maryannewaweru

A Kenyan Journalist Writing About Health

Archive for the month “October, 2014”

Turkana’s Children Race for Survival

By Maryanne Waweru-Wanyama

Among some mothers in Turkana, a newborn does not start breastfeeding until he responds to his name.

“After she gives birth, different names are called out and only when the newborn responds positively to a name will he begin breastfeeding,” says Nicholas Losike, a community health worker in Loima district, Turkana.

Losike says this traditional naming practice, which is still observed by some adherents, serves as one of the greatest challenges health workers face as they advocate for exclusive breastfeeding where the newborn is fed nothing else but the mother’s breastmilk for the first six months of life.

As a name is called out and the child shows no enthusiasm about it, it means he has rejected it, prompting more names to be called out. But when the child hears a particular name, opens his mouth and reaches out for his mother’s nipple, it means he has accepted the name and only then can his mother begin to breastfeed him.

“On average it takes about two days for the child to ‘respond’ to a name. Sometimes it can take even longer. In the meantime, the baby is fed on boiled goat or camel milk,” says Losike.

PASSIONATE: Nicholas Losike, a community health worker in Turkana. Photo/Maryanne Wanyama

Photo: Nicholas Losike, a community health worker

Even if the mother has delivered in a health facility, she will argue with the nurses about it and if they insist on her breastfeeding the newborn before he responds to a name, she will sneak out of the hospital, he adds.

Yet, the World Health Organization (WHO) recommends that mothers initiate breastfeeding within the first hour of birth. This is because of the immense benefits that breastmilk offers the infant.

According to Terry Wefwafwa, the head of nutrition and dietetics at the Ministry of Health, breast milk contains all the nutrients that an infant needs in the first six months of life. “Mothers should breastfeed as soon as possible after birth. This is because the first thick yellowish milk she produces called colostrum is filled with antibodies that give the newborn immunity from infection. It is actually the baby’s first immunisation,” she says.

Breastfeeding, according to Wefwafwa, is the single most effective prevention intervention for ensuring child survival and healthy development.

So when mothers such as those in Turkana discard this first milk due to long-held traditions, it gives the newborns a disadvantaged start to a healthy life as they miss out on the free and available first immunisation.

It is perhaps such cultural practices that contribute to a high infant mortality rate in Turkana, which stands at 60 in every 1,000. The health status of children in Turkana is wanting, with only 54 per cent of children aged 0-5 years being fully immunised, which is below the national average of 83 per cent.

This is partly attributable to the lack of quick access to health care services, forcing residents to trek long distances in the harsh, arid climate to reach health facilities.

“Many mothers take days to get to a dispensary or hospital, so they only come for services like immunisation when they are coming to seek other treatment services. We have women who bring in children for their first immunisation at 10 months,” says Susan Ilikwel, a 28-year-old mother of three in Namoruputh division.

Turkana has a population of 855,000, with only one doctor for every 52,434 people. This is against the universal recommendation of one doctor for 1,000 people.

The issue of child deaths in Turkana county is further compounded by the high maternal mortality rate, which stands at 1,500 deaths per 100,000 live births — which is three times the national average. Often, a mother’s death leaves devastating consequences for her family.

Findings from the study A Price too High to Bear released in March 2014 by Family Care International (FCI), the International Center for Research on Women (ICRW) and KEMRI/CDC demonstrated the great link between maternal deaths and neonatal mortality. Of the 59 maternal deaths in the study, only 15 babies survived the first 60 days of life. The deaths of mothers, most of who are in their productive years and engaged in different economic activities only deepens the poverty levels in the home. In some households in the study, surviving children had to be withdrawn from school because of economic disruptions. Often, the sudden death of a woman from pregnancy or childbirth-related causes begins a chain of losses that compromises her children’s health, education and future opportunities.

The WHO states that children from the poorest households are nearly twice as likely to die before their fifth birthday than children in the richest households. It is indeed a tough life for poor children as they struggle for food, health, education and other necessities that would enable them enjoy healthy mental, physical, emotional and spiritual lives.

With Turkana County ranked as the poorest county in Kenya, life for a child here is difficult, with the most pressing health problem being malnutrition. Malnutrition is marked by a deficiency of essential proteins, fats, vitamins and minerals in a diet. Without these nutrients, it becomes difficult for a child to achieve optimum health. Assessment reports indicate that the Global Acute Malnutrition level in Turkana is at 28 per cent, which is high considering the WHO threshold is 15 per cent.

