It’s a fact that only the wearer knows where the shoe pinches. Earlier last month I went in for regular cervical screening. Well, I didn’t go voluntarily. I was coerced and literally dragged into the clinic by a friend. Being a medic you’d expect it to be easy but it actually turned out to be a torturous ordeal.
To be honest I’ve never considered getting a cervical screening and this being my first time I’ll admit I was more than nervous. I was at the waiting area for about 10 minutes and let’s just say those were the longest 10 minutes of my life.
Then…I heard my name being called and as I made my way into the examination room I was prepared for the worst, whatever that was. The gynecologist took time to explain the procedure, how he’ll perform it and what to expect in terms of the screening results.
Believe me, when I say that I was 1000% sure I was healthy and nothing less but on the first glance of my cervix, the Dr’s facial expression changed. My heart dropped and I had what I believe to be a panic attack. A painful lump formed in my throat and the worst of scenarios played in my head.
Afterward, with a concerned look on his face, he summoned me to a chair. I was too weak to stand and he noticed my anguish. He explained in the simplest of terms that my cervix had marginal erosion. Well, I had never heard about it and he had to employ the use of a sketch to get the point home.
In the midst of all that, in my mind, I was sure it was something worse that he couldn’t bring himself to admit. I thought it was early signs of cervical cancer. I was required to get a Pap Smear done in order to rule out any underlying conditions.
Cervical erosion occurs when cells from inside the cervical canal are present on the outside surface of the cervix forming a red, inflamed patch. It’s caused by hormonal changes, pregnancy or being on the birth control pills.
Pap Smear is a test which involves taking cells from the cervix to screen for cancer in its early stages and other infections. Women need a pap smear though the frequency is determined by various factors, including age and other risks.
I later learned that cervical erosion is not caused by cancer and any woman can have it. I eventually got the pap smear done and I also got a second opinion just to be sure all was well. I was put on treatment for two weeks and by the grace, I was healed.
The two weeks I waited for the pap smear results got me thinking about how we take our health for granted. We all know someone with cervical cancer or someone who succumbed to it but we hardly take the opportunity to get a screening that is offered for free.
I realized how important screening is in terms of early detection, disease treatment, and a better outcome. Hence, I made a resolution to get checked every 3 years and take control of my health and body. It definitely pays off and I hope other women will take the initiative to undertake it and kick cervical cancer out of Kenya.
I know I will ruffle some feathers with this one…but lets face it, since time immemorial contraception has always revolved around women.
For the past 70 years since the invention of the female contraceptive pill, scientists have been researching on birth control options for men. Unfortunately, despite the many trials none came to fruition.
How amazing will it be to have men partake on the role of contraception and just be as responsible as women when it comes to reproductive health. We’ll for sure have more planned families and men won’t feel trapped by a pregnancy they probably didn’t plan for as is in most cases.
Over the years, men have played a role in contraception by using condoms, the pull out method which lets be honest is never reliable and a few even opted for vasectomy which is mostly permanent and if reversible requires a lot of surgeries.
With male contraception, the burden will be taken off women’s shoulders and who doesn’t dream of that?
I’m a woman on the pill and the side effects I’ve had to endure are just plain torture. Just imagine taking the pill and 12 hours later, the nausea, headache and migraine kicks in…the kind of nausea and headache that won’t just let you have a normal day.
I actually know the time lapse between each pill and the side effects since it’s been like that since I can remember. I was once advised to use a different method but being me, I dread anything invasive which includes the shot, implants or the Intra-uterine device.
Recently, in 2016 a promising trial on men involving a sperm-destroying hormone injection flopped due to it’s side effects. Results had shown that the contraceptive would have been 96% effective in the prevention of pregnancies.
The most common side effect was acne, mood swings, weight gain and low libido. For women, such are considered incidental risks.
I do applaud the men though for their willingness to take part in contraception. This is according to a number of global surveys. I pray the same is the case with our African men.
There are a number of contraceptive options for men still under research which include;
The male pill which contains sperm-suppressing hormone.
Implant which is synthetic and is placed under the skin of the upper arm lasting for one year.
The Gel that stops production of sperms by blocking the gonadotropin hormone responsible for stimulating the male hormone testosterone. The gel is applied on the arms and shoulders.
Non surgical vasectomy involves a scrotal injection with gel that blocks sperm during ejaculation.
These are a few methods currently on trial and the quest continues to develop a safer form of contraception for men. Though the new options have never materialized, the world is still optimistic that one day we’ll be reading a different script.
