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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. 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. 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 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.