Recurring droughts, increasing populations that have put pressure on the county’s resources, as well as insecurity characterised by clashes over water and grazing pastures as well as frequent cattle raids have compounded food insecurity issues for Turkana’s pastoralist population.

However, it is not all gloom for the county, as both the national and the country governments are putting in place measures aimed at bettering the lives of Turkana’s mothers and children.

In June 2013, the national government introduced free maternity services in all public health facilities. This move has seen an increase in the number of women accessing antenatal care services and subsequent delivery in hospitals.

With the cost barrier eliminated, the Turkana county government has put in place measures to ensure that pregnant women and children have better access to health services. “Because of the long distances women have to walk to access a health facility, we have now ensured that each ward in the county has at least one health centre. There will be additional 30 more health centres by the end of this year. With the assistance of partners, we have put up a model maternity section at the county’s referral hospital that will specifically take care of the health needs of mothers and children,” says Peter Ekai, Turkana’s deputy governor.

According to Ekai, the county has further committed 2.1 billion shillings to the health sector, a move that is expected to increase the positive health outcomes in the county.

“We also acknowledge the strategies that the Kenyan government has established at national and county levels with regard to mothers and children. One is the introduction of free maternity services which has seen more Turkana women access services in hospitals, and second is the introduction of free rotavirus and pneumococcal vaccines in public hospitals which will no doubt see more of our children surviving their childhood.”

Ekai was speaking at Lodwar Mixed Primary School during an event called ‘Race for Survival’ organised by the children’s rights organisation Save the Children on October 17 to mark the UN International Day for the Eradication of Poverty. On this day, children from across the world participated in a symbolic race aimed at highlighting the plight of children from the most difficult places in the world.

DISADVANTAGED: Children run in an event to mark the UN International Day for the Eradication of Poverty in Turkana on October 17. Photo/Maryanne Wanyama

Photo: Turkana children participate in the Race for Survival

In Kenya, the celebrations were marked in Turkana county where the focus was on malnutrition. Kenya loses 108,000 children each year from preventable diseases like diarrhoea, pneumonia, malaria and other neonatal causes. Malnutrition however remains a major threat to the survival, growth and development of children where it contributes to more than 3.5 million preventable deaths annually in Kenya.

Children who participated at the Race for Survival called on both the national and county governments to pay urgent attention to Turkana’s children. “We ask that our health and nutrition needs be given priority. We want our governments to ensure that every child has access to a nutritious diet as this will help us live longer,” said Elizabeth Sakasa, a 12-year-old girl from Lodwar Mixed Primary School.

Article courtesy: The Star.

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Jacklyne Nekesa: “I Lost my Uterus to a Rare Form of Cancer”

By Maryanne Waweru-Wanyama

Five years ago, Jacklyne Nekesa Nyongesa had her uterus removed, in a surgical procedure known as a hysterectomy. She was aged 35 then and even though she did not wish to have her uterus removed, it was her only option if she needed to stay alive.

“Ever since I was a little girl, I always desired to have my own child, but nature did not seem to favour me in that way. I have now accepted the fact I will never give birth to my own child,” she says.

Jacklyne’s journey to having her uterus removed began in 1997 when, for a period of time, she experienced heavy bleeding accompanied by intense pain to the extent that she would pass out. With time, the bleeding became constant and would see her bleed every single day of the year. And it was not light bleeding, for she would bleed in huge clots.

“Pads would not help as the blood would sip right through them and onto my clothes. I always had to carry a change of two or three clothes in my handbag. I was studying at that time and it became difficult for me to move around as I had to constantly keep dashing into public toilets to change my soiled clothing. Eventually, I stopped going to college and preferred to stay indoors,” she recalls.

Selina Cimmone

Photo: Jacklyne Nekesa during the interview.

As the bleeding continued, it would be accompanied by feelings of nausea, vomiting and extreme fatigue. Jacklyne then decided to visit Kenyatta National Hospital where the doctors ran a series of tests on her, including a pregnancy test.

“The tests showed that my pregnancy hormones (hCG) were very high. This puzzled me because I knew for a fact I was not pregnant as I was not sexually active. An ultrasound later on showed that I had abnormal growths in my uterus. These growths were mimicking a pregnancy, hence the symptoms of a firsttrimester pregnancy,” she says.

