Keratoconus: Esther Thairu’s Story

As told to Vip Ogola by Esther, her father Stephen Thairu and their good Samaritan Mr. Kamal Sanghani

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Esther: I was young, 2 years old. I had eye trouble and started going to hospital for eye drops. I could see maybe, 30 centimeters and my eyes would pain. The doctors told me it was treatable. It reached a point where I was told I would go in for an operation. I was not afraid even when I saw the razors. I thought it would be painful but it wasn’t. I was anaesthetized and I woke up seeing better. I was in hospital for four days, three of those with my eyes bandaged.

Stephen: Esther was born in Loitokitok. She started having problems with her eyes at the age of two years. She would wake up and find her eyes clogged shut with pus. This happened annually between April and August and we suspected it had something to do with the cold weather. We took her to the district hospital there and she was told she had allergies that would resolve themselves by the time she was eight years old. She was given medication for this.

Esther Thairu.JPGEsther: I do very well in school. I am now 13 years old, and apart from academics, I play football.

Stephen: We moved to Githurai and Esther joined Mercies Academy where she is currently in Standard 6, having dropped back a year due to her medical challenges. Since she was a bright student she caught the attention of her teachers. Teacher Teresia noticed her problems with her eyes and advised us to change to Lions Hospital in Loresho. In the initial year of her treatment, they kept changing drugs. Her right eye was in terrible shape and needed urgent surgery. The left one was also in bad shape. The cost of surgery would be Kshs 350,000/ and they were not taking NHIF. I was confused. I was advised to take her to KNH due to the more manageable costs. On examining her, they concluded that her eyes were badly off. They only perform surgeries once as year so they referred her back to Lions for more urgent attention. We found that the costs there would be the same. I talked to my employer who suggested that we sell my father’s land to offset the costs. She talked to Mr. Kamal Sanghani of the Rotary club about my case and they referred us to Dr. S.P. Amin. We had to wait until he was available.

Kamal: Dr. Amin is in the Board of Lions. He was my contact. I would talk to him and then talk to Stephen. The doctors of Lions are good friends of mine. My family agreed that we would sponsor Esther. We did not know her then, and we have since sponsored three others.  One of the Rotarians told me about her. It took time but Stephen was both patient and persistent keeping me on my toes. Initially it was difficult to get a Cornea. We did not loose home. My mother insisted pushed me from the home front. Since we were working on a tight budget, we agreed that she goes to Lions four or five times. She is a bright student so we wanted to see her excel. There were so many issues and at one point I almost lost my temper with the hospital. Finally we received a Cornea for her from India.

Stephen: They started with her right eye. Then after two months they did Cross linking. She was in a private ward at the hospital and was the only child admitted there at that time.

Esther: I did not go to school. I was told not to by the doctor as it was possible to play a bad game and hurt my eyes. I also needed to avoid dust. I stayed home with Mum and really missed Shule.

Stephen: We had to go to hospital every Saturday after for check-up as she was on medication.

Esther: They would change my specks, I think twice between the first and second operations.

Stephen: They needed to do this to adapt to her strengthening eyesight.

Esther: After I did my first operation, Mr. Francis Mwangi my teacher at my school, Mercies School in Guthurai 44, put me to sit in front of the class. He then moved me to the back of the class to see if I had improved after two week. I had. Fellow students were also supportive in helping me catch up with them, especially Peter Mutuku. I am in Standard 6.

Stephen: She is supposed to be in standard 7 but she lost a lot of time that year and was not able to do her exams.

Esther: My grades are good. I get 350+. At the cross linking the doctors told me that I would go through pain for the night. I stayed indoors for three days with Mum. I am the first of three children and the only daughter of my parents. My mother sells vegetables and my father digs for a living. They gave me eye-drops to put after every two hours.  I was told I could go to school after a week. This was in March 2015. Since that time I have only had my specs changed once. I am in no pain and I can see relatively well.

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Conquering High Blood Pressure with God’s Intervention

img_9679I am 39 years old. I was diagnosed with High Blood Pressure by a doctor at the Webuye District Hospital.

It began one morning with a terrible headache, accompanied by intolerance to any kind of sound. All sound manifested as noise and I resisted the impulse to bang my head against hard surfaces. I was with my husband and he rushed me to hospital. They decided to check my blood pressure and it was at 210/110. The nurse who checked me, was uneasy about the result and she called in another nurse, who repeated the test. They had a hushed conversation between then and then the initial nurse left the room to come back minutes later with a doctor in her tail. He connected his machine and repeated the test and said to them “there is nothing wrong with your machine. The test is accurate.” He put a pill under my tongue, then one of the nurses injected me with what we were told was valium. It was now about 2pm in the afternoon.

