The sun will rise and we will try again

Mbita Island

We all have those bleak days.

Once in a while you wake up and no, the planets are not aligned on that particular day. Nothings rests well with you. After opening your eyes, contemplating getting out of bed becomes an internal battle and that’s when the questions begin.

Why am I here?

What am I doing?

I’m I happy?

Is this what I want to do for the rest of my life?

Do these routines ever end?

Days are hard but I keep going, why?

Is it because of the money? No, money isn’t and shouldn’t be reason enough because what happens when it’s no longer coming in?

Where do I derive my satisfaction from?

What if I acquired the money that I’m striving for, would I still do what I do with similar zeal?

Is this it? Is this what life was meant to be for me? To wake up, go to work, come back exhausted, spend long nights on work that I’ll die and leave, eat, sleep and the cycle continues?

These are the places we are taught to and teach ourselves to evade for they will lead you down a dark, endless hole from which only self destruction sprouts.

At the end of the day methinks, serving and the giving of ourselves to others is what gives life meaning and a purpose otherwise you become a zombie hoping to stumble onto something that will lessen the emptiness, the unfulfilled desires and the unachieved expectations.

One of our lecturers, Professor Ojwang’ once told us during his introductory lecture that:

Most of all, the essence of life is making and leaving an impact in society so that when you are gone, with all the academic knowledge you acquired in your lifetime, your contribution to the community will remain even as you lay 6 feet under. Build that school you think your community needs, start a dispensary… you have a role to play in community and the impact you make is what makes life worthwhile as you live and even after you are dead.

And this has stayed with me ever since.

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DEATH IS PAIN

This is a dedication to Nathan, a friend and a colleague.

The sun will rise and we will try again.

Life is suffering.

Death is pain.

After a lot of deliberate deliberation, I settled on pain because sad does not quite describe. To say that death makes one sad would be an understatement because death makes you query your own existence and what’s worse than that for a species born to die? For a species driven by the fear of death? For a species that coined the phrase YOLO. You know why that is? Because who does not get goosebumps thinking of death? We walk on this earth for years and we appreciate the gift of life less each day. Funerals bring reality closer to home. They make you question the essence of your own existence. They make you ask yourself, why them and not me? What’s my purpose on this earth? How do I want to be remembered? I’m I ready to die? And the answer to that is a resounding NO! When reality sets in, you realize that you’re not ready to return to the dust you came from. You realize the many things you’ve been putting off on your bucket list and vow to live a more fulfilled, happy life. Historically speaking, we’re a forgetful species which is why we often have tragic events recurring albeit we could’ve put measures in place to evade this. These are fleeting thoughts. We mourn for the dead today, go to sleep and wake up unbothered. I pray you choose a different path. Choose to remember. Choose to live and not to survive because after you’re gone, after we throw the last soil onto your grave, will you live forever in our hearts and minds or return to dust and are gone forever? Forgotten?

It might sound like a cliché but I will say it anyway, no one deserves to die. I say this with a lot of heaviness in my heart as my mind is blunted from the exhaustion of reality. Death is a thief. Death harvests where and when we least expect and it snatches from us what we’re not ready to give up. It takes from us and leaves us scratching our heads and having vicious why thoughts that are unending. We lose ourselves in the process of questioning why this had to happen to us. Why now, why so soon. Why. Why. Why. This is a question we most often than not do not get an answer to and there is no worse turmoil to be in than this. To feel like life chose to cheat you. That life is like that lover you fell deeply in love with, the lover who is difficult sometimes but reasonable but then decided to wake up the morning before your wedding and leave you. The lover who leaves without leaving a note hinting to what might have made them leave. A lover who leaves you spending a lifetime seeking closure. Spending a lifetime lost in a series of why thought. Life is like a selfish lover. It gives and takes without warning reminding you how much your lungs like the taste of air.

When they tell you that people are replaceable, do not listen to them for people are irreplaceable. The void that the loss of a loved one leaves cannot be filled by anything or anyone else. The pain caused by their death is indescribable. During mourning you must have seen the mourners grab their clothes and tear them off, roll on the ground wailing, place their arms on their head and wail or sometimes move their hands all over the place because they do not know where to place them. That is pain. It demands to be felt and the loss of a loved one causes pain that one does not know how to let out. You feel like you want to pull your heart out of your chest. You feel like the tears will never stop flowing. You feel lost. You feel cheated and you feel empty and that’s the worse of it all. As much as pain demands to be felt, it numbs you. It’s so painful that at some point you do not know what you’re feeling anymore, how you’re supposed to feel. When friends and family hug you and tell you it’s going to be okay, you disagree with them in your head because no, it’s not okay and no, it might never be okay but man cannot live in fear. Man has to thrive on hope. Without hope, we are lost. You wonder how anyone expects you to cope. How you yourself are going to cope because that’s the thing with loss, it has to happen to you for you to experience it. The confusion. The pain. The emptiness. They all become a reality when you go through them. When you’re no longer walking a mile in someone else’s shoe but in your own. It’s your shoe. You’re walking in it and society is there watching you. Praying you don’t stumble. Praying you don’t trip and fall but instead hold your chin high, do not let those tears fall and face your fears.