So back to the drawing board… In the meantime, women get to endure the aftermath of the hormonal methods which can be long standing and life threatening with irreversible effects.
Our bodies are God’s handwriting, a wayward sacrament and many at times we fail to read the writings on the wall. We fail to take care of our bodies and nature has a way of getting back at us.
Your body has the ability to form stones in your kidneys though over a period of time. Kidney stones are hard deposits made of minerals and salts that crystallize together due to concentrated urine.
There is no single definitive cause of kidney stones but different stones form depending on the crystal-forming substance in your urine e.g calcium, oxalate and uric acid.
A close friend of mine was recently diagnosed with kidney stones. It all began with the flank and back pains radiating to the lower abdomen and groin. She was able to tolerate the pain with analgesics. Over time however, the pain fluctuated in intensity and came in waves. There was blood in her urine and severe pain associated with nausea and vomiting.
These prompted her to seek medical attention and after going in for a series of tests, she was diagnosed with kidney stones. They were inside her right kidney and ureter, a few of them were too big to pass through the ureter hence the excruciating pain.
After much evaluation and consideration, the urologist advised her that surgery was the best way out to manually remove the stones. She underwent percutaneous nephrolithotomy, a surgical procedure that allowed the stones to be removed through an incision in the back.
Guess what? I had never known how real the stones are until I saw the ones taken out of her kidney. They were as hard as any stone you see out there and the thought of it actually made it even more disturbing.
Kidney stones
She is fully recovered now but I couldn’t wrap my head around it. For me it’s baffling how our bodies has the ability to create such. Surprisingly, there are different types of kidney stones;
Calcium oxalate- is the most common form of kidney stones. Oxalate is found in food and also made by our liver. When the level of oxalate in urine is high compared to the liquid needed to dilute it, it adheres to calcium present in urine and crystallizes forming a stone.
Struvite stones- occur in response to a urinary tract infection usually bacterial. The stones are composed of ammonia, magnesium and phosphate.
Cystine stones- these type of stones are found in people with a genetic disorder known as cystinuria that involves production of too much amino acids known as cystine. The amino acid leaks into urine and when there is too much, stones form.
Uric acid stones- are also common just like calcium stones. They are found in people who don’t take enough fluids and those who take diet high in red meat. On the same, alcohol also increases the level of uric acid in your blood.
How to prevent kidney stones
Ensure you stay hydrated. It is recommended that you take 8 glasses of water a day to maintain hydration. If you are exercising or sweating a lot then your fluid intake should be more. The easiest way to know you are well hydrated is by looking at the color of your urine, it should be pale yellow. Dark urine means you need to take more fluids.
Avoid foods high in oxalate. These include coffee, soy products, chocolate, spinach, sweet potatoes. Oxalate binds with calcium in urine to form kidney stones. You can however take oxalate-rich foods together with calcium-rich foods. This way, they bind in the stomach and get absorbed before being excreted in urine.
When it comes to animal proteins less is more. High protein diet increases acidity in the body. Together with less fluid intake, may cause both uric acid and calcium oxalate stones.
Take foods less in sodium. Salt is a staple in many dishes and could be easily misused. This include processed foods which have a higher salt content. High salt diet increases your risk of developing calcium oxalate stones. It also prevents re-absorption of calcium from urine into blood.
The opposite is true when it comes to calcium-rich foods. It is recommended that you should take foods rich in calcium since it binds with oxalate in our diet and prevents its absorption in urine.
Some over-the-counter medications may increase your risk of developing stones when taken over a long period of time. They include steroids, chemotherapy drugs, decongestants, diuretics e.t.c.
Truth be told, kidney stones are common and there is no sure way of preventing them. The above ways might however reduce your risk of developing kidney stones. It all comes down to proper hydration and dietary changes.
I jolted out of my sleep…I felt a sharp stabbing pain on my right shoulder. It originated from my epigastric region. It was a pain I knew all too well. My acidity was acting up again. This time was however different, my breathing was labored and I struggled to talk. My stomach was on fire…
A few minutes later I was in the emergency room and after a few lab works, I was diagnosed with Helicobacter Pylori(H. pylori). To say the least, I wasn’t surprised. Prior to that night, I had experienced symptoms suggestive of the bacterial infection but as they say, “what you don’t know won’t kill you’.
H. pylori is a bacteria that infect the stomach lining and the small bowel. The bacteria is contracted in childhood probably from contaminated water and food. It lives in the digestive tract and with time, it causes peptic and duodenal ulcers.
