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How terminally ill patients prepare for death

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The recent deaths of Bomet Governor Joyce Laboso, Kibra MP Ken Okoth and Safaricom boss Bob Collymore, who were terminally ill, came with reports from relatives and friends that they were prepared for their final journey. In one instance, it was revealed that one had requested not to be placed on life support.

While the three died of cancer, two of them had something else in common — advance directive — a wish given by a patient on how they want to be handled as death approaches.It is a practice that Esther Munyoro, a specialist in palliative care at Kenyatta National Hospital, says is slowly gaining acceptance.

It involves one putting in writing, verbal or submission of an audio recording how they want to be taken care of in preparation for death.

Every hospital has its own version of the document that may involve a lawyer; to authenticate it.At times, says Dr Munyoro, the directive can be confidential between the doctor and the patient.As disturbing as it is, it is the painful reality that terminally ill patients have to face when all possible medical intervention has failed. Reversible conditions

While life support is always an open option, Munyoro says it should not be the case. “You should never get to the Intensive Care Unit (ICU) if your condition is not reversible,” she says, adding that doctors are obligated to prioritise patients with reversible conditions for ICU.

An irreversible condition is one which has impaired the critical organs of the body: the digestive system, lungs, heart, kidney and the brain.“However, for the brain, it is debatable since we have cases of people who live forever,” she says.

For kidney too, there is dialysis and the option of a transplant.However, a case like that of Mr Collymore whose bone marrow collapsed after a transplant, would not be reversible even if he was put on life support.Mr Okoth was also battling multiple organ failure by the time he was rushed to Nairobi Hospital.

 

A patient in this state is allowed to have an advance directive, which may range from the simplest requests like the choice of food or colour of bed-sheets to complex ones like if they want to continue with treatment.Their condition is managed by painkillers and steroids if they have trouble breathing.

“We had a woman whose only wish was to have a white wedding and we conducted one at the hospital. There was also a child who had leukaemia who wanted to be baptised. We had to convince the parents and we had the baptism ceremony attended by her friends,” said Munyoro.

This “11th-hour death scene” is so familiar to Munyoro that she reveals she has almost mastered the time when a patient will finally pass away. At times, she advises patients to hold parties to celebrate their achievements as part of their send-off.Some patients, however, choose solitude and request that the lights in their rooms remain on throughout.

“From experience, I have found that you can easily tell how someone will die. There are those who die immediately everyone leaves the room and those who die when everyone is around them. It usually happens according to their wishes,” she said.Munyoro said in cases when the advance directive is not available, doctors hold a conference with the family of the patient to inform them of the possible scenarios.

For example, the family is asked if they are willing for the patient to be given inotropes-drugs which keep the heart beating.“Sometimes we start you on a treatment and see it is not working, but you know we can’t withdraw… but then the patient chooses not to go on with the treatment when they see it is not working,” she says.In some cases, the patient will evaluate the outcome possibilities of the treatment if it works.

“They may look at it and say, if this treatment is actually going to add me just one month, and I can’t go back to the life I used to have, then there is no need for me to take it and sometimes we support those decisions. It is not always that we think these patients are wrong,” she says.But if the family or the patient wants to be in ICU, even when their condition is irreversible, doctors must oblige.

“You see the problem is sometimes when you die in ICU your dignity is taken away. We have to put catheters, we have to turn you, you are always exposed. There are people who tell me ‘I want to die with dignity’ they do not want their urine or stool removed with tubes,” Munyoro says.In other countries, like Netherlands and Belgium, if someone has been made aware that they will soon be writhing in bed in pain as they wait for death, they might opt for euthanasia, also known as assisted dying.This is when a doctor prescribes medicine — mostly anaesthesia in high doses — to help someone sleep through their death to avoid suffering.

Not legal

In Kenya, however, it is not legal, and Munyoro says such practice will interfere with the development of medicine since people will always opt for the easiest way out.

“You can get cancer that totally does away with your digestive system. If you are abroad you can be on intravenous feeds, but they have very many side effects. We do a few of the same here but the patients later die of other things. That is why I say if we have euthanasia, then our health system will not progress,” says Munyoro.

The medic says most times when a patient requests to be euthanised, the first call should be to a psychiatrist.For Munyoro, the worst place someone can die is a hospital. If the doctor has explained that one’s condition is irreversible, it is better for one to die at home surrounded by their loved ones.

She, however, insists that doctors should never tell a patient that “there is nothing they can do”.“Even if they are in a bad state and bleeding all over. Control that bleeding and tell them to pray to God so that when they die, they will get to heaven,” she says.

By standard


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Cry of a Kenyan man whose Multi-Million-Shilling Apartments have gone unoccupied for 4 Years

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A landlord in Kenya has been left counting losses after his real estate retirement plan goes down the drain.

85-year-old David Ndolo from Kitengela told the media that he had lost more than Ksh10 million in rent after his multimillion apartment block stayed unoccupied for 4 years.

Ndolo says he built the multi-million-shilling property in Kitengela, Kajiado County through his pension savings. Its construction was completed in 2014.

The building consists of five bedsitters and 19 two-bedroom houses, which should earn him a total of Sh250,000 per month.