They suggested admission but I resisted as my youngest child was 2 years old and needed me. I did not have a house help. I agreed however to come in daily for assessment and medication. My book was full of ‘patient refused admission’. They put me on Inderal for my blood pressure, Lasix to drain excess water in my system, and Ponstan Forte for the headache. Ponstan cost 300 shillings per tablet then. I don’t know if that was the real price or the chemist, to which we went to purchase my medication, was trying to exploit us. But the price was one of two reasons that helped me decide not to purchase it. The other was Dr. Ken’s advice. He was my husband’s close friend and a medical doctor. Dr. Ken talked to me about the dangers of addiction to pain medication, especially strong ones like the ones the hospital had prescribed for me.

I was asked by the hospital staff, after this and on subsequent attacks, about my family’s medical history. My maternal grandfather suffered a stroke just before I was born and was paralyzed by it on his left side. He too resisted medication. He was very fond of me. He lived 15 years after the stroke and then passed on. On my first attack a nurse heartlessly said to me that that was where I was headed. I rejected that heritage. One of my sisters also bleeds heavily during her pregnancies and suffers the swelling of her eyes. I also went through something similar during my last pregnancy, where I woke up once or twice to find my bedding soaked in blood. I did not seek medical attention for it, and my daughter was born healthy in September of 2011 by the grace of God. I was also asked if there was anything that would cause me undue stress. I told them even living in a police line was not a stress factor for me. I had a relatively good life.

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One time I had an attack in the night when my husband was away on duty. We were still living in a police camp at that time, a fact I thank God for. My children were able to run to a neighbour’s house, my husband’s colleague named Koech, and he rushed me to hospital. My head was aching badly, and when they checked my pressure, it was extremely high. They tried to get me to agree to admission, but three of my four children were unwell and on medication. I had no help at home and my husband’s work hours could not be changed to fit into their prescribed schedules. I could not leave my children alone.

I was lucky again, Dr. Ken was at hand to cover for me. He told the doctor attending to me that he knew me, and that I would be faithful in taking my medication and also attending a daily clinic. They again injected me with valium to help with the pain, and put a pill under my tongue. I was later to find out that this pill is called Propranolol. Koech took me home. My pressure was still very high the next morning but the hospital did not detain me. I eventually stabilised. I remained on Inderal and Lasix for the next two years. The headaches seldom came, but when they did, I took Panadol.

In 2005, my husband was transferred to Malindi and because there were some challenges with regard to accommodation, and I also wanted my children to have some stability with regard to their education, I opted to go live with my mother in Kisumu. My mother is a Clinician so she monitored my blood pressure and made sure I took my medication. One April afternoon, I noticed that there was a crusade happening at a hall in Mamboleo, just opposite my mother’s clinic. I asked my mother to take my blood pressure, as I was going over to be healed. I was so tired of medication. She took it and it was high. I went over to the meeting which was being run by Pastor Muliri and Bishop Mark Kegohe. The Bishop announced that there was a healing grace. He called on those with various illnesses that were able to believe God for healing to get up. We were asked to lay our hands on the general area in which we sought healing. I didn’t put my hands on any part of my body. I just spoke to God from my heart; I told him blood was all over my body and so I could not touch a specific part. I asked Him to go to the place where the problem lay and restore it as He had intended for it to work at my creation. I was calm. I went home and my mother measured my blood pressure and it had gone down significantly.

I have never taken any medication since that day, 11years ago, and my BP has remained relatively stable. In terms of diet, my husband loves beef so we have to eat it daily, to the point where one of my sons cannot stand it. I also went off salt for about a year. A few times, I have had a terrible headache that necessitated my going to hospital, and it was during one of those times that I met Dr. Lusi. But I am generally well, all glory to God. I have come to believe that the only thing that can beat science is faith in God.

vipslit@yahoo.ca

Photos by Nash of NaMeD Afrika Studios

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First Published in The Standard’s Sunday Magazine on September 4, 2016

http://sde.co.ke/article/2000215045/i-shouldn-t-be-alive-my-battle-with-high-blood-pressure

The Boda-Boda Saint Named Gordy

gordy-and-the-12-bodaboda-men-of-bunyala2The man arrives at the health center late into the night. He is helped by a community health volunteer, and between them, they support a wailing pregnant woman. All of them are wet, and bloody. A nurse takes the man’s place and supports the woman to the labor ward while the man gets someone to sign a little book and then leaves into the night. He is back two hours later, in different clothes, equally wet, equally bloody, this time he is holding a baby in one arm, while supporting a tired woman with his other. The nurses rush towards him and relieve him. They know him well. He is here almost every night. He is not staff, he is a perpetual good Samaritan.

gordy-with-baby-hildaWe traveled to Bumula sub-county, Bumula village to find out from the 34 year old married father of three Godwin Simiyu Wanyonyi (Gordy) just why he does what he does. Many men would probably rather walk through fire, than be with a woman, for any period of time, who was in labor, especially in the latter stages, even when it is their wife or close relative. But in Bungoma County we met, not just one, but 13 of 23 men with a different perspective. And just in case you are thinking that Bungoma County has hoarded Gynecologists, you are wrong. These are ordinary men, Boda-Boda riders with a calling that leads them to choose to be around pregnant women in labor, to support them by taking them, free of charge, to a health center for medically assisted deliveries.

