maryannewaweru

A Kenyan Journalist Writing About Health

Archive for the month “August, 2014”

Lilian Madonye: When Infertility Leads to a Life of Reckless Abandon

By Maryanne Waweru-Wanyama

When 37-year-old Lilian Madonye took her marriage vows 14 years ago, she looked forward to the exciting life that lay ahead of her. In her early twenties, she was marrying the man of her dreams, an athlete whom she had courted for two years.

The wedding marked the beginning of her new life, a life that would be filled with untold happiness from both her husband and the beautiful babies they would raise together.

Lillian, a second born in a family of three, had been raised in a relatively comfortable upbringing in Eldoret town. Her father, a banker, and her nurse mother had provided them with a stable home and good education.

Nurtured in a Christian environment, Lilian was a role model in her school, neighbourhood and church where she served as a worship leader. And her marriage did not disappoint.

Lilian Madonye

Photo: Lillian Madonye during the interview

The first year was full on love, warmth and laughter. However, in the second year, the couple became worried when they were unable to conceive.

After trying for a baby for three years in vain, Lilian decided to seek professional help and saw a doctor who put her on fertility drugs and supplements. However, the desire for a baby became a dominant, crippling thought which consumed her whole being.

“Sex became a laborious task that was no longer enjoyable because of the pressure to conceive. Family, friends, neighbours and church members were already spreading rumours about my barrenness,” she remembers.

Meanwhile, Lilian kept hopping from one doctor to another seeking a miracle treatment, but none helped her conceive.

“The day I would receive my period each month would send me to a very dark place where I would spend the duration of the menses in tears. Helpless, I wondered what worth I was as a woman if I could not bear a child. What justification did I have to call myself a woman if I could not have a child?” she asked herself.

Frustrated and at her wits end, she one day asked her husband to take a fertility test if only to encourage him to be part of their quest for a baby.

“Even though I knew I was the one with the problem because I believed that infertility was a condition only for women, I asked him to get tested anyway.” But the results of the semen analysis test on her husband shocked her.

“My husband had a low sperm count, hence my difficulty in conceiving! The news took me aback because all along I thought I was the one with the problem,” Lilian says.

A low sperm count decreases the odds of a sperm fertilising an egg which results in pregnancy. Lilian’s husband was then put on fertility treatment aimed at boosting his sperm count.

At the same time, out of curiosity, Lilian decided to take a fertility test as well, and whose results showed that she was perfectly capable of conceiving and bearing a child.

“I stopped all the drugs I was taking. I wished we had both done the tests earlier as it would have saved me all the medicines I had taken for three years!”

For the next two years, the couple continued trying for a baby, but were unsuccessful. During this time, their marriage began undergoing turmoil.

“We would constantly engage in verbal confrontations about anything and everything. We were both frustrated and very desperate about wanting a baby. At some point, the fights became physical. Our marriage became filled with extreme tension and anger. We both became very unhappy in our marriage. There were infidelity issues and I was constantly rebuking women with whom my husband was having dalliances with. We stopped talking and even slept in separate rooms. I felt there was nothing left to hold on to and I eventually walked out of my marriage,” she remembers.

Lilian then moved to Nairobi where she landed a job as a sales representative in a bank. Older, wiser and with her newfound freedom — her faith in God long gone, Lilian took to alcohol and drugs. A short while later, she got a transfer to Mombasa.

“As soon as I landed in the beautiful Coastal city, I met up with people who introduced me to a wide variety of hard drugs which were easily accessible unlike in Nairobi. Soon, I began engaging in prostitution to finance my new lifestyle as my salary could obviously not cater for my needs. I would have multiple affairs with married men who would take care of my different financial needs.

Lilian Madonye

Despite being aware of the dangers, I would have unprotected sex with my partners. I didn’t care about HIV, venereal diseases or drug overdoses because I had nothing to live for. With no husband and no children, my life had no meaning,” she confesses.

Lilian says she was on a constant high because when sober, the reality of her empty life would hit her, something she did not want to face. One morning after a night out, she began feeling sick.

