Tuesday, June 19, 2012

Kenya to host first African Epilepsy Conference

By Meluse Kapatamoyo
Come June 21 to 23, 2012, The International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE) will host the first African Epilepsy Congress in Nairobi, Kenya.
More than 40 speakers will present a range of topics over the three day period on recent scientific and clinical developments in epilepsy.

The conference is a firm commitment by African countries to improve the quality of life of people with epilepsy through support of education, research, knowledge dissemination and patient care.

The conference, among others, will focus on diagnosis, management and special epilepsy populations, as well as addressing management gap and research in Africa. The way forward in the African Region and primary healthcare will also be tackled.

Zambia will be represented by Anthony Zimba, Epilepsy Association of Zambia President who is also the IBE Africa region vice president.
Epilepsy is one of the most prevalent neurological disorders worldwide with no age, racial, social class, national nor geographical boundaries says the World Health Organisation (WHO).
It estimates that there over 50 million sufferers in the world today and of that number, 85 percent live in developing countries. Globally, an estimated 2.4 million new cases occur each year.

Zambia: The untold agonies of Care-givers

Picture by Miyon Kautz, World Vision Zambia

Nursing a loved one during an illness comes as a family responsibility to some people and part of the marriage vows to others. But whatever the case, it is an obligation that requires individual sacrifice to save a life.
While it is understandable that a patient receives undivided attention, great care and support should also be given to care-givers, also known as ‘bed-siders’ in most Zambian hospitals.
Care-givers spend countless hours attending to sick family members who may either be in hospital or at home. Their duties are mainly physical and include washing, bathing and feeding the patient.
Depending on the willingness of family members, these duties can be alternated. Unfortunately, some care-givers spend weeks and sometimes months without getting any relief.
Not too long ago, I was hospitalised at Zambia’s highest referral health facility, the University Teaching Hospital (UTH) and I got to see first-hand the emotional and physical stress it takes to take care of a sick person.
My diagnosis, a brain infection, which triggered on and off mild seizures, usually lasted a few seconds and meant I was very much aware of my surrounding.
I was admitted in the heavily-congested ‘Filter Clinic’ for the first night, with more than 15 other patients, each with one or two people by the bedside looking after them. I had my sister spending the night in a chair next to my bed.
We both did not sleep much and we did not talk much either. I felt as if by talking I was being disrespectful to care-givers whose relatives mourned and screamed in pain. I even felt guilty getting out of bed because they had to struggle to put their loved ones in wheel chairs before wheeling them to the bathroom.
Although I did not hear a single one of them complain, the troubled faces of worry and sometimes frustration told all that needed to be said.
The woman next to me was on life-support. A man and woman watched helplessly over her. In a conversation with my sister, the woman explained that her cousin had collapsed the day before. Diagnosis was a stroke. The elderly man who never left her side was her husband.
I also observed a man some few beds from mine. He was the only one in the room who seemed to have had as much energy as I did. He walked unaided to the gents but I was shocked when he died in the early hours of that morning. His bed-sider collapsed. I heard that she was his wife.
The boy opposite my bed had clearly been sick for a while. His body was frail. While his mother made conversations with him and smiled, I caught her in tears when the boy fell asleep.
I could not see the faces of all the patients but I was able to get a clear picture of the care-givers' desperation as they struggled to feed, clothe and make bed changes. It was at this point that I realised the impact of Zambia’s shortfall in health-care personnel.
The ministry of Health estimates that Zambia’s public health institutions, including the UTH are operating at 50 percent capacity; with the doctor to patient ratios standing at around one to 12,000. 