The doctors further took tissue samples from Jacklyne’s uterus, which established the presence of cancerous cells along her uterine wall.

Jacklyne was diagnosed with an unusual type of cancer called choriocarcinoma. She had to undergo two surgeries in a span of six months to remove the abnormal growths, as well as undergo chemotherapy to destroy the tumour cells. She underwent a total of 15 cycles of chemotherapy.

However, the pain and bleeding never stopped, despite the two forms of treatment.

“As the years went by and the bleeding and pain got worse, the doctors recommended having my uterus removed, but I resisted this. I believed I would heal, meet a nice man, get married and have babies,” she says.

For the next decade, Jacklyne experienced heavy bleeding accompanied by intense pain everyday. Due to the loss of blood, she became anaemic and lost count of the number of times she underwent blood transfusions. The disease affected not only her physical and emotional health, but her social life too.

“I could not date. How could I be intimate with a man yet I bled every single day of my life?” she remembers. Finally, in 2009, Jacklyne gave in and heeded the doctor’s call to have her uterus removed.

“My cancer had started spreading to other parts of the body. A hysterectomy was the only solution if I wanted to stay alive. My dream of birthing my own babies had to come to an end,” she sadly remembers.

After the hysterectomy, the bleeding and pain stopped and for the first time in 12 years, she did not have to wear a pad or carry an extra set of clothes in her handbag. It has been five years since Jacklyne had her uterus removed. The 40-yearold is still single, but hopes to find love someday.

“Most men want a woman who can bear them children. I am yet to meet a man who doesn’t want that. Maybe I will find him someday. For now, I am considering adopting a child,” she says.

Today, Jacklyne volunteers at the Texas Cancer Centre in Hurlingham, Nairobi, where she interacts with cancer patients and survivors.

Choriocarcinoma, the kind of cancer that Jacklyne had is a rare form of cancer. In majority of the cases, choriocarcinoma develops from Gestational Trophoblastic Disease (GTD), a group of diseases that see abnormal cells grow inside the uterus after conception.

The most common type of GTD is a hydatidiform mole, which is a tumour that forms inside the uterus at the beginning of a pregnancy. It results from an abnormal production of the tissue that is supposed to develop into the placenta, and is also referred to as a molar pregnancy.

However, in a few cases, choriocarcinoma can come about as a result of non-trophoblastic disease, where it is not pregnancy-related. Such is the case of Jacklyne, who developed this form of malignant tumour yet she was not pregnant.

According to Dr Amin Medhat, a gynaecologist and oncologist in Nairobi, this kind of cancer can originate from ovaries in women, or the testes in men. The choriocarcinomas, which result from genetic damage to a germ cell, make human chorionic gonadotropin (hCG) which is a hormone found only in pregnancy.

Dr Catherine Nyongesa, an oncologist, says that patients who present with choriocarcinoma give a positive pregnancy test results.

“This type of cancer is the only one that can cause a man to have a positive pregnancy test result. This is because it originates from some primitive cells in the testes. Therefore, if a man feels some swellings in his testicles, it is recommended that he sees a doctor immediately,” she says.

It is also these abnormal cells that may have caused Jacklyne’s tests to indicate a high hCG level (pregnancy hormones), even though she was not pregnant.

The symptoms of choriocarcinoma depend on the origin of the tumour. In the uterus, the most common symptom is bleeding, while in the ovaries, it is characterised by abdominal pain. In the testes, the choriocarcinomas present as small painless lumps.

According to Dr Medhat, most cases of choriocarcinoma can be treated if the correct diagnosis is made and treatment sought early.

“Treatment for choriocarcinoma includes chemotherapy, though in persistent cases surgery is necessary. All choriocarcinoma patients must be closely monitored following treatment,” he says.

In Kenya, cancer is the third leading cause of death, with a reported 40,000 new cases each year, according to Dr Nyongesa.

“Prostrate and oesophagus cancer is the most common among men, while in women, breast and cervical cancer lead the pack,” she says.

Cancer diagnosis, treatment and management still remains a problem in Kenya. In November 27-29, the Kenya Society of Haematology and Oncology will hold a conference that is expected to discuss issues surrounding cancer research, prevention, treatment, rehabilitation and palliation in Kenya.

