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You know what is killing us? Pollution, and a lack of curiosity

Monday October 26 2015

By BITANGE NDEMO
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I spent time in the week of October 19 with young adults from all over East Africa attempting to build new applications that would bring new innovations or disruptions in the agricultural sector. 

After addressing them, they asked me which areas would see the greatest disruption in the next five years. I said, without a doubt, that the healthcare sector is rife for disruption.

Even the blind can see that healthcare systems in Africa are dysfunctional. Facilities are in a poor state, and the cost of care is unnecessarily extortionate.

Rude health workers conspire with crowded amenities to make the experience of care very unpleasant. Public health is non-existent. We must change this for the better.

While we die unnecessary from curable diseases, we also generate new, more dangerous diseases as we pollute our environment, and our failed public health plays catalyst to stimulating these incurable diseases. 

This perhaps explains the increasing cases of all kinds of cancer, especially lung cancer. In the past few weeks, two very prominent TV personalities, Janet Kanini Ikua of NTV and Anjlee Gadhvi Noorani of K24, shocked Kenyans when they revealed their battle with cancer in Indian hospitals.

It takes no doctor to see that our polluting behaviour is killing us. The air we breathe, particularly in Nairobi, is patently unhealthy.

We have no motor vehicle emission standards. Lorries spew thick, dark gases from their exhausts as they labour on our roads. Old, poorly serviced jalopies ply our roads, and their half-burned fuel combines with thick smoke from factories to make the city air really unfit for breathing.

Meanwhile, crazy matatu drivers will not switch off their vehicles whether they are stationary or not. They keep revving up the vehicles, many of which are badly serviced by incompetent mechanics. This behaviour kicks off dust in addition to expelling dangerous fumes.

Then our pedestrians, boda bodas and cyclists walk or ride on every available patch of grass. The result is dust bowls in the city, which Kenyans breathe without complaint.

On some days, you can see the haze of polluted air hovering over the city like an ominous cloud of devil’s gas. Our environment regulators appear oblivious to the danger of pollution and helplessly allow us to breath in the bad air.

'DIFFICULTY BREATHING'

No wonder we regard news like the ongoing VW emission scandal in the US as mischief on the part of Americans, while we enthusiastically gorge ourselves on air guaranteed to kill us.

There is hope that we can disrupt healthcare in Africa. We must begin with a change of mindset. The mindset of most of our doctors centres on communicable diseases. 

If you walk to virtually all the hospitals with chest pain, the protocols will refer you to a chest specialist, who will most likely suspect that you have heartburn.

The prescription you get is a broad-spectrum medication to give immediate relief, but which does not deal with the underlying problem. What the protocols fail to take into consideration is the fact that we have more non-communicable diseases today than ever before.

My younger brother, Ronald Ndemo, died last year of heart failure. He had visited doctors with chest pain at a rural hospital in Kisii. After being examined, he was given some painkillers and discharged. 

Exactly seven hours later and late into the night, he was having difficulty breathing. By the time he could be driven back to hospital, it was too late.

Had the doctors taken the symptoms he was exhibiting into consideration as the advent of a non-communicable disease, he would be alive today. 

But that would have required following different Standard Operating Procedures (SOPs), which did not exist.

He should never have been left to step out of hospital when he first went there. At the minimum, the doctor should have done an ECG to rule out a heart problem.

A casual survey shows there is only one hospital in Kenya that treats chest pain with the urgency it deserves. In spite of the government having invested in expensive diagnostic equipment for all county hospitals, this equipment is rarely used.

Most doctors are stuck with old protocols and have no motivation or passion to seek to know more about the patient. They hardly refer to any previous data about the patient. 

Some patients have been coming to hospital complaining about the same thing but the doctor’s curiosity is lacking. One would assume that they would change tack when the patient complains about the same problem at every visit.

TRAVELLING TO INDIA

This is why and how we fail to detect cancer at an early stage. While working on this blog post, I listened to many cases where doctors failed to correctly diagnose the disease afflicting their patient.

In almost all cases the patient travelled to India only to be told it was cancer that had progressed.

The two cases of the prominent TV journalists highlight the plight of many Kenyans traveling to India as a last resort.

Janet Kanini Ikua, after treating Deep Vein Thrombosis (DVT) for some time, is now in India undergoing lung cancer treatment. 

After her condition failed to respond within the stipulated time, someone should have been curious enough to do more tests. At least this is what the Indians did before they started any treatment. 

Anjlee Gadhvi Noorani was diagnosed with a type of cancer known as hepatocellular carcinoma, a virulent form of liver cancer that is one of the hardest to treat.

Fortunately, India’s best doctors, who are probably the world’s best medical personalities, have confirmed that, indeed, they will treat this cancer by replacing the malignant organ.

