A SPECIAL PATIENT

A few months back a patient walked into my office frail and weak. He had come to pick his biopsy results for a suspicious growth. He had come in with his relatives; son, daughter and handsome grandson. I don't know why I took a liking to these strangers. Either it was the charisma and high spirit of the mzee or the non-Sumbua (non-fussy) nature of the relatives. We clicked !! I talked to them for a while, made them comfortable then slowly broke the news of the diagnoses. It was unfortunately the 'C' word. The 'disease' was at an operable location and I immediately knew that a trial of surgery was a viable option.

I never really get very involved with patients but for this special man, I went all the way. I privately talked to the surgeon (a visiting surgeon from Italy) and we agreed that there was no harm in trying as long as the tumor was localized. Again I gave it my all in doing the labs and the necessary radiological examinations. To cut the story short, a decision to try the surgery was made but there was that risk of local involvement of local structures by the tumor which was difficult to visualize on radiological examinations. I explained this to the relatives and they agreed to try it instead of doing nothing.

Surgery was unfortunately 'short' (lasted for only 20minutes) because we discovered that it was unfortunately too late. There was extensive local spread. Nothing could be done!! It was a matter of 'open, see and close'.

I met with the family the same day post-op and broke the news to them and again they were very understanding. I discharged the old man 4 days later and referred him for hospice palliative care. It was too late to even try chemotherapy or radiotherapy. The days we had him at the hospital were happy days because he would crack the other patients with jokes and stories.

I kept tabs on how the old man was doing and this past weekend, I did what I never do. I decided to pay him a home visit. I learned that he had to get weekly intravenous fluids due to dehydration episodes and I decided to spare him a hospital visit by buying I.V fluids, branula etc and do it for him at home.

He was extremely happy to see me and we had a chit-chat as the fluids run into his veins.  He was having some brief episodes of confusion but I went a long with the mildly confused talk. He got very energetic and even stood and walked outside later that evening. I left him a content man with a big smile and he blessed me just as I was about to leave. I promised to visit often but little did I know that this would be my first and unfortunately last visit with 'Mr. Charisma'.

His grandson did call me today and informed me the Mzee had gone to be with the Lord. I said a short prayer for him and I'm so glad that I gave him the best  care. I'm happy I went for the home visit. I learned a lot about remaining positive from this man and I pray that his soul rests in perfect peace. AMEN!!

MY EXPERIENCE AS A BIRTH COMPANION.

This past month I literally  got a chance to be on the other side of the table. My cousin had chosen me to be her birth companion( if you are pregnant and you haven't decided on who will be your  birth companion then you are not serious with your birth plan). I know that in most public hospitals, patients are not allowed to have companions in the labour room but it's something that should be allowed to some extent. I was excited about the honour that she had bestowed on me and I looked forward to it very much. When my entire family left the house to spend the weekend back home in Machakos like it always happens, I was a bit reluctant because I had given her my word to be around during the days approaching her E.D.D. (Note,a mkamba doesn't sleep in Nairobi on a Friday, this is a known fact; afterall Masaku NOO VAA!!)

I am an avid fan of all pregnancy related shows on TV like 'One born every Minute', 'I Didn't Know I Was Pregnant', 'Adventurous Deliveries' e.t.c mostly on TLC Dstv Channel 172 ; so I had an idea what birth companions go through.

The much anticipated phone call came in on Saturday at 8.00a.m and I was super excited. As a medical doctor, I get very irritated when patients come in with their 'medic relatives' who know it all and want to control everything so I knew that I had to play this very cautiously without crossing other medics  borders.

In the hospital where she was delivering, only the spouse is allowed into the delivery room but I gladly convinced them that I was stepping in on behalf of the spouse. Ofcourse I was a bit anxious not to let anything go wrong because I'm not sure if I would ever forgive myself, there's a sense of responsibility that kicks in when you are watching over your relative. We were in the company of her amazing friends but unfortunately they wouldn't be allowed in for as many hours as I, the 'spouse.'

I humbly introduced myself to the midwives and the 'Intern' (he was either a doctor intern or a very experienced nurse). I played it dumb and cool ; back in my mind I kept wondering if they knew that I practically run the maternity in my hospital and all decisions during working hours fall on me. They must have thought that I was meek and docile ; and that was excellent because I didn't want to intimidate anyone.

