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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.

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Education

TSC PROMOTION SHOCKER FOR TEACHER WITHOUT MASTER’S

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By JUDITH GICOBI

The Teachers Service Commission (TSC) is in crisis after insisting that teachers eyeing promotions to secondary school principal positions must have attained a Master’s degree.

Several tutors were locked out of interviews in spite of being shortlisted.  The interviewees were shocked when they arrived at the interview centers to be barred for failing to meet the new requirement.

In counties like Narok, Kericho, Bomet, only five candidates were cleared to sit for the interviews out of the 17 shortlisted candidates for secondary school principal positions.

“Only five of us were cleared to enter Kaplong Boys Secondary School in Sotik Constituency, Bomet County, which was the venue of the interviews for those from the South Rift on Friday,” said a candidate who was among those locked out of the interviews.

He added: “TSC should come out and clear the air on why we were shortlisted and invited for the interviews only to be turned away at the gate for lack of Master’s degree certificates.”

Kenya Union of Post Primary Education Teachers (Kuppet) and the Kenya National Union of Teachers (Knut) have since demanded the interviews be called off and the exercise be started anew in the spirit of fairness.

Ms Nancy Macharia, the TSC chief executive, admitted that material issues had been brought up by the teachers and trade unions which needs to be addressed.

“Concerns have been raised by the teachers, with Kuppet having formally written to TSC on the matter,” said Ms Macharia.

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News

Intimacy gone wrong: Woman bites, spits boyfriend’s tongue

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Police in Naivasha are hunting for a woman accused of biting off her boyfriend’s tongue during kissing over the weekend.

The unidentified woman aged 23, allegedly tore off her boyfriend’s tongue on Saturday evening, spat it out onto the floor before fleeing the scene.

“The two had been drinking for some time when the man started kissing the woman and it’s not clear what caused the woman to turn against her lover,” said Francis Wahome, who witnessed the bizarre incident.

Witnesses said part of the tongue was literally left wagging. The sorry incident which occurred in a bar lit up a discussion among residents in the area.

According to Wahome, the motive behind the attack was still a mystery to them as the man could not talk.He said that the two were well known as they have been lovers and were frequent visitors to the bar.

“After biting and cutting off a very big chunk of the tongue, the woman fled leaving the man writhing in pain and was rushed to the hospital,” he said.

Area Chief Hassan Guyo confirmed the incident adding that police were looking for the suspect while the man was in great pain and but undergoing treatment.Guyo admitted that it left many questions unanswered adding that only the victim and the suspect could reveal more.“The man cannot talk as a big part of his tongue is missing while the suspect responsible for the attack has gone missing,” he said.

Meanwhile, the search for a man who was washed away by River Malewa in Naivasha last week entered the fourth day.Friends and relatives gathered at the banks of the swollen river with divers unable to venture into the gushing waters in Olmagogo area.

According to a local elder Amos Kimani, the missing man was a worker in the nearby Morendat farm and was in the line of duty when the incident occurred.“At the moment there is very little that we can do but wait for the body to float as it’s very dangerous to enter into the river at the moment,” he said.Two weeks ago, the river burst its banks flooding nearby farms and homes but the levels have since dropped.

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Business

Motorists get slight price reprieve in festive season

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By JUDITH GICOBI

Drivers will take delight in a slight reprieve at the pump this festive season after prices of petroleum products dropped.

Petrol, diesel and kerosene will for the next 30days retail at a lower price, having declined by Sh1.09, Sh2.83 and Sh1.75 respectively in Nairobi, according to the monthly pricing review.

A litre of petrol in the city will sell at Sh109.50, diesel at Sh101.78 and Sh102.31.

The fuel prices are inclusive of a value-added tax of eight percent introduced in the Finance Act, 2018.

“The changes in this month’s prices are as a consequence of the average landed cost of imported petrol by 0.52 per cent from $463.24 per cubic metre in October 2019 to $460.83 per cubic metre in November 2019,” said the Energy and Petroleum Regulatory Authority in its pricing guide.

From October 14 to November 15, consumers had to cope with higher margins for oil selling companies after the price increased Sh10.89 to Sh 12.39 per litre.

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