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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.

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.

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 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

 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.