I noticed a few mishaps here and there that I would ordinary ignore but not with my cousin.  I literally kept bugging them in a friendly and flattering  manner until they did the correct things but without feeling pushed and intimated.

Again, my hand was sore from all the lower back massaging. At one point I would be told I wasn't rubbing the back adequately and at the other time I would be told I'm rubbing it too much; they are called women in labour, they are allowed to command the moment, haha! I also forgot to eat or drink anything till around 5.00pm when my cousin's friends brought me something to eat and I devoured it irregardless of the maternity environment. I thought I looked mean eating infront of an exhausted labouring woman but I reminded myself that I needed the energy to focus on the task ahead.

I was also very keen to feed her often and give her energy drinks so that she would have adequate energy when the time for pushing out the baby would come.


There are moments she caught me laughing at her but hey, the dramatics of a labouring woman can be comical. I'm sure every woman smiles over some of these memories. I also assigned myself the role of chief-photographer. I thought that she would want these life changing moments captured . I made sure I only took photos and videos with her phone and never mine to maintain privacy. I believe these are very intimate moments that only belong to her and her soon-to-be-born child.


When I felt like she wasn't being monitored adequately as need be, I would call the pretty nurse and request her to politely do what was needed, and we bonded well. I refused to enter the examination room as they did invasive examination because I didn't want to cross into another doctor's territory and I also respected her privacy.

Of course I have dealt with many pregnant women and I know when they are psychologically feeling things. When my cousin would tell me that she was at the point of pushing the baby, I would just sneak out and come back pretending that I have alerted the doctor. Of course you don't bear down so early until you reach a certain dilatation. This happens to us doctors a million times so when you tell your doctor that you feel like pushing and he ignores you, trust me he has your best interest at heart.

We laboured till evening and we reached a point where action (caesarean section ) was needed. I being a staunch supporter of Vaginal Delivery made sure we tried it fully but of course without putting the baby at risk. I would hate it to go home thinking that I contributed in unnecessarily rushing to a Caesarean Section. I had literally forewarned her not to mention the word Caesarean-Section infront of me because I was hoping that she had it the 'normal way.'  I had a partogram( a graphical monitor of labour) in my head, literally and I knew it when it was time to go to theatre. I anticipated a malpresentation, but behold it was a big baby coming out of what looked like a very small pregnancy bump; that caught me off guard literally. How could we have missed out on a Big Baby diagnosis? We had all relied too much on a scan done the previous week which had estimated a fairly small size baby.

In the labour room, I was able to calm down a husband who was very tense. He sensed that I was abnormally calm and he approached me for moral support. I did open up to him that  I am  a medic and with that, gave him the avenue to ask as many questions as he wanted to calm him down. They had lost their first baby at birth and were still traumatized and hoping they would be successful this time round. He managed to calm down finally and be strong for his wife who was clearly going through a difficult delivery. I realised that probably God was using me to wipe off fears from this family in my capacity as my cousin's 'spouse.'


I exited the birth companion role and entered the 'grandmother' role. I was alone at the bedside at the Post-Operative ward waiting for mother and child to come back from theatre. Those were long, tension packed hours. I expected them out in 45 minutes to 1 hour but they took a whole two hours. I kept re-assuring myself but as a medic, I kept going round and round on all things that could go wrong. Soon, I had the pleasure of being the first to hold and clothe the big baby together with the nurse as we waited for the mother to be 'sewed up'.

I would have jumped in to help if anything went wrong, whether with permission or not; I'm I not a licensed doctor in the country? This reminds me of a doctor friend whose child developed breathing complications immediately post delivery and she hastily jumped out of bed with placenta dangling in between her legs and resuscitated her child. By the time the doctor arrived, her child was sorted.

I left the hospital late in darkness but went home a very satisfied woman. Of course I carried home lots of my cousin's DNA, in form of amniotic fluid,  blood, tears etc in my clothes but those were marks of success and victory.

This task made me give a lot of respect to spouses who go through it all in the labour rooms. It's not easy sitting on that bed for more than 12 hours observing a loved one suffer. It's for the persistent, patient and strong at heart.

It also made me appreciate the importance of having a birth companion. I'm a medic and I know that patients who are accompanied are usually taken more seriously.

