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The problem drug patents pose for developing countries

By: Dr Brighton Chireka • 23rd November 2016

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Explainer: the problem drug patents pose for developing countries

Erica Penfold, South African Institute of International Affairs

Patents and restrictions on intellectual property have become more problematic for developing nations in the last decade. At the centre of the storm is the development and influx of inexpensive generic medicines that developing countries need to treat HIV, TB and other communicable diseases.

The generic industry is essential for provision of low cost medicines. In southern Africa, where there is a high burden of HIV and a lack of access to resources for health care and medicines, the industry is particularly important.

The growth of the generic drug industry has resulted in tensions with big multinational pharmaceutical firms. These firms rely on patents to protect the intellectual property of their products. Patenting laws like the World Trade Organisation’s agreement on Trade-Related Aspects of Intellectual Property (TRIPS) stipulates that patents last for 20 years from the date of registration. This gives manufacturers an opportunity to provide drugs exclusively for that period so that they can recoup money spent on research and drug development.

But it also places the power of managing drug prices in the hands of manufacturers. This drives up prices, making many medications inaccessible to the poor, particularly in developing countries.

The big challenges

This is particularly problematic for patients who have developed immunity to certain drugs.

Certain patients are reliant on new medication because of drug resistance. In Africa there are more than 32 000 people suffering from multiple drug resistant TB (MDR-TB). In 2010, according to the World Health Organisation, one in 20 HIV-positive patients worldwide were infected by a drug-resistant strain of tuberculosis.

Accessing affordable drugs for these patients is problematic because new treatments still under patent are exorbitantly expensive.

The same problem applies to a range of other potential treatments. For example some third-line anti-retroviral therapies are still under patent, making them expensive. Third-line and second-line treatments are necessary for patients who are not responding to first-line ARVs. There are 2.5 million people in South Africa on ARVs. Around 9% are failing first-line anti-retroviral therapy year-on-year and need to be put on second-line and eventually third-line ARVs.

The Indian generic drug market

India is one of the key providers of generics to developing states. It supplies 20% of the global market for generic medicines and accounts for more than 80% of the world’s anti-retroviral purchases annually. It has provided a large proportion of key medicines to global aid and non-profit organisations such as Medecins sans Frontieres, PEPFAR, UNICEF and the Global Fund.

Indian generic drug manufacturing capabilities, which have brought down the price of certain medicines, benefited from a lack of patent barriers.

But global patent laws imposed in the last decade, including one in India in 2005, mean that certain drugs cannot be manufactured by the generic industry.

As a result India has granted certain patents
for TB, HIV and hepatitis C medicines manufactured by US firms, which stopped its manufacturers from reproducing those drugs. At the same time, India has not been limited by the patent laws. Its patent authority has rejected applications for patents from big pharmaceuticals such as Novartis and Gilead which manufacture cancer and hepatitis C drugs respectively. This means Indian manufacturers are allowed to produce the cheaper generics of the same products.

In addition to the patent challenge, India’s ability to produce generics could also be hampered if it finalises a free trade agreement with the European Union, which it has been negotiating for eight years. Talks are set to resume next month.

Among the negotiations is a data exclusivity clause, which will allow the pharmaceutical producers of European Union member countries to retain the clinical test data which shows the safety and efficacy of a new drug before it can be commercialised for up to five years. It would mean that the generic companies would need to generate their own data before they market those off-patented drugs.

If the clause is approved, it could constrain India’s generic industry and be detrimental to southern Africa’s pharmaceutical industries as generics of these drugs would not be imported to the region.

Other barriers to drug provision

Medicine provision in the region faces several challenges which patenting could exacerbate. These include:

  • Regional business barriers such as small markets, weak and differing medicine registration policies and restricted access to medicines because of intellectual property rights on drugs.
  • Multiple regulatory authorities, which mean there are conflicting laws for the different countries in the region.
  • National irregularities in supply chain management which result in stock outs. The supply chains of products are disrupted, causing delayed distribution of medication.

Drug provision is also hindered by regulatory problems, such as drug regulators not having the capacity to evaluate medicines and approve new ones.

The future of generics

Patent laws and drug exclusivity agreements are a major challenge for the global HIV and AIDS movement. South Africa and the Treatment Action Campaign fought a long but successful battle to gain access to more affordable medicines. It used constitutional litigation to gain access to cheaper generic anti-retrovirals.

Other southern African countries like Malawi and Zambia also rely heavily on inexpensive treatment and generics because of high HIV rates and drug stock outs.

Given the fact that the future of generic drug production hangs in the balance, developing countries need to consider alternatives for southern Africa.

Pharmaceutical companies have traditionally offered “cut price deals” on anti-retrovirals to developing countries to prevent loss of income to the generic companies. These deals target specific products offered on a country by country basis. There is a lack of transparency around which prices are offered to which country.

There is an increased need for extensive research and development of new medicines and vaccines. This would allow additional companies to enter the market and ensure competitive prices.

The Conversation

Erica Penfold, Research Fellow , South African Institute of International Affairs

This article was originally published on The Conversation. Read the original article.

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Stop HIV stigma

We have won the battle against HIV but not the stigma

By: Dr Brighton Chireka • 16th November 2016

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We have won the battle against HIV “virus” but not the stigma

As I  see it by Dr Brighton Chireka

“He/she is HIV positive and is spreading it ” are the headlines in some online news sites or social media pages. Some people take it upon themselves to “inform the public” about the HIV status of somebody . Firstly the issue of disclosure should be a personal choice and it’s sad that the choice is taken away by ruthless people hiding behind fake names on social media. The sad thing is that some of the people are wrongly labelled as HIV positive . It’s more worrying when self claimed street doctors start to diagnose people as HIV positive by hearsay or by the way they look. This seems sadly driven by the fact that HIV still produces enough of a scandal to sell newspapers. Aids stories generates more hits to bloggers’ websites or social media pages.

 

And when shame is involved, it is inevitably accompanied by a healthy dose of blame. The people who perpetrate it have no personal connection to the disease. When you have a personal connection with HIV or any disease you will then realise how painful some of the things that we allow on social media . It’s well and good when it is others but we know that life is full of surprises and we know that those who dish the most shame are not good at taking it . When we ask them to taste or drink their own medicine they cry loudly telling us that it is poisonous. We then wonder why give it to others if it is poisonous?

 

According to the Center for Disease Control, 44 percent of people who are HIV positive are unaware of their status. Unfortunately, the people who may be perpetuating the shame game may soon find that it is they who need help. Even if they may claim to be negative themselves , it does not give them the permission to invade people’s privacy and we know that all is not well in their lives. We do not want to diagnose them online or in public but we humbly advise them to seek medical help whilst it is not too late. This involves the people who supply wrong information to these sites and also those sites that publish these rumours without verification and also without respecting the privacy of the people involved.

I respected and salute people who test positive for HIV , take their diagnosis positively and commence treatment. These people are taking responsibility not only for their health but the health of others. We should be encouraging people to come up in the open about their HIV status but we should never ever take away their right to remain secretive about their health. We all have our medical problems and we want them to remain private so the same applies to others as well.

Why should the naming be wrong

If you say that so and so is Diabetic , that person will received sympathy but not the person who is HIV positive . The problem is that as a society we are also to blame . We have allowed the rejection , prejudice and discrimination of people living with HIV. People living with HIV have nothing to be ashamed of . Our society should be ashamed of itself for lagging in the stereotypes and myths of several decades ago . Due to lack of knowledge about HIV a lot of myths came about which should be buried in this day and age as we are now fully informed.

The truth about HIV

With the advance in research we now know that early diagnosis and proper treatment of HIV results in good outcomes . Living with HIV is no longer a life-limiting condition. Life expectancy of an HIV positive person is now the same as for one who is negative. The good thing is that people on treatment have a suppressed viral load, making HIV undetectable in their bodies and they are the least likely to pass it on to others . The dangerous people are the so called ” negative ” ones who are spreading the news that people who get HIV are second class citizens.
Raising awareness

 

When prominent people in our communities talk about their health ,it raises awareness and end the stigma to some of the diseases that we face. In the UK when Jade Goody announced voluntarily that she had cervical cancer, the number of women taking smear tests increased by 400 000. If we force people to reveal their health status then we run the risk of scaring people from getting diagnosed. Stigmatising a treatable disease isn’t going to make people put a condom on, more that it’ll make people keep it a secret.

 

Naming and shaming people about their health condition is not the same as raising awareness . Actually naming and shaming is counterproductive as it results in stereotypes and stigma towards people with certain conditions. A lot of diseases are partly caused by our lifestyles and these diseases include , diabetes , heart disorders , high blood pressure , cancer to just mention a few . We do not blame or name and shame these people why ? People who are living with HIV have acquired it through different ways and to think that they are all promiscuous is following the stereotype by the ignorant people . I am afraid we still have people who “show off ” their ignorance on social media and sadly they have followers.

 

I was taught that a rumour needs an ear and if you want to stop rumours just block your ears or stop providing ears. The same applies to those that spread hate and try to character assassinate others, we should deny them the audience. We facilitated their behaviour by visiting their websites or social media pages. Even this article will “benefit” these people as more people will want to find more about these people . My message is that we should stand on the side of the person with a medical condition that has been made public without their permission. Also we must understand that the majority of these people do not have the so called diseases because no one will have done any tests on them. It’s a game of hate . I hate so and so , “so I will make him or her” HIV positive and I am going to tell everyone. We must also remember that no amount of writing or gossiping will make an HIV negative person become positive.

 

We must not continue to shame those living with HIV because of our outdated stereotypes and self-righteous, unfounded opinions. This is fear-mongering and it is wrong. Shaming or punishing someone living with HIV leads to neither prevention nor treatment.  Asking someone how they contracted HIV is not going to advance how we help people living with HIV/AIDS. Naming and shaming can also tar the innocent. We know of people that have been wrongly accused of being positive and have had their lives ruined by reckless reporting .

 

The way I feel when I am said (against my wish ) to have diabetes or high blood pressure and the way you the public feel should be the same when you hear that I am HIV positive. At the moment it is not the case because the moment we hear about someone’s fake HIV status we run into conclusions. We see headlines claiming that the person is spreading the disease and that they got the disease by being promiscuous.

 

We know that one can get HIV through birth, needle stick injury , blood transfusion if the blood is not screened properly and also through sexual intercourse. We also know that even one sexual encounter can result in someone getting HIV so this talk about promiscuity does not make sense. You do not need to have sexual contact with a certain number of people in order to get HIV . Just one encounter can result in you getting the virus and has nothing to do with your sexual behaviour.

 

Let me end by saying this quotation; “no one deserves HIV—not the people that are being paraded as positive, not drug users, not sex workers, not people who engage in condomless sex, not people who have sex with one person, and not people who have sex with 100 people every night for the rest of their lives.” We grow one step closer to solving this pandemic when we use compassion, conversations not rooted in reductive stereotypes, accurate scientific research, and nuance. We all have a role to play in eradicating the stigma and shame that surrounds this virus.

 

No one should be ashamed of suffering from any disease !

 

Read more about HIV/AIDS and be fully informed

 

AIDS is no longer a death sentence; Getting to Zero transmission is our aim!

 

 

This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

 

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Getting the truth about chemotherapy

Chemotherapy killing half of cancer patients ?

By: Dr Brighton Chireka • 9th November 2016

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Chemotherapy killing half of cancer patients . Is that true ?

By Dr Brighton Chireka

A lot of studies are thrown at me everyday by people who want to convince me to agree with them. It goes without saying that a good study adds credibility to the point being made . Just because something is quoted on the internet, does not mean it’s true. For those who read the bible it is written that, “my people perish for the lack of knowledge.” I am going to share with you some tips to help you evaluate the quality of research being used to support a theory. Dr “Google” is full of new researches but the challenge is on how to determine which of these studies is credible.

I am going to share with you the tips on how to quickly read a research paper and I will also look in detail at the story that went viral recently claiming that chemotherapy was killing half of cancer patients.

Evaluating research papers ourselves

We get manipulated when we do not know how to evaluate the quality of a study. Many of us think that we need to be statisticians to evaluate the quality of paper. The truth is that anyone can do simple things that are not difficult at all which enables us to evaluate the quality of research.

When we read articles that reference research we must ask a few questions about the study in discussion. The following questions must be asked ;

1- Who is reporting the results?

Media is there to sell news so they will try use attention grabbing headlines . In so doing they sometimes oversimplify the research or only use one part of it leaving the whole article. Be careful also when those reporting the results have a political or commercial agenda, as they may not fully or accurately summarise the original research. This will be fully explored below in report of the study about chemotherapy for cancer patients.

2 Who conducted the research?

Research produced or funded by organisations with a strong political or commercial agenda is less likely to be trustworthy, as these groups may have a vested interest in the study’s findings supporting their viewpoint.

3.Are they making wrong assumptions?

Just because two things are related does not mean one caused the other . We need to ask about other factors that could be affecting the results. I know most of us, we were made to conclude that certain schools offer better education but when you look into the way they select their students you will find that they are not good after all . They are taking intelligent students for example those that have have at least 5 As at Ordinary level .

4- Has this study been carried out before?

A single study , no matter how good it may be , it needs to be reviewed in the context of other studies. We need to find out what other studies have shown as far as the topic in discussion is concerned. We know that results obtained at one time may not hold true for another time. We should not jump into conclusions on the basis of one study .

You may want to look at the quality of research

Sometimes the article reporting research raises a lot of questions for you like the one saying that chemotherapy is killing half of the patients it is meant to treat . The best thing to do is to click on the link and have a look at the study itself. If the reporting article does not give you the link then ask the author of the article for a link. Failure to get the link to the original study should make you raise questions about the truth of the research being reported.

When you look at the original study , you will find interesting and useful information not included in the articles referencing the study . You will be shocked at times to see how the results have been manipulated by the media etc.

You may want to look at the following to further evaluate the quality of the research

1- Are the researchers trustworthy?

Look at organisation that carried the research whether it’s a reputable organisation. Institutions like Harvard or Oxford University are more more likely to be trustworthy because of their reputation in research.

2- How representative is the group that was studied?

The group that was studied must be generalised to a large population and for that to be the case then the sample must be large enough and represent the large population.

3 -Gathering of data

You need to know how the sample was selected and how the subjects were interviewed. Online surveys may not capture those that do not use Internet frequently. Look at the questions that were asked and make sure that there was no bias in the questioning.

4- How was data measured

Is the study just reporting numbers only . Is reliability and validity measured? Reliability means the study will produce the same results if you repeat it. Validity means it measures what it claims to measure.

5- Analysis of data

Are the reported differences significant. A difference between 10% and 25% might not mean anything at all. Differences must be statistically “significant” to be considered meaningful. A “significant ” result is one that is unlikely to occur randomly or due to chance

6- Is the conclusion acceptable ?

When we look at the conclusion from study we need to ask the following questions;
Is the conclusion based on sufficient data ?
Are the reported differences significant?
Is the sample size large enough to generalise from?
Is the causation more than just correlation?
Do the results make sense from what you have have read ?

 

SHOCKING NEW STUDY SHOWS CHEMO KILLS HALF OF CANCER PATIENT ???

Before I look at this study let me remind you about chemotherapy.

What is Chemotherapy?

Chemotherapy is a type of cancer treatment, with medicine used to kill cancer cells.

It kills the cancer cells by damaging them, so they can’t reproduce and spread.

 

Why chemotherapy is used ?

Chemotherapy is used if a cancer has spread or if there’s a risk that it will. The main aim of treatment may be:

to try to cure cancer completely – this is known as curative chemotherapy. If patients are selected wisely mortality rate after chemotherapy is very low. 


to help make other treatments more effective – for example, chemotherapy can be combined with radiotherapy (where radiation is used to kill cancerous cells), or it can be used before surgery


to reduce the risk of the cancer returning after radiotherapy or surgery


to relieve symptoms – a cure may not be possible for advanced cancer, but chemotherapy may be used to relieve the symptoms and slow it down; this is known as palliative chemotherapy. In this group of patients  mortality after chemotherapy  is high as the disease will have spread to other parts of the body and most of these patients will be generally unwell. 

 

The naturalnews website published an article on the 20th September titled “Shocking new study shows chemo kills half of cancer patients, not cancer itself” . The article went on to say that ;

A new landmark study found that up to 50 percent of people who receive chemotherapy are killed by the treatment, not cancer itself. For the first time, researchers from Public Health England and Cancer Research U.K. examined the numbers of cancer patients who died within 30 days of starting chemotherapy”

Public Health England and Cancer Research UK are reputable organisations and if their studies shows that half of people receiving chemotherapy are dying then this is worrying and scary to everyone.

NaturalNews

Natural News is a science-based natural health advocacy organization led by activist-turned-scientist Mike Adams, the Health Ranger. I do like this website but was disappointed on the way they try to manipulate the results of this study to advance their agenda.
MISLEADING NATURAL NEWS ARTICLE ON CHEMO

Just because reputable organisations are mentioned does not mean that it is true. As explained above the best way is to go to the original study and read it for ourselves.

The article was published in the lancet which is a reputable medical journal and the conclusions are different to the once presented by Natural news.

ACTUAL STUDY IN LANCET

The original article was also published by Public health England and it gives details of all the Hospitals that were involved .

PUBLIC HEALTH FULL REPORT OF THE STUDY
The original study involved 28 400 women with breast cancer and over 15000 patients with lung cancer receiving Systemic AntiCancer Therapy(SACT) in 2014 at 147 English NHS trusts ( hospitals ). The analyses was based on routine data from SACT datasets. NHS hospitals trust began submitting data in April 2012 , and submission became mandatory for all NHS hospitals trust in England from April 2014.

 

Why focus on 30 days after chemotherapy?

Patients dying within 30 days after beginning treatment with SACT are unlikely to have gained the survival or palliative benefits of the treatment, and in view of the side-effects sometimes caused by SACT, are more likely to have suffered harm. In particular, the risk of neutropenic sepsis (infection resulting from low blood neutrophil count, probably the most important cause of SACT-related death) is highest in the 30 days after SACT, peaking at around 11–15 days after treatment.5 SACT cycles are typically 21 or, less commonly, 28 days long, so death from neutropenic sepsis from the previous treatment is captured within the 30-day mortality metric.

STUDY RESULTS

STUDY RESULTS

 

 

The results showed that for palliatively treated breast cancer patients 30-day mortality was 7.5% while for palliatively treated lung cancer patients (small and non-small cell lung cancer combined) it was 10.0%.

For curatively treated breast cancer patients 30- day mortality was 0.3% while for curatively treated lung cancer patients (small and non- small cell lung cancer combined) it was 2.9%. As expected these figures are lower than those for palliative treatment.

The results showed that 30-day mortality varies depending on the reason for the treatment ( palliative versus curative ) , age of patient , general outlook of the patient and whether patient had received any previous chemotherapy.
It was noted that there are also some NHS hospital trusts with 30-day mortality rates that appear significantly higher or lower than the English national average.

 

One hospital which was unfairly targeted was Milton Keynes Hospital . It’s results were manipulated by the media to suit their own agenda.

NaturalNews reported that

“The mortality rate at Lancashire Teaching Hospitals for those undergoing palliative chemotherapy for lung cancer, for instance, was 28 percent. But in Milton Keynes the death rate for lung cancer treatment went up to 50.9 percent.”

 

RESULTS FOR FOR HOSPITALS ESPECIALLY MILTON KEYNES

RESULTS FOR FOR HOSPITALS ESPECIALLY MILTON KEYNES

 

One can see from the above data that mortality rate from the whole study  was not more than 10% so where did the media get the 50% that was their main headline.  I will show you how they twisted the figures supplied by Milton Keynes Hospital . I am not a spokesperson of the hospital but I was disappointed when l looked at the results and how the media twisted the facts.

 
Milton Keynes Hospital Results for 30-day post chemotherapy mortality for patients with Non Small Cell Lung Cancer (NSCLC) treated with curative intent in 2014 shows that only 6 patients were treated and only 1 died which gives us a crude mortality rate of 16.7 %. The data was also analysed to calculate a “risk adjusted mortality rate ” which is reported as 50.9 % .
Risk adjusted mortality rate is the number of observed mortality divided by the expected mortality

 

Here we see the dangers of a small sample size that is only 6 patients . One death gives us mortality rate of 16.7% . The media then chose to publish the risk as if it was the actual mortality rate instead of the actual mortality observed which is only 16.7 %

The hospital also responded to the report and their response is given below

 

MILTON KEYNES HOSPITAL RESPONSE

MILTON KEYNES HOSPITAL RESPONSE

 

Whichever way you look at it there is no evidence that half of patients being treated are dying . We have 147 hospitals that were analysed and several thousands of patients studied which only gives us the following:
palliatively treated breast cancer patients 30-day mortality was 7.5%
palliatively treated lung cancer patients (small and non-small cell lung cancer combined) it was 10.0%.
curatively treated breast cancer patients 30- day mortality was 0.3%
curatively treated lung cancer patients (small and non- small cell lung cancer combined) it was 2.9%.

 

Media is there to sell news so they decided to target one hospital out of the 147 and used that data to be representative of the whole research. This is mischief on the part of those that have an agenda to promote their views. Here the message by NaturalNews  is to try and say chemotherapy is dangerous and it’s killing more people than it is helping. We know that chemotherapy does have terrible side effects but when used appropriately it is a life saver in a lot of people that are diagnosed early .

 

The aim of the study was to establish a national 30-day mortality benchmark for breast and lung cancer  patients receiving chemotherapy (SACT) in England and to start identify where patient care could be improved.  The conclusion was that several factors affect the risk of early mortality of breast and lung cancer patients in England and that some groups are at substantially increased risk of 30 day mortality. Never was it reported or is there evidence that half of patients are dying of treatment.
I hope after reading this article you are now wiser and you will never be gullible to these “new studies ” that are reported on the internet.

 

 

 

This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

 

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Doctor

So you are a doctor or partner of a doctor?

By: Dr Brighton Chireka • 3rd November 2016

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So you are a doctor or partner of a doctor ?

By Dr Brighton Chireka

Growing up in the 70s and 80s we were only encouraged to be either a doctor , nurse or a teacher . Interestingly my older siblings went into the medical and teaching profession and myself I was no exception. Society still has some misguided facts about doctors and at times the conversations that doctors or their partners have with the public can be challenging to say the least . I will highlight some of the conversations and hopefully help in making the public pause before they start these conversations.

Marital conversations

The general public do not comment much about marital issues of most professionals but find it alright to do so when it comes to doctors. Some on knowing that you are a married male doctor , they rush into conclusion and ask you ,”so which hospital does your wife work in ?” The problem here is that someone has already made an assumption that the doctor is married to a nurse. Yes it is true that doctors do get married to nurses but to now assume that it’s the same for every doctor is not fair and can be disrespectful.

Still on the marital issue , some of the comments are really painful but the people who say them do not see any harm in what they are saying. Partners of doctors have been asked questions like, ” You know doctor’s marriages do not last ? Or All doctors cheat on their wives” . We know that doctors are not saints they do messy up like any other person but when you look at the divorce rate among doctors , it is actually half of the national average. One then wonders why people come up with these wrongs figures and spread them as the gospel truth. I hope that people will reflect first before they say these judgemental comments . Why is it alright to say these to doctors but not alright to say the same to other professionals?

Male partners of female doctors

Our community is still struggling to accept that women can earn more that their male partners. Male partners of female doctors are teased for having a woman earn more than they do. The fun thing is that the people who make these comments do not even do their homework well. In some cases the male partner though not being a doctor may be earning more that their partner who is a doctor. Some comments are really hurting such as , “So you got yourself a mum blesser or sugar mum” . Even if the female partner is to earn more than the male partner , that should not be met with comments about how uncomfortable their male partner should be.

I like what Sarah Epstein a master’s candidate in couples and family therapy who blogs at Dating a Med Student said in her article which made me write this one;

“The men who date and marry female physicians are generally supportive and secure, not emasculated by their wife’s earning potential.” I agreed with Sarah and I encourage our society to support and not tease these men.

 

Females are nurses and black people cannot be doctors

We have had several cases of female doctors that are called nurses during ward rounds in hospital by patients. Recently a black female doctor was not allowed to help a dying patient in a flight because she was not a doctor in the eyes of the air hostess. These comments perpetuate the frustrating stereotype that women are nurses and men are doctors. The recent stories emerging about men and women both failing to believe female physicians are actually physicians are important. The casual assumptions that women in medicine are always nurses or the insistence that a man cannot possibly feel ok that his partner might just out-earn him contribute to the problem. Society makes it worse by reinforcing such stereotype.

 

Financial comments

As a community we hardly talk openly about our salaries but when it comes to doctors it’s a different story all together. The day I became a medical student things changed because “everyone” started to see me as a rich person even though I was struggling to buy “sadza” at the student union cafe which used to cost $1.60 . Each time I visited a local drinking place I was expected to be a “St Buyer ” buying drinks for my friends and everyone present. By the way I used to drink alcohol heavily but stopped in 2004. You can read about my personal story here .

