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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. 

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. 

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. 

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.

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

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.