“I don’t know why, but most women give birth at night,” begins this hero in Kiswahili. “Some nights I get as many as three urgent calls. I respond to all. Many of them are in advanced stages of labor and this for me means that we sit on blood and water all the way to the health center. Sometimes we make it. Sometimes the baby comes on the way to hospital, and I never shy away from the challenge of helping out. Most times the lady is accompanied by a Birth Companion, a Community Health worker, her mother in law or a female relative. Sometimes, like last week, it’s just the two of us.”

Even in the best of times, the rush to hospital when in labour is, to say the least, uncomfortable for most women with the ever present risk of losing the mother or child to the journey. This is even more challenging in the counties outside the capital. In some places, women are ferried on the back of Lorries transporting quarry stones in attempts to save their lives and those of their soon to be born babies. gordy-taking-a-woman-into-healthcareBernard Mare, a Transport Officer with the Ministry of Health Bungoma explains “Many places in the County are inaccessible to regular ambulances due to climatic and infrastructural challenges. Many homes are at least 5kms from the nearest health centers and can only be accessed through footpaths, sometimes mountainous like in the Mount Elgon areas. When it rains, and it is night, family and community members here either use makeshift stretchers with blankets to carry women either  to the centers or to a waiting Bodaboda at more level places. Some are brought in on wheelbarrows. Bodabodas, though considered dangerous by most, is the way most people get anywhere these parts of the country, so it makes sense to encourage their use, with caution of cause.”

“I have been a Boda-Boda man for 9 years, and whenever I see someone sick, I help  them – for free. I think this is what built my regard in this area, but I didn’t know just how much until the election. In June last year, the sub-chiefs angordwinnounced in the markets and in the villages around that they were looking for a Bodaboda man to help the villagers get to hospital, especially in the night. They, the Government, GlaxoSmithKline and Save the Children, had laid out about ten requirements that this man needed to have.  He was to be dependable, a man whose phone was never off, with a volunteer spirit, not a drunkard or criminal, someone who would best represent the community. I had a funeral on the day the election was to take place so I went” Says Gordy.

“The requirements were deliberately stringent. With the challenges in the area, including security, we needed mature men, with good reputations, with valid Riders’ licences, Insurance and a log book showing that they owned the bike they were riding.” Explains Felix Makasanda a Community Development Officer with the Boresha Programme that rose up to respond to Gordy’s initiative.

“When we were just about to bury, I got a call from one of the community health volunteers who knew me well. They told me to hurry back to the market and try my luck. There were about 60 riders who had responded to the call. Some had been campaigning and had come with their supporters. When I walked in, their morale dropped, and one or two asked me what I was doing there. The short of it, is that most of my competitors became my supporters. At the end of it, the community shortlisted five of us, and I got the most votes,” smiles Gordy. At least, Gordy could now fuel his bike on his mercy errands and have a something left to care for his family.

gordy-with-his-wife-janet2“It’s not easy,” his beautiful wife Janet Nafula contributes. “Many of the women get pregnant in the food season and give birth in the drought season. Sometimes these calls come in at night. As a human being of cause there are times I feel bad, but I have learnt to wake him up and release him, with a prayer. The night holds many issues. I am proud of what he does. Sometimes it rains, and in those nights, he could get as many as three calls. Which means I get to wash more clothes, but I do not mind it. I know he is out saving lives, and I trust him totally. He has never been one with a wandering eye, so that does not even worry me,” she says playfully. “He is a responsible father and husband. We have never slept hungry, he has bought and built on this plot, my children are all I school by God’s grace, the last being in a private school. He has helped set me up in a small hotel business where I have 4 employees, and where he comes in to help from time to time. We also farm goats, chicken, maize and beans, which is where we started off.”