Death is pain.

To say I have attended a number of funerals in my life would be to lie. I have attended less than 2 and the second one changed me, my perspective of life.

I sat there helplessly watching them. The family sat in one tent, the clergy in another and the rest of us in the other tents. The coffin that was brown and gold plated stood in the middle as if commanding the attention of the audience. As if demanding to be seen whether you wanted to or not. It was open for viewing and he sat there. His back facing our tent along with his two brothers. I decided to fit his shoe and my heart broke for him. I cried with him and I hated that I was helpless about his pain, their pain. No matter how hard you try to fit one’s shoe, you never will quite imagine the end of it because it is not your cross to carry. In that moment, it is theirs which is why, perhaps, God decided to bless us with the gift of empathy. In that, I can share in your pain, when your tears flow, mine flow too and in your laughter, I find my happiness as you do yours. My eyes kept tearing up and friends, relatives and family said a word or two about the now deceased phenomenal man that once walked this earth. That once laughed till he cried, smiled, fought his fights on this earth. At that moment, I felt like my ribcage was no longer well equipped to keep my heart safe. I wanted to explode. I wanted to let it all out. That’s what pain does to you. You feel it in the whole essence of your existence till you cannot take it anymore. That’s when the only thing you want to do is to make it stop. This explains why when grief is not well dealt with, results in development of maladaptive behaviors. For instance, some people opt to excessively consume alcohol to ‘numb’ their pain, some smoke, some become cutters, some choose to end it all! In that moment, death in itself, becomes an option to them. For the ones whose body and mind cannot take the pain, the frustration, the confusion, the loss, their mind gives way. They lose their mind. Literally. Our mind is wired to protect us from that which harms us that’s why it can bury the bad memories so deep in our subconscious that we forget they happened. It’s how it works. When that fails, even the mind gives way for pain. Like I said, pain demands to be felt and when that fails, pain has to find a way out of you. Havoc is what’s left in its path. Pain is a destroyer of man. It brings even the strongest of them all to their knees. What’s more interesting is it has a thing for the worst timing ever.

They spoke about him. Affectionately, respectfully and most of all in the saddest tone of voices you’ve ever heard. From the pamphlet you could see the man full of life, tall and commanding. He looked like the man who, after he entered a room, everyone turned around to stare as he would tower over all others. He was described as a man of integrity by all his colleagues and how he would put his foot down on matters never to be swayed by anything or anyone. A man of integrity. What a rare thing that has become in our world! Clearly, necessity has become the mother of deception. I listened and as I did, I imagined having met this man who now lay there lifeless as if he had never moved an inch in his life. It broke my heart and I wanted to pull my short hair, hard, just to hope that this would be all a bad dream. I was in turmoil. I had never come so close to death before that it disoriented me. I had never felt these emotions before. I did not even know I had them before that day. What could he be feeling if I felt this lost and confused myself? To lose someone who was once your pillar, your role model, provider, protector is no easy thing. To deal and cope with it is more difficult because you cannot quite get used to loss. No one can ever be everything that that person was in your life. They might try but aren’t we all limited editions? One person made the statement that the deceased was such a strong, phenomenal man and he cannot fathom how he could come down with something so fast and within a few hours, cease to exist. He could not wrap his head around it. Now, tell me, how can a person, larger than life, be snatched from his loved ones in a matter of hours? How can someone be and the be no more? How fickle is our alive status? Is there something that we were meant to do and once it’s done death claims us? Why is it that people deteriorate faster than they have been blooming? Why is our life similar to the life cycle of flowers? In my mother tongue which is ekegusii, there’s a sad, moving song that goes like;

Obogima negesicha gwekwaroroka mambia 🎶

Life is a flower that withers in the morning

We are born.

We walk.

We live.

We grow old.

We wither and die.

Why is it then we’re born? What are we born for? Our sunset years are not guaranteed which methinks is what the person who said live fast, die young partly had in mind. Albeit, that’s a story for another day.

