneys.One of you told me that doctors give wrong diagnosis by saying that a person has to live on dialysis for the rest of their lives.Her argument was based on her sister had had a few sessions of dialysis and had her kidneys fully recovered.

Now friends,two major forms of kidney failure exist.The first is what I have discussed in various Wednesdays here and on Facebook where it all begun. That is Chronic Kidney Disease .Type #KidneyWednesday on my Facebook profile Cate Mimi and it will bring up all the series we have had since last year..The other is what is called Acute kidney injury mostly called by many acute kidney failure.

This is a reversible,temporary shut down of kidneys’ ability to produce urine.It means that if we intervene as soon as possible,we will help the kidneys to get back to their full potential.That explains why the lady’s sister received a few hemodialysis sessions and recovered.

It is important for me to highlight that if acute kidney injury is not treated in good time,it has a high chance of progressing to Chronic kidney injury.I will tell you of a story next week on Wednesday in relation to this.Something that breaks my heart to date.

A sudden reduction in the amount of urine production is usually the first sign of acute kidney injury.It means that you have been drinking water and other fluids normally(2000mls at the minimum) but somehow the amount of urine you have produced in the last 24hours can not even measure up to 500mls.

let me say that slowly…reduction of urine production not attributed to a reduction in fluid intake.That is what I am talking about.

What follows is fluid retention.The skin under your eyes start swelling and you will more often than not attribute it to lack of enough sleep.What surprises me in my not-so-old practice as a Renal nurse is how assuming Kenyans are in matters kidney health.We had a client who came to the unit in acute pulmonary edema.On history taking she said it was three days since she passed urine and that was alright to her.It still bothers me how we as a people do not pay attention to our bodies.

Maybe that is why I keep writing and hoping that you will stay informed.

There are many causes of acute kidney injury.In a nutshell,any factor causing a reduction in blood supply to the kidneys will impair its abilities to produce urine.If blood supply is not restored fast enough,the renal tubules will become acidic and fail to filter as they should.A good case is a severe hemorrhage as from a road traffic accident or commonly,post postpartum.That is after child delivery.

Postpartum hemorrhage accounts for many cases of acute kidney injury in Kenya.The statistics were released just last week by one of the Kenyan dailies.Besides reduced blood flow,direct injury to the kidneys is enough to cause a sudden shutdown of the same.This could be physical like from blunt trauma ,sharp objects or in the form of poisons to the kidneys.

Case on point is alcohol poisoning where large doses of alcohol metabolites clog the kidney tubules rendering them useless.That explains why your doctor will recommend urgent hemodialysis in cases of severe alcohol poisoning.That also happens with organophosphate poisoning like in the case of attempted suicide or poisoning with the common pesticide Malathion in Kenya.

These chemicals directly hurt kidney tubules and her blood vessels and we must remove them as soon as possible by way of dialysis.Usually hemodialysis.

In infants and children,Kenyatta National Hospital among other private hospitals,offers peritoneal dialysis which is a very child friendly mode of dialysis.In the aforementioned population,acute failure of kidneys is caused by severe dehydration mostly as a result of diarrhea and vomiting or other infections which will cause dehydration.Neonatal sepsis causes a generalized state of toxicity in the bloodstream and the tiny baby kidneys are unable to cope with the increased work of filtration,hence they shut down.

Doctors will prescribe aggressive medications as the neonatal and nephrology nurses focus on dialyzing the tiny weeny baby to remove the excessive wastes.

In all cases,it takes a matter of days (most of the times) for the kidneys to open up and make as much urine as the fluid you’re ingesting.It takes stages which I promise to not exhaust you with.Full recovery is progressively expected within six months.We must monitor patients lab values until we are happy with them.

What you should know is that any unexplained reduction in urine production is a cause for alarm.The other signs follow later like legs swelling and all that.Pay attention to your urinary elimination patterns.

When a lady is pregnant and they get diagnosed with a high blood pressure,it is very important for her to follow the advise of the doctor on taking the blood pressure medication.Sometimes it may mean an early delivery to save her life.

please stop treating yourself.Do not term it normal stress of pregnancy.A high blood pressure in pregnancy IS NOT NORMAL.I know I am shouting here.

As usual I will be happy to answer your questions.

FROM A FRIEND

Kidneys….

“My grandmother died of kidney failure. That was way back in 1985,” My good friend paused sipped his tea and gazed right back at me. After a while I motioned him to continue. “Wasn’t there anything they could have done?” He gave me a faint smile. “I was five then and would never have known what was going on. But later I did ask–she had suffered for years from blood pressure,”he concluded.