How do they get to know his number? “My mobile number is like a hotline around here. The Chiefs announce it during funerals, in churches, at the hospital during clinics and at meetings. Former traditional birth attendants as well as community health volunteers have it.” Gordy explains. beneficiary-1-mildred-simiyu-with-baby-hildaOne of his beneficiaries Mildred Nanjala Simiyu, not a relative of his, who had her baby in March this year shares how on the day she went into labour, they had no way of getting to the hospital. The young mother of three, had walked to the health centers in the company of her loving mother in law for the first two births. This time though, it was raining, dark, and the path to her home in Bonambobi village in Bumula is full of twists and turns and narrows to barely passable footpaths closer to home. It is about two and a half kilometers from Gordy’s. She had challenges with pregnancy related hypertension. Her mother in law had heard about a BodaBoda Ambulance that transport’s people to hospital for free. “I was surprised by how fast he responded. He rode fast, it was just the two of us that night. My mother in law had to stay back to care for the other children. He saved my life and that of my baby Hilda. If it was not for him, I would have died in the process of trying to have the baby here. She kept presenting her chin first.”

beneficiary-2-jessica-wamalwa-with-baby-prosperJessica Wamalwa had a similar experience. She got Gordy’s number from a neighbor at around 11pm in the night. It was a rainy night. “I was overwhelmed. He was gentle and encouraging. He would ride at the pace that was comfortable for me, but would not stop when I asked him to. He said it was important to get me to hospital. Sometimes he would use one arm to hold me steady on my back. We rode also with my mother in law. By God’s grace I had baby Prosper at 3am.”

Gordy confesses that there have been some challenges. The weather, the roads especially on rainy nights, his susceptibility to frequent bouts to malaria and pneumonia. The lack of proper riding and safety gear is also a challenge for him. “I wish also that they would train us in basic first aid so that we could be more useful in cases where the babies come before we get to the health centers. I have so far, in the past years, had four women give birth when I was taking them to hospital.” gordys-colleague-pastor-wilfred-sifuna-otunga-1The other Riders agree with him on these challenges. Pastor Wilfred Otunga who has been doing this work for 20 years due to his love for children says “There is also said to be a ghost rider who terrorizes road users. Many who have seen it describe it as a jacket riding a bodaboda. I have never met it. I believe God has been with me. Many of us have also met with thugs and thankfully none of us has lost their bikes.” Lack of clarity on the role they are playing, by police on patrol was previously a challenge, but since their partners gave them branded reflector jackets with government and partner logos and branded as Ambulance.

Gordy’s twelve colleagues are grateful to him for his perseverance, and good example that impacted all of them to do the work they do. They also appreciate the assistance that has come as a result of their love for their communities. Like Gordy, many have bought land and built their simple homes on them. Some are educating children at all levels including at the University. They have also initiated businesses for their wives in which they work when they are not on the road. Most importantly, it has enamored them to the communities that chose them for this noble work and are committed to supporting them. They echo Gordy’s sentiments as he concludes our day, “I am convinced I was born to do this. I am grateful for the help I have received from the partners, but I did it before and I will do it long after they leave.”

vipslit@yahoo.ca

 

What They Said

Mildred – Gordy is the kind of person who reacts urgently to every call. If it was not for that, I would have died in labor. He is helping the women here, they will not have their children at home unless they do not have Gordy’s number. The number of deaths of mothers has also reduced significantly. I have his number and would recommend him to any woman in labor.

Jessica – Gordy’s work is meaningful. I don’t think my neighbor would have helped me without transport.  I had seen his number on display during clinic. But on that day, I got it from the community health volunteer who is my neighbour called Martin.

dr-brian-inima-moh-bunyala-subcounty-hospital

Dr. Brian Inima

Dr. Brian Inima – MOH Bumula Sub-County: The BodaBoda Ambulances have increased greatly the number of hospital deliveries.

transport-officer-moh-bungoma-county-bernard-mareBernard Mare –Transport Officer MOH Bungom: Gordy has a lot of passion for the work he does.  He has a big heart.

img_0031Dr. John Papaya – Coordinator of Community Health Services, Bungoma County: Gordy has a lot of humanity. No man would otherwise volunteer to do the work he is doing.

Photos and Stories by NaMeD Afrika Studios – (Nashon David Dwoya and Vip Ogola)

First Published on The Sunday Standard’s Sunday Magazine on September 4, 2016

http://sde.co.ke/article/2000214893/birth-by-boda-boda-bumula-riders-who-provide-free-emergency-transport-to-women-in-labour

Elevated mis-Adjudications

“Who are you to judge another’s servant? To his own master he stands or falls. Indeed, he will be made to stand, for God is able to make him stand.” Romans 14:4NKJV

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I strolled into the balcony earlier this morning, with a stool in one hand so I could breath…perhaps more accurately, so I could get some air into my head. And it worked. I stood on the stool and idly looked around the hood from an even more heightened vantage point.

I noticed that my neighbor had some men over to rebuild his wall. He had brought it down about three weeks ago to allow for the digging of a bore-hole in front of his gate. The three men were doing awesome work, from my vantage. They were also raised considerably from the ground and were plastering and measuring and really getting Tassia’s black cotton dust all over them. I noticed another man, cleaning up the road. Picking up papers and lighting small fires to burn them. He is not an employee but a good samaritan. My son Leroy opened the gate, noticed him, and quietly but resolutely went to join him in this task.That’s when the air began swirling round my head…for you see, as his mother, I should know a thing or two about him, right?