To the two beautiful Kenyan ladies, I say this: You are strong women and you have everything to live for. You have your children and relatives to live for. You have your country, and us, with our negative and positive aspects, to live for.

It is the will to live that makes the difference and because you have been able to share your pain, God will reward you in many ways.

Ignore the words of pessimists and remember the words of Ambrose Redmoon, “courage is not the absence of fear, but rather the judgment that something else is more important than fear.” What is more important is the will to live to see your children go through college.

Not all is gloom in our healthcare system. Bidanya Baraza’s case was caught at an early stage. She played a key role in getting help at an early stage. She became the poster child for resilience against cancer.

REPEATING THE SAME TESTS

From her experience, we are perhaps our own best doctors before you get to see a health professional. There are some basics we must learn about our bodies and the more we share with others, the better we become. Her story did not end in India as many others do.

India should never be our last resort in healthcare after 50 years of independence. Every time a Kenyan travels to India for diagnostics and treatment, the cost of treatment in Kenya goes up while India makes treatment cheaper. 

This is basic economics, where economies of scale tilt the pricing downwards. We shall never attain affordable healthcare if greater numbers of our patients go to India.

We can change the status quo in our healthcare system.  First, we need to continuously digitise our health records such that all patient data can be made readily available anywhere it is needed. This will serve to highlight conditions that have been treated previously. Perhaps medical researchers could scale up patient cases to find out new complex diseases. 

It has already been established that our multi-tiered health system becomes expensive when we repeat the same tests at every tier. 

Were the patient data to be made available and shared between facilities, there may be no need to keep on repeating treatment that has been attempted before.

Virtually all communicable diseases can be dealt with through technology and rapid test kits. The rapid test kits should be widely distributed so that more sophisticated people can simply take care of themselves before seeking the intervention of doctors. 

Communicable diseases should ideally be handled by clinical officers with very strict SOPs. A case can only be escalated to a doctor if it keeps on recurring so that the doctor can begin to investigate the angle of non-communicable diseases. 

If this is handled carefully, we can remove between 30 and 40 per cent of patients who come to hospital daily and end up clogging the facilities. 

LAXITY OF HEALTH PROFESSIONALS

There is a link between lung cancer and environmental pollution. It is the reason developed countries have developed emission standards.

The recent Volkswagen scandal in the US was basically the violation of emission standards but we did not see it as affecting us in any way. We are consuming too many fumes and this is the reason we are seeing many lung cancer cases in Kenya.

We have the policy and legal framework in place but we lack enforcement capabilities. We must demand enforcement if are to save our lives in the future. 

Through social media we can force our enforcement agencies to see reason. If you see a vehicle spewing smoke, take a picture and tweet it.

Enforcement plays a great role in prevention. We must emphasise the role of public health in enhancing disease prevention in Kenya.

In the past this has worked well in eradicating malaria. But laxity of the public health professionals has changed the health landscape for the worst. 

Their work has been complicated by greed. In Kisii and Nyamira counties, for example, leaders have grabbed all the wetland areas, and with the rising population density, the ecosystem that mitigated the spread of malaria has changed. 

The outcome of this is a new strain of malaria often referred to as highland malaria that is more potent than any other malaria we have seen before.

In Nairobi, our abuse of the environment has reached unimaginable proportions. Unscrupulous leaders are grabbing all sorts of forest and riparian land and building high-rises. Some of these structures could be literally sinking and are a danger to citizens. 

Most of the poor selling their wares on the roadside are inhaling too much carbon monoxide and spending their entire savings treating cancers. We need proper planning to stop this nonsense.

SUPPORT GROUPS

We can leverage social media to build strong patient support groups to share their experiences while undergoing treatment. When my mother was suffering from cancer of the kidneys, it is a support group that I joined that pointed to new drugs that gave her some comfort and an additional two years before she left us. 

There is no single expert who knows it all and the sharing of knowledge may lead to new discoveries. It is my contention that if every individual were to make their DNA make-up available, we could very easily map out some diseases and deal with them more effectively. 

In the not-too-distant future, most medication will be personalised. This will only be possible if we know our DNA. The answers to many threats lies in data, but we have not quite established how to use the data without others abusing it the same way we have done with national resources like land.

Even with the little automation we attempted at Kenyatta National Hospital, there was a pattern emerging, with some non-communicable diseases concentrated in some areas.

We needed to follow up and establish what environmental factors were causing these diseases in those specific areas and possibly deal with the root cause of it. Nothing has been done since we did the pilot but there is much we can learn from digitised data.

We can change the landscape of our healthcare systems. We need the courage to change and make things better for everyone.

The writer is an Associate Professor at the University of Nairobi’s Business School. Twitter: @bantigito

Editor's Note: The article has been updated to correctly note that hepatocellular carcinoma is a form of liver, not lung cancer.