Drunk and You must Drive? Please use a Condom

I received a call from the village that my uncle was unwell. His legs were swollen, his eyes were watery and he seemed irresponsive. Malia, my younger sister who was visiting the village at that time was concerned with the medical reading of the creatinine and urea. By virtue of her medical training, she immediately ordered for urgent medical attention of James Royao. As we received the results, it was clear that Royao was suffering from Kidney Failure and needed immedite dialysis. In less than 12 hours, he was already in Nairobi’s Langata Hospital where several laboratory tests were done. I was among the first to arrive at the hospital where I had a lengthy discussion with the doctors. I wanted to understand the cause of the kidney failure. The doctors took me through a lenghty medical explanation. I was bored.

‘Doc, can you please summarise?’ I intejected midway. He pulled a paper, gazed at it and looked me. ‘Your uncle is immuno suppressed at the moment. We have done all the test. His liver is enlarged and his kidneys are not functioning to the desired capacity. He needs urgent dialysis. nd by the way has your uncle told you or informed immediate family members of his status?’ he posed.

Status! I bit my lower lip and grinned. There is only one thing that comes into my mind when anyone mentions the word 'status' with the words ‘know your’ – HIV/AIDS! Its not a state of affairs or union speech.

‘Doc, you mean HIV/AIDs status?’, I further inquired as the doctor nodded. Having worked previously with INGO that works with HIV/AIDS people in Kenya and Malawi, I was quick to maintain my coolness, smiled and shrugged my sholdiers in acceptance. I didnt anyone to know i was in shock. I have witnssed a lot of this since the i graduated as a HIV/Aids peer educator.

‘Huh, no doctor. Perhaps the daughter might be knowing. But would you mind telling me? Do you mean he has AIDS?’ Directly looking at the doctor’s eyes. James' dughter was working in the same medical facility.

‘If he hasn’t told anyone, then it is in our purview to maintain patient confidentiality’, he said. I protested and became more assertive. I explained to him that I am the one to cover for his medical bills and so I have the right to know what was going on. I pressed hard until the doctor agreed. ‘Yes. Elijah, when I said immuno suppression, it means your uncle’s status is critical. He has been having HIV/Aids for a long time. Infact he has been on ARVs for last 7 years as he told us on admission’.

I was dumbstruck. Seven years! No, it might be more! I gazed and walked out of the doctors room and headed straight to the ward where James lay on a slightly raised bed, drips on both sides of his hands, and snoring intermittently loud. Holding my son’s hands, we looked at James and made a short quick prayer and left the hospital. I informed the rest of my brothers, sister and James’ children that we will gather in the hospital the following day in the morning to discuss the way forward.

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Nairobi’s traffic to Langata was heavy despite the fact that it was a Sartuday. I arrived at the hospital at 10 am and had a brief discussion with the doctor on duty, a lady. I ashed her one question that I felt was important ‘do you think my uncle will make it?’ She took me to her office, closed the door behind.

‘To be honest Elijah, where it has reached, its just a matter of time! Your uncle stopped using ARVs and hypertensive drugs. We also suspect he got HIV not less than 7 years ago. But more. These exeggerated his condition. His kidneys are totally gone. But he needs to be dialysed and then we see what will happen but its not a guarantee’. She said.

My son and I hovered around the nearby market as we waited for the rest of family members to arrive. The last person to arrive was my elder brother Nahjo accompnied by his ever prayerful wife Nentonee. With Nentonee and Malia present, i was confident that they will handle any stress moment that may arise if anyone is in shokc and needs words of comfort. They are both strong Christiains.

We were now full house. To my left were my Boj and Najoh and to the left were my cousin’s, James children and my younger sister. The mood was tense, eyes were dry and silense ensued for sometime.

‘Okay, now the facts have been laid down. Uncle has been suffering from HIV/Aids for a long time. Did anyone of you knew this before?’ I poised, looking at everyone in turns espcially immediate family members. They shook their heads in utter shock. I regretted breaking it directly into their hears and eyes. No one knew including the immediate children.

‘So therefore, it has reached a critical condition and we must make a decision. To transfer him for dialysis or transport him home’.

We chatted through various possibilities and alternatives. It was clear. We needed to act with speed. Calls wer made to KNH, Coptic Hopsital, and MP Shah. Its when we learned that dialysis is an expensive phenomena.

The doctors were ready for the transfer. They provided an ambulance. But one issue remained thorny. As usually, the money factor! We were not ready financially. His condition was worsening and we were afraid. St Francis Hospital admitted him willingly and put him on medication before scheduled dialysis. I received a call on the date of dialysis and was informed that James had another issue – Hepatitis C which a very rare condition and the only hospital that can provide the machine for Hepatitis C is Nairobi West Hospital. We made a very quick arrangement for dialysis to be done at Nairobi West while St Francis takes charge of nursing.

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In was in the hospital veryy erlier the folowing day in readiness to accompany James for dialysis. As we wheeled him through the corridors down three floors, james held my hand and violently wanted to raise up. I assured him that all will be well. The ambulance ws waiting for us at the near entrance. The transfer nurse and myself occupied the behind seats, James lay on the stretcher. Still holding my hand tight 'Elly, its finished. Its finished, Its finished!' I continued assuring him that everything will be fine.

The ambulance pulled off at the emergency section of Nairobi West Hospital. I felt dizzy as i stepped out. My sugar levels had dropped drastically. I lost a little concentration of what was going on after that. Raamo, James daughter brought a fanta and pan cake which i swallowed quickly. After few minutes i was okay and joined the rest of the team.

