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Gender-based violence affects people around the world and is rooted in gender inequality. Anyone can become a victim and survivor of GBV: women, men, girls, boys, of every age and background. While there are a lot of approaches employed to address GBV cases by third parties(e.g health workers and law enforcers); people in the community should also be empowered to effectively respond and ensure that they are properly protected.

This user guide, therefore, aims to provide best practices in responding to GBV for communities. Click on the link below to download.

Hypertension; otherwise known as the silent killer often carries no symptoms nor warning signs but can drastically increase your risk of having a heart attack or stroke.

Mental health conditions like depression and anxiety could lead to hypertension. However, hypertension can also lead to depression and anxiety; a fact that is rarely addressed.

Being diagnosed with high blood pressure can cause a lot of profound emotions including immense stress. This can take an emotional toll and affect a person’s outlook, making him or her more susceptible to anxiety and depression. Consequently, a person’s behaviour including adherence to prescribed treatment can be negatively influenced. Needless to say, this would lead to poor control of the blood pressure and a vicious cycle quickly develops.

Psychosocial support needs to be factored in when caring for hypertensive people. Stress management has been demonstrated to greatly reduce the risk and complications of severe blood pressure.

Getting enough sleep is one great way to reduce stress. Inadequate or poor-quality sleep can negatively affect mood, mental alertness, energy level, and physical health.

Relaxation techniques such as meditation, progressive muscle relaxation, deep breathing exercises, and yoga are also powerful stress-busters. Learning these techniques can greatly help a hypertensive patient deal with stress.

Aside from that, regular exercise helps people to feel less anxious and more positive about themselves. When your body feels good, your mind often follows and your blood pressure stays in check.

Watching one’s diet is another important habit because its benefits extend beyond the waistline. A well balanced diet rich in fresh fruit and vegetables lessens the effects of stress, builds up the immune system, improves mood and lowers blood pressure.  

Finally, hypertensive patients need to be encouraged to socialize. Isolation is dangerous and can lead to a feeling of loneliness which complicates stress. It is important to connect by spending time with dear ones. This is a natural way to calm down and lower stress. When you connect with people in person, your body releases happy hormones that counter the fight-or-flight response caused by stress.

No doubt, good mental health can have a significant positive impact on blood pressure control just as much as well controlled blood pressure can contribute to good mental health.

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If you have not yet been infected, then you have definitely been affected by COVID-19.

Everyone is dealing with the so called new normal thanks to the pandemic. It means different realities to different people across the world as it continues to wreck havoc on lives since 2019. For some it has resulted in a numbing effect while for others it mimics daily addition of salt to a raw wound.

Many people have found great opportunities with this disaster but for many others it has marked huge losses, pain and disappointment. Whichever the case; the risk of poor health remains high due to the great level of uncertainty, scarcity of resources and stress. Therefore; it is important now more than ever to guard your wellbeing.

The combination of the direct effects of the disease on individuals and their families, and the indirect effect on financial security, unemployment and social isolation has led to an increase in emotional and psychological challenges worldwide. Lockdowns around the world have led to an increase in domestic violence cases as the victims are restricted to stay in the same place as their perpetrators, with no escape. Stigma and discrimination against persons who have tested positive for COVID-19 is another major source of distress, in addition to several already existing physical and mental health issues.

Worry, stress, loneliness, anxiety, depression, insomnia, harmful substance use, self-harm or even suicidal behavior and other emotional responses are to be expected during such times of instability; And; for those already suffering non-communicable diseases like high blood pressure, diabetes, cancer and mental illness, the extra pressure serves to exacerbate their conditions.

An additional challenge is that physical distancing regulations make it more difficult for many to access appropriate healthcare services. On the other hand; with the focus on bringing the pandemic under control, some local health facilities have been converted to COVID-19 care centres leading to deprioritization of non communicable diseases.

Self care should be a priority now more than ever. Taking basic steps to safeguard your health during these unprecedented times does not have to be complicated.

Start by being deliberate about the information you pay attention to. It is good to stay up to date; however, excess in the form of constantly changing alerts, continuous social media updates and mainstream media coverage if poorly managed can lead to infomania hence panic, paranoia as well as feeling overwhelmed despite the urge to want more. Screen sources for facts and relevance to your own reality before paying too much attention to them.

Know and practice self awareness. While there are various tips for looking after one’s health during this pandemic; not all would work for everyone and it is important therefore to realize what would work for you as an individual. Excessive pressure and uncontrollable stress even with good intentions only leads to triggering or exarcerbation of health problems. You cannot control and manage everyone and everything but you can be intentional in making choices that would promote your own physical, mental and emotional health. 

Physical activity will keep your health in check. Step out and appreciate your environment. Take in a deep breath of fresh air and enjoy feeling it go through your nose into your lungs; let go of stress as you exhale. Challenge yourself to at least 30 minutes daily of exercise that makes your heart beat even a little faster and your body sweat. Regular exercise has a profound positive impact on non communicable diseases as it relieves stress; improves memory and immunity; helps you sleep better; and boosts your overall mood.  

Eat and hydrate well. Avoid excess of anything. Do not skip meals in the name of losing weight. Observe that your diet has at least protein, vitamin and carbohydrate. These can be locally available foods therefore don’t need to be costly. Avoid smoking, excessive alcohol and any other psychoactive substances because they increase the risk of non-communicable diseases which in turn affects your life expectancy.

Get a good night’s sleep and speak to your family physician if suffering insomnia. Good-quality sleep makes a big difference to how we feel. Try to maintain your regular sleeping pattern and stick to good sleep practices such as avoiding screen-time in bed.

Maintain positive social connections as part of your self care. Building stronger, broader social connections in your life including with family, friends and other associates can increase your feelings of happiness and self-worth. Constant meaningful communication and a practice of genuine empathy goes a long way in achieving this.

Be kind to yourself. Taking time just for you, even if it is just a few minutes to retreat and just sit.  Pay attention, listen to your body and respond to it. Be intentional in assigning standards and value to yourself and do not beat yourself too much over other people’s opinions of you. Remember, not everyone might be genuinely caring or having the same perspectives as you. Others may also have their own challenges to deal with including a lack of empathy. Plan your breaks and use them to do something that makes you feel calm and happy such as a hobby or pursuing a new interest.

Know that it’s normal to have ups and downs in life. Talk about how you’re feeling with someone you truly connect with and trust. They could be experiencing similar feelings and sharing would be of mutual benefit. They could also lend a listening ear as you pour out your heart and in the process you could gain new insights. Remember that a problem shared is a problem halved.

Finally; but not the least; keep in touch with your family physician. Get regular checkups and check-in frequently to ensure that you remain physically, mentally and emotionally healthy.

Your health is your most valuable asset; make it a personal responsibility to guard it jealously and give it the attention it deserves. 

Motherhood should be a step in ascending the ladder of growth and development rather than a source of poor mental health.

Teenage mothers or mothers to be are at high risk of depression which is the leading cause of death among young people aged 15-49 years; a bracket that holds many teenage mothers. It also increases the risk of suicide by 20%. Though the prevalence rates vary in different countries (14-23 %); the consequences are dire across the globe affecting both mother and child; more so during the recent unprecedented crisis in mental health occasioned by the COVID-19 pandemic. On the other hand, depression among teenagers is a predisposing factor for unplanned pregnancy due to the increased risk of psychoactive substance use and abuse including Gender Based Violence.

A vicious cycle therefore exists between depression and teenage pregnancy.

The variation in prevalence across countries depends on social determinants such as cultural and religious beliefs; socioeconomic status and individual risk factors such as genetic predisposition, co-morbidities, previous history of mental health conditions, psychoactive substance use, poorly managed stress, physical and emotional abuse, diabetes, thyroid disease, complications during pregnancy, negative thoughts about motherhood and quality of relationships.

Consequences of depression in teenage pregnancy affect both mother and child. Symptoms can occur before child birth(antepartum) or after (post partum). Antepartum depression occurs during pregnancy and is characterised by sleep and appetite changes, mood swings and excessive worry. A lot of these symptoms are easily confused with the normal changes experienced during pregnancy. It is therefore beneficial to maintain close engagement between the mother to be and a health professional. Antepartum depression causes miscarriages, increases risk of high blood pressure, diabetes, suicide and homicide. Additionally, mothers with chronic illnesses easily falter on the consistency of their treatment and follow up appointments when depressed. This predisposes them to complications which can also affect the unborn baby negatively.

Post partum depression refers to sadness, anxiety and exhaustion that lasts more than 2 weeks after childbirth. Mood swings, changes in dietary and sleeping habits, difficulty in decision making, difficulty in bonding with baby, suicidal thoughts and anger characterise the condition. It is the commonest mental health problem for new mothers with a prevalence of about 15%. It can start during pregnancy or after (perinatal depression). This condition predisposes to neglect of the new-born as the mother may not be interested in bonding with, feeding the baby nor honouring the mother and child clinic appointments. The end result is malnutrition, increased risk to childhood infections and slow development which may affect learning ability, behaviour and metal health conditions later in the baby’s life.

Teenage mothers should be closely followed during the antenatal clinics to screen for risk factors for depression and measures including psychotherapy put in place to avert the dangers. They should be encouraged to be deliberate about remaining physically active; observing good diet and sleep habits (e.g sleeping when the baby sleeps); avoid psychoactive substances; keeping in touch with family and friends; asking for help when in need and positively managing stress.

 Full blown symptoms of depression are treatable to allow one live a normal life.

Teenage mothers and mothers to be deserve the best mental health care. This will not only ensure their safe navigation of the motherhood milestone but also that the next generation thrives since the mothers will diligently prioritize wholesome health for themselves and their young ones.

Thriving during this milestone should be the norm rather than the exception.

Let us all take stock of reality and invest in the wellbeing of our teenage mothers and mothers to be as a means to avert depression and give them and their babies a better chance at life. Incorporating prevention into our national health and education programs would go a long way in saving lives and promoting happy motherhood experiences.

It is a shame that Gender based violence has been normalized in our society.

Approximately 1 in 3 women and an unclear number of men are affected by GBV globally. It can be economical, physical, emotional or psychological. Anyone can be a victim or perpetrator of any form of GBV but intimate partner violence is the most widespread. Many a time the physical form is talked about because it is the most apparent; however; all forms of GBV through action, word or omission are equally damaging and should stop.

It is a global pandemic that ravages and forces victims to subordinate to the perpetrators resulting in impaired physical and mental health; stress; anxiety; loss of self-esteem; demotivation and depression. This in turn interferes with victims’ ability to reach their full potential; participate in economic activities or engage meaningfully in other life interests. It causes stigma and affects reputation. In fact, research has shown that sexual harassment claims have a greater effect on a company’s reputation than other forms of misconduct like fraud. For instance; allegations of sexual harassment by senior staff and drivers at the ride-sharing company Uber resulted in 56% of survey respondents refusing to use their services. In another example, allegations of sexual abuse and misconduct by construction workers on a major Ugandan infrastructure project resulted in the World Bank cancelling $265 million worth of funding and issuing a public statement.

The ultimate result of GBV if poorly managed is often the damaged goods syndrome which directly affects individual productivity.

A person with this syndrome believes they are no longer good enough nor worthy due to the negative effects caused by GBV on their self-esteem. This warps their expectations of anything good coming their way and in fact will often not accept it fully. Self-sabotage and/or harm is rampart in people suffering from this syndrome. It is not uncommon for them to even blame themselves for abuse experienced.

The casual or negative response to concerns raised about GBV in society contributes to survivors deteriorating to this syndrome. They are left feeling that they are making a big deal out of nothing. It is fertile ground for not only health complications, economic losses but also the all too familiar societal norms that lead to re-experiencing of GBV or attempts to cope through channels like substance abuse; and the cycle continues.  

Let us improve our attitude to this issue and take a more serious stance.

Rather than rationalizing in favour of perpetrators of any form, give the victim the attention and support they deserve. Listening with empathy, encouraging and guiding them to get health and legal help goes a long way. In some instances you may need to step in and be their eyes, ears, voice and do a lot of care seeking on their behalf. Remember that anyone can be a victim or a perpetrator of GBV.

Let us rally behind legal frameworks like the globally recognized standards for addressing violence and harassment set out in June 2019 by the International Labor Organization (ILO). They increase accountability from organizations through a more comprehensive way of responding to GBV including taking steps to prevent violence; to protect survivors through remedy and compensation; and to develop awareness raising, reporting and grievance procedures.

Identifying potential risks, leadership commitments to diverse, equal, and respectful workplaces backed by adequate resources would form a foundation to tackle root causes like gender inequality and mistrust amongst staff. Without this foundation, efforts to raise awareness can appear tokenistic and lack legitimacy. Clear policies and procedures including reporting and grievance mechanisms not only empower staff to take appropriate action when needed, but also reassure survivors, accused perpetrators, and whistle-blowers that the organization will handle cases effectively.

It is not an easy issue to tackle, but we all can deliberately take norm-shifting initiatives within our circle of control. We have a lot to gain, including improved overall performance, productivity and retention thanks to good mental health.

Dr Jeldah Nyamache,

Gender-based violence (GBV) is a widely known problem that is mainly perpetrated by men, and community members and individuals who tolerate negative masculinity. Men have also been victims of this scourge perpetrated by women.

But although numerous efforts have been put in place to fight GBV with women’s empowerment being one of the key approaches, one approach missing in most communities is a focus on engaging men to challenge norms of masculine behavior and support gender equality. Although ending GBV has proven to be a daunting endeavor, given that it means challenging gendered power divisions and cultural norms, this is an approach which could be a helpful contribution to eliminating GBV.

Ending violence in our communities is a responsibility of the whole community and it is significant that men and boys are active participants and promoters of change to get rid of the current status quo. On the same scale, it is also critical to combat not only the individual instances of violence, but also the systemic forms of violence, as violence does not occur in a vacuum but rather in a society that condones and encourages it.

GBV that is directed at women and girls by men, results in large part from women’s subordinate status in the society due to traditional and cultural norms, as well as their low economic status and serves to perpetuate male power and control over women. There is also ample evidence that gender inequality and the resulting economic deprivation and dependency are fuelling gender-based violence.

In order to achieve economic, social and development goals such as the SDGs 2030, individuals, government and civil society need to build a more gender equitable society with healthier gender roles for women and men. To be effective, strategies must not only empower women, but also should engage men and bring about significant changes in men’s attitudes and practices which are often discouraged by negative notions of masculinity. It is common among many communities for women and children to be subjected to gender-based violence and other forms of violence which include, harassment and harmful traditional practices such as female genital mutilation.

It is important to note that there have been numerous deliberate efforts to address this problem. These efforts have largely used women themselves as agents for change. However, multiple researches show that such an approach has not borne desired fruits as GBV continues to affect many communities.

As a result, many changes are being made such that gender transformative programs are now taking into account the involvement of men and boys in ending patriarchal norms, gender inequality and GBV. There are now a lot of programs promoting positive engagement of men in positive parenting.

Evidence from researches has proved that working with men and boys to challenge toxic masculinity and gender inequality has a positive impact in improving the health and wellbeing of women and children, and men themselves.

Achieving gender equality and ending gender-based violence is a societal responsibility that must fully engage both men and women. For many years, women have led efforts to prevent and end violence, and today more men are adding their support to the women’s movement. Men have a crucial role to play as fathers, friends, decision makers and opinion leaders, in speaking out against violence against women and ensuring that attention is given to the issue. Importantly, men can provide positive role models for young men and boys, based on healthy aspects of masculinity.

Dr Jeldah Nyamache

On May 31^st, the world marked the World No-Tobacco Day. This is a day dedicated to create awareness on the dangers of using tobacco with the aim of getting more people to quit the dangerous habit. But this is a conversation that cannot be undertaken once in a year. It is one that must be continuous to ensure more and more people get to stop the dangerous practice. Allow me to therefore give you a not-so-gentle reminder of why you need to quit smoking.

