One step at a time

It can be confusing to experience change.Love for the first time,for example.Prior to this ,you were used to affection from family and pets.Then that someone walks into your life and everything is just warmer,meaningful and different.
Then you grow up and start to see your world beyond face value.You see the true line between beautiful people,enemies and beautiful enemies.
First comes  a party then comes the hangover.Always.Because life is about stages.Change is the conveyor from one stage to the next.The brave ones handle change and move forward in life.The weaklings linger on,and everything always stays the same.Usually things change for the better,holding on to drowned pasts will only drown you as well.It's total energy drain.

Speed is vital.Be patient to experience each stage of life.It saves you from many future mistakes.Skipping any stage,is depriving yourself from being knowledgeable.You will pay for it in the future.
Also strive to be you.Strive to love you.Much more will have its place in your life.If you feel hate,you feel exactly that.If someone is hateful towards you,that is what you are worth to them. No debate!Don't force love out of places where it is nonexistent.
Think about the relationships that end after 7 or even 20 years of love.I believe that these would have ended two years or less into the relationship .Everyone likes to sugar coat the truth.Most people would rather run from painful fact that their 'soul mate' has imperfections that you cannot put up with.We ride on in the hope for change.A drowning man,drowns you with him.
 You cannot wait for a person to change into what you desire them to be.They are changing,growing up perhaps.You have already changed.It is a future stage for them and a past stage for you.The idea in life is to move forward never backwards.





Have a blast appreciating change and living life.!

HEALTH: Pregnancy Complications

Kidney complications caused me my unborn child’s life

                      

“When I went to the toilet, something like a ball with strings came out. I could not tell what it was so I put it in a paper bag and threw it away.”

These are the words of *Cheptoo, 24, a worker in a flower farm in Salgaa Area, Rongai in Nakuru Town. She had lost her pregnancy months prior to these remarks. Her journey down the Gusty Pregnancy Complications Lane began in May 2012.She had missed her ‘regulars’ for three months. Being married and a mother of one already, she believed she was pregnant. Few weeks into May, however, she began to bleed profusely. It was on and off heavy vaginal bleeding. Farm work can be hectic. Furthermore, the climate in Nakuru is the perfect definition of unpredictable. One minute it is scorching hot, the next it is bitterly cold. These factors may disorient hormonal balance of any sex. A research done by the College of Life Sciences, Nanjing Normal University, in June this year, confirmed that changes in hormonal profile are correlated to changes in temperature and rainfall.*Cheptoo did not know this fact. Nevertheless, like the ordinary Kenyan, she chose to monitor the bleeding for a week or so. “It could be anything!”She thought.

The situation actually worsened. There was a cutting pain in her abdomen. Distressed, she reported to the organization's nurse: *Beatrice. The medical practitioner did a physical examination and confirmed that *Cheptoo was indeed pregnant. A prescription was given to stop the bleeding. The medication was effective but after two weeks, it was the same old story. This time, the nurse, referred her to the Provincial District Hospital in Nakuru Town. Here, again, a physical examination showed that she was expectant. The doctor decided to have her begin on pre-natal care at the clinic. Her husband *James, is a security guard at the Gogar Farm in Rongai. Aware of their grand expectation, he worked even harder. It meant doing extra shifts and doing other casual jobs. The time called financial boost.*Cheptoo was worried as to why the pregnancy had been so troubling. However, just like any normal mother, she hoped for the best. Devotedly, she continued with clinical care, four months on. All was Bliss.

 The doctor told her that she would give birth in November. This would be a later date than she expected. Later, *Cheptoo understood that this was so, because of her complication (bleeding).*James and his wife were contented. Better late than never. “It would give us time to buy more new baby items and clothes as well.” Athletes wear such straight faces through their races. When they reach the final round, the winners begin to smile. The smile reigns all the way to the finish line. They have brought forth new records and sweet victory. The couple was headed for their finish line. They were in the athlete’s boat. “It was joyful.”

  A month shy off the due date, the bleeding came on again. This time *Cheptoo said, “Niliskia ni kama mtoto anatoka.”(As though the baby is coming out).She was given Buscopan at the Sister Mazolda clinic. This drug usually reduces muscle cramps in the stomach, intestines, bladder and urethra. A nurse then did a physical test. “She felt there was nothing in the stomach.”For further check up, she was sent to Rongai Health Centre. The doctor felt no child, as well. Later,*Cheptoo went for scan at the Provincial District Hospital. The scan was done but the doctor who could ‘read’ the results was absent. They administered medicine to halt the bleeding. When the scan results were finally out, she was informed. Her pregnancy was not growing.”It must be terminated,” the doctor declared. *Cheptoo’s kidney had also dropped and needed to be returned to position. “I was shocked beyond words, she mumbled, struggling to not succumb to tears. It was double trouble for Miss *Cheptoo.

