8 pregnancies and childless

By Dr. Lucianna

The pain of a woman

She had an engaging smile, dazzling white teeth, dimples and all! I have always loved dimples. When I was small I tried sucking in my cheeks but dimples eluded me. How on earth are dimples made! Little me had no idea. Anyways.., she had this intensely dark, shiny, almost ebony skin colour. And then she had those traditional facial marks peculiar to her tribe in the part of the world she came from. The marks were almost scary to one who had not seen them before. Aaand… she was pregnant, early pregnancy, the stage which most women will prefer to keep to themselves. She had been instructed to go to hospital early, why? She had been pregnant eight times before but had no child to show for her effort. Her name was Sarah.

I remember when I was still a student going with a friend to visit a friend. We got talking and the moment she realised I was a medical student she poured her heart out to me. She was in a live-in relationship (Kenyans call it “come-we-stay”) and the “husband” had refused to formalise their relationship because she appeared to be “barren”, to use her own words. Clutching at straws, you might think. What would a medical student do? I did what I had been taught, I took a history. I realised she had lost two pregnancies. And no, she had not seen any doctor yet because some “knowledgeable” older woman had told her she couldn’t go to hospital until her pregnancy was four months! Talk of ignorance! For one, she was not barren! She had proved she could get pregnant. I explained to her the little I knew then about loss of pregnancy, what the lay man calls “miscarriage”, what doctors call “spontaneous abortion”. I explained to her about a pregnancy-saving stitch and told her to see a gynaecologist immediately she got pregnant again. The rest, as they say, is history. The stitch saved her marriage.

Back to Sarah, my dimpled, tatooed patient. Her tribeswomen warned me of her stubbornness and perceived rudeness. It was almost impossible to put her smile and the said character together. I decided to ignore the character and go for the smile. In the course of our doctor-patient-relationship I flashed enough smiles to last me a lifetime. I don’t know why my cheeks never hurt. To cut a long story short, I was the only doctor available to Sarah. It was a very poor resource setting that had only two doctors. The hospital didn’t even have a theatre but fortunately there was a mission hospital nearby that allowed us to use their theatre as long as we did the surgery ourselves. That’s where I inserted the stitch in Sarah’s cervix and then back in our own hospital gave the necessary instructions.

Through the remaining months of Sarah’s pregnancy we fought, almost literally, she and I. She was not very good at following instructions. At some point I had to admit her for “forced bedrest”. Immediately I left the hospital compound Sarah would be out of bed. The staff would radio-call me and I would go right back. We would fight some more and I threatened to cuff her to her bed, not that I had any cuffs. Anything to keep Sarah on that bed. At some point she went into pre-mature labour. We were in danger of losing this pregnancy like all the others. We gave the necessary medication and elevated the foot of her bed by using huge stones. We had to keep that baby away from that cervix! That night I almost camped by her bedside because if we didn’t manage to abort the labour that stitch had to come out. When she settled I went away but still on high alert. Oh, looking after Sarah was exhausting. She listened to nobody but me, and even then, not very well. But her dimpled smiles persisted. Sometimes I don’t know how I managed to smile back.

After all the fights and the smiles, finally, true labour set in! Everybody was kind of ready. Her tribeswomen, who were her nurse-aides, however, wouldn’t let me go home. Despite having assisted numerous women deliver they were not quite ready for Sarah. It was night for goodness sake and camps were not safe at night! Sarah herself insisted if I wasn’t around she wouldn’t deliver. Smile firmly in place, cheeky or what? I stayed. Hallelujah! Stage 2 of labour came. After huffing and puffing and pushing, out came a baby girl! Everybody was so excited! I went home, with a smile in place I fell into an exhausted sleep.

Come the following morning I went to the hospital and my first stop was Sarah’s bed. Very deliberately Sarah showed me the baby’s card. Oh good Lord! What do I see? The baby was named after me! Only they didn’t know I was Lucianna, they knew me by my surname. I told them, “Oh, no, no, you have to change. This is a boy’s name!” She looked me in the eye and in her special English said, ” I look baby, I see you. I look you I see your name. That is baby’s name”. Incidentally she and her relatives had long agreed that the baby would bear my name. My surname was the only name they knew.

Families have undergone untold suffering because of pregnancy loss or inability to concieve. All it requires is taking the right action and having a sympathetic ear to guide them through. There are many advances in technology and many couples who thought themselves “barren” have been assisted. Our land is full of professionals in the area of infertitility, talk to them

Road traffic accidents (RTAs)

By Dr Lucianna

Safety precautions

I imagine the whole family was excited, especially their little girl, aged about 8. They had planned to do over 600km to visit the extended family. I imagine the little girl had missed grandma and grandpa. I imagine she was not very sure she remembered what they looked like. Had they withered with age? Were their backs bent over? How was she to know? There was time to find out. Meanwhile there was the drive through the Tsavo to enjoy. Were it a day drive, there would definitely be zebra in abudance. Beautiful majestic zebra! How can zebra and donkey be cousins? How? Zebra so curvy and beautiful, donkey so “not beautiful”! And then there would be monkeys upon monkeys! On a lucky day one might see elephants. Unfortunately this family was travelling at night and so sighting the animals was only a remote possibility.

