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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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Sarah Kabu surprises husband with retirement home on his birthday 

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BY KEVIN KOECH

Bonfire Adventure’s Managing Director Sarah Kabu caused a stir on social media after she bought her husband Simon Kabu his dream retirement home at OlPajeta.

Simon took to his Facebook page praising his wife for the surprise. According to him, he was not aware of Sarah’s plan.

“Thanks so so much everyone who wished me a happy birthday today. now… I’m overwhelmed by what sarah kabu surprised me with today. imagine a retirement home!”

He revealed that he was aware they would celebrate his birthday at OlPajeta, however, saying thay he was not aware that Sarah had bought him his dream retirement home.

Simon went on to reveal that whenever they went for a holiday at the OlPajeta, he always told Sarah that he would like to have his retirement home there.

“Sarah… I’m over the moon… you are a proverb 31 woman… this is too much on me. . we have been visiting olpajeta many times, and every time we visit there, I always comment…. ningetaka kuretire hii place…. but this year we have been affected in hospitality and didn’t have hizo plans hivi karibuni

“She organized my birthday bash at olpajeta ( with my knowledge) as we normally visit with bonfire adventures and events sept babies..but today…. I thought we were going for a bush lunch….. shock on me and my cubs… we got a surprise of our lifetime,” he said.

Simon then went on to confess his love for Sarah Kabu and promised to support her. He further appreciated her for taking a loan with Stanibic’s DADA program to finance the house.

“Sarah… I will continue supporting you in anything you do and will always make you happy. I will make sure you get a surprise of the century. thank you 1000000 times,” Simon added.

Further adding that;

“Sarah, I’m not sure why you want me to retire early 🤷‍♂️. I named the house after austin kabu and is known as #mtaliiparadiseolpajeta and is we will put it kwa #bonfiredeals.”

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Chris Kirubi says marriage is enslavement, urges men to be careful

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BY KEVIN KOECH

City businessman and tycoon Chris Kirubi has given his opinion on marriage claiming that it is enslavement.

Speaking in an interview on Churchill Show, Kirubi explained that men have to be careful when it comes to marriage, or else they will be sentencing themselves to imprisonment for life.

He went on to compare some women to the military army as they are always in a fighting mood.

He, however, pointed out that it is always a pleasure to marry a good woman but some women.

“Marriage is enslavement, you have to be careful. You have to agree to go into slavery, to go to jail, and not to go there to test it and get out. It is a permanent affair you are jailed for life

“If you marry a good woman, it is such a pleasure. But there are some women, it’s like they first went to the army then came back for you to marry them; they are always in a fighting mood. Good has to bless you,” he said.

The father of two went on to praise Kenyan a section of women noting that if a man wanted to become rich, they need to marry Kenyan women.

He added that if they are not always bringing drama, they will make money for the family. He explained that it is an inheritance Kenyan women have.

Kirubi also talked about his two children saying that while his daughter works as the Managing Director for one of his companies in the country; Haco Industries, his son refused to come back and works in Brussels.

While praising his two kids, he disclosed that his daughter does not fear him as someone he hired from outside and argues with him.

“My son is in Brussels, he works for DHL. I think they pay him so much money he refused to work for me but it’s good he has also accumulated a lot of experience,” Kirubi narrated.

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Maraga advises Uhuru to dissolve Parliament over two-thirds gender rule

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BY KEVIN KOECH

Chief Justice David Maraga has advised President Uhuru Kenyatta to dissolve Parliament.

The CJ said the Parliament should be dissolved over its failure to implement the two-thirds gender rule.

This is following six petitions filed by the Law Society of Kenya (LSK) , Margaret Toili, Fredrick Gichanga Mbugua’h, Stephen Owako, Johnn Wangai, Aoko Bernard and David Sudi.

The petitioners fault parliament over failure to pass the laws in accordance with Article 27(3) read together with Articles 81(b) and 100 of the 2010 Constitution despite four Court orders.

In a statement issued on Monday, CJ Maraga said Parliament should be held accountable for failing the Kenyan people.

“Your Excellency, the two-thirds gender rule is an acronym for the constitutional imperative which prohibits any form of discrimination in the appointive and elective positions in our country on the basis of one’s gender.

“It is grounded on the declaration in Article 27(3) of the Constitution that Women and men have the right to equal treatment, including the right to equal opportunities in political, economic, cultural and social spheres, ” said Maraga.

“Let us endure pain if only to remind ourselves that, as a country, being a democracy that has chosen to be governed by the rule of law, we must say no to impunity and hold everyone accountable for their actions or omissions.

“Your Excellency, it is my constitutional duty to advise you, the President of the Republic of Kenya, which I hereby do, to dissolve Parliament in accordance with Article 261(7),” the statement added.

In his statement, Maraga says that National Assembly Speaker Justin Muturi and his Senate counterpart Kenneth Lusaka argued that the six petitions were “incomplete”.

“The Speakers contend that the six petitions are incompetent and bad in law for the reason that no court order was ‘transmitted’ to either the CJ or to the Parliament as required by Article 261(6)(b),” it added.

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