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CABINET: Jobs for the boys? Why does Uhuru need 22 Chief administrative Secretaries as well as Principal Secretaries???

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President Uhuru Kenyatta’s expanded cabinet will cost taxpayers almost half a billion each year in salaries alone. The 22 Cabinet Secretaries (CSs) including a part-time one and the new 21 Chief Administrative Secretaries will cost Sh486.4 million each year if they earn the same pay.

The State functionaries are also expected part with Sh285.78 million in gratuities, pensions and insurance which is 60 per cent of their gross pay – bringing the total cost to over Sh772 million a year. The CSs earn fixed salaries of Sh924,000 down from Sh1.056 million while Principal Secretaries (PSs) earn Sh765,000 from Sh874,500 as per the new pay structure the Salaries and Remuneration Commission (SRC) announced on July 10. President Kenyatta has appointed 38 PSs, who will be paid an estimated Sh348.8 million a year with Sh209.3 million in gratuities.

This brings the total cost of running the Executive to Sh1.33 billion. It comes at a time when Treasury is trying to cut down spending after warning that recurrent expenditure demands could affect the economy. “Recurrent expenditure is a risk and we are having pressures on the wage bill from unions and if you allow me Chairman Budget from parliament,” Treasury PS Dr Kamau Thugge said during the presentation of the 2018 draft budget. He made the remarks after MPs overturned SRC cap on mileage which would pave way for the 416 MPs to pocket Sh668,000 extra in allowances and salary at the end of this month.

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According to the 2018 Budget Policy Statement by the Treasury, the public sector wage bill has increased by nearly Sh100 billion over the last three years despite the Government’s efforts to tame recurrent expenditure. Treasury predicts the wage bill, which stood at Sh307 billion in 2015 and has since risen to Sh401 billion, will hit Sh444 billion next year. Treasury data shows Kenya will pay Sh304 billion as interest on loans and Sh76 billion as pensions next year leaving less for development.
-Standard


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Lifestyle

The toughest 9 months: I was pregnant with cancer

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She peed in a cup at the health centre, praying that the chemotherapy was not bringing up other health problems. She had walked into the facility after feeling worse than usual. Chemotherapy effects were bad, but this morning she felt worse. She just wanted to be fine, then she would finally start enjoying her new marriage.

A few moments later, the young medical officer walked up to her with a smile. “You have nothing to worry about. You are pregnant,” he said calmly. Jackline Kanyua was not sure how to feel about the news. On one hand she was happy, motherhood did not seem like a far-fetched dream anymore.

But again, her doctor had told her that avoiding pregnancy as she went through her cancer treatment was the best thing for her health. Heck, her monthly period had even disappeared. But the doctor had assured her that the chemotherapy and the drugs she took were enough to cause that.

Yet here she was, in 2017, in her mid-20s, newly married, pregnant but with cancer; Stage 3 breast cancer that needed aggressive treatment. The journey had all began a few months earlier when she felt a tight hard lump in her breast while singing in the shower. She had been planning her wedding then. What luck? she mused.

World over, according to the World Health Organisation, one in 1,000 mothers find themselves in the very same quagmire as Jackline. And just like Jackline’s doctor, other medics warn that pregnancy could complicate cancer treatment, just as much as cancer treatment interferes with pregnancy.

Andrew Odhiambo, a Nairobi-based consultant oncologist, advises that once a woman is diagnosed with breast cancer, the safest option is to avoid pregnancy.

“Getting pregnant presents serious challenges, but even the treatment itself can cause a stoppage in menstrual flow,” says Dr Odhiambo.

The biggest dilemma presented, he explains, is whether to stop treatment and carry the pregnancy to term or to terminate the pregnancy and continue with medication. If chemotherapy has to start immediately, especially in advanced cancer stages, then termination has to be done. In fact, doctors recommend that women on treatment for cancer should be on contraception until some period after the end of treatment.

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“Carrying the pregnancy means stopping treatment, especially radiation or chemotherapy. Surgery can only be done after the second trimester. We always advise women to consider freezing their eggs and probably using them later once treatment is done,” Odhiambo says.

A 2019 study published in PubMed Central (PMC) affirms that radiation can be dangerous and that only non-ionising imaging methods are preferred to reduce exposure to the foetus.

“Unfortunately, not many medications can be safely used during pregnancy and mother should be exhaustive in thought about potential risks and complications of those systemic treatments,” the study states.

