OF LEAKING......

So today I was all up in arms in women’s nether lands…..doing what I do best. But today was different, we were  repairing the ravages that child bearing has on mothers, those who deliver at home, with no skilled attendants or those who actually have no access to medical personnel, the rest, those who entrust the beautiful job of child birth to untrained traditional birth attendants.

It all started yesterday, I admitted a lady with a recto vaginal fistula. What this means in simple terms is that her rectum, what transmits stool to outside the body is in communication with the vagina, meaning there is a hole and thus instead of faeces passing through the rectum and out through the anus, it instead leaks through into the vagina and thus the lady always had stool leaking. This usually happens due to prolonged and obstructed labor or in cases where a woman delivers at home by herself or with unskilled help and the baby’s head tears away at the mother’s “Nether lands” wrecking all that havoc.

In her case, 8 years ago she had a delivery at home. Unattended. Her husband was away and she was living upcountry. Soon after that, she noticed she was no longer able to hold her stool and she had leakage. She had had three other children prior to this, and all were home deliveries, I mean am sure she wondered why this last one would be any different. Am sure you’re wondering why it took her eight years to seek help…..I was curious too.

She told me; first and foremost she was ashamed about it. That I understand. But what came next broke my heart into very many tiny pieces…. Her husband abandoned her because of her condition….well, let me explain it. During sexual intercourse with her, sometimes he would go into the “wrong” canal….because she had sustained a very severe tear, the vagina and the rectum were almost one and the same thing and when her husband went into the wrong canal, she was in excruciating pain. To add insult to injury, you can imagine she ended up soiling herself, her inner garments, the bed… (I mean ladies we all know how clean and private our private biz is always kept). Secondly, she would not even associate with people because if she left the confines of her house, she would end up with a “stool accident” and you can imagine how she would be shunned if she happened to be in a matatu for example.

I looked at this lady, beaten and bruised by shame for eight long years. She had not a shred of dignity, let alone self esteem with her…she could not even pretend to smile, it wasn’t anywhere in her vocabulary, I can imagine her husband could possibly have abused her physically, mentally or emotionally for being a “dirty” woman…..well by just leaving her, spoke volumes and volumes. I can imagine how she lives with her kids, do they sometimes in their innocence ask why she reeks of stool? Her neighbors? Her relatives? Her fellow women? Until she heard the little announcement on radio, about leakage of urine and faeces following childbirth and where to seek help.

We sorted out the bad bad tear, the operation was like an hour long, by the time we were done, her perineum looked as good as new, better than an untouched girl….I saw a little smile on the corner of her mouth……..a fleeting smile like she couldn’t just believe that it was all over, that she could get her life back, a smile back, a dry vagina, a normal life….even get to enjoy sex once again.

If you know anyone with such a problem, in Nairobi, send them to VVF clinic, KNH, around Kenya, to any AMREF unit and around the world; hope the issue is not as burdensome as Africa. And to the selfless Doctors like Dr. W.K may God continuously bless you, in your footsteps I look forward to follow.

of THE SCOURGE....CANCER!

So, it has been a while..... but I was in elective Gynecology theatre last week. It is those dreaded four hour long cases that leave one tired like hell. This lady is wheeled in, she was diagnosed with Ovarian Cancer, she had received 4 courses of chemotherapy to sort of shrink the tumor in preparation for complete excision.To cap it all, she had retroviral disease. so we go in, open the abdomen and walala!!! The seemingly docile ovarian tumor had reared its very ugly head all over our patient's abdomen! you know how cauliflower looks? Now imagine pieces of that cauliflower all over the intestines, the liver, the abdominal wall on the insides and a huge ugly bigger mass resting on her ovary and the uterus! The situation was grim........

At this point I asked myself.......the surgery we were to do is called debulking....we remove as much tumor as we can so that as we then continue with chemo, it has a higher chance of being effective. in this instance, the monstrous cancer had reared it ugly head all up in this abdomen, even if we removed the primary one, would it be enough to cure the "rest of the many cauliflower pieces in the abdomen"? Furthermore, this lady had retroviral disease to add icing to this cake, if the cancer didn't get her, the chemotherapy combined with her status was surely going to win!

Needless to say, we were on our feet for more than five hours, the uterus and affected ovary were removed......(this was so tedious and painstakingly difficult) but it was done, then upon recovery, we embark on chemotherapy.... Sometimes I wonder, is it worth wile to do all these? do we add life into these cancer patients...a long, painful, bedridden life with our "heroic"measures? sometimes, why don't we just let them have more peace into the short time left? The mighty have fallen from it, am sure they had the best care in the world.....R.I.P Prof Wangari Maathai the next Nobel, may it be about a cure for the scourge,, R.I.P Steve Jobs.... the next APP, quick detections???

This piece I dedicate to my friend, she is so keen on being a cancer specialist, I pray one day, you will give us solutions.....<SIGH>