Monthly Archives: August 2013

Killed by Unwashed Hands

As doctors, we have the rare privilege of listening to patients’ pertinent histories. History taking is a skill that one grows with in the profession. Together with proper examination, these two skills still account for a successful medical encounter. A lot of trepidation and second-guessing characterized my first moments at history taking as a medical student. Most respectable people respect age and in many African societies, young people have boundaries of what they can speak or do in the presence of elders. Call it conservative or timid but I think it is fair and proper to show respect for senior citizens on mere account of their age. Well, everyone deserves respect.

The point however is the departure medical practice makes of this tradition. As students, all young doctors invariably attend to elderly clients. In this set up, the doctor –patient relationship kicks in and the little matter of age is not expected to hinder the encounter. It took me a while to drop my sensitivities and ask older patients all questions I needed to ask and examine all organs I needed to examine. My first prostate and breast exams are still etched in my mind. In this learning process, it was apparent some older clients have reservations at giving certain information to younger doctors. However, these relations are human nature and expected. Every society has its norms and traditions that modulate any interaction between individuals in different circumstances.

Just like patients, the medical practice has its history – some hilarious, others quirky. Trailblazing advances like the development of vaccines, the discovery of penicillin (an antibiotic) and advances in transplantation medicine are just few of the great strides in the field. Perhaps a revolutionary advance was the development of the germ theory; the concept that infectious diseases arise from microbial material. This theory was long in coming, spanning hundreds of years before Robert Koch conclusively demonstrated it in the late 19th century. He went on to earn the 1905 Nobel Prize for his work.  Prior to these works by Koch, Pasteur and others, the widespread belief that illness came from foul air in the environment was well grounded and accepted. Hospitals were not always as safe as they are today. Maternal and neonatal deaths were extremely common and the incidence among hospitalized and non-hospitalized patients was not significantly different. It was not uncommon to lose up to 30% of women delivering in hospital to infection! Many children died before their 5th birthdays. To put this in context, one Kenyan hospital today loses about 0.6% of the women they deliver.

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In 1847, one young doctor made a simple revolution that was 50 years too early. Dr Ignaz Semmelweis discovered that by doctors simply washing their hands before examining patients, the mortality rates in the obstetric and neonatal wards fell by over 60% within the month. He concluded there must have been some material in doctors’ hands that transferred to patients during the examination in order to cause the fatal infections. At the time, doctors and students shuttled freely between anatomy/autopsy dissection rooms and the wards. His theory turned the prevailing ‘foul air’ belief on its head. As a younger doctor, Semmelweis’ findings were generally dismissed by senior faculty at his university hospital in Austria without much of an interrogation. The stellar results in drastically reduced mortality rates were conveniently overlooked. The mere notion that doctors, respected gentlemen, harbored germs in their hands was in itself inconceivable.

 In spite of his remarkable results, brilliant Semmelweis eventually lost his job in Austria and had to return to his country, Hungary. Even back home, he could only practice in a small village hospital. As with the university clinic, he introduced his hand washing policy and the statistics spoke for themselves. Dr Semmelweis saved the lives of thousands of women and children but his work remained a one-man match against an army of entrenched tradition and norms. The frustration of having a solution no one would care to adopt in the face of great loss of life led the good doctor to mental breakdown. At the age of 47, he died of an infection from injuries sustained in a mental asylum.

Today hand washing is universally recognized to prevent several communicable diseases and is celebrated every October 15th. Among others, diarrheal and respiratory illnesses can effectively be kept at bay by proper hand washing. In operating theatres, surgeons spend a good deal of time scrubbing away at their hands and instruments are sterilized to destroy the germs they may carry. Looking back in time, one wonders how many lives were needlessly lost in breach of such a simple cost-free strategy. The medical establishment’s refusal to question prevailing norms and beliefs in the face of incontrovertible dissenting evidence caused needless and wanton pain and suffering. Dr Semmelweis was eventually honored 100 years posthumous for his work and is considered the real Father of Asepsis. If for nothing else, health workers need not forget to wash/disinfect their hands today in recognition of the brilliant colleague we drove to death by our refusal to wash hands.

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Home Abroad: Language

It has been one whole year since I left Kenya for my studies in Europe. A lot has happened in this period. Some occurrences had me think of myself as a Johnny-come-lately into this Western world (and I was) while others had me feel so sorry for my hosts.  The 10-country tour has been a most thought provoking period for me. In all, I have learnt a lot outside the lecture rooms than I anticipated but I also remain with several unanswered questions; some older than myself and others more recent.