James convulsed during he first dialysis. Relatives were hovering round and about the hosptial corridors. He was unrecgnisaby asleep with the pipes in and out. Scarly. A specialis doctro of Indian origin pulled me aside to explain the intricalities of the process.

‘Your uncle is seriously sick. You see he convulsed twice during the dialysis. His kidney are gone. The rest of his internal organs are also affected’, he said looking direclty at me.

‘Ok doc. Do you think he will make it?’ I asked the most obvious question with the most expected answer. ‘Chances are zero, I have treated many cases of such natureand this one is zero’. The doctor of the Indian was more blunt and straight. H etook me through what dialysis is and James' case was a little complicated.

James was returned back to St Francis and put on under the intensive care unit for one week. He never improved. Every day’s visit to St Francis was horendus and heart wrenching phenomena. I lost hope every evening I left the hospital. When his conditioned worsened, they put him a life support machine. It was time for us to make a decision – leave it or switch it off.

After four days of discussing our next course of action, majority felt that it was necessary for the machine to be switched off - but real no one was ready to sign the paperwork! It was scarly. The doctors also refused pointing out to us their mission was to save life until God decides! They convinced us that James had recorded significant progress and that he can go for the second dialysis. That day I spent a lot of time in the hospital trying to understand what was going on. I almost became part of the medical team at the ICU – for everytime I was checking the progress. I left the hospital in high spirits. Later in the night I received a call informing that they have movedd him to the normal ward.

The following day, I delayed. I was exhausted. I arrived at the hopsital a little late. I found James in the normal ward – his body was pale, swollen and dark. He was breathing slowly, heavily and loud. On the table were small packets of unopened milk numbering between 5 to 7. Clearly he hadnt fed on anything. 

‘Do you think my uncle will be able to pull through the night?’ I asked the duty Doctor. ‘Oh yes. He has improved and that is why we brought him here from ICU’ the doctor responded. ‘Thank you doctor. This is impressive. But do you think he will pull through? I am seeing that his body is a little swollen and dark’.

‘Don’t worry. That is the effect of medicine. He will return to normal’, the doctor affirmed.

I stood by the reception as we discussed the next steps for the dialysis which was to be done the following day. The nurse was keenly following our conversation. We agreed that I arrive at the hospital by 7 am to have him transported to Nairobi West which was approximately 30 kilometer away in South C.

As I was stepping out, I turned to the doctor ‘Doctor, thank you. Thank you very much. I think you are bored with me’. The doctor laughed. ‘Do you think he will actually make it?’. The doctor got surprised. This was the third time I am asking him the same question. Before he could respond,I quickly dashed back to the ward to pray for James before I finally go home. I held his hand – it was cold. I prayed with tears rolling down my cheek, asking for quick recovery.

James passed on the following morning at 4am on the very bed I had left him. May his spirit continue to rest in peace. The total hospital bill was a shocker to the family. Kes 975,000! I thought he would have been alife to tell us a story of how he got infected. It could have been a lesson to others. But a chat with the local medical staff revealed that a great number of rural folks are infected.

In 2015, the Gardener Africa Foundation held a medical camp in Kisii. Out of 2700 people screened in one centre, 117 were infected and discovered that for the very first time in their life. This was accmpanied by adult malnutrition which triggered other infectious ailments.

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In Kenya, approximately more than 1.6 million people are living with HIV with new infections estimated between 53,000 to 60,000. Nairobi County alone posts more than 146,000 adults with HIV/Aids with 3,200 new cases annully. Resoruce limitations, infrastruture. The biggest challenge to making Nairobi a HIV free city, as highlighted by Governor Mike Sonko in his recent speech at Elton Foundation conference held in London, is lack of resources. The national government has been relying on donor funding especially from Pepfar to supplement provision of drugs and medicines in the control and treatment of HIV/Aids. With 75% of affected adults and 82% children being on antiretroviral treatment, it can only be projected that more resoures are needed to contain the menace.

With new discoveries and aggressive campaign to make cities free of HIV/Aids, the only big question that remain and yet to be answered is why do we still have increased new cases of HIV/Aids? According to UNAID’s gap report, ‘ HIV prevalence is estimated to be 28 times higher among people who inject drugs, 12 times higher among sex workers, 19 times higher among gay men and other men who have sex with men and up to 49 times higher among transgender women than among the rest of the adult population’. The report also segment new infections to type and form of sexual orientations. Heterosexual sex forms the largest contribution of new infections with 44.1% while casual heterosexual Sex (20.3%), MSM and Prison (15.2%) and Sex Workers and Clients (14.1%).

Statistics further show more single women are infected perhaps by virtue of their lifestyles and openness to seek medical attention. Sex without a condom with an infected person is the greatest contributor to the menace. And though some infected individuals know their status, they have not come out in the open to declare their status. They hide it from their sexual partners and family members and further delay in seeking medical help and counselling.

Deliberate transmission of HIV or nay life threatening sexually transmitted disease, under Section 26 of the Sexual Offences Act is an offence which attracts not less than 15 years or life imprisonment. The offence is hinged on the offender having actual knowledge that s/he is infected with HIV or any other life threatening sexually transmitted disease and then goes ahead to intentionally, knowingly and will fully do anything or permitting to be done anything which s/he knows or ought to reasonably know: (a)will infect another person with HIV or any other life threatening sexually transmitted disease; or (b) is likely to lead to another person being infected with HIV or any other life threatening sexually transmitted disease; or (c) will infect another person with any other sexually transmitted disease.

As the old adage goes: if you are drunk and you must drive, then, please use a condom!