 The society has unshakable faith in doctors. It is such a glorified profession that the thought of quacks is subtle especially in the remote areas.*Cheptoo neither sought to understand the concept of termination nor declined. Every mother would be disheartened by this. The dawn of October twelfth, was when she passed ‘a bloody thing that looked like a ball with strings.’ She could not tell what it was. This is definitely the last thing, any woman, with the hope of bearing a child should see. Many have been through the misfortune of still births. It is such a shame that anyone can go through the hands of so many medical specialists but end up with such a loss. So what may have happened, exactly?

 Floating kidney (nephroptosis) is a condition where the kidney drops downwards. I mean it descends five centimeters from its usual position. It is also referred to as renal ptosis, hyper mobile or wandering kidney. It is a disorder that is common in women more than men. Those mostly affected are thin women with long waists. *Cheptoo is this kind. Exerting too much pressure onto your abdomen area can cause it. This includes hard blows onto the abdomen area or even lifting heavy loads. Other causative agents are deficiency in the potassium or perirenal fascicle. The latter is the tissue that supports the kidney. In this case, the kidney can drop to levels as low as the pelvis, even coil around other organs; the ureter, for example. This leaves the kidney and some other affected organs malfunctioned. In the end, waste is not effectively eliminated from the body. Accumulation of wastes inhibits oogensis (production of ova) therefore preventing menstruation and pregnancy. It also causes blood poisoning (Septicemia).This is because it is inefficient in filtering bacteria out of the blood. Other symptoms include very high blood pressure, chills, nausea, severe abdominal pains, pain while passing urine or even having blood in urine. When a woman is pregnant the situation is worse. The body has to struggle to sustain both the mother and child. The expectant woman will retain much more wastes and thus have much higher blood pressure .Very high blood pressure in the mother leads to :Hypertension, Preeclampsia (,(fluid retention, and protein in the urine),  Premature labor, Miscarriage, Decreased kidney function, Greater risk of urinary tract infections, Acute renal failure. In fact women with HBP and excess protein in their urine face a 60 percent risk of infant death during their pregnancy. 

Research on kidney cancer in the United Kingdom showed that some people live with nephroptosis for years without knowing. “It is asymptomatic.”Doctor Amir Javed, London, says. “However when symptomatic it is characterized by violent, sharp pains that radiate into the groin.”(Renal paroxysm).Tricky bit about this disease is that it cannot be diagnosed when lying down. This is because the kidney drops when you stand but returns to position when you lie down. The abdominal pain and pressure even subsides in the latter position. CT Scans and ultra sounds cannot detect it. A physical examination when standing and an x-ray on both the kidney and bladder should be done. 

For pregnant women, it is recommended that they have a credible medical practitioner monitor their blood pressure, creatinine levels, blood urea levels, protein levels, cholesterol and urine potassium and mineral levels. This should continue for the first 32 weeks of the pregnancy. Women planning to have children should consult a nephrologist before getting started. Kidney complications not only mean kidney failure but also breakdown of the immune system, central nervous system, heart and bones. They also dictate the kind of contraception to use and diet to follow if pregnant. The best contraceptives for such patients have been reported to include the diaphragm, sponge and condom .Those which contain spermicidal creams, foams or jellies are out of bounce. The last thing anyone with kidney complication needs is more chemicals in their system. Good news though! The cure is readily available.

Laparoscopic Nephropexy can be used to re-position the kidney. It is a surgical procedure. When floating kidney overcomes an expectant woman the doctor induces birth or recommends a caesarian section. The born one may then be placed in the neonatal intensive care unit. Here it is monitored in case of any complications. Other less expensive measures may be gaining weight or doing exercises that tighten the abdomen.

The world experiences 2.6 million still births annually. Africa ranks highest. The proliferation of this experience has to be diminished instantly. Pregnant women or couples trying to have children do need to understand the status of their kidney. In Kenya, there are 488 deaths per 100,000 live births. This is mainly because of infection, hypertensive disorders, and obstructed labor according to a research done by United Nations Development Programme. Mr. Twahir Ahmed, a kidney specialist at Parklands Medical Centre, agreed that high blood pressure, diabetes and urinary tract infections are the highest causes of kidney failure hence pregnancy complications.

Head of the kidney unit at Kenyatta National Hospital Dr John Ngige once mentioned that over 10 per cent of the entire Kenyan population have kidney complications with the majority being between 20 and 45 years .This is according to a report prepared by Kenyatta National Hospital. Well expectant mothers need to watch out for Nephroptosis among other kidney complications. Besides the Government launched a Maternal and Newborn Health (MNH) Road Map in August 2010.Thanks to this, user fees in all public maternity hospitals and clinics has been abolished. It is possible to deal with childbirth complications before they worsen.

