Thursday, April 21, 2011

Fighting menstrual cycle, a deadly game

Lucy Maroncha

The menstrual cycle was treated as sacred in the years that I was growing up. Our mothers started looking at us like adults the moment we reported that we had started the menstrual cycle. We stopped playing with the younger girls because we assumed we were more mature and even more important than them. The cycle was christened many names by the adults: the woman's pride, the monthly prize, the feminine dignity and to some it was just referred to as the "monthly". There was a lot of pride in getting the menstrual periods but we never talked about it openly and only disclosed it to the closest of friends. 

But times have changed. While we used to get the cycle at fourteen years, today girls start as early as nine or ten years old, perhaps because of the changing diet or hormonal changes. The menstrual cycle is no longer sacred; no one shies off when other people know they are in the menstrual cycle. Some women even send their children to the supermarkets with sanitary towels among the top items in the shopping list, and there is absolutely nothing wrong with that!

The menstrual cycle has never been comfortable. That is a fact we all must appreciate. in a much as we were proud of it, though expecting it, even today, is not as exciting as expecting my payslip! it is accompanied by many discomforts. They range from backaches and stomach pains to headaches and nausea. There is also the discomfort of frequently visiting the bathroom and generally being wet.

Women have therefore sought to end the pain caused by periods by the use of different methods. Some of these methods have proven fatal but women still insist on them. Some years ago, women used to take six antimalaria tablets to control pregnancies as well as controlling menstrual cycles. Others would take four cups of concentrated black tea daily for a week. A woman would brave the bitterness of herbs, roots and leaves to control this discomfort. These methods are not medically proven although those who take them believe that they work.

The medical world in its bid to bring solutions and make humans more comfortable have also come with pills to control the cycle. One brand of oral contraceptives is tailored to stop the monthly cycle and is said to regulate it from monthly to quarterly. This lets users make the timing of the menstrual cycle more of a lifestyle choice that a natural occurrence. The users of this contraceptive are cautioned against the risks involved, which include blood clots, strokes and heart attacks. The users are also strictly cautioned against smoking. With all that caution, someone would imagine a woman would only use the pill when their lives are hanging on a string, but it is not so!

Human beings being who they are are known to be adventurous and take risks hoping nothing bad will happen. They abuse any product that comes their way even if the product is meant for good and end up with terrible repercussions. However, there are also other people whose bodies do not respond well with foreign agents in their bodies. This group of people ought to keep a safe distance from anything that is detrimental to their health, however attractive it may look. If its not medically proven that the menstrual cycle can cause a health threat, women should embrace it as natural and address it as ordinary. After all it takes only three days to most women.

Recently, a newly graduated African doctroral student, a user of oral contraception passed out and was flown to a hospital. On reaching hospital, she was diagnosed to have a clot on the neck. She wrestled with pain and pressure for three days before she passed on. The cause of her death was said to be severe side affects of the birth control she was using, which allows for the menstrual cycle only three times a year. Doctors described the oral contraceptive as one that interrupts life's menstrual cycle. Her relatives requested that their names, country or hospitals not to be used publicly to maintain privacy but advised women to be cautious of such medication.

This was a painful death which could otherwise have been prevented. In as much as people would want to ease their menstrual cycle, it is evident that some experiments can be fatal. There is need for deeper consideration and medical consultation before using any drugs. Women should also avoid short-cuts to what would be called happy life.

Perhaps one can use pain-killers for the three days they have pain during menstrual cycle rather than try to control it and end up in physical deformity or even death. Pharmaceuticals should also give thorough information about their products. It calls for everyone's responsibility since users should also not abuse a new product especially where health is involved.

Monday, April 18, 2011

When The Patient is Patient Medics get Impatient

In many hospitals medical practitioners have been accused of "treating" even before the patient finishes explaining what they are feeling. Listening to patients queuing patiently outside a pharmacy in a hospital in a Kangundo hospital with Eastern Province of Kenya recently, one could tell the anxiety yet see the patients' patients’ from the conversation they were holding. “The doctor did not even look at me" one said. “Before I could show him the swelling on my neck, he had already shouted, “Next!" interjected another one. Yet they queued on!

