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Passaris: We have surgeons here in Kenya who take their patients for granted



After months of being the recipient of harsh criticism from Kenyans on social media, Nairobi Woman Representative Esther Passaris has explained why she opted to seek treatment in India.

Passaris says she made the decision after a close friend of hers who was suffering from a similar condition ended up being crippled after undergoing a surgery at a hospital in the country.

The friend then had to go to India for corrective surgery.

“… my girlfriend with the same condition was operated at a hospital here, with a surgeon perceived to be the best, and she ended up crippled due to nerve damage. She had to go to India for corrective surgery. We have surgeons who take their patients for granted,” Passaris.

Ms Passaris flew to India in December 31, 2019 where she was admitted at a hospital and underwent a spinal surgery.

Before travelling to India she underwent several procedures in the country.

She revealed that she had been having severe back pains dating back to 20 years ago when she gave birth.

The complication, according to the lawmaker, made her miss doing a lot, including working out in a gym. She also cannot walk for more than half an hour.


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Why cancer is killing more children in Kenya



Only three out of 10 children diagnosed with cancer annually in the country survive, the cancer institute has revealed. Unlike in the developed world, the survival rate for children affected in Kenya ranges from 10 to 30 per cent, the National Cancer Institute (NCI) Chief Executive Officer Alfred Karagu told The Standard in an interview.

Mr Karagu (pictured) noted that every year, up to 3,200 new cancer cases among children are diagnosed. Of these, 140 succumb to the disease. The survival rate in developed countries is over 80 per cent.Leukemia and lymphoma forms of cancer, Karagu said, are the most common.

They account for 16 and 14 per cent respectively of cancer deaths among children.Other forms that have proven to be top killers are kidney and brain tumours.“We have a problem with detection, especially at low-level health facilities yet a simple test like a blood count can tell if a child has cancer,” Karagu said.

Wrong diagnoses

He noted cases where children are routinely treated for aneamia, only to later be diagnosed with cancer. Karagu said this raises questions on how knowledgeable health workers are about the disease.He linked the dearth in cancer knowledge to lack of proper research, noting that out of 300 medical research papers published in the country annually, less than 10 address cancer among children.

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Karagu further noted that lack of specialised facilities with a capacity to handle childhood cancer is also to blame.“Apart from the two main national referral hospitals (Kenyatta National Hospital and Moi Teaching and Referral Hospital) we do not have any other public facility that can adequately handle cancers among children,” he said.

Karimi Mutua, an expert in hematology oncology, said separately that children are at a lower risk of being diagnosed with cancer than adults and that is why much has not been done to fight childhood cancers.Dr Mutua noted that exposure to benzene and ionizing chemicals as well as certain genetic syndromes are the main causes of cancer in children.

“More than 95 per cent of the cancers we treat among children have no risk factors,” Mutua said.She noted that cancer symptoms among children are similar to other diseases, and lower level health workers should be keen to make detection.“We have met parents who say they have been to hospital several times without being told that their children are suffering from cancer,” Mutua said.

She also averred that up to 98 per cent of childhood cancers are treatable when diagnosed on time and the right treatment is administered.

By Standard

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My sister always served me on the same plate after she learnt of my HIV status



Mary (not her real name) often made trips to the hospital when she was little.

She was too young to understand what was happening and her mother was hesitant to tell her that she was HIV positive.

When I met her, she greeted me with a firm handshake and apologized for showing up ten minutes late.

We quickly went to a nearby restaurant and ordered a cold drink. She gently dipped her straw into the mug of milkshake and took a sip before settling onto her seat.

She tells me that the interview might ‘go south’ any moment since the subject is quite emotional and she might need time to recollect herself.

When I was little, my mum often took to me to the hospital. From time to time I was down with a cold but I thought it was nothing serious.

By the time I got to Class Six, the trips were more frequent and I had to ask my mum why I was always in hospital yet my pals were outside enjoying their childhood.

“It is at this point that she told me I was HIV positive. I remember how distraught she was when she broke the news to me. Her eyes were teary.

She explained to me that it was not my fault and that she was actually the one to blame since it was a case of mother to child transmission.

READ ALSO:   Esther Passaris reveals special relationship with the late Moi

At the time, I could not comprehend the magnitude of the situation and my innocent self thought I would be healed within no time. This was not meant to be.

As the years went by, I realized that I had to live with the virus and I had to be on medication daily.

Fast forward to 2018, I have a lovely sister whom I deeply love. I have spent numerous nights at her place but on a certain weekend I noticed something peculiar.

I wonder why it never occurred to me. Ever since I had started going to her place, she had been serving me food on a particular plate.

At first I thought it was part of a set but later I realized that it was the only one.

On this particular day I approached the househelp and asked her why she always served me on that plate.

She confidently said, “Niliambiwa nikuwe nakuwekea chakula hapo.”

These words pierced into my heart like a double-edged sword. For a moment my heart sunk.

This was my blood sister. How could she do this to me? We grew up under the same roof…did I really deserve this?