“I feel lucky to be alive,*Cheptoo said smiling. Let us not wait to be lucky. Prevention is always better than cure.


PUBLISHED:http://issuu.com/nairobiaiesec/docs/cb5

HAT in Africa

The number of Human African Trypanosomiasis cases reported to the WHO has decreased by 77%. This is according to reports tabled by Dr. Pere Perez Simarro, the boss of the HAT Department of Neglected Tropical Disease at the World Health Organization (WHO) in Geneva since 2005. The Democratic Republic of Congo contributed largely to the percentage by recording a 65% decrease between 2000 and 2012.

Closer home, the people in Western Kenya can celebrate. Soon enough they will be away from the risk of infection. This is because by 2012 only 18 cases of HAT had been reported from the Uganda-Kenya border region. The economic resources invested in sleeping sickness patients or infected animals will be used on other development activities. This will raise the living standards of many. 

HAT is in two; Gambiense Trypanomiasis caused by Trypanosoma brucei gambiense and Rhodesiense Trypanomiasis caused by Trypanosoma brucei rhodesiense. Their significant reservoirs are humans and Domestic and wildlife respectively. The earliest cases were reported to WHO in 1998.Gambiense took 98% of the 36000 infections. In 2001, WHO joined partnerships with manufacturers of drugs to fight the disease .They also aimed at maintaining availability of the drugs. By the end of 2006, less than 10 000 cases were being reported in Africa. A meeting was held in Geneva in May 2007 which exposed greatly the feasibility of finding a cure to HAT. The talking was transmuted into walking after the WHO published its roadmap in 2011 towards elimination of the neglected tropical disease (NTD) by 2020.This was publicized during the London Declaration on Neglected Diseases in January 2012.

Now only 37.5 million people are exposed to Gambiense trypanosomiasis in Angola, Chad, DRC, Uganda, Sudan, Guinea, and Cote d’Ivoire. Rhodesiense trypanosomiasis is major in North Tanzania’s Serengeti and Ngorongoro reserves .It is also in South East of Uganda. It is finishing the wild and domestic animals. Sadly, Rhodesiense HAT complete elimination is not feasible yet.

The progress would have been faster were it not for the few challenges. 

Professor Theophile Josenando, director of the Trypanosomiasis Fight and Control Institute (ICCT), Angola, added that , “People will not win elections via trypanosomiasis so they want to involve themselves with other popular diseases.” These include Cancer and HIV.

Moreover, people in the some parts of Africa associate some diseases with witch craft so the ailing are abandoned or killed. Scientific negligence and disorganization among research institutions has made it harder to know the diseases and reach the infected.

However Dr. Grace Murilla, Deputy Director of Research, Kenya Trypanosomiasis Research Institute, said that the HAT situation was in control in Kenya. This has been achieved through advocacy.

“The impact has been effective and fruitful.”

She  explained that,

“The Antitrypanosomal medicines are affordable through donations from manufacturers. Geographical distribution of the disease is well known and limited. There are economic benefits from elimination versus control of the deadly disease.” 

She also spoke of the need to use of mobile technology to check prevalence of disease in Kenya. This will make it easier to get facts to present to the policy makers who “need convincing to invest funds.” 

The current tools and strategies have proven effective in progressively reducing prevalence of HAT. Better yet, new tools for diagnosis and treatment are in development. The Atlas of HAT initiative by WHO is a good example. It is a database implemented in conjunction with FAO to ensure progress of the elimination process. It also serves as the framework for checking quality of elimination process, monitoring impact, classification of villages according to cases reported and frequency and planning and controlling activities. The database is updated annually in terms of the geographical extent of the disease and population at risk.

The greatest ambition to eliminate Sleeping sickness can be attributed to the Nifurtimox -Eflorithine Combination Therapy (NECT) through WHO in 2009.

THE INNOVATIVE PARTNERSHIPS.

The International Monetary Fund (IMF) suspended support from Kenya in 1997 and 2001.This was due to poor governance policies according to research by Global EDGE, Michigan University, US. Recently, they threatened to stop the funding again. Is Africa ready for this? 
We run the risk of losing a lot but I am chiefly worried about scientific projects. This means that research on medicine, science and technology are at stake.

Shortly into the month of June, various organizations responsible for health-oriented innovations met to table their achievements over the years of partnership. It was interesting to find out how funds are being availed in plenty to these organizations. The Bill and Melinda Gates Foundation, for example, funded 70 000 US Dollars for the development of the Meningitis vaccine in June 2001. The disbursement of approximately $200 million under the Exogenous Shock Facility (ESF) of IMF can be another example. This was released to Africa in May 2009 to ‘provide policy support and financial assistance to low-income countries facing exogenous but temporary shocks’.