 

A personal story about drinking alcohol

 

Partners of medical doctors are congratulated for being married to doctors. They are viewed as having won a lottery ticket and get told how lucky they are as they will not have to worry about money. They are asked to dream about the luxurious houses or cars they will have. The people who say these things do not mean any harm . They genuinely believe that doctors are loaded with cash.

The problem is that let’s face it , it is not nice to discuss anyone’s salary . It also implies that partners of doctors have chosen their partners based on their earning potentials or actual earnings . This is also frustrating to the doctors who are struggling to make ends meet due to the low wages being paid to them and also huge bill of medical school debt incurred during training. My message is the next time you mention doctor’s wealth to them or their partner , remember that you may be talking to a couple that is struggling financially. Your comments may be insulting and distressing to them.

Comments on health of a doctor or their partner

Doctors and their partners are human beings who fall ill and need to be treated. They can be attacked by diseases such as cancer and also can have infertility problems. It’s sad when we make comments that tend to suggest that being a doctor or a partner of a doctor is a vaccination against any disease. Comments such as ; ” so your health is sorted now that you are married to a doctor or now you can have as many kids as you like ” . These comments may cause pain if the couple is dealing with infertility problems or if one of them has cancer.

Conclusion

 

There is always debate , comparisons and sadly competition and even racism when one looks into some of the comments made about doctors and their partners . As a doctor I have and continue to endure these comments and I hope they will lessen after this article. My appeal to everyone reading this article is we can do better for doctors and their partners . The life they lead is unusual and often extremely difficult. It is time to start pointing out these comments when we hear them and find ways to discuss medicine in supportive ways.

 

Credit goes to Sarah Epstein who is a master’s candidate in couples and family therapy who blogs at Dating a Med Student.

 

This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Stroke

World stroke Day raising awareness about stroke

By: Dr Brighton Chireka • 29th October 2016

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World Stroke Day 29th October 2016

By Dr Brighton Chireka

Today is the World Stroke Day. We observe this on October 29 to raise awareness about the serious nature and high rates of stroke. We want people to be aware about the prevention and treatment of this condition and ensure better care and support for survivors. Many of us have heard of stroke or we know someone who has had this disease. We always worry about it because we do not fully understand it and what causes it . Today, the World Stroke Day, I have compiled this article which will explain in simple language about stroke.

Statistics in Zimbabwe and United Kingdom

The disease burden from noncommunicable diseases (NCDs) in Zimbabwe is rapidly increasing. All data nationally generated between 1990 and 1997 were analysed in a study. Results were that, from 1990 to 1997, prevalence rates (expressed per 100,000 people) of hypertension increased from 1000 to 4000, rates of diabetes increased from 150 to 550, and rates of Stroke increased from 5 to 15.

In the United Kingdom, 120 000 people have their first stroke every year. 30 000 have a recurrent stroke . Stroke is the largest cause of disability and 3rd most common cause of death ( after heart disease and cancer ). Stroke occurs mostly in people above 65 years but we are seeing young people getting stroke

30% of people who survive a stroke are fully independent within 3 weeks . This rises to about 50 % within 6 months. I million are living with stroke in United Kingdom. Half of these depend on others for help with everyday activities.

Blood supply to the brain

All our organs including the brain need blood supply . Blood carries glucose and oxygen which is needed by these organs to function. Lack of oxygen and glucose can damage the cells in these organs . The heart and the brain need constant supply of blood. The brain is supplied by 4 main blood arteries. These are on the front, the right and left carotid arteries and at the back we have the right and left vertebral arteries. These arteries will branch into smaller blood vessels which supply the rest of the brain cells .

What is stroke?

Stroke is a non-communicable disease (NCD). NCD is a medical condition or disease that is not caused by infectious agents (non-infectious or non-transmissible).
Stroke means blood supply to the brain is suddenly cut off. As mentioned earlier the brain needs constant supply of oxygen from blood. Soon after the blood supply is cut off the brain cells become damaged or die. The effect of the damage will depend on the blood vessel blocked . If it is a large vessel then a large area of the brain will be affected . If it is small blood vessel then a smaller area is affected.

What are the types of stroke ?

We have two main types , the ischaemic and the haemorrhagic stroke.

Let us look at Ischaemic stroke
This type of stroke is caused by a blood clot ( ischaemic means a reduced blood and oxygen supply to any part of the body) 70% of cases are ischaemic stroke . In ischaemic stroke blood vessel will have developed a patch of fatty material called atheroma. When this becomes thicker it does trigger blood to clot. When blood clot in a blood vessel in brain it results in stroke .

Sometimes a clot forms in another part of the body and then travels through bloodstream – thrombus . This is what happens in Irregular heart beating called atrial fibrillation (AF). AF can cause a clot in the heart chambers due to abnormal turbulent blood flow. The clot is then carried in the blood stream until it gets stuck in an artery in the brain .

Let us look at the Haemorrhagic stroke
A damaged or a weakened artery may burst or bleed especially when the blood pressure is high. The bleed can happen inside the brain and is called Intracerebral haemorrhage- (a blood vessel inside brain bursts spilling blood into the nearby brain tissue.) The affected brain cells then lose their oxygen supply and become damaged or die . This happens in 10% of cases .

Another haemorrhage is called Subarachnoid haemorrhage- blood vessels burst in the subarachnoid space. This is the narrow space between the brain and skull. This space is normally filled with a fluid called cerebrospinal fluid . This type of stroke happens in 5 % of cases.

In some very rare cases the cause of stroke is not known.

 

Mini stroke ( Transient ischaemic attack TIA) is 

This is similar to stroke but the symptoms only last less than 24 hrs. It’s due to temporary lack of blood to a part of the brain. This is usually due to a very tiny clot blocking a blood vessel resulting in the brain being starved of oxygen . The brain soon recovers because the clot either breaks up quickly or nearby bloods are able to compensate and supply that part of the brain that is starved of oxygen . TIA you must see your doctor immediately as you are at an increased risk of getting a stroke.

What are the symptoms of stroke ?

Functions of the body are controlled by different parts of the brain so symptoms will depend on the part of the brain damaged and also on the size of the damaged area . We need to remember that these symptoms of stroke develop suddenly.

Stroke and TIA are medical emergencies. A checklist of symptoms was devised and publicised so that members of the public are aware of it . This is also one of the reasons why I have compiled this article. You have to think of the word FAST. F- A-S-T the first three letters stand for symptoms to look for and T stands for Time meaning that once you see at least one symptom you should call for an ambulance.

F stands for facial weakness . Can the person smile ? Has their mouth or eye drooped ?
A stands for Arm weakness . Can the person raise both arms ?
S- speech disturbances – can the person speak clearly ? Can they understand what you are saying ?
T – Time to call 999/112/911 or your local number for emergency ambulance

Please do not delay . Act fast by calling an ambulance if you notice any of the above symptoms

Other symptoms include;
Headache , dizziness , unsteadiness, leg weakness , confusion, problems with swallowing , balance problems , visual problems and in severe cases, patient can pass out ( loss of consciousness).

How do we diagnose a stroke?
We usually diagnose stroke from the typical symptoms and signs which develop suddenly. After suspecting stroke a person is rushed to the hospital and CT or MRI scan to find out the type of stroke .
Blood tests are carried out to check the blood sugar and cholesterol as high levels can increase the risk of further stroke.
A chest X-ray and electrocardiograph (ECG) are done to rule out atrial fibrillation. A scan of carotid blood vessels is also done to check for atheroma.

What is the treatment of stroke?

A quick scan is done to determine type of stroke – ischaemic or haemorrhagic . This is very important as the initial treatment of the two is very different.
If it is ischaemic stroke and it is less than 4 1/2 hours since symptoms started , you may be given medicine to dissolve the clot ( medicine used is called alteplase) this process we call it thrombolysis ( breaking the thrombus ) thrombus is a clot .

Platelets are particles in blood which help blood to clot. Person with stroke must be put on anti platelets to reduce the risk of clot . Aspirin and clopidogrel are tablets used for that .

If the person is unable to swallow may need to be fed via a tube.
If blood pressure or blood sugar and blood cholesterol are raised then treatment will be started to control these

If Atrial fibrillation is found then blood thinning medication can be started- old treatment is warfarin . Nowadays we have new oral anticoagulant drugs such as rivaroxaban or apixaban etc

If scan of the carotid arteries showed severe atheroma then one will be offered surgery to strip out the atheroma.

If you have haemorrhagic stroke and you are taking blood thinning medication , you may be asked to stop taking them and given medication to reverse the effects of some of it like warfarin.

Rehabilitation of stroke patients involves a huge team of professionals. Some of them are Physiotherapists, Occupational therapists, Speech therapist, Dieticians, Psychologists, Nurses and Doctors .

What are the causes of stroke ?

Let us look at the causes of Ischaemic strokes

These are the most common type of stroke and occur when a blood clot blocks blood flow to the brain. The blood clots usually form in areas where the arteries have been narrowed or blocked over time by fatty deposits. Arteries also naturally gets narrow as we get older but certain things can speed up the process. The following will speed up the narrowing of blood vessels and increase the risk of us getting stroke .

smoking
high blood pressure (hypertension)
obesity
high cholesterol levels
diabetes
an excessive alcohol intake

Irregular heartbeat called Atrial Fibrillation (AF) can cause ischaemic stroke .
AF is caused by heart problems , thyroid problems and excess alcohol intake

Let us look at the causes of Haemorrhagic strokes

As explained in previous articles this type of stroke occur when a blood vessel within the skull bursts and bleeds into space around the brain.

Causes of haemorrhagic strokes

The main cause of haemorrhagic stroke is high blood pressure, which can weaken the arteries in the brain and make them prone to split or rupture. Things that increase the risk of high blood pressure include:

being overweight or obese
drinking excessive amounts of alcohol
smoking
a lack of exercise
stress, which may cause a temporary rise in blood pressure

Haemorrhagic strokes can also occur as the result of the rupture of a balloon-like expansion of a blood vessel (brain aneurysm) and badly-formed blood vessels in the brain.

What can we do to prevent stroke?

The best way to help prevent a stroke is to eat a healthy diet , exercise regularly and avoiding drinking too much alcohol.

These lifestyle changes can reduce the risk of problems such as arteries becoming clogged up by fatty substances, high blood pressure and high cholesterol, all of which are important risk factors of strokes.
These lifestyle changes are also important in those that have had stroke in the past in that they reduce the risk of having another stroke in future .

Let’s look at diet

An unhealthy diet can increase our chances of having a stroke because it may lead to an increase in our blood pressure and cholesterol levels.
We must eat a low- fat , high fibre diet including plenty of fresh fruit and vegetables and whole grains.
We must cut down on foods that are high in salt and also processed foods .
We must limit the amount of salt we eat daily to 6 grams ( this is about one teaspoonful). Too much salt will increase our blood pressure.

Let’s look at exercise

Ideally we should aim for at least 150 mins ( 2hours and 30minutes) of moderate-intensity aerobic activity, such as cycling or fast walking , every week.
Those recovering from stroke must discuss their exercise plan with their rehabilitation team as it is different from the general advise that I am giving you in this article.

So combining a healthy diet with regular exercise will help us to maintain a healthy weight , lower cholesterol level and keep our blood pressure at a healthy level

Let’s look at smoking

Smoking is not good for us at all. It narrows our arteries and makes our blood more likely to clot. If you stop smoking, you can reduce your risk of having stroke . Not only will you benefit as far as stroke is concerned, you will also reduce your risk of developing lung cancer and heart disease.

Let’s talk about alcohol 

Excessive alcohol consumption can lead to high blood pressure and trigger irregular heartbeat (atrial fibrillation), both of which can increase our risk of having a stroke.

Alcohol has high calories which also cause weight gain . Research has shown that heavy drinking multiples the risk of getting stroke by more than three times.

Managing underlying conditions

I Make sure that if you have medical conditions such as high blood pressure , high cholesterol, diabetes , mini stroke (TIA) , which are known to increase your risk of stroke, are well controlled .
Please share this article with your friends as we raise awareness about stroke. Leave me some comments as I love to hear from you all.

 

This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG

 
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Talking about oral health

let’s talk about oral health

By: Dr Brighton Chireka • 27th October 2016

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Dental/Oral Health and Your overall Health and Wellness

By Ingrid Muhambi 

If you are like me, growing up in the 80s and 90s in Zimbabwe, the only time I ever got to see a dentist was when I had a toothache. I was at the dentist’s office and the troublesome tooth was promptly removed. I don’t remember much education about the importance of good dental hygiene beyond brushing. The TV commercials were mostly about Colgate and Close Up and how these toothpastes would make my teeth white if I used them, nothing about flossing or about the importance of dental visits. My parents did ensure I brushed my teeth twice a day, made sure I had my supply Colgate or Closeup and toothbrushes when I needed them.

Fast forward to 1993 when I left Zimbabwe, a few back teeth missing due to cavities. I end up in London and I got my first dental exam abroad almost 8 years later. The only reason I went to the dentist was because the NHS offered free dental care for expectant mothers, I took the opportunity to have the free check up. Well I cannot remember most of what happened at that visit, but I did come out of there with a couple of black horrible mercury fillings in my back teeth. I never went back again. Partly because I didn’t have dirty teeth that anybody could see, my teeth where pearly white when I smiled, and I got compliments on how beautiful they were.

10 years later I move the USA, I chipped a tooth chewing on a piece of bread. That chipped tooth caused me so much agony because it rubbed against my tongue giving me some really bad mouth sores. I had dental insurance which I had never bothered to use, but I found a reputable dentist and made an appointment, again I couldn’t stand the discomfort. That dental visit was different for me, for despite my pearly looking white teeth, it turned out I had some problems with gum disease and a lot of plaque build up that had not been cleaned for some years, if ever. That dentist fixed my tooth, did a deep cleaning scrapping away the plaque and there was no need to extract any teeth. As a matter of fact, he was surprised how many of my teeth back there were missing.

You see, most good dentist will not remove teeth if they can help it, but they would rather save them. I came out of that dentist visit with a $25 000 dental plan on what I needed to be fixed in my mouth. I also came out with a variety of educational materials on gum disease. A dental hygienist taught me about the need and importance of flossing and the best toothpaste and mouth washes to use. My dental plan included the need to remove my other decayed teeth, which included all of my wisdom teeth. In the process learning that I don’t need my wisdom teeth and due to the location of these teeth it is difficult to get a good cleaning of them by regular brushing and they tend to harbor bacteria due to their location. I also needed root canal for that other tooth that had been painful and hypersensitive for sometime, but I had ignored and simply chewed with the other side of my mouth. I studied a little more about dental hygiene to discover the scary truth of the different health conditions that could affect my overall health if I didn’t start taking particular attention to my teeth and gums, and it was not limited to bad breath alone, medically known as halitosis, bad breath was to become the least of my worries. There were some serious if not some life threatening conditions that could come about just because of poor oral hygiene.

Is It About the Money when it comes to oral health ?

Socio economic Status and ill oral health is well documented. There is a body of evidence showing that poor oral health is associated with low socio economic status (www.dentalhealth.ie) Why is this important to understand? Well because when most of us leave home for the diaspora, our minds are set on making money by working constantly, going to school, ensuring family we leave at home are taken care of financially and during this process some people tend to neglect the oral health and sometimes overall health. Most people will not spend money on a dentist, unless of course its is because one cannot sleep during a bad sore tooth episode. And some will have a friend remove that tooth for them, sometimes using homemade tools. We all know that one uncle who will gladly and proudly use his skills. This is not an area of importance to spend our hard earned money. It may not be because one does not have the financial means, it could simply be because it may not seem that important. But would it make a difference if people knew otherwise?

Well oral health does hold important clues to overall health and wellbeing. Studies have shown that oral health can provide warning signs for other diseases or conditions.

A Relationship and Link to Heart Disease

Cardiologists (doctors that treat heart disease) and Periodontists (the dentist that treats gum disease) have debated this very link. A review of published studies finds that gum disease is by itself a risk factor for coronary heart disease.  (www.m.webmd.com) (Gum disease and Heart Disease). This study shows that people with moderate or advanced gum known as periodontal disease are more likely to have heart disease than those with healthy gums. The warning signs of for gums disease include: Red tender or swollen gums or other pain in your mouth. Most people will notice bleeding gums while brushing or flossing or eating hard food. Gums that seem to pull away from your teeth or receding causing the teeth to look longer than before. Chronic or persistent bad breath, a bad taste in your mouth. Teeth that are loose or separating from each other. Sores in your mouth. (https://www.perio.org)

I personally ignored some of these symptoms for a while. Note also gum disease is often silent, meaning symptoms may not appear until advanced stages of the disease. Being a cardiac nurse for almost 20 years, I have witnessed many patients who need open heart surgery who require teeth extractions due to poor dentine of their teeth, this will often happen prior to the surgery. The Cardiothoracic surgeon knows the ultimate high risk of infection after surgery associated with decayed teeth, untreated dental abscesses, and gum disease. Particularly endocarditis, (an inflammation of the inner layer of the heart).

Cancer and Oral Hygiene… this may shock some of you… but….

People with poor oral hygiene/dental care may have an increased risk of oral cavity cancer. Poor dental hygiene, especially in people who use alcohol and tobacco products, may contribute to an increased risk of oral and oropharyngeal cancer. Poor oral hygiene makes these individuals more susceptible to oral viruses that can cause these mouth and throat cancers. (www.cancer.net). The results of a study by researchers of men who had mild to severe periodontitis in some cases suffered from prostate cancer. These patients with the most severe form of prostatitis also showed signs of periodontitis. (deltadentalazblog.com). There is a link between poor dental care and breast cancer. You maybe 11 times more likely to develop breast cancer if you have poor oral health or gum disease. (Journal of Cancer Research or Treatment). The World Health Organization (WHO) reported a study that concluded that gum disease increases the risk of breast cancer. (www.totalhealthmagazine.com)

Other conditions have also been linked to gum disease, including pneumonia, this happens when the bacteria of the oral cavity causes respiratory diseases. Diabetic patients are more likely to develop gum disease, which in turn can increase the risk of infection. Inflammation that starts in the mouth seems to weaken the body’s ability to control blood sugars. Gum disease further complicates the diabetes because the inflammation impairs the body’s ability to utilize insulin. High blood sugars provide an ideal condition for infection to grow. (www.m.webmd.com). (Oral Health: The Mouth – Body Connection). Pregnant women who have gum disease are more likely to have babies that are born too early and too small.(www.totalhealthmagazine.com). While many other factors can contribute to low birth weight deliveries, researchers are looking at the possible role of gum disease. Some other mouth body connections under investigations include Rheumatoid Arthritis, Lung diseases ie chronic obstructive pulmonary disease, obesity and even infertility. (www.m.webmd.com).

Lets Tie This all together,,,,

Periodontitis or gum disease begins with bacterial growth in your mouth and may end if not properly treated with tooth loss due to destructions of the tissue that surround your teeth. Gingivitis or gum inflammation usually precedes periodontitis. All gingivitis progresses to periodontitis. Usually plaque builds up, causing the gums to become inflamed and easily bleed during teeth brushing as discussed earlier. If the condition is left untreated it progresses the inner layer of the gum and bone pull away from the teeth and form pockets. This space then collects debris and can become infected with bacteria. The disease can progress and the pockets deepen and more gum tissue and bone are destroyed. When this happens teeth are no longer anchored in place, they become loose and tooth loss occurs. Do not ignore red bleeding, tender gums. ( American Academy of Periodontology). Make that appointment to see a dentist. Let it not be a one time visit, schedule regular dental check ups that include cleanings and examinations of your mouth. While regular dental exams  and cleanings are necessary to remove this bacteria and plaque and tarter build up and detect gum disease, these dental check ups also could save your life. Learn how to floss if you do not know how. This is an essential part of taking care of your teeth and gums. Floss twice a day to remove the debris in between your teeth and food particles where your toothbrush cannot reach. My dentist recommends brushing teeth at least twice a day including the tongue, the last time before bedtime. I look at this way, if I do not brush and floss my teeth before bedtime, I imagine food rotting in my mouth overnight,,, morning breath anyone?

Fast forward some many years later, I am glad to report that I have not had anymore gum or teeth problems, my $25000 dental and periodontal bill is $0 after many dental visits. My ugly black mercury fillings have replaced by a composite resin that matches the colour as the rest of my teeth. I have had a couple of root canals, a few deep cleanings in the beginning. But that’s all in the past. I now maintain a regular dental cleaning every 6 months and once a year I get xrays of my teeth done, overall excellent dental/oral hygiene. If you have dental issues, start now to a healthy overall you.

 

Article was compiled by Ingrid Muhambi who is a guest blogger on this website. You can contact her via our usual email info@docbeecee.co.uk

 

 

About the author Ingrid Muhambi

Ingrid Muhambi RN/BSc, is a Registered Nurse who has been practicing in her profession since 1997. She graduated from the University of the West of Scotland with a Diploma in Higher Education Nursing and also has a Bachelor Of Science in Health Studies from the same institution. She started her career at the Royal Alexandra Hospital in Paisley Scotland and worked in the Coronary Care Unit (CCU) for almost 10yrs. She has remained and specializes in Cardiac Care and Cardiac Nursing for almost 20yrs. Having started her career in the United Kingdom, she now resides in North Carolina in the USA working for UNC/Rex Healthcare as an RN\Team Leader for a cardiac telemetry unit. She has a passion for health, with hopes of educating and getting the message about healthcare related issues to fellow Zimbabweans both at home in Zimbabwe and abroad in the Diaspora.

 

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BEFFTA blog of the year nominee

BEFFTA blog of the year nominee

By: Dr Brighton Chireka • 15th October 2016

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BEFFTA Blog of the year nomineee

 

By Dr Brighton Chireka

 
I am excited that our website docbeecee.co.uk has been nominated for BEFFTA Blog Of The Year 2016.
Let’s continue to stand together as Africans as we raise health awareness and demystify medical conditions.

Voting lines have been open since 26th September and will close today 16th October so please vote and help us bring the gong home.

 

Once again, thank you for the nomination and support, I am truly humbled !

 

For voting go to the link below and put your name and email address as instructed. Then look for blog of the year on nomination category and on nominee look for docbecee.co.uk and vote

 

CLICK HERE FOR BEFFTA VOTING

 

BEFFTA Awards is a distinctly special awards ceremony honouring the best showbiz and entertainment personalities in the black and ethnic communities in the UK, USA, Africa, Caribbean, Canada and globally. BEFFTA Awards is the first of its kind rewarding under one roof outstanding achievements and contributions from Africans, Caribbeans and Asians in entertainment, film, fashion, television and arts. This international prestigious ceremony celebrates an all round accomplishments of a hard working community within entertainment and showbiz especially the unknown talent that need exposure. The awards ceremony founded by Pauline Long also aims to inspire black and ethnic personalities worldwide to achieve at the highest levels. It provides a networking platform for industry personalities.

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Cancer in zimbabwe . ZNCR team

Cancer in zimbabwe 2014 report

By: Dr Brighton Chireka • 13th October 2016

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Cancer in Zimbabwe

By Dr Brighton Chireka

On Tuesday, the 11th October 2016, I was privileged to receive the ZIMBABWE NATIONAL CANCER REGISTRY (ZNCR) 2014 ANNUAL REPORT from the ZNCR Registrar Mr E Chokunonga. I must commend the ZNCR for working so hard to provide us with a more up-to-date information on the incidence and pattern of occurrence of cancer in Zimbabwe. I am passionate about cancer as I have lost very close relatives from Cancer of the Gallbladder, Cancer of the Prostate, Kaposi sarcoma to name a few and I also have very close people that that have suffered from breast cancer as well.

Zimbabwe National Cancer Registry (ZNCR)

The registry with its limited resources is achieving a lot due to committed and determined leadership by using what it has in its hands. The ZNCR is a voting member of the International Association of Cancer Registries (IACR) and the Union for International Cancer Control (UICC). It is also one of the founding members of the East African Registry Network (EARN) which became the African Cancer Registry Network (AFCRN) in 2011. The ZNCR has provided technical support to several other African cancer registries over the last two decades. It successful hosted the 2nd Annual Review Meeting of the African Cancer Registry Network (AFCRN) in Victoria Falls in January 2014.

Cancer in Zimbabwe in 2014

In 2014 the total number of new cancer cases recorded among Zimbabweans was 7018 comprising of 4037 ( 57.5%) females and 2981 ( 42.5) males. In 2013 the total number of new cases of cancer recorded among Zimbabweans was 6548. This shows a 7% increase in cases.