“I knew that Aids had finally caught up with me,” she remembers. Lilian went to the hospital, but the doctor’s diagnosis shocked her. She recalls his words:

“Lilian, your HIV test is negative. But there is another test that has yielded positive results. Congratulations, you are pregnant!” She did not believe it.

“I was living a very evil life, engaging in all the abominable acts mentioned in the Bible, but yet God remembered me? I wondered why, yet when I was a good Christian, faithful in my marriage and with enviable morals, he ignored me. But now, when I was fully immersed in sin, he remembered me?”

Shocked to the bone, Lilian decided to sober up for the sake of her unborn baby. She packed all her belongings and moved back to Nairobi to start a new life.

She got back her old sales job at the bank, and began piecing her life together, which was not easy. “I was used to men taking care of all my bills, but now I had to support myself and my unborn baby. It became very difficult to make ends meet, but I did not despair. My baby motivated me and kept me going,” she says.

One day, in her seventh month of pregnancy, she noticed some blood stains. She rushed to hospital, and by the time she got there, her clothes were soaked in blood and she was writhing in pain.

An ultrasound done on the foetus revealed that Lilian’s baby was already dead. Lilian had faced high blood pressure issues during the pregnancy, which led to her having pre-eclampsia, a condition characterised by a high level of protein the urine and which can be fatal.

But she had to deliver the baby anyway, and after six agonising days, she finally gave birth. “It was a baby girl. Even though I wanted to see her and hold her in my arms, the doctors refused and only showed me her legs. They said that because she had been dead for more than a week, she was already decomposed and in a bad state. I called her Zawadi, because she was my special gift,” she says, struggling to contain the tears welling up in her eyes.

As she walked out of the hospital on that day in May 2012, Lilian left with a new resolve. To completely turn her life around and find her purpose in life again.

“I don’t blame anyone for the path I took in life. I am responsible for all the decisions I made. I could have made better choices, but I did not. I have forgiven myself and I am embracing my new life.”

In January this year, Lilian formed a group for women struggling with infertility. The group is called Diamonds Women Ministry, and it brings together women struggling with infertility, and teaches them to focus on other areas of their lives even as they try for a baby.

“The reality is that not all women struggling with infertility will have a happy ending where they will get pregnant and have babies. I encourage women not to be consumed by the search for a baby to the extent that other areas of their life suffers. They should also not peg their worth as women solely on the basis of motherhood. I talk to women during bridal showers and talk to newlyweds about marriage expectations. I always use my personal experiences because I know I contributed to the loss of my marriage and advice them not to make the mistakes I made. I am a strong believer in marriage and just because mine did not work, it does not mean that it will not work for another couple,” she concludes.

Article courtesy: The Star

Fistula: When Childbirth is a Cause for Misery

By Maryanne Waweru-Wanyama

Lovina Okwara is a bubbly 17-year-old whose broad smile, infectious laughter and carefree attitude is evident of a young woman enjoying her life. However, this has not always been Lovina’s attitude. For the last four years, her life has been one of misery.

Lovina traces it all back to four years ago when she gave birth to her daughter. An occasion that was supposed to bring her untold joy and happiness turned out to be the beginning of her nightmare. She recalls the day.

“My mother helped me birth my baby in our small house. Maternity services were not free back then so going to hospital was not an option as I had no money,” Lovina says, adding that the baby’s father, also a young man, had no financial means either.

Lovina comes from Teso district, Western Kenya. She comes from a poor background and so do many of her neighbours. Many of the women deliver their babies at home with no skilled care — among the reasons being personal preference, ignorance and poverty. While some women and children die during childbirth, Lovina and her daughter are among the lucky who survived.

But it was not an easy survival.

“I laboured for about 48 hours and when my baby finally came, I was exhausted, physically damaged and in pain. My private parts had been ripped apart during the delivery,” she remembers.

A few hours later, Lovina noticed she was unable to control her flow of urine and faeces.

“When I sat, I felt wetness overcome me and when I looked down, I noticed I was urinating on myself. I also noticed that my underwear had stool. Worried, I asked my mother about it.”

Lovina’s mother reassured her that the leaking urine and faeces were nothing to worry about, that many other mothers experienced it too.