The bacteria has the ability to survive in stomach acid hence weakening the protective mucous membrane lining the stomach. This allows acid to get through the sensitive lining beneath. Both the bacteria and acid irritate the lining causing ulcers.
Signs and symptoms
According to research, as many as 85% of people may never develop symptoms and for those who do they include:
abdominal pain often described as ‘gnawing’ or ‘biting’
bloating
loss of appetite
acid reflux
heartburn
nausea
It’s estimated that 1 in 10,000 people will die from complications related to stomach ulcers. These are bleeding, perforation of the stomach lining and stomach cancer.
In my case, I had experienced the abdominal pains mostly on an empty stomach, in between meals and early in the morning among other symptoms. I resorted to self medicate with an acid-suppressing drug mostly pantoprazole, rabeprazole and the likes. This was my biggest mistake since it gave the bacteria more time to multiply and cause more damage.
Diagnosis of H. pylori infection is done through blood and stool tests. In severe cases where there is gastritis or inflammation of the stomach lining, an endoscopy is done. This allows your doctor to pass a flexible tube equipped with a camera down your esophagus into your stomach. With this method, tissue samples can be collected for biopsies to further analyze the ulcer.
After my diagnosis, I was put on the triple therapy regimen which includes two types of antibiotics and an acid-suppressing drug (clarithromycin+ amoxicillin+omeprazole) for 14 days. I got relief from the medication and afterwards went back for repeat lab tests to confirm the eradication of the bacteria.
The bacteria was still there but in lower values. It didn’t hurt as much but the realization scared me. I did some digging and found natural home remedies that with time helped with the symptoms and though I can’t actually say I’m free of the bacteria, they gave me much relief.
These remedies include:
Cabbage juice- fresh cabbage contains vitamin C and K which are antioxidants. These have protective properties and reduce inflammation on the stomach lining. Cabbage stimulates the production of mucin which is the main component of mucus. Mucus provides a protective layer against digestive juices mainly hydrochloric acid hence preventing ulcers. Better results can be achieved with fermented cabbage juice.
Probiotic- this is live bacteria and yeast which improves or restores the gut flora. Among other benefits, it fights stomach ulcers by stimulating production of mucus within the mucous membrane lining the stomach. Probiotic can be taken as supplements or derived from food such as yogurt, pickled vegetables and buttermilk.
Garlic- is a super food that has both antimicrobial and antibacterial properties. Its medicinal actions against ulcers is evident by its ability to speed up recovery of stomach ulcers, prevents growth of the bacteria Helicobacter pylori (H. pylori) which is the leading cause of gastrointestinal ulcers.
Honey- just like garlic, it has antimicrobial and antibacterial abilities. Generally, honey promotes wound healing such as mouth ulcers, chronic wounds and burns through its ability to stimulate tissue growth and enhance epithelial cells formation. It inhibits the action of H. pylori on the stomach wall.
“Let food be thy medicine”, stated Hippocrates the ancient healer. This shows that adoption of foods as remedies in relief of ailments dates many years ago and has proven to be just as effective. These however, should not replace conventional medicine and can be used as an adjuvant therapy.
Elisa was only 12 when the symptoms started to show, the neighbors whispered when she walked by. They gave her the “look” and quickly turned the other way whenever she went out. They said she was bewitched and was shunned by both the young and old. She stood out like a sore thumb mostly due to her swollen belly that one would think she was a little over nine months pregnant.
She gasped for air if she walked uphill and experienced decreased muscle tone and pain. Her heart beat was abnormally high and she coughed up blood even at night.Her arms were thin like broomsticks, shoulders jutting like a skeleton’s against her frail body. Her joints were also affected and her movements limited.
At her tender age, she wished she could play with other kids. She yearned to participate in kids’ games like hide and seek,skipping and jumping rope. She had vivid memories of such from when she could manage to run around healthy with a promising future.
She could only wish…No, she wasn’t bewitched and no, she wasn’t pregnant. Her heart was failing. It pumped blood so poorly that blood backed up in her veins , bloating her liver and spleen, and filling her abdomen with fluid.
A few years back she had suffered a sore throat which went undiagnosed and eventually became her death sentence. The streptococcal infection left untreated found its way to her heart and gradually led to rheumatic heart disease in which the immune system affects the heart valves. These are tissue-paper thin membranes attached to the heart wall that constantly open and close to regulate blood flow.