The dangers associated with smoking are well known. In fact, if you smoke, you have likely heard the pleas from friends, family and health professionals to quit. You probably know that smoking makes heart disease, stroke, cancer, emphysema, chronic bronchitis, and other killers more likely. You might even know that smoking is the number one cause of preventable death in the and worldwide.

But knowing about long-term risks may not be enough to nudge you to quit. It can be hard to feel truly frightened by illnesses that may strike decades later. And quitting smoking is hard, no doubt about that. In fact, some people don’t see the point in quitting because they have been smoking for so long. However, it is important to note that it is never too late to stop smoking and improve your quality of life.

There are many benefits of quitting smoking and one that many are probably already aware of is that you have a chance to increase your life expectancy once you quit smoking. Tobacco products contain dozens of dangerous chemicals that make you more prone to potentially fatal illnesses. If you smoke, you have a shorter life expectancy than non-smokers. If you quit, you can extend your life expectancy—and the sooner you do it, the more years you may recapture.

A study conducted in 2013 by the Centre for Global Health Research and published in the New England Journal of Medicine, shows that people who quit before they turn 40 lower their risk of dying from a smoking-related cause by about 90%. At 50, people can regain six years of life expectancy. At 60, it’s three years. If you have a heart attack related to smoking, you can cut the chance of a second heart attack in half if you quit.

For those who love doing exercise need to remember that smoking has been proven to limit one’s fitness levels. You become out of breathe easier and quicker, making any physical activities much harder. In fact, some smokers feel out of breath from simply walking up the stairs. But within 10 months of quitting, your lung capacity will start to increase and in the process improve your breathing abilities.

On the same note, you may be interested to realize that quitting tobacco smoking improves one’s sexual life greatly. This is because it improves your blood circulation, which increases sensitivity, leading to a happy sexual life. Studies have also shown that non-smokers are three times more appealing to a prospective partner than smokers.

But aside from these benefits that come with you quitting smoking, it is also important to note that if you stop smoking, you’re not only protecting yourself. You’re also protecting those around you, including your loved ones. This is because breathing in second-hand smoke has been proven to increase the risk of lung cancer and heart disease by 24% and 25% respectively – in children and adults. Studies have shown that children in specific are most at risk from second-hand smoke because they breathe faster than adults and therefore take in more of the harmful chemicals in cigarette smoke.

Despite all of the excellent reasons I have highlighted to quit smoking, I understand that kicking the habit is no easy task. However, this means that the pride you feel after quitting successfully is even more satisfying. So, take it upon yourself, make it a deliberate effort to stop the bad habit for your own sake and that of your loved ones.

Dr Jeldah Nyamache,

Over the recent few months, incidences of Gender-Based Violence (GBV) have been on the rise Kenya and the world at large. It remains to be one of the most wide-spread acts of violations of human rights violation and which has been further exacerbated due to the COVID-19 crisis.

Statistics show that one in every three women or 35% of women around the World will experience some form of violence during their lifetime. These acts have proven to know no geographical or cultural boundaries as they remains wide-spread across the World; it’s a global crisis! Worthy to note is that the endemic nature of gender-based violence especially that against women and girls is rooted in structural gender inequalities and discrimination. All forms of violence against women and girls are interconnected and have common root causes.

GBV takes place in different forms including domestic violence, sexual assault, and female genital mutilation. Women from marginalized communities especially those from poor backgrounds are more likely to experience it with most of it coming from their husbands and partners. It is a culture deep-rooted in the gender inequality and stereotypes that women have been subjected to for ages- since time immemorial with most believing that violence against women and girls is normal and acceptable in the society.

This is the case in many cultures where violence towards girls and young women is accepted as a social norm. This must be challenged as a matter of urgency, and the blame, shame and stigma faced by victims must be eliminated. This thinking has made violence towards women become one of the most widespread injustices and violation of human rights with long-term harming effects on the lives of women, their communities and societies at large.

GBV remains to be one of the biggest barriers towards social, political and economic development in the world. It not only devastates the lives of women and divides communities but also undermines development efforts and the building of just and peaceful societies. Women get locked in poverty and are unable to exploit their freedoms and rights fully, some of which are inherent.

Efforts towards ending violence over the years have focused on the survivors of these acts but don’t seem to look into the root causes at all- which happens to be mostly cultural. Bias against women and girls, in most instances; starts at a very young age. Female children the world over begin experiencing sexual and physical violence at the hands of boys and men they know well before they become adults.

These experiences have damaging impacts on their mental and physical health as well as their likelihood of continuing to experience violence into adulthood. In most societies, for instance, women have been perceived as lesser human beings. Small girls face more punishment for mistakes at home while boys would more often get away with much under the disguise of them being boys. Discriminations against women and girls most times leads to violence against them. Societies with a higher degree of equality experience lesser acts of violence against women and girls.

On the same note, the culture of girls being held responsible for the violence that happens to them needs to stop. Violence is the sole responsibility of the perpetrator, who must be held accountable according to national or international legislation. Fear or threat of violence must not restrict girls from living free and full lives, or from realizing their full potential.

More work therefore need to be done at this early stage in life in dealing with violence against women by educating and promoting respectful relationships between young boys and girls and cultivate a culture of mutual respect, gender equality and responsibility. Public policies which often overlook this critical stage need to relook at this critical stage of life where cultures, values and norms are nurtured.

It is time for all stakeholders including women, women, civil societies, government officials, religious groups and policy makers to step up efforts in addressing the biggest distraction towards ending this widespread injustice against women. It is time for the world to challenge the deeply-rooted unjust cultural norms that encourage men’s control and power over women and that further encourage tolerance for violence against women.

Dr Jeldah Nyamache

There is a reason why your doctor will always test your blood pressure every time you visit them, regardless of the complaint that brought you there. Rightly known as ‘the silent killer,’ high blood pressure often carries no symptoms or warning signs but can drastically increase your risk of having a heart attack or stroke.

While it is widely known that some mental health issues like depression and anxiety could lead to one being hypertensive, it is the reverse situation that is rarely addressed. Just like patients with other chronic conditions, the knowledge of one having high blood pressure can cause immense mental challenges. It can take an emotional toll, affecting your outlook and making you more susceptible to mental issues like anxiety and depression.

Hypertensive patients experience many profound emotions which increase their risk for the development of mental health disorders. Imperative to the management of hypertension is the need for patients to adhere to medicinal and non-medicinal therapies and these negative emotions may also adversely influence their adherence behaviour towards these therapies.

It is therefore important that the aspect of mental health awareness and management is factored in when it comes to administration of hypertension therapies. Ignoring this aspect can only lead to a worse situation.

No doubt, high blood pressure is a dangerous condition and could be fatal. However it is important for patients who have been diagnosed with hypertension to be made aware that with adequate treatment, one can get their blood pressure under control and protect their heart and mental health. Having high blood pressure doesn’t mean that one is destined to die of a heart attack or stroke.

It is important that mental health issues such as stress, depression and anxiety are managed. Stress management in particular is one often overlooked strategy is managing stress. Stress management has been demonstrated to greatly reduce the risk of severe blood pressure and is therefore important to always be addressed.

Getting enough sleep is one great way of reducing your stress levels. This is because inadequate or poor-quality sleep can negatively affect your mood, mental alertness, energy level, and physical health. Getting sometime on the bed can therefore relieve you of some pressures in the mind.

Relaxation techniques such as meditation, progressive muscle relaxation, deep breathing exercises, and yoga are also powerful relaxation techniques and stress-busters. Learning these techniques can greatly help a hypertensive patient deal with stress and be able to manage their situation.

Aside from that, regular exercises is also a great way to relieve stress. People who exercise a lot tend to feel less anxious and more positive about themselves. When your body feels good, your mind often follows and your blood pressure stay in check.

It is also important for hypertensive patients to be trained to watch over their diet which has a direct relation to the mental health. The benefits of eating health foods extend beyond your waistline to your mental health. A healthy diet can lessen the effects of stress, build up your immune system, level your mood, and lower your blood pressure. Lots of added sugar and fat can have the opposite effect. And don’t forget that junk food can seem even more appealing when you’re under a lot of stress.

Finally, hypertensive patients need to be encouraged to socialize. Isolation is dangerous and can lead to a feeling of loneliness which complicates your stress situation. It is important for to connect with people by spending time with friends or family members. This is a natural way to calm you and lower your stress. When you connect with people in person, your body releases hormone that stops your fight-or-flight response.

Hypertension in itself is life threatening, but it can be worse if mental health challenges associated with it are not addressed. It is therefore important that hypertension therapies include managing mental health challenges.

Dr Jeldah Nyamache

The month of April has been recognized as the Stress Awareness Month since 1992. The purpose for this is to raise awareness about stress, learning to cope with our stress and finding healthy ways to deal with these situations. A major reason that led to this recognition is that stress is one of the health issues that does not get the attention it deserves. Despite it being the most common challenge, it is one that is often ignored as one that can lead to greater mental problems.

But what exactly is stress? Simply put, stress is the body’s response to a challenge or demand. Everyone experiences stress, which can be triggered by a range of events, ranging from small daily hassles to major changes such as increased workloads, illness, accidents, problems with relationships, family, money or housing. Even seemingly small daily hassles like someone pushing in a queue can make us feel stressed. The stress response includes physical components such an elevated heart rate and blood pressure, thoughts and personal beliefs about the stressful event, and emotions, including fear and anger.

While stress is not a psychiatric diagnosis, numerous research have shown that it is closely linked to our mental health as it can cause mental health problems, or make existing ones worse. For instance, if you often struggle to manage feelings of stress, you might develop mental health problems like anxiety or depression. Admittedly, it is impossible for an individual to completely avoid stress. However, is t critical that we are able to manage our levels of stress to avoid even worse mental health problems as a result.

There are lots of ways to manage stress or help anyone who is stressed. The first thing is to try and identify the underlying causes of your stress and tackle them. Great way is to sort the possible reasons for your stress into three categories; those with a practical solution, those that will get better given time and those that you can’t do anything about. Try releasing the worry of those in the second and third groups and let them go. Avoiding the problem entirely may make the situation worse.

However, often it isn’t possible to change a situation and prevent stress. But, there are many other ways to help control it, and stress management may be effective in improving general health. Talking to someone you trust is one of the best ways to relieve stress. Talking things through openly with someone we trust can help us see things differently and find new solutions. Even just knowing that somebody is there to listen can make a huge difference. Giving someone who is feeling stressed your time and undivided attention is one of the best things you can do to support them.

Taking a break is also a perfect way to relieve yourself of stress. In the current fast-moving world that calls for multi-tasking, we endure increasing tension both at work and home. As we struggle to accomplish more in the same amount of time, we often eliminate breaks from our work schedule. However, research indicates that short, frequent breaks actually help us get more accomplished by reducing stress and helping us concentrate better.

Further, it is important to avoid as alcohol and drugs as a means of dealing with stress. While this may seem to help, they can create additional problems and increase the stress you are already feeling. On the same note, it is crucial to generally take care of your physical health. Healthy eating, enough sleep and regular exercises have been proven to improve your state of mind when faced with stressful situations.

Over and above, it is important to recognize when you need more help. If you try by yourself to deal with your stress but still find it difficult, it is important to seek professional help from a psychologist or counsellor who can help you out.

As we mark the Stress Awareness Month therefore, make it personal priority to be wary of our stress levels in order to protect our mental well-being.

Dr. Jeldah Nyamache

HIV continues to be a major global public health challenge. According to the World Health Organization, as of 2019, approximately 38 million people are currently living with the disease. So far, the disease has claimed almost 33 million lives.  At personal levels, most of us now know someone who has been affected directly or indirectly by HIV.

And while attention on the disease has majorly been on its physical health impacts, its mental effects is one critical aspect that has largely gone unaddressed. Like with any other chronic illness, a diagnosis of HIV is likely to have a huge emotional impact. It challenges one’s sense of well-being and can complicate pre-existing mental health disorders.

People living with HIV can experience mental health issues that can affect their quality of life and stop them from seeking health care, adhering to treatment and continuing care. One of the commonest mental conditions that people living with HIV face is depression. A study conducted by UNAIDS across 38 countries showed that 15% of adults and 25% of adolescents living with HIV reported depression or feeling overwhelmed, which the study notes could be a barrier to adherence to antiretroviral medication.

Other mental challenges that often face this group include anxiety, mood and personality disorders. They range from mild to severe in the symptoms and easily affect a person’s day-to-day life. Many are unable to cope hence a mental breakdown and in worst case scenarios; cases of homicide and suicide have been reported. Identifying mental health issues among people living with HIV is critical. But despite their significant prevalence, they are often under-diagnosed and/or inadequately managed in people living with HIV & AIDS.

On the other hand, people living with mental health problems can also be at higher risk of getting HIV. These risks are occasioned by low access to information and knowledge of HIV; psychoactive substance use especially injecting drug use; risky sexual behaviour and sexual abuse.

The impact of neglected mental health in people living with HIV substantially predisposes them to stress which in turn weakens the immune system among other problems. As a chronic disease that is primarily managed by the use of antiretroviral drugs, the availability of the drugs becomes a life and death affair. A lack of them or news of their scarcity is therefore enough to have a great mental effect on the patients. For instance recent media reports that the country faces a supply shortage of anti-retroviral medication must be causing stress to patients whose lives rely on them. This is further compounded by other present realities such as the unrelenting COVID-19 pandemic and the harsh economic times.

In view of this, it is imperative that health experts caring for HIV-positive individuals normalise screening, diagnosis and management of mental health related issues as they present. This contributes to the overall wellbeing, which helps one live to the fullest and get good treatment results.  

In addition to mental health service facilities ensuring access to voluntary and confidential HIV testing and counselling for people who may be at increased risk of HIV as is their primary role, they should also integrate structured mental health program that is accessible, affordable and tailored to meet the unique needs of the people cared for. Primary health-care providers must also be trained to recognize and treat common mental health challenges among the patients. 

Further, increased awareness on HIV and mental health is crucial. Normalising discussions around mental health care will help fight the stigma surrounding this topic. Informing and reassuring people that many mental health conditions are treatable to full recovery will help them get a positive attitude.

The aspirational efforts to end the HIV epidemic will be difficult to achieve without health experts proactively and intentionally addressing the significant mental health challenges associated with HIV. Key to this is to ensure integration of mental health and HIV programs to prevent new HIV infections and improve the mental health and well-being of people living with and affected by HIV.

Dr. Jeldah Nyamache

Since the beginning of the Covid-19 pandemic, there has been a reported increase in the number of cases of gender based violence all over the world. And while there are many factors that could be contributing to this rise, one aspect that has certainly played a major role is mental health challenges. The Covid-19 pandemic has ripped through almost every country on the planet, causing devastating decay to the mental health of many people.

As governments around the world instituted tough measures to curb the spread of the virus such as lockdowns, travel and gathering restrictions, many people found themselves in situations they have never been before or one which they are not used to. But while these measures are necessary to reduce the spread of the virus, they have also had serious psychological and socially disruptive consequences. For instance, before the pandemic, most people had not been used to spending a lot of time at home and many of their regular social activities were no longer available. Not only that, the pandemic also led to many people losing their jobs and livelihoods, further complicating their mental situation.

The stress due to health risks and economic uncertainty triggered conflicts within households as survivors were trapped in the same space as perpetrators, and therefore facing a greater risk of abuse.

Apart from the mental effects of the Covid-19, there are also other factors such as divorce, poverty, financial difficulties, that lead to increased mental health issues such as stress, depression and drugs and alcohol abuse which in turn contribute to increased gender based violence.

While there should be no justification for gender based violence, there is no denying the fact that mental health is a major contributing factor as seen during the Covid-19 period. It is for this reason that it is important that mental health awareness should be considered as key in efforts towards tackling gender based violence.

Increased mental health awareness would lead to a much more mentally stable population and in the process reduce the risk of increase in gender based violence. This is because mental stability allows people to reason properly when faced with difficult situations.