At the time when Jackie found out she was pregnant, she had had 10 chemotherapy sessions and a lumpectomy.

To navigate this new development, the couple made an appointment with their doctor at Kenyatta National Hospital (KNH), where tough decisions had to be made. The doctor gave her two options; to keep the baby and forget about the treatment or terminate the pregnancy and continue with her treatment. And being at cancer stage 3 at the time of diagnosis, this was a decision she had to make fully aware of the risks.

Abort or not?

“Keeping the baby was a huge risk but I decided to go for it. I told them that I did not require any time to think about anything because this was the best gift I could have. Or I could even give to my new husband. So I quickly signed the consent forms to stop treatment,” she recalls.

With pregnancy, several changes occur in a woman’s body. They include a drop in the number of lymphocytes that act as defence against foreign objects, including disease-causing pathogens.

“A pregnant woman naturally has increasing levels of oestrogen hormone. But these increasing levels, in the case of a pregnant woman with cancer, have a potential of accelerating breast cancer. Now add to the fact that you have stopped treatment, this can get too bad too fast,” says Dr John Ongech, a consultant gynaecologist.

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Jackline’s first trimester was, however, uneventful despite treatment having stopped. The fifth month of pregnancy, however, turned into a nightmare, as her right breast, which had undergone surgery, burst, becoming a raw open wound. She could not, however, be put on medication because of the growing foetus.

“The wound festered and smelled so horrible. The only way to care for the wound was using water and no drugs. My husband, Jude, had to stay home to take care of me. One of the women from church came visiting and found me in such a deplorable condition that she decided to take us into her home to provide care,” says jackline.

Unbearable pain

When Jackline was six months pregnant she had had enough and told her husband that they had to terminate the pregnancy.

“The pain was unbearable, and the wound didn’t seem to be healing. The cancer seemed to be growing and I wanted to resume treatment.”

And so they booked and paid Sh15,000 for the procedure.

“When we got to the KNH procedure room and I saw the devices that were to be used, I literally ran and called my husband once I was ‘safely’ seated inside a bus headed to the CBD,” she says.

A week later, facing unbearable pain, Jackline and Jude went back to have the pregnancy terminated, the second time. This was never to be, since when they got to hospital she changed her mind, again.

“I remember asking the attendants what they thought was the worst thing that could happen to me now that I had cancer, and their answer was “death”. I also asked them what was the worst that could happen if I carried the pregnancy to term. Their answer was still “death”. I was then ready to give up my life for my baby.”

On noting her dogged determination and the excruciating pain she was in, the medics suggested that she carries the pregnancy to seven months and then she could deliver preterm and have the baby put in incubation.

Pain notwithstanding that seemed like the best choice she had. And so, it would be. At seven months, labour was induced and baby Zawadi made her entrance into the world. The distressed baby would be whisked off to the ICU immediately to begin her recovery. As for her mother, aggressive treatment would resume. Luckily, Zawadi made a good recovery and was moved to the nursery and later to the paediatric ward.

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Two months later, mother and baby were back home, where new challenges awaited.

“Due to my medication, I could not breastfeed Zawadi and she had to depend on formula milk,” says Jackline.

All was going on well, until April this year when a cycle of chemotherapy and trouble struck again.

“Because I was lactating, yet the milk was not being consumed, the infected breast started having complications and I had to begin treatment once more.”

Doctors also discovered that the previous surgery had not completely removed the cancerous cells and they had to go in again. Her latest session of chemotherapy ended in October, after which Jackline was taken in for a mastectomy. She is recovering.

“This will be followed by another round of radiation to kill any remaining cancerous cells. I need close to ShI million for that. I have Sh450,000 already, thanks to support from well-wishers after I was featured on comedian MC Jessy’s show. I am hopeful that it will work out, and I will be here for my baby and husband,” she says.

This may have worked out for Jackie, but doctors caution that hers was a big risk they would not encourage because of the potential for fast spread of cancer cells, a complication that would mean she would be on lifelong treatment, or just die.

“Also, pregnancy while with cancer has been linked with a likelihood of recurrence of the cancer,” says Dr Ongech.

As Jackline cradles her baby, with a smile, as the interview comes to a close, it is clear that it was worth the risk.