When they coined the phrase YOLO, they probably must have had a near death experience that left their arteries pumping with adrenaline and their hearts racing faster than ever before that they decided that this life is something you’re guaranteed to have forever. This body is just a vessel to enable you experience our physical world. That without it, you’re wiped off the face of the earth. Without it, you cease to exist. That you could be healthy and bouncing this moment and the next you’re in the hospital in a coma because of a head injury because the matatu driver swerved to avoid hitting the motorbike rider and his passenger. Because you made that right turn sooner than you should have and suddenly you’re lying there-a vegetable. You cannot open your own eyes, talk, move your own limbs, clean up after yourself after you visit the toilet or hug your loved ones. I’ve always wondered, what goes on in such a person’s mind? Do they perhaps go to another plane of existence and exist there as their physical body heals and one that none of them ever recalls? One thing I know for sure is, a minute can change a lifetime. Like the minute that the last drop of soil is thrown on the graveyard.It’s in the most vulnerable moments that we discover parts of ourselves we did not know existed. Perhaps it’s how strong we can be when it’s the only we have or how terrible we are at handling trying moments or how much we love our family to death. It’s a time of discovery. Grief evokes emotions in us that run as deep as the ocean. It makes us take a step back and see everything in a new light. It makes us want to love more, forgive more, call our loved ones more, text them to check up on them and to make peace with the fact that we only have one life to live and that we wouldn’t want our day to come and find ourselves filled with remorse about the things we could have done but didn’t do, the things we should have done but didn’t do, the opportunities we didn’t take and the people we took for granted. It makes you reflect which is why I believe that it is possible to be lost in your own mind. Your mind can wander within itself.

I stood there again, helplessly, watching his face fall, his eyes heavy with tears but because the African society has painted the man, an emotionless being, he couldn’t let them out while the rest of the family wept in anguish. In that moment I became angry. Angry at us. Angry at society. Why do we do this to our men and still wonder why women live longer than men? We are all human and different in our anatomy shouldn’t be used to oppress us. Men should be allowed to express their emotions. Wait, who do they need permission from? Exactly! My eyes kept filling up and I couldn’t cry because well, I’d cry a river and I was supposed to be the shoulder to lean and cry on. We all had to be and stay strong for him for he needed us. They gently lowered the large coffin into the ground. I could not believe this was happening. I could not believe my eyes. I could not believe that this is what death does to someone. I could not believe that this once feared, respected, loved and towering man was being buried. That he was going back to the soil that we came from. No, it was not happening. But yes, it was happening right before me. Reality set in when the throw the first batch of soil. In that moment, I wanted to scream. I imagined that if they waited a little longer, I don’t know, a miracle could happen. That if they gave my friend more time to see his father, it would alleviate his pain. His face spoke emotions I’m not sure that even as a writer, I’d be able to put down. It is hard to witness a burial. It is harder to witness the burial of someone close to you. Someone that you once hugged, that you once ate together and laughed, someone that you called in times of trouble, someone that you grew up knowing is invincible. It is hard. I wished that movies were a reality in that moment then maybe, just maybe, I’d have cast a magic spell that would have taken all his pain away. If this was affecting me this much and I never met this man, what was it doing to his own family? I did not want to start thinking deeply about it because I was at the verge of breaking down. My heart broke for him. My heart broke for all of them. It’s in such moments that even the slightest of touch, if done well and with well meaning, can make a tangible difference. A hug, a squeeze of the hand, a rub on the back. We’re social beings. We thrive on connection and to know that you’re with me in the most difficult of moments makes a lifetime difference in me. It creates a ripple effect so I want to believe that us being there, made a difference. That by looking up and seeing familiar faces, it brought a little bit of comfort and hope that even at the speed of a kidney stone, it will pass.

It’s in the most vulnerable moments that we discover parts of ourselves we did not know existed. Perhaps it’s how strong we can be when it’s the only we have or how terrible we are at handling trying moments or how much we love our family to death. It’s a time of discovery. Grief evokes emotions in us that run as deep as the ocean. It makes us take a step back and see everything in a new light. It makes us want to love more, forgive more, call our loved ones more, text them to check up on them and to make peace with the fact that we only have one life to live and that we wouldn’t want our day to come and find ourselves filled with remorse about the things we could have done but didn’t do, the things we should have done but didn’t do, the opportunities we didn’t take and the people we took for granted. It makes you reflect which is why I believe that it is possible to be lost in your own mind. Your mind can wander within itself.

How do you cope with loss? How do you grieve till you can speak about that person and not break down? Methinks this can be possible overtime by trying and focus on the good the person did, to celebrate them, to remind yourself that in as much as life cheated you, in as much it left you without closure, that person will always be with you at heart. Like one person said that do not be saddened for we now have one more angel in heaven who will forever watch over you. And I found that comforting because yes, perspective can make all the difference! This is not to mean that I’m belittling loss. No. Like I said, all I wanted do was take all that pain away. To see the light in their eyes that once existed before it flickered in the face of loss and drained away. But there’s only so much man can do and where man cannot go further, God can go miles further. God can and will hold your hand, no, he will carry you as you find your footing. Do you know of the story of footprints in the sand? No? I got you.