I never confronted her about it but to be honest, our relationship changed. I could not help it.

I tried to forget it but I couldn’t. I was facing stigmatization from family. It was tough.

READ ALSO:   Esther Passaris to dedicate Sh200k from her salary every month to help youth with business ideas

I cried myself to sleep every single day. I cried out to God so many times. Why me?

Life had lost meaning. I felt I was a baggage to everyone.

But I vowed that my destiny was in my hands and I had the ability to turnaround my fortunes.

I used all the setbacks I faced as a catapult to achieve all my dreams. I felt lonely but I knew God was on my side.

I dedicated my life to him and slowly things started changing.

I landed a decent job with a top city hotel and made good money. I invested the money in various businesses and boy didn’t they pick.

At times I feel like my status influenced me positively. I am now at a better place… I have been on ARVs too but I am used to them

I am living positively, with a positive mindset and I will do my best on earth until the Almighty calls me home.

At this point, Mary takes a look at me and says, life is like an elevator. Challenges can take you up or pull you down but you are at liberty to choose the button you desire.

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Mis-conception: Abortions within marriages



Evelyn Wambui (not her real name) had her career and family life all planned out. She wanted to have three children and a stable career by the age of 36. Everything had gone according to plan by the time she gave birth to her third born in February 2018.

She had a good career as a human resource manager at an insurance firm in Nairobi. She was also married with two children aged eight and five years. Six months after the birth of her third born, Evelyn started taking birth control pills. “Pills were my most favourable option at the time. I was not ready to use an intrauterine coil. I had also ruled out the Jadelle levonorgestrel implant because of previous heavy menses and constant spotting,” she says.

Having taken her pills faithfully, Evelyn was shocked when she started to miss her periods last year. It started in August, a year after she started taking the pills. “I was not alarmed at first. I had taken my pills well and there was no way I could have been pregnant,” she says. But she knew something was wrong when she missed her periods for the second month in a row. “I became very anxious. I wanted to take a test, but I was afraid. I decided to wait it out for another month,” she adds.

Evelyn finally took a pregnancy test after missing her periods in October. The test came back positive. “I was shocked and angry at the same time. I became very irritable. I had not planned to have another baby. I didn’t want another baby.” Evelyn decided to keep her pregnancy from her husband as she contemplated what to do. “I knew there was no way I could have another baby. I had to act fast before any pregnancy signs could emerge.” She decided to procure an abortion.

“I had calculated and figured out that I was about 12 to 13 weeks pregnant. I evaluated my options with a close friend in the medical field and got a trustable referral,” she says. On Monday, November 4 last year, Evelyn took the day off work and drove towards Upper Hill for her secret abortion. “I was examined and informed that a surgical abortion using a suction method was my best option. The procedure lasted less than 15 minutes,” she says.

Currently, Evelyn is using a five-year intrauterine coil as her preferred family planning method. “I have no regrets. Conception is a choice and a right for every woman. I would still opt to procure another abortion if things went south instead of carrying a pregnancy I haven’t planned for,” she says.

Her sentiments resonate with data and experiences of many married Kenyan women procuring abortions today. According to a study conducted at Kenyatta National Hospital (KNH) in 2013, a significant number of women who procure abortion for the first time are likely to do it again.

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It would be easy to assume the majority of abortion cases are procured by unmarried women or helpless, young girls. But, there are many women who procure abortions in Kenya in the same marital status as Evelyn. Married. For instance, the KNH study, titled ‘Acceptability of Rapid HIV Test Screening Among Patients Presenting with Incomplete Abortion at Kenyatta National Hospital’, further noted that nearly two-thirds of women who seek post abortion care services are married, 22 per cent single, divorced or separated (12 per cent) while 4.4 per cent are widowed.

A related study conducted by Marie Stopes and published in the journal Plos One in November last year shows 22.4 per cent of women in Nairobi who procure abortions are married, partnered or cohabiting.

In most cases, married women procure abortions in secrecy. Take Kristie Nyachiro* She had an abortion one year after getting married. “It was my first pregnancy. I wasn’t ready. I was already juggling my career and a Master’s degree,” she says. Kristie and her husband had planned to have their first baby after five years. “I got married at 28. I wanted to concentrate on my career and academic progression first. I knew I wanted two children, the first born at 33,” she says.

When she fell pregnant a year down the line, Kristie saw abortion as the perfect solution to stop her career and academic plan from crumbling. “Having a baby is not as easy as it sounds. It takes sacrifice and commitment. It’s not like juggling tennis balls,” she says. At the same time, there are women who opt for abortion because they do not want to have any children at all.

In any given instance, the procurement of abortion reflects the conception of unwanted pregnancies. According to the 2014 Kenya Demographic Health Survey (KDHS), unsafe abortions in Kenya accounted for 35 per cent of maternal deaths. This was not the first national data set to show the high cases of unintended pregnancies. Take the 2008 to 2009 KDHS. This survey showed 43 per cent of women had unplanned pregnancies. Out of these, 17 per cent were unwanted while 26 per cent were mistimed.