I also learned the importance of respecting colleagues when in their territories. The midwives loved me to the point of sneaking a joke or two when I went to enquire anything. The maternity guard(Askari) also liked me and praised me for my persistence till I had seen the end of the delivery.

I also learned to treat patients with utmost care because for us, it's an everyday job with 'objects' to treat, but to a patient, this is the first time in their lifetime to ever go through an unforgettable experience. When a doctor spoke harshy to my cousin, I was hurt, yet I do use such words frequently in maternity. For example, I don't like being touched by a labouring woman when doing a vaginal examination yet it's a painful procedure that they have probably never encountered in their lives. With this, I have become a more compassionate doctor especially in maternity.

I pray that my cousin Jacinta and her beautiful daughter have an amazing life together, full of wonderful memories and friendship.

'Dear Jacinta, should you require a birth companion for another pregnancy, I'm all yours. Thanks for trusting me with this very important role.'

BLIGHTED OVUM

             BLIGHTED OVUM
I have been spending so much time with pregnant women of late such that my body, soul and spirit is in pregnancy-mode, I'm actually awaiting my 'first delivery' 3 days from today.  2 close relatives and a best friend are pregnant so I have been bombarded with lots of pregnancy questions. One of the questions that has always come up is about a formed pregnancy with no baby (embryo). This might sound very impossible but it’s a frequent phenomenon. My patients look at me in disbelief when I tell them that they are indeed pregnant but with no baby forming. I have had to take them step by step on the ultrasound till they get it. In the hospital I work in, I see at least two cases weekly. For those who don’t believe the diagnosis, we always advice them to repeat the ultrasound after a week or so, or get a second opinion for the sake of psychological satisfaction.



WHAT IS A BLIGHTED OVUM?

A blighted ovum occurs when a fertilized egg implants in the uterus but doesn't develop into an embryo. It is also referred to as an anembryonic (no embryo) pregnancy and is a leading cause of early pregnancy failure or miscarriage. Often it occurs so early that you don't even know you are pregnant. The pregnancy appears normal on an ultrasound scan in its early stages, but as the pregnancy progresses a visible embryo never develops or develops and is reabsorbed. In a normal pregnancy, an embryo would be visible on an ultrasound by six weeks after the woman's last menstrual period.

WHAT ARE THE CAUSES?
The causes of a blighted ovum are often due to problems with chromosomes, the structures that carry genes. This may be from a poor-quality sperm or egg. Or, it may occur due to abnormal cell division. Regardless, your body stops the pregnancy because it recognizes this abnormality.

 For most women, a blighted ovum occurs only once in their lifetime but I have seen a few women getting it twice or thrice. It becomes very depressing for some.

WHAT ARE THE SIGNS?
With a blighted ovum, you may have experienced signs of pregnancy. For example, you may have had a positive pregnancy test or a missed period.
Then you may have signs of a miscarriage, such as:
• Abdominal cramps
• Vaginal spotting or bleeding
• A period that is heavier than usual.
If you're experiencing any of these signs or symptoms, you may be having a miscarriage. But not all bleeding in the first trimester ends in miscarriage. So be sure to see your doctor right away if you have any of these signs.

HOW IS IT DIAGNOSED?
An ultrasound test is usually needed to diagnose a blighted ovum -- to confirm that the pregnancy sac is empty. For diagnosis, the sac must be of sufficient size that the absence of normal embryonic elements is established. In case the doctor is doubtful, he can recommend one extra week of observation followed by a repeat scan to be sure of the diagnosis once a sufficient size of sac is achieved.

HOW TO TREAT IT

If you have received a diagnosis of a blighted ovum, discuss with your doctor what to do next. Some women have a dilation and curettage (D and C). This surgical procedure involves dilating the cervix and removing the contents of the uterus by curetting. Because a D and C immediately removes any remaining tissue, it may help you with immediate mental and physical closure. It may also be helpful if you want a pathologist to examine tissues to confirm the reason for the miscarriage.

Using a medication such as misoprostol ('the white tablet') to stimulate the uterus to expel the contents may be another option but this must be strictly done as an inpatient in case bleeding complications arise. However, it may take several days for your body to expel all tissue. With this medication, you may have more bleeding and side effects. With both options, you may have pain or cramping that can be treated.