The nine most frequently occurring cancers among Zimbabweans of all races in 2014 were cervix uteri (19%), prostate (9%), breast (7%), Kaposi sarcoma (7%), non-Hodgkin lymphoma (6%), non-melanoma skin cancer (6%), oesophagus (5%), liver (4%) colo- rectal (4%). Of note is that prostate cancer has risen from 7% in 2013 to 9 % in 2014 and is the second most frequently occurring cancer in Zimbabwe. The good news is that Kaposi Sarcoma has come down from 10% in 2013 to 7% in 2014.

The most common cancer in Zimbabwe is cervical cancer

Cervical Cancer can be prevented

The leading cause of cancer among Zimbabwe black men in 2014 was prostate (23.1%). cancer followed by Kaposi Sarcoma(11.5%). In Zimbabwean black women the most common cancer was cervical cancer followed by breast cancer.

Breast Cancer

Death caused by cancer in Zimbabwe

A total of 2 474 cancer deaths comprising 1 192 (48.2%) males and 1 282 (51.8%) females were recorded in Harare and Bulawayo in 2014. The leading causes of the deaths were cervical cancer (12%), prostate (10%), liver (8%), oesophagus (8%), breast (7%), non-Hodgkin lymphoma (6%), Kaposi sarcoma (6%) stomach (4%), lung (4%).The other cancers constituted 35% of the recorded deaths.

The most notable observation in the data for 2014 is the striking increase in the incidence of prostate cancer as mentioned above. Cancer of the prostate is now by far the leading cause of cancer among Zimbabwean males. It was also the second leading cause of cancer mortality after cervical cancer in 2014. ZNCR is now calling for epidemiological investigation about prostate cancer in view of these findings

The incidence of HIV-related Kaposi sarcoma (KS) continues to decline. The incidence of KS was half that of prostate cancer among Zimbabwean males in 2014. It is important to note that other than these two cancers (prostate and KS), the pattern of occurrence of cancer has hardly changed in recent years.

 

Prostate cancer in detail

 
The registry gave us an analysis of cancers by stage of disease at diagnosis in 2013.The analysis showed that people were presenting very late when the cancer had spread to other parts of the body. It is now well known that the outcome is very poor when people present to their doctors too late.

 

The analysis by stage was also done in 2014, and the results are remarkably similar to those observed in 2013. However, most of the cases (71%) were not staged, and for those that were staged, the majority (84%) were in stage three and four. Clinicians need to make sure that they are staging the disease of the patients they manage . Information on stage is important for cancer management and is also important in determining survival.

 

I hope by compiling this article I am helping in raising awareness on the need to take cancer seriously and see our doctors as soon as possible. I also hope that my colleagues in the medical field in Zimbabwe will stage the disease of the patients they are managing.

What cancer staging is

According to Cancer research UK

Staging is a way of describing the size of a cancer and how far it has grown. When doctors first diagnose a cancer, they carry out tests to check how big the cancer is and whether it has spread into surrounding tissues. They also check to see whether it has spread to another part of the body.
Cancer staging systems may sometimes include grading of the cancer, which describes how similar a cancer cell is to a normal cell.

Why staging is important
Staging is important because it helps your treatment team to know which treatments you need. If a cancer is just in one place, then a local treatment such as surgery or radiotherapy could be enough to get rid of it completely. A local treatment treats only one area of the body.

If a cancer has spread, then local treatment alone will not be enough. You will need a treatment that circulates throughout the whole body. These are called systemic treatments. Chemotherapy, hormone therapy and biological therapies are systemic treatments because they circulate in the bloodstream.

Sometimes doctors aren’t sure if a cancer has spread to another part of the body or not. They look at the lymph nodes near to the cancer. If there are cancer cells in these nodes, it is a sign that the cancer has begun to spread. Cancer doctors call this having positive lymph nodes. The cells have broken away from the original cancer and got trapped in the lymph nodes. But it is not always possible to tell if they have gone anywhere else.

If cancer cells are found in the lymph nodes, doctors usually suggest adjuvant treatment. This means treatment alongside the treatment for the main primary tumour (chemotherapy after surgery, for example). The aim is to kill any cancer cells that have broken away from the primary tumour.

Types of staging systems
There are two main types of staging systems for cancer. These are the TNM system and the number system.
The systems mean that
* Doctors have a common language to describe the size and spread of cancers
* Treatment results can be accurately compared between research studies
* Guidelines for treatment can be standardised between different treatment hospitals and clinics
Some blood cancers or lymph system cancers have their own staging systems.

The TNM staging system
TNM stands for Tumour, Node, Metastasis. This system describes the size of the initial cancer (the primary tumour), whether the cancer has spread to the lymph nodes, and whether it has spread to a different part of the body (metastasised). The system uses numbers to describe the cancer.
* T refers to the size of the cancer and how far it has spread into nearby tissue – it can be 1, 2, 3 or 4, with 1 being small and 4 large
* N refers to whether the cancer has spread to the lymph nodes – it can be between 0 (no lymph nodes containing cancer cells) and 3 (lots of lymph nodes containing cancer cells)
* M refers to whether the cancer has spread to another part of the body – it can either be 0 (the cancer hasn’t spread) or 1 (the cancer has spread)

So for example, a small cancer that has spread to the lymph nodes but not to anywhere else in the body may be T2 N1 M0. Or a more advanced cancer that has spread may be T4 N3 M1.
Sometimes the letters a, b or c are used to further divide the categories. For example, stage M1a lung cancer (the cancer has spread to the other lung) and stage M1b lung cancer (the cancer has spread to other parts of the body).
The letter p is sometimes used before the letters TNM – for example, pT4. This stands for pathological stage. It means that the stage is based on examining cancer cells in the lab after surgery to remove a cancer.
The letter c is sometimes used before the letters TNM – for example, cT2. This stands for clinical stage. It means the stage is based on what the doctor knows about the cancer before surgery. The stage is based on clinical information from examining you and looking at your test results.

Number staging systems
Number staging systems usually use the TNM system to divide cancers into stages. Most types of cancer have 4 stages, numbered from 1 to 4. Often doctors write the stage down in Roman numerals. So you may see stage 4 written down as stage IV.
Here is a brief summary of what the stages mean for most types of cancer.
Stage 1 usually means that a cancer is relatively small and contained within the organ it started in.
Stage 2 usually means the cancer has not started to spread into surrounding tissue but the tumour is larger than in stage 1. Sometimes stage 2 means that cancer cells have spread into lymph nodes close to the tumour. This depends on the particular type of cancer.
Stage 3 usually means the cancer is larger. It may have started to spread into surrounding tissues and there are cancer cells in the lymph nodes in the area.
Stage 4 means the cancer has spread from where it started to another body organ. This is also called secondary or metastatic cancer.
Sometimes doctors use the letters A, B or C to further divide the number categories – for example, stage 3B cervical cancer.

Carcinoma in situ
Carcinoma in situ is sometimes called stage 0 cancer or ‘in situ neoplasm’. It means that there is a group of abnormal cells in an area of the body. The cells may develop into cancer at some time in the future. The changes in the cells are called dysplasia. The number of abnormal cells is too small to form a tumour.

Some doctors and researchers call these cell changes ‘precancerous changes’ or ‘non invasive cancer’. But many areas of carcinoma in situ will never develop into cancer. So some doctors feel that these terms are inaccurate and they don’t use them.

 

Because these areas of abnormal cells are still so small they are usually not found unless they are somewhere easy to spot, for example in the skin. A carcinoma in situ in an internal organ is usually too small to show up on a scan. But tests used in cancer screening programmes can pick up carcinomas in situ in the breast or the neck of the womb (cervix).
This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Itchy legs

Dealing with itchy legs when running

By: Dr Brighton Chireka • 5th October 2016

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Dealing with itchy legs when running

By Dr Brighton Chireka

I promised to walk my talk and start exercising. This other day I was running and enjoying it when suddenly I felt pain and itchiness in my legs . I tried to persevere but the sensation was so overwhelming that I had to stop to scratch my legs . I was annoyed as I was eager to continue with my exercise. What made the situation worse was that no matter how much I scratched my legs , the itchiness did not seem to go away.

 

I know many of us have experienced this problem of itchy legs. But thankfully for us , we can do something about itchy legs and prevent this awful situation from disturbing our exercise routine. The itchy legs does not only affect runners, it can also affect those that are doing intense cardio exercises.

Why do runners get itchy legs ?

If the skin is dry it will easily itchy when one tries to exercise especially running. Dry skin can be caused by “over showering ” as too many showers can wash away some of the skin’s natural oils that keep it moist . It is advisable to apply lotion before exercising . I have found this very useful and I now make it a habit to “cream” my legs with moisturising creams before I start my workout.

 

Dehydration makes the skin dry and causes itchiness when we try to run. Cold weather usually has less humidity, which means we get exposed to dry air. We get dehydrated in winter because of the dry air . As we breathe we also lose our moisture so we need to drink enough. The challenge is that in winter we do not feel like drinking. Failure to replenish fluids in winter leaves us dehydrated which contributes to dry skin.
Lack of fitness can initially be the cause of itchy legs when one tries to go back to exercising. If one has been inactive for sometime , the blood vessels does expand on exercising. This expanding of the blood vessels causes a sensation that is perceived by our brain as itchiness. The good thing is that if one can work through the discomfort , the itchy legs should get better and eventually disappear.

 

The itchy legs can be due to the type of sports gear one may be wearing . The sweating caused by exercising can make the reaction worse and cause severe itching. It may be worth changing the sports wear and see if that helps . Sometimes workout gear made with moisture-wicking fabrics is the best as it minimises the amount of sweat that sticks to the skin during exercising.

In conclusion let me say this;

There are plenty of steps that we can take to prevent itchy legs . The following are some of the steps that I would recommend to everyone who may be suffering from itchy legs each time they try to run;
– make sure that you are well hydrated by drinking enough fluids preferably water
– Use moisturising lotions after showering and before exercising.
– For women you may need to shave your legs even in winter .
– If you have been inactive for sometime , it’s best to keep on exercising to allow the body to adapt .
– Consider changing your laundry detergents or your sport attire if the above does not help.

Exercise induced urticaria

In rare cases some people do get what is called exercise induced urticaria. This is characterised by hives and severe itchiness . This can go away on its own after a few work out sessions but in some people it does not go away . In these cases I suggest you visit your doctor urgently as you may need medication to stop the itchiness and swelling .

I look forward to hearing from you about your experiences with itchy legs when running . Kindly leave me any tips that you have used to get rid of the itchiness.

This article was compiled by Dr Brighton Chireka, who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG

 
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Cure for HIV infection

A cure for HIV infection reported

By: Dr Brighton Chireka • 3rd October 2016

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A cure for HIV infection reported

By Dr Brighton Chireka

HIV infection is no longer a death sentence and research continues to find a cure for HIV infection. A 44 year old British man with HIV infection is the first of 50 people to complete a trial treatment designed by scientists and doctors from 5 of British leading universities. The results are so far encouraging as early tests on this British man have shown no sign of the virus following treatment.

The study for a cure for HIV infection

This study is a big collaborative effort involving 5 leading British universities and funded by Medical Research Council. Around 50 volunteers, all recently infected with HIV , were put on standard Antiretroviral drugs until the virus was almost undetectable, and then given a drug normally used in cancer treatment – to make the virus reveal itself( deactivate dormant HIV) .The participants also received a therapeutic vaccine that helped the immune system to recognise the virus and destroy the infected cells. The trial to flush out the virus and prompt the immune system to recognised it is now called the “kick and kill approach ”

 
HIV is able to hide from the immune system in dormant cells where highly sophisticated modern testing cannot find it, and therefore resist therapy. The treatment being used in this research endeavours to trick the virus into emerging from its hiding places and then trigger the body’s immune system to recognise it and attack it.

Currently we know that Antiretoviral drugs alone are highly effective at stopping the virus from reproducing but do not eradicate  the disease, so must be taken for life.

 

The findings of a possible cure of HIV infection are a cause for celebration but we are still a long way to go before this treatment can be deemed successful. Previously we rejoiced that some people had been “cured” only for virus to re-emerge a few years later. The researchers in this study are not sure if the virus has actually gone forever hence the continuation the usage of antiretroviral drugs .

 

Why should we be cautious about a cure for HIV infection?

It is difficult to declare a patient clear of HIV as attempts in the past backfired . The case that comes to mind is that of a girl in Mississippi who was put on a strong course of antiretroviral drugs within 30hrs of her birth in 2010 after her mother was found to be HIV positive. Treatment continued until the hospital lost contact with the mother 18 months later. When mother and child reappeared five months later the baby had no detectable virus in her blood, raising hopes that early intervention was a cure for HIV. This was sadly not the case as two years later the virus re-emerged.

The only person believed to have been cured was Timothy Ray Brown, an American treated in Germany. He needed a bone marrow transplant to replace his own cancerous cells with stem cells that would remake his immune system; his doctor found him a donor who was naturally resistant to HIV infection due to a genetic mutation that blocks HIV from entering the cells in the human body.

Sadly other HIV infected patients that had bone transplant have not been cured as their donors were not naturally resistant to HIV infection.

You may want to read more on HIV below

 

AIDS is no longer a death sentence; Getting to Zero transmission is our aim!

 

 

This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG

 
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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God and doctors

Does God prohibits people from consulting doctors?

By: Dr Brighton Chireka • 2nd October 2016

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Does God prohibits people from consulting doctors?

By Dr Brighton Chireka

It pains me when I see children and women dying from preventable diseases and God being used as reason why these people refuse to consult the doctors. Does it mean that if we go to the doctors or take medicines we lack faith in God ? Is it an accident that one of the disciples of Paul was a medical doctor. Should people like myself feel bad that we are both physicians and Christians ? As a pastor, we have prayed for a lot of sick people and have seen many miracles , but also as a doctor we have treated several people who got well. I am not going to judge anyone but will present my views with a passion . You are welcome to join in the discussion.

The people that get miracle healing have have faith and belief in God but God’s ways are not our ways . At times He expects us to use one of his good gifts – doctors to treat us. We know that God’s power begins where our ability ends.

Is it not interesting that those that refuse to go and see doctors , do take their cars to the mechanic when damaged or not functioning properly. One would expect them to pray to God to fix their cars instead of taking it to the mechanic. Our God is just as capable of fixing a car as He is of healing our bodies. The fact that God can and does perform miracles of healing does not mean people should always expect a miracle instead of seeking help of doctors who posed the knowledge and skills to treat.

Refusing treatment from the doctors and trusting God to keep you healthy is in a way testing God , unless we do so in response to His guidance. We know that it is sinfully to test the lord. Matthew 4 v 7 “Jesus answered him, “it is also written: Do not put the Lord your God to the test ”

I feel strengthened by the scriptures when I read about Luke. Paul refers to ” Luke , the beloved physician” ( Colossians 4:14). What I like most about this verse is that Paul does not say, “beloved Luke, who used to be a physician before he discovered the power of Christ”

Was Asa prohibited to consult physicians by God ?

In 2 Chronicles 16:12 we read that, “In the thirty-ninth year of his reign Asa was afflicted with a disease in his feet. Though his disease was severe, even in his illness he did not seek help from the LORD, but only from the physicians.”
Some may take this verse to mean that Asa was not supposed to consult the doctors. The issue was not that he consulted physicians , but that ” he did not seek help from the Lord.”
The same applies to us today when visiting a doctor, our ultimate faith is to be in God , not the doctor.

What did Jesus say about physicians ?

Jesus, in answering the Pharisees as to why He spent time with sinners, said to them, “Those who are well have no need of a physician, but those who are sick” (Matthew 9:12 )
Mark 5:25-30 relates the story of a woman who had trouble with continual bleeding, a problem that physicians could not heal even though she had been to many of them and had spent all of her money. Coming to Jesus, she thought that if she but touched the hem of His garment, she would be healed; she did touch His hem, and she was healed.

Mentioning of medicines in the bible

In biblical times there was not the wide range of medicines available to us today and yet the Bible is not devoid of positive reference to the use of medicine. For their medicinal qualities, the good Samaritan used both wine (an antiseptic) and oil (Luke 10:34). Paul urged Timothy to use wine to help a stomach condition (1 Timothy 5:23). Again, this is using medicine. Also applying bandages (Isaiah1:6), leaves (Ezekiel 47:12)

We need to take ownership of our health

Failing to plan is planning to fail so they say. It is wise that we plan for our future . Proverbs 6:6-8 says “Go to the ant , you sluggard; consider its ways and be wise! It has no commander , no overseer or ruler , yet it stores its provisions in number and gather its food at harvest.”
Proverbs 27:12 “The prudent see danger and take refuge, but the simple keep going and pay the penalty”
This wisdom applies to our health . We are what we eat and do after eating. Preventative healthy habits such as eating and sleeping well, drinking enough water , doing regular exercise will gradually improve any person’s health and give them the strength to do whatever God has given them to do . But if we lack wisdom and let our bodies fall into disrepair , we rush sudden sickness or injury that can cripple us.

 

Let me conclude by saying the following:

God created us as intelligent beings and gave us the ability to do certain things like making medicines and repairing our bodies . There is nothing wrong in applying that knowledge and ability towards physical healing . Doctors should be viewed as a gift from God but they are not God. They can sometimes help but there will be other times when they cannot . Our ultimate faith and trust should be in God , not doctor or medicines. Placing our faith in the Lord involves giving him the right to tell us not to use a doctor if the Lord should ever so lead, as well as giving him the right to tell us to use a doctor, even if we would prefer not to use a doctor.

 

I would like to hear from those that do not use doctors . Their comments are welcome in this debate as I have presented a one sided view .
This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

.

 

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Depression is a disease

Explaining what is Mabayo / Isihlabo

By: Dr Brighton Chireka • 29th September 2016

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Explaining what is Mabayo /Isihlabo 

By Dr Brighton Chireka

Mabayo is a Shona word or Isihlabo in Ndebele ,  that is causing a lot of debate among the Zimbabwean community. Questions are being asked as to what actually is “Mabayo”. Some have even suggested that it means pneumonia which is chest infection. The question that remain unanswered is if Mabayo is pneumonia why is it that some get it in their lower tummy area? Is it still chest infection when one is getting Mabayo in the groin area.

The problem lies in people not understanding Mabayo hence the confusion when people try to come up with a definition. I will try to explain what Mabayo is and hopefully bring the debate to an acceptable conclusion.

Mabayo / Isihlabo is a symptom

Mabayo is a symptom and as such it is a subjective evidence of a disease , while a sign is evidence of disease. Mabayo is a phenomenon that is experienced by the individual affected by the disease , while a sign is a phenomenon that can be detected by someone (doctor , nurse etc) other than the individual affected by the disease.
The problem comes when people try to diagnose themselves and start giving their symptoms such as Mabayo a diagnosis such as pneumonia (Chest infection) . Mabayo like stomachache, lower-back pain, and fatigue,are symptoms and can only be felt by the patient; they are subjective – others only know about it if the patient tells them

The better you can describe your pain or Mabayo the easier it may be for your doctor to find the cause of the pain and treat your pain. Information that is helpful to your doctor includes:

1-How long you have had your Mabayo
2-Where you feel it
3-Whether it is in one spot or spread out
4-How it feels and how severe it is
5-Whether it is constant or comes and goes
6-What activities make it worse or improve it
6-How it limits what you can do
7-How often it occurs and how long it lasts
8-Anything that triggers it 

Keeping a pain diary or record of your Mabayo is a good way to track what triggers it as well as symptoms over time. Be as specific as possible. Some words that can help you describe the way your Mabayo includes:

 

Aching (kurwadza)
Cramping ( Kuruma-ruma)
Fearful ( anondityisa )
Gnawing (  anondishupa ndinobva ndashaya chekuita)
Heavy ( kutsimbirirwa)
Hot or burning ( Kupisa)
Sharp (  akapinza)
Shooting (kunge magetsi)
Sickening (ndoda kurutsa)
Splitting ( kutsemura chaiko)
Stabbing (kubaya-baya)
Punishing or cruel ( kunge kutochwa chaiko)
Tender ( side rese kudzimba)
Throbbing ( kuvhita kunge mune hurwa kana kunge katururu)
Tiring or exhausting ( ndonzwa kuneta kana kupera simba kana  atanga)

 

It is important for your doctor to know which of these symptoms you mean when you say, “I have Mabayo,” because the cause, diagnosis, and treatment are different for each symptom. If Mabayo are in chest area they could be due to chest infection such as pneumonia or it could be just muscular problem or anxiety. If Mabayo are located in the tummy then they could be due to diseases such as gallstones, kidney stones, appendicitis, pelvic inflammatory diseases, urinary tract infection to just mention a few . At times it could be just tummy upset , constipation or muscular strain.

 

Your doctor will come up with the right diagnosis if you explain your Mabayo fully without hesitating. Focus mainly on how you are feeling and not what you have read here or what others have told you about Mabayo. Mabayo is a pain symptom that can be located in the chest or abdominal area and can be like a spasm, cramp, ache, pins and needles and is caused by several diseases. Your job as a patient is to describe your Mabayo clear so that you get the right diagnosis and right treatment at the right time.

 

This is not only our problem

Patients both English or African often use the word “dizziness” when they are talking about a variety of symptoms, including:
* Vertigo (a feeling of spinning or whirling when you are not actually moving).
* Unsteadiness (a sense of imbalance or staggering when standing or walking). This sometimes is called disequilibrium.
* Lightheadedness or feeling as if you are about to faint (presyncope). This may mean there is a heart problem or low blood pressure.
* Dizziness caused by breathing too rapidly (hyperventilation) or anxiety.

It is important for your doctor to know which of these symptoms you mean when you say, “I am dizzy,” because the cause, diagnosis, and treatment are different for each symptom.

 

Just be yourself and express your symptoms  in simple terms answering the questions being asked by your doctor . Do not worry about memorising medical jargon , it’s not your area but your doctor’s, who will come up with the right diagnosis.
This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Talking about emergency contraception

Talking about emergency contraception

By: Dr Brighton Chireka • 26th September 2016

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World contraception day 26th September 2016 talking about emergency contraception 

By Dr Brighton Chireka

Today is the world contraception day and I am taking this opportunity to raise awareness about emergency contraception which is popularly known as the morning after pill. Emergency contraception is just for the morning after the night before when something did not quite go to plan. Accidents do happen in all walks of life and sex is no different. Emergency contraception does offer a second chance to prevent pregnancy after having unprotected sex or if your contraceptive method has failed – for example, a condom has split or you’ve missed a pill.

What is emergency contraception?

These are pills used to stop,or delay the ovaries from releasing an egg or devices that work by changing the lining of the womb that may prevent implantation of a fertilised egg. Time is of the essence here so for best chance for it to work , it should be taken as soon as possible after unprotected sex .

Emergency contraception is not intended for regular use and does not protect against Sexual transmitted infections or HIV. After using emergency contraception one should use another form of contraception for the rest of the cycle to protect themselves if they do not want to become pregnant. However if you use the IUD as emergency contraception, it can be left in as your regular contraceptive method.

Types of emergency contraception

There are two types , one is the emergency contraceptive pill popularly knows as the morning after pill. The other type is the Intrauterine device (IUD) or coil. With the pill there are two kinds of emergency contraceptive pill- the Levonelle and ellaOne. Levonelle has to be taken within 72 hours (three days) of sex, and ellaOne has to be taken within 120 hours (five days) of sex. Both pills work by preventing or delaying ovulation (release of an egg).

The IUD can be inserted into the uterus up to five days after unprotected sex, or up to five days after the earliest time one could have ovulated. It may stop an egg from being fertilised or implanting in the womb.

Points to remember about emergency contraceptive pill

  • The pill can make you feel sick, dizzy or tired, or give you a headache, tender breasts or abdominal pain but this mild and does not last long.
  • The sooner you take the pill , the more effective it will be.
  • The pill can make one have their period earlier or later than usual. See your doctor if your period is more than seven days late as you may be pregnant.
  • If you’re sick (vomit) within two hours of taking Levonelle, or three hours of taking ellaOne, seek medical advice as you will need to take another dose or have an IUD fitted.
  • If you use the IUD as a regular method of contraception, it can make your periods longer, heavier or more painful.
  • You may feel some discomfort when the IUD is put in – painkillers can help to relieve this.
  • There are no serious side effects of using emergency contraception.
  • Emergency contraception does not cause an abortion.
  • Levonelle and ellaOne do not continue to protect you against pregnancy. This means that if you have unprotected sex at any time after taking the emergency pill you can become pregnant.
  • Levonelle is fairly safe whereas so can taken by anyone whereas ellaOne is not recommended in those with asthma and for those breastfeed they have to stop for seven days after taking it. ellaOne does also react with other drugs as shown below.