Aspects such as empathy, self-esteem, compassion, emotional regulation and resilience, stress management, relationship building, and challenging problematic social norms are crucial in ensuring a stable mental status. Furthermore, competencies such as rapport building, emotional nurturing, and the prevention of trauma are important for the successful implementation of gender based violence prevention programs.

Most gender based violence cases occur as a result of couples not understanding what their partner is going through mentally. It is important that couples living together are trained to understand their partner’s mental state and to regulate their own emotions. The primary mental health support should come from the partners themselves. Understanding one another is a first step in preventing gender based violence as a means of tackling issues.

Further, it is critical that the space of mental health services is opened up to allow more people access to mental health assistance. Most countries including Kenya still lag behind when it comes to provision of mental health services. This therefore denies many the critical services and in the process contributes to increased gender based violence.

More importantly, it is critical that experts, and policy makers dealing with gender based violence understand the importance of integrating mental health support in efforts to tackle the menace. Continued overlooking of this aspect which is a major contributor to gender based violence only serves to derail these efforts.

Dr Jeldah Nyamache

Mental wellbeing is one of the most neglected areas of human health even as much as it is said that there is no health without mental health. According to the World Health Organization, 1 person dies every 40 seconds by suicide. 1 in 10 people in the world are living with a mental disorder such as depression, post-traumatic stress disorders, anxiety and many more. Relative to these figures, only a handful of people take it upon themselves to proactively seek professional help for their mental health.

While a lack of adequate mental health professionals and mental health services contributes to this situation, evidence shows that people actually avoid seeking medical assistance due to various other reasons. Key among them is that people avoid seeking professional assistance because of fear of judgment, doubt, pride, fear and misinformation. They don’t want to be disgraced or criticized (STIGMATISED). Others have developed the belief that if they seek mental help, it means they are crazy, which is not true.

Mental health illnesses just like any other diseases do not discriminate and can affect anyone anywhere. Our different ways and realities make us unique and nothing should stop anyone from getting help. Mental health status has been linked to family genetics, biological factors, environmental and life experiences, therefore, no one should ever feel ashamed to seek help when they need to. 

We must realize that mental health is important to living a healthy and balanced life. It includes emotional, social, and psychological factors that affect how we feel, think, and act. Our mental health dictates how we make choices, how we relate to those around us, and how we handle stress. Good mental health should be cultivated from childhood and nurtured through adulthood as part of a wholesome life including physical and emotional health.

Psychotherapy provides a safe space to freely talk about how one is feeling and thinking without being judged. While friends and family are all a valuable resources for overall wellness, mental health experts are important in addressing the mental health challenges by helping you keep a clear mind and manage any stress, anxiety, phobias, and other problems you face. They can help you get the most out of life and keep you free from symptoms of depression and other mental health problems.

Other than that, a healthy mental status also positively impacts ones physical health by improving the immune system, regulating sleeping habits, and lowering pain levels. On the flipside, poor mental health can negatively impact on physical health, leading to an increased risk of some mental conditions.

It is important that people are informed about the importance of seeking mental health services to address this growing health concern. Avoiding counseling can only lead to mental health deteriorating further. It is encouraging that mental health awareness is increasingly taking root in our society and related services are expanding to allow more access to the vital care. There is however more that needs to be done especially in fighting the stigma and misinformation associated with mental health challenges.

The constant message that should be out there is that mental health challenges are normal and there is nothing to fear nor be ashamed about it. Mental health services are life-saving and should be easily accessible to all.

With many people having been affected by the COVID-19 pandemic, which is having a further impact on people’s mental health, mental health awareness messages should be clear. It is also important that mental health services are expanded to allow for more access to the vital services.

Dr Jeldah Nyamache

Over recent years, mental health has slowly moved out of the shadows into the spotlight. After centuries of being side-lined, our state of mental well-being is gradually receiving more of the attention that it deserves. But despite mental health receiving increasing attention as well as research, there are still many myths and misconceptions associated with it which derails efforts to address the challenges.

As is the case with many things in life, the more information we are armed with, the less likely we are to allow myths to influence our opinions and it is therefore important to confront these misinformation on mental health. It is sad that there is still a significant stigma that is attached to mental health conditions much of which relies on old-fashioned thinking and outdated assumptions. Let me therefore try to highlight some of the myths and misconceptions associated with mental health.

To begin with, one of the reasons why mental health has for long been neglected as a public health concern is because most people think that mental health problems are uncommon. This is has however been addressed as the World Health Organization notes that mental disorders are among the leading causes of ill health and disability worldwide as around 450 million people currently suffer from such conditions as depression which is one of the main mental health problems.

Secondly, many people experiencing mental health challenges have also often been labelled as weak. This is simply not the case. It is important to note that mental health disorders are illnesses like any other and not signs of poor character. If anything, the opposite is true: Fighting a mental health condition takes a great deal of strength.

Thirdly, those suffering from mental challenges do not seek medical help for fear of not to be labelled as not having friends. However, there is a big difference between structured talking therapies and speaking with friends. Both can help people with mental illness in different ways, but a trained therapist can address issues constructively and in ways that even the best of friends cannot match. Also important to note is that not everyone can open up entirely in front of their nearest and dearest. Therapy is confidential, objective, and entirely focused on the individual, which is not generally possible in more informal conversations with untrained friends.

Further, there is a perception that metal health challenges are permanent which is not entirely true. A mental health diagnosis is not necessarily a life sentence. Each individual’s experience with mental illness is different as some people might experience instances, between which they return to their version of “normal” while others may find treatments that restore balance to their lives.

On the same note, not so long ago most societies shunned people with mental health conditions. Some people even believed that evil spirits or divine retribution were responsible for mental illnesses. Although this line of thinking has been extricated from most societies, it still casts a long shadow on mental health awareness.

In addition, the notion that all people with mental health weaknesses are violent is nothing but a myth. Thankfully, as people become more aware of mental health conditions, this misconception is slowly dying away. While it is true that some people with certain mental illnesses can become violent and unpredictable, but they are in the minority and even individuals who are experiencing the most serious conditions are mostly nonviolent.

As the mental health challenges continue to increase all over the world, it is important for increased awareness on mental health. Addressing untruths relating to our mental well-being is more pressing than ever as without the right information these myths and misconceptions will continue to derail efforts towards improving mental health awareness.  

By Dr Jeldah Nyamache

Most often when discussions are held around the effects of teenage pregnancies and parenthood, we tend to focus mainly on the medical complications and we tend to forget about the emotional aspects of pregnancy. In this article therefore I seek to highlight this forgotten challenge among the adolescents.  

There is no doubt that teenage pregnancies are on the rise worldwide. According to the United Nation’s World Health Organization, approximately 12 million girls aged 15–19 years and at least 777,000 girls under 15 years give birth each year mostly in the in developing regions. In Kenya recently, the media was awash with reports of a surge in teenage pregnancies which were widely blamed on COVID-19 crisis and the lockdowns that followed. One county was even reported to have recorded up to 4,000 teenage pregnancy cases. This just proves the seriousness of this issue.

And while the social, economic and reproductive health challenges are well known, mental health problems such as depression, substance abuse, and post-traumatic stress disorder are usually overlooked. Teen mothers are also more likely to be impoverished and reside in communities and families that are socially and economically disadvantaged. These circumstances can adversely affect maternal mental health.

In many communities, young girls who give birth for the first time, do this with very little knowledge on reproduction, maternal health care, and they don’t get enough support. Too few of them are also empowered enough to access the very critical sexual and reproductive health services. Not to be forgotten, some of these pregnancies are usually as a result of defilement which further compounds their risks and certainly makes them prone to emotional and mental health issues.

Further, it is reported that in some parts of the world, especially in developing countries, suicide is one of the main causes of adolescence mortality; often caused by sexual and reproductive issues including pregnancy. Research has also shown that twice as many teenage mothers are at risk of developing antenatal depression – during pregnancy, and postpartum depression (PPD) - the period just after delivery, as their older counterparts.

There is therefore a great need to address the emotional and mental health aspects of teenage pregnancy, not only for the young mothers but also for their children. This is because infants and newborns also get affected when their mothers are experiencing depression during and after pregnancy. It can make it more difficult for the mother to interact with her baby as depressed ways of thinking and behaving may get picked up by the child in an ongoing cycle of learnt behavior.

Addressing mental health challenges for teenage mothers should be everyone’s business. From the mothers themselves, to the doctors, psychiatrists and society at large. For the young mothers, it is important to encourage them to connect with mental health professionals, their parents, guardians, as well as their peers. On their part, health professionals should always seek to assess the mental well-being of the pregnant or young mothers and offer the necessary support. Societal support also plays a key role by creating a conducive environment for them and their babies. It does not help to condemn them for getting pregnant at an early age and making them feel unwanted. This can only exacerbate their situation.

Further, it is also important to ensure that our health policies and budgets take into account this problem by ensuring proper funding for psychiatric services at hospitals and maternity centers. For a long time now, these services have been focused on addressing physical aspects of pregnancy and motherhood, forgetting the mental aspects of the same. In conclusion, I think it is also time to talk about how modern life might need to change to support young women, before this rise in mental challenges takes its toll on the next generation too.

Addressing Gender Based Violence against Men and Boys

The World Health Organization defines obesity as excessive fat accumulation that may impair health. Worldwide, obesity has nearly tripled since the year 1975 affecting people of all ages. In 2016, over 340 million children and adolescents aged 5-19 were overweight or obese. In the same year, 39% of adults aged 18 years and over were overweight and 13% were obese. In 2019, statistics showed that 38 million children under the age of 5 were overweight or obese.

The word obesity often causes us to think of physical appearance. It is however more than that. It is health condition that increases the risk of several non-communicable diseases such as high blood pressure, diabetes, cancer, arthritis and poor mental health.

What are the causes of obesity?

Obesity and overweight occurs when there is an energy imbalance between calories consumed and calories expended. This means that one takes in more calories than he/she burns through exercise and normal daily activities. This makes the body store these excess calories as fat.

Several factors can contribute to this condition and they include:

Genetic make-up: A person’sgenes may affect the amount of body fat stored and it’s distribution. It also affects appetite and the body’s metabolic rate through food is converted into energy.

Nutrition: A diet that is high in calories, lacking in fruits and vegetables, full of fast food, and laden with high-calorie beverages and oversized portions contributes to weight gain. Liquid calories from beverages such as alcohol and sugared soft drinks, can contribute to significant weight gain.

Inactivity - A sedentary lifestyle can easily lead one to take in more calories than expended

Pregnancy - Weight gain is common during pregnancy. This weight gain may contribute to the development of obesity in women if managed poorly

Poor sleeping habits – Insufficient or excessive sleep can cause changes in hormones that increase appetite. One may also crave foods high in calories and carbohydrates, which can contribute to weight gain.

Stress - Many external factors that affect mood and well-being may contribute to obesity. People often seek more high-calorie food when experiencing stressful situations.

What are the health complications associated with obesity?

Heart disease and strokes - Obesity increases risk of high blood pressure and abnormal cholesterol levels, which are risk factors for heart disease and strokes.

Type 2 diabetes - Obesity can affect insulin function in the body. Insulin is useful for the metabolism and control of blood sugar. This raises your risk of insulin resistance and diabetes

Digestive problems - Obesity increases the likelihood of heartburn, gallbladder disease and liver problems

Poor mental health- Many people especially in younger age groups battle with self-image and this can cause low self-esteem, which in turn predisposes to poor lifestyle choices, which could contribute to poorly managed weight gain. On the other hand, obesity in itself is a cause of stress for many people and it can lead to depression, anxiety and eating disorders such as anorexia and bulimia among other health problems.

Increased severity of symptoms of infections like COVID-19 - Obesity increases the risk of developing severe symptoms if you become infected

What you need to do to avoid and manage obesity

These three measures can prevent you from complications of obesity.

• Exercise regularly and consistently
• Mindfully follow a healthy-eating plan
• Visit your doctor for regular check-ups and weight monitoring

Sadness, anger, stress, depression and anxiety are keeping many people from celebrating their lives’ milestones. Negative thoughts and feelings make it difficult to be happy and fulfilled.

They affect family life, work and business. They also increase vulnerability to Non Communicable Diseases such as hypertension and diabetes; and affect immunity to predispose to infectious diseases.

A vicious cycle is thus created and the consequent high burden of disease affects performance and productivity, hence influencing the economy negatively.

Milestone Support and Wellness Centre was established to provide individualized primary health care and support to its clients including survivors of Gender Based Violence and other disasters in different African contexts.

We walk with the person to help him or her find once more a wholesome happy life, free of stress, anxiety, sadness and depression.

When clients call or visit us, we partner with them to achieve better health.

We tailor our wellness packages to meet individual needs because we know as medical professionals that each person’s experience is different and diverse. Indeed; for true healing to work; no one size fits all.

Our doors will always be open to anyone who needs us.

Motto
Compassionate milestone support.

Mission

Dedicated to providing compassionate milestone oriented support

Vision
To be a pillar of support through the milestones for vulnerable populations across Africa

Values
Dedication, Accountability, Quality-oriented

Strategic pillars

Human centeredness:
We are all about people. Our work is deliberately human centred without any form of discrimination.

We strive to be accessible to our beneficiaries at their point of need and build a lasting partnership in their journey to improved wellbeing. We design and implement all our programmes with integrity built on professional code of ethics.

Efficiency and entrepreneurship
We take deliberate steps to maximise available resources for effective care of our beneficiaries while striving for sustainability

Our Services Include:

Mental Health Services

These include:

1. Group and individual therapy
2. Assessment and diagnosis of mental health issues such as:
   • Depression
   • Bipolar
   • Drug Addition
3. Personality tests
4. Couple therapy
5. Trauma counselling, loss and grief therapy
6. Mental heath education and family therapy

Gender-Based Violence Recovery Centre

These services include:

1. Psychotherapy
2. Medical examination, treatment and follow-up
3. Referral and linkage

Family Medicine

These services include:

1. Medical consultation, examination, and treatment for communicable and non-communicable diseases
2. Nutrition and lifestyle consultation
3. Travel clinic
   • Check-ups
   • Vaccinations
4. Maternal and child clinic
5. Wellness-medical check-ups
6. Sexual and reproductive health and rights
7. Home based care
8. Health education
9. Referral and linkage
10. Other specialised clinic
    • Obstetrics and gynaecology
    • Paediatrics
    • Surgery
    • Pathology

Other Services

These services include:

1. Professional writing
2. Project management

Contact us:

Tel: +254 794789870/ 0742459877

Email: info[at]milestonemedical.org

Working hours:

Monday to Friday 9: 00 am to 5:30pm

Saturday: 9: 00 am to 2:00pm

Location:

Family Health Options Kenya, 3rd floor, Mai Mahiu road (off Lang’ata road), Nairobi

Kindly book your appointment in advance

Our services include nerve stimulation, infra-red therapy, deep tissue massage, muscle group physiotherapy, joint physiotherapy, speech therapy, occupational therapy, etc

1. Be friends

2. Practice a healthy lifestyle together

3. Give the children a sense of security and teach them how to show care and concern

4. Raise awareness

5. Talk to your family doctor

Dr. Mokeira Nyamache

The occurrence of GBV during disasters is poorly understood though common. Its prevalence varies from country to country and in some instances it has been deprioritized during disasters leaving vulnerable male and female  groups including adolescents and young people; groups that are discriminated against or criminalized at higher risk. The lack of adequate information increases the vulnerability of these at risk groups. The World Health Organization reported a spike in GBV cases during the pandemic calling for urgent action from all stakeholders.

 What might have caused the exponential increase in GBV? Women typically take on more physical, psychological and emotional burdens as caregivers during health crises. These pre-existing social norms and gender inequalities; the economic and social stress caused by the COVID-19 pandemic; restricted movement and social isolation measures have heavily contributed to the rise in numbers. In addition, confinement as a result of restricted movements means the vulnerable people have more exposure to abusers in their homes and communities. Loss of income during this pandemic has also contributed to higher stress levels. Without adequate psychosocial support, the stress easily leads to poor mental health which is manifested by violence including GBV; psychoactive substance use; mood disorders like depression and anxiety; homicide and suicide. Limited access to normal support services for GBV recovery such as medical and legal services has been another contributor. The limitation is due to movement restrictions, lack of money, fear of repercussions of reporting and ignorance. It is also important to note that most such services have been overburdened by responding to the COVID-19 pandemic.

