He weighed more than 170 kilos and could not walk. But a procedure at Kenyatta National Hospital that removed part of his intestines has offered a glimmer of hope.
John Muthama made history last week when he became the first patient to have his stomach hived off to reduce weight in a public hospital.
A week after John Muthama’s discharge from Kenyatta National Hospital, Lifestyle linked up with him at his home in Waithaka, Nairobi, to take stock of his recovery journey.
The surgery the 66-year-old underwent to reduce his weight, where medics hived off a portion of his stomach, was historic as Kenyatta National Hospital (KNH) said it was the first to be conducted by a public hospital in Kenya.
During the interview, Mr Muthama reflected on his mental calculations ahead of the operation.
“This is probably the most difficult decision I have made in my life. It took me 10 years to give my nod. I was afraid that I would not make it out of that small theatre room alive. The doctors considered the procedure a high-risk one,” said Mr Muthama while lying on his bed.
Mr Muthama underwent the surgery in May. Then, he weighed 176 kilos with a body mass index of 59.5, more than 29 units above the obesity mark.
Mr Muthama had been diagnosed with class III obesity. This got the family worried.
“Do you know how it feels to look at yourself in a mirror and all you see is flesh everywhere? This is how I have been feeling. Most of the times I wished the mirror was faulty,” he said.
Mr Muthama’s weight issues started in 2009. He knew he was eating well. Since he was a retired civil servant, he thought, he was happy with the life he was leading. Little did he know that he was inviting a host of problems.
At the age of 60, he opened a timber workshop after retiring from the Public Works ministry. At that time, he weighed 130 kilos and could still move.
He went on with his work normally as the weight continued to increase. In 2012, he closed the shop and went to supervise the construction of his buildings, only for him to start getting unwell.
Mr Muthama loved his matoke and chapatis. The doctor said the two led to the abrupt increase in weight.
His wife Agnes admitted to Lifestyle that she is partly to blame.
“I am a good cook. If they say it’s what he eats that led to this weight problem, then I stand accused because I loved cooking very nice matoke which is our staple meal. Chapatis were a must-have. Beef also,” said Mrs Muthama.
When her husband’s weight started growing tremendously, she recalled, her in-laws were praising her for “taking good care” of their son.
“I was happy that I got all the praises. This motivated me more. I cooked well and ensured that I used all the ingredients to make the meals tastier,” she said.
This changed when she noticed that her husband could no longer work and Agnes was advised to check on his eating habits.
“I thought I was adding love to our marriage but I was bringing more problems,” lamented Mrs Muthama.
They did not realise the magnitude of the problem until he developed breathing difficulties, his legs started swelling and the heartbeat became unusually fast. Everyone who came visiting advised him to exercise.
At 167 kilos, however, attempts to exercise were fruitless as he could barely bend. So, exercise was not an option.
“The spirit was willing but the body was weak,” said Mr Muthama.
He could barely walk, let alone run. What really pained Mr Muthama was that he was a marathon runner in secondary school, a sport he enjoyed. Now, he was struggling to walk.
He tried dieting for a year, eating only vegetables, water and skipping meals. But that did not bear results. He even joined several social media groups and books to seek advice but failed.
“My dieting journey was very interesting. My daughter told me of a low-carbs (carbohydrates) diet, which we tried but it failed. We started fasting but it also failed. I was not so disciplined.
“I would eat a small portion of carbs or at times no carbs at all, proteins and a half plate of vegetables and fats (avocado). The dinner was always served by 6pm and not later than 9pm to give room for digestion. I also took a lot of water — four litres a day.
“For a fasting diet, I had a well-crafted timetable and would even go for three days without food and no sugar. I would only have coffee and water during the fasting window. And during the feasting window, I would not eat carbohydrates. I could not have any fruit since the nutritionist instructed that it would stop autophagy (drawing energy from the body’s own tissue). I did it diligently but I lost only two kilos.
There was no much difference,” said Mr Muthama.
With every measure hitting a wall, he finally started consulting doctors to know where the problem was.
“I started at Aga Khan Hospital since I was told I had a spinal injury. But when we went for X-ray, they did not detect anything. However, the problem was getting worse; I could not walk. We went to a Kikuyu hospital and I was told that I could not walk again since all the muscles in my legs were dead. I lost hope,” he recalled.
Mr Muthama saw close to eight different specialists for advice but all of them prescribed exercise as the only way to reduce the weight.
At some point, he was diagnosed with hypertension, warned that he was developing obesity, and did not take long before he was diagnosed with it.
On the matter of obesity, he sought solace in the fact that being bulky run in the family. All his siblings and also their parents were big and none reached the obesity line. He was, however, the biggest.
In December 2018, his condition worsened and he could not even lift his legs. It took four people to take him outside the house and back.
He could not even turn in bed and would need his wife’s assistance.
“I was really suffering and really wanted to lose the weight, though I did not have the stamina and discipline to do so,” he said.
Doctors insisted that he had no option but to shed several kilos since obesity was a major health hazard that kills.