This conversation and many others of its kind leave people wondering if the medical practitioners  truly understand at all what the patients say or in their impatience they just treat from experience.
A person living with HIV has different complications in their bodies. Opportunistic infections are many and it is not unusual for the PLHIV to experience a new infection often because their immune system is already compromised. The medics need a little more patience in dealing with such people because in the process of "detecting it from far" they may ignore a symptom that is likely to prompt serious new opportunistic infections.

A recent episode in a hospital within Eastern Province of Kenya left a man widowed and a child crying for his dear mother. Regina (not real name), died as she was being rushed to a different hospital after the clinician dismissed her severe headache as "ordinary for people living with HIV". Her relatives, who did not want their names disclosed for fear of intimidation, said that they had taken Regina to the hospital with a severe headache. The doctor they found seemed to be in a hurry and according to her husband, “he barely listened to her". Headache is common to people living with HIV “he had said prescribing pain killers to the patient who was almost unconscious with pain.

A private doctor later explained to them that Regina was suffering from severe meningitis. She advised the family to transfer her to a hospital where she would be admitted immediately. She never made it. She passed on as her husband and son watched helplessly.

For a long time, medics have been accused of "knowing it all from experience." But in the HIV era, this has been proven wrong because of the many opportunistic infections which manifest in different ways. A recent interview with a medical practitioner revealed that sometimes the practitioners are overwhelmed with a lot of patients that they lack the patience. He said that if anything, most symptoms are similar especially for people living with HIV. He said that most hospitals have only two practitioners servicing throngs of people living with HIV. “If I have to see all of them, then I need to play my cards well" he said.

While his case is purely understandable, we all must appreciate that any sickness is a matter of life and death. Guess- work in this field can be more fatal than the sickness itself. It would be prudent, to attend to few patients and identify the sickness than see the throngs and give them wrong prescription. The gospel instructions for PLHIV are that any sickness symptoms should be addressed by a clinician as soon as possible. But a day long queuing, a doctor who does not even look at you, another queue at the pharmacy is so discouraging. There are other times when the patient can try asking a question and the medic retorts," are you going to listen, or you still want to argue" But the patient is ever patient, no wonder they are called patients!

Tuesday, April 5, 2011

Fight ignorance, kill stigma.

Fighting stigma of any kind has never been easy. It calls for extra boldness from the stigmatized person and more understanding of the one stigmatizing. However, those who have never been victimized think that it is easy. “I just ignore them and continue with my life!”, a friend once told me when I disclosed to her how my HIV positive status has caused me embarrassing moments. But when I narrated my story, she only shook her head and said no more.
When I moved to the city I got a good house within the estates. My next door neighbors looked kind and good. I thought it prudent to disclose my HIV status to one of them in case of emergency illness or anything that would have required my ART clinician. But word went round in the compound faster than I had intended. My intention was received with great indignation.
This Saturday was a pleasant day. I had decided to make myself a good meal and spend the whole afternoon making my house tidy. I bought chicken and wheat flour in preparation to coat the chicken in the oven. Of course the aroma was so attractive that a bachelor next door knocked and wondered why I was not inviting him for lunch.
“Welcome!”, I exclaimed ,of course happy that I would have company for the delicious lunch. I told him that I would signal him as soon as the food was ready. True to his word, he came as soon as I gave the signal but apologized that he would come with another friend since he had got an unexpected visitor. The food was more than enough so I embraced the idea. If anything, the other person would protect our single egos.
No sooner had I served my two guests than I heard a bang on my door. “We won’t watch you infect every man in this estate with AIDS!”. A woman threw open my door and menacingly wagged a finger at me. It was the wife of my second visitor. How she had known that her husband had been invited to my house remains mysterious. She upset the plates spilling all the food on us before dragging her husband out of the house amidst HIV related insults.
My afternoon had been spoiled but I would not take that lying down. The following day which was a Sunday found me in the local church where I requested to meet all the sisters after the service. My request was granted and I organized an impromptu seminar on HIV transmission and prevention. From the questions the women asked, I realized that ignorance reigned in their lives. I was so sorry that I had allowed myself to be upset by the previous day’s ordeal. The woman has acted from absolute ignorance. I sympathized with her instead.
I took another step and looked for her cell phone number and called her. She was still wild at me but agreed to meet me. We met at a restaurant and I offered a cup of coffee. I got a chance to explain to her that HIV is not a moral issue but a viral infection. She did not look convinced at first but gradually she got my point. A friendship ensued thereafter and she would accompany me whenever I had a motivational chat.
Today, she is a HTC counsellor. She had to train to understand HIV better. But it takes boldness to fight stigma, especially through public speaking. Extra strength is required to enable people to start living with HIV infected people without suspicion.