They had not done 200km when suddenly, screeech!! Dad hit on the brakes!! Out of nowhere a zebra appeared, right in the middle of the road. He hit on the brakes and swerved. Still the vehicle hit the zebra, rolled and landed in the bushes by the roadside. Dad still at the wheel, seat belt firmly in place. Mom in the passenger seat next to him, also seat belt firmly in place. But where was the little girl? The backseat was empty. All the doors were firmly closed. But the windscreen was shattered. The little girl was hurled out the windscreen! We were told about the accident later in the day. We had lost the little girl. Mom and Dad were celebrating their wedding a few days later. Indeed that’s why they were traveling. A happy occasion during a sad time. Who knows, maybe if she had been secured with seat belts the little girl would have lived. Who knows?

This reminds me of one day eons ago when I was driving from Nairobi to Nyeri, a distance of about 150km. At a little over 100km there was a 2-lane incline that goes on forever. There was a slow moving truck, heavily loaded with cement ahead of me and I knew that if I stayed behind it, it would take me forever to clear the incline. I took a peek and the road ahead all the way up the hill was clear. I hooted to alert him, turned on the correct indicator and took the right lane. What the heck!! He took a swing onto my lane and crushing into him was imminent. I was just next to his tail and not in a position to swing back to the left. I swerved off the road, for a moment I thought I was a goner, but purely by God’s grace I swang right back onto the road ahead of him. Well, not quite! I almost did. That’s when I saw it. I saw what had made him swerve. A donkey cart!! For goodness sake, a donkey cart!! I swerved off again to avoid hitting it or crushing into a bus-stop full of people right ahead and to the left. This time I was not so lucky. I found myself in a spin. One moment I was upside down, the next I was “upside-up”. The crazy dance went on for several, very slow seconds. The doctor in me saw crazy things. I imagined, “Oh God! Head injury! Raptured liver! Raptured spleen” And then all was quiet. I wondered if I was dead. The crowd came running to the rescue, I imagine the same crowd I tried to avoid hitting at the bus stop. They unfastened my safety belt and got me out. The vehicle was a complete write off, but I was intact. I shudder to think how things would have turned out without the safety belt. While I know that God saved me that day, I know that the safety belt was one of the tools He used. For people of faith like me, I found salvation in that upside-down upside-up car. I decided next time I died, I want to be sure of my destination.

Our greatest challenge today is the boda-boda epidemic! It has changed the topography of public hospitals. (Boda-boda are motorcycle taxis). Most orthopaedic cases used to be housed in a section of the surgical unit. These days we have fully fledged orthopaedic wards for boda-boda casualties. Why is this so? There is nothing as challenging as the ignorant fellow who has no idea he is ignorant. These operators are completely clueless about traffic rules. They don’t go to riding school. As long as he can balance a motorbike he’s good to go. And his riding gear? Quick summary, it doesn’t exist. He dresses for the weather. In Mombasa they turn out in shorts and t-shirts and flip-flops. Helmets? What for? Riding boots? Do they exist? Knees and shoulder pads? What are those? Armoured riding jacket? Ooliskia wapi? First rule on the road for these guys – grab the next available space on the road, weave in and out of traffic if you have to. At the roundabout please give Him “your right of way” because if you don’t, he’ll take it anyway and as a bonus unto himself his bike will grab your bumper and drag it behind him. Second rule, pile on as many pillion passengers as you dare, who cares? The result of this madness is a full orthopaedic ward in the nearest public hospital. You will find legs hanging in all directions, some pulled down with orthopaedic weights, others look like construction pillars with metal frames and nails jutting out. This madness is caused by operators completely throwing caution and precaution to the wind and the traffic cops pretending there’s nothing they can do about it. But funny enough they’ll always be a available for post mortem of the boda-boda fatalities. Ask me, I know, I did many.

It always gives me the shivers when I see kids playing in a moving vehicle. It gives me even greater shivers when I see fathers on the driver’s seat, yes fathers, sitting their baby boys on their laps, yes baby boys, driving around town and generally feeling very proud of themselves. One sudden obstruction and those babies will have their heads bashed against the steering wheel or windshield! Other kids stick their hands and heads out through the windows making gestures at fellow motorists, most of them not so polite. We need to secure kids in baby booster chairs or harness them securely onto the mother or other caregiver. Most people think baby boosters are just for show. Take it from me, they could mean life or death for your kid in case of motor vehicle collision.

(In this covid19 3rd wave, wear your mask properly, wash your hands, keep your distance!)


By Dr Lucianna

Children born with defective skull bones and brains

This was her first baby. The only thing she was scared of, like most first time mothers, was labour pains. She waited in anticipation. Months came and went as she approached D-day. One evening, a while before she was due, her waters suddenly broke and it was like a dam burst. Her bedroom floor was flooded! They said it looked like somebody had poured a bucket of water. She was rushed to the private hospital where I happened to be on duty. After receiving her, we left the mid-wives to do their thing. She progressed rather fast but when she got to what we call 2nd stage, the baby refused to come out. They alerted me as the doctor on duty. After a short assessement I realised we needed the help of an obstetrician. We called one. She came quite fast. As she was examining the patient, I saw her face cloud and knew we were all in for some heavy news. She did her thing like she was trained to do, and finally out came the baby. Jesus! Who was going to tell the mother?? The practice is, immediately the baby is born, the mother is shown her baby with the relevant area well displayed. I prefer it when the mother herself actually pronounces whether its a boy or a girl to avoid any confusion later. This time, the sex of the baby was not our primary concern. The congenital abnormality was. It explained why her waters had flooded her bedroom. She had polyhydramnios, that is excessive amniotic fluid. This is the fluid in which the baby swims in there.