What to do after taking the emergency contraception

Depending on the reason for taking the morning after pill , you may want to start or resume a regular form of contraception. If you have taken Levonelle, then you should:

take your next contraceptive pill, apply a new patch or insert a new ring within 12 hours of taking the emergency pill ( for ellaOne wait for 5 days before your next contraceptive pill). You should then continue taking your regular contraceptive pill as normal but you need additional contraception, such as condoms, for:
the next seven days if you use the patch, ring, combined pill (except Qlaira which needs 9 days), implant or injection. As for the progestogen-only pill you need just two days.
Please contact your doctor after taking the emergency pill if ;

you think you might be pregnant
your next period is more than seven days late
your period is shorter or lighter than usual
you have any sudden or unusual pain in your lower abdomen (this could be a sign of an ectopic pregnancy, where a fertilised egg implants outside the womb – this is rare but serious, and needs immediate medical attention)

The emergency pill and other medicines

The emergency contraceptive pill may interact with other medicines. ellaOne cannot be used if you are taking the following medicines , as it may not be effective. Levonelle may still be used with the following medicines , but the dose may need to be increased. Speak to your doctor or pharmacist for further advice.

These medicines include:

the herbal medicine St John’s Wort
some medicines used to treat epilepsy
some medicines used to treat HIV
some medicines used to treat Tuberculosis (TB)
medication such as omeprazole (an antacid) to make your stomach less acidic
There should be no interaction between the emergency pill and most antibiotics but if you are taking rifampicin or rifabutin you must not use ellaOne

Where can I get emergency contraception?

You can get the pill from a pharmacist without a prescription or you can get it from your doctor. Family planning clinics , sexual health clinics and genitourinary medicine clinics will all be able to supply patients with emergency contraceptive pills.

Regular contraception

Having written about emergency contraception it would not be right if I do not put emphasis on the need for a regular method of contraception. If you are not using one , you might consider doing so in order to lower the risk of unintended pregnancy. Long-acting reversible contraception (LARC) offers the most reliable protection against pregnancy, and you don’t have to think about it every day or each time you have sex. I will cover LARC in one of my articles in the near future.

We must also not forget to have safe sex and prevent against Sexual Transmitted Infections. I would like to hear from you about your experiences in trying to get emergency contraception.

 

This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Travelling is good

Travelling is good for our health and wellbeing

By: Dr Brighton Chireka • 24th September 2016

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Travelling is good for us 

By Dr Brighton Chireka

Growing up in the rural villages of Zimbabwe, I used to get excited when a trip to visit the capital city, Harare, was being arranged. The night before the trip would be very long as the excitement will be overwhelming. I would be the first one to wake up and be ready to travel before my elders were even awake. The thought of travelling brought happiness and excitement to me.

Studies have shown that travelling offers health benefits to our mind , body and soul. We have all travelled and we can attest to the excitement that comes from being in a new environment. Travelling is not only exciting, it offers health benefits which I will cover below.

Travelling promotes the health of our heart

As a child the day of travelling would see us walking to the bus stop which was a few miles away . The rushing to the bus stops and now through airports as well walking on beaches promote physical activity. Physical activity lowers blood pressure and the risk of heart disease and stroke. Framingham heart study found that women who vacationed only every six years or less were nearly 8 times more likely to develop heart disease or have a heart attack compared to women who travelled at least twice a year. I would suggest that we must take a holiday at least twice a year to stay healthy.

Many companies are generous as they allow most of their workers at least 4 weeks of paid annual leave. Let us not use that time to go and do another job. We must use that time to travel and in the process improve our health.

Let’s have time for a good sleep when travelling

Let’s talk about sleep problems

 

Travelling is good for our mind

As we travel our brain is challenged by new environments and new experiences. This will increase cognitive stimulation and has been shown to improve both our memory and concentration. We know that staying mentally active is as important as staying physically active. We stay mental active by travelling as we meet new people , cultures , situations and experiences which will help our mental wellbeing. It is also advisable to visit different locations and not stick to the same spot every year. Our brain will benefit from the different activities associated with the new locations we may visit each year.

Most of us in the diaspora tend to just go back to Zimbabwe and visit the same locations. We are denying ourselves some of the benefits that are associated with traveling to new places.  It is cheaper and also good for our brain if we travel to some nice places in Europe or America as well as in other African countries.

Travelling relieves our stress levels

We all get stressed at times and struggle to carry on with our lives. The routine of our lives may be making us more stressed and putting ourselves out of that daily routine and see new environment will relief that stress. Travelling has been noted to relief our stress according to a 2012 Expedia survey. The survey found that 89% of travellers could let go of stress and just relax only a day or two into their trip. No more excuses that we do not have time because having something to look forward to, even if it’s a two or three-day trip can feel rewarding. The mere panning of a vacation boost our morale as we look forward to the things that we will be doing on holiday. Further studies have shown that travelling can lower levels of depression and improve our mental wellbeing.

We sometimes overwork ourselves which is not good for our health. Studies have shown that workers who take time off are more productive, have higher morale and are less likely to be stressed or burnout. Those that have been on holiday will agree with me that we experience less stress and we are more satisfied with our mood and outlook after returning from a trip compared to non- travellers.

Do not overwork yourselves

Overworking – killing me softly with this work

We are not worse off

When we are stuck in our usual environment we tend to feel bad about our situations. We tend to imagine that our personal problems are the worst in the world. When we travel we may see people who are worse off than us. This will make us realise that our problems are not as bad as we previously thought. This will help in lowering any stress or depression that may be affecting us. We will learn to value what we have in our lives and that will promote our mental wellbeing and stop us from being anxious and worry over little things.

Have time to eat some good food as well

Healthy eating , what diet should I follow

 

Travelling improves bonding with our loved ones

I will digress a bit on the issue of bonding with our loved ones. The family is the engine room that sustain us. It is the taproot that provides us with all the “nutrients” that we need to manage our daily life activities. We must have time to travel with our family and make the most out of it .

Our lives are so busy that at times we do not have enough time for our families and friends. We need to create time for our families as they are very important to us. Family is the people we depend upon. They know us better than anyone else and we can call on them whenever we need a hand. Before we have friends , teachers , colleagues and partners , we have family. Spending time with our family will make us realise our own strengths and weaknesses. We learn how to support each other. However and whenever we need them, the people we call family will be there – but it takes effort.

 

Family time

Family time

 

We need to build the bonds from an early age by setting aside time for the family. It’s not only about travelling together , it also include things that we take for granted such as eating dinner together every night .It’s easy to think ‘we see each other all the time, we can do it another time’, but once you fall out of the routine it’s much harder to schedule it back in there. Remember that this is not time you get to opt out of. Take time to have a one- on-one when you are on holiday and also try to find things that you all enjoy.

We need to be “present when travelling with family”
We are now good at multi-tasking in our busy lives, but when we are spending quality time travelling with family we need to stop answering phones or checking emails or posting on social media. If you have children remember that you are their role model . Every move you take is being watched . If we spend all the time on the phone during family vacation then we are giving them the impression that they can pull out their hand held games and not participate in family activities. As our children grow they must know that if they are in trouble they can talk to us. By being there from the beginning means they are more likely to come to you when they really need your help.

 

I hope that after reading this article you will be called to action and go ahead in booking that long overdue vacation. Enjoy your vacation and make the most out of it .

 

Please do leave me a comment telling me how travelling has enhanced your life and your health .
This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Chocolate

Chocolate good for us ?

By: Dr Brighton Chireka • 16th September 2016

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So is chocolate good for us after all?

By Dr Brighton Chireka

Growing up in Zimbabwe my favourite or the only chocolate I could afford was called Chomp. Chomp is a brand of chocolate by Cadbury. During the 1970s Chomp bars were sold in Australia with the catchphrase “Ten cents never tasted so good”.

This chocolate was affordable so we would buy it each time we get some spare change but we were not allowed to indulge in chocolates. We were rightly told that it was not good for our teeth as it had too much sugar and also that we would put on too much weight due to high fat content in the chocolates.

Research on chocolate is continuing all the time, and some studies are showing that chocolate is good for the heart, circulation and brain. It is also suggested that it may be beneficial in diabetes as shown by the Luxembourg study.

Luxembourg chocolate consumption study

 

Now a study in Luxembourg has come up with interesting findings. This study examined the association of chocolate consumption with insulin resistance. 1153 individuals, aged 18–69 years, were recruited to participate in the study. The results suggested that chocolate consumption may protect against insulin resistance ( insulin resistance leads to diabetes mellitus)

Read about diabetes

Let’s talk about diabetes

 

Insulin resistance

When we eat food it gets absorbed into the bloodstream in the form of sugars such as glucose and other substances. This increase in sugar in the bloodstream signals the pancreas ( gland located behind stomach ) to increase the secretion of a hormone called insulin. This hormone allows for sugar in the blood to move into cells so that can be used for energy.

In insulin resistance the body’s cells have a diminished ability to respond to the action of the insulin hormone. To compensate for the insulin resistance, the pancreas secretes more insulin resulting in more insulin. Over time, people with insulin resistance can develop high sugar levels or diabetes as the high insulin levels can no longer compensate for elevated sugars.

 

Causes of insulin resistance

It is thought that the principle cause of insulin resistance is obesity. One theory suggests that central obesity (too much fat around the belly) causes the fat cells to become starved of oxygen and die.
It is thought that the body reacts with an inflammatory response which then sets off the start of insulin resistance.

Diets high in saturated fats, trans-fats, refined carbohydrates and processed foods have been closely linked with chronic inflammation disorders and insulin resistance.

Symptoms of insulin resistance

One of the earliest and most noticeable symptoms of insulin resistance is weight gain, particularly around the middle.
Further symptoms include:
* Lethargy
* Hunger
* Difficulty concentrating (brain fog)
* High blood pressure is another common symptom which is caused by high circulating levels of insulin in the blood

If insulin resistance develops into prediabetes or type 2 diabetes, the symptoms will include include increased blood glucose levels and more of the classic symptoms of type 2 diabetes.

 

Conclusion

More research is needed before we all rush to indulge in these chocolates. The take home message is that maybe an occasional intake of chocolate ( dark chocolate, with a cocoa percentage of around seventy per cent or more) may be acceptable. However overindulgence will be bad for our health as it will cause us to put on weight which will lead to us getting diabetes. Current research has shown that cocoa can have a beneficial effect with regards to maintaining healthy vascular tone and insulin sensitivity, the reverse is true for sugar. Sadly eating sweetened chocolate is still not good for us !

 
This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG

 
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

 

Reference :

LUXEMBOURG STUDY

 

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Tension headaches

Let’s talk about tension headaches

By: Dr Brighton Chireka • 13th September 2016

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Tension headaches

By Dr Brighton Chireka

We have or we will all experience some form of headache at some point in our lives. Sometimes we panic fearing for the worst when there is no need for that. The headache that the majority of us experience is tension headache. In most cases we do not need to see a doctor if we have occasional episodes of tension headaches. The big question is how do we know that this headache is tension type and when should we seek urgent medical advice ? I hope this article will be able to answer some of these questions.

What is tension headache ?

This is a headache that feels like a constant ache and usually affects both sides of the head . One may feel pressure behind the eyes or tightening of the neck muscles. Some describe it as feeling like a tight band around the head . This headache is mild and does not usually stops you from doing your everyday activities. It usual lasts 30 minutes to several hours but in some instances can last for several days.

Tension headaches are classified as primary headache. This means that they are not caused by an underlying condition. Other primary headaches include cluster headaches and migraines. I am only covering tension headaches for now and will cover the other two in my next articles.

When should you seek medical help ?

There is no need to see a doctor if you get occasional headaches. See a doctor if the headache is now occurring several times a week or if it’s getting worse.

You should seek urgent medical advice if your headache is ;
coming on suddenly and is unlike anything you have had before
– Accompanied by a very stiff neck , fever , nausea ,vomiting, seizure, double vision and confusion
– happening following an accident especially if it involves a blow to the head
– accompanied by weakness, numbness, slurred speech or confusion

 

What causes tension headaches ?

We do not know the exact cause but certain things have been shown to trigger tension headaches. These are :
Dehydration
Tiredness
Stress and anxiety
Poor posture
Squinting
Missing meals
Lack of physical activities
Noise
Bright sunlight
Certain smells

How do we treat tension headaches ?

These headaches are not serious so they can be managed with simple painkillers or lifestyle changes.

What are the lifestyle changes ?
Relaxation techniques help with stress-related headaches . The techniques include:
Massage
Exercise
Yoga
Even applying a hot flannel to the forehead and neck .

Pain killers should be used for a short time otherwise overuse of them may lead to medication-overuse headaches developing.

Medication overuse headache

 

How to prevent tension headaches ?

It is advisable to keep a diary of your headaches to try identify what could be triggering them. Some people find that they can control their tension headache by altering their diet or lifestyle.

Exercising regularly and relaxing helps to reduce the stress and tension that triggers tension headaches .
Maintaining a good posture and making sure that one is well rested and well hydrated can help in preventing tension headache.

Other measures

Acupuncture has been known to prevent chronic tension headache
Amitriptyline may be use to prevent these headaches and I find it very useful in my patients who have chronic tension headache.

 
This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG

 
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Belvedere medical centre

Belvedere Medical centre putting Zimbabwe on the world map

By: Dr Brighton Chireka • 7th September 2016

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Belvedere Medical centre putting Zimbabwe on the world map


By Dr Brighton Chireka

Two weeks ago I flew from Victoria falls to Harare after the ZIMA congress and had a 24hr stop in Harare. I then decided to visit one medical centre in Harare to see how things are run there. I always make it a point that each time I am in Zimbabwe I must visit one health centre and learn more about it. I have visited Parirenyatwa and Harare hospitals and I did travel at one point all the way to Karanda hospital in Mount Darwin. I have written about these hospitals and this time I am going to write about Belvedere medical centre.

Belvedere Medical Centre (BMC) is situated at 189 Samora Machel and Blakeway. BMC caters for both up market clientele ,the working population, and the busy entrepreneur . Its location provides easy access for residents in Belvedere, Harare North, Harare East and Harare South.

 

Dr Simbarashe Makuni
I had the opportunity of meeting Dr S T Makuni who is the clinical director and co founder of Belvedere medical centre. What a humble man who is soft spoken and down to earth . His passion for saving lives and charity work to help the underprivileged members of our society resonates well with me. Dr Simba Makuni’s motto is that, “Human life is sacred and it is our business to safeguard that sacredness”

 

I also met his staff whose customer care was excellent and patients were speaking highly of some of the nurses. It is pleasing to get good feedback about nursing care in Zimbabwe. We tend to hear about the bad practice of some nurses but not at BMC. The centre is very neat and smells very nice and one will mistake it for a hotel .

Zimbabwe Investment Authority awards 2015

On the 23 October 2015 BMC scooped 2nd Runner Up spot in the Investor of the Year Award For The Most Innovative and Promising Investor In The Small to Medium Enterprises Category. This award by the Zimbabwe Investment Authority shows the hard work and determination character of the whole team at BMC. I am confident that they will continue to save lives and make a difference in the health of our people in Zimbabwe.

Partnership with hospital in India

BMC Hospital is now in partnership with SPS Hospital from India. This partnership will pave way for the provision of advanced medical services locally in Zimbabwe and to promote BMC Hospital as a medical tourist destination in Africa. I await a day when people will be flocking to Zimbabwe for holiday combined with medical treatment at places like BMC.

Services provided at Belvedere Medical Centre (BMC)

BMC has the invested in efficient and quality equipment and experienced staff and service software in order to ensure the delivery of top quality service to all its patients. The centre has capacity to handle traffic of 100 out -patients per day. BMC is a one stop shop offering a comprehensive range of testing and procedures and the convenience of an on -site pharmacy. The pharmacy is open from 8 am to 10pm .

They also offer ambulance services for prehospital assessments and the efficiency of their service is first class. I used their service when a relative needed an ambulance and was impressed with their efficiency.

BMC’s services encompass various dimensions of wellness by carrying out the following initiatives such blood pressures measurements , health checkups, body mass index calculations, blood sugar tests, vaccinations and cervical cancer screening.

Cervical cancer screening

They offer VIAC service at BMC. Visual Inspection with Acetic Acid and Camera, or VIAC, is an effective way to prevent cervical cancer in women. It involves examining the cervix for changes that might lead to cancer. If these changes are detected early, the cells can be eliminated before they become cancerous.

This “screen-and-treat “approach is an effective, low-cost way to reduce the incidence of cervical cancer in low-income countries. The disease is caused by the human papillomavirus (HPV), and it is the leading cancer killer of women in Zimbabwe and other sub-Saharan African countries.

BMC offers home visits to those that are unable to come to the medical centre. They also run a travel clinic where one can get travel advice and vaccinations.

 

Diaspora product

BMC has come up with a solution to help people in the diaspora. Some of you will remember that I had a company in 2007 that facilitated the people in diaspora to support their loved ones back home. BMC has taken this further and come up with a medical debit card. This allows people in the diaspora to open an account for their loved ones from anywhere in the world and deposit money straight into that account without sending money to an individual who may misuse it. We know that many times we have been told that so and so is sick and we send money so that they get medical attention. Instead of seeking treatment, the money is misused or sometimes it doesn’t even get to it’s intended beneficiary.

 

BELVEDERE MEDICAL CENTRE HARARE

 

This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer:Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with or the official position of Belvedere Medical Centre.

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Be honest with your doctor

Be honest with your doctor

By: Dr Brighton Chireka • 6th September 2016

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Be honest with your doctor

By Dr Brighton Chireka

The doctor–patient relationship is central to medical practice and is essential for the delivery of a high-quality service. It forms one of the foundations of contemporary medical ethics. Be honest with your doctors as this relationship relies on trust. Trust is considered the corner stone of effective doctor-patient relationships. Without trust patients may well not access services at all, let alone disclose all medically relevant information. Doctors will not be able to offer a safe and effective medical service if patients are not truthful with their medical information.

Research has shown that at least 25 % of patients do not tell the truth , exaggerate, or purposely leave out details during consultation with their doctors. Several reasons are given as to why many patients do that. Maybe some feel ashamed or they just want to avoid being told off by their doctor. No matter whatever the reason I would suggest that it is better to be honest with your doctor. Your doctor is your advocate and is there to support you. If you do not feel supported or listened to then you may consider registering with another GP and start afresh.

Healthy eating and exercising

Doctors want to know the eating habits of patients and also need to find if the patients are active. Many a times when I ask some patients , they start to fidget and avoid eye contact with me . They then try to “please me ” by saying that they eat a healthy diet and exercise regularly. What then surprises me is that my examination and investigations tells me an opposite picture. This then causes problems when it comes to discussing treatment options. Doctors have heard so many stories so nothing will shock or surprise them. It is best to tell them nothing but the whole truth so that they can work with you to come up with a treatment option that suits you perfectly. It is fine to spoil yourself once in a while but be honest about it when asked by your doctor.

Taking of medication

75% of people have problems taking their medication as directed. Some do not even pick up their prescriptions. Others do not even tell their regular doctors about new drugs given to them by other health professionals . There are several medications on the market and if one does not suit you tell your doctor who will be able to review your medication and offer you an alternative. Medicines do not work if you do not take them. It is dangerous if you overdose or take less that recommended. You might even become resistant to it , meaning that the medication stops working altogether. This may mean that you will need to be put on expensive hard to find drugs which you may not afford. We are sadly noticing drug resistance in those who are not taking their Antiretrovirals as directed.

Be honest all the time

My message to every reader of this column is that please be honest with your doctors . Tell them the whole truth and make sure that you have mentioned your ideas , concerns and expectations about the consultation with them. Lying to your doctor does not pay as at the end of the day it’s your health that you are putting at risk. Be honest about your alcohol intake , smoking habits and your lifestyle. Your doctor is not there to judge you but is there to help you to live a healthy life. Make it easier by taking ownership of your health and also raising your hands up if you are not coping well.

I would love to hear from you about things that make you lie to your doctors and also what can be done to make you feel free to open up to your doctor.

This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Health of our political leaders

Should we know the health of our political leaders ?

By: Dr Brighton Chireka • 1st September 2016

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Should we know the health of our political leaders?

By Dr Brighton Chireka

The question of the public’s right to know about the health of their political leaders versus the leaders’ right to privacy is an ongoing debate worldwide. No country has to my knowledge come up with a proper legislation to address this issue. One would have hoped that countries like America would have clear guidelines yet the truth is that they do not have the code of conduct to deal with the health of their leaders.

In America the debate is currently taking place about the health of Clinton or Trump. Presidential candidates do not undergo any kind of independent medical examination and they are not required to release their medical records either. The two candidates have shared some medical information with the public but what they have shared is not the full story. The things that people want to know about their leaders’ health unfortunately has not been revealed.

The same problem is also faced by Africa where we witness the tight lipped of the leadership on their health. Commenting or even writing about the health of political leaders is risky and dangerous as one may be arrested or even be killed. We all know that diseases affect anyone and death will also visit everyone so there is no need to be secret about it. The media is like a hungry predator, which if not fed with information, will prey upon anything in its path. One would hope for a daily medical bulletin on the condition of a political leader who may be admitted in a hospital. Failure to do that can disabilise the country or scare investors.

The lack of clear rules and reporting conventions can cause dramatic turn of events each time a political leader is suspected to be unwell. You will notice the marathon of reporting in both the national and international media including self-claimed journalist on social media as well. We must remember that the health of political leaders has far-reaching implications on the running of a country and its people .

The doctors treating the political leader have a duty to their patient of keeping their patient’s medical information private and confidential. Concern about patient privacy and confidential­ity is as old as the practice of medicine itself. It is central to the doctor patient relationship so it must be respected. By its nature, health care is very personal, and patients have always told doctors things they would prefer that others not know. The desire to protect privacy is in part an outgrowth of a basic human desire to live free of intrusion, judgment and prejudice. The dilemma comes when the public wants to know the health of their leaders. Doctors can only go public if given the permission by the patient so it’s pointless to pester them.

 
The debate is we all know that everyone is entitled to privacy but when a person goes into public life, he or she must understand there is sadly a price to pay when they run for public office. Being a public servants means putting the interests of the public ahead of yours. If a private matter affects the performance of the officeholder’s duties , most people would agree that it is no longer private. So, for example, the president of the United States submits to a yearly physical, which is made public, because his or her health is of such key importance to the nation.

I would like to say that illnesses that affect job performance of any leader may be legitimate subjects of inquiry. Behaviours that might impede performance, like substance abuse, are matters of public interest. Failure to make these issues public through a guided media will result in a media free-for-all. Sometimes we see other doctors giving commentary about the condition of a political leader out of speculation. This is unwarranted and causes great harm to the nation. If only the politicians could know and make the information public in order to save the nation.

Examples of political leaders that did not reveal their health

There are many examples of the public’s lack of knowledge regarding the health of its leaders. In the U.S. for instance, President Woodrow Wilson is reported to have hidden the fact that he suffered from heart disease and high blood pressure, and suffered a major stroke during his term in office. His condition was not disclosed to the American public, and his wife, along with his advisors, essentially ran the country.

President Franklin Roosevelt, is reported to have hide his polio and concealed hypertension and heart failure.

President John F. Kennedy is reported to have suffered from Addison’s disease, which he covered up, and his doctor even went so far as to lie about it.

In Africa and Zimbabwe in particular , the health of our political leaders is kept secret. As a doctor I will respect the right of these politicians to privacy but when prominent people in our communities talk about their health ,it raises awareness and end the stigma to some of the diseases that we face. I hope we can debate and come up with clear guidelines to deal with the publicising of the health of our political leaders.

What do you think ? Please join in the discussion.
This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Medical tourism

The hidden costs of medical tourism revealed

By: Dr Brighton Chireka • 29th August 2016

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The hidden costs of medical tourism revealed

By Dr Brighton Chireka

We all like to travel and spend sometime on holiday. It is good for our health as we cannot work all the time without a break. While on holiday we can combine that trip with our medical treatment. Some just go to overseas countries for medical treatment only. There is now an industry that is catering for people who want to combine their treatment and luxury. Medical Tourism (MT) is that industry.

Medical tourism is sometimes described as the best way to enjoy luxury while getting excellent medical treatment. It is mainly for people who do not have health facilities in their own country that can perform certain procedures. Some people prefer medical tourism if the cost is cheaper than their country of origin or if they do not trust or have confidence in their own health system. Some use medical tourism as a status symbol and would seek overseas treatment for services that are locally available.

We see a lot of people in Zimbabweans shunning their local facilities in preference to those in countries like India , Malaysia, Singapore and South Africa. We are all guilty of this and sadly we are seeing even the heads of states, government officials , business people , medical doctors etc seeking medical treatment outside Zimbabwe. Some of the treatments that we are seeking from overseas health institutions are locally available.

The financially less advantaged people are also fundraising in order to get funds to go overseas for treatment. With all this rush to seek treatment outside Zimbabwe , no attention is being given to the impact of this “medical tourism rush” to our country. I will try to look at the impact of this rush and also discuss some solutions which hopefully will make you change your mind about our health system in Zimbabwe.
Majority of people use medical tourism as they perceive it to be “cheaper”. I have been involved in medical tourism for several years now and would like to share with you my experiences. As already stated above, I hope after reading this article you will be wiser in making a decision about medical tourism.