“I have watched helplessly as my retirement investment crumbles,” he lamented.

According to neighbors, his tenants started fleeing due to sewer water suspected to be coming from an adjacent building linked to a retired government official.

Ndolo’s troubles began in 2014 when over 200 tenants occupied the adjacent building and sewer water started seeping into his apartments.

He says he reported the matter to the National Environmental Management Authority and public health officials but the authorities closed the building instead.

His daughter Roselyn Ndolo said that officials ordered the closure citing that the apartments were a health hazard.

When contacted by journalists, Kitengela Public Health Officer Benard Kiluva stated that he did not have enough information on the matter since he was recently posted to the area.

Kajiado NEMA Director Joseph Kopejo promised to visit the site to probe the matter.

Government officials say Many landlords in the country have been contravening these provisions by either discharging untreated effluent into a public sewer or discharging it into the environment without an effluent discharge license.

“According to Kenyan law, it is illegal for  any person from discharging any effluent from sewer treatment works, industry or other sources into the environment without a valid effluent discharge license issued by the authority,” said a NEMA official.

 


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Diaspora

VIDEO: Kenyans in Diaspora reject BBI report, referendum

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A lobby for Kenyans  in the diaspora is urging voters to reject the  Building Bridges Initiative report in the  referendum being championed by President Uhuru Kenyatta and ODM leader Raila Odinga.

According to Commonwealth Voter Privileges Right Association (COVPRA) the report is being imposed on Kenyans after the views of  certain groups and  elected leaders views were rejected..

Uhuru and Raila have rejected amendments to the final report saying those opposing it had time to give their views to the fourteen member committee they appointment.

 

The lobby avers that the recommendations in the final report do not represent the position of all Kenyans and a contested referendum would divide Kenyans.

“Kenyans should reject the BBI report. It is two man initiative that is being imposed on the people. The clergy have rejected it, several groups have rejected it. It’s not a Wanjiku Initiative. A few people and their surrogates want to change the Constitution for their personal gain,” Mr David Kimengere Waititu, the association’s Organising secretary told the Nation.

“It would have been  necessary to allow debate on all the issues that  arose in the final report  before coming  up with a bill. Kenyans are being taken for a ride,”  he said.

In June the group petitioned the committee  led by Garissa senator Yusuf Hajji to allow views from all dissenting voices saying all Kenyans should be allowed to participate.

“Freedom to Assembly, Freedom of expression and Freedom to political participation are so important in a  process like this one. It would be a sham  if the BBI Team was to ignore the views of some Kenyans. During the  meetings to sensitize the public on the initiative,” Kimengere said.

Leaders allied to Deputy President William Ruto and civil society are opposed to some of the proposals in the final report.

The group says a contested referendum would leave the country divided.

“We do not want a process that would leave Kenyans more divided. Let all Kenyans reject this report in a referendum to save their country from a few people who think they own Kenya.  We in Covpra, have our motherland at heart,” he said.

 Covpra said that the future of Kenya lies in the hands of the hollo polloi and not it’s leaders.

“ We call upon the Kenyans poor not to buy to the schemes of the dynasties. Let us protect our country by rejecting this monster called BBI if it goes to the referendum.

The group said in a statement that Kenyans should reject plots by politician to engage in chaos.

“At the end, this might result to   a badly contested referendum and  create a poisoned society ahead of the 2022 general elections. Let’s refuse any incitement to violence and stand up against the dynasties to shape the future of Kenya,” he says.

In their June petition, the group cited the strained relations between the Executive and the Judiciary and the fall out in the ruling Jubilee party over the process as a matter of concern.

“Our position stands that there is no proposal  to fix the simmering tensions between the two arms of government and between the two leaders of the Executive,” Mr Kimengere stated.

-nation.co.ke


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Diaspora

Life In America No One Tells You About

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BY BOB MWITI

Life in America no one tells you about. In this video, you will learn the following.

1.My journey to the US

2.Opportunities in USA

3.Challenges immigrants face in USA

4.How to transition from a student to a skilled worker in corporate America

5.The attractions & opportunities in the city Of Tampa

A Little Bit About Me!

I am a former international student in USA and I am a senior IT consultant in the areas of Oracle EBS Financials and Robotics Process Automation (RPA) here in USA. I am the programs director of Appstec America – A consulting company based in Tampa, Florida, USA.

I’ve been blessed to have learned a lot in my career as an IT consultant. My life has truly changed, and I’ve made it my mission to give back and serve others beyond myself. Whether that be helping you to relocate to USA as an international student, train you as an IT consultant, help you start and build your own online business, creating your financial freedom, motivating you to pursue your goals and dreams, to being more productive, to inspiring you to constantly improve yourself.

My mission is to get you to wake up to the unlimited potential within you and achieve what you’re truly capable of through my various self-development training programs.On the internet, I openly and passionately share my life experiences and all of the very best concepts, strategies, tools, and resources that I continue to discover that have made a measurable difference to my life, and will do for you as well.

Keep your dream alive and never give up! To learn about my company’s amazing programs, please go to;

www.appstecamerica.com or www.successwithbobmwiti.com

Contact me at;
success@successwithbobmwiti.com
info@appstecamerica.com
+1 813-573-5619 ext 402


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