“My baby was the best choice I made. It will be fine.”

by STandardmedia.co.ke


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Business

SUKARI HEIGHTS Affordable Luxury 2 br, 3 Br plus Dsq & studio apartments

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Sukari Heights is magnificently designed luxurious and executive residence offering world class lifestyle.
Starting from Ksh 2.7M. Sukari Heights is located in the most exclusive Kahawa Sukari neighborhood just 15 minutes drive from Nairobi CBD.

The location of these homes avails a short commute to work using an easy transport network, a large choice of dining and entertainment options within easy reach, a low maintenance apartment that offers safety and security, and opportunities to immerse yourself in a socially diverse environment.

Designed to be the finest expression of world class finishes, SUKARI Heights is a rare opportunity to reside in one of the most exclusive addresses in Nairobi.

This immaculately designed apartment is set amongst manicured grounds within a private and secure complex. As a resident, you will have access to lifestyle amenities including, shopping centre, gymnasium, spa, eateries, basement parking etc.
The apartment interiors are designed for the way you live, with features that add beauty and utility to your home.
Expansive windows and balconies offer breathtaking views of the surrounding.
Bright, spacious, airy open-concept interiors flow seamlessly from living to dining to kitchen.
The unit has spacious bedrooms with well fitted built-in closets, with master ensuite bedrooms.

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Suitable for family living as well as investment.
As an investor you will enjoy, good ROI owing to Recurring rental income, Property appreciation leading to higher resale value.

Enjoy a flexible payment plan of up to 24 months kes 1.5m deposit.
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Features&Amenities
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To book Call/WhatsApp +254711128128
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Health

Close friend, carrier of deadly disease

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Dog has always been mans best friend, but without responsible ownership, they are turning to I be the worst man’s enemy bet cause of rabies.

J The deadly virus spread to people from the saliva of infected animals, usually through a bite. Warm-blooded animals serve as reservoirs for rabies, with unvaccinated dogs as the main reservoir worldwide.

Florence Ndinda from Makueni county is one of those who can’t stand a dog’s presence after her two granddaughters, who she is taking care of, were bitten by her own dog, which was rabid.

She remembers vividly how two years ago one of her granddaughters, Florence Mbithe [then eight], was bitten by one of her puppies. Mbithe was playing with other children outside their house when a puppy came running to her. Before Florence could rescue Mbithe, the puppy had already bitten her.

Confused without knowing what to do, Ndinda took her granddaughter to the nearby dispensary for first aid. After receiving help, she was connected to the Makueni Rabies Surveillance team who came and took samples from that dog and the result showed it was rabid. They were also referred to Makueni Level Five hospital for Mbithe’s treatment.

“I was advised to isolate the dog for 10 days as the rest were getting the vaccine, but I didn’t. I felt that since it was a puppy it won’t harm any other person,” she says.

Since she couldn’t manage to go to Makueni hospital that same day, she had to go there the following day. While away, the same puppy attacked her youngest granddaughter Abigael Ndinda then aged four. With no Post-Exposure rabies Prophylaxis [PEP] vaccine at the hospital, she was forced to buy it from the nearby pharmacy.

It was not easy to get the required five doses per person for both her granddaughters. With a dose going for Sh950, she only managed to buy them three doses each. She also vowed to never ever keep dogs in her compound and even her neighbor’s dogs are always chased away when spotted in her compound.

“PEP is compulsory if you are bitten by a dog, cat, or another animal that is rabid or is suspected to be infected with rabies. An exposed person who has never been vaccinated against rabies should get four doses of the vaccine and another shot called Rabies Immune Globulin [RIG]. A previously vaccinated person should get two doses of the vaccine. They do not need RIG. Always, make sure you complete the dose,” says Dr Emily Mudoga, Animals Campaign Manager at World Animal Protection.

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The vaccine is made up of the dead rabies virus. When it is injected into the body, the immune system immediately starts to produce antibodies to fight off the perceived infection. Multiple shots ensure the levels of antibodies remain elevated so that even if the live virus is already in your system, the antibodies will neutralise it.

Besides humans, rabid dogs attack livestock. Makueni county alone lost 300 livestock in the last five years. The number, however, is suspected to be higher since most cases go unreported.

Jane Nduku is one of the residents who lost her cow after it was attacked by a rabid dog. It took some days before she realised the cow had been bitten. She only found when she called the veterinary to report that the cow was suffering from foot and mouth disease as it couldn’t swallow anything. The veterinary confirmed otherwise.