The heart has 4 valves each for each chamber of the heart. As the valves deteriorate, the heart struggles to pump blood through it and eventually wears out. With time, heart muscle damage occurs, congestive heart failure or even sudden death.
Over the years, cases of rheumatic heart disease has been on the rise with over 33 million people worldwide and at least 319,000 people died from it in 2017. The figures are staggering and continue rising mostly in the younger population aged 5-15 years.
What’s worse is the realization that it can be prevented. However, the most affected are those in poor countries where treatment costs an arm and a leg. The World Heart Federation refers to rheumatic heart disease as “neglected disease of marginalized communities.” Poverty, crowded living conditions and lack of medical attention create breeding grounds for streptococcal bacteria.
When the disease is detected early, long-term treatment with penicillin can prevent heart valve damage. This however won’t work in Elisa’s case. Hers’ is advanced and even surgery to replace the valves might not help. Heart valve replacement allows for replacement of a failed valve with a mechanical or biological tissue valve.
Any sore throat infection should not be ignored and proper medication sought especially in children since they are the most at risk. This will go a long way in preventing complications associated with untreated streptococcal infection.
It is a metabolic disorder characterized by increased blood glucose levels also known as hyperglycemia due to impaired insulin secretion, action or both. Insulin is a hormone secreted by the pancreas and its release is triggered by food.
Normally, after a meal insulin aids in conversion of glucose in the blood to other needed molecules or its storage. However, in a person with diabetes there is abnormal breakdown of carbohydrates leading to elevated levels of glucose in the blood and urine.
According to World Health Organization(WHO), more than 400 million people are living with diabetes mellitus globally. Sadly though, this number is increasing at an alarming rate and we continue to loose more people to diabetes.
In Kenya, 1 in every 17 people has diabetes with an estimated 458,900 cases as of 2017. This is according to the International Diabetes Federation. The above cases were recorded in the adult population alone hence could be higher with children involved.
The common signs of diabetes include;
Frequent micturition
Increased thirst
Increased hunger
Weight loss
Other signs and symptoms can mark the onset of diabetes. For example, blurred vision, headache and fatigue among others. There are three types of Diabetes Mellitus; Type 1, Type 2 and Gestational diabetes.
Insulin is produced in the pancreas
Type 1 Diabetes also known as Insulin Dependent Diabetes. This means that ones body does not produce insulin in the pancreas hence one is dependent on insulin shots to control blood sugar.
This type of diabetes is characterized by an early acute onset, usually below 30 years of age and one experiences weight loss prior to the diagnosis. It accounts for 5-10% of all diabetes cases globally. Children are affected by this type of diabetes with its first peak between 4 and 7 years old.
Risk factors for type 1 diabetes include; family history, age, genetics.
Type 2 Diabetes or non-insulin dependent diabetes. People with this type of diabetes experience insulin resistance. The pancreas produces insulin but it’s not utilized by the body hence a build up of blood sugar. Over time, the pancreas fails to produce enough insulin.
It usually develops slowly over the course of time with usually no noticeable symptoms. It affects older people over 30 years of age who are obese at the time of diagnosis. It’s the most common type of diabetes and accounts for 90-95% of the cases.
This type of diabetes can be controlled with diet, exercise and oral medications. The risk factors include obesity, genetics and a sedentary lifestyle.
Gestational Diabetes occurs during a pregnancy in a woman who had normal blood sugar levels before the pregnancy. This is usually due to hormones produced during pregnancy which may predispose one to insulin resistance.
It’s prevalence increases with age affecting pregnant women over 45 years. Its believed that both the mother and the baby are at a risk of developing type 2 diabetes later in life. Gestational diabetes normally resolves after delivery.
Screening of Diabetes
According to the International l Diabetes Federation(2007), many newly diagnosed persons don’t realize they have diabetes and is often discovered when one presents to a health facility with seemingly unrelated complaints. This increases the occurrences of complications related to diabetes.
Screening and management of diabetes begins with awareness which is very low across Kenya. Many are screened through medical outreach camps which are not held as often or as many to reach everybody.
There are several diagnostic tools to screen for diabetes. These are;
Blood Glucometer: This measures the concentration of glucose in the blood. It’s used by diabetics to monitor blood sugar and dictates when medication should be taken. As a monitoring tool, it’s inaccessible to many in low income communities due to its prohibitive cost.
HbAIC: It’s a laboratory test in which the blood is tested for the average blood sugar over the past 3 months. For diabetics, the HbAIC level is high. The high cost of the test is an obstacle in monitoring diabetes and its complications.