Other women prefer to forego medical management or surgery. They choose to let their body pass the tissue by itself. This is mainly a personal decision, but it must be discussed with a doctor. I remember almost losing a patient who decided to wait for the body to expel but ended up getting life threatening bleeding and ended up being rushed to theatre for an emergency D&C and had to have urgent transfusion.

HAVE I EVER SEEN A NON-DEVELOPING EMBRYO??

I remember doing a D&C and of course after almost rupturing the amniotic sac on my face, the small embryo came out. It was so small, about 3 cm long, I put it aside to study it after the D&C but of course it had melted into a white matter by the time I was done. This fascinated me.

I hope this post was educative enough and I hope that Doctors also stop telling patients 'mimba imeharibika na lazima uoshwe' (pregnancy is spoilt) instead of explaining the exact nature of the condition that made them miscarry and telling them all the options available for them.

Have a fruitful week!!!

A DAY IN COURT

A day in court

I did get a court bond to appear as a witness in a case. Working in a private mission hospital, I thought all along that the job of appearing in court only applied to doctors working in government hospitals. I had to go, skipping a bond can call for a warrant of arrest. I had been called upon to attend court cases before as an expert witness and never had to testify because the cases would be moved to other dates due to unavoidable reasons. My work would always end at the prosecutors office and not at the court house.

I left my house at 7a.m, so that I can be in court at exactly 8.00a.m. I guess I was being paranoid, Kenyans don't really mean the actual time they indicate in the particular summons and memos. I realized that I had arrived an hour earlier than all officers working in the court. So I burned time in the car browsing the internet for more than an hour and regretting why I had not left late after completing a ward-round.


At around 9.30a.m I entered the court house and yap, sat on the wrong side meant for prisoners and offenders and one police officer politely informed me to move to the opposite side. The court was packed to capacity, at one point I thought that I was in a packed Chaaria Probox Matatu. We were all squeezed in together.

I thought court was a very serious affair. I had previously attended court at Milimani Law Courts in Nairobi in which the Grand-Mullah was a lawyer to one of the parties( I don't know law jargon so forgive me). The court was conducted in a very serious manner and I didn't understand a word in that particular case because it was all about 'mentions', 'petitions',  millions of shillings in bond etc.

Back to this court, the judge entered and we all stood as per protocol. Did I mention that the judge looked quite handsome and neat?(I might get divorced for mentioning this, haha). I was so respectful of the house of justice, so I sat quietly at the back,  switched off my phone and was careful not to cause any noise, even a cough. I didn't want to be 'thrown in' incase my phone rang.

The judge started going through the files calling each offendant ( are they called that?). There was a lot of comic and laughter in the cases. Here was a judge, who knew all common petty criminals by name, character and their common offenses. He would even bring in a joke in Kiswahili or Sheng' and this made me relax.  The same way I know my 'regular patients' by heart, is the same way he knew his 'boys and girls.' At one instance he send a police officer to call one lady he had spotted loitering in the compound because he knew she would definitely be linked to one of the cases of the day because she was a 'regular'; and behold she was indeed involved.

A lot of the cases involved sale of alcohol without license, illicit brews business etc. 50% of the criminals were actually minors, to my shock and surprise. My case was called out and I stood, excused the court, introduced myself and politely asked if my case would be heard first as I was needed at work.

The judge was very very polite, he told the rest of the court to take a break as he went to hear my case in his chambers. We went in, I swore by the Quran. I was very uncomfortable to see a non-Muslim carry the Quran to bring it to the chambers. There are purity and cleanliness protocols to be observed before one can hold the Quran, which I'm sure they had not observed or were not aware about them; ignorance of the 'Quran protocols' is no defense.

The case proceeded well, cross examination was done on me which put me at an uncomfortable spot. I'm not used to confrontations. I was excused to leave immediately after my testimony(is it called that?). On my way back to work, I kept on wondering if I had given my all,if I had given the evidence to the best of my ability to ensure that justice is served. Again, it related well with my work. My paranoia and quest to do the best has sometimes made me go back to the hospital very late at night   just to make sure for example, that I have not left a tourniquet on a child's hand that could cause gangrene. Of course all the time it ends up being just paranoia. The driver kept asking me details of the case and I reminded him that my profession demands confidentiality at all times, even when outside the hospital.