HIV knows no betters and makes all equal

I cried for several weeks and refused to be comforted. Nothing would make sense to me any more, Bob* was gone, never to come back. He left me with only a bunch of nostalgic memories.
He was more than a partner to me, we grew up and played together in the same village, went to the same school, his instincts detected what mine detected, his thoughts reflected my thoughts and we shared a journey of understanding and friendship. Bob was more than a brother to me. As we grew up, we shared stories about our secret lovers and developed a journal we christened "lovers diary".

After completing high school, Bob pursued law in Kenya's Nairobi University while I went for journalism. We remained very close to each other long after we completed our courses and started practising in our respective professions.

When I tested positive for HIV, Bob stood with me like a brother. He had long left Nairobi and was practising in Western Kenya where he was doing very well. Last year Bob and his girlfriend, Marie, visited me. He looked distant and was not in a hurry to run to the fridge for his favorite coke as usual. I knew something was wrong but did not expect what he disclosed.

We gave each other the pet names Sister and Brother Don't. We had got the names from the many warnings we used to give each other. "Sister Don't," he said, calling me by the pet name, "lets take a walk as Marie prepares lunch." I glanced at Marie for any signs of disapproval but the beautiful smile was evident; permission granted.
 "Sister Don't, all is not okay," he said while we walked, "I tested HIV positive but I can't go to the Comprehensive Care Centers, I am a renown lawyer and..."

"Stop it Brother Don't!" I interrupted, momentarily disgusted. I explained that this virus has nothing to do with profession, career or racial background. If anything, I pointed out, as a journalist I was more in the public domain than him. Bob was not convinced. He had not told another soul about his status, not even Marie. Numerous visits and phone calls that followed in my effort to help him bore no fruit.

He still clung to his pride and wondered what his collegues, friends and professors from his former university would think about him. On his death bed,early this year, he wrote me a note: "Sister Don't, remember our many don'ts. This is probably the last 'don't' I am giving you. Please don't disclose my status to anybody even after I have gone. I have been a very respected lawyer!" I was given the letter by his lawyer a day after he died.

No words could console me. Why would Bob die such a cowardly death? What pride was this that someone would cling to until the grave? I watched Bob's funeral prosession from a distance and when I went to lay my wreath, I collapsed and cried: "Why, why, Brother Don't?" Every time, I think or talk about Bob I find my self crying out aloud: "Why,why, Brother Don't?!"

*names, dates and locations have been changed to protect individual's privacy

Loliondo life-saving Drink: PLHIV beware risking ARV resistance!

The east African community recently woke up to a new dawn. A dawn of blessing and healing. What is more valuable than good health? This has been evidenced by the throngs of people pushing and pulling, kicking and wrestling in an effort to reach Northern Tanzania; the destination with the promise of life, and not only life but a healthy life. People have travelled even overnight from central and eastern Kenya to get a taste of the healing drink. Some by vehicle, others by flight and others on relatives' backs! Its traumatic even to reach there, leave alone getting the drink itself.