This shortfall means that care-givers have to help-out the few nurses in dealing with the patient needs. Regrettably, due to lack of training and perhaps emotional involvements, the process can be frustrating.
The next day, I was moved to what was to be my home for the next nine days. I felt relieved. Unlike the filter clinic, things at the High Cost wing seemed calm. Perhaps it was because 90 percent of the ward remained unoccupied. In total, it had four patients, inclusive of myself. I was relieved for my sisters who were already taking turns in taking care of me.
The sanitary conditions were better and the over-worked nurses were more attentive.
However, it was there where I witnessed the strength and patience it takes to look after a sick person. Opposite my bed was a woman in her 40s. She was in a state of confusion. The emotional and physical abuse she inflicted on her sister, who she accused of wanting to kill her, shocked me.
Surprisingly though, she developed a liking for one of my sisters who took over the responsibility of feeding her and making sure she took the medication.
Her sister was not allowed to touch her food, not even water. If she did, it had to be discarded. She was forced to sleep under the bed, pretending to have left. One day, I witnessed her bend over and empty a bottle of water on her blanket. The sister took walks to calm herself down.
I also remember Tina, a young lady suffering from malaria who had a lumbar puncture. Her guardian was a heavily-pregnant young lady. Despite her condition, which made it difficult for her to attend to all of Tina’s needs, none of the woman’s relatives came to help her out.
She struggled to feed and bath her knowing that a call for assistance to the nurses meant an extra charge. One evening, after she had tucked Tina into bed, exhausted, she tried to leave and spend the night home, only to be called back by the nurses.
I realised that whether in high-cost or low cost wards, most nurses go to sleep soon after midnight. Their duties, it seems, mainly involve checking the patients’ temperature and blood pressure as well as delivering medication. It was the bed-sider's responsibility to watch over the patient during the remainder of the night.
Two days before I was discharged, I was awakened by someone wailing. The woman in the side ward had died. I never got to see her but had watched her mother trek to the bathroom every so often.
All I knew was that she did not want to die. For two days she screamed, saying she wanted to live and raise her children. Her mother was inconsolable.
Six hours later I was awakened by another cry. Tina had died and we found out that she had been an employee of the pregnant woman who had only worked for a month before she got sick.
Wailing, the lady asked how she would explain Tina’s death to her relatives who lived in another province. She also wondered how she would manage to transport the body and meet the funeral expenses.
Three hours later, the elderly woman who had been brought in two days before, also passed-on. She was the same woman who had been next to me in the filter clinic. Her husband and cousin were witnesses as she took her last breath, both were grief-stricken.
In a country where people do not culturally accept professional counselling and still consider it a trend synonymous to white people, I often wondered where one gets the emotional strength to continue giving support and love to their loved ones during such times even when they are exhausted.
Months later, my siblings and I suddenly became care-givers to my mother who suffered from dementia. The encouragement I got was “be strong, now is not the time to break-down, take it one day at a time”.
I guess this is how bed-siders do it; they take each day it as it comes, watching helplessly and hoping for the best. I realised then that one has to dig deep within themselves to find the strength and patience to care for a person who is ill, especially those suffering from terminal illnesses because love alone is not enough.
Care-givers go beyond relatives and friends. Most of them take the time to nurse even total strangers because of their desire and passion to save a life. We should all salute care-givers, as even in death, they are life-savers indeed.

Tuesday, June 12, 2012

Fibroids : A woman's enemy

By Meluse Kapatamoyo
A visitor to my blog recently requested that I do some research on fibroids. Here is an interview I had with Dr Mulindi Mwanahamuntu, a gynaecology consultant at the University Teaching Hospital (UTH) in Zambia’s capital, Lusaka.