Of course I swore never to attend court again because I live in a village where everybody knows each other. I'm afraid testifying against some people could put my security at risk, one has to be very careful when dealing with Murumes. Because of this I called the police officer involved and told him to never ever link me to a case involving issues in my locality. (Sometimes I feel like Santalal- the doctor actor in the Series 'Santalal' at Citizen TV).

So Judges, lawyers, police officers are just like doctors in so many ways. They do exactly what we do. I saw the judge writing down 'history' notes and I realized that we are not the only ones who write notes.  I'm sure they sometimes lose sleep due to work issues just like us. Law was always my second choice after medicine and I wonder what kind of a lawyer or magistrate I would be!

LESSONS LEARNED FROM RAMADHAN- THE HOLY MONTH

LESSONS LEARNED FROM RAMADHAN

1). TO BE A GOOD TIME MANAGER....

Ramadhan has taught me to be an excellent time manager. The 5 obligatory prayers plus many more prayers have to be prayed in this holy month, some in the middle of the night or very early before 4a.m yet we are still expected to do our service at our places of work with utmost diligence because diligence at work is also a form of worship. We also expected to read the Quran as much as possible and do dhikr(devotion).The trick to this is being a good time-keepers and planner.3 Sleeping time has to be pre-planned and pre-calculated to fit the schedule, no more wasting time lazing around, T.V time is strictly for news only and Islamic channels because the time is very minimal, traveling has to be pre-planned to fit prayer schedules at different mosques on the way e.t.c. 24 hours are so less.

2). IBADA(WORSHIP) INCLUDES GIVING MY BEST

I can't afford to be harsh to anyone or treat a patient half-heartedly because giving our best is considered a form of worship which is very crucial in life and mostly in this holy month. Hurting someone could make ones fast null and void. Giving substandard services yet you are drawing a salary could be considered sinful.

3). INTER-PERSONAL SKILLS ENHANCED

My communication skills and relationship with my colleagues has greatly enhanced. I have to be careful how I talk to people to avoid hurting anyone, there is no space for talking ill or complaining about anyone, I have learned that direct, firm yet friendly confrontation is the best approach.

4). ALL MY SENSES ARE IN FASTING MODE

EYES- I can't watch things that are detrimental to my spirituality and personality. Islam teaches us to lower our gaze even on the roads.

EARS- listening to gossip, unnecessary talks, bad music etc is a NO NO NO ( not that I listened to these before anyway!)

MOUTH- what comes out of my mouth should not hurt anyone but should instead be a  blessing to them and if possible be in the path of worshipping Allah in one form or another.

5). THE ART OF GIVING.
The whole idea behind fasting is to be able to give back to the society. Nobody slept hungry or suffered because of giving to the less fortunate. Giving should be as secret as possible because giving is not meant to be for show-off but for the sake of Allah. The Quran says that what the right hand gives, the left hand should not know about it.

6). MODESTY
Ramadhan has a way of drawing people back to being modest. Modesty in form of ones behaviour, dress-code, talk etc. People might judge but that's one of the purposes of Ramadhan, to draw people back to their creator.

7). IT'S OKAY TO 'UGLY UP'
I am rocking dark eye bags and I'm proud of it. If we can trans-night studying to pass exams or do crazy night calls in the hospital , then surely we can sacrifice for Allah; waking up very early e.t.c. I'm in constant contact with water more than the 5 obligatory times, but that's okay. Natural face with no foundation on is the way to go, so I realize.

8). HEALTHY EATING

Ramadhan has a way of 'shrinking' ones stomach. No matter how gluttonous you are, you can't eat much. A bite or two and fruits is almost always enough. We are also prohibited from eating much Iftar so as to remain light during the long taraweh prayers.

9). HUMILITY
Ramadhan has a way of humbling us. We all become equal. A rich man and a poor man go through the same pangs of hunger, the same prayer sessions, etc. Ramadhan is an equalizer in it's own right.

10). TOLERANCE
If you can tolerate pangs of hunger with a happy face, then trust me you can tolerate anything. I have realized that  when treated badly I let it pass unlike in the past where I would whine, hurt, complain etc. There's just a tolerance and peace that comes with Ramadhan that I can't explain.