Anyway, I immediately installed myself as his supervisor. After all, I was standing on a stool on an elevated balcony, and am his mother right? I suddenly noticed seven small pieces of white paper that, as far as I was concerned, would the determine the success of his mission. He missed them every time, but what I failed to focus on, was that, from his vantage point, he was able to see and deal with a lot of rubbish. Including, ahem, my attempts at supervising him. After a while I kept quiet but continued to anxiously watch for him, willing him with all of my heart and blood pressure to notice the seven pieces of white paper. Suddenly this all seemed very familiar to me…I was Leroy. I heard God rebuke me saying, “let the lad be. You did not ask him to do this work, I did. I did not send you out to supervise, and you definitely have not been qualified by Me to adjudicate or  determine his success. Only I can do that.”

Okay, I figured out too, that since I had noticed the seven pieces of white paper that Leroy kept missing, it was probably my job to go down there and pick them up. So let’s just say, there was an air-leak in my head as Wisdom set in and settled quietly. The little fires have died down as I thought through this, and wrote it down, and the jarring existent of the seven pieces of white paper, can not change the fact that Leroy did something lovingly, as best as he knew how to. The area around our house and across the road looks a lot better than it did before he stepped in. I am proud of him.

I learned that I can not disqualify who I cannot qualify. I can only evaluate a project based on its set objectives and including the presenting challenges – when these have been presented to me and I have been blessed with the soundness of mind and wisdom to do so. I also learnt that sometimes we erroneously feel that just because we have done something before, or know the person who is doing it relatively well in our opinion (which may not actually be true) we automatically qualify to vet those who are bent over to the task. Just because I define success one way, does not always make it true, not even most of the time. Finally, that just because someone is perched at a higher point, it does not give them the whole true picture of what is on the ground. A more realistic assessment is made by those actually doing the work – without really ruling out the truth of that higher view.

As I go out to pick out the seven pieces of white paper, I continue to learn from this scene. I hope this helps someone else, even if its just one person.

This morning’s lesson is both humbling and comforting. When we get too much air in our heads, we get light-headed, and are in no position to judge weightier matters.

Shalom

vipslit@yahoo.ca

 

Kangaroo Mother Care: What is it

IMG_9841.JPGBy Dr Angela Muriuki, Head of Child Survival, Save the Children – Kenya

Definition and History: KMC is continuous, prolonged, skin to skin contact between a baby and a mother or any other adult for at least 18 hours a day for several weeks. It provides warmth, promotes breastfeeding, reduces infections and links with additional supportive care, if needed. It is a powerful easy to use method to promote the health and well-being of infants born pre-term as well as full term. There are two types s KMC- contious which is skin to skin contact for at least 18 hours and intermittent where contact is brief and at least for 3 hours.

KMC begun in Bogoa, Colombia in 1979 by Dr. Edgar Rey and Hector Martinez in response to a shortage of incubators and severe hospital infections.

Who qualifies for KMC? The current Moh recommendation for KMC in Kenya is for stable babies (not on oxygen, not receiving intravenous medicines) as long as they meet the criteria: baby less than 37 weeks or completed gestation and the mother willing to provided KMC for at least 18 hours, mentally sound, not ill etc. It is hard to objectively say who is most likely to use it i.e. which mother is likely to accept KMC, early involvement of their partners and family in the process and promotion of support systems at home but also using mothers who have successfully practiced KMC.

Challenges that face premature babies and which of these can be resolved by KMC: In the simplest forms, small babies are at risk of death due to hypothermia (they are not able to regulate their body temperature very well), hypoglycaemia (also not able to regulate their blood sugar very well as their systems are not fully developed),and respiratory diseases (they get severe problems with their respiratory system in part due to the fact that their lungs are not fully developed and that they get infections very easily) as well as problems with their eyes, brain and gastrointestinal systems all because of being born too soon.

Some of the benefits of KMC for the baby include thermoregulation (the constant contact20150303_183400 between mother and baby keeps the baby warm), it promotes exclusive breastfeeding (hence addressing the issue of hypoglycaemia), babies gain weight faster (due to better thermoregulation, feeding and bonding which reduces stress for the newborn) and therefore it shortens the hospital stay (reducing the risk of exposure to infections). For the mother, it gives her confidence in caring for her newborn, it improves bonding between mother and baby and empowers the mother to be the primary caregiver. It also reduces stress for the mother since she is with her baby constantly as opposed to conventional care in the newborn unit where the mother only comes to feed her baby every 3 hours (and in between feeding times is constantly worried about whether her baby is still alive). For the hospital – engaging mothers in the care of their babies means that the nursing staff available can focus on the very sick babies and work with the mothers to care for the stable babies, incubators are in short supply and often shared so KMC ensures that incubators are left for the sick babies who really need them and the shorter hospital stay for babies is also advantageous
Some of the benefits of male involvement: There are several reasons why men should be involved (especially when mother is discharged to practice KMC at home)

–        Financial support for the care of the baby especially if the mother has to be away from work (her daily source of income) to care for the baby

–        Emotional and psychosocial support for the mother

–        Fathers themselves can practice KMC giving the mother some time to rest or carry out other household activities

–        They can help around the household so that she focuses on care for the baby (or get some help for the household)

–        Financial resources so she can attend the monthly follow up visits at the health facility

Women experience the lack of male involvement differently depending on their support networks.