Cost of healthcare in Zimbabwe

The cost of healthcare in Zimbabwe is relatively high and majority of the people cannot afford it. Zimbabweans have been looking outside their borders for medical treatment and countries such as India are preferred as there are perceived to be cheaper. I welcome some reductions in the cost of medical services that are already taking place. May I say thank you to those health practitioners that have reduced the cost of consultation fees and also to those that have reduced the cost of operations. This is a step in the right direction and it will go further if the whole country does the same as these health professionals cannot go further down if the cost of living remains high.

Surely should we celebrate sending people to India ?

I have heard of success stories and even our media recently published an article about 7 patients that returned from India after open heart surgery. What did not come out clear in that article is that all those patients could have been operated at Parirenyatwa. We now have basic equipment at Parirenyatwa to carry out open heart surgery although more funding is needed to be able to carry out other procedures such as Coronary Artery Bypass Grafting (CABG) . We need Cath lab for that and the resources we are using to send people to India can be channelled into buying equipment for the lab.

A catheterization laboratory or cath lab is an examination room in a hospital or clinic with diagnostic imaging equipment used to visualize the arteries of the heart and the chambers of the heart and treat any stenosis or abnormality found. This will help our country to be able to treat heart attacks quickly and effectively.

A paper presented last week at just ended ZIMA congress by one of the “heart surgeons” in Zimbabwe clearly highlighted the impact of Medical tourism on their operations. The local surgeon highlighted the lack of resources and equipment but what touched me was the lack of patients. How can we have lack of patients when we are sending several of them to overseas countries ? This means that our local surgeons will lose their skills as they are not having enough people to operate. Some of these surgeons may end up leaving the country and our health system will remain in ruins.

The quality of some of our local health facilities is not too bad and with support as well as good committed leadership, will be able to compete at the international level. The support has to start from the highest level in Zimbabwe and the rest will follow suit in using our local facilities. Some of our local facilities have a long way to go to meet the international standards and it is our duty to make sure that they improve and are properly funded, run and led.

Benefitting overseas countries
Countries like India are now known for Medical Tourism and this gives the country a good image and many people would want to visit it. This will result in huge foreign currency earnings for the country . Jobs will be created and hotels as well as airlines will see a lot of business coming their way.

Some problems in overseas countries
Medical tourism in these countries is run by private companies and specialists leave government hospitals to go and work in the private sector. This means that the public sector in countries like India may end up losing as most of the specialists will be in the private sector. The local population will suffer as they cannot afford the cost of health care in the private sector.

Solutions that may help governments promoting Medical Tourism

A committed leadership is needed and laws needed that medical tourism benefits everyone such as requiring private hospitals to treat the local population at a low fee. We know Medical tourism promotes ” internal brain drain” . Experienced health professionals are drawn to large urban centres and into large corporate run health institutions. Laws must be put in place that will require the specialists in the private to offer certain hours in the public sector.

Taking a closer look at the cost of some of the procedures.

Medical tourism may appear cheaper but my experiences tells me otherwise. I will share with you a true scenario to illustrate my point. I would like to discuss with you about a procedure called Total Hip Replacement . In short this is a surgical procedure that replaces a damaged hip with a new ” prosthetic hip” . This procedure aims to relieve pain and improve mobility.

Total Hip Replacement currently cost 11 000 USDollars in Zimbabwe whilst in India it cost 7 500 USDollars . At first look it appears that one is likely to save 3500 USDollars. Please wait a minute as I explain to you the whole process. The patient will need to go with someone to India so 2 return tickets to India will cost approximately 3000 . When in India the accommodation of the patient is included but not for the accompanying person. The accompanying person will need food and accommodation and for 2 weeks the cost is approximately 700 USDollars. This already gives us a total bill of 11 200 USDollars which is now more expensive than the local cost.

Things can get worse and they do in reality. One hopes for the operation to go well and the patient comes back in 2 weeks having used about 12 000 including other minor expenses. In some cases the patient may develop infection which may prolong the stay in hospital at an extra cost and also patient may be slow to be fit to walk and may need more time. Any delay in getting better will mean more expenses for the patient and the accompanying person. The original cost does not include this extra stay or any complications.

In some rare but not uncommon circumstances things can get worse and the patient dies away from home. If that happens in India then one is looking at 2500 USDollars to repatriate the body back to Zimbabwe. This cost is not covered in the initial cost and it will have to be met by the family of the deceased. If the trip was funded by donations then another embarrassing call will be made asking for more donations to get the deceased back to Zimbabwe.

I do not want to scare you but I am addressing reality so that you are wiser in your planning and decision making about seeking treatment outside Zimbabwe. In most cases the operation is successful but a problem comes in following up. If one needs a review or develops complications having left India then they have to fly back. This is another cost that is never mentioned when one is told about how good medical tourism is. Also the regular doctor of the patient in Zimbabwe may not be aware of what treatment was done in the overseas health institutions. There are no arrangements made between the doctors in the overseas health institutions and the doctors in Zimbabwe.

Bringing the undesirables back to Zimbabwe

 

As we go to these overseas health institutions it means that we will be exposed to hospital acquired infections(HAI). Some of these HAI are new to Zimbabwe and treatment is not easily available . This means that we are now bringing severe infections into our country when our health system is struggling to cope with what it has already. Lots of lives will be lost just because one person decided to seek medical treatment overseas. The sad thing is that the treatment that was sought overseas is available and is of high quality in Zimbabwe.

Message to those that might be thinking of or are using medical tourism

Medical tourism is justified as a temporary measure if the expertise and health facilities are not available in the country of origin. If both the expertise and facilities are there then it is advisable to use local facilities. Make sure you are referred by your local doctor and you both agreed that it is the best option for you. When choosing the country to seek the treatment , make sure that you get more information about the overseas health institutions and their doctors. You would want to make sure that the health institution is properly registered and it offers high quality medical services. Make sure that the doctors are properly registered and have good reputation .

You must ask for a Patient Advice and Liaison Services (PALS). Excellent international hospitals will have some form of PALS. PALS offer confidential advice, support and information on health-related matters to patients, their families and their carers.

Make sure that you have taken an insurance to cover your death if things do not workout well or have resources put aside for this.

Ask for follow up arrangements and make sure that these will be agreed and communicated to your regular doctor in Zimbabwe.

Make sure that medical tourism is carefully governed and watched by the government you intend to visit so that your rights as a patient or tourist are safeguarded.

Message to my colleagues in the medical profession

At times we do not address the issue of death properly. It is high time that we start these discussions early when a patient is faced with a terminal illness. Failure to address this issue will give patients false hopes and the inappropriate use of the meagre resources that they may have. Desperate patients and relatives will end up going to overseas country for no reason trying to find a cure for a terminal illness. It is better to be open with your patients and then give them the option to seek a second opinion if they so wish. Many patients will take your advice and prepare for their death rather than traumatising themselves with unfruitful trips to overseas medical institutions.

If you decide to refer your patients to overseas institutions , you should ask to be kept informed on the treatment and progress of your patient and discharging of the patient must be discussed with you. You should have directed contact with the health professionals who will be treating your patients.

A challenge to the local health professionals is that why can we not join in this medical tourism industry and make Zimbabwe a place to visit for luxury and affordable quality medical treatment?

Conclusion
Let me conclude by saying that It is my hope that one day I will open the newspaper and read the following advert:

“Visit the Victoria Falls in Zimbabwe, one of the Seven Natural Wonders of the World, for a safari , with a stopover for plastic surgery , a nose job and a chance to see lions and elephants”

This hope of our healthcare system rests with the radicals, the heretics and mavericks in our midst; the people who are willing to stand up, think outside the box, challenge the status quo and make change happen because they can see that there is a better way.
This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at ‪info@docbeecee.co.uk‬ and you can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Tear gas

Do we know the effects of tear gas on our health?

By: Dr Brighton Chireka • 26th August 2016

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Do we know the effects of tear gas on our health?

By Dr Brighton Chireka

We are witnessing a population that has had enough of the suffering and is now protesting. Sadly the government of Zimbabwe is as usual deploying the riot police fully equipped with tear gas . The main aim is to disperse and frighten the citizens but no attention has been or is being given to the health effects of that tear gas. I have tried to ask some of the riot police if they knew the effects of the gas on themselves and those people they are trying to chase away. The honest answer I got was, “we do not know and we do not care all we want is for you to stop demonstrating ”

Immediate effects of tear gas

I have been involved in demonstrations during my days as a student at University of Zimbabwe and have experience this awful tear gas . When this gas gets to your eyes it causes intense pain and secretion of tears and also mucous ( madzihwa) in the airways. Sometimes you feel as if you are suffocating or drowning and you try to gasp for air . The experience can be shocking as you feel as if you are about to die.

If you are a healthy and fit person the effects can last a few minutes to a couple of hours but it can last longer in those that have breathing problems such as asthma, or tuberculosis.

The challenge now is do we know what happens to victims of tear gas in the following weeks , months , or even years? I got the answer from one of the police officer that they do not care but myself I do care and I am worried . This is an area that has not been addressed and people continue to be tear gassed unabatedly .

CS gas

Tear gas is commonly known as CS gas a name derived from the first letters of the surnames of the scientist that discovered it . ( Ben Corson and Roger Stoughton) .
Sometimes methylene chloride is used as a solvent for the tear gas and it is known to cause cancer. The other solvent in which CS is dissolved is Methyl Isobutyl Ketone (MIBK) which is also classified as harmful.

Studies on tear gas

I have looked at research that has been done to look into this area and found that in Turkey studies have been done and the results are worrying. Victims of tear gas have been followed up by Turkey doctors and the results are showing that there is lung damage that occurs after exposure to the gas. Victims were found to have symptoms similar to asthma and also reduced capacity for their lungs to breathe properly. This is worse in those that already have underlying breathing problems.
In 2011 Chile temporarily suspended the use of tear gas after a university of Chile study linked it to miscarriage and foetal harm. Physicians for human rights in 2012 found that local doctors in Bahrain were reporting increased numbers of miscarriages in exposed areas. UN officials have also connected tear gas to miscarriage in the Palestinian Territories . CS gas is also known to damage the heart and liver as well

In Egypt , CS gas was reported to be the cause of death of several protestors in Mohamed Mahmoud street near Tahrir during the November 2011 protests.

These effects of the tear gas are not only seen in people involved in demonstrations. The CS gas does spread and cover a large area thereby affecting people who may be away from the scene of demonstrations.

What can you do to stop the effects of CS gas

Some News reporters are able to cover the riots regardless of tear gas because they wear gas masks, mask and googles. These work well but not everyone can afford them. If you have no protection then it is advisable to cover your mouth and nose with a handkerchief. Avoid being in a confined space, try to stand in fresh air. Remember that you will need to wash yourself and all clothes as the gas will remain on you and your clothes.

Any exposed skin should be washed with soap and water. Use shower to clean yourself and do not bathe. Don’t rub your eyes or face as this will make it worse.

Chemical Weapons Convention (CWC)

Use of CS in warfare is prohibited under the terms of the Chemical Weapons Convention (CWC) but domestic use is allowed. The reason is that if allowed for military use then other forces will end up using chemical weapons such as nerve agents. This does not make sense to me because we know that desperate governments do not follow the manufacturer’s guidelines on how to use tear gas. Research as stated above shows that it is not safe to use CS gas even in domestic cases.

In Zimbabwe we have witnessed tear gas canisters being thrown into confined places such as vehicles (Kombi). This is not only cruel but it is illegal . There are instructions on how to use and not to use the tear gas and I doubt if our police are fully trained. If this abuse of tear gas continues then a call for an export ban of the tear gas is justified. I have personally witnessed these riot police throwing tear gas canisters into halls of residence at the University of Zimbabwe.

Conclusion

A responsible government does not use dangerous chemicals on its own people regardless of disagreements . My question is why then do we allow tear gas to be used as a crowd control agent when studies are showing that it is not safe. Some governments use statement by the manufacturers that it is safe when independent research is showing otherwise. In view of the current research I call for the stoppage of the use of tear gas until the Zimbabwean government can show us the independent evidence that it is safe to use and that our police is trained on how to properly use it. We also need more research on the effects of tear gas on Zimbabweans who live within and near harare city centre. The health of a nation must not continue to be jeopardised in the quest to retain political power.

Reference

1- WIKIPEDIA ON CS GAS

2- STUDY IN TURKEY
This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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KISS

Keep It Simple Summary -KISS

By: Dr Brighton Chireka • 23rd July 2016

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Saturday 23rd July, KISS ( Keep It Simple Summary)

By Dr Brighton Chireka

For those that did not have the time to read our articles this week we covered a very important topic about overworking. As promised Every Saturday I will bring you KISS of all the medical articles that I will have covered in that week.

According to many studies , working too much is not good for your body or mind. Most studies conclude that the greater the number of hours worked per year , the greater the likelihood of premature death and poor quality of life . Overwork doubles the risk of heart attack and stroke and significantly ups the risk of depression.

I am seriously concerned at the number of sudden death that are occurring in the Zimbabwean Diaspora Community. Sadly these people are young and heart disease seems to be the cause of these premature deaths.

“A word of caution to Zimbos in the diaspora, do not spend your health gaining wealth. You will sadly spend that wealth trying to regain your health and that may be too late “. ~modified by Dr Brighton Chireka.

Overworking – killing me softly with this work

We also encouraged you to see your doctor regularly . For those in the UK you may be deregistered if you have not seen your GP in the last five years.

Are you registered with a general practitioner (GP) or a family doctor? When did you last visit your doctor? Do you attend for routine check-up and participate in screening for cancer? When you last saw your GP, did you feel listened to and are you following the instructions as directed? Have you gone for the next appointment? What is it that is stopping you from making full use of your GP? What are you doing about it?

 

Visit your doctor on time


This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Overworking

Overworking – killing me softly with this work

By: Dr Brighton Chireka • 20th July 2016

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Overworking – killing me softly with this work

By Dr Brighton Chireka

I remember dosing off as I was suturing a wound of a patient who had just been involved in a road traffic accident. I had been on call for 72 hours non stop as a Junior doctor and was exhausted. The patient I was suturing felt pity for me and even suggested that I stopped suturing her so that I could get some rest. That was back then and today the situation is still the same as we continue to overwork ourselves.

Overworking

We could not and cannot continue to work like this and we tried without success but should continue to highlight the toll of long hours on our health. According to many studies , working too much is not good for your body or mind. Most studies conclude that the greater the number of hours worked per year , the greater the likelihood of premature death and poor quality of life . Overwork doubles the risk of heart attack and stroke and significantly ups the risk of depression.

I am seriously concerned at the number of sudden death that are occurring in the Zimbabwean Diaspora Community. Sadly these people are young and heart disease seems to be the cause of these premature deaths. We need a study to look at why we are having a rise in sudden deaths. Whilst we are waiting for that study I saw it fit to look at our lifestyles and the results of similar studies carried out so far.

From a frying sauce pan into fire
Some years ago I decided to join the exodus to Unit K ( UK) for a two week vacation. That two week vacation has turned up to be at least sixteen years in the UK. Before I came to UK I used to hear about how easy it was to work and save money for a better future in Zimbabwe. We were being told stories of people who had come to the UK for six months only and managed to change their lives. As with many stories the devil is in the detail as I soon realised when I came to the UK.

On arrival into the UK I was welcomed by my brother at the airport . My brother had taken a few days off to be with me before returning to his working routine. I soon found myself spending a month staying at home watching television. I felt bad that I was not working like ” everyone” else that was in the UK. I was eager to join in so that I could earn some monies towards my future.

I found myself working as a health care assistant popularly known as BBC ( British Bottom Cleaners) in a nursing home before I finished my medical registration exams with the General Medical Council. I was keen to work as many hours as I could so that I could earn enough money for personal use and be able to send some to my parents and siblings back in Zimbabwe.

Let me digress by looking at the working time regulations in the United Kingdom so that you will understand my personal story and also do something about your situation.

The working time regulation in the United Kingdom

You cannot work more than 48 hours a week on average – normally over 17 weeks. For those under 18 they cannot work more than 8 hours a day or 40 hours a week. If one is over 18, can choose to opt out of the 48-hour week.

Opting out of the 48 hour week
This option has resulted in many of us overworking ourselves as we are allowed to choose to work more than 48 hours. An employer can ask an employee to opt out but cannot sack or treat that employee unfairly for refusing to do so. An employee can opt out for a certain period or indefinitely. This must be voluntary and in writing. Some workers cannot opt out such as those in the airline industry or ship crew to just name a few.

Cancelling an opt out agreement

If after reading this article and you want to stop overworking yourself you can cancel your opt-out agreement whenever you want – even if it’s part of your employment contract. You must give your employer at least 7 days’ notice. You may have to give more notice (up to 3 months) if you have a written opt-out agreement.

Personal experience with overworking

I was a very “flexible worker” in that I did not mind the shift pattern and was available at short notice to cover shifts if colleagues reported sick for work. One week I worked for about 18 hours daily. I would do a night shift from 8pm to 8am and during handover in the morning , there was always at least one day staff member missing due to illness. I would be asked to help cover the shift resulting in me doing an extra ” half shift ” from 8am to 2pm. I would then use one of the empty rooms to sleep and be ready to start another shift at 8pm.

This went on for six days working eighteen hours daily. On the seventh day I then decided to go home to collect new set of clean clothes. I was so tired that I was even dosing whilst waiting for the train. I missed my destination twice as I found myself sleeping in the train. Eventually after a struggle I managed to get off at my destination and went home for a quick nap. I remember being awaken by my phone around midnight. It was workplace people calling me as I had not turned up for the night shift. I was so exhausted to even be able to open my eyes. I apologised and told the manager that I was not feeling well and she understood why I was in that state.

I have given a personal experience so that my readers realise that I am not making up the story or that I have heard of it at a social gathering. This is the tip of the iceberg and fortunately for me I managed to reduce my working hours. Me passing my medical registration exams meant that I could follow my medical career. The reduction in my working hours was short lived as I am now struggling with the need to earn more. I have to discipline myself otherwise you will soon be saying, “rest in peace Dr Chireka”.

Reality in the United Kingdom

We work very long hours and in addition some of us have parental care making our weeks very arduous . We sometimes drink a lot of alcohol as coping mechanism but it is likely to aggravate rather that alleviate our problems.
Read my personal story with alcohol .

A personal story about drinking alcohol

We sometimes do shift work with frequent changes of shift between early , late and even night work. The role of the pineal gland and circadian rhythms is very interesting but, constantly changing the pattern of waking and sleeping with frequent changes of shift upsets the functioning of the brain and endocrine system.

Let’s talk about sleep problems

What does other studies have to say?

A study reported in the American Journal of Industrial Medicine found that people who worked in excess of 60 hours a week , but few than 70 hours , increased their risk of developing coronary heart disease by 63% compared to those who worked lighter schedules. Those who worked over 80 hours a week increased their risk by a shocking 94% . This study was based on 8350 participants in Korean National Health and Nutrition Examination Survey who were followed over a 10 year period.

This study is worrying to me as I know that some of friends in our community are working these hours. When workers spend so much time in the office or nursing homes, they may not have time to cook at home and so grab meals on the go. I remember surviving on take away foods as I did not have time to cook. We know that when we overwork we hardly exercise and also that excess working is stressful. We become overworked and stressed which is not good for our health.

Other research links long hours on the job to increased depression, anxiety, and insomnia, as well as weight gain and higher divorce rates. This is also true in our communities marriages are not lasting that long resulting in many single mothers struggling to cope with small children and a demanding job.

A Japanese study of 238 clerical workers published in the Journal of Occupational and Environmental Medicine found that employees who put in more than 60 hours a week had 15 times the rate of depression one to three years later, compared to their coworkers on more moderate schedules. A Kansas State University study of more than 12,000 participants also found increased depression among those who worked 50 or more hours weekly.

Benefits of working

I do not want people think that working is bad for their health. My message is that overworking is bad for our health . Studies have also found that those who work less hours like less than 30 hours a week actually have higher blood pressure and cholesterol levels than those who work between 31-60 hours.

It seems that staying at home without doing anything puts us too close to the fridge and the food cabinet. We may end up overeating without exercising as well . However some of these studies may not be 100 % true because some of the people stay at home due to ill health. This may mean that some of these people working less hours are already unwell and not that working less hours is making them ill. However in some it does as they do not eat healthy food, they smoke a lot and abuse alcohol .

In conclusion

Some governments and employers may not support healthy working schedules for employees so it’s up to the employees to make sure that their health is not put at risk. Some people will work right through their vacation. This may lead to higher earnings but less time to spend enjoying it . We need to get the balance between work and life otherwise our family and health will suffer.
If you’re locked into a job that causes you stress and demands that you work excessive hours, at the least you need to make every effort to fit in exercise, eating well, and doing some form of mental activity such as meditation that de-stresses you. Remember you can reduce your working hours without losing your job.

The bottom line, according to these and many other studies, is that working too much generally isn’t good for body or mind. The greater the number of hours worked per year, the greater the likelihood of premature death and poor quality of life as well as increasing the risk of developing heart attack , stroke and diabetes. Could it be one of the reasons why we are having high numbers of sudden death in our communities? I do not have the full answer but I am persuaded that overworking is part of the problem and the sooner we address it the better.
This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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MR PRESIDENT

Our healthcare needs urgent attention Mr President

By: Dr Brighton Chireka • 12th July 2016

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Our healthcare needs urgent attention Mr President

By Dr Brighton Chireka

Mr President Mugabe, the 22nd of August 2013 went down in our history as the day you were inaugurated to lead Zimbabwe for another 5 years. Today it’s now almost three years and our health system is no better but worse. I am blamed for trying to compare the health system of our country with the best in the world. I still maintain that Zimbabweans are not second class citizens and deserve the best. In my appeal to you as the President of Zimbabwe , I have taken time to read your Manifesto on Health that you published in 2013. It will be my basis for discussion and assessment of what has been achieved so far .

ZANU PF 2013 Manifesto on health;

“An overaching goal of the people is the improvement of the health delivery system to attain health for all. This is particularly important in view of the numerous challenges facing Zimbabwe’s health sector such as shortage of skilled professionals and healthcare staff, an eroded infrastructure with ill-equiped hospitals or clinics and lack of critical medicines and commodities. As part of its policy of health for all, Zanu PF will address these challenges as a matter of top priority over the next five years.”

Further Analysis of ZANU PF MANIFESTO ON HEALTH

Health for all

This phrase “health for all ” is now a joke as no one is taking it seriously especially coming from politicians. We do not forget what you promised us. We know politicians have short memory and easily forget their promises. May I remind you that you promised us a ” health for all” by 2000 and it’s now 16 years past that target. To the majority of us it is now becoming like its a “death for all ”

What are the challenges as identified by your party ?

You rightly pointed out that there is a shortage of skilled professionals and healthcare staff. Before we even talk of increasing the numbers of health professionals we need to make sure that we are taking care of the few that we have. It is common knowledge that happy health professionals means happy patients. The health professionals will go an extra mile if there are well looked after. Mr President you have failed to look after our health professionals and we continue to witness strike after strike by our health professionals. You promised us that as part of health for all, your party will address these challenges as a matter of top priority over the next five years. Three years have already gone and the situation is now worse and sadly we are not seeing any prioritisation of our health system.

 

According to you , we have an eroded infrastructure with ill- equipped hospitals or clinics and you promised to address that as a top priority. Our hospitals are still struggling to get the basic equipment. We want our government hospitals to have fully functioning equipment that is of world class. We cannot in this day and age give relatives specimens to take to private hospitals just because our government hospitals do not have functioning facilities to carry out the tests. If this issue is a top priority then surely it should have been addressed by now.

 

Your Manifesto mentions the lack of critical medicines and commodities. Sadly the budget that you have been allocating to our ministry of health is a joke to say the least. If it was not for the donor community and dedicated hardworking health professionals , our health system would have ground to a halt. We are sick and tired of hearing the rhetoric about the impact of the so called sanctions against Zimbabwe. If we are to accept that argument , then how come we are receiving more money in donations than what your government is allocating to our ministry of health. It is reported that in 2014 the government of Zimbabwe only allocated one million for the management of malaria whilst donors paid over 17 million .

Mr President stop underfunding our ministry

You, Mr President and your government are putting ” sanctions ” on the Ministry of Health. Year after year the budget allocation keeps dwindling and the Ministry of health has never been given the largest budget it rightly deserves.

 

As a nation let us learn to reflect on the effects of our actions and also let us not take the citizens of Zimbabwe for granted. We need an open discussions about these issues. We need to hear the strategy that is in place to address these issues. We are sick and tired of blaming the west for our own failures.

 

The people of Zimbabwe are forgiving and will respect a government that admits it’s mistakes and takes quick action to go back on track . Sadly Mr President we hear of sanctions every day and you know what, I agree that these so called sanctions ( travel bans) should be removed with immediate effect. We cannot allow this to be an everyday excuse to cover up for the lack of leadership and corruption that is going on unabated.