Enter Mzee Mwasapile from Northern Arusha in Tanzania. God has spoken to him about some herbs which experts say may be deadly but Mwasapile and the faithful behind him are fully convinced that it can heal. Some have disputed this message with hospitals suggesting that this miracle healer has "robbed them of their patients." Dr. Julius Mbuya of Arusha's St Stephen's hospital recently said that some HIV positive patients have gone to him after neglecting their ARVs, lamenting that the drink did not work.

Mzee Mwasipire is a busy man. According to him the medicine cannot work unless he serves it himself and from where he lives. From his little mud-hut hygiene is not guaranteed. Though the medicine is boiled fully, perhaps to produce the desired color, there is a threat of more infectious sicknesses than Mwasipire can heal. Mwasipire serves thousands of thousands of people every day. TB is airborne and as people are scrambling for this drink (remember they are patients) there is a possibility of TB transmission.

The Tanzanian government had earlier this month suspended this drink until it has been tested in the government laboratory. The suspension was later rescinded due to a pubic cry of demand. But the government ought to consider the effects of those on ARV treatment stopping their treatment and taking the drink instead: failure to adhere to ARV treatment may lead to drug resistance. People living with HIV and using ARVs should be aware of these facts before they gamble their lives with this drink. In conjunction the government should intensify drug adherence seminars lest this life saving drink turn to be a slow killer.

The hygiene involved in the serving of this drink is also really wanting.The cups are metal and no one is clear if they are well washed while serving this drink considering the thousands of people thronging the service venue. I would advise this healer either to seek reinforcement from some donor or the government of Tanzania to buy disposable cups or to hike the price of the drink in order to purchase the cups. If this does not work, perhaps a patient can come with a bottle or some other container to get the fill! Whether this drink is medicinal or poisonous, the beneficiaries have a tale to tell.

All in all this miracle drink has opened the eyes of many at how desperately people can desire their lives. I wish people were more eager to adhere to ARVs as they are to reach this drink which is not even medically proven yet. As an adherence counselor, I would be very glad if this drink did work for people living with HIV, but the reality is that it is likely to cause deaths which could have otherwise been avoided.

What happens when donors bid farewell?


"ARVs are now free in most health facilities!" That was too good to be true. Many people had died poor after selling all their property to buy anti-retroviral drugs (ARVs) Kenyans would cross the border to the neighboring country, Uganda, where there was medicine albeit at a very high price. What news would then have been more welcome than the announcement that the medicine was now free and available in most health facilities in Kenya! There was also a nutrition pack available which the local community had christened 'care' and there was free civic education on HIV.

But recently, the National Empowerment of People Living with HIV/AIDS in Kenya (NEPHAK) revealed rather disturbing news: there is an acute ARV shortage in Kenyan health facilities. The news was as frightening to patients as the first time they knew their HIV sero- positive status. In an effort to enhance treatment adherence, health providers had pointed out the repercussions of skipping the medication or failing to take the medicine at its right time. The consequences included drug resistance and subsequent death. With that in mind, the ARV beneficaries were required to get a guarantor to ensure that they never defaulted. They followed the prescription to the letter principally out of fear of the repercussions.

 The civil society group, led by NEPHAK's head, Nelson Otuoma, held a demonstration last week to protest at what they called the government's denial of the ARV situation in Kenya. To resolve this the protesters asked the government to create a trust fund for HIV treatment, should funds from donors dry up.
Agreeing with Otuoma completely, what this group was asking for is something that should have been done the moment HIV was declared a national disaster. But the notion put forward by the government was that HIV treatment was free. I am fully convinced that this service was not free but someone, a body or an organisation was meeting the staggering bills. ARVs are an expensive type of medication. In this case 'paid for' would be a more appropriate word than 'free.'