“When the veterinary visited us, the dog that had attacked the cow had started showing rabid signs, but hadn’t gone crazy. So after taking samples and the result turned positive, we were advised to kill both the cow and the dog. That is exactly what we did,” says Nduku.

Richard Muteti, a veterinary who also doubles up as a field officer for rabies surveillance for Kenya Medical Research Institute in Makueni county, says some cases go unreported because livestock owners confuse rabies with foot-and-mouth disease, hemorrhagic septicaemia or choking.

Disease surveillance To ensure farmers are able to differentiate rabies from the above, he says they have been creating awareness about rabies and advising farmers to report if a dog attacks their animals. Because of these, reported cases of livestock being bitten by dogs have increased unlike before when people used not to report.

“At Makueni sub-county alone, we have been getting about 12 cases of dog or animal bites weekly. Since not all dog/animal bites are rabid about 20 cases turns positive annually,” says Muteti.

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Currently, over 70 per cent of the county is now reporting any dog /animal bite witnessed. Muteti reveals they are targeting 90 per cent.

To make sure all bite cases have been captured at the county level, Dr Daniel Ksee, Acting Director, Veterinary Services in the county, says they are set to unveil an Integrated Bite Case Management [IBCM], an approach for rabies surveillance that directly and formally links workers in public health and veterinary sectors to assess risk of rabies among animal bite patients and biting animals, respectively.

“This approach will help us with contact tracing, and we will be able to come up with concrete data about rabies in the county. We hope this approach will be embraced by other counties,” says Ksee.

Apart from this approach, Ksee says other initiatives in place include: annaul mass dog vaccination, that have seen about 300,000 dogs vaccinated; and training the community and teachers about responsible dog ownership.

He says most farmers don’t know the importance of vaccinating their dogs. Farmers have been focusing on animals that generate some income such as cows, goats, pigs and donkeys.

“We decided to use teachers because they can easily reach the students. They have been integrating responsible dog ownership topics in their programmes and we have recorded a decrease of stray dogs across the county,” adds Ksee.

It is recommended for puppies to get the vaccination at three months for the first time, followed at nine months, and then yearly boosters. In some cases, the first vaccination can be given as early as two months, but with precaution. For adult dogs, the first vaccination should be given as soon as possible, and a local veterinarian

should be consulted.

In Kenya alone, about 2,000 people die annually because of rabies yet it is 100 per cent vaccine-preventable. The World Health Organisation says rabies is estimated to cause 59,000 human deaths annually in over 150 countries, with 95 per cent of cases occurring in Africa and Asia. Due to widespread underreporting and uncertain estimates, it is likely this is a gross underestimate of the true burden of disease.

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“In Kenya, domesticated dogs are responsible for transmission of over 98 per cent of all human rabies cases. Apart from dog bites, the virus can also be transmitted when saliva enters any open wound or mucus membrane,” says Mudoga.

Although the campaign to make Kenya a rabies-free country has been running for the last 100 years, we are yet to eliminate the virus because, according to Mudoga, there is lac” political goodwill.

“Rabies vaccine has not been prioritised by counties despite that it is easier to vaccinate than to treat. The government needs to make this vaccine mandatory, put more resources for the campaign, and bring communities on board. With all that done, it will be possible to have zero human deaths from dog-mediated rabies by 2030,” adds Mudoga.

Survival chances

Generally, it takes between 30 to 50 days for rabies symptoms to develop. They appear once the virus reaches the spinal cord or brain. However, in some cases, symptoms can appear in just 10 days or it even over a year The duration depends on factors such as location of virus entry and viral load. Initial symptoms are flu, difficulty swallowing followed by fever, a headache and vomiting.

“Currently there is no cure for raibes. If you are bitten, you should visit your doctor right away. The incubation period can be as little as five days, so don’t assume you can wait for a week to see if the animal that bit you is unwell before seeking medical attention. The chances of survival are extremely low once the patient becomes symptomatic,” adds Mudoga.

And what should one do if bitten by an animal?

M udoga says the most effective first-aid treatment against rabies is to wash and flush the wound immediately with soap and water for 10-15 minutes. If soap is not available, flushing it with water alone is also acceptable.

MANAGEMENT

• Extensive washing and local treatment of the bite wound or scratch as soon as possible after a suspected exposure.

• A course of potent and effective rabies vaccine that meets WHO standards. • The administration of rabies immunoglobulin (RIG), if indicated.

by PD.co.ke


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