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>

OF BLOCKED TUBES...

So today am in the usual, very jam packed clinic working my school fees away, when this lady walks in. Young lady not more than thirty years of age. She has been on follow up in our institution for the last year or so on issues of infertility.

On her last visit, she had been admitted with a diagnosis of primary infertility for tuboplasty (an operation done to open up the blocked tubes). Unfortunately, when the doctor went 'in' the situation was grim, the blockage was too close to the uterus, an area that is almost impossible to venture into due to the thickness of the tube, the menacing blood vessels that lie beneath there waiting to be poked and give the doctors grief plus success rates on this area are very poor. So the operation had ended as an open and literally shut case! With advise to the woman to seek '''other options''.

So today she comes in, she has done a repeat HSG (an xray that is done to delineate the uterus and tubes) just in case the surgery worked......HOPE for a desperate soul. Unfortunately for her, I had no hope to offer her, tubes are still as blocked as ever. I told her, she has other options, IVF(donation and implantation of an embryo into her uterus), here the procedure costs an arm and a leg, and remember it usually requires repeat implants due to pregnancy losses associated with it. Her, she is a housewife(not the celebrated real housewives of Atlanta or New Jersey...Who has watched that reality show???whaaat???) and her husband is a driver....need I say more?

Option number two-adoption. Africans have something negative about it....(Why? there are too many motherless and fatherless children out there, looking for someone to love them back!) She was downcast, sad, forlorn, desperate, very very heartbroken. I can only imagine what she will have to tell her husband when she gets home in the evening....

I felt tears well in my eyes, and today I pray for every woman out there in the pursuit of a child........the long, dark,rugged and sometimes very disappointing road!

OF PAP SMEARS

So last week on Friday I was in theatre doing Examination of women with cervical cancer under anaesthesia.For those who are in the profession you know that this is not an exciting thing at all. I went in ready to tackle the five women who were waiting for my examination. So along came the first lady, an elderly cucu and she had pretty advanced disease and the tumor just reared its ugly head at me as soon as I put in my tools of trade.....sad! Next was a middle aged lady, she had advanced disease but this time her tumor was ingrown......a rugged, nasty, gross aggressive thing....horrible! Next was a thirty something( I Say this with a pinch of salt seeing as I had a birthday recently....Twentieth!) and I remember praying and asking God to please let this be a better story. But alas, as soon as I put in the speculum, the menacing tumour glared at me and bled with so much gusto like it was leering at me and saying...."I got here first doc! Ha! In your FACE!". The next was a forty something and lets just say-HORRID!

Cervical cancer is caused by a virus simply known as HPV. It is on the increase and we are now seeing very young ladies suffering from it. Once it attacks, it is so vicious and in advanced cases, the ending is sadly.....just that, sad! In our out patient clinic we get to see so many terminal patients who have nowhere else to go and being a referral unit and not a Hospice Centre we actually have nothing much to offer....

The most exciting thing about Cancer of The cervix is that it can be detected early and early detection is tantamount to CURE....AS IN SERIOUSLY......CURED! HEALED! and what does it take.... a simple PAP SMEAR. Ladies, dudes with ladies in your lives, we all have mothers,we all have sisters and aunties, even the sister-in law you don't quite get along with... all it takes is a five minute procedure at the gynecologist clinic and we can eradicate this monster.

So, this week, if you do nothing else at all......please get a PAP smear done.....and at our facility, it just costs  a hundred bob! Come on people, PAP SMEAR PAP!

OF MY LOVER………SIIIIIIIGH!!!!!

So I have been missing in action…..been having exams, the stress, the adrenaline, the tension and worst of all the feeling that what I had read was not enough. Well, exams came and went and it went well. My name is now written in ink, and I can now walk with a little more pride in the corridors of our great institution.

So last week when I was busy trying to calm my queasy stomach and nerves for the impending exams, I watched an ARSENAL match. Well I thought the team was insignificant and nondescript and I knew that this was the game to watch in preparation for my exams….well…until I saw my ARSENALget whooped so badly, by the nondescript team….sorry, Liverpool.

Today, ARSENALplayed ManU. Today ARSENAL lost miserably. How in or under this earth does Van Persie miss a penalty like that one? (Am a chic, I could have done better) How do you ARSENAL get beaten 8(EIGHT) goals??? Is this you or QPR? (Or whatever that team is called). I remember when our affair started; my blood was always at boiling point when we engaged in games… I miss Henry, I relish the days of one Vierra… I fondly remember the days when Walcott ran like a bullet across the field. Cesc, my love, the most handsomest Spanish man walking, Gregarious Gallas, the Persie of hat tricks, Smooth and innocent Nasri, my white haired allure that was Almunia…(well, until he became a kin-chu-ngi!), the Bartender who would sometimes make us scream in delight and other times wail in grief!I I could go on, with this list……Those were great days, great moments, and orgasmic meets!

Today, ARSENAL, you are full of all these young players…with all the letters of the alphabet! (ARSENE,what’s that about? Can’t even recognize you anymore! ARSENAL!) Six years, I have cried and I have laughed with you. I have borne ridicule from all quarters. I have put up with your disappointing rendezvous under the covers…each and every week. And what have I to show for this, nothing….am as barren as I was six years before I met you! The only thing I have to show for this union is a lot of dust and cobwebs.

