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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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Peace deal earns Uhuru and Raila US invite

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The architects of the peace deal, President Uhuru Kenyatta and opposition leader Raila Odinga, will be sharing a podium in the US on February 5 to tell their “personal journey of faith and reconciliation” during the International Lunch in Washington, DC.

The International Lunch will take place a day before the annual US National Prayer Breakfast, to which President Kenyatta and Mr Odinga have also been invited, according to a letter of invitation that the Sunday Nation has seen.

President Donald Trump and First Lady Melania Trump will be the guests of honour at the National Prayer Breakfast.

The International Lunch is one of the annual National Prayer Breakfast-related events and honours members of the Diplomatic Corps based in the US.

President Kenyatta and Mr Odinga will be the joint keynote speakers for the lunch, according to an invitation from the US Congress’ National Prayer Breakfast co-chairs, John Moolenaar and Thomas R. Suozzi.

In the invitation, the co-chairs ask Mr Odinga and President Kenyatta to “consider speaking at the International Lunch on Wednesday February 5, 2020, at 12.30pm”.

“As the keynote speakers for the lunch, we would like to ask you to share your personal journey of faith and reconciliation.”

Mr Odinga had made reference to himself and President Kenyatta meeting in the US during a public rally at Bukhungu Stadium in Kakamega last Saturday to drum up support for BBI.

“The handshake has got many people talking. I was recently invited to Togo to help them find a way to work together with the opposition in that country. This time around, President Kenyatta and I have been invited to Washington, DC, in February to the National Prayer Breakfast so that we can tell them more about the handshake, because it is a unique thing,” Mr Odinga said.

It is still not clear if President Kenyatta and Mr Odinga will travel together to Washington or just link up there.

State House spokesperson Kanze Dena gave a “No comment” response to the Sunday Nation on the significance of the two handshake architects taking their reconciliation message across borders to the US. Mr Odinga’s office and the US Embassy in Nairobi did not respond.

The US has been a great supporter of the handshake and, according to ANC party leader Musalia Mudavadi in his biography, Washington was instrumental in having President Kenyatta and Mr Odinga announce the unity pact through carrot-and-stick diplomacy.

The day of the handshake in March 2018 coincided with the arrival in Nairobi of then US Secretary of State Rex Tillerson.

At a press conference later in the afternoon, Mr Tillerson announced that “the United States looks forward to supporting the process that was announced … to bring the country together and to address the various national divisions”.

The invitation to the two leaders comes at a time when there is acrimony between political leaders allied to President Kenyatta and Mr Odinga on the one hand and those allied to Deputy President William Ruto on the other.

The deputy president had initially opposed the public rallies organised by allies of the President and Mr Odinga to popularise the Building Bridges Initiative (BBI) report, terming them a waste of public resources.

However, ahead of another BBI rally on Saturday in Mombasa, Dr Ruto’s allies announced that they would join the rallies.

“After consultations as leaders, we have decided that in order to pursue the original spirit of the BBI irrespective of our concerns against the use of public resources in a process that has been blessed with full nationwide consensus, we will participate and, where necessary, take charge of these public rallies,” the Senate Majority Leader and a confidante of Dr Ruto, Kipchumba Murkomen, said.

In an interview with the Nation on Friday, Dr Ruto had been cagey over whether he would attend the Mombasa rally.

“It is not anybody’s business to invite me to Mombasa or compel me not to go. I will have consultations with my boss (Uhuru Kenyatta) and we will agree on the attendance of the meeting or subsequent ones,” he said in the interview.

He also accused Mr Odinga and ODM of hijacking the BBI process to start planning for 2022 General Election.

“There are people who have arrogated themselves the role of chaperons to be inviting people there. Who gave them that responsibility? We are neither guests, refugees nor visitors in Kenya to be ushered in and out by anybody. BBI must give space to ordinary Kenyans to give their views on how to move forward,” he said.

BY Nation

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Locusts now in Embu County as residents cry for help

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 Embu County residents are worried as Desert locusts have been sighted at Kiambere and Mutuavare villages of the arid Mbeere South Constituency.

Reports indicated that the swarms were first seen on Friday evening, damaging shrubs, green pastures and millet.

Mbeere South Deputy County Commissioner Charles Igiha said the voracious feeders entered Embu from Kitui County, through Isako.