Dr Mulindi Mwanahamuntu, a gynaecology consultant at the University Teaching Hospital (UTH)

Fibroids in Zambia
Fibroids, also called Leomyoma, are new overgrowths of the fibrous muscles of the uterus. Although they are essentially one and the same type of tumour, they are given different names according to the part of the uterus they occupy. Intramural fibroids are located in between the uterine muscle while the ones that push into the uterine cavity are called sub-mucous and those on the surface of the uterus are known as Sub-Serosa fibroids. The sub-serosa fibrods can even be in a suspended position from the uterus surface like fruits hanging from a branch, these are referred to as Pedunculated fibroids. All these are seen in equal measure at the University Teaching Hospital (UTH) but they present with different severity of problems (symptoms).
Fibroids occur in the years of child bearing age and most symptoms culminate when a woman is in her 30s. This is because fibroid growth is aided by prolonged presence of the hormone, oestrogen. Oestrogen is only opposed by the hormone progesterone when a woman is pregnant and this may explain why women that have never experienced a pregnancy-related-protection by progesterone are more prone to fibroids.
Early Detection
It is important to mention that of the diseases associated with the uterus, cancer of the cervix is the commonest cause of severe illness and responsible for 98.1 percent of all deaths related to new growths on the uterus. The preoccupation of women and care givers should be to discover cervical cancer cells early and not fibroids. That said, fibroids are responsible for much suffering and poor quality of life that include bareness, heavy menses leading to anaemia, life threatening infections, pain and occasional death to mention but a few.
What are the statistics of fibroid cases at UTH?
Fibroids are common among women such that slightly over 10 percent of women live with fibroids and only 2 to 3 percent of these actually have them large enough to cause symptoms of pain, menstrual disorders and sub fertility thus requiring treatment.
Preferred Treatment
Treatment of fibroids ranges from simple implantation of anti oestrogens under the skin to surgical procedures such as uterine curettage, open surgical procedure referred to as myomectomy (operation conducted on the uterus to remove fibroids) and to hysterectomy - the total removal of the uterine.
What determines the treatment?
The location of the fibroid and accompanying symptoms all guide to the selection of the method of treatment. Location, size and symptoms are most crucial determinants of mode of treatment. However, age of the patient, general condition, fertility wishes and previous intra-abdominal procedures all contribute to the choice of treatment. Patients are part of the process of choosing the mode of treatment but basic medical principles mentioned should not be breached. Most importantly, the cost of treatment, thoroughness of treatment and safety of the patient should not be confused. In navigating between these principles, many patients at UTH rightly end up undergoing surgical procedures.
The treatment can even cause death. Poor evaluation of pelvic and back pains has led into fibroid “operations” and the pain continues or worsens alongside many other irreversible complications. Treatment of fibroids is a specialist undertaking which does not entertain shortcuts.
Can a woman who has undergone a fibroid operation before get pregnant?
Part of the evaluation and counselling process in treatment of fibroids include preserving or enhancing chances of fertility. Treatment of fibroids when fertility issues are pertinent, it is not an event but a process. Majority of women treated for fibroids even surgically fall pregnant but the doctor must continue to look after such a pregnancy until delivery. For example, a third of fibroids are treated because of demand to restore fertility and 70 percent of such treatments are successful.
Every single operation is different from the other and doctors will advice since they are aware of how mutilative the procedure is. For example, after curettage, a month is all the rest you need while after a myomectomy, anything up to one year’s rest from pregnancy may be required.
Fibroids and Pregnancy
Fibroids undergo a painful degenerative process because of hormone changes during pregnancy. Sometimes labour can be difficult or even impossible when fibroids impinge on the pathway of a baby. Further, this uterine anomaly can be responsible for increased post-delivery bleeding. All this constitutes interference with pregnancy.
A woman has a 70 percent chance of normal vaginal delivery. But an evaluation of this possibility needs to be made by specialists and not by trial and error.
Statistical Occurrence
This is not studied but fibroids will keep coming if the contributing condition continues to persist. Interestingly the majority of fibroids stop growing or even shrink after menopause. Doctors do not usually wait for this natural “self-treatment” of menopause since some fibroids are known to become cancerous and in any case, cancers in their own right increase at this age.
Recommended Diet
There is no known dietary connection to fibroids. However heavy menstrual bleeding related to fibroids requires replenishment of iron by foods rich in iron such as greens, fish and stake.

(A huge thank you goes to Mrs Annoymous to whom this article is dedicated. I hope all your questions have been answered)