Doctors are not super-human nor are they sub-human, they experience your pain. When there is bad news to be relayed the people around furtively look at each other, silently each trying to evade the role of bearer of bad news. Not even experience trains medical people for this. Usually it’s left to the senior-most member of the team, in this case, the obstetrician, but somehow, she managed to slip away leaving me literally holding the baby. The mid-wives didn’t abandon me, they stood by, silently having my back. I started stammering and stuttering as I tried to tell the mother that the baby had a problem. Already she had sensed that all was not well and she cried as she said she wanted to see the baby. Thank God for mothers! Initially, she only saw the positive attributes of her baby. Smiling through her tears she told me, “he is beautiful and he is chubby!” We were a bit worried, we thought she had missed the obvious, what we had all seen. Then she asked, “what is wrong with his head?” I told her it was not well formed. God forbid that anybody should use the word “deformed” when explaining to such a mother. There was literally no head above the eyebrows. There was no forehead and anything beyond the forehead. It’s called anencephaly. The bones forming the upper part of the skull are missing and so is the part of the brain supposed to sit there; the cerebral hemispheres. Such babies don’t survive long.

There was this other lady. Just married, got pregnant in the first year, and real excited about it. Months came, months went. Soon she was in labour. When she got to 2nd stage baby refused to come out. The doctors did what we call vacuum extraction. Out came the baby looking beautiful. I wasn’t there but I’m sure those who were must have noticed the head was markedly smaller that normal. Either they didn’t explain very well to the mother or she refused to accept and lived in denial. The baby didn’t acquire the milestones children her age were supposed to acquire. The last time I saw her she was about 7 years of age but still a baby in terms of development. The mother firmly believed that her baby was damaged when the doctors “pulled her out”. What she didn’t know was that a well formed, large, normal sized head negotiates the birth canal and makes way for the rest of the body. This baby had severe microcephaly with the head too small to effectively create the path. She had to be assisted. Such babies have an underdeveloped brain, the degree varies.

What causes these problems? It could be genetic, brought down either side of the the family tree. It could be folic acid deficency. It could be other micronutrient deficieny. It could be a mother who indulges in alcohol or smokes during pregnancy. It could be prescription drugs bought over the counter or other toxic substances. Sometimes the cause is not identified. Is it possible to know before delivery whether a kid has such a problem? Yes it is, especially for people who have access to blood tests and proper technology handled by properly qualified individuals. But the moral question is, what will you do with that info? I leave it to you and your conscience and your God.

Bottom line, ladies, please feed well. Stop being picky with your food. Eat what you know you must eat, not just what you feel like eating. Take your supplements faithfully; folic acid, iron and vitamins. If you vomit your doctor should be able to prescribe some anti-vomiting. Don’t buy medicines across the counter. Sleep enough. Let them think you are lazy. To those who love to party, avoid alcohol, take juice. You owe it to yourself and to your baby.

Battered baby syndrome

By Dr. Lucianna

Nanny from Hell

It was his first birthday! His momma’s excitement knew no bounds! You see, he was her first baby. My favourite, sweet, baby nephew! He was cute, he was chubby, you could bounce him like a ball, or so it seemed. He was a baby you just wanted to pick up and hug. The guests had been invited and tripple-reminded. There were no mobile phones those days and not everybody had a landline. So it took a very deliberate effort to invite people to a function. All was set. The cake was ready, only waiting to be collected. Finally! The party day… guests arrived… guests were horrified! Birthday boy’s leg was in a plaster cast!! Baby fractured!!

On the eve of the birthday party, baby’s mom arrived home from work to find her baby whimpering in the cot, after having cried his little heart out. Baby’s leg was broken! The nanny gave wierd, conflicting stories of how the baby got injured. She said he was trying to climb out of the cot! At one year!! Come on!! The cot was kid-proof, the height and gaps were completely baby-proof! My sister went bananas. She grabbed the nearest stool and hurled it at the nanny. Fortunately for her, it missed. She was sent packing. What she did to the baby we never really got to know. We didn’t consider baby’s injury accidental because there were a few other “accidents”. One day his mom found the back of his hand burnt. How??? The nanny said the baby accidentally touched the “jiko”!!! With the back of the hand, my foot! Kids touch with the palm! Maybe he was checking the temperature of the jiko, ha! That’s me sneering.

We were all horrified by the story of Gladys Naliaka last week, the nanny from hell. How she was sacked by her employer and how she plotted revenge. How she came back and sneaked in when mom was away at work. How she repeatedly stabbed the two innocent little boys! We can’t keep a nanny who is clearly a danger to the children now, can we? Oh no, we can’t! One day, as a mother of one, my little girl asked me, “mom, if I tell you something will you tell so and so?” I sensed danger and promised I wouldn’t tell. That day I sent the nanny packing. After that the question was modified to “mom, if I tell you something about so and so, will you chase her away?” It happened twice, I think, and both times I sent them packing. Each time the “something” my little one told me was horrifying.

How anybody is able to harm children is beyond most normal minds. You’ll be surprised to hear that even parents are capable of harming their own children. Children who are always in plaster casts leave a lot of questions un-answered. Most of the guilty parents will not take the children to the same hospital for new injuries. What they don’t know is that doctors can recognise tell-tale signs of a battered child. A casual glance at a child will tell a keen doctor that the child is abused. Further examination will show multiple healed and healing scars. X-rays done will reveal healed and healing fractures.