So how do we address gender-based violence (GBV) in the context of the COVID-19 pandemic? Prevention and mitigation initiatives need to be integrated across sectors to achieve the following Awareness raising and sensitization: We need to accept that GBV exists and that it is a problem that requires solutions. Normalizing discussions about GBV in the community will help in reducing stigma and affected people will be more encouraged to speak up and seek help. People also need to be informed on availability of help and how they can access it.

Targeted GBVR services: Different populations groups need different approaches. This is especially so in consideration of our diverse cultures. Tailoring interventions to respective groups will get better reception. These interventions should include, among others, emergency centers for the reception of victims at risks, safe accommodation for survivors, a hotline for information, and an emergency line to report abuse.

Psycho-social support: Creating enabling environments for people to freely discuss GBV, offering care and support to the affected; building structures that aid recovery and reintegration into the society; changing social norms that foster GBV in society Promoting good mental health: Building self-awareness, healthy boundaries, resilience, stress management and proactive debriefing goes a long way in protecting vulnerable people from GBV To address GBV in such a time therefore requires concerted efforts from all stakeholders. Disaster response and recovery planning must ensure that those impacted by this problem are not forgotten.  

Dr. Mokeira Nyamache

The mind is our most powerful ally and good mental health leads to an incredible life. With our fast-paced and 24/7 work-life culture, many people have multiple jobs and increased working hours. The overuse of social media leads to continuous bombarding of the mind with information. These are only some of the daily threats to our mental health. It is easy to take our mental health for granted; protecting and strengthening it could not be more important. A person with good mental health can cope better with the daily challenges whereas being mentally unhealthy can make every day functioning difficult. Mental health status of a person not only affects him/her but also those around him/her. It is a major factor affecting relationships, achievements and even physical health. Protecting and strengthening it could not be more important. Life doesn’t pull its punches so here are some simple and easy ways to look after your mental health. 

Accept who you are and value yourself We are all unique. It is healthy to accept that and quit trying to be someone else. Self-acceptance is the first step towards self-improvement and increased self-esteem. Do not try to fit into a box created by society. It can be a slow process but keep working at it by focusing on your strengths. Treating self with respect and kindness is most essential in today’s world.

Feel the Rush Do and enjoy the things that you like. Discover new hobbies and be creative as it helps the brain to be calm and deal with stress. Adventures like mountain climbing or leisurely activities such as swimming, exercise and even a nature walk are of great importance. Simply feeling the rush naturally will help to improve mental health.

 Feeling Stressed? Smile Stress is a part of our reality so dealing with it and finding our own way to cope is necessary. Having an active lifestyle helps in dealing with everyday stress. Regular exercise, meditation and other relaxation techniques can help deal with stress. Just enjoying a hobby and nurturing the creative self can effectively reduce stress. A smile is the best stress buster and laughter is the best medicine.

Talk About It Talking about problems and worries can help to maintain good mental health. Opening up to someone can help manage stress effectively and sometimes may even help in changing perspective. Surround yourself with good people and be in touch with trusted friends and family. Maintaining open communication lines is key to building a strong social support network.

Maintain a full emotional tank Good experiences, memories, times of laughter, moments of enjoyment and anything that makes us feel good or happy adds to our emotional tank. The more of these we get, the fuller the tank, the happier we are. Keeping this tank full is a personal responsibility; keep alert to its level so that each time it is running low you can do something to fill it up again.

Break Up With Monotony  Routines make us efficient but they are tedious and at times can causes stress. Monotonous lifestyle can cause tension and restlessness. Altering and making small changes in daily routines can help in dealing with such stress. Even small changes like a jog on a new path, trying out new restaurants, making new friends and taking road trips can perk up a tedious schedule.

 Aim High-But Be Realistic We often dream and set our academic, social and financial goals high. The setting of high goals and not being able to achieve them can lead to depression or a sense of failure. Hence; set goals that are realistic and work on them every day in order to achieve them. Even small wins cause a tremendous sense of accomplishment and help increase a sense of self-worth; celebrate them.

Mindfulness  It is self-awareness training. Be in the present and do not dwell on the past or be in constant worry about the future. Pay full attention to things going on in the present. It is a very effective way of dealing with depression and helps to be fully aware of the surroundings. It keeps the mind positive and effective.

 Avoid Self Medication Self-medication may seem effective for a shorter time period but can cause long-lasting damage on a person’s mental as well as physical health. Sometimes people use alcohol and drugs to self-medicate which can easily lead to increasing of the problems rather than curing them.

Ask For Help Seeking help is a sign of strength and not weakness and treatment is effective. People who get appropriate care can recover from mental illness and addiction and lead full and rewarding lives. We need to care about mental health. After all, there is no health without mental health

Dr. Mokeira Nyamache

 Smoking is a common habit most of us have encountered. It might be our friends, family members or even ourselves indulging. We have also heard severally that it is bad for our health; but just how bad is it? In recent times and particularly during the COVID-19 pandemic, health experts have warned that smokers are more susceptible to contracting the virus. I felt it is just right to amplify the message. Smoking seems cool, fun, glamorous and adventurous. Its true image however should depict stained teeth, constant coughing, bad breathe, fatigue, insomnia, loss of appetite, nervousness, and damaged organs as numerous researches have shown. It affects all organs in the body and nothing about that true image is glamorous. The effect of this dangerous habit on the immune system is suppression such that one is more vulnerable to infections and worse complications that they would have otherwise fought off. COVID-19 which primarily affects the respiratory organs is one such infection. Quitting This can be difficult for some people because of the known withdrawal symptoms that are experienced by the body as a result of dependency on nicotine found in the tobacco. It can be unpleasant and even dangerous to suddenly quit if one is addicted to any substances including nicotine. Symptoms of substance withdrawal include irritability, frequent headaches, fatigue, body pains, restlessness, tremors, sweating and vomiting to mention but a few. So how can one quit safely?

• Make up your mind that it is time to quit completely and be at peace with that decision
• Identify a trusted accountability partner in your social support system. This could be a family member, a friend, colleague, health worker or any other person you are comfortable with
• Talk to your personal doctor and share your plan to quit. Seek his/her advice on your strategy and commit to following the advice given
• Set realistic goals together with your doctor about gradually reducing the number of cigarettes smoked and keep tabs of the same with your accountability partner
• Make deliberate small steps towards achieving your goals
• Celebrate small wins and keep going at it until you finally quit completely.

It is important to note that there is no fixed time to fully quit because different people have different thresholds and respond differently to withdrawal. The most important thing is to remain committed and to continuously make deliberate steps to finally and completely quit with the help of a doctor. The sooner one can achieve this the better. Benefits of quitting There are several benefits to physical and mental health that are definitely worth the effort in quitting.

1. Mental health benefits.

• The burden of addiction is lifted off the mind. This gives a sense of freedom and well being
• Improved self-esteem that comes with improved self-image. The worry about bad breathe, smelling smoke, stained teeth is diminished
• Better relationships with family and friends. The uncomfortable conversations about effects of smoking become a thing of the past

2. Physical benefits

• The body organ damage is reduced significantly if permanent damage has not yet occurred. These include lungs, ears, eyes, heart, skin, liver and brain to mention but a few.
• Reduced risk of non-communicable diseases such as hypertension, diabetes, blood clots and cancer
• Reproductive health is improved by better hormonal balance associated with quitting smoking. This increases the chances of safe pregnancy and reduces chances of erectile dysfunction
• Better immunity as the circulatory system delivers optimum oxygen and nutrient levels to organs and white cells start to function normally. This means more strength, better healing of wounds and protection against infectious microorganisms.

Smoking is dangerous to health. The negative effects associated with it are definitely a good reason to stop.

Dr. Mokeira Nyamache

 The annual World Hepatitis Day in 2020 was marked on July 28^th themed "Hepatitis-free future". It focused on prevention of hepatitis among mothers and newborn babies. The day brings together stakeholders under a single theme to raise awareness on the viral disease. It seeks to support efforts being made towards elimination of the serious health challenges posed by the various strains of hepatitis; mainly B and C.  

What is hepatitis?                                                 The World Health Organization defines hepatitis as an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis, cirrhosis or liver cancer. Hepatitis viruses are the most common causes of hepatitis in the world but other infections, toxic substances such as alcohol and autoimmune diseases can also cause hepatitis. There are 5 main strains of the hepatitis virus: A, B, C, D and E. These 5 types are of greatest concern because of the burden of illness and death they cause and their potential for outbreaks. In particular, types B and C lead to chronic diseases in hundreds of millions of people and, together, are the most common causes of liver cirrhosis and liver cancer. Hepatitis A and E are commonly caused by ingestion of contaminated food or water while B, C and D usually occur as a result of contact with infected body fluids. As of July 2020, statistics from the World Health Organization indicated that 325 million people were living with viral hepatitis B and C; 1.3 million people were dying annually and of these, 900 thousand died of the hepatitis B infection. Limited awareness of the disease globally was shown by the fact that only 10% of those living with hepatitis B and 19% of those living with hepatitis C were aware of their status. Further, only 42% of children globally were reported as having access to the very important birth dose of the hepatitis B vaccine. Despite the great heath challenge presented by hepatitis, its significance as a global health problem is underappreciated by both clinicians and the general public due to limited awareness of the disease. This is a major obstacle to successfully preventing the liver complications caused by these infections.

 Symptoms to watch out for

 As a personal responsibility, it is also important to be able to identify hepatitis if you think you or someone you know may have it. Signs and symptoms of acute hepatitis include dark urine, abdominal pain, unexplained weight loss, and yellowing of the skin and eyes. It is worth noting also that chronic hepatitis forms at a slower rate and so some of these symptoms may be harder to notice at first.

Fighting viral hepatitis 

 The first step in fighting the disease is raising awareness about the existence; hygiene practices (hand washing, cleaning the home and the environment) and proper waste management (including human waste). Many people are likely to get infected and pass the virus to others without knowing. Awareness raising will therefore lead people to take steps in prevention while seeking timely treatment from health care providers. This will in turn improve quality of life, prevent people from transmitting the disease to others, reduce liver complications and avert possible deaths. Secondly, vaccination plays a key role. Currently there is only vaccination for hepatitis A and B strains of the virus. Visit your health provider for details. Thirdly, ensuring hospitals are well equipped for testing, detection and treatment. Medical treatment which comprises of supportive care and antivirals helps in the recovery of majority of cases while also preventing further complications and transmission.

 Complications of hepatitis

  Viral hepatitis is often silent (without symptoms) and goes undetected until the development of significant liver disease; which can occur years after the initial infection. It can lead to liver cirrhosis, liver failure, and liver cancer.

Conclusion

Creating awareness and reducing the stigma of viral hepatitis is important to encourage people to enroll for care so that they can be vaccinated against B and C; tested and treated when necessary.  

Dr. Mokeira Nyamache

 The world recently commemorated the annual World Breastfeeding Week whose goal is to highlight the importance, encourage and promote breastfeeding and improve the health of babies and mothers globally. Breastfeeding is a critical maternal and child health aspect that promotes better health for mothers and children alike. The practice is still not well adopted all over the world due to various reasons including a lack of adequate awareness of the benefits especially among mothers. While some women are unable to breastfeed for medical reasons, others simply choose not to. Over and all, it is medically recommended to exclusively breastfeed babies (no formula, juice, or water) for the first 6 months of life. This should be followed with breastfeeding for at least a year with introduction of other foods (such as vegetables, grains, fruits, proteins) which should be started at 6 months of age (weaning).

What are some of the benefits of breastfeeding?

Breast milk alone is enough to provide all the nutritional requirements a baby needs for the first six months of life. This is because it has perfect mix of water, vitamins, protein, carbohydrates, minerals (sodium, calcium, phosphorus , iron), fat, trace elements and antibodies all provided in a form that is easy to digest - everything your baby needs to grow. The first milk known as colostrum is usually very thick and rich in protein and is loaded with antibodies. It forms the first immune system defense for the baby after birth and also helps in developing the digestive system. This first milk is produced during the first week of breastfeeding after birth and takes three weeks to transition to mature milk.  Mature milk is less concentrated in protein and fats but remains equally balanced to provide all the nutritional needs for baby. Breastmilk is cheap, always available from the mother, at the right temperature, does not need time-consuming preparation and comes with minimal risk of contamination. All these allow the mother to relax and bond with the baby.

 Breastmilk and the immune system

As mentioned above, breast milk is important in building the immune system of the baby. This is because of the non-nutritional components including antibodies, antimicrobial factors, digestive enzymes, hormones and growth factors that are important for passive protection against infections and immune-mediated diseases and regulate the development of the immune system. When the mother is exposed to illness, she starts producing antibodies which are secreted and passed through breast milk to the baby. These protect the baby by forming a thick protective layer that is in the nose, throat and digestive system. 

Breastmilk and obesity

 Breastfed babies self-regulate their milk intake by only taking what they are satisfied with. This helps develop healthier eating patterns including prevention of childhood obesity. Studies show that breastfed babies are 15-30% less likely than formula fed babies to develop obesity. Breastfed babies also have more Leptin in their system which is a hormone that helps to regulate appetite and fat storage.

Breastmilk and intelligence

 Studies suggest that breastfed babies have higher intelligence scores and are less likely to develop problems with behavior and learning. Brain development is influenced by the physical intimacy, touch and eye contact that is associated with breastfeeding. The physical closeness, skin-to-skin touching, and eye contact between a mother and baby helps to create a strong bond that makes the baby feel secure.

Breastfeeding and mother’s health

Mothers burn extra calories during breastfeeding. This can contribute to lose of weight gained during pregnancy faster. They also release the hormone oxytocin, which helps the uterus to contract and return to its pre-pregnancy size and may reduce uterine bleeding after birth. Breastfeeding has also been proven to also lower the risk of breast and ovarian cancer.        

Dr. Mokeira Nyamache

It is common to feel that physical exercise needs vigorous activity done in the gyms or playing grounds. I would like to remind us that it does not always have to be vigorous or done for a very long time in order to be effective. A 30-minutes’ walk daily at a moderate pace is enough to garner immense health benefits. Though it is one of the most underrated forms of exercise, walking is a powerful way to relieve perceived stress, anxiety and depression while achieving general well-being and good mental health. It is simple, fun and free for all, connects one with surrounding nature and has been scientifically proven to be effective.  It enables exposure to sun and fresh air while increasing the heart rate with minimal strain to muscles and joints.

What is the link between exposure to sunshine and health?

Sun rays trigger the brain to release a hormone called serotonin, otherwise referred to as the happy hormone. This hormone is associated with mood elevation, calmness and focus. This decreases depression. On the other hand, darkness triggers release of a hormone called melatonin which induces sleep. Another health benefit of sunshine is vitamin D production which is responsible for strong bones. Additionally; in moderation, sunshine contributes to prevention of some types of cancer including colon, ovarian, prostate, pancreatic and Hodgkin’s lymphoma by contributing to vitamin D levels in the body. 

How about the benefits of fresh air?

Fresh air ensures that the body gets sufficient oxygen supply to all the vital organs. This in turn ensures that all the cells are able to produce energy for their various functions. The brain for concentration and good mood, the digestive system for good absorption of nutrients, the lungs to remove air-bone toxins as one breathes out, the kidneys and liver to carry out the chemical processes in the body necessary to maintain life. 

How to walk safely for maximum health benefits.