Urinalysis:This measures the level of glucose in urine. However, this is not a reliable method of diagnosis or monitoring since it can’t assess levels of hyperglycemia or hypoglycemia. It’s effective in detecting ketones in urine which is an indication of ketoacidosis in type 1 diabetes, which is a medical emergency.
The test is cheaper and easily available in most health facilities even those in resource constrained environments.
Treatment and Management of Diabetes.
Persons with Type 1 diabetes are insulin-dependent hence must use insulin shots to control their blood sugar levels. This involves periodic monitoring of blood sugar using a glucometer usually before meals. In case of a high sugar level, one takes an insulin shot as required.
With Type 2 and Gestational diabetes, management is primarily geared toward maintaining a well balanced diet, physical activity and oral anti-hyperglycemic agents(OHA).
Regardless of the type of diabetes, diet plays a vital role in keeping blood glucose in check.
American Diabetic Association recommends a diet balanced in calories, dense in nutrients and low in fat and sodium. Using the portion plate ensures a well proportioned and balanced meal. This helps one keep blood glucose level on track.
If you have diabetes, do not:
Skip meals
Eat heavy and fatty meals
Eat foods high in sugar e.g. cakes, ice cream, doughnuts or sweetened cereal
Add sugar to your food
Drink sugar-sweetened beverages e.g. sodas
Exercise or physical activity is equally important especially with type 2 diabetes. A 30 minute work out regimen at home makes all the difference in maintaining a healthy lifestyle.
Drinking and smoking also increases one’s chance at developing diabetes-related complications. Cessation of both is usually advised to tone down on the long term effects of diabetes.
Using and Storage of Insulin at home.
Upon diagnosis the care provider will determine the right kind of medication to control the blood sugar levels. In most cases insulin is usually the preferred choice. Even those with type 2 diabetes are initially put on insulin if at the time of diagnosis the blood sugar levels are abnormally high. This is later changed to oral antihyperglycemics after assessing that they are effective.
It’s a scary moment for a newly diagnosed diabetic when they are handed a bottle of insulin and insulin syringes at the pharmacy. They literally know little or nothing pertaining self medication. I encounter many of them at the ER and we take an initiative in providing health education to enable an easy transition for the client.
Together with the client or patient, you identify injection sites and the best possible ways of injecting themselves or get help from a relative. The insulin injection site is as illustrated below;
In terms of storage, insulin is stored in a refrigerator for 28 days and should not be frozen to ensure potency. But what if one doesn’t have a refrigerator? In Kenya, more so in the rural setting one may not afford a fridge hence posing a threat to effective management of diabetes.
In such cases improvisation comes in handy by use of a bucket filled with wet sand or wet charcoal dust in a humid part of the house. One has to ensure the sand or charcoal doesn’t dry out. The cons for such methods is one will never know the exact temperature and it might fluctuate but in desperate situations, it’s worth a try.
Short-Term Complications
These are acute in nature and occurs over a short period of time. They are;
Hypoglycemia: This is low blood glucose levels less than 50-60 mg/dL. Blood glucose can drop especially if one skips a meal, eats less while on insulin. Other causes include alcohol, too much exercise and some medications for example higher doses of aspirin. Signs and symptoms are: sweating, headaches, rapid pulse, confusion, anxiety, slurred speech and coma. Treatment is usually with a glucose tablet, fruit juice, candy or sugar.
Hyperglycemia: This is abnormally high blood glucose levels between 300-800 mg/dL. This can result in a medical emergency known as diabetic ketoacidosis(DKA). This may occur due to decreased or missed insulin, infection or illness. Signs and symptoms include: increased thirst, frequent urination, blurred vision, fatigue, hunger, trouble concentrating, hypotension, nausea and vomiting, hyperventilation and lethargic. The management of DKA includes insulin therapy and re-hydration.
Long-Term Complications
Possible complications develop gradually over a long period of time and when they manifest, it includes;
Diabetic Retinopathy: This affects the eyes and involves changes in the retina due to damage in the blood vessels
Diabetic Nephropathy: Also kidney disease is damage to the kidneys due to uncontrolled high blood glucose. One may develop kidney failure and end up on dialysis or opt for kidney transplant.
Diabetic Neuropathy: Is damage to the nerves and pointers include; numbness, tingling, sharp pains on the lower legs. Over time, this leads to serious injuries due to reduced sensation.