To begin with, I suddenly was without a language on arrival in Amsterdam. My main language of communication, English, is only spoken spatteringly and unenthusiastically by the locals. All signs, products and general conversation are in Dutch. It felt awkward to me that these people did not need to learn a language to transact their lives. A number of my friends take pride in their mastery of what they call the ‘Queen’s Language’. Here I was in a land with her own Queen, her own language and whose citizens frowned upon having to speak in any other language. All the 16 million of them! My own native Luo instantly found a new relevance in my mind. Unfortunately, 9000 miles away, I could only converse in my Luo in my mind. It was a fleeting pride, all in the mind. With great difficulty, I learnt to do my shopping using the graphics on the products as my only language. Bees on a jar would mean honey and pastures on a tetra-pack would mean milk. On many occasions, this never worked right. In my quest to keep the relevance of Ugali in my life, I severally bought packets with maize graphics only to realize they were other maize products like cornstarch, which do not make Ugali. This language barrier followed me in every country I went and in every sphere of life; in public transport, at the airports, in restaurants and even once at church.

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As a true Kenyan believer, I quickly found my SDA church within the month. My first attendance was marked with the joy of being in familiar company for the first time in many days. Nearly 100% of the congregation was African. Ghanaians made about 80% of the nearly 100-person congregation. A significant portion of the rest were Nigerians. The remaining few were I and a few Dutch associated with the rest through marriage. The language thing reared its head in a strange way. All the children in the congregation only spoke Dutch. Nearly all the adults spoke Dutch too but in addition, the Africans also spoke Ibo and Twi. Twi is one of the main local languages in Ghana and was the official language of communication in this church. What I thought would be a normal church session turned into a mini UN Conference. The children had their service separately in Dutch since they did not speak any other language. The main service was in Twi since they were the majority. A translator was available to translate Twi to Dutch which nearly everyone at the congregation understood anyway. And as if it was not already too complex, there were booths with translators into English, French and Spanish! I have never been back for nothing else but the logistics of language.

At my apartment, my next-door neighbors are two African brothers. Immigrated to Holland from Angola at the height of the civil war as children, the two brothers have been in Holland for 12 years. Naturally, I was glad to have someone from ‘home’ close bye. In my elation, it missed me that Angolans speak Portuguese. So here I was with my wonderful neighbors who only spoke Dutch and Portuguese. Friendships know no languages, so they say, but conversations become rough and hard when half the time all you do is nod and hum at each other. It was not until much later that I met a Kenyan and a South Sudanese classmates who both spoke Kiswahili. My classes and faculty were all in English, for the avoidance of doubt.

I was however to be confronted with another novelty. The ‘personal space’ here is a hallowed possession not to be intruded, or so I think. Coming from a country where I would initiate and reply to tens of greetings a day, I was to rudely learn that things don’t always stay the same. I have met really cheerful people, black and white, who received and said greetings and other social pleasantries like any Kenyan does. However, many are the times I got the cold shoulder for my pleasantries. Grudgingly, I learnt to keep my distance and silence. It became a really cold world of my known friends and acquaintances only. I started wondering how it is that Kenyan strangers in a bus, on the street, in the shops or in a pub could strike a conversation and hold on so easily. I questioned my social skills and my general outlook. Was I repulsive or was it them? While my language handicap limited how interactive I could get, I realized this general coldness had little to do with me as an individual. In the buses, as everywhere else, it is standard fare that no one talks to the other. People almost fear each other. The silence is louder than the bus’ huge engines. The distance is vast and the coldness is biting. Everyone comes with their friends to all public places and leaves with them. A large number just come alone and leave alone.

In this silence, I always raised questions in my mind. How is for Africans who move over to settle in this environment? How do they manage the transition? I am lucky to have travelled back to Kenya thrice over the last year but I know of colleagues who never did. How forlorn did they get? On chit chat with my Angolan neighbors, I asked them how it had been to be away from their family in Africa for 12 years. It was obvious they were grateful to have escaped the war. They felt safe and had a chance at that tender age to attend school and grow like kids. However, I felt empathetic at the sadness in their tones when they recounted the difficulty of being torn away from loved ones all those years. It was most difficult knowing their parents and siblings were in certain danger while they were safely away.  Having no family or friends in a foreign country and culture was a tall hurdle they had jumped. 12 years later, they still do not feel part of the Dutch social fabric despite having mastered the language and many other aspects in between. The one thing they cannot change about themselves is their African appearance and that has put a distance between them and their hosts. When one brother visited Angola last year, the changes that have happened since were too much to handle. Starting life all over again in Angola is a task too herculean with their subsistence wages in Holland. The assumptions back home do not help matters either. They are therefore caught between two worlds. An Angola that accepts and loves them but which they do not understand and a Netherlands that they very well understand but in which they have hit a glass ceiling in all spheres. Their plight makes me cherish my Kenya. She does not match many European countries in many aspects of convenience but I have learnt that being in one’s country is in itself a reason for pride. There is an inexplicable feeling of home and contentment in one’s own country where you speak your first language and buy your food with certainty.