1. Timing: Avoid extremes of weather-very hot sun is bad for your skin (it leads to sunburns, risk to skin cancer, wrinkles, eye injury) and causes dehydration from excessive sweating.
2. Security: Avoid dark or risky areas where you may fall victim to thugs. Avoid carrying valuables and move around with only necessary items like a simple phone for emergency communication and timin
3. Dress right: Comfortable, light, absorbent clothing, footwear including socks and in case of cold weather a comfortable jacket will be sufficient. Avoid unnecessary jewelry. Wearing shoes with wet feet may lead to an infection called athletes foot which can be stubborn to treat. Choose comfortable well-fitting sports shoes in order to avoid damaging your joints and other tissues.
4. Embrace consistency in your routine. This is helpful in planning your schedule to allow time for walking.
5. Walk with company if possible. This enhances security and it is also an opportunity to create and build relationships through bonding.
6. Listen to your body. The ideal is 30 minutes but if you can do more the better, or if your body can’t tolerate this then start with shorter walks.
7. Mind your posture. Upright posture with a straight back and a brisk stride with shoulders held high and arms freely swinging by your sides is good posture for walking.
8.  You can combine walking with other exercises depending on personal preference. Remember to listen to your body and follow your doctor’s advice
9. Set a realistic pace. One that raises your heart rate is good enough. If you can sweat and carry out a conversation while walking it means that you are applying moderate exertion. If you can only speak in short sentences then it is intense exertion. You can choose the pace depending on your tolerance levels and advice from your doctor.
10. Set and work towards targets. If walking to lose weight then longer walks and quicker pace over time might be necessary depending on your level of tolerance and medical advice from your doctor. This will work well also in combination with healthy nutrition and sleeping habits.
11. Physical distancing. To reduce the risk of getting highly infectious diseases like COVID-19 while walking, practice personal protective measures including wearing a good quality face mask and maintaining at least 1 meter between yourself and others around you. If you have a compound you can walk within it while timing yourself. If not choose a route with less human and vehicle traffic as much as possible.

Dr. Mokeira Nyamache

 The world recently marked the Myeloma Awareness Week. Myeloma is a common but probably the least known or discussed type of blood cancer within the general public. The number of cancer cases has drastically increased in the past few years. The World Health Organization ranked it the second largest cause of death in 2018 with 1 in 6 deaths globally being attributed to it.

But first, what is cancer? 

 It is a collection of different diseases characterized by abnormal multiplication and growth of any cell type in the body. This leads to abnormal cells which continue to further multiply and grow in an abnormal manner and the cycle continues. Multiple myeloma is a type of cancer that originates in the plasma cells. These cells are a type of white blood cells and they originate in the bone marrow. They play a critical role in immunity because they produce antibodies in the fight against any foreign particles in the blood.

Risk factors for developing multiple myeloma

 Though causes of the disease are unclear, there are risk factors that may influence a person’s risk of developing it. These are older age, female sex, and family medical history. Other risk factors for cancer are high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use, and alcohol use. The disease is known for high rates of delayed diagnosis as symptoms are usually vague or even absent in its early stages. It is often discovered by accident during a routine blood or urine test. Early diagnosis and detection is important for better outcomes following treatment. Symptoms may include bone pain, extreme fatigue, nausea, and numbness in the limbs, opportunistic infections which can be life threatening and kidney problems.

Psycho-social support and multiple myeloma

A diagnosis of myeloma is life changing. Receiving treatment for any medical condition let alone chronic diseases and cancer in particular requires a lot of psycho-social support. It is human to feel tired of persisting in a treatment plan that seems endless. The symptoms to deal with are another burden. The effect on family, social relationships and financial state can be overwhelming. Feeling hopeless, depressed, anxious and even indifferent is common during these trying seasons. This is where counseling and support groups can help lighten the load. Individual counseling is aimed at tackling and helping one to cope with emotional reactions like depression and anxiety, family and relationship issues, personal issues and practical issues that often arise while undergoing cancer treatment. While it goes a long way in helping patients in the journey, it faces limitations in that it lacks opportunity to socialize and connect with people undergoing similar experiences. Patient support groups fill the gap by providing a safe space for patients to share, learn and work through feelings, challenges and other similar situations. The same issues covered during individual counselling can also be discussed among support group members and ideas freely exchanged. These groups add quality to the lives of members regardless of the number of years lived. Many such groups also take initiatives to fund raise for research and treatment of multiple myeloma as well as raising awareness about the disease.

The fight against cancer is a collective effort. Together we can.

As individuals, we ought to normalize taking regular wellness checks including cancer tests in order to increase chances of early detection and treatment in case we have the disease. The earlier any type of cancer is diagnosed, the better the chances of getting cured. Let us all provide support for people in our circles affected by cancer in one way or the other.  It is a tough journey that cannot be borne alone. Governments and other institutions need to also increase budget allocations to cancer diagnosis, treatment and research to confront the disease with the energy it deserves.

Dr. Mokeira Nyamache

Covid-19 and all global efforts to fight it have ushered in the new normal. One where many social and economic activities have been shut down. The economic impact triggered by the pandemic has exacerbated some already dire situations among vulnerable populations globally. The rates of unemployment and business decline continue to soar leaving a big population that was already exposed to malnutrition at an even greater risk. It has worsened global inequity on food and nutrition. Agricultural activities lessen leading to an acute food shortage in low and middle income populations. Closer home, in addition to the effects of the virus; the problem has been compounded by the locust invasions on sections of the country and floods in others further diminishing the hopes of many. Social services such as school nutrition programs among the most marginalized in some regions have been stopped. Some people today claim to be more scared of death from hunger than from COVID-19.It is a sorry state of affairs. Availability, accessibility, utilization, stability and malnutrition levels determine food security in any population. It refers to the reliable access of sufficient affordable and nutritious food. Malnutrition remains one of the major health challenges affecting a large population especially the marginalized communities, internally displaced persons and refugees. Its effects are immense as it affects every stage of life and has severe long-term consequences that can affect generations. Malnourished mothers are at a high risk due to poor immunity which predisposes them to severe infections that may even lead to death. They suffer low energy levels and are not able to adequately care for their families, particularly the children. In pregnancy, poor nutrition is a risk factor for low birth-weight, miscarriages and congenital malformations. Children born to malnourished mothers are also at a high risk of contracting infectious diseases, suffering from stunting and even death due to poor immunity as the mothers are not able to adequately ensure good nourishment. Persons living with chronic diseases such as cancer, diabetes and HIV are at an even greater risk during this time. Their immunity is low and lack of adequate nutrition translates directly to a weaker state predisposing to complications such as opportunistic infections. Kenya has a fragile healthcare system and particularly with regard to emergency preparedness. Prevention and health promotion are therefore the best approach in ensuring that people's immune systems are strong. One strategy to achieve this is by ensuring food security. A multi-sectoral approach with the agricultural sector playing a leading role in smart and sustainable production of diversified nutrient-rich foods and promotion of home farming would help secure communities’ livelihoods. This must go beyond high-calorie staples to include protein and vitamin rich sources to boost people’s resilience and lower risks related to poor immunity. While it is true that we are all at risk of getting COVID-19, the narrative that it has made all of us equal is a fallacy and should be shunned. This is because vulnerable populations including the poor, women and children, those living in fragile or conflict-affected areas, minorities, refugees, the displaced and the unsheltered are particularly affected as a consequence of pre-existing inequities.  These vulnerable groups often bear a huge burden due to malnutrition now worsened by this pandemic.

What steps can one take as part of personal responsibility towards food security during this pandemic? First, develop healthy dietary habits.

Eat the right food and at the right time. A balanced meal should have proteins, vitamins, carbohydrates. Breakfast should be the heaviest meal to start the day with energy. Dinner should be light and eaten at least 2 hours before bed-time. The body needs approximately three liters of water per day from various sources such as fruit juices, soups and safe drinking water. 

Second, choose locally available foods.

 These are likely to be cheaper, more acceptable and easily available as compared to other foods. They can also be produced easily in kitchen gardens.

Third, do not waste food.

 Serve just enough to finish and get seconds if necessary. Eat to live. Don’t live to eat. Plan meals ahead of time to ensure no wastage. Left overs should be utilized as much as possible before other meals are prepared.

 Fourth, if you can, help someone have a meal at least once a day if you know any such a person Fifth, avoid alcohol, cigarettes and any other substances prone to abuse.

They pre-dispose to addiction which in turn compromises health status including immunity. 

Sixth, store for a rainy day. 

Stock food items like cereals that can last a long time with good storage. Ensure the storage area is free of contamination and pests and is not dump. Take advantage of sales to save on the cost of stocks.

 Seventh, share information on nutrition and food security with those around you.

Take advantage of opportunities to share information about nutrition and food security at a personal level in order to positively impact those around you.  

Dr. Mokeira J. Nyamache

 How can you protect yourself from the dangers posed by social media especially during these harsh times? First, it is important to take control by putting a limit on when and where to use social media. Too much use of social media can interfere with your interpersonal communication.  Consider switching off from the platforms when having one-on-one interactions with family, friends or even colleagues at work. Better still; try to create a regular time schedule of when you will be on social media. Second, try not to have your phone near you all the time and especially during such times as when you are about to go to bed.

 Switch it off at times. Having your phone during these times disrupts sleep not only because of the alerts received but also because of the subconscious expectation of the mind that keeps one alert to the possibility of messages or calls coming through. This contributes to inadequate sleep, which poses multiple health risks. Third, be selective and limit the number of your online networks and connections. 

Pay more attention to real life relationships. For many, social media relations are given top priority even though sometimes they are irrelevant, annoying, boring or even upsetting. Deliberately mute, unfollow or even block them. Instead, follow accounts that provide enriching content that you like such as sports, inspiration or even religion. Limit the amount of news you receive through these sites and be careful about what you read and internalize. Fourth, do not take social media matters too seriously. There is a lot of fiction.  Many people on the sites are not displaying their real lives, it is mostly just for the likes and comments they would like to receive. They could be suffering from poor mental health. Never evaluate yourself based on social media appearances and comparisons. In conclusion Online interactions cannot replace real-life connection. It is natural and healthy for human beings to connect and have a sense of belonging. Invest in time with friends and build relationships away from social media. That is protective of your mental health.    

Dr. Mokeira J. Nyamache

The speed with which I learned new things, shared ideas and updated my knowledge was more than I had ever before imagined. I even stopped referring to my medical textbooks and calling colleagues to consult because with just the touch of a button everything popped up on a screen in front of me. I could research material from different sources and triangulate within minutes. No matter how hard I invested my meagre resources in these pages though, I was constantly giving, emptying, seldom getting satisfaction. I was chasing my tail, a mirage to be precise.

On the other hand, valuable things like school, friendships, family relationships, and work were falling behind. The worst was when one of my social media accounts was used to plan my daughter’s failed kidnap. I learned the hard way. I had to stop yelling every detail of my life to the world through those accounts. Fast forward to a few years later. Nothing comes close to the stress I experience when my child is glued to a gadget. It is even worse if they are on social media without my direct supervision. Any parent to generation alpha category of kids knows how they are with technology.

They do not need introductions nor training. Their ability to soak information within seconds is beyond my understanding. It is even more complicated for me the perspectives they take and creativity with which they apply it. Do not get me wrong. I still like and admire technology. It is at the center of global development even in health. We are updated on many issues today instantly for almost free unlike years ago. Voice calls across countries and continents are instant and as good as free.  Social media has revolutionized almost every aspect of our lives. It is where you find all sorts of people and information, some good and some not. Wisdom from hard lessons learned through experience has reminded me however a thing or two about moderation and stewardship. Even too much of a good thing can be toxic. There is a lot of competition in the virtual world that can be draining in real life.

Everyone seems to be having great fun, achieving greater success or getting more attention.  This predisposes to poor mental health especially among the youth. Studies have linked social media to an increased risk and occurrence of depression, anxiety, loneliness, low self-esteem and even suicidal thoughts. Infomania is another area of caution in dealing with social media. The numerous pieces of information spread through these sites with sometimes-disturbing images often lead to some people compulsively checking for information across sites in their gadgets.  This pre-disposes to anxiety. Trolling and cyberbullying that which have now become common have caused unprecedented harm to many people’s mental health such as low self-esteem and depression. To continue...

Dr. Mokeira J. Nyamache

About 12 years ago, a friend who was visiting Kenya from Germany introduced me to Facebook. I had never heard of that phenomenon. Apparently, it was a way to keep in touch with friends from all over the world in real time. You could even make new friends just like the way we used to have pen pals in primary school years ago but in a more efficient way. No envelopes nor postage stamps were needed. I just needed my computer to be connected to the internet. Therefore, I took to studying Facebook and how to add friends and request for friendships;   

updating my profile and pictures to always look dashing; updating my timeline; commenting on my friends’ updates etc. I would rush through my daily activities just so that I could log into Facebook and see who liked my pictures, commented on my status, requested for friendship and checked on me…It was amazing. Being a night owl by nature, sleeping at 1am due to the prolonged chats with multiple friends was usual. Of course, this meant that my already not very productive mornings were even less productive. The liberty of being self-employed and not having to conform to certain timings compounded the situation. The bliss of virtual connection got better. It became apparent that many similar platforms existed and continued to be developed. I could sign up to multiple ones at the same time. Nimbuzz, Skype, IMO, WhatsApp, Instagram, Snapchat, Telegram, Twitter, LinkeIn, Tiktok etc.

 It was normal to casually just mention to people that they could find me on this or the other platform as alternatives to face-book. They would keep me up most of the night and spend a lot of my energy during the day catching up on chats and timelines. It was part of being cool. Keeping up with these things on a laptop quickly ceased to be trendy. One needed to invest in a smart phone and keep up with the newer versions with better features in order to optimize the experience. The pictures needed to be clear, showing flawless skin in perfect lighting ready for instant updating…and they kept getting better.

 How much money I spent on all this catching up escapes me because it was too much to keep up with every few months, with or without other financial obligations. At school or work; the gadget was in my hand or just in my pocket, where I could easily reach for it in case a message came through; even in the middle of a ward round…Dating, friendships, family connections, work relations all became virtual. The world was in my hand. My virtual connections knew 90% about me just by looking at my Facebook page at some point. I updated everything about my life and hanged on to the comments and likes that came through. It was as if I was validated by the virtual world. This is when the meaning of basic needs as my lovely teachers in primary school had taught me changed in my life. They could no longer be just food, shelter and clothing; Internet and a smart phone qualified for the list. To continue...

Dr. Mokeira Nyamache

 Did you know that the popular movie Sarafina was based on the happenings of 16 June 1976, exactly 44 years ago? In what came to be known as the Soweto Uprising, the morning of this date saw an estimated 20,000 students from around South Africa take part in demonstrations against the poor quality of education. They demanded to be taught in their own language as opposed to Afrikaans and English that were to be introduced. During the protests, police brutally killed 700 of them. It is in honor of their courage and resilience that Africa celebrates The Day of the African Child yearly on the same date.

The theme this year is “Access to a Child-friendly Justice System in Africa

 About seven years ago in a health facility in Nairobi, a six-year-old girl was escorted by her grandmother to the health facility for treatment following reported molestation by her maternal uncle. All procedure was followed in her care and it emerged that this was not the first incidence she was experiencing this. In fact, it seemed as though it was a normal part of her life. We wondered why she had not received prior professional attention based on this information. It emerged that her grandmother feared that if she had sought help earlier then her uncle (grandma’s son) would have been arrested and that would have ruined his life… So why did she bring the child this time around? The uncle had married a new wife and this issue was causing problems in the marriage so his mother decided to try to help. One is left to wonder:

who was the grandmother really helping? Was it be her son by trying to help with his marital problems? Or her granddaughter who had become accustomed to molestation? The patient’s mother was a single parent who traveled frequently to buy merchandise in a neighboring country for business in Kenya. She trusted her mother to care for the child while she ran the business that supported the entire family including the perpetrator in this case. The little girl (survivor) had suffered injustice and she was not even aware that it was a big deal. The guardian who should have protected her had enabled and facilitated it by not reporting and seeking help promptly. Normalization of abuse in children sets the stage for further mental health and psychosocial problems including Gender-Based Violence, dysfunctional relationships, substance abuse, mood disorders, low self-esteem, and suicide among others. The treatment journey is usually long and without guarantees of full recovery.