Diabetic Foot: This stems from cases such as ingrown toes, dry skin or minor injuries. Any injury to the feet heels at a slower rate due to poor blood flow and nerve damage. This is the leading cause of limb amputations in people with diabetes. This accounts for 50-75% of lower extremity amputations.
Periodontal Disease: Also gum disease due to high blood glucose leading to tooth decay, loss of collagen in the gums, formation of plague and poor blood circulation. Signs and symptoms include; bleeding, sensitive, painful and receding gums.
Cardiovascular Disease: In diabetics, the risk of heart disease or stroke is high due to clogged blood vessels. Cholesterol levels and blood pressure should be kept in check.
Once seen as a disease of the affluent, diabetes now affects even those in low income communities with the rise in obesity. The WHO Global action plan for the prevention and Control of Non Communicable Diseases(2013-2020) geared towards halting the rise in obesity and diabetes.
As we celebrate the World Diabetes Day, we should strive for advocacy, empowerment and capacity building in the control and management of diabetes. Effective prevention strategies are not costly in relation to treatment of diabetes related complications.
This is probably one of the most bizarre experiences I’ve witnessed as a nurse. During my third year in college, I was posted to a health center for my attachment. It’s a one month period but usually the best since you get to run a health center with little or no supervision. We got allocated to the child welfare clinic, family planning clinic and maternity ward.
On this particular day, I was on duty at the maternity ward and being a health center we hardly received any mother in labor. The ward was surprisingly small with one delivery couch and a separate room for postnatal mothers. Well, it was a typical delivery room that could handle deliveries once in ages.
Hours dragged by and apart from the occasional chatting with a colleague, nothing much happened. Around mid-morning, a woman was brought in and reported to be in active stage of labor and was progressing fast. The woman was grand multiparous meaning she had given birth more than five times. Actually, this was her seventh pregnancy.
From her history, she was at risk of having precipitate labor and developing Post-Partum Hemorrhage due to uterine atony which accounts for 75-80% of PPH cases. Atony of the uterus is the failure of the uterus to contract after child birth. This can be caused by very rapid labor, one has had many prior births, multiple births or induced labor among others.
I didn’t think we were prepared to handle such a life threatening situation but we couldn’t refer the mother to a better equipped facility. She was far into labor and that wasn’t an option.
Labor progressed unexpectedly fast and in less than an hour of regular contractions, she expelled the fetus. The baby was put on the breast as soon as possible to stimulate the hormone oxytocin that causes contraction of the uterus to stop bleeding.
Then all hell broke loose…my worst nightmare became a reality. The mother’s uterus failed to contract and the floodgates opened. The midwife was massaging her uterus to expel any clots and hopefully stop the torrential bleeding. On the other hand, I administered oxytocin; an intravenous injection to stimulate contraction of the uterus.
She was having postpartum hemorrhage( PPH) which is loss of more than 500 mls of blood or more within 24 hours after birth while severe PPH is blood loss of 1000 mls or more within the same time-frame. According to World Health Organization(WHO), postpartum bleeding is the leading cause of maternal deaths globally. In Kenya, postpartum hemorrhage accounts for 34% of maternal mortality. This is as documented in The Confidential Enquiry into Maternal Deaths report.
Nothing seemed to work. Her blood pressure began dropping drastically an indication of an imminent shock. Her extremities had gone cold, her skin was clammy and a death like pallor covered her face. She had rapid,shallow breathing and was slipping into unconsciousness. We had to act fast lest she became another statistic on maternal mortality.
We were at the verge of despair and then the light bulb moment…the condom tamponade!. It was what we could work with and was ready available. I set up the working area to ensure sterility and availed the necessary kits. This included; a condom, suture, folley or urethral catheter, fluid giving set and an infusion bag with fluid.
Using aseptic technique, the midwife using a speculum inserted the catheter into the vagina with condom tied onto the end. She held the cervix open using forceps and pushed the condom further into the uterus.
Afterwards, she instructed me to connect the other end of the catheter to the giving set already inserted into an infusion bag and slowly inflated the condom with normal saline. In turn this applied pressure to the uterine wall hence stopping bleeding.
Believe me, 15 minutes later the bleeding had stopped and the mother was stable and conscious. I was baffled that it actually worked and with such easily available equipment. The condom was slowly deflated to ensure the hemorrhage had stopped completely. Should bleeding recur, the condom is re-inflated and the patient monitored closely. However, if bleeding is not controlled within 15 minutes of initial insertion then surgical intervention is sought immediately.