~FOOTPRINTS~

One night a man had a dream. He dreamed he was walking along the beach with God. Across the sky flashed scenes from his life. For each scene, he noticed two sets of footprints in the sand. One belonged to him and the other to God. When the last scene of his life flashed before him. He looked back at the footprints in the sand. He noticed that many times along the path of his life there was only one set of footprints. He also noticed that it happened at the very lowest and saddest times in his life. This really bothered him and he questioned God about it, “You said that once I decided to Follow you, you’d walk with me all the way. But I have noticed that during the most troublesome times in my life, there is only one set of footprints. I don’t understand why when I needed you most you would leave me alone.” God replied, “My precious, precious man, I love you and I would never leave you. During your times of trial and suffering, when you see only one set of footprints, it was then that I carried you.”



Moral of this story: You’re never ever alone, especially during your most trying times. God is always with you. Even if you cant be your own best friend as yet, make sure to acknowledge the fact that God is your best friend always!

And by the way, this story was originally written by a Mary Stevenson in 1936 when she was just a little girl. Amazing how the right stories just find its way into our lives if we let them !

So yes, God will carry you.

Take heart.

What did my body do to you?

I remember growing up having an enormous appetite that my parents used to commend and me being a mommy’s and daddy’s girl, eat I did. After class 8 I had this, should I call it cute? No, I won’t brand it anything as that never crossed my mind. I had this belly and I recall vividly that after meals I’d be so full that the only thing I did afterwards was sleep. I’ve always been useless after meals, especially supper. This perhaps explains why I stopped taking a heavy supper since I have to stay up and function as an adult. So many things to be done.

I had this cute long sleeved white, warm, night dress that had cute little pink flowers all over it and whenever I would wear it to bed, my tummy would stretch it out and no, it never even crossed my mind one bit. Imagine my shock when I grew up(after high school) and started hearing phrases like:

no, tuck you tummy in honey.

With that tummy you shouldn’t buy a body con dress.

Oh no, I’m planning to start hitting the gym, nimenona aki! (I’ve grown fat). Says the lean bodied lady.

Where did we lose it? Is it the magazines? Social media?

The thing with cameras is you can always position them at a certain angle to bring out your best features. So you tuck that tummy in a little, you pop the butt backwards, smile and voilâ, your end product is a goddess (which you already are without all the posing by the way). When you scroll your social media and see your friends all poised and sharp, you start hating on yourself.

Why do my things rub against each other? I want a thigh gap like her.

Why do I have to sweat so much after walking a short distance? She doesn’t.

She’s doing well. I’m not.

Stop. Stop. Stop.

Stop comparing yourself with others. We all grow at different paces and no, there’s no perfect women. By virtue that you’re female, you have the estrogen hormone in your body that is responsible for your feminine features. Trevor Noah, in one of his stand-up comedies said that black is about size and shape. That with a black woman, you can gently slap the right butt cheek and wait for the wave to hit your hand on the left butt cheek hehe. So why are you trying so hard to strip yourself of what makes you you? Your femininity. It’s your biggest strength. Joan Thatiah in her book, Things I will tell my daughter, elucidates that we live in a society where everyone else, who has no experience whatsoever in being a woman, takes it upon themselves to tell you how you should live your life.

Be yourself. No, not like that.

You shouldn’t speak like that, ladies don’t do that.

You should smile more often, it’s unladylike to frown a lot.

I say, tell them to buy a journal and write their opinions in it!

Be you. The world will adjust.

Love your body. If you want to be better a version of yourself, hit that gym, start the morning runs but do not do it because someone body shamed you.

About colon cancer

In kenya, cancer ranks 3rd as a cause of death after infectious diseases and cardiovascular disease. It causes 7% of the total national mortality each year.

This gives our health care system a mouthful as we have to deal with both communicable and non communicable diseases (double burden of disease). With cancer being the leading cause of death worldwide,accounting for approximately 7.6 million deaths annually, it is only necessary to start dealing with the cancer menace sooner other than later. This is in light of the fact that the cancer mortality rate is predicted to continue to rise with an estimate of 13.1 million people worldwide affected in 2030.

Colon cancer is one of the most common cancers in the world. In kenya, it constitutes 40-50 % of all cancers of the large intestine with the mean age of diagnosis being about 50 years. It is highly curable, particularly if caught early and when localized within the intestine. With time, like most cancers it spreads and hence makes cure more difficult.

Risk factors would include a personal history of colon or any other cancer, Tobacco use, irritable bowel disease, family history of ovarian, endometrial or breast cancer among others.

Early diagnosis and treatment is possible. This is achieved by screening the at risk patients. The screening test is inexpensive and infrequent, to be done after every 3 years. This is the fecal occult blood test (FOBT ) . It is the proper screening test for the at risk population. It is basic stool test that checks for blood that is invisible to the naked eye but can be seen on microscopy. If the stool test is positive then further tests will be recommended and advisable.

The early features of colon cancer are quite nonspecific. They include discomfort, weight loss, changes in bowel habits and tiredness. This can indicate any other gastrointestinal disorder and are not indicative for colon cancer. However the need to seek medical advise cannot be overlooked and a high index of suspicion is required on the side of health professionals for an early diagnosis to be achieved.