Most battered children are caught in between parents’ battles. People have been known to grab a kid by the hand and hurl them across the room. In the process the shoulder is pulled off its socket. Others have bashed babies’ heads against the wall in a state of fury. Some mothers have used their babies as shields against abusive husbands and later blame the father for battering the child.

Some parents cause injury unintentionally. When a parent grabs a child by the shoulders and angrily shakes him, it damages the brain. You see, the skull is a closed box. The brain sits in there and leaves a bit of space in the margins. When you shake a baby, you bounce the brain around the box causing injuries; some small, some major. When you make this a habit, the small injuries congregate into larger injuries and before you realise it, your baby starts getting convulsions. This is one cause of epilepsy but since this baby-shaking history goes unrecognised, the cause of the epilepsy will never be known. You will stretch your memory down both family trees but you’ll find no family history of epilepsy. You will then start accusing your neighbours and business rivals of bewitching you. You will even “remember” when your neighbour went to that infamous region for charms, after your child beat theirs in the exams! Talk of literal witch-hunting! Ignorance will kill us! By the way, some baby-shaking causes death from massive bleeding.

It’s important to detect when your child is being battered. I’ve heard parents ignorantly confessing that their kids can only eat when fed by the nanny. “My kid is a fussy feeder”, they’ll say, “but when the nanny feeds him, he will swallow everything; food, plate and spoon!” Well, not literally. They don’t know that the kid is so terrified of the nanny that he dare not risk her wrath.

Other kids will come crawling into your bed at night. That’s the only place they can peacefully sleep without nightmares. If your kid refuses to sleep in his bed, gently find out why. Promise to keep them safe from anybody who hurts them, and keep your promise immediately they tell.

Other kids will start wetting their beds. If your kid suddenly starts bed-wetting, find out why. It could be the new nanny or a new teacher whose first name is “terrorist”. It could even be a new baby brother or sister and your older baby is trying to tell you that you are neglecting them. I was given quite a mouthful by my little girl, “mom, you’ll take that baby back where you got him from!!” I had unknowingly dampened her sibling spirit, she was not going to take it lying down! Oh, and how excited she was when her baby brother first arrived! It turned out that I was “over-supervising” her time with baby brother and a lot of “don’ts” came out of my mouth. “Don’t do this, don’t do the other!” Baby girl came out guns blazing! Shooting from both hips! Mistake noted, mistake corrected, mom sorry. Baby girl happy.

Keep your eyes open and your ears flapping. You won’t miss the signs of physical or emotional baby battery. Save your baby today.

Kid-proofing homes

By Dr. Lucianna

Home accidents Part 3

My daughter, aged about 7, zoomed across the living room like a scooter with a new engine, her brother hot in pursuit, equally energized. My son reminds me that there was a black out that evening and we were using candles. The instant the lights came back on, the race was on to blow out the candles. The next thing they knew, her forehead had connected with the corner of the coffee table, an untidy gash resulting, evidence displayed for all to see. I don’t know what caused the greater panic; the impact, the pain or the blood! Oh, didn’t she bleed! Everyone tends to panic at the sight of blood. The other day a ceiling fan came off and fell on a child and slit a gash on his head! Oh, didn’t the people around panic! Especially the mothers who happened to be in the area! Scalp wounds really bleed; even when the cuts are small.

We quickly grabbed our daughter, administered some first aid to stop the bleeding and went to hospital. Usually, doctors don’t treat their own, but I was not going to let anybody stitch my baby. We psyched her up a bit to prepare her for the stitching. Baby girl didn’t even whimper as I administered a local anaesthetic injection and stitched her up. It healed pretty well. The scar is hardly visible. This other boy injured recently was taken to hospital after I administered some first aid and he was stitched up too. Cuts in the head tend to bleed more than cuts elsewhere so causing greater panic.

The incident with the boy reminded me of myself when I was 6, around the time my siblings and I set the log cabin on fire (see earlier posting for this story). Ahead of me I was rolling “my car” which was a circular tin contraption. It’s origin must have been the base of some metallic drum. Kids have been known to imagine and create “cars” out of anything that can roll; from old tyres to old bicycle rims; anything that can roll. Then there is this long wire whose end is shaped into a “U” where the “car” is cushioned as it rolls. Most of those “cars” had only one wheel. Our local name for it was, and I guess still is, “mugara”. It was mainly a game played by boys, but being sandwiched between two boys I was quite a tom-boy and quite an ardent “mugara” driver. I could hold my own against any boy.

The particular “mugara” I was driving that day had an inner jagged margin. Quite a dangerous contraption, if you ask me. You might wonder why that particular detail has remained in my memory to date. Here is why: As I gathered speed, somehow I lost coordination and my little legs run faster than my “mugara”. I can only think about this in retrospect. As I was about to overtake my own car, my foot got caught in the inner margin! Ouch!!! Ouch does not even begin to describe the horror and the pain and the blood! Talk of a bad cut! Not even time has been able to remove the scar. It has faded, but my right foot is testimony to what happened that day.

One of the most embarassing things I remember that day is being carried on my mother’s back to and from hospital. Embarassing because I was a big girl. Big girls don’t take piggy-rides on their mamas; complete with a leso, or whatever cloth-sling was used those days. You might think a six year old shouldn’t feel big, but with two small brothers and a sister; 3 babies born after me, mom never stopped reminding my big brother and I that we were big people. He was only 7. Anyway, on that particular day I felt my legs hanging all around mom. I felt like I had 8 of them like a spider. Baby’s legs are supposed to be neatly tucked under them but mine were dangling all over, too long if you ask me. I’m surprised they didn’t trip her! I imagined people were asking, “what is a big girl doing on her mother’s back?” In answer to the imagined question I displayed my bandaged foot for them to see.