Well, are these innovation partnerships for the good of Africa or a banquet for the organizations to enjoy donor money?

THE HAT PLATFORM

This began in 2005 and now reigns in eight countries.
 “The initial beginners were Democratic Republic of Congo, Sudan and Angola which are the most affected by Human African Trypanosomiasis,” reported Dr. Augustin Kadima, the coordinator of the HAT platform in Democratic Republic of Congo.

The platform had to exist because “HAT is so neglected with little research, little treatment and diagnostic tools available,” Dr. Kadima added.

The seven years of work have allowed them to develop and implement the NECT Treatment.In 2000, over 25,000 cases of HAT were reported in Africa. By the end of 2012, WHO reported a 72.6% decrease in the cases. They have also provided fertile ground for anyone in need of research.

They established the shortcomings in the area being non-existent regulations, poor roads and lack of human resource, electricity and water.

THE LEAP PLATFORM

“LEAP was formed in a meeting in Khartoum in 2003 by Sudan, Ethiopia, Makerere University (Uganda) and Kenya (KEMRI plus Ministry of Health). Somalia has recently expressed interest,” said Dr. Ahmed Musa, the current chair of Leishmaniasis East Africa Platform (LEAP)

Their objective is to develop a strong clinical trial network. It is vital since Kala azar, in Horn of Africa alone, affects 30-40 thousand people annually.

They have managed to conduct consensus so as to prioritize needs of the affected people. This is made easier through use of clinical officers. These officers are trained at village level to enhance their efficacy.

“Some workers are sponsored to travel abroad for further studies and training,” he mentioned, as a form of capacity building.

They get international recognition through publications and conferences. This allows them to share experiences within the region.

The Gondar Ward in Ethiopia was renovated to a more spacious and modern facility. The previous one of tents was inefficient since the region experiences six months of rain.

A research and Treatment center in Arba Minah, Ethiopia.

They offer community service so as to gain popularity and trust from the people. This, if you asked the deputy director of Research of Kenya Trypanosomiasis Research Institute, Dr. Grace Murilla, is a good idea since “No one supports ideas unless they understand your agenda,”

 WHO accepted LEAP which helped to reduce the duration of availing SSG’s from 70 to 17 days. This has reduced the cost of the medicine.

“However maintenance of infrastructure and motivating workers to stay in endemic areas is still a problem,” Dr. Musa said in conclusion.

THE MVP PLATFORM

Meningitis has been a problem since 1948 but it was not until there was an epidemic in 1987 that Angola Chad and Ouagadougou met to discuss a MVP vaccine.

The Meningitis Vaccine Project availed the medicine at fixed price of 0.50$ per dose. Thanks to collaboration between MenAfriVac, PATH and WHO .This cost is affordable even to those who live under a dollar per day. The cases of Meningitis have since decreased from 188,345 to 28 805.The next big thing for this project was its acceptance by the president of Burkina Faso in June 2010 as the Godfather of the project. It is now implemented in 10 African countries. All these helped bring the new vaccine to the patients as presented by Dr. Mamoudou Djingarey as the coordinator of the vaccine introduction.

Countries like Uganda Kenya and Burundi are not within the MVP belt but they will be vaccinated by 2014.This assurance was voiced by Dr. Kadima. Dr. Charles Mgone, the executive Director of EDTCP added, “Northern Uganda, North eastern border of Sudan and Chad will be implemented as part of routine for 2016.”

They work with an accredited well known institution in India to develop these vaccines. . It takes 8-10 years to develop a new vaccine so they use polysaccharides non-vaccine serotype strategies are used to while awaiting a new vaccine, added Dr. Kadima.

ANDI (African network for Drugs and Diagnostics Innovation)

The acting director, Dr. Solomon Nwaka, mentioned that NIPRISAN (NIX-O699) has been developed for sickle cell anaemia in Nigeria.

Their centers of excellence (COEs) are pampered with fellowships, training and technical publication. They however have administrative, human resource and funding issues. They sought to have a business plan with European Union (EU) which will alleviate their standards. This will be discussed in the 5^th ANDI meeting from 1^st to 3^rd October 2013.There is hope.

On the whole, their presentations may have been a small scale representation of their achievements. I would rather settle on that idea because a platform like HAT that receives funding from close to 15 international companies can do much more. When the effort of every innovator is slight the general development of Africa will be slight as well. The funding will still flow in though but is the amount equitable to the rate of innovation in Africa?