Reference; NATIONAL GUIDELINES FOR CANCER MANAGEMENT KENYA.

By Julian Wanjira Wachira

TUMORS OF THE LARGE INTESTINE

Benign

Polyp – a clinical description of any elevated tumor.

Polyps can occur:

  • Singly
  • Synchronously in small numbers or
  • As part of a polyposis syndrome

In familial adenomatous polyposis (FAP), >100 adenomas are present.

Adenomatous polyps

Classification of polyps of the large intestine

Adenomatous polyps vary from tubular adenoma rather like raspberry on a stalk, to the villous adenoma, a flat spreading lesion.

Solitary adenomas are usually found during the investigation of colonic bleeding or sometimes fortuitously.
Villous tumors more usually give symptoms of

  • Diarrhoea
  • Mucus discharge
  • Occasionally hypokalaemia

Risk of malignancy developing in an adenoma increases with increasing size of tumor.

Adenomas larger than 5mm in diameter are usually treated because of their malignant potential. Colonoscopy snare polypectomy click here or diathermy obliteration with hot biopsy forceps click here can be used.

Huge villous adenomas of the rectum can be difficult to remove even with techniques per anus, and occasionally protectomy click here is required ; the anal sphincter can be preserved.

Proctectomy is a surgery to remove all or part of the rectum.

Familial adenomatous polyposis

Clinically defined as presence of >100 colorectal adenomas.

Over 80% of cases come from patients with a positive family history.

20% arise as a result of new mutations in the adenomatous polyposis coli gene (APC).

It is less common that hereditary non-polyposis colorectal cancer (HNPCC) and accounts for <1% of colorectal cancer (CRC).

Although the large bowel is mainly affected, polyps can occur in the stomach, duodenum and small intestine.

It’s inherited and mendelian dominant conditions.

Risk of CRC is 100% in patients with FAP.

Males and females are equally affected.

It can also occur sporadically without any previous sign or history, presumably by new mutations. There’s often, in these cases, a history of large bowel cancer occurring in young adulthood or middle age, suggesting preexisting adenomatosis.

FAP can be associated with benign mesodermal tumors such as desmoid tumors and osteomas. Epidermoid cysts can also occur (Gardner’s syndrome) ; desmoid tumors in the abdomen invade locally to involved the intestinal mesentery and, although non-metastasising, they can become unresectable.

Up to 50 per cent of patients with FAP have congenital hypertrophy of the retinal pigment epithelium (CHRPE), which can be used to screen affected families if genetic testing is unavailable.

Clinical features

Polyps are usually visible on sigmoidoscopy by the age of 15 years and will almost always be visible by the age of 30 years.

Carcinoma of the large bowel occurs 10–20 years after the onset of the polyposis.

One or more cancers will already be present in two-thirds of those patients presenting with symptoms at the time of diagnosis

Symptomatic patients

Are either patients in whom a new mutation has occurred or those from an affected family who have not been screened.

They may have

  • Loose stools
  • Lower abdominal pain
  • Weight loss
  • Diarrhoea
  • Passage of blood and mucus

Colonoscopy is performed with biopsies to establish the number and histological type of polyps.

If over 100 adenomas are present, the diagnosis can be made confidently.

If there are no adenomas by the age of 30 years, FAP is unlikely. If the diagnosis is made during adolescence, operation is usually deferred to the age of 17 or 18 years unless symptoms develop.

Screening policy

  • At-risk family members are offered genetic testing in their early teens.
  • At-risk members of the family should be examined at the age of 10–12 years, repeated every year.
  • Most of those who are going to get polyps will have them at 20 years, and these require operation.
  • If there are no polyps at 20 years, continue with yearly examination until age 50 years; if there are still no polyps, there is probably no inherited gene.

Carcinomatous change may exceptionally occur before the age of 20 years. Examination of blood relatives, including cousins, nephews and nieces, is essential, and a family tree should be constructed and a register of affected families maintained.

Treatment

The aim of surgery is to prevent the development of colorectal cancer. The surgical options are:

  • colectomy with ileorectal anastomosis (IRA);
  • restorative proctocolectomy (RPC) with an ileal pouch-anal anastomosis, the anastomosis may be defunctioned with a loop ileostomy;
  • total proctectomy and end ileostomy (normally reserved for patients with a low rectal cancer).

The patient is almost always young and likely to prefer to avoid a permanent stoma and so the choice is normally between the rst two options.

The advantage of an IRA is that

  • it avoids the temporary stoma frequently required for an RPC
  • avoids the potential compromise to sexual function that accompanies proctectomy.
  • has a lower morbidity and mortality.

However, the rectum is left and requires regular surveillance, as there is a risk of adenomas and carcinomas in the residual large bowel. Even with optimal surveillance of the rectal remnant, up to 10 per cent will develop invasive malignancy within a 30-year follow-up period.