The kidneys could not take it anymore and they could not afford a transplant. Even in those days, transplants were rare and expensive. I said sorry and he nodded his appreciation. So we sat there lost in our own thoughts pensive for a while and my mind wandered again to our country’s Kidney welfare.

Currently, about one in every 10 persons has some form of chronic kidney disease and about four million Kenyans are affected with a significant proportion of this population progressing to kidney failure.

It is estimated that 4.8 million Kenyans will be suffering from kidney disease by 2030. The two main causes of Kidney disease are diabetes and high blood pressure and these two account for about two thirds of the damage the others are obesity, smoking and high cholesterol level.

Let’s now look at the cost side of things. In the past years, the National Hospital Insurance Fund (NHIF) has made significant progress in supporting patients with chronic kidney disease, with payouts for treatment of kidney failure last year, increasing by 41 per cent, seeing the insurer pay up to Sh1.8 billion for dialysis. This was an increase from Sh1.24 billion spent in the 2016/2017 financial year, highlighting the burden of the procedure to insurers. A scrutiny of the benefits package utilisation report also shows that in the last half of 2018, NHIF paid a further Sh64.7 million towards kidney transplants, up from Sh21.7 million the previous year. This makes the procedure one of the top expenditure items in the health care benefits package.

Why the story and the stats you may ask. It’s because from these numbers it’s clear that the problem is only getting worse.Though one can argue that the awareness has also grown. It’s also because from the above there is something we can do before we start thinking of cure so here are a few tips

Control your blood sugar if you have diabetes.

Keep a healthy blood pressure.

Follow a low-salt, low-fat diet.

Exercise at least 30 minutes on most days of the week.

Keep a healthy weight.

Do not smoke or use tobacco.

Limit alcohol.

Remember diabetes and high blood pressure are the main causes of Kidney failure.So please keep these in check.

In other editions to come, we shall talk about the bionic kidney as the future of dialysis expands beyond the hemodialysis and peritoneal dialysis. Remember our lessons.

DIETARY NEEDS IN CHRONIC KIDNEY DISEASE

A friend wrote to me and asked me why the nurses and everyone in the renal team managing her mother insisted upon curfews upon curfews of dietary restrictions.She sadly told me her mum’s diet was tantamount to ash–bland.I really understand her concerns and those of many others.I partly blame this perception on lack of proper counseling and explanation on the disease process of chronic kidney disease.

Let us do some basics here and hopefully by the end we shall have understood why and what is allowed or not in renal patients.

Please note that I am talking from a perspective of Chronic kidney disease and not Acute kidney injury which we will discuss next week on #KidneyWednesday.

The kidneys have a role in eliminating a very important waste called urea from our body.Urea is usually as a result of protein metabolism.We normally have such a fine balance between the proteins we eat and what is in the bloodstream.This is because the kidneys maintain the harmony by excreting the excess urea in urine.

Now,when kidneys are no longer working,this metabolite accumulates in the bloodstream trying to escape.It sticks onto the skin and in a patient acutely ill you may see this as a few patches of whiteness on the face called uremic frost.It looks like the person has an unnaturally dry skin and it is quite itchy.

That is not all,too much urea clogs in the gut making the person have a severe case of diarrhea and or vomiting.If nothing is done,the urea will easily cross the protective membrane in the brain called the rain blood barrier.This will present as confusion,hallucination and such and you may wrongly diagnose the patient as being ‘crazy.’These are just some of the signs.Every system is affected differently by high levels of urea in the blood.

What we do therefore is eliminate as much sources of urea as possible.It is important for people to eat foods rich in proteins but our renal patients do so cautiously.Even then,special preparation of lentils,beans and such other plant-based proteins is called for.This is because the best protein is the one that has a high biological value.This is mainly white meet.Small portion is allowed ,approximately the size of one’s fist.

The problem is,our patients can barely manage to pay for the fare to attend the dialysis sessions.How do we expect them to afford chicken,rabbit and fish?

Pause and reflect.

That is why we end up guiding them on how to minimize the assault that plant-based proteins have on them.

The other culprit is Potassium.We need this electrolyte for many functions in our body.Most foods are rich in potassium.The body does not store potassium.It maintains a safe level again through kidneys function of elimination.Excess Potassium is excreted in urine.When there is a high level of potassium,the heart senses it very fast and this causes a cardiac arrest and death in most cases.