What does justice mean for the African child? Who ensures it and how?

It starts with the home and the local community. Guardians and parents need to be aware of this and should take responsibility in safeguarding the same. Children must be protected from witnessing and/or experiencing abuse such as domestic violence, verbal abuse, economic abuse, child labor, molestation, unfair treatment of children, discrimination, and brutality from law enforcers. Ignorance, poverty, peer pressure, social injustices, and self-identity problems in the larger community all reinforced by slow legal systems, cultural norms fostering inferiority in certain groups, and social tolerance of different forms of abuse are all predisposing factors. Abuse jeopardizes the future of the children by risking their achievement of full potential and positive contribution to society as well. During this time when the world is fighting the Covid-19 Pandemic through lockdown measures;

 children require responsive caregiving; good health; adequate nutrition; opportunities to learn and protection from abuse and stress. These elements are interdependent and mutually reinforcing. They are essential to enable children to thrive and achieve all they can. Denying them is in itself a big injustice to children. All stakeholders have a responsibility to take care of children’s mental health by protecting them from exposure to abuse and taking the right immediate actions in the event it happens.

Dr Mokeira J. Nyamache

Any man can be a father, but only a special one can be a dad. A father does not have to be biological to be a great dad. He is like the superhero who is always ready to take on everyday troubles for his dependents. He lets them dream and offers his shoulders to stand on while they reach for the skies and beyond. Working and sacrificing tirelessly to fulfill the demands that come with the responsibility does not make him upset and mean.  A dad is a friend whose significance and worth goes beyond words. It is for the love of dads that I choose today to address one most pertinent issue that most of them unfortunately tend to forget or ignore; that is their health.

Many dads avoid preventive care that would have kept many health challenges at bay. Unlike most women who tend to seek medical advice whether or not they are symptomatic; men often believe that if one “feels fine,” then there is no reason to go to the doctor. This might be explained by the fact that many communities with deep-seated cultures and stereotypes dictate how men should behave. They are generally expected to be tough within an unspoken code of conduct. ‘Small’ ailments should not put them down.  It is not surprising therefore that most of them fear visiting hospitals for checkups due to the fear of being labeled  or feeling  ‘weak’ .They usually only do so at advanced stages of illness.

Many dads do not even realize or accept that it is possible for medical conditions such as high blood pressure, high cholesterol, cancer or abnormal blood sugar levels to attack them silently. Some even fail to comply with treatment once diagnosed. They also commonly indulge in unhealthy behaviors like smoking, excessive alcohol use, unhealthy diet, little physical activity, workaholism and sleep deprivation among others increasing their risk of these Non-Communicable Diseases. Being a good dad is not as simple as reading about it or trying to emulate someone else. It is more of a dedicated and deliberate process that involves developing among others good health practices over time. Great dads are a result of the daily choices they make and habits they grow into. The responsibility of being a dad demands strength not only mentally and emotionally but also physically.

This directly correlates with life style.  As a dad, you should consider and understand that your health is no longer just about you. Your dependents may not tell you often enough but the truth is that there is nothing they would want more than to see you healthy and happy.

What are some of the healthy habits dads should practice?

First, healthy eating. As it is often said, 'we are what we eat'. Dads should provide leadership by setting the example in the family even in food choices. Studies have shown that parental health is a good predictor of children's health. This is because children learn what and when to eat by observing then developing their own eating habits. Therefore, the healthier the choices a dad makes, the healthier the habits his dependents are likely to develop. An adult requires 3 liters of fluids per day from a combination of healthy drinks and food ingested.

Balanced meals should comprise of locally available and affordable energy rich, body building and protective foods from a variety of sources ingested at least 3 times a day. Fruits, vegetables and whole grains are a source of the much needed of fibre in the diet. It is advisable to have heavier meals for breakfast and very light meals for dinner. Additionally, it is best to eat the last meal of the day at least 2 hours before bedtime. Second, physical fitness. Let us face it; there is nothing like instant fitness. The only way to improve our physical health is to get into the habit of regular physical exercise. One does not necessarily need to go to a gym or buy expensive equipment. It can be as simple as jogging, walking or even running around with the kids for half an hour at least 5 times a week. The simpler and more fun it is, the easier for one to follow through on a regular basis.

Exercise choices like playing with the kids not only contributes to physical wellness but also to emotional and psychological health of dads and the entire family because they increase bonding. Sweating, increased breathing and heartbeat while you can carry a conversation are the basic signs of healthy moderate physical exertion. More intense exertion should still allow one to converse though in shorter sentences. It is wise to consult your doctor too on the level of exercise you should do especially if you are on follow up for any medical condition. Third, emotional fitness. While a healthy diet and physical fitness are a critical component of well-being, emotional health carries just as much weight for a healthy dad.

A stressed dad who is constantly in a bad mood might cause similar effects on his family; sometimes, even years down the line. It could lead to behavioral problems and long-term effects on his children’s emotional and social skills including but not limited to poor self-esteem, lack of cooperation and self-control, psychoactive substance abuse and even vulnerability to vices like Gender Based Violence. Work-life balance is key for emotional health. Good time-management to ensure dedicated rest and recuperation periods from the demands of a responsible life is a necessity. Self-awareness and building of a healthy support system are complimentary to all efforts towards good health. A healthy, stress-free dad translates to a happy family because he creates an enabling environment for them to engage with and be around him. Participation in family activities becomes easier; hence, the strengthened bonds.

A dad’s role as a leader in the family becomes more satisfying when good health abounds. On the other hand, being unhealthy increases family stress that may have many unpleasant outcomes. As we celebrate this year's edition of Father's Day, make it a priority as a dad to take care of your physical and mental health.  It is not just about you but your whole family. Let us all remember, appreciate and honor the contribution of dads to our lives.

Dr. Mokeira J. Nyamache

 Maintaining a healthy lifestyle during COVID-19 pandemic is crucial.

 As the global fight against COVID-19 continues, we are advised to take measures in order to slow and prevent its spread (flattening the curve). People have now become accustomed to new lifestyles; otherwise known as the new normal. Self-isolation, quarantine, social/physical distancing and working from home are now very familiar concepts all over the world. Boredom and frustration are however a challenge for many during this period because social events like sporting and entertainment have been suspended, travel restrictions have been instituted, businesses have failed to thrive and jobs have been lost. Infomania has also found new realities during this pandemic where it is easy for anyone to access social media in one way or another.

Every cloud has a silver lining. 

 Though the situation is frustrating for some, others have seen the opportunity to become creative and explore some of the things they previously had no time to do. Taking a tour of the various media platforms, you will notice for example that cooking is one of the most discussed topics during these times. People are sharing delightful pictures with recipes of foods they cook; the small joys!

Non-communicable diseases

The uncertainty associated with the current situation however causes limited availability of fresh products like fruits, vegetables and fibre, which in turn may compromise opportunities to continue accessing ingredients for a healthy, and balanced diet. The option is often an increased utilization of highly processed foods, which tend to be rich in fats, sugars and salt. Timing of meals is another consideration here. When people are mostly indoors and especially if not as busy, they tend to snack more frequently in between meals. It is also common that mostly available snacks are energy-dense and rich in fats and sugar. These dietary factors, coupled with a lack of physical exercise, gyms remaining locked and people fearing to venture outside could increase the risk of Non-Communicable Diseases such as high blood pressure, diabetes and obesity.

Mental health problems

 In addition to the above restrictions and loss of jobs and business income, many people have been separated from their loved ones for months on end; hence disrupting their social support systems. Limited conversations and physical contact, long periods of silence, spending most times alone and having no one to laugh with can be frustrating. The constant sad news making rounds on various media platforms can be too much for some people to bear. Imagining the possibility of self or dear ones, contracting COVID-19 makes many people paranoid.  It is only natural therefore that stress leading to depression, anxiety, mania and triggers of otherwise well controlled mental health conditions such as schizophrenia might set in. It is worth noting that healthy choices including diet and physical activity largely depend on a person’s mental status. If one is mentally unhealthy, they may not make the best choices given their circumstances.

Self-awareness is key

Anyone is at risk of contracting COVID-19. Every individual should be able to set personal standards that guide choices with the full realization that they all produce results that converge to determine physical, mental and even emotional health. One can therefore align everything in life to these standards including health matters. This directly and indirectly strengthens immunity. 

So why should you stay healthy during the COVID-19 pandemic? 

Studies have shown that poor weight management, lack of physical exercise, fatigue caused by sleeplessness, unhealthy social relationships and poor mental health disrupt the immune system. There is a life and other illnesses especially Non-Communicable Diseases happening concurrently with this pandemic. They are not waiting for it to boil over. They are right in the mix as we face COVID-19 and if we neglect our overall health, they will become an even bigger challenge. Stay healthy as you stay safe.

 Dr Mokeira J. Nyamache

I confidentially did my self-prescribed investigations just to be sure that indeed it was fatigue and hypoglycaemia. My vitals were perfect, there was no anaemia, my blood sugar levels were normal and there was nothing pointing to the syndromes or illnesses that are often of common onset at that age. I even called my dad to check on genetic illnesses in our family that I might not have been aware of.  All was fine.

Infection Prevention and Control

Thinking back I cannot help wondering what it would have been like if I had collapsed on a patient with a disease as contagious as COVID-19. In the line of duty I would have been contaminated, because I was too tired to be safe. I would have also contaminated my team that was at hand to assist me, while they mostly depended on my decisions and guidance. Mark you in those days I did not know as much information on Quality Management Systems in primary healthcare settings, Infection Prevention and Control as I do now. I safely got by through observation and God’s grace. On occasion of course there would be a senior colleague to teach a valuable lesson usually on management of medical conditions and rarely was reference made to quality management. 

 The expectation of course was that you already knew; you had the title ‘’daktari’’, and so the environment was not enabling for questions on ‘’basics’’ while there were more life-threatening details to discuss. The heaviest protective gear was mostly the cotton theatre gowns we would wear on top of our scrubs and an improvised apron made from the bin liners. Surgical masks, a rewashable head cover, surgical gloves and boots completed the ensemble for high-risk areas; i.e theatre. This ensemble was for the surgeon and the assistant. If materials were few, the assistant would have to do with less. A few times I noticed dried up pieces of body tissue on the theatre gowns and drapes.

 Sometimes they would be semi-dry, because the autoclave was not working well enough…but we trusted, and the patient’s life was at stake. It was also not surprising to notice blood stains here and there while washing hands after taking off the theatre gown and gloves. This is because the sleeves were sometimes too short to adequately stay tucked in to the gloves during maneuvers. If a splash of body fluid happened to the eyes or forehead in the poorly ventilated theatre where sweat dripping down the forehead was norm then one had to hope that the splash could not cause infection. In such situations, I would re-check the patients file for history of contagious diseases; and at that time my biggest fear was HIV and Hepatitis B (which was rarely diagnosed given our laboratory’s limitations). If I had reason to feel unsafe then I would go over to the pharmacy and explain the exposure before starting myself on the tough course of Post Exposure Prophylaxis for 28 days.

There weren’t many other disease that were as dreaded when exposure and a breach of Infection Prevention Measures as we knew them happened. That is just how it was over there, and I had never had to deal with known highly infectious diseases. The anesthetist being a key member of the team was often comfortable in only scrubs; pockets loaded with a tourniquet, cannulas and a stethoscope around the neck; open shoes, a head cover and a mask that was mostly covering the chin than the nose and mouth. Gloves were seemingly not essential for this colleague though he/she had to touch the patient from time to time. 

Different strokes for different folks.

 Out of theatre, the risk was perceived as little. Examining patients without any protective gear was common. Many times, I would palpate fundal heights and listen for the fetal heart with only my sleeves rolled up, stethoscope balancing on my neck supported by one hand while my ear was placed against the fundoscope hinged on the gravid abdomen. Sometimes I even had open shoes during ward rounds and related procedures. I shudder to think the number of splashes I came into direct skin contact with.

Ignorance was bliss; but I digress.

 Forgetfulness and lack of attention while going about duties where your ability to think, remember and process information for correct decisions becomes affected due to lack of sufficient sleep. To be safe as a worker, these are the times to sleep well. For the health worker especially, you will need to be alert and strong in order to use Personal Protective Equipment properly, to follow Infection Prevention and Control measures to the letter, to give your patients the quality of care they trust you for and to be a strong link in your team.

 Sufficient sleep is not a luxury.

 Consistent sleep-wake patterns of going to bed late and waking up early can lead to lack of enough sleep. Stimulants like coffee and energy drinks as well as environmental factors like too much noise could also be a cause.

 So, how do you get enough sleep?

 Find a good comfortable spot, switch off your gadgets, fall into a bedtime relaxation routine, and accept that tomorrow is also another opportunity to deliver more good quality work. Many people depend on you and so it is necessary to be healthy, alert and able to make the right decisions. While sleep needs vary from person to person and across ages it is advisable that adults should sleep at least 8 hours a day. Babies require more sleeping time of at least 14 hours a day and as they continue to develop and grow this changes. During this COVID-19 Pandemic, where everything is uncertain and situations are rapidly evolving, we may find ourselves depriving our bodies of the much-needed resting time.

 Getting enough quality sleep is vital as it helps protect our mental, emotional and physical health while also improving our quality of life and safety while navigating this season. Please let us learn to sleep well. Inadequate sleep may cause more long term and serious health problems, and it could directly or indirectly increase the risks associated with COVID-19 by affecting memory, immunity, physical strength and emotional stability. These may cause problems in putting on and taking off  Personal Protective Equipment correctly and following the strict Infection Prevention and Control measures in place; problems thinking through actions and plans as well as problems delivering on programs to be implemented. All these translate to being less than one’s own best performer…and the cycle continues. Falling casualty to the health consequences of sleep deprivation is sad because while you deal with them the rest of the world will move forward, it might even replace you in the process.  

Dr. Jeldah J. Nyamache

Don’t lie to yourself as many of us often do that eating a balanced diet and exercising regularly will do the trick. The fact is that not getting enough sleep undermines all efforts at a healthy lifestyle. The brain suffers when you skip a good night’s sleep causing slowness in some parts and physical sluggishness. I can testify to this because about 12 years ago I fell victim to the consequences of sleeplessness.  I worked in a provincial hospital in one of the remote parts of Kenya. Being on call meant working regular shifts during the day and in addition to that tending to all patients in your department beyond working hours. It was around Christmas and we were few, as many colleagues had gone on leave.

 Being an intern in that station came with the unspoken obligation to always be available in the hospital especially when no other doctor was available for whatever reason. You ran the show and the narrative was vividly captured in the nurses’ cardex, creatively so at times… Virtual consultation is actually not new because often when stuck as an intern you called everyone in the order of fellow interns, medical officer, senior medical officer and finally consultants in case you were caught in a clinically tricky situation. The calls were at your cost because the hospital phone often did not have airtime. It was often not surprising that the phone could not go through to any of the officially listed colleagues and you were left to often consult ‘’elsewhere’’ just as long as your patient was sorted. You also tried to avoid mortalities at all cost.

Mark you if the phone went through to the senior medical officer or consultant you would be at pains to first explain why you needed to call them before talking to the medical officer; it would often be turned into a small viva perhaps to keep the intern reminded of their hierarchical position in knowledge and experience. The incident would also likely come up during the next major ward round and one would not be sure what to expect out of the discussions. My ‘’elsewhere’’ was usually my dad because I knew he could pick my phone call at any time and he would work through the situation with me. He would call me back in order to save my airtime as we worked together for as long as it took.