Home accidents are real. What’s the lesson today? It’s minimising chances of accidents at home, Kid-proofing the home, so to speak. I have learnt from the many stories in my life and the lives of my patients that you can’t be too careful. Avoid tables and home surfaces with sharp corners and margins. Kids will bump into them and get hurt. Avoid glass topped coffee tables if you have small kids. Should they drop something on them that could shatter them, everybody will be in a lot of trouble. Kid-proof your stair case if you have one by putting gates at the top and at the bottom. This will protect kids from rolling down the stairs. Kid-proof your balcony and windows if you live in storeyed houses or apartments. Any gaps that can accomodate a kid’s head can surely accomodate the whole kid and they’ll fall off. Avoid balcony levels that a kid can climb over. This remimds me of a very sad story recently when a four year old kid climbed over the roof top balcony, four floors high, and fell to his death. It was quite a tragedy. Any levels should be such that anybody able to climb over is somebody able to understand the associated danger.

Something else that people don’t seem to realise is that floor tiles can be a death trap. At home avoid those shiny tiles you can almost see your face in. It takes just a few careless drops of water to send you hurtling.Use tiles that have a bit of grip. In the bathroom use tiles that have a lot of grip. On a light note, I know a church that gives me jitters because of its shiny tiles, not because I’m afraid of slipping and falling, but because ladies are uncomfortably displayed as they raise their holy hands in worship, if you get my drift. oh, and if your house has shiny tiles, avoid using those decorative throw mats, they’ll throw you into a massive spin one day.

Don’t anybody dare call me a prophet of doom, rather consider yourselves warned


By Dr. Lucianna

The African child wives

“She has fainted”, sounded like “painted!!!” “She has painted!!!” “She has painted!!!, came the disorganised chorus from a group of young men, carrying a girl aged about 16 on an improvised stretcher. Of course I rushed in to see what I could do and, believe it or not, I immediately saw the tell-tale signs of hysteria. This was a scenario that was to be repeated over and over again in the two years I worked in that hospital. I remembered these stories as I thought about what to write for the International day of women, March 8th. I like this year’s campaign theme, #ChooseToChallenge. I aim to expose and challenge the idea of marrying off little girls!

This first scene is based in a multi-cultural, multi-national hospital somewhere in Africa. When I realised that the girl was hysterical I knew I had to trend carefully. I asked the accompanying mob of concerned young men to give me a spokesperson because they all eagerly tried to explain the situation. They had trudged in the darkness from the furthest parts of the settlement carrying this girl who had suddenly fainted in her house. They had no idea what had triggered it, or so they said. Laboriously I extracted the information.

Picture this: A young, beautiful, jet black girl with plump cheeks and full lips, skin glowing with the hormones of youth and the excitement of marriage. Marriage is supposed to be a good thing, yes? Yes. Oh, you could almost see your own image in her face! It was so shinny and radiant it could pass for a mirror. The days towards the build up of the climax were nothing but pure joy, pure celebration. And finally, oh finally, the shy bride is led to her hut. Shy for real because in this community a bride has to be a virgin.

And then…. drums roll… abracadabra!!! There emerges this scarecrow of an elderly polygamous man, with skin like cow-hide or a lizard. And in the light from the oil lamp she sees him, wearing this earie smile that sends shivers down the spine of the innocent little girl. The light casts ghost-like silhouettes in the background. And he is weilding a dangerous device that is more felt than seen. And, heavens come down! Which area is he aiming for? And just before impact, the girl collapses. When the initial shock is over the girl realises that the only way out of this nightmare is by remaining “unconscious”. Oh, and these little ones are good actors! They’ll stay unconscious for 24-48 hours. They’d rather stay on i.v. fluids than wake up. What kind of world is this that forces little girls, pure virgins, to be used like this? And by the way, she won’t escape it, even if it means being held down by male relatives of the so called husband. They will patiently wait for her to be discharged from hospital.

In another area I worked in I was horrified to hear a man introduce a 13 year old as “my wife”. I was relatively new in this area and hadn’t witnessed such. When it was time to examine the girl, I still remember with horror what I saw. It’s difficult to explain what the skin of her abdomen looked like. It was a cross between an old blanket and a “kiondo”. Honestly, I’m not exagerating. Her last pregnancy left such horrible stretch marks it was painful to just look at her.

Some of the damage inflicted on the little girls takes their lives and dignity completely away. Ever heard of VVF or RVF? Allow me to go into biology. The pelvic bones protect the delicate organs in the pelvis. The bladder is located at the front and stores urine. It empties through the urethra. The rectum is at the back and stores the heavier stinky stuff and empties through a small opening. Urine in the bladder and stinky stuff in the rectum don’t just flow at will, no, they are guarded by rings of muscles untill it’s appropriate to empty them. Not even a sneeze will defy these muscles. OK, lemme admit that I’ve occasionally heard twin blasts when some people sneeze, especially men. And yes, some ladies will exprience an embarassing wet jet of fluid down there when they sneeze or laugh. This is an indication of weak muscles. Ladies are adviced to do pelvic muscle exercises to strengthen them.