With cancer treatment costs being out of reach for most Kenyans, it is hoped that the government and other stakeholders will come up with innovative strategies that can work towards enabling and ensuring the cancer cases in Kenya are reduced through prevention, early diagnosis and treatment in local health facilities.

Article courtesy: The Star

Sex and People with Disabilities

By Maryanne Waweru-Wanyama

Many are the times that Susan has come across people who have, with some astonishment, blatantly asked her, “You mean even people like you have sex?”  Such questions have come from her friends, relatives and strangers alike, and her reaction is almost always the same – one of consternation and bemusement at her sexuality.

You see, Susan, 25, has a physical disability. “Even though hurtful, I have learnt to live with society’s ignorance towards people like me,” she says.

One of the common societal attitudes towards people with disability is that they are asexual; that they do not have sexual relationships. Ignorance fuels these attitudes, where engaging in sexual intercourse does not seem acceptable – at least according to society.

Phitalis Were Masakhwe, a disability rights activist says the idea that people with disabilities do not engage in intimate relationships is the norm in society.

“People with disability are constantly portrayed as incapable of having sexual feelings. Yet, they are normal human beings who also seek meaningful relationships with members of the opposite sex. Just because one has a disability does not mean a diminished need to experience love and affection,” he says.

Often, sex is associated with physical fitness and the virility of youth. And with the media awash with the perfect body image, sex is also associated with the perfect physical body – one with a balanced symmetry devoid of physical limitations. Many people with disability, and especially women endure constant internal battles with the ideal body type, knowing only too well that they may never achieve it. For many, this affects their self-esteem and their relationships with other people, especially those of the opposite sex.

Susan says that society is fed on unrealistic images through the media – where boy meets a perfectly flawless beautiful girl, and they instantly fall in love.

“The sex which then follows is always mind-blowing. Physical attraction is always the dominant theme, and I am yet to see a soap opera that has the lead character as a person with disability. When cast in a programme, they are often portrayed negatively,” she says.

Besides the perfect body image, people with disability have a myriad of other issues to deal with, all of which can affect their sexual functioning. These include feelings of anxiety, fear and depression. Other times, certain prescribed medications may affect sex drive and sexual function.

For those with physical disabilities and whose mobility is aided by wheelchairs or crutches, their ability to move in what can be considered standard sexual ways is limited. Some have to contend with among others; pain and loss of sensation in areas where their partners expect them to be sensitive, as well as impaired bowel and bladder control. In men, it can have an effect on their erection and ejaculation.

For many people with disability, sex is not as spontaneous or as frequent as that of their able-bodied counterparts. Many times, it has to be a planned activity where issues of physical location and fatigue have to be considered. In some cases, the use of assistive devices to achieve pleasure is required.

“It takes a lot of effort and courage to explain some of these things to a sexual partner, especially one without disability,” says Susan. “That is why we prefer to date our kind most of the time – someone with a disability because they understand these things.”

Susan says that even though she gets attracted to people without disability, it is the fear of rejection that makes her stay away.

Even worse is the fact that some members of society consider it ‘embarrassing’ to date someone with a disability.

“Many men have sex with women with disability under the cover of darkness. They have intercourse with them at night but during the day, shun them. This accounts for the high number of women with disability who are single mothers. Often, their children have been sired by different men,” says Masakhwe.

Such a man, Masakhwe says, fears the likely ridicule he will receive from his family and friends, who will question his selection of a wife and tease him for his ‘unsuitable’ choice. “Such is the shame of our society”, he says.

In some communities, people with disabilities are often sterilized against their knowledge or will. Some women have even been forced to undergo abortions in the anticipated disgrace the pregnancy will bring to the family.

“It is this kind of prejudice that makes people with disability fear seeking health information,” Masakhwe says. “Even though sexually active, most lack confidence enough to seek information and services on ‘private matters’ such as reproductive health, even when this information is life-saving for them.

Caroline Agwanda, the proprietor of Hyacinth Ornament Production Enterprise (HOPE) in Kisumu, and who has a physical disability concurs with Masakhwe and further decries the reaction pregnant women with disability receive from society.

“Many express their sympathy at your pregnancy. They tell you ‘pole’ and question the morals of the man who ‘dared’ impregnate you. ‘What was he thinking? Why didn’t he look for another woman if he really wanted to have sex?’ they ask, while shaking their heads in disgust.