Restorative proctocolectomy has the advantage of removing the whole colon and rectum (although a small cuff of rectal mucosa may be left behind with a stapled anastomosis). However, there is a pouch failure rate of about 10 per cent. In addition, and particularly where a stapled anastomosis has been created, there remains a very small but denite incidence of cancer developing in the small strip of rectal mucosa between the pouch and the dentate line. This is why some colorectal surgeons advocate complete mucosectomy of the residual rectal cuff and a transanal pouch anal anastomosis, although it is acknowledged that this results in worse function.

Postoperative surveillance

  • rectal/pouch surveillance, with biopsy of the pouch-anal anastomosis.
  • Gastroscopies are also carried out to detect upper gastrointestinal tumours.

Even with prevention of colorectal cancer, FAP patients have reduced life span due to the development of duodenal and ampullary cancers and the complications of desmoid tumours.

Hereditary non-polyposis colorectal cancer (Lynch syndrome)

characterised by increased risk of colorectal cancer and also cancers of the endometrium, ovary, stomach and small intestines.

It is an autosomal dominant condition that is caused by a mutation in one of the DNA mismatch repair genes. The most commonly affected genes are MLH1 and MSH2.

The lifetime risk of developing colorectal cancer in Lynch syndrome is 80 per cent, and the mean age of diagnosis is 45 years.

Most cancers develop in the proximal colon.

Females with HNPCC have a 30–50 per cent lifetime risk of developing endometrial cancer.

Diagnosis

Tumours of the large intestine 1163 HNPCC can be diagnosed by genetic testing or the Amsterdam II criteria:

  • three or more family members with an HNPCC-related cancer (colorectal, endometrial, small bowel, ureter, renal pelvis), one of whom is a rst-degree relative of the other two;
  • two successive affected generations;
  • at least one colorectal cancer diagnosed before the age of 50 years;
  • FAP excluded;
  • tumours veried by pathological examination.

Patients with HNPCC are subjected to regular (every one to two years) colonoscopic surveillance.

Why are we here?

The first lecture of clinical chemistry, our lecturer, Professor Ojwang’ gave us titbits of advice which I’ve held dear to date. Amongst them he talked of the meaning of life. When you ponder, why am I here? What is the meaning of life? What is my purpose on this earth? Since from dust we came and to dust we shall return.

We are driven by fear. Fear of dying. I watched this documentary series called year million and they talk of an age whereby humanity will achieve immortality. We will begin by being able to delete the unwanted genes from our DNA. Is your mother short-tempered? You can eliminate that. Do you want a child who is super smart? Yes, please. You can preprogram their genetic sequence to generate the perfect human being. Which didn’t settle well with me because are we human without imperfections? Then we’ll reach a point whereby telepathy will be made possible to enable engineers and great minds to come up with formidable inventions but what are we without our privacy? Then we’ll be able to upload our minds onto a computer and be able to have a virtual world. This is to avoid death from physical injury such as road traffic accidents. Did I mention we’ll no longer work? Yes, robots will be doing everything for us meaning there will be a generation who’s wonder will be really? You used to work? What is that like? But of course there comes the fear of the robots turning against the human race. I hope you’ve watched Terminator.

Immortality brings about the question, how different would you live your life if death became a thing of the past? The fear of death, I want to believe, is what gives life meaning. We go to school, care about people, go for what we want because we’re afraid of regretting. Thinking about what could have been since we have an expiry date. It’s just a matter of when.

Not to digress, to paraphrase what professor Ojwang’ said, most of all, the essence of life is making and leaving an impact in society so that when you are gone, with all the academic knowledge you acquired in your lifetime, your contribution to the community will remain even as you lay 6 feet under. Build that school you think your community needs, start a dispensary… you have a role to play in community and the impact you make is what makes life worthwhile as you live and even after you are dead.

The impact you make is what makes life worthwhile. Tell me how felt after you last visited that children’s home. When did you last volunteer for something? Can you describe the satisfaction and sense of fulfillment that comes with it? You feel at peace and in line with your purpose when you go out of your way to help others. Both the less fortunate and the able.

This reminds me of a piece my mother shared with me a while back from the daily nation

The founders, Griffin, last words to Starehe boys were, ‘… This world is full of people who do their duty half-heartedly, grudgingly and poorly. Don’t be like them.

Whatever is your duty, do it as fully and perfectly as you possibly can.

And when you have finished your duty, go on to spare some time and talent in service to less fortunate people, not for any reward at all, but because it is the right thing to do.

Follow my advice in this and I promise you that your lives will be happy and successful.

May God bless you all. ‘

Profound. Serving gives life meaning.

The bodaboda man

You will never know lunch time frustration, when you’re hungry, tired, worried about something, until you board a motorbike with an incessantly talking rider.