There was seemingly a baby boom in that province that Christmas season. All beds were occupied with at least two mothers in labour. If one occupant advanced to second stage, the bed mate was quickly moved to share in another calmer bed since there was only one delivery couch and it was rare in that ward that only one baby was born at a time. Meconium and bloody splashes were the usual sight accompanied with a certain characteristic smell whose components I never quite deciphered. If I was not supporting a perineum, I was repairing a cervix, evacuating Products of Conception, or scrubbed for a caesarian section, all on autopilot. It was a rough several days. Rest, let alone sleep was not an option because the mixture of zeal and the Hippocratic Oath I had recently taken would not let my conscience rest easy knowing there were patients in distress.

I was supposed to be saving the day. Then there was the cardex to remember. In the middle of the buzz of activity, I collapsed on a patient in theatre during the final stitches while closing the abdomen. The lovely nurses who resuscitated me later informed me that it was fatigue and hypoglycaemia; they were convinced that no further consultation was needed to make that conclusion. I was at their mercy and I humored them. I however could not believe them: that I had actually collapsed just out of tiredness and hunger? I was definitely going to get another opinion, even if it would largely be my own. Of course, once I got off the drip they had hang on me I was dusted and ready to move to the next patient in a day; because I was the doctor you see, and the patients depended on me. Granted, I had not slept more than an hour or so out of 48, but I was supposed to be and had to stay strong. To continue...

Dr. Jeldah J. Nyamache

The day I Collapsed in Theatre

 Experience is the best teacher or so it is said. Responding to disasters becomes usual for a significant chunk of your career if you are a health worker especially in public and primary health settings. No disaster resembles any other and that is why they cause such panic. I have learned that in some instances, even a good plan does not completely deter panic and stress during response. The seemingly sensible thing is to ‘’redeem time’’ by sleeping less, staying awake, alert, reading and knowing everything about the disaster all the time. Or at least try to keep up with it… Growing up I knew that it was nothing short of laziness to sleep for long hours. Long being relative but in my mother’s house 8 was as far as it could go. It was also specific that these hours had to be planned in a way that one wakes up by latest 6:00 am in order to avoid the endless lecture on laziness mother dearest would give. 

 The opposite was of course true, only that you did not get endless praises. A nice cup of tea accompanied by a question as to whether you were so busy hence, the little or no sleep the previous night as evidenced by puffy eyes was actually a compliment…no long lecture. The situation was worse in medical school even though no one was around to directly ask.

 Most of us have been there in one way or the other.

Perhaps it is for times such as this COVID-19 pandemic that the lesson of little sleep=hardworking was being entrenched in some of us. How does one have sound sleep when uncertainty, fear, pressure and even hopelessness or disenchantment abound? If you have responsibilities, you will testify to those many days that sleep has been pushed so far down your priority list. Intentional sleep deprivation is common nowadays also due to unclear understanding of the health value and importance of sleep. I have recently realized that when I deliberately go to bed in time to try and cover the 8 hours at least 50% of those will be spent alert in my mind. The different interconnected areas of my brain are accustomed to scanning the checklists up and down as I just lay there: family, work, school and social obligations to mentions but a few.

The ever-growing to-do lists need to end before I can really sleep for the 8 hours. Sometimes I even quickly grab a gadget in the middle of the night to make draft notes so that I can polish the next morning. Studies have shown that lack of enough sleep can increase chances of developing conditions like hypertension, diabetes, obesity and even depression. It could also lead to emotional challenges and poor job performance. Then add the issues from disasters ranging from war, floods, cholera, food insecurity, malaria, lack of shelter, locusts, loss of property etc. Imagine these risks combined with the anxiety that this pandemic carries in its tide. In my opinion, immunity automatically stands to plummet due to the high stress levels and this is where COVID-19 thrives based current data. To continue...

Dr. Mokeira J. Nyamache 

You see, these populations by the nature of their economic activities were mobile, lived in close interaction with specific communities, were stigmatized and largely lived in low socio-economic states. So thanks to my loud thoughts the task force was drawn to the attention of key populations’ and truckers’ needs and circumstances which would make them highly at risk as well as a source of spread across borders. A good discussion ensued even suggesting inclusion of WASH partners in the plan for hygiene considerations.

I left the meeting a happy doctor, knowing my clients would be well catered for in the national and by extension regional contingency plan. I drafted the infection prevention and control guidelines for them in my head and could not wait for the enrichment that would come from sharing it with the task force. That moment felt like true service to humanity. Never mind that the chair of the meeting seemed to struggle with the definition of the term key populations and the relevance of truckers in this discussion. In my naivety I offered to explain just so that the minutes would capture the details accurately albeit briefly. Notably though, the minute taker upon reading through the draft notes prior to the meeting conclusion had coined a term to refer to these categories of populations and my attempt to have it correct was met by ‘’the members of the task force will understand the point’’. I trustingly rested my case.

The phone call

Nothing prepared me for what would come next. It was about 3:00pm and I was in the office having late lunch while updating my colleagues on the meeting when my phone rang and I eagerly picked up as it was from a colleague from the meeting. She was responsible for its convening and worked for an influential global health organisation. She said that she had received concerns about the ‘’controversial topics’’ I raised in the meeting: key populations, truck drivers, transport corridors, borders. She asked if our organisation did HIV programing and I responded that it was one of the programs under our primary healthcare umbrella. She said that our contribution was not welcome nor valid for COVID-19 contingency planning based on the complaints from the Ministry of Health leadership in the task force. My attempts to explain the logic to her for almost 15 minutes were futile.

Finally I requested at least for training of our frontline staff. That too was denied because they were not really in ‘’the line of danger’’ because they were dealing with ‘’just truckers and key populations who were mainly HIV positive and being followed up. By the time a person reaches your team,’’ she continued, ‘’ they will have been screened and so no chance of risk. In fact, it would be impossible for a COVID-19 client to reach your team before being reached by a different facility…’’ She seemed to be saying. My heart sunk. I knew better and suspected that in a short while we would have to contend with reality: infected truckers crossing borders and key populations moving to different locations due to movement restrictions and closure of hotspots. Three weeks later, the dilemma arose at the western border and just days after that, a truck driver tested positive. That trucker was one of our regular clients and the first in a growing list of truckers being diagnosed positive across our network.

On the brighter side, not all was lost and our close working relationship with the ministry still allowed us to forge ahead in partnership. We started trainings, awareness raising campaigns and active case finding. The guidelines I had drafted in my mind came to life and our target population was getting the attention it required. Thinking back to the phone call, I could not help wondering if it was not too late firefighting as was the norm in these parts of the world. Perhaps if the controversial topics had been included in the planning, the ongoing trucker case numbers might have been less.

That aside however, I could not help weighing knowledge versus experience, and the answer was the same as before: synergy in timely application of knowledge and experience; inclusion would be a good addition for perspective too. Then I remembered my patient and the blind men of Indostan, it should never be about who gets credit but about credibility of the intervention knowing that no one knows it all. After all, nobody is perfect and this thinking would keep us ahead of the virus I am sure. So now, each day I watch the news or receive reports from my colleagues in the frontlines about more truckers turning positive I remember that afternoon phone call. They won’t let me forget it. It reminds me to grow no matter what.  

Dr. Mokeira J. Nyamache[/caption] Certainly, 100% good or bad is a fallacy. Do we pay the price for herd immunity or isolate until we find a cure and vaccine? And how will the masses be able to follow the guidelines whichever way we opt for? Floods are now competing with COVID-19 for lives in my country, malaria cases are going up, and cholera outbreak is in full swing with death toll competitively rising. As if that is not enough, unemployment has soared on eagles’ wings and pests are taking away the hope of at least a meal a day in many homes with the government opting for yet another huge loan to salvage the situation; we will pay when we pay. Simply thinking, two are better than one. Knowledge and experience are synergistic and yes, waiting to learn everything from own experience is a bit on the slow side of life.

  Let me tell you a bit about one patient that became a friend. A brilliant soul who eats life with a big spoon. Never too sad no matter the circumstances and even when I don’t think we should joke, he beams with laughter and says “Doc, you need to always be two steps ahead of them.’’ By the way, he has never specified who ‘them’ is and each time I ask, diversion is norm. The man is the age of my father and an excellent scholar in his field. One day we had to discuss a change in his management plan because the treatment was failing.

It was a tough conversation and I had lined up some of my super specialist colleagues to explain the situation that we were battling. The 45-minute discussion felt like it had lasted a whole day because of the weight of the matter. I did not know how my next consultation alone with him would be but I had to compose myself, hopeful for even a miracle. Nothing prepared me for what was to come next. He was physically frail, but his spirit as beaming as ever. He said he wanted to tell me a story before going home and so I needed to make time for him. I did. He told me about the six blind men of Indostan. I had not heard it before. Eager to learn they all went to observe the elephant though all were blind.

To one, upon touching the elephant was like a wall, and to the next like a spear.  To the third like a snake and to the fourth a tree. The fifth and sixth likened the elephant to a fan and rope respectively. And all were satisfied in their own blind worlds that they knew what an elephant is. He said if I forget everything about him, I should never forget the two things: this story and the need to always ‘’be two steps ahead of them.’’ Two years later, I was preparing for COVID-19 response targeting one of the most vulnerable populations I have ever interacted with in my entire career. Truck drivers, key populations and the communities along transport corridors and near borders. In my past, I had met several other categories of undeserved populations but these were different. Tough and real situations on the job taught me about their unique needs. 

 Therefore, as usual while planning, I was looking for opportunities to maximise the benefits for them and thankfully, I found a link to the national task force in preparation for COVID-19. I requested to participate in the discussions but seemingly, an envelope on the table was the pass in. After a few conversations, I thankfully got a chance to be there, even as much as the proverbial envelope was still unavailable. I was excited to see colleagues from years past in the frontlines across the continent and I knew I was in the right place at the right time. Our beneficiaries would definitely get consideration among these great minds. My knowledge and experience were limited, but I was confident in the power of synergy. To continue....

Dr Mokeira J. Nyamache

Early days I was pre-occupied with quality supervisory visits in one of our sites when the Coronavirus disease drums started rolling mountains and seas away, begging for an ear. At this point, even the official name COVID-19 allocated by the World Health Organization did not come easily to mind. Back home, like was the case with many other African countries, all sorts of chaos drowned the sounds away and most paid little or no attention. The risk analysis by the World Health Organization rated it low after all; it was mainly a problem in China. Human to human transmission seemed not to be a concern at the time either. The disease had not qualified to be labelled a global pandemic. Four weeks later however;

 the horror of infections and deaths from the virus was fast sweeping across Europe and America with massive strokes, taking lives with it. Many were caught off guard on this one.

Getting in the mix

As the drums grew louder, paranoia and multiple past experiences flooded my mind. Memories of being caught up with ebola, cholera, malaria, flooding and mass fire responses were all coming back. I instinctively switched to response mode: sanitisers, physical distancing, reduced unnecessary movement, obsessive reading, just about anything and everything that could be termed infection prevention and control. I knew it was time for immense uncertainty and planning. This time though, I would be leading from behind as opposed to the frontlines.

I had to frame the plan and it had to evolve with changing situations within available resources across seven different countries spread over two continents. It had to engage vertically and horizontally, within and without. How would such a plan be possible where health was not a priority given the little investment in quality of healthcare systems? Never mind the experience garnered from dealing with other equally deadly diseases in the past. Anyway, somehow the frontline teams and clients had to be catered for amidst the theories ranging from mythology to laboratory inventions. Information about the disease was scattered and scanty.

Rolling with it

The slow arrival of this disease in some of our countries should have bought precious time for preparation. I wondered if Africa should not have been leading the world in best responding to this new disease thanks to our many experiences with infectious disease outbreaks. Then also, the extensive western knowledge would probably still reign supreme. The thought of both maybe and perhaps none also crossed my mind. Many nations had no plan and many who had were mostly copy pasting from the various trending response plans. There should have been a context specific disaster contingency plan before the plan for faster effect across nations, especially with a history of outbreaks.

 And so?

We have to make do with the usual capturing of moments through select experiences shared in various platforms. You see, the world that is currently dealing with Covid-19 is a different one from the one that dealt with SARS and H1N1, a lot has definitely changed, technology-wise at least. I still think based on this though that we should have been in a better position to deal with the scourge. Having spent decades fighting some of the world's deadliest diseases like HIV/AIDS, tuberculosis, cholera, Ebola and malaria; we should be ahead of the pathogens. Trusting of course that we will live through this one, we do not need to wait for next time to use archived beautifully documented lessons that may have even been forgotten through the filing systems. The answer lies in the synergy between knowledge and experience applied in a timely manner. Harnessing that for our world’s well-being without caring who takes credit. It is time to grow.

Nurse

Laboratory technician

Program director and family practitioner

 There was a time when reading used to make everything better for you. From fixing your broken heart, shortening a lengthy day, cooling your nerves just before an important interview and even uplifting your lowly moods. Those days, you could be passing through hell and not even realize it because books offered you a nice escape, to beautiful shores, Rocky Mountains, deserts whose air was laden with too much dust you wanted to cover your eyes with your hands by just reading about them. These days, you hardly enjoy a book.

As a matter of fact, you are finding it increasingly hard to pick a book and start reading. Every time you talk yourself into reading one, you barely go through the first ten pages before the over powering urge to stop comes again. There are ten books all book marked at page ten that you have started to read in this past week alone but couldn’t go beyond the tenth page. You don’t get the kick you used to get from reading anymore. You have tried movies but realized every time you start watching one, your thoughts wander. The movie plays on till the end only for you to realize you have no idea what the movie was even about. You can’t read, you can’t watch a movie, and as if this is not enough, you can’t seem to fall asleep at night.

On those nights when you fall asleep, you can’t stay asleep for more than two hours. And on those days (which is every day by the way) you have nothing to keep you company apart from your own thoughts. You realize you would give anything just to run away from this hopelessness that has descended upon your world. Three quarters of the time you are lying in your bed turning, tossing and even then, you don’t want to get out of that very bed where you lie gazing into space. Every time you push yourself to get up, the farthest you get is to the bathroom. Just to empty your bowels and pee, take a really quick shower on the day when you feel it is absolutely necessary, serve yourself a mountain of food and sit on the bed that you last made two weeks ago, and eat all that food. You have added a few inches to your waist, the clothes hug your body more, three skirts are threatening to burst at the seams.

You know you are headed for obesity but that is the least of your worries now. You know you are supposed to feel better in the morning but all days are the same old and dull to you. You feel as lonely on Friday nights as you feel every Monday morning. Your friends no longer call. They are tired of the lack of enthusiasm on your voice when you finally choose to answer their calls. You have missed friendship re unions with no explanation and they are tired of trying to pull you down from your high horse. Your mother has made peace with the fact that you are going to call home once in a blue moon.

She is okay if you are okay.  You don’t care about social media any more. You are tired of running into your ex everywhere in these streets of face book. You are tired of trying to tell yourself that he doesn’t deserve you. Probably you are the one who doesn’t deserve him with your body looking like a roto tank with all the eating you have been doing. You feel so empty; you have a pain that you can’t even describe. You slap yourself. You want to feel physical pain. You wish for someone to come and beat you up. Or even for a matatu to run over you, break a limb, break something in your body, leave you in a coma where you will lie and wake up and scream over a physical pain. You know whatever is happening to you is not even normal.

You are in a place to the extreme left of sadness. If you could walk even a little bit, then walk yourself to the bus station and ask them to drop you at a hospital gate. Because you are depressed and if it is going to get worse, you will commit suicide… Most of your friends aren’t even going to realize that you are depressed. If anything, they will accuse you of all sorts of things. Maybe we can’t blame them. We live in a society that has taught us that it is okay to be unhappy. That we don’t even deserve too much happiness. That we can’t blame anything in our lives for the feelings that we feel.

Raise your hand if you have ever been bitten by a dog. Raise your other hand if this dog that bit you has never been vaccinated against rabies. Move to the left if the dog that bit you was a strange dog…..

A small boy, about six or seven lay in the hospital isolation room, with saliva drooling down the side of his mouth. Occasionally, he suffered a strong seizure that made his whole body tense and shake at the same time, before slipping into episodes of apparent calm. His mother sat by his side, with hands supporting her cheeks. Occasionally, she would stand and pace the room, raise her hands and place them over her head before finally walking back and taking her place beside her son. He later slipped into a coma, and as we all know, this story doesn’t end well. When he had shown up in their house one evening three months earlier with bite marks and scratch marks thanks to a neighborhood dog, they decided the bite was too small and just ignored it.