Mr Igiha said the Agriculture ministry was informed of the invasion, whose seriousness he noted in his appeal for urgent action.

“Locusts are a menace. They should be eliminated before they wreak havoc on farms,” he said.

Mbeere South member of Parliament Geoffrey King’ang’i asked residents to monitor the insects’ movements.

Some villagers said they were afraid that without urgent measures, the insects would ravage their crops.

“The locusts are spreading very fast and are many. We are worried because they are feeding on trees and the grass for our animals,” one said.

Another said they expected a bumper harvest following heavy rains but may end up with much less.

Kiambere Ward Representative Lenny Mwaniki described the situation as serious and called for quick intervention by the government.

“The locusts are destroying all plants. They should be controlled before they clear everything,” Mr Mwaniki said, and warned of a famine if measures such as spraying are not taken.

The appeal has remained the same in at least 10 other counties affected by the invasion so far – Isiolo, Samburu, Wajir, Garissa, Marsabit, Laikipia, Mandera, Kitui, Baringo and Turkana.

Residents want the government to act quickly to ensure food security and cushion farmers from losses, but officials have admitted challenges in aerial spraying, including lack of enough personnel, aircraft and pesticides, as well as training.

Agriculture Principal Secretary Hamadi Boga, who on Thursday supervised aerial and ground spraying in Lengusaka in Samburu East, admitted that the government was struggling with inadequate resources.

The PS said only five aircraft used for spraying and four helicopters for surveillance were at their disposal.

The Food and Agriculture Organization of the United Nations has warned that the situation could worsen if authorities do not act fast to contain the marauding swarms.

The FAO says the weather has fuelled the insects’ movement, meaning the spread may not end soon. The agency added that the pests could multiply 500-fold by June if unchecked.

The UN has released $10 million (Sh1 billion) for aerial spraying in response to the worst locust outbreak in decades to hit East Africa.

by nation.co.ke

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Health

Kenyan drunkards say now they know the secret to living for 100 years

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As Kenya’s first Attorney General Charles Mugane Njonjo celebrated his 100th birthday on Wednesday, Kenyans couldn’t fail to notice that on that next to him, was a bottle of cold Heineken and a three quarter full glass of the frothy liquid.

From the pictures shared on social media, there is no doubt that that is what he was imbibing.

Not to miss an opportunity to air their views, many Kenyans were happy with what they were seeing.

“Kumbe this is the secret to 100 years?” wrote JohnKaris on Insteagram..

“I was conteplating stopping drinking but after seeing this, I postpone the idea  with immediate effect,’ said JoeOdhiambo on Twitter.

Others however were cautious.

Jeremy Muriuki wrote: “I know some of you will satart saying ati kukunywa si vibaya. But you should note the kind of drink he is taking (Heineken which is one of the finest beers imported all the way from Amsterdam). Usiende kunywa kumi-kumi huko halafu uexpect kuishi miaka mia moja.”

 

The only surviving member of the country’s first independence Cabinet was born on January 23, 1920 in Kiambu.

The “Duke of Kabeteshire” says his family is what he considers as his greatest blessing and treasure.

“On this occasion I am humbled by what I consider to be my greatest blessings: my loving family, which, as expected, has grown over the years,” he says.

While confirming receiving numerous messages of congratulations and best wishes for his milestone birthday, Mr Njonjo upholds his family as the source of his energy and love for life.

“First of all my wonderful wife and life companion, Margaret, followed by our children. I have also had great joy and privilege of grandchildren, to date six of them, all of whom have had the most uplifting effect on my energy and love for life. I am truly grateful to God,” he notes.

 

As he turns a century old, the father of three and two son-in-laws says among the things he treasures is his long service to the country, church, people and civil service.

He also treasures his service to the people of Kikuyu – now Kabete Constituency – whom he represented in Parliament, his service in the private sector through various boards he was involved with, as well as the All Saints Cathedral.

“I have also dedicated many hours to numerous charities, social enterprises and educational institutions such as the Alliance High School, the Kenya High School and Starehe Boys Centre,” he states. He schooled at Alliance, which was the only high school open to Africans in those days.

In all those endeavours, Mr Njonjo says, he is honoured and proud to have interacted and worked alongside many talented and gifted people.

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