Potassium is found in bananas,pineapples,oranges and most green leafy vegetables.The Renal nutritionist advises total abhorrence of these fruits(and many other),as well as special preparation of green leafy vegetables.

Therefore we advise patients to boil first the vegetables,rinse out and fry without tomatoes because these again contain a good amount of potassium.

I know it looks bleak when I write this.It looks very unappetizing and downright grim.I wish it was different.Look,your kidneys and mine function 24 hours a day and 7 days a week around the four seasons of the year.Renal patients get to ‘clean their blood’ only twice a week.

How fair is that?What will happen if they have too much urea and too much potassium in their blood before the next dialysis session?

I know in the developed world the patients dialyse thrice a week but well,this is Kenya.

Thank you for passing by.

The Renal Unit

The burden of kidney disease in Kenya is highly underappreciated.This is evidenced by the general acute poverty of data to give the nation a clear picture of the extent of kidney failure amongst our people.Yet day in and out Renal units are sprouting anywhere there is a town.

The government under the Medical Equipment Services launched a campaign that saw every County in Kenya get a renal unit with about five Hemodialysis machines.

This move was golden.However the joke was that there were no trained Nephrologists and Nephrology Nurses to run these units.These professionals were concentrated at Kenyatta National and Teaching Referral hospital (KNH).

I work in a County whose first renal unit had to run by offering locums to nurses from KNH so as to run the renal unit until the county could train her own nurses.

I know this story is replicated all across the 47 counties.That is the problem we sometimes,(read always) have as a nation.We do not plan.We are fond of jumping onto the current trending topic,whip a few emotions then abandon the idea altogether.We start cars and don’t fuel them.We start songs without tunes.We dive without oxygen tanks.We hate preparation.And when we sink,we cry foul.

See,it is Paramount that renal units are ran by qualified individuals.That means Nephrology nurses do more than circulate blood through a pump.We must achieve adequate dialysis and for that reason we go back to school to specialize.It is funny then that when we come back to the Renal unit,armed with enviable skills and knowledge,the unit lacks supplies.

I wish that the renal unit was handled with as much tenderness as a newborn baby.Patients depend on the effective and efficient running of the unit.If they do not dialyse adequately,we condemn them to a life of misery and death then say if only…

We cannot continue having sessions interrupted because there are no consumables.There is nobody to repair the ever-breaking down water unit,no gloves and some other weird circumstances Renal nurses have to contend with.

As far as Hemodialysis goes,it’s very easy to transmit a myriad of blood-borne diseases if the required standards of care are not met.That is why time and again County Renal units close down in the name of waiting for supplies.This should never be allowed to happen.

We need to plan (I know it’s expecting too much from the ministry of health) otherwise the same people we claim to want to help will lose their lives prematurely.Thanks to our casual approach to the seriousness of an effective Renal unit.

Other privately owned renal units have come in to cover the man-made gap conveniently created by our public hospitals.However most of these are set up,not to help,but to make money.The fact that the National Hospital Insurance Fund(NHIF) gives good kickbacks is the motivation.

Some of these units are ran by professionals and that is a very impressive aspect of care.

However some are not.They keep employing people who are not Nephrology nurses but because on-the-job training has made them know how to operate a machine,they become the Dialysis nurses.

Talking of which,there is a difference between a Nephrology and a Dialysis Nurse.The latter can connect and disconnect a patient from a machine.The former can tell why and how not to or to dialyse a patient and assess for its adequacy.

This,friends of God,is the difference between life and quality of life.

NHIF only pays for the session of Dialysis and not the many drugs the patients are on.Not the many tests the patients must have done.Makes me ask,is Hemodialysis really free as long as one has is an NHIF contributor?

Private Renal units use this loophole to charge for the drugs and tests as they wish.

The charges are usually arm,a leg and a slice of your liver.Add that to an already financially drained patient.

Extortion.

Exploitation.

Blood money.

The best we can do is hope that one day the government-owned facilities will run flawlessly.

Let there be a set-apart team overseeing every aspect of supplies to the renal unit.It is a matter of life and death.Just have what is needed at the time it is needed to avoid stopping.Then.Starting.And.Stopping.Of Hemodialysis sessions for our patients.

Supplies and maintenance are to a Renal unit what a pen and chalk are to a teacher.

Raise your glasses a better Renal unit!

#KidneyWednesday.