This situation would see Lovina, who dropped out of school in class seven, eat very little food and take few sips of liquids to avoid quickly filling up her bladder and bowels.

“I would starve myself yet I was breastfeeding. I also stopped laughing as this would make my urine gush out. Even though I am grateful for my daughter, it has been a harrowing experience for me ever since she was born,” she says.

When Lovina, a causal labourer in Nairobi, tried to seek treatment for her condition, she learnt it would cost her about Sh30,000, money she could not raise. So it therefore came as a pleasant surprise when in July this year, she came across information about a free fistula medical camp at Kenyatta National Hospital.

Lovina wasted no time in going to the hospital for screening and a few days later, underwent a successful fistula repair surgery. Today, she is a happy teenager who has since regained her cheer and laughter which had been taken away by the fistula she suffered for four years.

Lovina Okwara

Photo: Lovina Okwara

Lovina’s fistula is likely to have been caused by the prolonged labour she went through. According to Dr Stephen Mutiso, a gynaecologist and fistula repair surgeon at Kenyatta National Hospital, obstetric fistula is a childbirth injury that develops due to prolonged and neglected labour which becomes obstructed.

“Obstructed labour causes destruction of vaginal tissue which leads to the development of a hole (fistula) between the bladder and birth canal. This causes urine to leak continuously through this hole. When the same damage occurs between the rectum and the birth canal, faeces leak continuously from the rectum to the birth canal,” he says.

Prolonged labour is that which goes on for more than 24 hours and according to the World Health Organization, obstructed labour accounts for up to six per cent of all maternal deaths. Dr Mutiso says that majority of the patients who present with fistula often have laboured for three to five days at home usually under the assistance of relatives or traditional birth attendants. In most of these cases, nine out of ten babies are born dead. Many of the women are from remote areas where the overall infrastructure is poor and they are unable to reach hospitals in good time.

In Mwingi district, Kitui County in Eastern province for example, women have to walk long distances in rough terrain to the nearest health centre. And when they get there, lack of personnel as well as lack of equipment and supplies is yet another challenge. A case example is Nyaani dispensary in Nuu location, where there is only one health worker, a community nurse who attends to all patients seeking services there. Nyaani dispensary serves a population of about 7,000 people.

Without a theatre or other basic equipment necessary for handling birth complications, the nurse has to call for an ambulance from Mwingi District Hospital which is 79km away. By the time the ambulance arrives and gets the pregnant woman to hospital, about four hours have elapsed. And this is when an ambulance is available. Many times it is not.

“A pregnant woman experiencing a birth complication and who is referred to the district hospital often has to use public transport. Public vehicles are hard to come by because of the poor state of the roads. Sourcing for transport and eventually getting to the hospital can even take a day,” says Damaris Wanjiru, the nurse in-charge at Nyaani dispensary.

Interestingly, while Damaris sees an average of 12 pregnant women a month attending antenatal clinics, she only delivers about three babies a month, with the rest delivering at home. Lack of transport is one of the major reasons the women cite for failing to make it to the dispensary when labour checks in.

Eastern province is one of the regions that bears the highest number of fistula cases. Other areas include Nyanza, Coast and Northern Kenya regions, as well as West Pokot. It is important to note that fistula can affect any woman regardless of her age, marital status, education level or income status. For as long as she experiences prolonged and obstructed labour and does not have access to emergency and quality obstetric intervention, then she can develop fistula.

In Kenya, there are an estimated 300,000 women living with fistula, with an occurrence of about 1,000 new fistulas each year, according to Dr Mutiso.

The consequences of fistula on the woman are dire. Stella Mburu, a nurse at Mbagathi District Hospital and who has been trained in fistula care, says that in most of the cases, the woman is emotionally pained following the loss of her baby. In addition, she has to deal with the continuous leaking of urine or faeces which make her smell foul. Most women from poor areas cannot afford fistula repair surgery and therefore use pieces of old cloth or mattresses to contain the leaking urine or faeces.