 

New strategy

I call for a new strategy to save our health system. This comes only if we have a committed leadership that value human life and is prepared to go an extra mile to make our health for all a reality. I do not care where that leadership comes from. What is important is that , the leadership must put its citizens at the heart of its decision making. That leadership must be prepared to serve the people and not focus of lining its pockets all the time.

Right to speak !

I thank you Mr President and I can reassure you that I wrote this article in my personal capacity as a concerned Zimbabwe. I am intelligent enough to know what I want as a citizen of Zimbabwe. This notion that anyone who criticise you is after regime change or want to topple you only shows how paranoid we have come as a people. Let us allow peaceful exchange of ideas and let us allow the bringing to account of the government of the day. That accountability is what I call for based on what you promised us. A promise is a credit and Mr President , you owe us a health for all !

 

 

This article was compiled by Dr Brighton Chireka, who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

 

Disclaimer: Views expressed here are personal and do not in any way, shape or form represents the views of organisations that Dr Chireka work for or is associated with.

 

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Bowel cancer

Bowel cancer demystified

By: Dr Brighton Chireka • 1st July 2016

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Bowel cancer demystified

By Dr Brighton Chireka

Bowel cancer is fairly common and it occurs mostly in Caucasians aged over 50. Studies are sadly showing that it is rising in black Africans. If bowel cancer is diagnosed at an early stage , there is a good chance of a cure. If diagnosed late then the less chance that treatment will be curative. Having said that, treatment does often slow the progress of cancer regardless of its stage. I welcome the announcement by MDC leader Morgan Tsvangirai as it helps in raising awareness about bowel cancer. My prayers goes to Morgan Tsvangirai and his family as he fights this bowel cancer. I am optimistic  that he will overcome it because studies are in his favour as far as treatment of bowel cancer is concerned.

Why soft spot for Morgan Tsvangirai ?

It is common knowledge that I was once heavily involved with the MDC. I was appointed by Morgan Tsvangirai to be his representative in the UK in March 2004. I was involved in organising his meetings in the UK when he visited in November 2004 soon after being acquitted of treason. I had  the opportunity to have one on one discussion with him and was initially impressed but the drama that followed made me quit politics. The party split over whether to contest the 2005 senate election, into MDC-T, the larger party still led by Morgan Tsvangirai, and the MDC -Ncube, a smaller faction then led by Arthur Mutambara and currently led by Welshman Ncube.

Raising health awareness

I hanged my political boots in 2005 and I am now focusing on raising health awareness amongst mainly the black communities in the UK as well as Zimbabwe. The message is now spreading to the rest of Africa and the world as well. I have been able to achieve this by using the social media and at times featured prominent people in our community talking about their health. I welcome the revealing by MDC President Morgan Tsvangirai that he was diagnosed with bowel cancer and is undergoing treatment. When prominent people in our communities talk about their health ,it raises awareness and end the stigma to some of the diseases that we face.

 

Bowel cancer

This is sometimes called colorectal cancer and colorectal means the colon and rectum. It is one of the most common cancers in the United Kingdom. It can affect any part of the colon but it’s most commonly found in the lower part of the descending colon , sigmoid colon or rectum as shown below

COMMON SITES FOR BOWEL CANCER

COMMON SITES FOR BOWEL CANCER

 

How does cancer begin?

Cancer begins in cells and cells are the body’s basic unit of life. Let me expand on what normally happens in our bodies and what can go wrong . The body is made up of many types of cells. These grow and divide in a controlled way to produce more cells that are needed to keep the body healthy. When cells become old or damaged, they die and are replaced with new ones. However, sometimes this orderly process goes wrong. The genetic material (DNA) of a cell can become damaged or changed, producing mutations that affect normal cell growth and division.

When this happens, cells do not die when they should and new cells form when the body does not need them. The extra cells may form a mass of tissue called a tumour . These cancerous cells can invade and destroy surrounding healthy tissue, including organs and spread to other areas, for example cancer of the bowel (tummy) can spread to the liver or lungs. This process of spreading is known as metastasis.

 

CANCER IN GENERAL

 

Bowel cancer in Zimbabwe rising.

 

In Zimbabwe colorectal cancer is traditionally thought to be rare but the diagnosis of this cancer in MDC president Morgan Tsvangirai gives us a different story. This is not only that Tsvangirai is a public figure but that the studies being carried out in Zimbabwe are calling for us to change our views on bowel cancer.

 

A retrospective study of colorectal cancer in Zimbabwe by Dr Katsidzira, Prof Gangaidzo and Prof Matenga which looked at cases from January 2006 to Dec 2011, demonstrates that colorectal cancer is as frequent a finding in Africans presenting for colonoscopy in Zimbabwe as it is among Caucasians. These African patients are often younger. The study also found that diverticular disease was present at higher that expected frequency among black African patients. This relatively higher than expected frequency of diverticular disease is possibly as a result of changes in dietary habits.

 

The “take away home message” is that colorectal cancer is an emerging challenge among black Zimbabweans. The public and doctors should be aware of the common symptoms such anaemia and weight loss in everyone regardless of the age. Bowel cancer in black Africans can present at a relatively young age, and thus young patients with the right clinical picture (symptoms) should be investigated just as thoroughly as older patients.

 

These findings that colorectal cancer is more frequently than common assumed should lead to the change in clinical practice among doctors in Zimbabwe and also funders should allocate more resources towards the prevention and treatment of bowel cancer. This is one of the reasons that I have decided to compile this article to raise awareness about bowel cancer. We used to think that it was rare but the truth of the matter is that it is rising in our community. The good thing is that it can be prevented and if diagnosed early it can be cured.

 

This does not apply to Zimbabwe only but there are other studies showing that colorectal is on the rise in Africa. A study on colorectal cancer trends in Kenya by Saidi H, et al showed that there was a 3-fold increase in the number of patients diagnosed with colorectal cancer at a single referral unit in Kenya between the periods 1993-1998 and 1999-2005.

 

What are the risk factors for bowel cancer?

 

Bowel cancer can develop for no apparent reason however there are certain risk factors that increase the chance that bowel cancer will develop. These risk factors include:
1- Ageing : In Caucasians bowel cancer is more common in older people . 80% of people who are diagnosed with bowel cancer are old than 60 years . In Zimbabwe it’s a different picture , black Africans are being diagnosed at a young age. One case reported in Zimbabwe is that of a 19 year old who was diagnosed with bowel cancer .
2-If a close relative has had bowel cancer
3-If you have colon disease such as ulcerative colitis or Crohn’s disease for more than 8-10 years.
4- Obesity
5- Lifestyle factors : not exercising , drinking a lot of alcohol.

 

REDUCING THE RISK OF GETTING BOWEL CANCER

REDUCING THE RISK OF GETTING BOWEL CANCER

Protective factors

People who eat a lot of fruit and vegetables have reduced risk of developing bowel cancer

HEALTHY EATING

So how do you know that you have bowel cancer ?

Let’s look at the symptoms of bowel cancer

At first it does not have any symptoms but as the tumour grows the following appears:
1- bleeding from the cancer . One may see blood mixed with faeces or blood can make faeces turn dark colour. The bleeding is not severe and may not be noticed but can lead to anaemia which will make one feel tired and look pale.
2- can pass mucus with the faeces
3- a change from one’s usual bowel habits causing bouts of diarrhoea or constipation
4- a feeling of not emptying the rectum after passing stool
5- Tummy pains

 

As the tumours becomes bigger and bigger the following can happen:
1- worsening of all symptoms stated above
2- one can feel generally unwell , tired or lose weight.
3- tumour can become bigger such that it can cause a blockage of the colon. This may results in severe abdominal pain, constipation and vomiting
4- the tumour can perforate the wall of colon resulting in a hole which can allow faeces to leak. This is a medical emergency and if not dealt with quickly can be fatal.

 

SOME OF THE SYMPTOMS OF BOWEL CANCER

SOME OF THE SYMPTOMS OF BOWEL CANCER

How is bowel cancer diagnosed?

If one has any of the above symptoms they are recommended to see their doctor without delay . The doctor will ask further questions and examine the person. Depending on the findings the doctor may decide to carry out some blood tests or refer the person urgently to the specialist.

A specialist will carry out further tests and the most common one is colonoscopy . Colonoscopy is the looking of the whole of one’s colon and rectum using a long ,thin, flexible telescope called colonoscope. The colonoscope is passed through the anus into rectum and colon.
Other tests such as barium enema or CT colonography can be carried out .
A biopsy is usually taken and send for examination to confirm whether the tumour is a cancer. A biopsy entails a small sample of tissue being cut from a part of the body in this case the colon.

 

Staging of the cancer

If one is confirmed to have bowel cancer then further tests will be carried out to find out if the cancer has spread out or its confined to the colon only. This is called staging of the cancer and its aim is to find out:

– Is the cancer only in the colon and how much of the colon is affected
– Whether the cancer has spread to the local lymph nodes
– Whether the cancer has spread to other parts of the body such as lungs, liver , bone or brain ( metastasised)
The staging may be finalised after operation and it helps the doctors to decide the final treatment and also to determine the outlook of the condition ( chances of survival).

 

Treatment of bowel cancer.

Treatment options include surgery , chemotherapy and radiotherapy. Treatment will depend on the stage of the cancer and the general health of the patient.

 

Please note in the treatment of cancer we do not talk of cure but we use the word remission. Remission means there is no evidence of cancer following treatment. If you are in remission , you may be cured however in some people the cancer can return months or years later . This is why we are reluctant to use the word cured.

 

I hope you found this article useful and it has added knowledge to you. I urge you to see your doctor without delay if you have some of the symptoms mention in this article. There is no need to panic as some of the symptoms are very common and can be caused by other simple diseases.

 

I would also love to here from you as always your comments add value to me as well . Also please help me in raising health awareness by sharing this article with your friends.

 

 

This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.
References
Saidi H, Nyaim EO, Githaiga JW, Karuri D.
World J Surg. 2008 Feb;32(2):217-23.
CORORECTAL CANCER TREND IN KENYA

 

Retrospective study of colorectal cancer in Zimbabwe by Dr Katsidzira, Prof Gangaidzo , M Mapingure and Prof Matenga
World J Gastroenterol. 2015 Feb 28; 21(8): 2374–2380.
Published online 2015 Feb 28. doi:  10.3748/wjg.v21.i8.2374

RETROSPECTIVE STUDY OF COLORECTAL CANCER IN ZIMBABWE

 

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Rest relax and enjoy

Rest , relax and enjoy

By: Dr Brighton Chireka • 24th June 2016

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Rest, relax and enjoy more beats!

By Bertha Mukodzani 

We are forever darting back and forth. Goals to achieve, places to go and problems to solve. Perhaps, we fear that life will pass us by if we don’t get a move on. Imagine the anticipation of an interview. Meeting that girl, the one you’ve been chatting with, for the first time. Nothing at all wrong with having a little bit of adrenaline pumping through our veins, spurring us on. But, the tide works against us when the excitement, the huffing, and puffing prolongs, turning into fatigue. That ‘lean, mean, grilling’ machine we call the body cannot cope. And before long, disease has found a home. So, it is time to stop and consider these consequences?

It’s not news that lack of rest and relaxation is detrimental to our health. And yet, we do not seem to take heed. Rest and relaxation imply that we allow ourselves the freedom from the cares of this world. That we give ourselves the opportunity to slow down and enjoy that well-deserved break. Could be a mean feat for some, considering the fact that we are not always in control of our circumstances. Challenges, troubles, and strife grip us when we least expect, sucking the life out of our very souls. Nevertheless, the body was not designed to continue gripping and grinding. It thrives when we give ourselves time to breathe and just be in the present moment. When we give nature a chance to revive and restore us.

The following are some of the ways in which the body is revived and restored:

Sleep – not only does sleep give our musculoskeletal framework a break, it gives our brain time to process and digest information absorbed during the day. It is a well-known scientific fact that people filter a lot of information in order to retain specific information, therefore, when you give the brain a chance to rest, it sorts and synthesises this information for retrieval from the long-term memory.

Rest also decreases the chance of us making mistakes, both at work and within the home as the mind is more alert, focused and rejuvenated. This, in turn, avoids the stress that comes with dealing with disgruntled colleagues as well as restless family members. The equation is that simple!

We often come across the expression ‘I need my beauty sleep. I use it quite often and I find after I’ve had a good night’s sleep when I look in the mirror the following morning, I like what I see. I do not see those unsightly bags under my eyes or so-called ‘panda eyes’. Not only that, my skin glows too. Nature’s way of letting me know the body is doing well!

Physical activity – there is scientific evidence to suggest that physical activity reduces the risk of developing chronic diseases such as coronary heart disease, diabetes, stroke, some cancers, mental health problems and musculoskeletal disorders. Not only that, physical activity has been shown to play a part in the reduction of psychological conditions such as depression, anxiety and other emotional disturbances. Relationships are also strengthened when we engage in physical activities as this encourages social interaction and give the mind that well-needed break from overthinking and focussing on what it cannot change.

Admire Nature – Flowers for example – Several medical studies, including The Harvard Home Ecology Study, have revealed that looking at flowers first thing in the morning brings about a feeling of relaxation, cheerfulness, and energy throughout the entire day. The magic is in their colours and scents. And here are a few examples:

a) The scent of lavender flowers has been found to contain compounds which lower the heart rate and blood pressure thus putting you in a relaxed state.

b) Blue/violet flowers are known as the garden’s harmonisers with their ability to help you feel serene and self-assured.

There are lots of flowers to pick from, so next time you pass by the flower shop pick one or two bouquets of your favourites. Better yet grow your own and pick whenever you choose, or just take the time to sniff or stare!

N.B. Please be mindful that some people may be allergic to certain flowers!!

Therefore, I encourage you to find that which enables you to relax at your very best and give yourself that well-earned break. Go fishing, play a game of cards with a friend, laugh, lie naked on the beach (okay maybe put some clothes on) and breath some fresh air or indeed spread a blanket under a tree and stare at the leaves rustling up a tree. Take off your load for a while.

Rest, relax and enjoy more beats!

References: The Benefits of Rest, Reprieve, Relaxation, and Rejuvenation by John A. Lanier.

The Ministry of Healing: Health and Happiness. http://www.bhg.com, http://www.bhg.com

BMJ, Harvard Family Health Guide

 

Bertha Mukodzani is a Nurse Practitioner and an Author of the book ‘A  Life Steered’ which can be purchased on Amazon . You can read more of her work on BERTHA MUKODZANI’S WEBSITE

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Mugabe's health

Mugabe’s health, the missing message

By: Dr Brighton Chireka • 22nd June 2016

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Mugabe’s health the missing message

how to prepare for the health issues we face as we reach the age of President Mugabe

By Dr Brighton Chireka

President Robert Gabriel Mugabe is the world’s oldest leader. He turned 92 years in February this year and despite his age, he continues to give lengthy speeches in public. However he has had at least a couple of incidences that brought his health into question. One incident was the tripping and another was the reading of the same speech that he had delivered a month before. When these incidents occur I get worried with the debate that follows, as those on the side of the president try to deny that these incidents ever occurred and those on opposition seizing the opportunity to call for his stepping down.

 

The political debate has and is still taking place and this article will not dwell on that but will try to focus on health of the elderly. I have personally tripped on carpet before and fallen down, my 3 year old son falls a lot and at work, I refer several elderly people to the falls clinic. My message is that we all fall sick one day and the sooner we prepare for it the better.

In our excitement about President Mugabe’s health, we must not forget the health challenges of aging. We must remember that just as planning for future financial needs or burial is important, so is planning for optimum health in old age. We may have lots of money but that money can make us go to the grave early if we do not pay extra attention to our health. We may be struggling to make ends meet but there are things within our control that we can do to have a better chance of reaching old age.

 

My encounter with President Mugabe

 

President Robert Mugabe was born on the 21st February 1924 and has outlived all his siblings and first wife. I first shook President Mugabe’s hand in 1986 when he visited Nyava show grounds in Musana area. He was 62 years then and his hand shake was so strong that I can still remember it. The next encounter was when he visited Kutama College in 1991 with Australian officials. My last encounter was in February 1992 when I shook his hand again as I was paying my last condolences for the death of his first wife Sally Mugabe. The body of Sally Mugabe was brought to Kutama rural area for the traditional send off and that year I was finishing my advanced level studies at Kutama college . In all these encounters I saw a fit elderly person whose health was defying his age.

 

How should we prepare for old age?

 

It would have been better if I had managed to personally interview President Mugabe about his health as young person. I would have liked to look at what he did or did not do and how it is impacting on his health as an elderly person. A great number of diseases can be prevented, forestalled, or minimized with a healthy lifestyle and regular health screenings. We all know that Mugabe was once in prison and also in the bush fighting but despite these experiences he is still going reasonable strong. Sadly though is that if the conditions in our prisons today were the same when Mugabe was detained , he would not be alive today. Sending anyone to our prisons is becoming like death sentence as the chances of dying are high.
This subject may seem irrelevant now to those in their teens but believe you me I was also a teenager and never thought that I will reach 40. Life expectancy in Zimbabwe was estimated to be 33 and then I just lived a day at a time . There are things that I wished I had done better but I am glad that I am working on those areas. I urge each one of you reading this article to reflect on your lifestyle and see if it can lead you to a good old age. We must know that old age is what lies ahead of us so we have to prepare for it . Failure to prepare for it means two things for us , it’s either we die young from preventable diseases or we die old but severely suffering that we wish we had died long ago.

 

Let me digress a bit

 

I remember going back to Zimbabwe in 2008 after being away from Zimbabwe for 8 years . I was eager to meet my old friends and was saddened each time I asked for their whereabouts . My question was always followed by a pause and then same answer kept coming – he /she is now at “kumbudzi” ( name of a burial place in Harare ). I was taken aback when I asked about a certain person who was very close to me .

 

He looked after me and offered me shelter but was not so luck with women. I remember talking to him as a medical student about the risk he was putting himself in by his lifestyle. Each time I came to see him when I was on my break from college I was certain to find him nursing a new sexual transmitted infection. He trusted me so he would confide in me and I made sure that I took him to see a doctor . At one point the doctor had to be blunt and said in Shona , ” Pawakabuda napo ndipo pachakuuraya” meaning that “he will die of sexual transmitted infection” . If I am to write about all the things that he did, most readers will think that I am now a fiction writer. I cannot reveal more details as I respect his confidentiality but even when he was alive he was not ashamed to tell all his friends that he had a new sexual transmitted infection. He told a group of us about what he did when he developed pubic lice . He went to buy an insecticide called ” killem” and sprayed it on his genitals and then used a comb to remove the dead lice on his genitals. He did the same to his partner and when he told me I was saddened by it and took him to see his usual doctor . He was treated and recovered from it .

His views was that he was capable of assessing a person whether she had STI or not. His assessment was pathetic to say the least so I will not dwell on it . I have taken much of your time trying to highlight the lifestyle of one person . He never used a condom even though I used to bring lots of condoms for him.

In 2008 when I asked about his whereabouts I was not surprised by the answer that I got from my friend. My friend said the following , I quote, ” If XXX had been alive today then there is no HIV and it does not kill as well”. He refused to be tested only to agree when he was on his death bed. He used to brag about how many STIs he had acquired and how fit he was. I remember leaving for UK in 2000 and looking at him from outside , he looked very fit and used to think that he was resistant to HIV. Sadly he died two years later at a young age.

We contract HIV by different means and most of the times it’s not our lifestyle but in a few it may be due to our lifestyle. The point is not about how we contracted the infection , the point is our attitude towards the infection. Nowadays if you get early treatment you are guaranteed to reach old age and live a near as normal life as possible. My message is that we must get tested and started on treatment as soon as possible.

As we share the articles talking about President Mugabe’s health, I would like us to pause and think what should we do to get to that age. We have the evidence that it can be reached and the good news is that a great number of diseases can be prevented, forestalled, or minimized with a healthy lifestyle and regular health screenings. The more you are like myself in the middle age , the higher the call to prepare for successful aging

I have been writing about our weight and DIABETES as we know that from research it is reported that about 75% of adults age 60 and older are overweight or obese. Obesity increases the risk of getting type 2 diabetes , cardiovascular diseases , breast and colon cancer, gallbladder disease and HYPERTENSION

 

As we grow older we tend to put on weight and this puts us at high risk of diseases . Some studies estimates that more than 40% of adults 60 and older have a combination of risk factors known as metabolic syndrome, which puts people at increased risk for developing diabetes, cardiovascular disease, and certain cancers. It is characterized ;

A bigger waist
High fat in our blood (cholesterol)
High blood pressure
Inability to control blood sugar levels ( insulin resistance )
Increased risk of developing clots
A tendency to develop inflammation

 

Looking at our joints

 

As we mature our joints take the knock from all the sporting activities we engage in , the high-heeled shoes we put on and the injuries we suffer as young kids. About 50% of the elderly populations suffers from arthritis and affects their mobility. Regular exercise now and avoiding overusing our joints is the best way to preserve them. Weight management is still very important for the health of our joints. The Framingham osteoarthritis study showed that a weight loss of just 11 pounds could reduce the risk of developing osteoarthritis in the knees by 50%.
Brittle bone disease ( osteoporosis ) affect almost 44 million adults age 50 and older, most of them women. Osteoporosis is not part of normal aging and healthy behaviours and treatment should allow us to prevent the condition or reduce its burden.

More than 33% of adults age 65 and older experience a fall in a given year. Almost a third those who fall suffer injuries that decrease their mobility and their independence. Sadly falls are the leading cause of death from injury in this age group.

 

What can we do to avoid osteoporosis

 

We need to stop smoking , watch our alcohol intake and get plenty if calcium in our diet . We must not forget the importance of the “sunshine vitamin ” –VITAMIN D. It is important to use sunscreens to protect against skin cancer, but sun preens blood the light rays needed by the body to make vitamin D. Remember that as we from older our skin becomes less efficient at making Vitamin D from sunlight.
We need to start exercising from now , it’s never too late as exercise helps to keep pour bones healthy . Do not delay , the sooner the better.

 

Looking at Cancer in older age

 

The risk of developing most types of cancer increases with age. As for women the rate of CERVICAL CANCER  decreases they age and endometrial cancer increases. As for men the risk of prostate cancer increases with age, and us black men have a higher rate than white men. We need to be aware of symptoms of  PROSTATE CANCER and how to prevent it.

We see a lot of young people smoking tobacco –  HEALTH EFFECTS OF SMOKING. yet it causes lung cancer. Lung cancer is said to account for more deaths than BREAST CANCER, prostate cancer, and colon cancer combined. My message to the young people is to stop smoking.

Looking at cardiovascular diseases ( diseases of the heart or blood vessels) as we grow old .

 

The incidents of cardiovascular diseases increases with age and are the leading cause of death in countries like America and studies are also showing that it will be the case very soon in Africa.

I am an advocate of HEALTHY EATING   and there is evidence to back me on that. A healthy lifestyle can reduce the risk of heart disease by as much as 80%, according to data from the Nurses’ Health Study, an extensive research effort that followed more than 120,000 women aged 30 to 55 starting in 1976. Looking at data over 14 years, the researchers showed that women who were not overweight, did not smoke, consumed about one alcoholic drink per day, exercised vigorously for 30 minutes or more per day, and ate a low-fat, high-fibre diet had the lowest risk for heart disease.

I have covered the topic of high blood pressure and highlighted the need to have it under control as it will reduce the rate of stroke and heart attacks. We need to cut done on salt and stop eating canned or frozen food or fast foods. Remember we are what we eat and do after eating.

 

Looking at vision and hearing loss as we age

 

The incidence of eye diseases such as cataracts and glaucoma increases with age. Smokers have been noted to have high risk of developing macular degeneration.
High-frequency hearing loss is common in old age and made worse by a lifestyle that includes exposure to loud sounds. The loud music that we subject ourselves in the night clubs is not good for us in the long run. Another factor is working in a noisy environment such as airports or factories . People at any age are advised not to put iPods directly into their ears.

Teeth and aging

 

We need to brush our teeth twice a day with fluoridated toothpaste , flossing daily and visiting a dentist regularly. Failure to do this will result in us losing our teeth.

 

Mental health and aging

 

We see a lot of senior people having problems with their memory and we even joke that we are having a senior moment when we forget things. Advice is the same , doing things that keep our hearts healthy will also keep our brain healthy. Exercising , controlling blood pressure, quitting smoking, and if we have diabetes, keeping it under control will help our brain and heart as well.
Many people that are of the same age as Mugabe cannot even remember their names or their homes. The reason is that most of then retired and stayed at home doing nothing. We know that staying mentally active is as important as staying physically active. It has been found that joining a book club, staying up to date on current events, engaging in stimulating conversations, and doing crosswords puzzle will help our mental wellbeing.