Some of the major reasons married women opt for abortion are failure to use contraceptives, failed and untimed contraceptives.

Nonetheless, the use of contraceptives within marriage has been on a steady increase. While speaking during the World Contraceptive Day in 2019, outgoing Health Cabinet Secretary Sicily Kariuki said contraceptive prevalence among married women in Kenya had increased from 46 to 58 per cent over the last decade. “For every Sh100 invested in contraceptive services, we are able to save Sh200 in maternal and newborn healthcare as a result of a decline in the number of unwanted pregnancies,” she said.

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But it is not just the lack of or wrongly used contraceptives that is leading married women towards abortion. For instance, women who took part in the Marie Stopes study reported they did not have an agreement with their partners on the number of children they wanted to have before getting married. While some women like Evelyn are able to procure safe abortions, the vast majority take the unsafe route in unlicensed backstreet clinics. The life and financial consequences of unsafe abortions have been extreme.

A study titled ‘The Costs of Treating Unsafe Abortion Complications in Public Health Facilities in Kenya’ conducted by African Population and Health Research Centre (APHRC) and the Health ministry between 2012 and 2016 found that Kenya used Sh500 million on cases of unsafe abortion during that period. The report estimated that in Kenya, about 464,690 abortions are procured every year.

“These cases could be higher since these are only figures officially reported at health centres,” says Dr Janet Thuthwa, an obstetrician-gynaecologist in Nairobi. Out of these figures, the report further shows that seven women die every day in Kenya from unsafe abortions.

Strikingly, nearly one-third of women who procure abortion do not care that it is illegal. According to Murigi Kamande, a lawyer, abortion is outlawed, save for certain instances such as when, in the opinion of a trained health professional, there is need for emergency treatment or the life or health of the mother is in danger.

“Section 159 of the Penal Code provides that any woman who procures an abortion outside the boundaries stipulated by the law shall be guilty of a felony and will be liable to imprisonment for seven years upon conviction by a court of law,” he says.

The effects of unsafe abortions and the legal and moral dilemma in Kenya are exemplified by the case of an 18-year-old girl identified as JMM who died in 2018.

JMM died after suffering complications from an unsafe abortion. In 2014, at the age of 15, JMM had procured an abortion after getting raped and falling pregnant. The abortion cost her Sh1,500 from a chemist who used metal rods to terminate the pregnancy. Her legal guardian, identified as PKM, received a call informing her JMM was vomiting and bleeding profusely at a clinic where she had sought medical attention after procuring the abortion. While JMM received post abortion care at numerous hospitals, she sustained a chronic kidney disease that eventually claimed her life in June 2018.

Following JMM’s predicament, the Centre for Reproductive Rights filed a case challenging the government’s withdrawal of Standards and Guidelines for Reducing Morbidity and Mortality from Unsafe Abortion in Kenya.

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The guidelines cover among others prevention of unwanted pregnancies through contraception, and prevention and management of unsafe abortion. They state that facilities providing sexual and reproductive health services should have protocols for providing abortion services to survivors of sexual violence and all termination of pregnancy should be carried out in a health facility with appropriate equipment, but in accordance with the article 26 (4) of the Constitution.

In a landmark ruling by the High Court on June 12 last year, termed abortion illegal, save for certain instances. However, the judges also ruled that any Kenyan woman can go to a licensed health facility and procure an abortion on the basis these guidelines. This ruling effectively restored the abortion guidelines withdrawn by the Health ministry in February 2014.

“The withdrawal of the national guidelines on safe abortion amounts to discrimination, violated right to life, violated the rights of women and adolescent girls, violated access to information, consumer rights as well as having access to scientific progress,” they judges ruled.

Despite abortions being undertaken in the tens of thousands every year, the number of cases reported to the authorities remain acutely low. This suggests unsafe abortions occur unnoticed by the national legal apparatus. For example, according to the Economic Survey 2019 report, only 18 cases of procured abortions were reported to the police.

Nonetheless, Dr Thuthwa says for many women, procuring an abortion is not so much about the legality of the process, but the morality and stigma associated with it.

“No woman wants to walk down the street bearing the abortion tag. The stigma associated with abortion is one of the reasons women are reporting the effects of unsafe abortions when it is already too late for post-abortion care,” she says.

In the Marie Stopes survey, 56 per cent of women who confessed having an abortion took abortion pills while 44 per cent had surgical abortion. However, more women faced difficulties in meeting the actual cost of the abortion.

In Kenya, Marie Stopes International is one of the facilities that provides post-abortion care services. Post abortion care service providers have been on the spotlight for many reasons. For example, in 2018, Marie Stopes was ordered to stop providing abortion related services by the Health ministry over what was termed running abortion-by-choice adverts. The ban was, however, lifted in 2018. Over the three weeks the ban was in effect, the clinics reported turning away three women who needed post-abortion care services.

By Nation.

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