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?

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.