When the fear of death leads to illogical reactions

There is nothing more powerful than fear. Fear of death when one feels they have everything to live for. Fear of death when one feels they are too powerful to die or too rich not to be able afford to buy life.

This is what the current Covid-19 pandemic is beginning to reveal. Two decades ago, we dealt with the HIV/Aids pandemic and human nature was unmasked in much the same way. The rich believed they could buy their way out of the march to the grave. A story was told to us by a mentor during our medical school training of a wealthy entrepreneur in Kenya who was diagnosed with HIV in the early 90s. He travelled the world seeking treatment without success. He was one of the first patients to visit the infamous Prof Arthur Obel as he launched what was thought to be the first ever HIV cure in the world in 1993, Kemron. Kemron was quickly quashed into oblivion. New treatment started trickling into the market in the West and our desperate patient flew out in search of the magic bullet.

Unfortunately, it took a few more years to figure out that the novel anti-retroviral drugs needed to be used in combination for them to be beneficial. By this time, it was getting too late for him. As his body failed him, he re- sorted to blood transfusions and anything else possible to no avail. By this time, he was beginning to go broke. Worse, he developed kidney failure, subjecting him to dialysis, which plundered his resources. A kidney transplant was not an option as no one was going to put a good kidney in someone who was considered to be dying.

His dialysis demands increased and when he began to sell his assets to finance the bills, his wife asked his friends in the medical field to talk to him. She had accepted she was dying along with him, but she would not agree to leave her children destitute. He died four months later, having let go of his most prized vintage car. He never got to benefit from the ARVs we take for granted now. The level of desperation exhibited by man in trying to stay alive when death is imminent, is only measured by his purchasing power. While the poor man may be seen to not care much, it is only because he knows he has no means to fight for his life. However, give him money and he will surprise you.

BUYING VENTILATORS

Last week, this story came flooding back when a friend told me of the ridiculous steps being taken by the wealthy to avert death from Covid-19. When we were just recovering from people binge-shopping and hoarding toilet paper, the people of means were purchasing ventilators for their personal use at home, should they need them. To a lay person, the Internet makes it look like a ventilator is designed to work on its own, with multiple fail safe mechanisms to protect the patient. Further, it is also listed as a home care device. Is this really true? Yes it is. This concept was devised for patients, especially of paediatric population who require long-term ventilation due to chronic conditions. These children are stable, only that they lack capacity to breathe for themselves due to muscular of nerve conditions that otherwise would not kill the patient. The child is carefully assessed for suitability for home care and the caregivers are intensively trained to care for the patient and to operate the machine and spot problems. The care is fully supported by doctors, respiratory therapists who configure the settings necessary for the patient and biomedical technologists who service these machines. Can this work in the context of coronavirus infection? Highly unlikely.

The critically ill patient in need of a ventilator requires a lot more care than just being able to breath. There is need for medication to control the infection itself and the damage it is causing to the body organs. There are multiple tests done every 24 hours, sometimes repeated multiple times a day, to maintain the body’s homeostasis. These tests require a lab that is not available in the house. There is need for careful calculation of fluids and electrolytes that need to be administered to the patient, based on the function of the other body organs, a function that can only be performed by a highly skilled intensive care doctor. The body needs to be fed through tubes to maintain nutrition. There may be need for concurrent dialysis as kid- neys begin to fail, blood transfusion when shock sets in or resuscitation when the heart stops.

The simple message to these extremely naive people is that even if you bought an entire intensive care unit and brought it home, it is worthless without the critical care teams that run the unit. Would you be able to afford to employ them? Highly unlikely because you will first have to find idle ones looking for employment. Newsflash, Kenya has just about 180 anaesthesiologists to run all our critical care units across the coun- try, and further care for patients in theatre undergoing surgery. Once we hit the peak of the pandemic, they will be so overwhelmed in the actual hospital ICUs, supported by every generalist with any training on critical care. Further, the government will be digging each and every one of them out to come on deck. This is even worse for critical care nurses who are ridiculously scarce, yet pivotal to the ICU function.

The millions worth of equipment will be worthless junk to you. Primal impulse to stay alive leads to ridiculous reactions. Even the skilled anaesthesiologist cannot intubate himself, should he need to use the ventilator. The only sure- fire way to tame the pandemic is selflessness. You are only safe if you keep those around you safe and infection-free. That $50,000 would keep you out of ICU if you spent it on the economically vulnerable to assure them of a full stomach, access to water and security of a roof over their heads for the next three months. They would gladly stay at home and break the chain of transmission so that the virus never found its way to your pristine backyard.

Dr Bosire is an obstetrician/gynaecologist