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 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.

 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. 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 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.