Ideally, all motorbike riders and passengers ought to wear a helmet meaning no communication can take place. Even in the absence of helmets, the wind blows against the direction of the motorbike meaning sound will be lost in between and hence discouraging talking. But no! Some people’s determination will make you marvel.

I swear this man couldn’t shut up. He went to the extent of literally turning to try and be heard. My heart rate was over the roof the whole of that ride. I almost asked him, do you have a wife? A grandmother at home? A friend to talk to back at home? No? That’s unfortunate because you can talk! I wondered so because I recall one of our lecturers mentioning that while taking a history from patients, especially the elderly, they will tend to go on and on mostly about irrelevant things. They will start telling your about their chicken back at home and you have to politely guide them back to track. They do this because they’re lonely. Yes, they’re lonely. Society has neglected the old.

About a fortnight ago, my cousin broke down while explaining to me how our step grandmother has been neglected by everyone. I mean, we visit her, she visits us but that’s about it. Very few check up calls are made to her and she has to live alone for the rest of her life. She talked about how you could feel the excitement and thrill in her voice everytime she picked the phone. As if she was eagerly waiting for the phone to buzz. It broke my heart honestly and made me start to appreciate the essence of nursing homes. Perhaps it’s about time we embrace this idea and set in motion a plan to cater for the old and to give them a reason to continue living long after their children have moved out and spouses died and no one is around for them anymore save for the occasional visits from their grandchildren.

This is why I did not get offended with the man’s chatter for they say be kind always for you never know what someone is going through.

ACT ON MENSTRUATION WITHOUT HESITATION

This an article I wrote following a training on Menstrual heath Education that I attended in Kampala, Uganda starting 27th April to 1st May, 2015 that, unfortunately, never got published as anticipated.

The future of girls in East Africa remains bleak as many are dropping out of school due to, among others, menstrual related challenges. The society’s stereotypes inculcated in them pertaining menstruation being a curse, makes the girl child believe that their future is bleak the moment they spot blood on their underwear. In Uganda, 61% of girls admit to missing school due to their menstrual period, the numbers continue to soar with each passing moment of our ignorance and the statistics are bound to rocket if we do not act on menstruation without hesitation.

Irise International, a UK charity, organized a training on Menstrual Health Management at Entebbe in Uganda from 27th April to 1st May, 2015. An eye-opener for the Irise ambassadors who were in attendance and a reiteration of what we all know but take obvious. Providing education on menstrual hygiene is paramount. In order to break the silence and rise above the stigma, girls need to be enlightened on the normal physiological process they are bound to undergo; menstruation, because girls matter.

Light needs to be shed on the facts and the myths used by society to put the girl child down. In addition, men need to understand that menstrual hygiene management affects them directly because everyone is a product of a missed period however much they consider women “unclean creatures.” These beautiful, promising young girls should not be bashed, perturbed or miss opportunities because they are menstruating instead, we should empower the girl child to be bold and unshakable on matters concerning her menstruation cycle. Statements such as, “I cannot trust a creature that bleeds for five days and does not die” from our male counterparts are demeaning, disheartening and exposes men’s ignorance on this global phenomenon; menstruation.

The lack of clean water in some areas, sanitation and medical care has negative consequences, especially for the female members. Menstruating girls and women are forced to use mattresses, old cloths, drying them in moist places this, almost always lead to vaginal infections. This is because menstruation is a taboo issue and menstruating girls are flushed to open up about their menstruation.

In addition, there are different ways of relieving painful cramps and getting pregnant is not an effective method. Alternatively, one can take painkillers, exercise, place a warm water bottle on the stomach and incase of severe dysmenorrhea or menorrhagia, a health care should be contacted.

The constant emphasis on our patriarchal society is counterproductive since it takes two to tango. The facilitators of this training spiked my interest the most since they gave up their daily routine and commitments to come and echo how serious menstrual health education is to us and to our sisters, brothers, parents and friends. You can corroborate with me that most people expect a stipend even after offering to volunteer therefore, these facilitators are an inspiration to me and my fellow ambassadors and they should be to you too because if they can, why wouldn’t you?

Last but not least, this training in Entebbe, Kampala taught me many new skills for instance I was able to learn how voluminous effect one’s body language and choice of words has on a conversation. For instance, when trying to convince a chauvinistic, misogynistic set to win politician that women’s anatomy is not something to be used against them. Therefrom, this menstrual hygiene day, break the silence, become a superhero and help to ensure that no girl is ever held back by her period! Act on menstruation without hesitation by supporting friends, teaching others and keeping girls in school. Be your own super hero.

“Maybe I’m tough because I’m a girl.”

If I were born a boy, my father would’ve raised me to be one hell of a macho man.

Growing up I did everything with my dad. When he was changing light bulbs, I was there handing him the bulbs. When he was fixing the doors lock, I was there handing him the screws. When he treated our chicken, I was there to hold their beaks open. When he went out to let loose our fierce dogs, I was there tying up three as he dealt with the other four. When he was slaughtering a chicken, I was there!