The World Health Organisation projects that deaths from lifestyle diseases (diabetes, cancer, hypertension, chronic respiratory diseases among others) will in the near future exceed those from communicable diseases like malaria and HIV.
Having struggled with no results and in pain, he was referred to Kenyatta National Hospital by a friend who knew Dr Kennedy Ondede, a surgeon at the facility.
“When I met Dr Ondede, he looked at me and recommended surgery since all other options had proven futile. I gave in since I was in a lot of pain and a burden to my wife,” he says.
Together with other surgeons and specialists, he was monitored and on May 7, wheeled to the theatre room. It took an hour and a half for the five specialists who attended to him to complete the procedure. The experts who attended to him were specialists in renal matters, cardiology, nutrition, neurology and psychiatry.
Mr Muthama walked out of the theatre 10 kilogrammes lighter.
“The surgery was not a big deal; it is a minimal access surgery. Though it is not a one-off thing, we need to follow up the patient for three years to ensure that he maintains the kind of life that we want. If the patient is not followed within the three years and goes back to his eating habits, he will gain weight,” Dr Ondede said.
“We informed him about the surgery being a risky but he agreed, adding that he was ready,” Dr Ondede told Lifestyle.
In weight loss, there are two types of surgeries including the gastric bypass, where a surgeon makes a small pouch in the stomach straight to the intestine.
Then there is gastric sleeve surgery that involves the removal of part of a patient’s stomach then joining of the remaining portions to make a new banana-sized stomach or “sleeve”.
In Mr Muthama’s case, after the surgeons weighed options they picked on the sleeve gastrectomy, which is the most ideal for people who have a BMI of 40 and above—which means the weight is way above their ideal weight.
“Some people are too heavy for gastric bypass surgery. In the case of Mr Muthama, for instance, the sleeve one was a good alternative,” he said.
The surgery enables patients to have sustainable weight loss and also to normalise blood sugar, blood pressure, cholesterol and to resolve joint problems.
The surgeons removed 80 per cent of Mr Muthamas stomach, leaving a tube-shaped stomach the size and shape of a banana.
“This restricts the amount of food a person is able to consume, which consequently leads to weight loss. He will feel full a lot quicker than he did before and he won’t be able to eat as much as he used to, which helps in losing weight,” Dr Ondede said.
The surgeon made a few small cuts in Mr Muthama’s belly and inserted a laparoscope (an instrument with a tiny camera that sends pictures to a monitor).
Then they inserted other medical instruments through the additional cuts and removed 80 per cent of his stomach.
They then reattached the rest of his stomach to form the “sleeve”.
If done in private facilities, the procedure costs Sh1.5million, which most Kenyans cannot afford. It was the first time it was conducted at a public hospital and it cost Mr Muthama Sh900,000.
“This is because of the materials being used are very expensive. It is possible to do this in a public hospital and we are looking forward to ensuring that obesity is treated like any other disease which is funded by the government,” said Dr Ondede.
The doctor said the patient will be monitored closely for two months to ensure he does not gain weight. They are expecting him to lose more weight.
According to the World Health Organisation, about half of Kenya’s population suffers from obesity.
“Kenya is not unique, the sedentary life that we live and the food we are eating is predisposing us to non- communicable diseases,” said the surgeon.
Kenyan private hospitals conduct over 50 procedures like the one Mr Muthama underwent every year, with over 100 Kenyans traveling abroad for related procedures.
“This successful surgery adds into the list of the great milestones that KNH specialists have achieved to save, transform, reclaim and prolong lives of many Kenyans and patients from East and Central Africa,” said Dr Evanson Kamuri, the hospital’s acting chief executive officer.
When the Lifestyle followed Mr Muthama to his home in Waithaka where he is recovering, he had improved.
He was able to sit, albeit painfully. He said he is feeling lighter.
“Surgery was the scariest thing I ever did, but it was easily the best choice I ever made. It has been embarrassingly easy to adjust. It is remarkable. I am not hungry. More importantly, my interest in eating a lot of food has gone away,” he said.
He added that during preparation for the surgery, he was mentally prepared for the fact that he was not going to be able to eat as much.
“After surgery, I cannot eat my matoke dish, I crave nothing and I am sure I am going to lose more weight after I fully recover. My digestion is different. I have a lot more energy,” he said.
“My body now feels light. Although I have not yet hit my target, which is 100kgs, I have learnt that weight loss needs a lot of discipline. I would not wish to be where I was anymore. I am hoping that I will be back on my feet soon,” Mr Muthama added.
Mr Muthama now feeds on mashed meals until he recovers fully. He takes at least seven spoons and he is full.
During the home visit, his wife recounted how the 10-year weight loss journey robbed her of her happiness. She noted that she is looking forward to enjoying life with the man she married.
“With that weight, everything changed. There are things that he used to do that he could no longer do. I am praying and I am sure there will be an improvement, we will get back to our lives,” she said.
Mr Muthama advised others not to wait till it is too late.
“When you start feeling that your legs cannot carry you, start doing something as fast as you can. It is not an interesting scenario to be carried yet you have the eyes to see your direction. One should watch what they eat since 80 per cent of weight is determined by what we eat,” he said.