When is the best time and for how long? KMC is initiated immediately (and as long as mother and baby meet the criteria described above). KMC is practiced for at least 18 hours a day. When a baby gets to 2000gm, they can be discharged to go home and continue KMC until the baby is 2500gms (with frequent visits to the facility to make sure the baby is ok and gaining weight).

Can it be practiced instead of/along with incubator care and when?KMC is not a replacement for incubator care or an intervention for poor countries/communities. It is the current recommended care for small babies (in the west, even unstable babies are put on intermittent KMC – can send pics from internet though copyright could be an issue). KMC is practiced alongside incubator care because as I mentioned, there are babies who still need incubator care and don’t qualify yet for continuous KMC according to the Kenya guidelines  – very sick, on oxygen, on IV medicine etc. even these sick babies can be put on intermittent KMC and returned to the incubator.

Is KC beneficial for babies born term? No, term babies don’t tolerate KMC at all.

KMC should be differentiated from skin to skin care for all babies – this is where any baby born should be put skin to skin with its mother to keep it warm until it can be wrapped warmly. This is standard practice for all babies at delivery. KMC on the other hand is for small babies (preterm, low birth weight), and is continuous (at least 18 hours)

Which institutions within and outside Nairobi are equipped to and encourage KC?

I can only speak for the ones we support. We have supported county MoHs to set up KMC in Bungoma and Busia counties and provided technical support to other organisations to set up KMC services. From August 2016, we will be supporting Nairobi County to do the same and Wajir County later in the year.

We also extend an offer to any organisation/county which requires technical support to set up KMC services. If they get in touch with us, we are happy to provide this support (technical support since financial resources are limited).

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Photography by: Nash of NaMeD Afrika Studios and Family File

https://viphealthyleadership.wordpress.com/2016/08/23/kangaroo-mother-care-saved-baby-winnie/

Kangaroo Mother Care Saved Baby Winnie

IMG_9851Phyllis Wanja Kariuki

Age: Early 30s

In her own words:

I lost my first pregnancy at 15 weeks. I had 20150303_183406begun bleeding, and doctor in Mandera, where I worked as a Logistics officer with Save the Children, Kenya, recommended two weeks bed-rest. I came back home to Nairobi and all went well. The day before my scheduled return to Mandera, my friend and I went shopping. I started feeling funny, like cramps and remembered that the doctor had permitted me to take regular painkillers for this, so I took a Panadol. I did not expect that there would be any adverse effects, and it helped. At night however, I woke up to the same cramps, intense pain. When I went to the toilet, some water came out. I did not understand what to make of this, as it was my first pregnancy. I was rushed to Nairobi hospital, and on getting there, they discovered that the amniotic fluid had leaked out. Their prognosis was not good. They suggested a termination of the pregnancy as it had only a 90% chance of being viable. I resisted this and sought a second opinion. I went to Aga Khan hospital. I was given the same story. The doctors there meet and make sure that by the time they are giving you your report, they have tested you, they have discussed it together and allow you to make the final decision based on their thorough analysis of the your case. I had stayed for so many hours, and since this was my second stop, I felt I had no other choice but concede.

It was a horrible experience. They started with the treatment, and I was discharged and moved on with my life. After six months I conceived again, and I still had issues. I started bleeding at 8 weeks. This time I was more cautious, and able to see the warning signs. I went to the nearest clinic, St. Bakita in Utawala, and was injected with Buscopan. They suggested I go for a scan.  I went home and the next morning went to Agakhan for the scan. I was frightened of loosing my child. During the scan, the doctors were discussing the point of bleeding around a certain spot. But there was another spot and when I asked what that was, I was told it was another baby. I understood them the magnitude of what I was carrying and how careful I needed to be. After the scan at the ER, I was referred to Dr. Obura, a Gynaecologist. He looked at the results and gave me hope.  He gave me medication to strengthen the wall of my uterus, and advised me to avoid strain.