Like I said, the bladder is at the front and the rectum at the back. Sitting in between them is the uterus and birth canal. As the baby negotiates the harzadous route out, he can sometimes get stuck in the birth canal. One of the commonest causes is the mother’s pelvis being too small for the baby’s head. Bone will press against bone. Baby’s bony head against mother’s bony pelvis. Caught in the middle will be the bladder at the front or the rectum at the rear or both. What eventually happens is that the bladder wall or the rectal wall are so damaged by the pressure that they develop holes, called fistulae (singular, fistula). The baby usually dies. So this little girl is left with no baby and with urine or stinky stuff freely draining from her body through the birth canal. Her husband of course cannot stand her stench. He discards her. She is damaged goods! Still a child! A child with no future. Any gynaecologist will tell you what a challenge it is to repair a VVF or an RVF. Those who are lucky go through repeated operations before they are finally free of the indignity of having to hide from the public because of the stench they carry around. The unlucky ones carry their stench for life.

I choose to challenge marriage of little girls! #ChooseToChallenge, who is with me?

The magical blue pill

By Dr. Lucianna

Magic, really?

There was this fellow who was found stark naked in a small maize plantation in Nairobi, dead. I won’t dwell very much on his identity but he was well known in one of those government ministry headquaters. The story? He was alleged to have visited some lady-love and he had to prove his prowess. So blue pill, down the throat you go!! What followed must have been a real rough ride because the fellow didn’t survive the “thunder”. Many such stories have graced the media pages, about prominent men stricken by thunder, some proven, some not.

Boys will be boys, the age doesn’t really come into the equation. They live in a perpetual rat race! They will compete about everything from cars to bank accounts to ab-cubes to sexual conquest. Where the facts don’t support the claim they will fabricate. Sexual prowess cannot be proved so fabricated stories of conquest and performance come in very handy. A lot of lies are told at the numerous unofficial “men’s conferences” and the gullible swallow the lies hook, line and sinker! And of course they want to do something about it. Anything! That’s where our blue pill comes into play.

What is this blue pill? It has cost the lives of many men in the rat race. In an attempt to match the stories, men have told their own exagerated stories of thunder. They tell others about how they single handedly generate multiple thunder and storm (ngwa na marurumí) for their ladies. Those who haven’t had such experiences will do anything to experience such and live to talk about it. The blue pill is said to be magical in helping men achieve those dreams.

Before I explain about the blue pill lemme remind you a bit of biology. Little johnie is spongy when in the rest position. When the spongy areas are filled with blood, he stands to the salute. The angle of the salute achievable depends on the age of the individual. Little boys can point in an acute angle almost vertically upwards to the sky. As they get older the angle increases to 45 degrees, goes to 90 and in time point to the floor in an obtuse angle. These are facts of biology and there is nothing anybody can do about it. Just like the mammas in ladies will point at the toes and dance to any tune!

By the same fact of biology, the number of salutes achievable decreases with age. Young men will cause thunderstorms most times if they so desire. There are of course variations and these are all normal. Number of salutes can also decrease because of fatigue, stress or disease, e.g. diabetes. They can also decrease because of obesity!! So you can’t eat like there’s no tomorrow and expect to continue creating thunder, no way!

So what does the blue pill do? It helps retain blood in the spongy area of little johnie, hence maintaining a salute. But swallowing the blue pill does not only give you a salute, it also affects other areas of the body, especially the heart. In fact in modified doses it is also used for certain heart conditions. I must stress here that this pill is extremely dangerous for certain heart conditions. People who are prone to heart attacks and especially if they are taking heart attack medicine are in extreme danger.

A few years ago this young lady walks into my consultation room with this elderly “tourist’ boyfriend whom she referred to as “my husband”. They wanted to buy some blue pills. (The East coast of Africa is said to have a thriving sex tourism). So l looked at this elderly fellow who was already panting after climbing a set of stairs and I wondered how he survives normal thunderstorms, let alone blue pill induced ones. I told them I was not in the business of selling medicine, but prescribing after evaluation. And even then, not on demand but only if I felt it was necessary and not posing a health risk. They were rather reluctant to discuss it but it was my duty to offer my advice. After all they were in my office, weren’t they? I don’t walk the beach dishing out advice to couples who look like they are planning to indulge, no sir, I don’t. But I won’t let anybody walk out of my office without giving some advice, or at least trying to do so.

Basically what I wanted to confirm or rule out was any of the conditions that are incompatible with the blue pill. Men have taken this pill to their peril. Disaster strikes at the peak of the thunder that’s why most men are found naked, almost always with empty plates and wine glasses. The girls will usually take off in embarassment and also because they are scared of being accused of murder. Forensics will sweep the plates and glasses for evidence of poisoning but will find none. Death is usually because the man forced a salute where it didn’t belong. Unfortunately, even young men, who have normal God given salutes will try prove to the girls what a master they are at salute making! Woe unto them!

Viagra, whose real name is sildenafil is a death trap if taken by men with certain pre-existing conditions or when taken in overdose. When you encounter St. Peter at the pearly gates of heaven, don’t say you weren’t warned.

Fractured by the cat??

By Dr Lucianna

Who are you kidding?

Or rather, who are you protecting? I know cats are vicious scratchers and biters, but fracturing a woman’s ankle?? Out of nowhere?? Nah, you are taking us for a ride!! I have a vicious cat named Harry. Harry has scratched my other cats out of existence. He scratced away Sniffy, scratched away Paka, (yes, I had a cat named Paka) scratched away Brownie and is now terrorising Siren. All in an effort to protect his testosterone rights to Lexie, the only girl cat. Yes, my cats all have names! None of the terrorised cats walked away with a fracture. I chase Harry around the house with a mop stick each time he is a bad boy but he will always meow his way back into my heart. Domestic cats aren’t vicious towards their owners. A cat will fight back only and if he is cornered.