So today, my LOVE, my ARSENAL, I move out of our bedroom. I will no longer be your bed fellow! Am tired, am disappointed, am heartbroken…but I have to do this. Enough is enough. Put your act together and maybe just maybe my eye will rove around for a more experienced, more gregarious, more alluring, a smoothie handsome, a lover with speed and hat tricks with an orgasmic finish.

I love you; I always have….will probably love you forever too.

of contraception......HORMONAL!

So I have sat in The Family Planning Clinic and I must admit that was a very exciting one.Women have tales to tell!!! One, almost 45year old stuck in my thoughts. She had come for insertion of a coil (IUCD)...OK before you start wondering why this is a big deal, let me explain...sit back and  take a chill pill. The said woman had been widowed for over ten years and she swore she had had not other relations and thus I gave her a look of so why bother now and you're almost hitting menopause.....??She went on to tell me a tall tale about how a certain young man (young enough to be her son), who was a husband to another woman in her women's group had been throwing darts her way.....she told me she just wanted to be on the safe side in the "unlikely" event that this "young" man would get his way with her...(I doubt that she hadn't already tried him out! WINK)But I didn't judge...I happily gave her what she wanted but I thought of something....here is a woman, in the prime of her life, going after her own "happiness" and taking control of it......mmmmmmh!

The commonest complaint in that one week I spent there was "lack of" or reduced libido.....commonest culprit....hormonal contraceptives! God in his infinite wisdom as he created the menstrual cycle in woman, planned it to the last detail...!! Around the time when ovulation is about to occur, estrogen is produced in copious amounts, this estrogen causes the vaginal secretions to be clear, and it is alot...overall effect..increased wetness. Just when the egg has been released, there's also some testosterone that is released and in women this  is the hormone that increases libido....even the temperature rises!!! So the woman is so to speak...at her peak....(this may sound bad but it can be equated to being "on heat") and if coitus takes place, a baby is very likely to be conceived at this point, but in the event that this is not desired other methods are used like condoms etc to prevent it!

Now the sad part of all this is that hormonal contraceptives(The Pill, Patch, Implants etc)...well....blunt this very exciting phase in the woman and many a men are left wondering what happened to their once hot blooded, ready to have sex chic they had dated initially....you know, the one who used to call and ask for it with the urgency of a firefighter on a mission...the one who'd get so turned on from a single kiss....and for fear of sounding like am on a Mills and Boon series, I will end it there, but you do get the drift (are those books sold anymore???)

So guys, sometimes the answer is right in front of you, ladies, if you want to get that control back....look for better options and yeah, enjoy that part of life...before physiology fails you in the later years!

OF A FAILING HEART...

So the other day we admitted a patient with a severe heart condition at 26 weeks gestation. She had rheumatic heart disease...(that one caused by untreated throat infections that then spread and cause your heart untold grief....). She had severe Mitral  valve stenosis with elevated pulmonary pressures. Now pregnancy as much as it produces a smile and a bouncing bundle of joy also wrecks alot of havoc on a woman's body (Now this is one reason why every woman should be respected....especially after she has carried a baby to term.....)One of the systems that is badly battered is usually the heart. So the patient is admitted because the pregnancy was taking a toll on her weak heart for intervention.

Now in this part of the world, resources are limited and scarce (ahsanteni AKUH for the brand new cardiac unit.....). A cardiologist reviewed the patient and he suggested they could do a minimally invasive procedure where they pass a catheter from the patients thigh to her heart through a blood vessel and try and open up the blockage. Well that was welcome news..wow...a solution! Damn problem, The Cath Lab that does all those procedures has been accumulating serious dust and all those funny creatures! It has been out of order for...eh....ah.....DOG YEARS! Now as much as it can be done in other units, the operation costs two arms and six feet! And my patient didn't have such resources sadly.

The other option we offered was terminate the pregnancy, save her ailing heart then plan for the operation later. Only problem was,the pregnancy was quite advanced, terminating it would cause more harm than good the seniors shuddered at that option. I had a chat with her and offered the options, we were stuck. Her husband was even more lost (aren't men always lost on such issues??)

Then along came our knight in shining armour... Cardiothoracic team. They said they could try open heart surgery and replace her valve with one of those brand new shiny ones(I think they're cool....you can hear every heart beat as a click!!! ) OK, we were stuck really, and there was no way we would keep her in the ward and just watch her waste away, something had to be done. We prepared her for theatre, haggled and begged for an ICU bed post op and finally she was taken to theatre.

She managed almost 2hours on the fancy heart lung bypass, another two hours of....... (Honestly I don't know what they do, but I really admire their skill, holding the heart in ones fingers and feeling it stop beating and after all that, feel it beat all over again once the whole operation is done... I think it must feel exhilarating!) So she pulled through it and she awoke in ICU. She was even breathing on her own, without all those tubes down her throat....until some 24hours later, complications arose, she threw a clot and in a matter of minutes....she was gone.

We lost them both. Could we have lost her if we did nothing? Very likely. But we still lost them when we did something.

Such is the life we live day in, day out :-(