ANIMALS IN TROUSERS!!

For the first time I almost slapped a patient's mother.  Yeah, that's right . I was told that i was heard quarreling. I was livid. A  very young girl was giving me a history of having been raped 4 times over 4 months by a person well known to her but the mother was not aware and did not seem to care. What happened to motherhood? I naturally expected her to be boiling in anger and crying. She seemed okay and even had the guts to tell me the baby could have been saying yes to everything unknowingly, but my examination proved that she was being very truthful.  I wanted to blame the mother but again the perpetrator was an adult of sound mind and whether or not the child was left unattended he should have known better and not done the heinous act.  In just 3 days(23rd,24th,25th Dec) the hospital has received 6 rape cases. Some are adult female women who were assaulted on the roads and farms. Two were mentally disabled innocent angels. It is stories like this that make me want to hate men forever.  Why not go to red streets and get willing women if they cannot control their feelings? What did innocent women do to manhood to deserve all this? One of the family that brought in their young one for assessment told me that the villagers had sworn to burn alive the perpetrator and i silently wished I could support the vengeance plan.  This reminds me of cases where very mentally disabled ladies have come in heavily pregnant and I couldn't help but wonder which animals had done the sinful act and made them pregnant when they knew that they wouldn't take them in as wives. In such cases we have had to do caesarean sections because it becomes very difficult to monitor a normal vaginal delivery. I once questioned my friends if a mentally disabled man I know had children and everybody laughed. How would he bear children? I wanted to ask another question. If a mentally disadvantaged man couldn't be assaulted to make a pregnancy, why is it that a female in a similar situation would be taken advantage of and given several children? Do we just conclude that men can be animals? Why is it that the festive season is a high-season for sexual assaults? Is it the alcohol, the adequate free time ? I need answers. Or is our legislation not tough enough to deal with such fools? Are parents too busy partying to look after their children? You tell me! While you sit there and enjoy your festivities, know that an innocent girl somewhere is vomiting from prophylactic ARVs and her life will never be the same again, ever. Take some 5 minutes and pray  for such angels to overcome their physical and psychological traumas, pray for us women and our children to be safe. Have a safe festive season!

CONTRACEPTIVES

I'm sitted in my 'usual' seat at the '10-sitter' proboxes on my way to work in the 'wilderness'. I hear on the radio the advertisement on the 'C' word that has been going round for a long time. The preaching on contraceptive use among the youth and especially teenagers. I get thinking during the one hour drive  and wonder if we are misleading our young brothers and sisters. It reminds me of episodes when young girls as young as 18 years would come in for depo-provera injections, Norplants, Mirena e.t.c. Young unmarried women using high hormonal methods and taking risks of future infertility because they need to keep their 19-year-old boyfriends. Yes, you heard me, boyfriends and not husbands. I'm able to have precognition in my office because in one instance a teenager would walk in asking for contraceptives and the next patient would be a 37 year-old unable to conceive because of anovulatory cycles caused by long-term high dose progesterone contraceptives use . I'm not being judgemental, not all women with anovulatory cycles used contraceptives.   Anovulatory cycle is lay-man's terms means an alteration in menstrual cycle caused by hormone disturbances  resulting in ovaries not releasing mature ovums. I have also witnessed a number of fairly young girls with intra-uterine copper devices (IUD) presenting with bad infections. Some researchers would argue that infections results from unhygienic conditions during insertion of the IUD or from unsafe sexual practices later on. But all in all, a foreign body would encourage more infection, wouldn't it? Then 20 years to come the same person presents with infertility due to blocked Fallopian tubes. (I'm being too harsh, aren't I?) I'm not against contraception use among teenagers and I'm not judging people battling with infertility; but do we also make the effort to preach to the girl-child some probable side-effects of some of the contraceptives use? It's all about avoiding pregnancies but we don't sit and think on how to protect the same pregnancies in the future after getting married and being at the right age for such responsibilities. Why not encourage the use of barrier methods or be conservative and preach abstinence. Nobody died from lack of coitus after all!! I have no problem when an informed decision about contraceptives is made at the right time, in a family-setting or when a person is mature enough. Contraceptives are good when used at the right time. I feel like our society is getting dangerously modernized. There are times I'm tempted to take a rod and instill some sense in my young patients. I have seen tens of cases of 18-20 year old boys (I call them boys) coming in with sole complaints of decreased libido over a number of years. So when did you start young man????? Weren't you supposed to be concentrating on your high school education and not running after 16-year-old girls? I see it all in the november - December period after KCSE. Some walk in and confidently request for a prescription of Sildenafil drug (google it). Then comes last week of December and first week of January when hospitals would be flooded with cases of criminal incomplete abortions gone wrong in girls preparing to go back to school. During our days( tens years back), getting ready for school meant shopping for new socks, new uniforms, toiletries, finishing assignments  and not visiting a gynecology unit.  ( I sound old, 'during our days' ).  Have parents neglected their duties? As i was growing up, ( and even now ), mother knew my every move and could foresee my future plans( I sometimes thought she used some juju).  She would instill thorough discipline and stop any naughty schemes ahead of time. I remember being shown a documentary on HIV Clinical manifestations  when I was only 10 years old. It was very scary . I remember having night-mares after watching it. She called a spade a spade and there was no beating around the bush. Those images are still fresh in my mind to this day. You can look out for the video, I remember it was presented and produced by Raphael Tuju. It changed my life forever in a good way and made me look at sexuality in a different perspective. I need to look for it somewhere in the family archives. The documentary was produced in the late nineties when there was a lot of stigma associated with the disease and when ARVs where not available to all.  I want to write some more about this topic but let me sit back and watch the reactions to this first.  #somebodytellthemedia to include long-term side-effects of some of the contraceptives so that young persons can make informed decisions.