 Three months later, he presented with full blown rabies. (This is a true story). September 28th is rabies awareness day. Incidentally, yesterday I saw a woman who had been bitten by a dog two days before she presented to the hospital. She was admitted for reasons other than the dog bite. But I had to bring up that “small matter” of a dog bite. She didn’t have money to buy the anti-rabies, she promised to look for the money. Meanwhile, we will just sit back and pray that she gets the money….before it is too late because rabies is real. Rabies is a viral disease that affects the central nervous system (brain), usually transmitted through a bite by a rabid animal. Rabies is transmitted through a bite by a rabid animal, usually a dog. In my village, they are called t-nine, or mbwa wa kichaa. Other animals that can transmit rabies include monkeys, skunks, cats, wolves et cetera. In the unfortunate event that an unvaccinated or a strange dog bites you, please make sure that you seek medical help. Go to the hospital and have the wound cleaned, get an anti- tetanus shot and get a dose of the anti- rabies vaccine. Now ideally, you should get five shots of the vaccine. The day you are bitten is the first time you get the vaccine.

That is day zero. Then you should get a repeat shot on day three, day seven, day fourteen and day twenty-eight. Of course most people rarely get the anti-rabies. The few who get it get a single dose on day zero and never return for the remaining doses. The issue is money constraints. The anti- rabies vaccine costs an average of one thousand five hundred shillings. Public hospitals almost always never stock it and most medical insurances don’t cater for it. So most people who present to the hospital end up skipping it altogether. The question is, if a dog bit you today, would you afford the anti- rabies vaccine right this moment? Maybe we should remind the forty seven county governments that they need to stock anti- rabies … As a young girl growing up in the village, once in a while, we used to have mass vaccinations. A community vaccination of all domestic animals. I haven’t heard about them for a long time now. People are too broke vaccinating their domestic animals is the last thing on their mind. Maybe the reason why we are a third world country is because we are still killed by diseases like rabies. Of all diseases that should kill us, rabies shouldn’t be one of them. But it is. NB; on day zero, rabies immune globulin is administered together with the anti- rabies vaccine.

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.

TREATMENT

Our care departments include:

• Pediatric Care
• General Surgery
• Orthopedic Surgery
• Cancer Care
• Family Medicine
• Wellness
• Geriatric health services
• Communicable and non-communicable disease treatments
• Physiotherapy and rehabilitation 
• Training and capacity building for health
• Community case management and home-based care
• Gender-based recovery centre
• Medical health services - both individual and group therapy

Dr Jeldah Nyamache,

Gender-based violence (GBV) is a widely known problem that is mainly perpetrated by men, and community members and individuals who tolerate negative masculinity. Men have also been victims of this scourge perpetrated by women.

But although numerous efforts have been put in place to fight GBV with women’s empowerment being one of the key approaches, one approach missing in most communities is a focus on engaging men to challenge norms of masculine behavior and support gender equality. Although ending GBV has proven to be a daunting endeavor, given that it means challenging gendered power divisions and cultural norms, this is an approach which could be a helpful contribution to eliminating GBV.

Ending violence in our communities is a responsibility of the whole community and it is significant that men and boys are active participants and promoters of change to get rid of the current status quo. On the same scale, it is also critical to combat not only the individual instances of violence, but also the systemic forms of violence, as violence does not occur in a vacuum but rather in a society that condones and encourages it.

GBV that is directed at women and girls by men, results in large part from women’s subordinate status in the society due to traditional and cultural norms, as well as their low economic status and serves to perpetuate male power and control over women. There is also ample evidence that gender inequality and the resulting economic deprivation and dependency are fuelling gender-based violence.

In order to achieve economic, social and development goals such as the SDGs 2030, individuals, government and civil society need to build a more gender equitable society with healthier gender roles for women and men. To be effective, strategies must not only empower women, but also should engage men and bring about significant changes in men’s attitudes and practices which are often discouraged by negative notions of masculinity. It is common among many communities for women and children to be subjected to gender-based violence and other forms of violence which include, harassment and harmful traditional practices such as female genital mutilation.

It is important to note that there have been numerous deliberate efforts to address this problem. These efforts have largely used women themselves as agents for change. However, multiple researches show that such an approach has not borne desired fruits as GBV continues to affect many communities.

As a result, many changes are being made such that gender transformative programs are now taking into account the involvement of men and boys in ending patriarchal norms, gender inequality and GBV. There are now a lot of programs promoting positive engagement of men in positive parenting.

Evidence from researches has proved that working with men and boys to challenge toxic masculinity and gender inequality has a positive impact in improving the health and wellbeing of women and children, and men themselves.

Achieving gender equality and ending gender-based violence is a societal responsibility that must fully engage both men and women. For many years, women have led efforts to prevent and end violence, and today more men are adding their support to the women’s movement. Men have a crucial role to play as fathers, friends, decision makers and opinion leaders, in speaking out against violence against women and ensuring that attention is given to the issue. Importantly, men can provide positive role models for young men and boys, based on healthy aspects of masculinity.

Motherhood should be a step in ascending the ladder of growth and development rather than a source of poor mental health.

Teenage mothers or mothers to be are at high risk of depression which is the leading cause of death among young people aged 15-49 years; a bracket that holds many teenage mothers. It also increases the risk of suicide by 20%. Though the prevalence rates vary in different countries (14-23 %); the consequences are dire across the globe affecting both mother and child; more so during the recent unprecedented crisis in mental health occasioned by the COVID-19 pandemic. On the other hand, depression among teenagers is a predisposing factor for unplanned pregnancy due to the increased risk of psychoactive substance use and abuse including Gender Based Violence.

A vicious cycle therefore exists between depression and teenage pregnancy.

The variation in prevalence across countries depends on social determinants such as cultural and religious beliefs; socioeconomic status and individual risk factors such as genetic predisposition, co-morbidities, previous history of mental health conditions, psychoactive substance use, poorly managed stress, physical and emotional abuse, diabetes, thyroid disease, complications during pregnancy, negative thoughts about motherhood and quality of relationships.

Consequences of depression in teenage pregnancy affect both mother and child. Symptoms can occur before child birth(antepartum) or after (post partum). Antepartum depression occurs during pregnancy and is characterised by sleep and appetite changes, mood swings and excessive worry. A lot of these symptoms are easily confused with the normal changes experienced during pregnancy. It is therefore beneficial to maintain close engagement between the mother to be and a health professional. Antepartum depression causes miscarriages, increases risk of high blood pressure, diabetes, suicide and homicide. Additionally, mothers with chronic illnesses easily falter on the consistency of their treatment and follow up appointments when depressed. This predisposes them to complications which can also affect the unborn baby negatively.

Post partum depression refers to sadness, anxiety and exhaustion that lasts more than 2 weeks after childbirth. Mood swings, changes in dietary and sleeping habits, difficulty in decision making, difficulty in bonding with baby, suicidal thoughts and anger characterise the condition. It is the commonest mental health problem for new mothers with a prevalence of about 15%. It can start during pregnancy or after (perinatal depression). This condition predisposes to neglect of the new-born as the mother may not be interested in bonding with, feeding the baby nor honouring the mother and child clinic appointments. The end result is malnutrition, increased risk to childhood infections and slow development which may affect learning ability, behaviour and metal health conditions later in the baby’s life.

Teenage mothers should be closely followed during the antenatal clinics to screen for risk factors for depression and measures including psychotherapy put in place to avert the dangers. They should be encouraged to be deliberate about remaining physically active; observing good diet and sleep habits (e.g sleeping when the baby sleeps); avoid psychoactive substances; keeping in touch with family and friends; asking for help when in need and positively managing stress.

 Full blown symptoms of depression are treatable to allow one live a normal life.

Teenage mothers and mothers to be deserve the best mental health care. This will not only ensure their safe navigation of the motherhood milestone but also that the next generation thrives since the mothers will diligently prioritize wholesome health for themselves and their young ones.

Thriving during this milestone should be the norm rather than the exception.

Let us all take stock of reality and invest in the wellbeing of our teenage mothers and mothers to be as a means to avert depression and give them and their babies a better chance at life. Incorporating prevention into our national health and education programs would go a long way in saving lives and promoting happy motherhood experiences. 

It is a shame that Gender based violence has been normalized in our society.

Approximately 1 in 3 women and an unclear number of men are affected by GBV globally. It can be economical, physical, emotional or psychological. Anyone can be a victim or perpetrator of any form of GBV but intimate partner violence is the most widespread. Many a time the physical form is talked about because it is the most apparent; however; all forms of GBV through action, word or omission are equally damaging and should stop.

It is a global pandemic that ravages and forces victims to subordinate to the perpetrators resulting in impaired physical and mental health; stress; anxiety; loss of self-esteem; demotivation and depression. This in turn interferes with victims’ ability to reach their full potential; participate in economic activities or engage meaningfully in other life interests. It causes stigma and affects reputation. In fact, research has shown that sexual harassment claims have a greater effect on a company’s reputation than other forms of misconduct like fraud. For instance; allegations of sexual harassment by senior staff and drivers at the ride-sharing company Uber resulted in 56% of survey respondents refusing to use their services. In another example, allegations of sexual abuse and misconduct by construction workers on a major Ugandan infrastructure project resulted in the World Bank cancelling $265 million worth of funding and issuing a public statement.

The ultimate result of GBV if poorly managed is often the damaged goods syndrome which directly affects individual productivity.

A person with this syndrome believes they are no longer good enough nor worthy due to the negative effects caused by GBV on their self-esteem. This warps their expectations of anything good coming their way and in fact will often not accept it fully. Self-sabotage and/or harm is rampart in people suffering from this syndrome. It is not uncommon for them to even blame themselves for abuse experienced.

The casual or negative response to concerns raised about GBV in society contributes to survivors deteriorating to this syndrome. They are left feeling that they are making a big deal out of nothing. It is fertile ground for not only health complications, economic losses but also the all too familiar societal norms that lead to re-experiencing of GBV or attempts to cope through channels like substance abuse; and the cycle continues.  

Let us improve our attitude to this issue and take a more serious stance.

Rather than rationalizing in favour of perpetrators of any form, give the victim the attention and support they deserve. Listening with empathy, encouraging and guiding them to get health and legal help goes a long way. In some instances you may need to step in and be their eyes, ears, voice and do a lot of care seeking on their behalf. Remember that anyone can be a victim or a perpetrator of GBV.

Let us rally behind legal frameworks like the globally recognized standards for addressing violence and harassment set out in June 2019 by the International Labor Organization (ILO). They increase accountability from organizations through a more comprehensive way of responding to GBV including taking steps to prevent violence; to protect survivors through remedy and compensation; and to develop awareness raising, reporting and grievance procedures.

Identifying potential risks, leadership commitments to diverse, equal, and respectful workplaces backed by adequate resources would form a foundation to tackle root causes like gender inequality and mistrust amongst staff. Without this foundation, efforts to raise awareness can appear tokenistic and lack legitimacy. Clear policies and procedures including reporting and grievance mechanisms not only empower staff to take appropriate action when needed, but also reassure survivors, accused perpetrators, and whistle-blowers that the organization will handle cases effectively.

It is not an easy issue to tackle, but we all can deliberately take norm-shifting initiatives within our circle of control. We have a lot to gain, including improved overall performance, productivity and retention thanks to good mental health. 

If you have not yet been infected, then you have definitely been affected by COVID-19.

Everyone is dealing with the so called new normal thanks to the pandemic. It means different realities to different people across the world as it continues to wreck havoc on lives since 2019. For some it has resulted in a numbing effect while for others it mimics daily addition of salt to a raw wound.

Many people have found great opportunities with this disaster but for many others it has marked huge losses, pain and disappointment. Whichever the case; the risk of poor health remains high due to the great level of uncertainty, scarcity of resources and stress. Therefore; it is important now more than ever to guard your wellbeing.

The combination of the direct effects of the disease on individuals and their families, and the indirect effect on financial security, unemployment and social isolation has led to an increase in emotional and psychological challenges worldwide. Lockdowns around the world have led to an increase in domestic violence cases as the victims are restricted to stay in the same place as their perpetrators, with no escape. Stigma and discrimination against persons who have tested positive for COVID-19 is another major source of distress, in addition to several already existing physical and mental health issues.

Worry, stress, loneliness, anxiety, depression, insomnia, harmful substance use, self-harm or even suicidal behavior and other emotional responses are to be expected during such times of instability; And; for those already suffering non-communicable diseases like high blood pressure, diabetes, cancer and mental illness, the extra pressure serves to exacerbate their conditions.

An additional challenge is that physical distancing regulations make it more difficult for many to access appropriate healthcare services. On the other hand; with the focus on bringing the pandemic under control, some local health facilities have been converted to COVID-19 care centres leading to deprioritization of non communicable diseases.

Self care should be a priority now more than ever. Taking basic steps to safeguard your health during these unprecedented times does not have to be complicated.

Start by being deliberate about the information you pay attention to. It is good to stay up to date; however, excess in the form of constantly changing alerts, continuous social media updates and mainstream media coverage if poorly managed can lead to infomania hence panic, paranoia as well as feeling overwhelmed despite the urge to want more. Screen sources for facts and relevance to your own reality before paying too much attention to them.

Know and practice self awareness. While there are various tips for looking after one’s health during this pandemic; not all would work for everyone and it is important therefore to realize what would work for you as an individual. Excessive pressure and uncontrollable stress even with good intentions only leads to triggering or exarcerbation of health problems. You cannot control and manage everyone and everything but you can be intentional in making choices that would promote your own physical, mental and emotional health. 

Physical activity will keep your health in check. Step out and appreciate your environment. Take in a deep breath of fresh air and enjoy feeling it go through your nose into your lungs; let go of stress as you exhale. Challenge yourself to at least 30 minutes daily of exercise that makes your heart beat even a little faster and your body sweat. Regular exercise has a profound positive impact on non communicable diseases as it relieves stress; improves memory and immunity; helps you sleep better; and boosts your overall mood.  

Eat and hydrate well. Avoid excess of anything. Do not skip meals in the name of losing weight. Observe that your diet has at least protein, vitamin and carbohydrate. These can be locally available foods therefore don’t need to be costly. Avoid smoking, excessive alcohol and any other psychoactive substances because they increase the risk of non-communicable diseases which in turn affects your life expectancy.

Get a good night’s sleep and speak to your family physician if suffering insomnia. Good-quality sleep makes a big difference to how we feel. Try to maintain your regular sleeping pattern and stick to good sleep practices such as avoiding screen-time in bed.

Maintain positive social connections as part of your self care. Building stronger, broader social connections in your life including with family, friends and other associates can increase your feelings of happiness and self-worth. Constant meaningful communication and a practice of genuine empathy goes a long way in achieving this.

Be kind to yourself. Taking time just for you, even if it is just a few minutes to retreat and just sit.  Pay attention, listen to your body and respond to it. Be intentional in assigning standards and value to yourself and do not beat yourself too much over other people’s opinions of you. Remember, not everyone might be genuinely caring or having the same perspectives as you. Others may also have their own challenges to deal with including a lack of empathy. Plan your breaks and use them to do something that makes you feel calm and happy such as a hobby or pursuing a new interest.

Know that it’s normal to have ups and downs in life. Talk about how you’re feeling with someone you truly connect with and trust. They could be experiencing similar feelings and sharing would be of mutual benefit. They could also lend a listening ear as you pour out your heart and in the process you could gain new insights. Remember that a problem shared is a problem halved.

Finally; but not the least; keep in touch with your family physician. Get regular checkups and check-in frequently to ensure that you remain physically, mentally and emotionally healthy.

Your health is your most valuable asset; make it a personal responsibility to guard it jealously and give it the attention it deserves.