The mother got a dose of intravenous broad spectrum antibiotics to prevent any intrauterine infections. A few hours later after ensuring the mother was out of the woods, she was allowed home but instructed to seek medical assistance in case of anything out of the ordinary pertaining a normal puerperium.
I applauded the midwife for the much she had done to save the mother’s life. Unfortunately, the method is not adopted in our facilities considering its availability and affordability. WHO recommends the use of intrauterine balloon tamponade for the treatment of post partum hemorrhage in cases where women fail to respond to uterotonics or their unavailability.
Currently, the government together with the Ministry of Health is planning to incorporate the use of intrauterine balloon tamponade(IBT) in the management of PPH. A ready made balloon tamponade kits should be made available and this will definitely make a huge difference. A study titled Every Second Matters found that 306 women with PPH had a 97% survival rate when IBT was used.
Maternal mortality is preventable and we don’t have to loose a life for another.
The use of herbal or traditional medicine is increasingly finding relevance today in the treatment of cancer and even other ailments. Despite it’s widespread use, there’s little publications or records on the use of herbal medicines. This is due to lack of evidence-based medicine validation procedures.
According to the World Health Organization,5.6 billion people or 80% of the world’s population use traditional medicine for primary health care. In rural Africa,traditional medicine is usually the first line of treatment as soon as a disease is diagnosed and may be the only possibility of care for some patients.
Lack of affordable cancer treatment including therapeutic surgery, chemotherapy and radiotherapy make traditional medicine a go-to form of treatment.With this kind of a gap in the conventional medicine, traditional herbalists step in and respond to health needs of the majority of the population and display affordable prices and immediately available health products.
But does it really work?
There’s no strong evidence that herbal medicines work against cancer but it’s still being used. Surprisingly, there are over 40,000 herbalists in Kenya compared to about 4,500 medical doctors. A clear indication why traditional medicine is here to stay.
With herbal medicines, people use it to feel more in control of their situation and have responsibility for their treatment. However, use of herbal medicines as adjuvant treatment in chemo or radiotherapy helps one to relax and cope with anxiety and depression. It’s also believed to reduce side effects associated with chemo-radiation therapy.
Earlier today, I nursed a patient with breast cancer and what saddened me about her situation was the fact that she had not accepted the fact that she had cancer. She came in today after being convinced by her sister that she needed some blood works done.
Even after getting to the ER, she refused to see a doctor and insisted she was fine. To say the least, she was at her worst and clearly had difficulty in breathing. She was frail and could barely stand on her own. She clung to a leso covering her chest, her left arm was tensely swollen from the arm to the shoulders. She was evidently in so much pain and an acrid smell filled the air.
It was hard to get through to her and she couldn’t accept she needed medical help. It took a few hours and much persuasion and she finally let her guard down. On examination, she had a fungating cancer wound on her left breast a clear evidence of the severity of her condition. A chest x-ray showed left lung involvement ,a probable sign of metastasis.
While talking to the sister, she stated that the patient had refused medical management in one of the country’s best hospital and opted for herbal medicines. Evidently that didn’t work but she still had a strong belief it was all she needed.
She was admitted for assessment by an oncologist and later started on cytotoxic drugs. It wasn’t going to be easy but she had a chance of fighting it. We could only hope for the best.
The condition is just as strange as the name itself. To be honest, I’d never heard of it even in nursing school until a patient was admitted with the diagnosis.
It is a group of autoimmune disorders which causes hardening and tightening of the skin, connective tissues, muscles, blood vessels and internal organs. An autoimmune disorder is a condition in which one’s immune system attacks healthy cells. With scleroderma, the immune system causes the body to produce too much protein collagen hence, the skin gets thick and tight.
There are two types of scleroderma; localized and systemic. Localized scleroderma involves the skin while systemic involves the whole body and includes blood vessels and internal organs.
There’s no known cause of scleroderma but genetics may play a role. It’s progressive and a crippling disease. Diagnosis is based on a person’s symptoms. There’s no specific treatment for scleroderma and management is geared towards preventing or limiting the damage caused by the disease.
According to Ann(not her real name), she first noticed changes on her hands and face. The skin became thick, shiny and smooth. Her fingers and toes became very sensitive to cold (Raynaud’s phenomenon) which later became stiff and puffy. She sought treatment after noticing the changes but got misdiagnosed.