So years ago, this lady is helped into a private outpatient facility where I was working in Nairobi and claims that a cat had fractured her ankle! We all took her explanation with a “knowing look”. Almost rolled our eyes! Of course she was beaten by her husband, so we thought. Anyway, we didn’t immediately dwell on the cause of her injury, instead we went ahead to do the needful. I examined her gently. She was in a lot of pain. It actually looked like a fracture clinically. I prescribed a strong pain killer injection which the nurse promptly gave and stabilised the injury to minimise further damage. Then sent her for an x-ray.

The x-ray actually confirmed a fracture of the ankle joint. At this point I needed to get the history right for medico-legal purposes. Most people are not aware how important proper information is at the first contact with the doctor. It is useful if one needs to go to court or is slapped with some settlement. It is especially useful in cases of assault of whatever nature, be it physical bodily harm or sexual assault. Some people will tell the doctor that they were attacked by a stranger, so the doctor’s notes will read, “attacked by a person unknown to him/her”. Only for the doctor to be summoned as a witness in court! The plaintiff will insist, “so and so attacked me, I saw him with my own two eyes!” But then the doctor takes the witness stand and reads out from the notes, “attacked by a person unknown to him/her”. Case doomed!!

On several occasions, while on medico-legal duties, I saw patients begging me to change the initial narrative while filling out the “p3” form. My sad answer always was, “sorry, I go by the original story”. When an attack is fresh, especially if the perpetrator is a loved one (or a feared one), people tend to be economical with the truth. After several attacks and say, a woman wants to prove her case of battered wife in a divorce court, she has nothing to back her story.

In other instances, corruption will see an innocent man framed for assault he didn’t commit. Say, one reports on the first visit to the doctor that they were assaulted by a person unknown to them. Then he or she gets into some disagreement with a totally different person and goes to the doctor to change the story! You can imagine the gravity of the matter should the doctor agree to do so and the assault victim dies of his injuries!! Homicide!! So an honest doctor cannot change the narrative just because somebody cries in the consultation room claiming he or she gave the wrong information on the day of assault. It could be just a ploy to fix somebody.

I had to get the story right about the woman alleging to have been fractured by her cat before sending her to the orthopaedic surgeon. I was the doctor of first contact and this carries a lot of weight. I even ventured to suggest that maybe she was not telling the truth in an attempt to get to the truth. Now that her injury was stable and she wasn’t in pain she was able to narrate what happened. She was going down the dark stairs at night, for some reason she didn’t switch on the lights, when she stepped on the family cat! One screeching meeeooow and down the stairs she went! Hurtling!! She landed with a most excruciating pain in her leg. That story is believable. Any cat person will tell you how they’ve stepped on a cat once in a while especially in the kitchen.

My patient was not trying to protect anybody like women are wont to. She was simply telling the truth.

At this jucture I want to thank my many readers from around the world for being receptive to my stories and for keeping me busy. In order of statistics in this blog, they are recorded as being from:

United States
European Union
South Africa
Czech Republic
United Kingdom
United Arab Emirates

Please continue sharing my stories in your groups with your friends and aquintances.

Thank you, thank you, thank you!

Dr Lucianna

Wives, what drives you, love or fear?

By Dr. Lucianna

The battered wife syndrome

Why won’t battered wives tell on their husbands? Some will say that they love them too much to expose them. Some will say that they must protect their children. Some of them will say they must protect their status in society. Some will say they must protect their positions in church. Some are plain embarassed to talk about it. They feel helpless and blame themselves.

But there is one thing most women will not talk about, FEAR. Fear of the husband and fear of the unknown world out there. When women finally leave abusive marriages, they have ceased to care about status. They have overcome their embarassment. They have realised that to protect their children they must leave. For most of them, it’s a tough decision because they still love their husbands, but finally FEAR drives them out of their comfort zone to confront the unknown.

I remember when I was still a student at the University of Nairobi Medical School doing my surgical rotation. One morning during ward rounds we came across a patient who had been admitted the night before and taken to theatre as an emergency. Diagnosis? Acute appendicitis. She gave a history of sudden onset of very severe pain on the right lower abdomen. Upon examination there was excruciating pain at the site. So the surgical registrar feared it was a raptured appendix and rushed her to theatre. Shock upon shock! There was no problem with the appendix but there was a large blood clot within the layers of the abdominal wall. How on earth did this happen? Of course the patient was under anaesthesia so they couldn’t ask her. It had to wait for morning.

When she came the night before, she was escorted by her “very loving husband” who sat by her side, probably holding her hand, Shindwe! Much later, when he wasn’t there, the woman was able to give the correct information. During a domestic “misunderstanding” (my foot!) her husband kicked her in the abdomen! The kick was so vicious it resulted in bleeding between the layers of the abdomen. The treatment for this was not surgery! Lemme say it in a different way, the surgery was unnecessary! But the woman who would have helped the surgeons avoid it was too scared of her husband to tell the truth. FEAR…

During the obstetrics/gynaecology rotation, we came across another woman who lost her baby because of placental detachment. A short biology lesson here to educate us a bit on this, the placenta is the organ that helps transfer food and oxygen from a pregnant mother to her unborn baby. It also helps get rid of the waste products from the baby. In other words, it’s the life line for the baby. It is in turn anchored to the wall of the uterus. If it gets detached the baby can die from lack of food and oxygen and the mother can die from bleeding. Indeed, a detached placenta is a dire emergency.