Preparing for retirement

 

Not everyone will be fortunate enough to be working at 92 years so we need to prepare for retirement. One of the biggest life changes is retirement. Many people have their sense of worth tied up with work. In retirement, depression and suicide rates rise. There are several voluntary projects that one can get involved with after retirement.

People tend to think that exercise is for young people , it is common knowledge that heads of states do have personal trainers to help them keep fit . We may not afford that we need to keep ourself active by even taking regular walks and or swimming .

In retirement we may need to make new friends , move to a new area , accept that family and friends may be gone or distant . Loneliness is inevitable but we have to prepare for it .

We must not forget about religion . For those who are Christians they know that Psalm 122 is always there for them . You should be glad to go to the house of the Lord. Old age may be the time to reconnect and focus on life after death

We know our lives today and we know our challenges , we need to make some strategic decisions about how we want to live our lives .

We know that much of the illness, disability, and deaths associated with chronic disease are avoidable through known prevention measures, including a healthy lifestyle, early detection of diseases, immunizations, injury prevention, and programs to teach techniques to self-manage conditions such as pain and chronic diseases. We have to take care of our parts as we do not know what the future hold for us. Hopefully we can reach the same age as Mugabe and still raring to go.

This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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World blood donor day

World blood donor day

By: Dr Brighton Chireka • 14th June 2016

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World Blood Donor Day

By Dr Brighton Chireka

Today is World Blood Donor Day and this day – 14th June has been celebrated annually since 2004. It’s aim has been to improve the safety and adequacy of national blood supplies by promoting a substantial increase in the number of safe , voluntary , unpaid donors who give blood regularly. Voluntary donors play an important role of putting others before themselves and in most cases it’s people they do not even know. This is an act of being selfless and today I join hands in thanking these kind people.

According to World health Organisation (WHO), about 108 million blood donations are collected globally every year. “Voluntary, unpaid blood donations must be increased rapidly in more than half of the world’s countries in order to ensure a reliable supply of safe blood for patients whose lives depend on it” , says WHO on World Blood Donor Day.

Blood is very important in saving lives and many countries all over the world struggle to meet the demand of blood. Blood can be used whole, or separated into its component parts, such as red blood cells, platelets, plasma, and other “substances” that can be used to treat a wide range of diseases. A single unit of blood can be used to benefit several patients.

Transfusions of blood and blood products helps save millions of lives every year, including during emergencies such as conflicts, natural disasters, and childbirth. It can help patients suffering from life-threatening conditions live longer and with higher quality of life, and supports complex medical and surgical procedures.

As we are celebrating World Blood Donor Day , I thought I should take an opportunity to talk more about blood.

What is blood made up of ?

We have the plasma which is the liquid part of blood and it makes up about 60% of blood volume . It is mainly made of water but contains many different proteins and other chemicals such as hormones, antibodies, enzymes , blood sugar, fat particles , salts etc.
Secondly we have blood cells which make up about 40% of the blood volume . Blood cells are made in the bone marrow and are divided into three main types.

Types of blood cells
1- Red blood cells ( erythrocytes ). These cells give the blood a red colour . Just a single drop of blood contains about 5 million red cells . Red cells contain a chemical called haemoglobin which binds oxygen and takes oxygen from the lungs to all parts of the body.
2- White blood cells ( leukocytes) . These are the soldiers of our body as there are part of the immune system. They are mainly involved in combating infection. There are different types of white blood cells such as neutrophils, lymphocytes, eosinophil, monocytes , basophils .
3- Platelets. These are tiny cells which help the blood to clot if we cut ourselves.

In order to receive blood safely there is need to make sure that it is compatible with the person receiving it. There is need to know the blood group of any individual . The mains reasons why we need to know blood group is when one needs transfusion or if one is pregnant.

What is blood group?
Red blood cells have certain proteins on their surface called antigen. Also the plasma contains antibodies which will attack certain antigens if they are present. We have several types of red blood cell antigens but the most important types are the ABO and rhesus types.

Let’s look deeper at ABO types
If one has type A antigens on the surface of their red blood cells, they will have anti-B antibodies in their plasma. ( these people will have blood group called  A) .
If one has type B antigens on the surface of their red blood cells , they will also have anti- A antibodies in their plasma. (They will have their blood group called B).
If one has both type A and type B on the surface of their red blood cells , they will not have antibodies to A or B antigens in their plasma. (They will have their blood group called  AB).
If one has neither type A or type B antigens on the surface of their red blood cells, they will have both anti- A and anti-B antibodies in their plasma. ( They will have their blood group called O)

Taking the explanation above we can now say the following ;

There are four main blood groups defined by the ABO system:
* blood group A has A antigens on the red blood cells with anti-B antibodies in the plasma
* blood group B has B antigens on red blood cells with anti-A antibodies in the plasma
* blood group O has no antigens on red blood cells , but has both anti-A and anti-B antibodies in the plasma
* blood group AB has both A and B antigens on the red blood cells but no antibodies in the plasma.
Let’s look at Rhesus types
On top of having type A or type B antigens most people have rhesus antigens on their red blood cells and are called Rhesus positive. About 15% of people do not have rhesus antigen and are said to be ‘rhesus negative’ . This means about 85% of the UK population is rhesus positive.

Can you explain these blood group names please with rhesus as well

One’s blood group depends on which antigen occur on the surface of the red blood cells. The genetic make up that we inherit from our parents will determine which antigens occur on our red blood cells.

Blood group A
One is blood group A positive if they have A and Rhesus antigens on the surface of their red blood cells.
One is blood group A negative if they have A antigens but not rhesus antigens on the surface of their red blood cells.

Blood group B
One is blood group B positive if they have B and Rhesus antigens on the surface of their red blood cells.
One is blood group B negative if they have B antigens but not rhesus antigens on the surface of their red blood cells.

Blood group AB
One is blood group AB positive if they have A, B, and Rhesus antigens on the surface of their red blood cells
One is blood group AB negative if they have A and B antigens but not rhesus antigens on the surface of their red blood cells .

Blood Group O
One is blood group O positive if they have neither A nor B antigens but have Rhesus antigens on the surface of their red blood cells
One is blood group O negative if they do not have A, B or Rhesus antigens.

Almost half (48%) of the UK population has blood group O, making this the most common blood group.

Blood transfusion

Receiving blood from the wrong ABO group can be life threatening.  It is then vital that the blood one receives is well matched ( compatible ) with theirs. If one is blood group B they should receive blood group B on transfusion. If blood group B people are given for example blood group A, the anti-A antibodies in a recipient with group B blood will attack the group A cells if transfused to them. This is why group A blood must never be given to a group B person.

As group O negative don’t have any A or B antigens or Rhesus antigens, it can safely be given to any other group. Therefore blood group O negative is often used in medical emergencies when the blood type isn’t immediately known. It’s safe for most users because it doesn’t have any A, B or Rhesus antigens on the surface of the cells, and is compatible with every other ABO and Rhesus blood group.

Pregnancy and blood group testing

Pregnant women are always given a blood group test. This is because if the mother is Rhesus negative but the child has inherited Rhesus positive blood from the father, it could cause complications if left untreated.
Rhesus negative women of child-bearing age should always only receive Rhesus negative blood.

Giving blood

Hopefully after reading this article you want to donate blood please get in touch with your country’s blood transfusion services for further information. Most people are able to give blood, but only 4% actually do. You can donate blood in the UK if you:
* have a good overall level of health
* are 17 to 66 years of age (if it’s your first time)
* weigh at least 50kg

 

You can check more information in Zimbabwe and UK below

National Blood Services Zimbabwe

NHS BLOOD TRANSFUSION SERVICES
This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Health fact of the day

Docbeecee Health fact of the day #docbeeceeHFOTD

By: Dr Brighton Chireka • 6th June 2016

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docbeecee Health fact of the day #docbeeceeHFOTD

By Dr Brighton Chireka

#docbeeceeHFOTD. This started on the 1st of June 2016. It tries to cover in just a few lines some health tips. This is to cater for those that do not have time to read long articles or are not interested in the history or the reasoning behind some health facts. The HFOTD is published daily on Facebook page Nothing About Me Without Me

1st June 2016

docbeecee Health Fact Of The Day #docbeeceeHFOTD

By Dr Brighton Chireka

Morning after pill ( emergency contraception)

If you are not planning to have a baby and you have unprotected sex or if your condom split or you have missed your usual contraception pill , you can use a morning after pill or the coil. Please do not delay in taking the morning after pill. Remember levonelle has to be taken within 72hrs of sex and ellaOne within 120 hours (5 days) of sex. The coil can be inserted up to 5 days after unprotected sex.

Emergency contraception does not protect against sexually transmitted infections (STIs) so you may need to think about getting screened for infection as well.

Have a healthy day! et in die salutis ( salutis means health , die means day , )

2nd June 2016

docbeecee Health Fact Of The Day #docbeeceeHFOTD

By Dr Brighton Chireka
There are lot of myths and wrongly held beliefs about acne ( Pimples)

1- acne is not caused by poor hygiene . In fact, excessive washing may make pimples worse

2- stress does not cause acne

3- acne is not just skin infection . It is caused by interaction of changes in hormones , more oil production, overgrowth of harmless bacteria and inflammation. You cannot catch acne so do not worry . It is not contagious.
4- acne cannot be cured by drinking a lot of water . ( drinking water is good for general health though )

5- no evidence that sunbathing or sunbeds help to clear acne

6 – some think acne cannot be treated . It can be treated – see your doctor .

 

3rd June 2016

docbeecee Health Fact Of The Day #docbeeceeHFOTD

By Dr Brighton Chireka

Back pain

Symptoms of non specific lower back pain are mainly pain in the lower back area without any other symptoms. Most people find that movement causes pain and resting relieves the pain.

There are some symptoms which should not be ignored so I urge you to see your own doctor without delay if you have back pain and:

* a high temperature (fever)
* Unexplained weight loss
* a swelling or a deformity in the back
* it’s constant and doesn’t ease after lying down
* pain in the chest
* a loss of bladder or bowel control
* an inability to pass urine
* Constant or persisting numbness around genitals, buttocks or back passage
* it’s worse at night
* it started after an accident, such as after a car accident

 

4th June 2016

docbeecee Health Fact Of The Day #docbeeceeHFOTD

By Dr Brighton Chireka

Let’s look at cough

A cough is a reflex action to clear our airways of mucus and irritants such as dust or smoke. It is a necessary action as it helps us to clear our airways so that we can breathe well.

Dry cough is a nuisance and is usually felt in the throat as a tickle that sets off the coughing. This happens when the throat and upper airways become inflamed (swollen). No phlegm ( thick mucus – makararwa ) is produced. The common cold or flu causes a dry cough because our brain thinks the inflammation in our throat and upper airways is a foreign object and tries to remove it by coughing.
If the dry cough is disturbing your sleep or daily activities and lemon and honey is not helping then one can try cough mixtures and visit their doctors for further assessment.
A chesty cough usually produces phlegm. The cough is helpful, because it clears the phlegm from your lung passages. I would advise against using cough mixtures for a cough that is producing phlegm. This cough is helpful and must not be suppressed but the underlying cause may need treatment and the best thing to do is to see your doctor.
When should you see your doctor?

We know that most of these dry coughs are caused by viruses and are self limiting in that they will clear up within a fortnight or 3 weeks. Having said that there are symptoms which must not be ignored and their presence should prompt one to make an urgent appointment with their doctor.
The following list is not exhaustive but it does include most symptoms that one must not ignore . Their presence means one has to see their doctor without delay.
1- a cough for more than 3 weeks after viral infection

2- a worsening cough regardless of duration

3- cough with breathing difficulties

4- cough with chest pain

5- coughing up blood

6- unexplained tiredness and weight loss

7- sudden onset of night sweats

8- if you are just worried about your cough or if it does not feel right.

5th June 2016

docbeecee Health Fact Of The Day #docbeeceeHFOTD

By Dr Brighton Chireka

Underactive thyroid ( hypothyroidism )

Symptoms

There are the same with so many conditions so they may be missed . Also they usually develop slowly and you may not realise you have a thyroid problem for several years.
Common symptoms include:
* tiredness
* being sensitive to cold
* weight gain
* constipation
* depression
* slow movements and thoughts
* muscle aches and weakness
* muscle cramps
* dry and scaly skin
* brittle hair and nails
* loss of libido (sex drive)
* pain, numbness and a tingling sensation in the hand and fingers (carpal tunnel syndrome)
* irregular periods or heavy periods

See you doctor if you have the above and it’s persistent.

6th June 2016

docbeecee Health Fact Of The Day #docbeeceeHFOTD

By Dr Brighton Chireka

Talking about breast cancer
Early detection is vital in the fight against breast cancer, so it is important to know the warning signs, perform regular self-exams, and learn to identify the causes and symptoms of breast cancer. I would like to encourage all women out there to have an Early Detection Plan as we know that early detection provides the greatest possibility for successful treatment.

When breast cancer is detected early (localized stage), the 5-year survival rate is 98%. This Early Detection Plan includes performing monthly breast self-exams, regularly visiting your doctor for scheduled clinical breast exams, and following your healthcare provider’s recommendations for mammograms, which will depend on your age and health history. A mammogram is an x-ray that allows a qualified specialist to examine the breast tissue for any suspicious areas.

Remember, if breast cancer is detected late the chances of survival are slim because the cancer cells will have travelled to other parts of the body such as the liver, lung and the bones. In the UK all women between 50 and 70 years of age should be screened for breast cancer every three years as part of the NHS Breast Screening Programme. In USA the Centers for Disease Control and Prevention (CDC) recommend that women ages 50 to 74 should have a mammogram every two years. Women 40 to 49 should discuss risk factors like family history with their doctors in determining the best time to start mammogram screening. Unfortunately some countries do not have screening programmes and in these countries self-examination is the best way forward.

 

7th June 2016

 

docbeecee Health Fact Of The Day #docbeeceeHFOTD

By Dr Brighton Chireka

Increase fibre in your diet

diet with plenty of fibre:
Will help to prevent and treat constipation

Will help to prevent piles or anal fissures

May help us to lose or control our weight.

May reduce the risk of developing bowel cancer.

May help to lower cholesterol in blood

May reduce the risk of developing diabetes and help to control our blood sugar levels.

 

Tips on increasing fibre in our diet
Fibre needs fluid to work, so we must drink a lot of fluids when we eat a high-fibre diet. For adults it is advisable to drink about 8 to 10 cups ( 2litres) of fluids per day . The fluids may include water , sugar free squashes , herbal /fruit teas without sugar.

When you start to increase your fibre in diet , you may have some bloating and wind . Do not worry much as this is temporary . As your tummy becomes used to the extra fibre , the bloating or wind tends to settle over a few weeks .
You can avoid getting wind by increasing your fibre intake gradually for example introducing one new food over a 2-to 3-day period.
A good snack with high fibre in Zimbabwe is the small packs containing roasted peanuts and maize grain.

 

8th June 2016

docbeecee Health Fact Of The Day #docbeeceeHFOTD

By Dr Brighton Chireka

Skin lightening creams

Skin colour, along with hair and eye colour, is genetically determined by the amount of melanin found in the top layers of skin. Its varied presence – which accounts for different skin colours – is linked to a population’s historic levels of sun exposure. Melanin is produced by melanocytes to protect the DNA of our skin from sun damage.

Skin lighteners contain an active ingredient or a combination of ingredients that reduces the amount of melanin in the skin where it is applied. Excessively reducing this concentration of melanin may increase the risk of skin cancers.

Most skin lightening creams are sold illegally on the black market and can contain toxic substances, such as high steroids, mercury and hydroxyquinone, and sadly many people are typically unaware of the risks. Exposure to mercury can have serious health consequences such as damages to the kidneys and the nervous system, and interfere with the development of the brain in unborn children and very young children. The sad thing is that you don’t have to use the product yourself to be affected.

People – particularly children – can get mercury in their bodies from breathing in mercury vapours if a member of the household uses a skin cream containing mercury. Infants and small children can ingest mercury if they touch their parents who have used these products, get cream on their hands and then put their hands and fingers into their mouth, which they are prone to do.
Steroid creams can be used under the supervision of health professionals to treat skin diseases but skin lightening creams have high dose of steroids and are sold on the black market. Unmonitored use of high-dose steroids in skin lightening creams can lead to many problems such as:

Permanent skin bleaching
Thinning of skin
Uneven colour loss, leading to a blotchy appearance
Redness
Intense irritation

Some of the dangers associated with the use of these creams include blood cancers such as leukaemia and cancers of the liver and kidneys, as well as a severe skin condition called ochronosis, a form of hyper-pigmentation which causes the skin to turn a dark purple shade.

Hydroquinone which is found in many creams works to reduce the amount of melanin your skin produces, which in turn makes your skin lighter in appearance. However, doing this makes your skin more susceptible to sunlight that can lead to dangerous sunburns, and over a prolonged period of time, an increased risk of certain types of skin cancer. Also hydroquinone can cause ochronosis and this is difficult to treat as it is permanent turning of skin into a dark purple shade.

 

 

These health facts of the day are compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: These facts are for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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docbeecee 100th blog

Celebrating our 100th blog post on docbeecee website

By: Dr Brighton Chireka • 2nd June 2016

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Celebrating our 100th blog post

By Dr Brighton Chireka

11th August 2015 was when I published my first article about CERVICAL CANCER on this docbeecee blog. Today , 2nd of June 2016 is when I am publishing my 100th post on this blog . This makes it 100 articles in 43 weeks which is at least 2 articles every week.

As we reach this milestone, on behalf of our technical team, guest bloggers , I would like to extend our gratitude to you the reader. You are the reason we began this blog and you are the reason we continue to publish more articles on health matters. It is our belief that health awareness is better than curative medicine . Our world needs committed professionals who are prepared to make real change in the world. So as we continue our blogging journey we invite you to share our blog with friends and colleagues . Our commitment is to raise health awareness and we invite you to join us weekly to read and respond and together let us make our health impact greater.
In wanting to do something special to celebrate our 100th I started reflecting on the name of our website – DOCBEECEE. Sometimes names are not often something we choose. They are given to us and may or may not truly fit us. Sometimes it becomes necessary to rename ourselves. This name is now associated with health information. DOCBEECEE website is now our one stop centre for health information. In celebrating our 100th blog post I am going to look at each letter in the name DOCBEECEE and link it to the articles that we have published already.

D- for Diet . We covered this in our article on HEALTHY EATING DIET. D was covered in our article on DIABETES MELLITUS . D also was covered in our article on VITAMIN D . Also D was covered in our article on DEPRESSION
O – OVARIAN CANCER , overuse of painkillers causing MEDICATION OVERUSE HEADACHE
C – for CANCER. Cancers covered are BREAST CANCER  , oand PROSTATE CANCER
B-BEAT DISEASE , BACK PAIN , BRONCO COUGH MIXTURE ABUSE
E- EBOLA VIRUS
E- ERECTILE DYSFUNCTION
C- CHILDREN AND PARENTAL ILLNESS     celebrating zimbabwe my MY PAD STORY
E- Exercise is mention in several articles as necessary to prevent HYPERTENSION and DIABETES MELLITUS
E- EFFECTS OF SMOKING TOBACCO , END TUBERCULOSIS

When you google it do not forget to docbeecee it

Google is here to stay and our patients are well informed nowadays. It’s up to us in the medical profession to keep up to date with medical knowledge and be able to “correct” any wrong information that our patients would have got from Internet. The internet is full of information which can overwhelm patients. I suggest that when you google it do not forget to docbeecee it. This allows easy pick up of articles that are on docbeecee website.

docbeecee sadza

 

I would like to conclude this blog by saying thank you. Thank you to our readers for your contributions, feedback and comments which have allowed us to write regular blogs. Thank you to our bloggers and technical team for the passion in maintaining the discipline and commitment to writing regularly and challenging comfort zones to put forward ideas, thoughts and insights.

 

We look forward to continuing this journey and the next hundred!

 

This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Drug driving

Drug driving on the rise in United Kingdom

By: Dr Brighton Chireka • 24th May 2016

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Drug driving arrests on the rise in United Kingdom

By Brighton Chireka
Last year I wrote an article raising awareness about drug driving and the changes to the law that came into effect in March last year, which saw new road-side drug screening devices introduced. According to data obtained by CONFUSED.COM THROUGH FOI  , drug-driving arrests have increased. In 2015, 1,686 drivers were caught drug-driving, compared with only 738 in 2014 – a rise of approximately 130%. This is very worrying and may I urge people once again to check any medication carefully before going behind the wheel.

In short may I suggest that before taking any medication , please read the instructions carefully and speak to your doctor or pharmacist. If you cannot get any advice then I suggest that you err on the side of caution and stop driving after taking certain drugs. Your road safety and that of others must be a top priority.

The new drug driving offence

IN the United Kingdom a new offence of driving with certain specified controlled drugs in excess of specified levels in the body came into force on the 2nd March, 2015.

I thought I should once again use this platform to explain what it means to all of us so that we do not get into problems. Ignorance is no defence so get the facts right and stay out of trouble. It is worrying that the numbers of drivers caught drug driving has risen by 140% since the law came into force. Sadly the majority of those arrested drivers were taking prescription medication rather than illegal drugs. It has been found that British motorists are four times more likely to drive under the influence of legal drugs, such as diazepam and codeine. This is not only confined to the United Kingdom but does apply to all the drivers world over.

You must all be aware of the existing offence of driving whilst impaired through drugs in the United Kingdom (whether due to non-medical use or due to legitimate use of medicines) in section 4 of the Road Traffic Act 1988. This offence did not change and will remain alongside the new drug driving offence that came into effect in March.

The new offence refers to driving, attempting to drive or being in charge of a vehicle with a specified controlled drug in the body, in excess of a specified limit (Section 5A of the Road Traffic Act 1988 as amended in April 2013).

These controlled drugs include, Diazepam, Clonazepam, Temazepam, Oxazepam, lorazepam, Methadone, Morphine, and Amphetamines ( were to be included) . They are prescribed for several medical conditions so many innocent people will be affected by the new law but there is no need to panic as there is a “medical defence” that can be used if one is genuinely taking the medication prescribed by his/her doctor.

Another thing is that the cut off limits which have been set are above the normal therapeutic range so most patients are unlikely to be driving with a concentration of a specified drug in their body above the specified limit. However, those on particularly high doses, for example, could test above the specified limit and would still be entitled to raise the statutory “medical defence”.

Police using gadgets to fight drug driving

The police are now using roadside drug screening to identify if the person driving or in control of the vehicle has taken a listed drug. Following a positive screening result using oral fluid, the person can then be requested to provide a blood sample for evidential purposes, to enable prosecution for the new offence if above the specified limit.

Any person who would have taken their medicine(s) in accordance with the advice of the prescriber (their doctor) or supplier of medicine(s) (and /or the product information included in the medicine pack) who are found to have blood level higher than specified in the regulations are entitled to raise the statutory “medical defence” at any stage and might then not be asked to provide a blood sample.
The statutory “Medical Defence” Any person who is to be investigated for drug driving would generally be entitled to raise the statutory “medical defence” if:

The drug was lawfully prescribed, supplied, or purchased over-the-counter, for medical or dental purposes; and
The drug was taken in accordance with advice given by the person who prescribed or supplied the drug, and in accordance with any accompanying written instructions.

If the police had evidence that the patient’s driving was impaired due to drugs, whether prescribed or not, they can prosecute under the existing offence of driving whilst impaired through drugs offence described in section 4 of the Road Traffic Act 1988, for which there is no statutory “medical defence”:

This means that it remains the responsibility of all drivers, including patients, to consider whether they believe their driving is, or might be, impaired on any given occasion, for example if they feel sleepy. It will remain an offence, as now, to drive whilst their driving is impaired by drugs; and, if in doubt, drivers should not drive. The statutory “medical defence” will not be extended to be available for the existing ‘impairment’ offence because even if legitimately taking medicine, the patient should not be driving if actually impaired.

Also if you are taking the controlled drug as prescribed medicine it may, therefore, be helpful to keep some suitable evidence with you when driving that shows that you are taking the controlled drug as prescribed medicine or supplied by a healthcare professional or bought over-the-counter and taken in accordance with the leaflet accompanying the medicine, in case that you are ever stopped by the police.

Please make sure that you are taking these controlled drugs as instructed by your doctor. If you are overdosing and you happen to be stopped by the police, you cannot use the “medical defence” as you will not have followed your prescriber’s orders.

In conclusion just remember the police have new powers to test and prosecute drivers who are suspected of driving having taken certain specified controlled drugs in excess of specified levels in the body. You must not worry if you are taking your medication according to the instruction and your driving is not impaired. This is because, unlike the existing offence of driving whilst impaired by a drug, the new offence has a statutory “medical defence” to protect those patients who may test positive for certain specified drugs taken in accordance with the advice of a healthcare professional or the patient information leaflet that accompanies the medicine.