At around 18 weeks I started spotting again, but this was not serious.  Both at home and in the field in Mandera, I took very good care of myself. Mandera was less strenuous for me as I only had short distances to walk, and we are basically taken care of. I did not have to cook or do anything for myself. I stayed there for six weeks and then came back for R&R. At the airstrip, the flight attendant asked me how far along I was. She alerted me to the fact that I could not travel in a small aircraft beyond that point, and I understood that to mean that I would now be working from Nairobi. I worked for one more month before I started swelling. One of my colleagues, Eric Muthiani adviced me to have my blood pressure checked to rule it out as a cause for the swelling. My pressure was normally but now my feet begun to swell as well. It was during clinic test. I was to do a HCG test to determine my glucose level. It takes time, but they advised I change the clinic date as it was too late in the day. But I wanted to understand what was causing the swelling. The doctor insisted on a urine test. I had to do it twice for them to determine what the problem was. The doctor told me that my urine had a lot of protein in it, and suggested for additional tests to determine the functionality of my kidneys. This came out normal. They connected me to someone closer to home who would monitor my blood pressure daily, as they had noticed that it was fluctuating. I was to call the hospital daily to give them the readings.

This was on a Friday, but on Saturday, I was planning on going shopping for baby clothes so I did not go to check my pressure. I went in on Sunday, it turned out high. It read 170/100mmhg. The doctor recommended I go home and rest. I rested, and went back for another reading in the evening, this was even higher after then rest. I know High Blood Pressure is serious, but had no reference for people having it around me, and therefore did not see it endangering the pregnancies. The doctor recommended that I go into hospital immediately. I went home, got ready and then went to hospital. I was alarmed to find a team waiting for me on my arrival at the hospital. I was feeling fine, and wondered why they found this reception necessary. The scan showed that the blood was not flowing into the second baby as it should. I was admitted, but even then I thought it would just be for a night. At around 1am the doctor came to check on me and informed me that they would have to do an emergency Caesarian Section if my blood pressure did not go down. I had no idea that HBP could lead to one giving birth to pre-terms.

In the morning, a group of four doctors, took me to radiology for a scan. They sat around me and studied me. They told me they needed to do the emergency CS, in order to save my life and try save the lives of my babies. I therefore signed the consent and the CS was done at 3pm that day. This was on February 2, 2015. Everything went well. They did a spinal epidural, where I can see what is going on. They did a good job, they engaged me a lot. I heard my babies cry and I was excited. I was not able to see them immediately as they needed to be taken into the ICU, as they were a bit small. My daughter was 790grams and my son was 970grams. My son was a bit bigger. Everything was completed and I was taken to the ward. I wanted to go see my babies but I was not allowed then. It was too early, I was still numb. I saw my babies the following day.

It’s quite bad when you are in the ward, can hear other babies crying and you don’t have yours. You deal with a lot at that point, even the bills. I went to see the babies on February 3rd, around mid-day. I remember the nurses telling me that I needed breast milk, even if it was just two drops. Imagine there is no way I can be able to stimulate…you need the baby to stimulate it to produce milk. The nurse told me to be strong, calm down, focus on the babies, and try to express. There are other liquids they give the babies for feeding. I tried to express and nothing was coming out. By evening I had two drops and the staff was quite encouraging. The biggest trauma was when I saw the babies and how tiny they were, and wondered when they would ever grow to the size of the other newborns in the ward. I remember my daughter was the size of the 300mm soda bottle, she could be held in a hand. A nurse advised me to be strong and to take every single day at it comes. Her words remained with me through my darkest times.

The reality of the bills started hitting me. My insurance had been exhausted and my family began counselling me towards moving to a cheaper hospital. I was spending about Kshs 50,000 per baby per day in the ICU. On the 4th the doctor attending to the babies came to the ward. I sensed that something was wrong. The previous night, my son Jaden had been transfused. She started with the positive, telling me that my daughter Winnie was doing well, but the boy was struggling. I did not want to hear anymore. I told her to take me to them. She got somebody to take me to them in the ICU. I found them trying to resuscitate him. They did this while I watched. I told them to do all they could, within their power to make sure he was well. A male doctor assured me that they were. They kept encouraging me that girl was doing well. Unfortunately Jaden passed him while we were looking at each other. I felt like he was telling me ‘mum do something’ or ‘you are going to be okay just take care of my sister.’ Everything was done. I cried a lot. But I turned to the girl, and prayed to God ‘God I am going to walk out of this hospital with this one, and I know you can make it happen.’ I kept telling my close friend and colleague Jane the same. She was there for me through it all. I told her I was sure God would answer my prayer to the affirmative.

20150203_214802I did not want to mourn a lot because I needed to be strong for the girl. I had no choice. I remember the nurses counselling me and telling me, “this one was not yours, let go.” I could not let go the first day. It could hit me and I could cry, and then remember that this one was not mine but I had one surviving. I also remembered that the first time I came to this hospital, I had left without a baby, this time I had a chance to leave with one. I gave it all my energy, I did everything possible to get enough milk. I did not want stress to be a reason for not having milk for my baby. We paid a fee for the hospital to take care of my son’s remains as I did not have the energy to handle it. The hospital recommended some counselling, but most times I cannot and help me move on during dark times. I stayed for a while as they needed to monitor my pressure, but I was doing well. I was discharged on the 6th of February.