So this mother has a detached placenta under wierd circumstances that she couldn’t explain in the presence of her husband. She only explained later, after surgery and after her husband had left, that he had “accidentally” sat on her abdomen when he was drunk! Can somebody explain to me how a man accidentally sits on the belly of his pregnant wife? This is the stuff of horror movies. And yet it’s true, it happened.

How can anybody explain what those two women were still doing in their marital homes. I am not an advocate for divorce but surely, how does such a woman stay in such a marriage? I still recall with horror, many, many years ago the woman in Kirinyaga, a teacher, whose eyes were gorged out by the husband. Her life completely changed! And why the viciousness? Because she only gave birth to girls. The ignorant fellow had no idea that a woman only delivers according to the seed she is given. The determinant of the sex of the baby is the man. If he gives an X-chromosome seed he is presented with a girl. If he gives a Y-chromosome seed he is presented with a boy. And then he blames her for giving birth to girls only!!! What ignorance!

The several incidents that I encountered taught me as a doctor to talk to possible victims alone in strict confidence. The husband will not even know that I am doing it, nor the parent, when it comes to young girls. When you see a parent hovering over a young girl, they or the girls are trying to hide something. If you are waiting for me to tell you how I conduct the interviews, I’m afraid you’ll have to wait for your next lifetime. I won’t tell you because I want to reassure your wives and daughters that their secrets are safe with me.

Quack ” doctors “

By Dr. Lucianna

Preying on ignorance

She came to the private hospital where I was working with a referral note from some “doctor” in one of the estates in Nairobi. The note said that she had resistant malaria. The fellow treating her honestly thought the girl had malaria. The girl believed him. He had seen her on two separate visits and tried different anti-malarials. On the third visit he referred her to a proper hospital. He signed himself off as “Dr. so and so”, pharmacist. I never got to know whether he was a real pharmacist or not.

Pharmacists in Kenya, most of whom have a bachelors degree are allowed to use the title “Dr” throwing patients into total confusion. But then again, Kenya is unique in the confusion of medical personnel. Every male who wears a white coat, except a butcher of course, is referred to as “doctor” by the ignorant masses. Every lady working in a health facility, whatever their qualifications and whatever they are wearing, is referred to as “sister” meaning “nurse”. When I was a young doctor it used to drive me crazy. After all those years of torture at the University of Nairobi Medical school and the crazy hours we kept!! Hhmm! A young doctor craves recognition! A stretcher bearer wheeling the patient to theatre would be called “doctor” simply because he was a man, while the knife wielding lady, yours truly, is referred to as “sister”. These days it annoys me less, though it’s still an irritation.

Back to our patient, when she arrived she was so sick she looked toxic. She had fevers approaching 40 degrees celcius (104 F). I quickly went into the history. When I asked about her monthly periods, she admitted to having delayed menses. This raised a red flag. I changed my approach to enable me extract as much information as possible so as to plan proper management. This was not a time to judge, it was a time to help.

She said she was dumped when her boyfriend realised she was pregnant! According to her, going to her parents was unthinkable. Rejected and abandoned! She imagined her friends would laugh at her. In short, she didn’t talk to anybody about it. She was fighting her predicament alone. When she was teetering at the edge of her sanity and felt she could take it no longer she decided to have an abortion!

She went to some backstreet quack who thoroughly messed her up. Those backstreet Kenyan “fake doctors” are responsible for many, many deaths of mothers. After their wierd unhygienic operations some of the girls die of excessive bleeding, others die of infection. Some of those who survive get secondary infertility. They are not able to get babies later in life.

A few days after the backstreet quackery, our patient started feeling weak and developed a fever. She went to seek help at the local pharmacy. To the untrained “doctor” behind the counter, fever and weakness meant only one thing, malaria. Of course he had no idea how to arrive at the correct diagnosis. So he put her on first line treatment for malaria. It didn’t help. A day or two later he changed the treatment to second line anti-malarials. It didn’t work either. Another day or two later he referred her to hospital for what he imagined would be third line treatment for malaria. Unknown to the pharmacist, if indeed he was a pharmacist, the poor girl had developed complications of an abortion done elsewhere, and now had a terrible infection! She had what we call septic abortion!

Kenyatta National Hospital used to have a doctor on duty every day dedicated to cleaning up women, some very young, who had been messed up by quacks. As a society we blame these women for taking the option of abortion without even bothering to understand where they are comimg from. Some are at the blink of suicide by the time abortion looks like an easy way out. Most of them, indeed, a vast majority, have no access to psychological and emotional support. Some are cast away from home by harsh parents. Church goers are labelled “sinners” by their fellow believers. The “virtuous church ladies” chant “shetani ashindwe!” (“devil, be defeated”). If only these girls had access to professional and spiritual care! There would definitely be much fewer abortions taking place, not to mention, fewer pregnancies.

Times are changing. Pregnancies in unwed mothers are getting more and more accepted. Time is giving us freedom of choice with one hand, but snatching away our morals with the other. Moral decay has eaten into society, it has become the norm. Yeah, yeah, I can hear those voices agitating for freedom of choice. “My life, my choice!” “My uterus, my choice!” You don’t have to shout so loud, I hear you, but my point is made.

Quacks are having a field day, call it bumper harvest

Our girl received appropriate antibiotic treatment and recovered fully.

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