She was diagnosed with eosinophilic fasciitis which is a disease that causes collagen to encase the muscles. It affects joint motility and causes tightening of the skin. She never got much relief from the prescribed medications and as time went by she only discovered new symptoms.
This was mind boggling and I wondered how many more are misdiagnosed. Some of them even die without knowing what ails them. Five years later a visit to a rheumatologist changed her life. She was diagnosed with scleroderma…this, she described was like being handed a life sentence. She had heard about scleroderma but never thought that was it.
Soon after she sank into depression and somehow this kind of emotional stress caused an exacerbation of the condition. Those were the most dark moments in her life. With support from family and friends, together with counselling she accepted her diagnosis and learnt to live it.
That was twenty years ago…
As she sat on her hospital bed,eyes huge in her gaunt face,Ann looked impossibly fragile. It was no mistaking that she was at her worst. Her skin was pallid, taut and callous, her movement was restricted. She could barely move. All those years suffering from scleroderma had resulted in multiple complications.
Her lungs and heart were failing due to scarring of the connective tissues. She had Pulmonary Arterial Hypertensive which resulted in severe breathing problems and right heart failure. She was on oxygen therapy to supplement where her lungs failed. Swallowing food was a struggle and had to have a feeding tube inserted. Her hands were missing some fingers, a clear sign of an amputation from gangrene; caused by restricted blood flow to the fingertips.
It was clear she had gone through it all, her life had been a battle field where she fought her own demons. She was resigned to her eminent doom. My heart went out to her, I couldn’t imagine how one person could go through so much yet still have the strength to go on.
I was by her bedside when she passed on and never have I felt so much emotions at the same time. I was numb, shocked and in disbelief. That was one strong woman I’ve encountered in my life. She made broken look beautiful and strong look invincible. She walked with the universe on her shoulders and made it look like a pair of wings.
I recently lost a colleague, a Medical Officer assigned to the Out Patient Department and two months later we still can’t come to terms with his death. What’s even more hard to accept is how he died…
This is a term used to describe blood clots that form in the deep veins of the body mostly the legs or pelvic area. If left untreated, these clots can dislodge and get carried up the blood stream to the lungs causing pulmonary embolism(P.E). This is life threatening since blood flow to the lungs is blocked.
The risk factors for developing deep venous thrombosis include;prolonged bed rest such as long hospital stay or paralysis, injury to the veins or surgery, pregnancy due to the increased pressure in the veins in the pelvis and legs, birth control pills can increase the blood’s ability to clot. Other factors are age, heart failure, familial history of DVT or pulmonary embolism, obesity and smoking.
For my colleague, we never really knew when it started but he would complain of pain in his calf muscles. He was diagnosed with deep venous thrombosis and put on medication. Unfortunately, he never thought how serious it was and knew it would soon resolve. But one thing he admitted was he wasn’t taking his drugs as he should. Funny how medics are the first to emphasize to patients on drug compliance but fail to do so themselves. I’m guilty of that.
Deep Venous Thrombosis can be diagnosed through physical examination;this involves checking for any swelling,discoloration and soreness of the affected area. A Doppler Ultrasound of the limbs monitors blood flow ensuring there are no clots or blood restriction. Blood tests are done to identify a small protein fragment(D-Dimer) that is present in patients with DVT. Also, x-ray tests and CT scans can be used to identify clots in the deep veins.
In some cases of deep vein thrombosis there may be no symptoms but most common symptoms include; pain on affected leg, swelling and tenderness in the calf muscle. The skin around the area is warm and can be felt with the back of the palm. The skin is discolored to a reddish or bluish color due to affected blood flow.
Pulmonary Embolism(P.E) is a complication of DVT, it’s the blockage of one or more pulmonary arteries in the lungs. This is caused by blood clots that dislodged from the deep vein in the legs and traveled to the lungs. P.E is life threatening and if not diagnosed early leads to death. The symptoms include; shortness of breath which is sudden and gets worse with exertion, severe chest pain usually compared to an heart attack and cough which is productive of blood streaked sputum.
Pulmonary Embolism can be treated with anticoagulants(blood thinners) which prevent clots from getting bigger and prevent new clots forming. Treatment depends on the severity of the condition and after thorough assessment by a physician. Other treatment involve wearing compression stockings and rarely surgery.
Sadly enough, that’s the end our colleague met. Barely 30 years of age, he died due to Pulmonary Embolism. It could have been prevented and treated. As the sad reality sets in we realize just how many more will die this way…silently.
Chronicles of a Kenyan Nurse 