Sometimes I wish that each of the 365 days of the year was Ramadhan. The joy and peace that comes with Ramadhan is amazing. Everything is always in synchrony worshipping Allah. It's the time of the year when we all get to drop any vices and  go back to God fully. I pray that Allah gives us grace to make each and every day of our lives Ramadhan; Amen!! Ramadhan Karim

WORKING IN COTTOLENGO MISSION HOSPITAL

My experience in Cottolengo Mission Hospital Chaaria


I remember one evening when I was having dinner with younger colleagues in Meru during a KMA meeting, one of the colleagues causally said 'The doctors in Chaaria are quacks.' I was so hurt and shaking from head to toe in anger . I took it so personally and gave him a piece of my mind. I almost shed a tear, I didn't know that I had come to own Chaaria that much. I asked him to go ahead and give me ten reasons why he had generalized Chaaria to be a substandard hospital; he couldn't point on any single reason despite thinking hard. My final conclusion is that he had inherited that ideology from his seniors. He had never been to chaaria, couldn't point at any single patient we had mismanaged yet he had gotten used to the ideology that Chaaria must be substandard because the prices are too cheap. I feel very sorry for the doctors who have refused to change this school of thought. Instead of doing blame games, we would be of much help to the citizenry by having collaborations, consultations  and referrals among one another.  My boss Dr. Gaido always tells me that our 'Big-Brother' is our patients. They still come despite discouragements from medics in town. They came from as far as Mandera and still spread word for the good job we do.

The first day I took Chaaria seriously was during a KMA meeting when Dr. Gaido announced that he was looking for M.Os to apply for locum chances. My colleagues reminded me that Chaaria was in the middle of nowhere and that no sane lady would make it to locum there. I decided to visit the hospital and keep an open mind. I remember it was a Wednesday afternoon when I made the trip, I found the OPD so full of patients and told myself that if so many patients could make it here while frail and sick then I could also make it for work. The first person I talked to was Senior Clinical-Officer Jonah Gitobu Mworia, I introduced myself and he was very helpful. He showed me a place to sit and asked me to sit and wait for the 'boss'. Dr. Gaido saw me a few minutes later and told me the he instantly trusted me due to my religion and believed that I would not let him down. As planned , I was able to work in the days agreed upon and it wasn't bad at all. While my colleagues back in Meru still complained that it wasn't humanely possible to commute to Chaaria, I was busy making an extra coin and learning a lot at the same time.

When I applied for my annual leave at Meru Hospital, I knew 45 days was a long time to sit at home and do nothing. I was also tired of working in an environment where systems where just not running. Thanks to the county health administration , things at Meru Hospital are much better now. So anyway, despite having an opening at Agakhan Meru, I approached Dr. Gaido and asked him if he could give me a 45 days locum opportunity. He gave it to me without blinking, it was such  a  relief. During the course of the locum, I came to really love working in Chaaria. I felt that I belonged there. The satisfaction of helping a very poor patient get 1st class health service at a near zero cost was immense. I did the unimaginable among young doctors and decided to apply for a long-term secondment opportunity. Many people called and discouraged me, I was going to get cut off from civilization , that's what they told me. 8 months later, I'm so glad I took the plunge. I'm definitely not the same Khadija. My life has changed, I have gotten so much experience, I have gotten so exposed by working with professionals from Italy, Poland,Britain, Canada etc.

Chaaria is the only mission hospital in Meru that never turns away anyone because they cannot afford admission fees. Service to the poor is really the mission here. We have done major surgeries for patients knowing very well that they wouldn't afford the bear minimal of the cost but we have done what we have to do to save their lives.

I remember one instance, my friend from Meru brought his sister to have a kidney stone removed. The minimal cost he had been charged in Nairobi was 500,000 shillings. I called him and told him that he would pay nothing if he had a NHIF cover. He couldn't believe it. He asked me a few questions just to clarify if it was standard surgery. I reassured him. Because his patient was not covered by NHIF, he paid a total cost of KShs. 6,500 and surgery was successful. Since then he has been a good ambassador to us. He is one man that shuts down those that call us substandard because we are too cheap. Kenyans must change that ideology that cheap is fake. If an organization wants to help, don't start doubting it for being too cheap. Another thing is that our buildings are not as posh,  but would you rather be in a posh building and get substandard yet costly service or be in a standard simple room and get 1st class service at a low cost???? Food for thought.