The bills were also increasing but my colleague encouraged me to focus on the baby as the money would somehow come.  Miraculously everyday passed. When I was told to give a deposit of Kshs 600,000. I borrowed this. I did not care where it came from as long as I could save a life. The credit office kept calling me and one day I went there and just told them “you are ladies like me, and am sure some of you are even mothers. You call me every time. I know you are doing your job, but at some point try and engage someone. My baby is in these wards, meaning I have not running away. Meaning I cannot run away. At this time my baby was in ICU. She stayed there for two weeks, and luckily she was doing well. She had the oxygen tubes from the 2nd to the 7th then they removed them because she was able to breath on her own and her oxygen saturation was normal. We moved out of ICU to the normal HDU ward. She had a oxygen desaturation, so she was put back on oxygen. I remembered the nurses words about living a moment at a time. She had also told me about how much pre-term babies were affected by movement. Moving mine from 1st to 2nd floor had had this effect.

Proffesor Aketch, told me that they would put the baby on medication to strengthen the lungs, and this caused the sugars to rise up to 21 and its supposed to be between 6 and 8. It really stressed me. I tried to get information for myself, from Google. The pain of seeing my child on injections, tubes and the thought of them having to put down her sugars. I cried a lot, it was very painful to watch.

I started doing Kangaroo at 800grams while she was still at the ICU. She was very tiny. I remember the feeling of putting her against my chest, how nice it felt. It was the first time I was touching my baby and she was calm. Every time I was doing Kangaroo I was happy and not tense. I could sense how happy she was as she could pray. Whenever I arrived in the hospital in the morning, she would play as though she sense I was there. I would do at least two hours daily. I would split this between morning and evening. I sometimes extended depending on how available the baby was in between procedures. The nurses used to encourage us and I used to Google the importance of Kangaroo MotherCare. It improves oxygen saturation, helps in weight gain which was very important for me since I needed my baby to gain weight, and also the bonding thing. These three are the three things that made me keep at it. It really motivated me.

There is this powder they normally mix with the milk call suffactor that helps them to gain weight. Winnie’s body rejected this, so they needed to lower the quantity they put. She got an infection after getting it. Imagine this was her chance for boosting weight gain. I could look at other babies, and though we were told not to compare our babies. I was jealous. They had their own problems but not those challenging weight gain like mine. I never lost hope. I even encouraged others. We had a group and I was considered the experienced. We had a room and we would chat and I discovered that others had problems that made mine. For instance one lady told us how her cousin had triplets and stayed in hospital three weeks and then they suddenly died, one by one. This really challenged me, as I still had a baby. Every time I remember that situation I remember her. I realised how blessed I was. There were others who were crying, and I needed to motivate myself to care for my baby. These helped me get stronger daily.

It was my job to wake up in the morning like I was going to work, get to the hospital, express milk as I could not kangaroo with the milk as it would leak, and then kangaroo. The fact that our babies could not breast feed by themselves, they were too tiny for it. For Aga Khan, until the baby is 1800grams they are still kept in an incubator. After that they are put in a cot. The first time when I saw my baby in cloths it was really happy, it was exciting. I would tell the other mothers “am nearing the door”. In her first two months Winnie went through several lung treatments and two blood transfusions. I did Kangaroo for two months and increased the hours. I could do several 1 and a half hours sessions. I used to cry a lot when I had to leave her especially when she was under treatment. She went through two transfusions. These were the worst since I connected the death of my son with the transfusion he had undergone the night before he developed breathing complications that led to his death. From Google I learnt that transfusions sometimes cause complications in pre-terms.

Some of effects of Kangaroo on Winnie Wakanyi is that she is very close to me, she is alsoIMG_9869.JPG friendly and independent. She is still small bodywise though she weighs 8.3kilos, but this does not discourage me. I knew this would happen. The nurses taught us that when we went to the clinic and were asked the age of my baby…even now when I tell them that she is 1 year 5 months, I see the shock in their faces. I don’t explain unless I feel it’s necessary. One time a nurse responded by asking me if my child was picky about food. She is doing very well, I make sure that I don’t miss clinic. She has never been put on a special diet on her hope. She is now walking on her own and is really fast. I remember the nurses telling us to never compare our children’s milestones with another child’s. The pace does not really matter as long as they get there. As long as everything else is normal, they are good. For pre-terms, don’t mix yourself with pressures from outsides, its her time. If its kangaroo, her time is her time.

vipslit@yahoo.ca

Photography: Nash of NaMeD Afrika Studios and from Family Files

First published on the Sunday Magazine, Sunday Standard, August 21, 2016 (shorter version)

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