Celebrating Kenya @ 50: Who’s Hosting?

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In colonial Kenya, long before I was born, the government was a foreign entity only domiciled in Kenya. It came with its structures and practices from yonder and paid little courtesy to what the locals felt or thought of its ways. If anything, the government’s goal was to subdue locals so the protectorate could advance the Queen’s agenda. That is how the fertile highlands were settled by the rulers and not the locals. To ensure the locals remained on their knees, the government decided what activities anyone could do. For instance, locals could not grow coffee or tea; Kenya’s black gold back then. If a local got within the white man’s circle, it was for their role in keeping their fellow black man subdued. We therefore had chiefs and askaris who were meaner to African Kenyans than the supposed-oppressor White rulers were.

At independence, for some strange reason liberation carried with it the animosity that existed between the privileged few and the masses. The police continued to be agents of torture and repression. The average public servant was not accountable to the ordinary citizen but to the new black “white” man. Colors changed but the relationships did not. Citizens were liberated but were still supposed to remain in their pre-independence clothes. The rulers meanwhile conveniently grabbed the white man’s wardrobe and did not care to turn out in the white man’s best attire.

Today, 50 years later, your average public officer will easily lose their job if they went against the grain of the establishment. Even when their action was in public interest! We still cherish the GSU for their ability to reign terror on fellow citizens. We still clothe our tribal demigods in the colonialist’s garbs; irreproachable, benevolent and with a free will to tread over us as they may please. The ordinary citizen has remained at the same spot he was at independence; unwilling to upset the leadership with uncomfortable questions, unquestioning when called to vote and always sorry for his own sad plight.

In the last week, two events got me thinking of how stagnated our society has remained in leadership and accountability. On Wednesday 14th, former Congressman Jesse Jackson Jr and his wife were both sentenced for what in Kenya would be called corruption. Jackson was sentenced to 30 months in jail for stealing Ksh 65M of public funds. While that may not be big news in Kenya, the news is that these public funds were donations by the public to Jackson’s election campaign kitty. Now that would get most Kenyan politicians and citizens in serious thought trying to contemplate what the offence was! And as if that were not strict enough, his wife got a sentence for falsifying tax returns to hide the theft. The Jacksons were condemned and chastised for what in Kenya would never be known in the first place. A man once touted as potential president climbed down the public moral altar in disgrace courtesy of greed and public accountability.  Jackson displayed a kind of greed we are not strange to in Kenya. He spent the money on a Rolex watch and few other little luxuries at a time when his family’s combined annual earning was over Ksh 26M. In essence, Jackson stole money he already had to spend on things he did not need. The Kenyan public sphere is replete with supposedly honorable men who steal money they have for things they do not need but get away with their impropriety. Sadly and oddly, the ordinary citizen is firmly stuck to his colonial mindset; not asking questions and worse, swearing support when tribe is appropriate.

The second event was in Germany. An 8-year old boy was bitten by a turtle while swimming in a small lake. The boy sustained an injury but nothing life threatening. However, what followed is unimaginable in Kenya. The entire lake was drained and residents and firemen searched for the single 40cm turtle in the mud all weekend.  Such is the value of human life. And such is the epitome of public accountability. It saddens that we lose thousands of innocent productive citizens in Kenya in such senseless ways as road accidents yet nothing is done about it by the responsible public officials. The idea of public officials serving the public is still a far cry. The colonial mentality of serving a boss has held our leaders from recognizing the dignity and potential of our own people. Instead, all decisions must conform to the interests of the establishment first before those of the citizenry.  This is why we will still cherish the GSU for their batons, fear the police for their handcuffs and hold leaders in awe for their positions. In the meantime, nobody will move to fix the carnage on the roads, the want in hospitals and the disarray in schools. All this while, the public remains firmly seated in their role as subjects rather than employers of the leaders. The few who try to make a difference are just that, few.  In Mandela’s words, it remains a long walk to freedom.