“They face rejection by their families and communities and because of the stigma, they soon stop going to public places such as the church or the market. They also stop attending social gatherings like weddings or chama. They also find it hard to find employment or engage in business. Some women experience domestic violence while some are disowned by their men who leave them to marry other women. Some women suffer depression as a result,” she says.

The good news is that fistula is treatable. Small fistulas can heal if a urinary bladder catheter is inserted for about four weeks immediately the fistula occurs. Surgery is the other option. However, the costs of surgery remain far beyond the reach of many women affected by fistula. In public hospitals, fistula repair surgery costs between Sh20,000 and Sh40,000 which is a subsidised fee. In private hospitals the price is much higher.

For women such as Lovina who cannot even afford the subsidised cost at government hospitals, they are lucky to benefit from organisations that sponsor their treatment through free fistula medical camps. Her surgery was made possible by the Freedom from Fistula Foundation, the Flying Doctors Society of Africa and Kenyatta National Hospital.

Fistula can be prevented by delaying the age of pregnancy and ensuring that all women have access to quality maternal care. The free maternity services in public health facilities are aimed at encouraging more women to deliver in hospitals under the supervision of skilled birth attendants to reduce negative maternal outcomes such as fistula.

Article courtesy: The Star

Dads Have an Important Role to Play in Breastfeeding

By Maryanne Waweru-Wanyama

Many new mothers know that breastfeeding their babies is the best way to give them a healthy start to life. The good thing is that most fathers know this too! Indeed, the benefits of breastmilk abound.

Breastmilk is the perfect food for babies as it provides them with all the nourishment they need for their first six months of life. Because of the antibodies in it, breastmilk increases a child’s ability to fight off infection. This means that a breastfed baby has fewer trips to the doctor because of their strengthened immune system.

Less medical bills also means the family is able to save and channel their finances to other investments. In addition, the skin-skin touch during breastfeeding between mother and baby enhances the lifelong bond between them.

The World Health Organisation recommends that babies be exclusively breastfed for the first six months of life — meaning they take breastmilk only during this time. To achieve this goal, a mother needs support from the people around her and one of the most important people who can support her is the baby’s father.

Interestingly, breastfeeding does not come easy for most new mothers, and many need to be taught how to go about it. If her baby does not latch properly, then she may experience problems such as cracked, bleeding nipples which can cause her unbearable pain and discourage her from going on.

Also, when baby does not latch properly, it means he is not feeding well and this may cause him to become dehydrated. Her husband can assist in ensuring that she leaves the hospital having been taught how to place baby on the breast for a proper latch. He can be present as she is taught how to do so for purposes of assisting her after their return home in case she experiences latching difficulties.

Being a new mom can also take a toll on even the strongest of women. The fatigue of the nine-month pregnancy coupled with sleepless nights, changing diapers, rocking the baby to sleep, hosting visitors during the day, nursing a wound if she delivered via caesarean section, bathing baby and other such tasks can be quite challenging. When a nursing mother is stressed, it can affect her ability to produce sufficient milk for her baby.

Her partner can help by undertaking some of these chores, such as changing diapers, bathing baby or taking him out for walks to get some sunshine.

When the baby wakes up at night, the father can pick him up from his crib and bring him over to his mother for nursing. After the breastfeeding session, the father can take him again, burp him and then rock him back to sleep. This allows the mother to rest before the baby’s next feed.

Due to the dietary needs of a breastfeeding mother, her husband can ensure that her food is well balanced by doing grocery shopping and buying all the foods and supplements she requires. In between night feeds, he can offer his wife a glass of water, prepare her a cup of hot chocolate or warm some porridge for her.

More importantly, he should support her emotionally and offer her words of comfort on the days she feels overwhelmed. If left unchecked, the rigours of being a new mom could lead to post-partum depression. He should ensure her environment is stress-free and he should never stop showing her genuine love, concern and care.

When her husband is supportive, a new mother is able to breastfeed for longer thus giving her baby a healthy start to life. Men should remember that babies who are breastfed exclusively for the first six months have stronger immunity, meaning less hospital visits in the future and less financial costs for the family. They should know that investing in breastfeeding is investing in their child’s healthy future.

Article courtesy: The Star

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