MOMMY'S PHOTOCOPY

   A very busy Monday morning and my moods are swinging dangerously because I'm not used to having so many patients at a go. The rainy season had made me lazy because I would see a maximum of 10-15 patients in a day. With the brief rain detour, the grading of the roads by the county government, the rich fruits harvest and the plenty of free time because people are done with planting ,the patients are in plenty from the North (Moyale,Marsabit), to Tseikuru  (Kalonzo land) to the locals in Meru. I was boiling up inside and wondering how I was going to finish up my increasing queue by 5.00pm. My boss(he says I call him 'colleague') was already exhausted at oesophago-gastro-duodenoscopy number 7, more than 10 ultrasounds, 2 ECGs,emergencies,consulations here and there, an impending appendicectomy,Caesaren Sections, D&C etc on  their way to theatre. I would pop in and give him moral support before going back to my office to continue with the endless queue.  I was spurting at my colleagues wondering why all patients were being sent to me for rather simple conditions but the more I saw them the more I realized it was not a day of simple 'hapa-kule' syndromes. There were important medical decisions to be made; for instance,10 suspicious and confirmed cancers diagnosed on imaging and pathology in one day was no joke. It was turning out to be an emotionally draining day. A day of intense counselling and bearing the brave face  to break sad news to patients; giving false hope when deep inside I knew some of them  had advanced conditions and had utmost a few months to live.   To make it was, I was struggling with a cluster headache thanks to using computer for long hours the previous day to prepare a hospital based Continous-Medical-Education presentation .  So anyway, amidst all this mess, in walks a beautiful eloquent lady with a bright smile together  with her happy cheerful daughter.  During consultation I note that she is a my fellow 'Cambodian' and I don't hesitate to tell her that she is my 'sister'. We Kamba chics have some undying love for each other when out there in the 'diaspora.' Out of nowhere she asks me if by any chance I was the daughter of One Miss.Rajab. Shell shocked, I immediately acknowledge that the said person is indeed my mother and she goes ahead to tell me that she was her high school Kiswahili teacher. We get talking for a good 10minutes in total disregard of the queue outside (I needed the break) and my day is immediately transformed. She tells me how i'm an exact photocopy of my mother and what a wonderful mother I have . I feel honoured, excited and challenged to be a good ambassador for mommy cos clearly I carry not only her looks, her walking style, her brains , her habits but also her legacy to do our duties at work with one heart and dedication; to leave a positive mark in every person who passes through our hands.  All this reminds me of one great saying, ''Women grow up and our energy is largely turned towards men, but the original love relationship is with a mother. If we as daughters don't acknowledge that, we're closing ourselves off from a great source of power and fulfillment and understanding of ourselves." - Lee Sharkey Have a great week ahead, won't you? 

OF SNAKE BITES AND THINGS AFRICAN-CHEMISTRY

My week kicked off well, but at a rather slow pace thanks to the rains. I admitted several children with snake bite related injuries and it literally gave me goosebumps at every instance. They say the snakes come out to the houses and the roads to get some warmth and avoid the extreme cold during the rainy season.  I have seen patients lose their limbs, others get permanent paralysis, late brain injury manifestations, kidney failures and even lose their lives in minutes. I work in a hospital located in a village in a semi-arid area.  Stories in the community are that the area did not originally have snakes but rather the ‘snake-eggs’ came in with construction sand, stone and gravel from the Tharaka area. I was having a chit-chat with the security guard one evening and he told me of a case in the village the previous year of a mother who was carrying her infant on the back. She saw a snake cross the road and she promptly took a rod to hit it. He tells me that the snake is a variety that sticks to anything used to hit it. The snake clung on the rod and as she lifted the rod to hit it the second time, it jumped out to the baby. The young mother unknowingly continued with her journey only for her to be startled by cries by the baby then total silence. The baby was sadly dead in minutes.  As he told me the story I kept on checking my feet and overhead just in case anything jumped out to me. I had very restless nights in the week and had to inspect the entire house every evening. I made the bushes near my house cleared and spread the beddings afresh every evening. Anyway in all this fear, it was fulfilling to have acted promptly and saved the hand of a child who had been bitten by a deadly snake.

Away from the snakes’ topic, this week I was able to witness a diagnosis called AFRICAN CHEMISTRY. They call it WITCH-CRAFT in society. I don’t believe in it but after listening to some of my patients about the aetiology of their illnesses, I must say I was convinced. One of the patients allowed me to share his story. He came in with a clean, well dissected cut on the neck that had gone very deep and the cricothyroid and thyroid cartilages were exposed. One thing to note is that the cut was so professionally done I thought an experienced surgeon had been involved. All major blood vessels and nerves had been skillfully spared. That put me to shame because the anatomy of the neck has always been a hard nut to crack for me. I asked him what had transpired and he informed me he had cut himself. Yes, you heard it, he had attempted to slaughter himself. I further tried to ascertain if he was a psychiatry patient or if he had a suicidal tendency but he was of sound mind and stress free. He went ahead and told me his story. He had stolen a goat and the owner had declared that whoever had stolen the animal would slaughter himself instead of the goat. He says an unseen power directed him and he did what he did. I was shocked, amazed and convinced that indeed AFRICAN CHEMISTRY is a diagnosis they forgot to include in our medical training. Nobody should call me a quack if I ever write it as my working diagnosis or if I refer a patient to a Mganga Kutoka Zanzibar for consultation. What a week!