But it does not end there, Agwanda adds. “Woe unto you when society discovers that such a woman did indeed plan for the pregnancy,” says the mother of one.

“When I was expectant, many people asked me why I wanted to bring yet another disabled person into society. For them, it was automatic that I would give birth to a child with a bad leg like mine, and wondered what kind of a person I was to want to do so.”

Agwanda says that society’s ignorance on disability issues further manifested itself after she delivered. “After I got my baby girl, I was excited by the huge number of people who came to see me and my baby. However, I was to later discover that most were merely coming to ‘confirm’ that my child had been born with a bad leg too. This greatly saddened me.”

Too often, women with disabilities are teased, humiliated or otherwise harassed by peers and healthcare workers should they decide to become pregnant, decreasing the likelihood they will receive appropriate reproductive healthcare.

“Many are the times a clinician will ask a pregnant woman with disability; ‘Who got you pregnant? Why were you having sex in the first place?’ Even worse is that they ask this out loud along the hospital corridors, something that is really embarrassing,” says visually impaired Jacqueline Osoro, 31.

According to the Association for the Physically Disabled in Kenya (APDK), 1.6 million Kenyans have a form of disability.

Of these, about 640,000 are physically challenged. One such woman is Godliver Omondi from Mumias, who shares that pregnant women with physical disability have an especially hard time accessing antenatal care.

“I remember when I was pregnant, a nurse asked me to climb onto the examination table for an examination procedure during an antenatal visit. I use a wheelchair for mobility, and it is hard for me to get atop an examining table without assistance. The nurse did not bother to assist me,” says the mother of three children aged between five and twelve years.

“All health facilities must be made accessible to women with disabilities, and these include accessible examining tables, ramps and sign language interpreters. Clinicians should also be trained on how to be more sensitive to our needs,” she says.

One time when she was in labor and on her wheelchair, Godliver says many nurses passed her, assuming that she was there to visit a patient.

“I kept asking for assistance, and when I finally managed to catch the attention of one nurse, she asked me which patient I had come to see. The nurse was shocked when I told her I was in labor. She had not imagined that I could possibly be pregnant”.

Dr Julius Rogena of Machakos District Hospital admits to the lackluster attitude of health providers.

“Just like any other person, people with disability engage in behaviors which place them at various health risks, such as HIV infection. It is unfortunate that the attitudes of some healthcare workers do not reflect this reality.

As it is, people with disability have limited access to HIV education, information and prevention services. They may be turned away from community HIV education forums because of assumptions that they are not sexually active, and therefore at little or no risk of infection,” Dr Rogena says.

This is despite a growing body of research that indicates that those with disabilities are at increased risk of HIV due to their vulnerability.

Thoraya Obaid, Executive Director of the United Nations Population Fund (UNFPA) alludes to studies that show that persons with disabilities are up to three times more likely to be victims of physical and sexual abuse, and are at increased risk of HIV/Aids.

Yet for people with disability to be responsible about their reproductive health, they must be provided with sexual health information and given the safe space to openly express their sexuality. Rarely do adolescents with disabilities receive, either at home, or in school, reproductive health education that enables them to prepare for or appropriately respond to their specific needs and situations.

Jacqueline, who attended an integrated school for her secondary education says the only credible information she ever received on reproductive health was what she learnt during her form three biology class.

“Those who attend special schools hardly receive any sex education, and depend on those who listen to radio or television programmes to ‘educate’ them. Most of the information people with disability have on sex is what they learn from their peers,” she says.

Daniel Aghan, Advocacy Officer at Handicap International says there is an urgent need for the development of policies on access to disability-friendly information, education and communication materials, which take into consideration the different facets of disability.

For the visually impaired, Masakhwe advocates for their special needs.

“To protect themselves from HIV, blind persons use condoms, but their privacy is infringed when for example, they need to check the expiry date on the condom pack.

“They have to rely on a seeing person to read it for them. It is time brailed condoms were designed and made available to this population,” he argues.

Masakhwe says reproductive health programmes should be more accessible through disability-friendly adaptations such as cassette tapes, sign language interpretation, Brailled information, or in formats that are easily readable (such as pictures) for those with intellectual disabilities.

Article courtesy: The Star

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