I highly doubt there is anything I cannot do by myself. I have done most of the things ever since I left my dad’s shadow by myself. I have moved out and moved in alone. I have fixed my fitness bicycle from only parts to a fully functional, aesthetic piece that I could ride on. I have fixed my bed from pieces, tightened the screws by myself. Oh and its still sturdy. I have fought my way through a lot of things. Growing up, my dad made it a song that only the tough survive. Tough I was made. You have to stand up for yourself. Standing up for myself I did.

The world is a strange, beautiful and dangerous place. Everyone, who has no idea on what it is to be you, will feel like it’s their place to tell you how to live and be and they will breathe down on your neck hard if you let them but I made a decision way before I turned 13 to never let other people to decide who I am. I want to decide that for myself.

I watched a certain series a while back, The Brave, if I’m not wrong and there was a soldier amongst the 6 who was a woman. She was strong, poised and her demeanour a sight for sore eyes. She knew she had to put in work to get to where she was and she never let her femininity stop her. She did not let superiority complex infiltrated men intimidate her either. This one time they were on a mission to save the ambassadors daughter from a heist and a little girl was passing by the gates. She saw the lady, gun hanging off her straight shoulders and stared in awe.

“You’re tough… but you’re a girl,” the little girl stammered in awe
“Maybe I’m tough because I’m a girl.” She replied with a smile and straight shoulders, her sophisticated gun dangling off them.

Never underestimate a strong woman.

You can watch that here:

https://m.facebook.com/story.php?story_fbid=193478867888203&id=120404095195681&_rdr

It’s one of the most profound things I’ve heard in my life and I couldn’t help but think about it this morning. I hope you never let being a woman stop you and I hope, as a man, you never let women be intimidated out of achieving their full potential by men with delicate egos. These are your sisters, friends, mothers and daughters.

Add this series to your watch list! 🙂

Do you fight in your relationship?

Do you think some people only feel truly alive in the presence of conflict? Both internal and external. Do some people thrive on it? I have these, what you would call a power couple, neighbors who at first glance resemble any ordinary couple you’d see going around and about their business. They’re cohabiting and the lady is a stay-at-home girlfriend or wife. Didn’t the court rule the other day that come-we-stay is proof of marriage?

Not to digress, it’s a war zone in my area of residence. Every morning and evening. As soon as the guy gets home in the evening, not more than 5minutes later and its shouting and yelling and utensils being thrown around and physical abuse. It’s a pity these walls are not soundproof because they sure are not bashed to air their dirty linen in public. What baffles me is, what is it that two people could fight about yesterday, today, tomorrow and the day after tomorrow that is incapable of being resolved that they have to reiterate the argument daily? Its disturbing to hear people verbally fighting and even physically and you’re not in a position to interfere also its toxic to the children around. How does this affect children exposed to violence in their own homes or in their areas of residence growing up? I read an article by Troy Onyango a while and the protagonist had grown up watching the father physically abuse his mother and in his adult life, after marrying, he made a habit of beating the daylight out of his wife every dusk. He would come home, drunk or not, and start hurling insults and throwing blows at the wife. In his mind, he only knew to express love with violence. To him, love did not exist where violence didn’t. Sad, right? Disturbing too.

What baffles me is why would two adults consent to live together disharmoniously? This is how people die! It starts with verbal abuse, then a slap here and here, next it’s punches being thrown and next thing you now, someone slips into unconsciousness never to come to again.

Domestic violence is a real issue amongst us and we need to find ways to address this issue to reduce the mortality rate in both parties involved. This mortality rate is increased by both physical and psychological factors. You should see the guy walking around, he’s usually agitated for no apparent reason and rude. Stress is one of the risk factors for several conditions. High blood pressure being one of them.

Some of the peaceful ways to resolve conflict are:

  1. Calmly talk about it and in case you cannot calmly talk about it at that moment, excuse yourself and resume the conversation when your temper is out of control.
  2. It’s not a competition. Going into an argument with the mentality that you want to win will destroy the relationship. Its about meeting halfway, not winning the argument.
  3. Know your trigger points and avoid them. If you know that your partner is the type to use your words against you especially out of context in an argument, avoid exchanging words with them as this might escalate your temper and end in a disastrous way. Also, try to tell them beforehand that you do not like it so they can curb it or even better stop entirely.
  4. Don’t be afraid to involve a third party when things sprawl out of control.

Lastly, a caveat for those women who ignore the tell-tale signs of a violent lover, better to be safe than sorry. Below are some of the warning signs also, suggestions of how to tackle this issue will be highly appreciated and acted upon.

If you’d like to share you story please text me 0727946060 or email me at ybritty@gmail.com. It can be done anonymously. Don’t be ashamed of your story, it will inspire others.