When I asked Dr. Gaido to teach me how to do Hysterectomies, I was scared, I didn't know what to expect. I had been in a system where no one would dare teach you something major for fear of you bringing competition in the private sector. He was very happy with my new interest and taught me very selflessly and patiently. I'll forever be very grateful to him.

One of my patients told me that in his opinion, Chaaria was the prime Cancer Diagnostic Centre in Meru and that I should look for Hon. Julio Mbijiwe and show him our cancer registry and challenge him to ask the County Government to facilitate a monthly visit by an oncologist at Chaaria. I was touched by this view.  The patient had visited the Oncology clinic at Meru Hospital and had noted that 98% of the patients there were referrals from Chaaria with referral-letters written by me. So instead of sending the patients there, why not send the doctors to the patients? I hope Hon. Mbijiwe sees this post and does something about this situation. We are the only hospital in Meru doing ultrasound guided biopsies and  having an organized histopathology chain.

The road to Chaaria is terrible, totally impassable during the rains. If Chaaria sees a net of 150 patients per day despite the bad road, can you imagine how many more patients we would help if the road was tarmacked. I implore the County Government to take the example of Machakos County and prioritize infrastructure especially if it also opens up a health facility. Hon. Munya are you listening? It just takes three months to tarmack a road 'Mutua-style.'

I could write and write, but Cottolengo Mission Hospital Chaaria has changed my life in so many ways and I'm very grateful for the opportunity to work here. I don't take it for granted. My ideologies have changed, I have become more tolerant and patient, but above all, I have become a better clinician with so much experience that my colleagues can only envy.

ALCOHOLISM AMONG POST-MENOPAUSAL WOMEN

Alcoholism among post-menopausal women



It would surprise you to note that many of my 'above-50' female patients are chronic alcoholics. I'm following quite a number for Liver Cirrhosis secondary to alcoholism. I see their daughters cry when they open up to me about their mothers drinking behaviour and how they had tried to no avail to help them quit drinking.  I have also admitted quite a number in alcoholic coma; drinking till someone passes out completely.

All these women have many things in common. All are above the age of 50, all are widows and only started drinking after the passing of their husbands, all have inherited quite a lot of property and land, all have extremely responsible and well behaved daughters who bring them to hospital and wash them when they pick them from the streets(meaning they were extremely responsible mothers during their productive age).


So what makes them develop this disturbing behaviour? Is it the freedom that suddenly comes with the passing of their husbands? Is it the unlimited control of inherited property? Is it in course of countering the stress that comes with body changes in menopause? Is it the increased loneliness that comes with losing their spouses?Or is it just a mid-50 crisis among women?

I researched on this online to satisfy my curiosity and also to understand my patients better.

The hormonal changes occurring during menopause may lead to uncomfortable emotions. The woman may also have many concerns and fears about what is happening to them such as:

* It is common for women to feel sad because their child bearing years are coming to an end. For many women this will have been an important aspect of their identity

* Menopause is a reminder to women that they are getting older

* The woman can feel less attractive because of the things happening in their body

* They may worry that their low libido due to menopausal changes is going to be permanent

* It is common for women to become easily irritated

* They may feel excessively nostalgic for their younger days and younger bodies

* Women can feel anxious because their body is doing things out of their control like hot flashes and temper fits

* They may experience an identity crisis

Woman use different strategies to help them cope with the emotions of menopause. Unfortunately, some women may turn to negative coping strategies such as alcohol abuse.


So how does one deal with the change that come with menopause.
* Techniques such as meditation are great for helping people cope with stress and anxieties and it can also make it easier to sleep at night.

* Hormone replacement therapy (HRT) mainly estrogen can make a difference for people who are struggling with the symptoms of menopause.

* Night sedatives like Piriton  may help people sleep better at night

* Some women may need to begin taking antidepressants if their symptoms are too disruptive. They will need to speak to their psychiatrist or psychologist for this.

* Regular exercise and walking can improve mental and physical symptoms.

* Avoiding spicy food and hot beverages may lead to a reduced incidence of hot flashes.

* Having support groups with their agemates going through the same phase can be a good coping mechanism .


I hope this post helps to highlight a common problem in our society that we have not been keen on. I hope it will help a struggling postmenopausal lady or help the rest of us in the future when our golden years come. Let me know what you think!!!