This situation reminds me of a folk tale where a fox and a man were partners in a farm. The man would dig and plant while the fox was tasked with chasing away the birds and other animals as the crops grew. After every harvest, the farmer would spare some grain to plant in the next season while the fox cleared his granary, so sure that man would plant. Come one season the man got wiser and declared an immediate termination of the partnership, and the fox died of starvation (maybe a few foxes demonstrated in protest).

Like the fox, Kenya perhaps relaxed and was sure that the donor would provide so no emergency measures were taken for the day the giver may not arrive. There are many HIV and TB related organizations that are donor-funded in Kenya today. My wish would be that they learn from this threat and start laying strategies on life after the donor. The ARV situation in Kenya is not a laughing matter, so many lives are threatened! Scrapping off the lessons of adherence seminars from those who have received them may require serious civic education. To tell someone they can live without ARVs after the stern caution that skipping a day may be suicidal will not be easy.

I would suggest that we be ready for the day when we need to be self reliant. Kenya does not need to be under duress from demonstrators to meet their own responsibilities! Exit the donor, enter the government of Kenya to save its population from mass deaths. Someone should help Kenya in management: Kenya is a resourceful country, we can't watch people die in their thousands because the donor has left. People living with HIV (PLHIV) should also start farming and supplementing what the HIV nutrition package offered.
Let us all be ready, when the proverbial goose that lays the golden egg dies, we must continue fending for ourselves and save a population. The next generation should not find a country demonstrating because the donor has left but a country well sustained and able to protect the pride of its population.

Tuesday, March 22, 2011

WHY WE PAY SEX WORKERS ………clients speak

Men are curious and generally love adventure. This statement was not foreseen as the interview with sex workers' client started. The Network of Journalists living with HIV (JLWAH) had embarked on interviews to find out why sex work is on the increase despite HIV and STI upsurge in the country. The JLWAH, Kenyan chapter, has been carrying out  interviews in a bid to reach the clients and educate them on transmission and prevention of HIV and other STIs.

But the clients interviewed had various reasons why they go out to “buy sex”. A client who sought anonymity for fear of prejudice said that he has been married for the last eight years and has had more sex with the sex workers than his wife. He lamented that his wife is ever on board, a flight. He noted that she is either in a workshop out of the country or she is busy preparing for a meeting.  “We hardly have time as husband and wife!”

But this was not so with yet another who said that he derived pleasure from “violent and angry sex” He confessed that whenever he is annoyed or distressed, he gets cooled down by having violent sex. This, he said, he does during the day time to avoid suspicion from his wife whom ironically he called an angel. Having been married for three years, the man pointed out that there are things he cannot do to his wife. He noted that he likes it when he beats the girl and roughly has sex with her before banging the door leaving all his stress and anger behind.

The father of one said that he has never had unprotected sex adding that he was surprised that most sex workers carried their own condoms and opted to put them on their clients. This explained the role of many organizations in Kenya in educating sex workers on safe and correct condom use. He said that the sex workers did not mind his violence but were very cautious that the condom does not burst and he pays his bill!

The spotlight indicated that most clients are married men and pay better than the single, young men. An unmarried young man was categorical that he was fond of paying the female sex workers because they are less expensive. “A wife is very expensive and offers very little,” he lamented.

He expressed that his involvement with female sex workers is non-committal. He noted that he can do away with a girl anytime he wished. He also pointed out that he opts to have different women who play different roles for payment. These roles, he said, included having sex, warming him on a cold night, or washing his clothes and cooking for him. All these are roles that a wife would do but “charge” more expensively in the name of upkeep. “Whenever I pay a sex worker, it is none of my business where she takes her money, she can buy food or have a hair-do for all I care!” he said adding that that is not so with a wife. He noted that for a wife you need to buy her clothes, feed her and meet all her other needs.
Female sex workers interviewed on violent men said that they did not mind as long as the man paid for whatever service.