 

This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at info@docbeecee.co.uk and you can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Acne and pimples

Let’s talk about acne popularly known as pimples

By: Dr Brighton Chireka • 19th May 2016

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Let’s talk about acne popularly known as pimples

By Dr Brighton Chireka
Acne (popularly known as pimples) is a common skin condition that affects most of us at some point. It causes spots, oily skin and sometimes skin that’s hot or painful to touch. Acne is very common in teenagers and younger adults. About 80% of people aged 11 to 30 are affected by acne. It is most common in girls from the ages of 14 to 17, and in boys from the ages of 16 to 19. It often disappears when a person is in their mid-twenties. Unfortunately in some cases it can continue into adult life . About 5% of women and 1% of men have acne over the age of 25. Acne usually affect the face but may affect the back , neck and the chest. Inflamed pimples need to be treated early to prevent scarring.

What causes acne

Acne or pimples formation
Let’s look at the picture above

If you look at the picture about you will see that under the skin surface we have small sebaceous glands. These glands produce oil ( sebum) that keeps the skin supple and smooth . If you look again on the skin surface you will see pores (holes). These pores on the skin allow the oil to come on to the skin surface . Hair also grows through the same pores .

 

What happens during the teenage years ?

During teenage years people make more oil due to changes in hormones at puberty . The more oily one makes the more acne they get.

Types of acne and how it is caused

1-Mild to moderate acne
This is composed of blackheads, whiteheads and small pimples . Some pores on the skin become blocked due to the skin at the top of the pores becoming thicker in combination with dead skin that is shed into the pores . Plugs that block the top of the pores can be seen as tiny spots known as blackheads and whiteheads .Please note the black of the blackheads is due to skin pigment and is not dirt as people may think .

Some oil may collect under the blocked pores forming small spots called this pimples or papules.
2-Moderate to severe acne
This is composed of large spots and inflammation. On our skin we have bacteria called Propionibacterium acne ( P acnes) in small numbers and it’s harmless. The trapped sebum (oil) is good food for this bacteria P acnes . If there is more oil trapped in a blocked pore this bacteria multiply . When it multiplies our immune system reacts and cause inflammation . When inflammation occurs the skin becomes red and the spots become larger and get filled with pus . This can get worse into small nodules or cysts.

Rare causes of acne

Other diseases such as polycystic ovarian syndrome (PCOS) can cause acne . PCOS is a condition in women that causes excess male hormone to be made in the ovary or adrenal gland. It also causes thinning of scalp hair , excess growth of facial hair or body and other problems.

Another rare cause of acne is exposure to chemicals at workplaces ( halogenated hydrocarbons)

 

What makes acne worse?

1- Progestogen only contraceptive pill
2- Hormonal changes around periods can cause flare up of acne in some women
3-Thick or greasy make up may make acne worse, but most make up does not affect acne . You can use make up to cover some mild spots . Make up is different from SKIN LIGHTENING CREAMS
It is advisable to use non comedogenic or oil- free products
4-Picking and squeezing the spots may cause further inflammation and scarring
5-Sweating heavily make acne worse especially ladies working in hot kitchens preparing food for the family
6-Spots can develop under tight clothes eg headbands , tight bra straps , tight collars etc
7-Some medicines make acne worse for example , phenytoin used for epilepsy or Steroid creams used for eczema or high steroid dose SKIN LIGHTENING CREAMS

8-Anabolic steroids taken by body builders are not good . They make acne worse
9- There is no evidence to support that diets high in sugar or milk products make acne worse.

There are lot of myths and wrongly held beliefs about acne ( Pimples)

1- acne is not caused by poor hygiene . In fact, excessive washing may make pimples worse
2- stress does not cause acne
3- acne is not just skin infection . As explained above it is caused by interaction of changes in hormones , more oil production, overgrowth of harmless bacteria ( P acnes) , inflammation, etc as described above . You cannot catch acne so do not worry . It is not contagious.

4- acne cannot be cured by drinking a lot of water . ( drinking water is good for general health though )
5- no evidence that sunbathing or sunbeds help to clear acne
6 – some think acne cannot be treated . It can be treated – see your doctor . I will talk about treatment here as well

 

Skin care for people with acne
1- do not wash more than normal . Max wash should be twice a day and not to be obsessed about washing your face . ( very hot or too cold water may worsen acne)
Do not scrub hard when washing. Do not use powerful soaps . Use a soft washcloth and fingers instead . Excessive washing and scrubbing make acne worse
2- antiseptic washes may be beneficial

3-remember this, you cannot clean off blackheads . The black tip of a black head is actually skin pigment ( melanin ) and cannot be removed by cleaning

4 – use fragrance free , water- based moisturising cream . Do not use ointments or oil rich creams as these may clog the holes of the skin

 

Treatment of acne or pimples

Aim of treatment is to clear spots and prevent scarring
Various gels , lotions and creams are used to treat acne .
When applying creams make sure that you apply it to all affected area of skin and not to each spot .
Treatment can take weeks even months so do not give up easily. It is advisable to continue with any treatment for a least 6 weeks before deciding if it is working or not .
Remember acne can clear but does flare up every now and then . It is common to need maintained treatment for 5 years to keep acne away .

 

Types of treatment

 

Benzoyl peroxide is a common topical treatment . It has 3 actions
1- it kills germs
2- reduces inflammation
3- helps to unplug pores
In UK you can buy this medicine without a prescription.
It works best if you wash the skin 20-30minuted before use .
It may bleach hair , bed linen, or clothes that come in contact with it
Commonly causes mild skin irritation. If skin becomes irritated one must stop using the medication and sees a doctor as soon as possible .

Your doctor can prescribe retinoids which are good at unplugging blocked pores . Sometimes you make be given topical antibiotics which reduce the number of bacteria and inflammation. Unfortunately they do not have effect on unplugging blocked pores. Azelaic acid is an alternative and works on unplugging blocked pores

Combinations preparations can be used such as benzoyl peroxide plus an antibiotic or retinoid pulse an antibiotic.

Oral antibiotics can be used to clear inflamed acne but have little effect on unplugging blocked pores. If one has a lot of blackheads and whitehead as well as inflamed acne spots , it may be advised to try benzoyl peroxide in addition to taking an antibiotic tablet .
Antibiotics commonly used are tetracyclines based antibiotics . These include oxytetracycline , tetracycline ,doxycycline and lymecycline

The combined contraceptive pill can be used treat acne in some women. A variety of pill called co-cyprindiol is useful

Specialist treatment can be sort and they can use isotretinion tablets which reduce the amount of sebum made by sebaceous glands

 

This article was compiled by Dr Brighton Chireka, who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way, shape or form represents the views of organisations that Dr Chireka work for or is associated with.

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Medication overuse headache

Medication overuse headache

By: Dr Brighton Chireka • 18th May 2016

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Medication overuse headache

By Dr Brighton Chireka

When painkillers are taken frequently to treat headache can, over time, lead to daily or near daily headaches. Overuse of painkillers can cause headache which is called Medication Overuse Headache (MOH).

How does Medication Overuse Headache occur?

The following is a typical case:

This may occur typical if one has headache such as tension headache or migraine. One start to take painkillers to stop the headache and continue to do this. The body becomes used to the painkillers such that a “rebound” or “withdrawal” headache then develops if one does not take the painkillers within a day or so of the last dose. One will think that it’s another tension headache or migraine, and so one takes a further dose of painkillers. When the effect of each dose of the painkiller wears off, a further withdrawal develops and so on.
A vicious circle develops. In time one may have headaches on most days, or on every day, and end up taking painkillers every day, or on most days. Some people start to take painkillers everyday to try to prevent headaches. This only makes things worse.
One has Medication Overuse Headache if one has the following

:
1- A headache for at least 15 days each month


2- One has been taking painkillers for headache for more than 3 months. Overuse is considered to be occurring when one takes painkillers on 15 days or more each month.


3- The headaches develops, or is markedly worsened , during medication overuse.

 

Which medicines cause medication Overuse headache?

 

All of the common abortive medications used to treat tension-type headaches or migraine can cause this problem if used too often. These include:
•

paracetamol
• paracetamol combinations, especially if combined with codeine / dihydrocodeine (for example, cocodamol, codydramol, Migraleve®, Solpadeine® and Syndol®).


• antiinflammatory painkillers such as aspirin, ibuprofen, naproxen,diclofenac.


• codeine, dihydrocodeine, tramadol, opiates


• triptans used for migraine (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan)
•

.ergotamine (such as Cafergot®).


Medication overuse headache is likely if they are used on more than ten days a month or on average more than two days a week.
The message is that any pain killer can cause this medication overuse headache if used more frequently over a long time. The names of medication above may be different in your country but the message is that those pain killers whatever name is used in your region can cause this headache.

What is the treatment of Medication Overuse Headache

 

Please do not attempt treatment without seeing your doctor!
The treatment for medication-overuse headaches is simple – stop taking painkillers.
The most important thing is to stop the medication for long enough to allow it to be “washed out” of your system. The best approach is to stop abruptly if you have been taking the medication for months only not years .
Your headaches will probably get worse immediately after stopping, and you may feel sick or sleep badly, but after 7 to 10 days when the painkillers are out of your system you’ll feel better.

 

If you’ve been getting painkiller headaches for several years as a result of taking codeine-containing products, it can be dangerous to stop abruptly. Instead, gradually reduce the number of painkillers you take. This is best done under the supervision of a doctor.
Once your painkiller headaches have stopped and your tension headaches or migraines are back to normal, you can start to use painkillers again as you need them.

 

Around 80% of people with medication-overuse headaches manage to stop regularly taking painkillers and feel much better as a result. The other 20% relapse over time and may have to go through withdrawal periods repeatedly.

Final may I urge you to think before you take the painkillers for headache as you may be making your problem worse.

This article was compiled by Dr. Brighton Chireka who is a GP and a Patient Engagement Advocate (PEA) in Folkestone Kent, UK. You can contact him at: info@docbeecee.co.uk or read his work DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr. Chireka has used all reasonable care in compiling the information, but makes no warranty as to its accuracy. Consult a doctor or other health care professionals for diagnosis and treatment of medical conditions.

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Write to your MP.

Our health system, write to your MP

By: Dr Brighton Chireka • 12th May 2016

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Our health system, write to your MP

By Dr Brighton Chireka

Dr Parirenyatwa was reported in the Herald to have said that our health system needs 8000 nurses yet we have 3000 nurses unemployed. He went on to ask Dr Bimha MP for the area where he was giving the speech, to support him in parliament.

Now Central hospitals such as Harare hospital and United Bulawayo Hospitals are cancelling elective operations due to shortages of drugs.

This failure to employ our health professionals is not only affecting nurses. This year Zimbabwe has failed to absorb at least 50 doctors who completed internship. This figure is going to rise as more and more doctors qualify. I am reliably informed that we have at least 400 medical students doing 4th year at the university of Zimbabwe. Looking back during my days we had only 80 medical students per stream. This means we will have more doctors unemployed but the irony is that we need more doctors.

 

This reminds of 1999 when as a junior doctor we went on strike. We then invited the then Minster of Health Dr Timothy Stamps. He listened to all our grievances and said that he agreed with us but then said it was difficult for him alone to convince his colleagues in the cabinet to allocate more resources into the health system .

Many a times we blame the individual ministers as not performing but we need to understand that the situation is not that simple . There are several ministries that are competing for the meagre resources available. We all need to play our part to make sure that our health system does get a fare share of resources.

 

It is sad that we are relying on donor funds to run our health system . It is reported that in 2014 the government of Zimbabwe only allocated one million dollars for the management of malaria whilst the donor community  paid over 17 million dollars.

 

Something has to done to lobby our government. Instead of the war veterans only asking for more personal benefits , they should be asking for more resources to be allocated to the Ministry of Health. Very few of us can afford private health care so we have to rely on the public health system.

 

I call upon each individual to write to their local Member of Parliament ( MP)and ask them to support Dr Parirenyatwa in having more resources allocated to his ministry . If all MPs support the call for more resources in our health system, maybe we will have more funding. There is power in numbers and the government will listen to the voice of the crowd. If the war veterans as a group are managing to have their needs looked into, then we should also do the same . The same war veterans use the same public hospitals as us so they must join us in our call for more funding for our health system.

The first call is to ask for the 3000 unemployed nurses and 50 unemployed doctors to be urgently employed as our health system needs them badly. This call to action must be channelled through various avenues . This includes MPs , Cabinet Minsters , Ministry of health officials etc .

I welcome the efforts by Zimbabwe Medical Association (ZIMA) and Ministry of Health and Medical and Dental Practitioners Council of Zimbabwe ( MDPCZ) in trying to address the issue of unemployed doctors. These are desperate times and calls for new ways of practicing that involves innovation and thinking outside the box. Accepting the status quo is not an option as we will continue to lose lives from avoidable deaths.

 

Here is the suggested letter to send to your MP

Dear[ Hon MP’s name]

 
I am writing to express my deepest concern about the current situation of our health system in Zimbabwe. Dr Parirenyatwa was reported in the Herald to have said that our health system needs 8000 nurses yet we have 3000 nurses unemployed. This year Zimbabwe has failed to absorb at least 50 doctors who completed internship. This figure is going to rise as more and more doctors qualify.

 

Now Central hospitals such as Harare hospital and United Bulawayo Hospitals are cancelling elective operations due to shortages of drugs.

 

As your constituent, I request that you support the call for more funding to the Ministry of Health and the immediate employment of these desperately needed health professionals as well as the resumption of elective surgery at our central hospitals .

 

The government and the public used their meagre resources to train these health professionals so that they can work in our hospitals. In addition to setting a dangerous precedent for our country , the status quo if left unchanged , would send the highly undesirable message that we do not care about our investments in our health system.
We cannot allow ourselves to die when resources are there but are not being allocated properly.
I look forward to your response and thank you in advance for your support in this important matter.

Yours sincerely,
[Your Name]

 



If you want to meet your MP to discuss in person you can add the following;

 
I would also very much like to meet you to discuss this matter further . Please could you contact me to arrange a meeting suitable time?
You can contact me at [Email] or [Telephone]. Thank you for your help with this matter, I look foreword to your response.

Yours sincerely

[Your Name]

 

This article was compiled by Dr Brighton Chireka, who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

 

Disclaimer:This article is for a peaceful call to action to save our health system. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult your lawyer or legal professional for a detailed understanding of your rights as a citizen of your country. Views expressed here are personal and do not in any way, shape or form represents the views of organisations that Dr Chireka work for or is associated with.

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Healthy eating

Healthy eating , what diet should I follow

By: Dr Brighton Chireka • 11th May 2016

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Healthy eating , what diet should I follow ?

By Dr Brighton Chireka

There is a lot of talk about diet and healthy eating. It is confusing to many of us to know the right diet options. There are so many diet options to choose from. I am going to focus my talk on healthy eating and not a particular diet. The principles of a  healthy diet is all we need . It may help to prevent chronic diseases such as heart disease, HYPERTENSION  , stroke and DIABETES . It may also reduce our risk of developing CANCER. This article will try to explain the principles of healthy eating . I hope that after reading this article you will all feel empowered to try any particular healthy diet of your choice and live life to the full.

 

Let’s first look at different groups of food

Our body need energy to be able to work well and keep us alive. We obtain this energy from carbohydrates , protein and fats that we eat. We also need minerals and vitamins so that we stay healthy. We need a balanced diet and it must contain food from each of the following groups:
1-Stachy foods – bread , rice , potatoes , pasta , Sadza etc
2-Fruits and vegetables
3-Milk and dairy foods
4-Protein foods – meat , fish , eggs , nuts , beans and pulses etc

We have got a fifth food group that we should only eat a small amount of it . This group include fatty and sugary foods.

When we have taken a balanced diet of the five food groups mentioned above we must not forget to take plenty of fibre and water.

What makes up healthy eating ?

The principle of a healthy eating is more plants and less animals . This means that vegetables, fruits and starchy foods should provide the bulk of most of our meals . Milk and dairy foods and protein foods are needed but in a lesser quantities. In a healthy diet foods and drinks that are high in fat or sugars are not advised.

Let’s look at carbohydrates

We get most of our energy from carbohydrates. Carbohydrates are divided into complex carbohydrates- generally include Pasta, bread , rice and potatoes , Sadza ( roller meal ) – and simple carbohydrates which comprises of the sweet sugary foods. We are recommended to make sure that about a third of food in our portions is from carbohydrates. These carbohydrates preferably must be higher- fibre such as Sadza from roller meal , whole grains cereals , brown rice and wholewheat bread . These higher-fibre carbohydrates release glucose more slowly into the bloodstream providing more stable and sustainable energy levels to the body.

Remember that eating foods with high sugar can contribute to us becoming overweight. Being overweight can increase our risk of developing diseases such as: heart disease , type 2 diabetes , stroke

Tips on cutting down our sugar intake

1- try not to add sugar to tea , coffee and breakfast cereals. I had a struggle to stop taking tea without sugar but since 1990 I have not drank tea with sugar and I enjoy the taste. Your taste for sweetness often changes with time.
2- try sugar free drinks . Give children milk or water as their main drink
3- avoid chocolates or sweets and if you do eat them then keep the quantity down. Try eating them during meals and brush your teeth soon after.
4-remember the so called pure juices have lots of added sugars so be on the look out .
We must eat more fruit and vegetables

Research has found that eating at least seven portions ( realistically its 5 a day ) of fruit and vegetables daily reduces the risk of many diseases such as stroke , heart disease and some cancers . We should eat more vegetables than fruit in our diet . Fruit and vegetables contain lots of fibre which keeps our bowels healthy. We are less likely to develop constipation or diverticular disease if we eat plenty of fruit and vegetables. We get plenty of vitamins and minerals from fruit and vegetables. They are also filling but have low calories and low fat which is ideal in keeping weight in control.

On average people who eat lots of fruit and vegetables tend to be healthier and live longer. Having a low intake of fruit and vegetables is estimated to cause about 31% of heart disease , 19% of cancers of the digestive system and 11% of stroke. Fruit and vegetables also contain chemicals called antioxidants, such as beta-carotene and vitamin C . These are thought to protect against damaging chemicals that get into our bodies.

A word of caution on fruit juices

A 150ml glass of juice is counted as only one of your five a day, even if you drink more than one glass. The best way of eating an orange is to have the fruit not the processed fruit juice. During processing most of the fibre is removed and the product has a higher sugar content which is not good for our health. You may try to dilute the juice or get the one with no added sugars.
The fruit juices contain high amounts of added sugar which is not good for our health.

If you look at the 100% fruit juice below , you will see that it contains 28g of sugar in 200mls which is about 5 teaspoons of sugar in a glass of juice. This is a lot of sugar . You may want to read more on SUGAR HERE

Healthy eating fruit juices

 

The following are not counted as fruit and vegetables

There is a lot of healthwashing that is going on and many people get fooled into eating junky food thinking its healthy.

Fruit cake/fruit yoghurts contain little fruit and also have added sugar , fat and other ingredients which are not good for our health. We should keep these to a minimum in our diet. Fruit- flavoured soft drinks are not counted as they usually contain minimal fruit and are high in sugar . Tomato ketchup, jam and chutneys all have high salt /sugar content so are not good for our health.
Potatoes , yams , cassava and plantain all contain more starch so they are not counted as fruit and vegetables but as part of carbohydrates.

 

We must eat plenty of fibre

We should aim to eat at least 18grams of fibre per day. In the UK the average person eats about 12g of fibre a day which is not enough)

There are two types of dietary fibre :

Soluble fibre is found in oats ,peas , beans and many fruits and vegetables . It increases the feeling of fullness and can lower blood cholesterol and glucose levels.

Insoluble fibre is mostly found in wholegrains, and also in fruit and vegetable skin. It is not digested by our body but forms bulk in gut , which helps to keep the bowels moving normally.

We get our fibre from starchy foods , fruit and vegetables. Eating a higher-fibre diet makes us feel full for longer. Remember fibre is filling but has no calories and is not digested so help us to lose weight. We need to make sure that we are drinking enough fluids when taking a high-fibre diet.

A diet with plenty of fibre:

Will help to prevent and treat constipation
Will help to prevent piles or anal fissures
May help us to lose or control our weight as mentioned above.
May reduce the risk of developing bowel cancer.
May help to lower cholesterol in blood
May reduce the risk of developing diabetes and help to control our blood sugar levels.

Tips on increasing fibre in our diet

Fibre needs fluid to work, so we must drink a lot of fluids when we eat a high-fibre diet. For adults it is advisable to drink about 8 to 10 cups ( 2litres) of fluids per day . The fluids may include water , sugar free squashes , herbal /fruit teas without sugar.
When you start to increase your fibre in diet , you may have some bloating and wind . Do not worry much as this is temporary . As your tummy becomes used to the extra fibre , the bloating or wind tends to settle over a few weeks .
You can avoid getting wind by increasing your fibre intake gradually for example introducing one new food over a 2-to 3-day period.

A good snack with high fibre in Zimbabwe is the small packs containing roasted peanuts and maize grain.  See picture below .

 

High fibre healthy eating

 

 

Eat enough milk and dairy foods

 

Milk and other dairy foods such as cheese and yoghurt are important in our diet . They provided calcium which is needed for healthy teeth and bones. Other foods such as butter and cream are not considered as dairy foods here , as they are also high in fat .
We are recommended to have three servings a day from this food group so that we get enough calcium in our diet. One serving is:
200mls of milk
A small ( 150g) pot of yogurt
A 30g of serving of cheese ( about the size of a matchbox)

Word of caution is that dairy foods tend to contain high fats so it is advisable to go for lower fat options . These include skimmed or semi-skimmed milk , low-fat cheese and low-fat yogurt.

Non dairy sources of calcium include leafy green vegetables , dried figs, almonds , oranges , sesame seeds , seaweed and some type of beans .
Non dairy sources of calcium must be eaten with a source of vitamin D , as the body needs this to help it absorb the calcium.
Remember the best source of calcium is sunshine.
Read more about VITAMIN D

 

Eat other protein foods in moderation

Other protein-containing foods include meat , fish , eggs and plant sources of protein. Plant source of protein include nuts, seeds, tofu, beans such as red kidney beans and canned beans , and pulses such as lentils and chickpeas.
We need protein for mainly growth and repair in our body . The problem is that we tend to eat more protein that we need .
When eating eggs let’s try to boil or poach them instead of frying.
On fish there is some evidence that eating oily fish helps to protect against heart disease. Oily fish include herring Sardines , markerel, salmon, fresh tuna ( not tinned ) , killers , pilchards , trout, whitebait, anchovies and swordfish. Aim to eat at least two portions of fish per week , one of which should be oily.

 

Let’s talk about fat now

Fat has been blamed for a long time for obesity but it’s not that clear . Recent research is now suggesting that carbohydrates plays a large role in weight gain than we previously thought. Having said that it’s still a good idea to eat less fat if you are trying to lose weight.

What can you do to reduce fat in your diet ?

Avoid frying food . Try to grill, bake , poach , barbecue or boil food . If you fry , use unsaturated ( mainly from vegetable oil) . Drain the oil from food before eating .
Cut off any excess fat from meat
Avoid adding unnecessary fat to food. Make sure you spread less butter or margarine on bread
Beware of hidden fat in pastries, chocolates , cakes and biscuits
Try low fat milk , cheese , yoghurts
Avoid cream

 

Avoid too much salt

Too much salt increases our risk of getting high blood pressure. We are recommended to take no more than 6g ( a teaspoon is 5g)
Tips on on how to reduce salt intake
– Try using herbs and spices to flavour the food rather than salt. Also make sure that the spices do not have salt already.
– Those who eat sun dried fish , it may be better to sock if first to remove excess salt
– Limit the amount of salt you use on cooking . Also do not add salt to food at the table. I know fellow Zimbabweans who blindly add salt at the table without tasting the food.
– Choose foods labelled ” no added salt”
– As much as possible , avoid processed foods , salt-rich sauces, takeaways , and packet soups which are often high in salt. I was a fun of soup but now I am cutting down because of the salt intake in it . A cup of soup as shown below has 1.2g which is 21% of the reference intake of an adult per day. This means that if one takes two cups of soup a day then they have already taken 42% of their recommended daily intake.

Soups have high salt and sugar content so make sure that you do not overindulge.

 

Healthy eating soup image

 

 

Do not forget portion size

I struggle a lot with portion size. I love my plate of food to be full and you wish is for it to be full of starch especially our stable food – Sadza. Read more ABOUT SADZA

I have compiled this article with an aim of helping ourselves to lose weight and live a healthy life. We may follow what I have said above and eat healthy foods but still we need to keep an eye on our portion sizes. If the portions are too large , we will still gain weight increase our risk of developing diabetes and stroke.

Tips on food portions

Deliberately try to take small portions when having a meal .
Do not feel that feel that you have to empty your plate
You may want to try using small plates if the ones that you are using are too big and you have a habit of filling them up.
You may want to fill up your plate on fruit and vegetable and not too much starch ( sadza).
When eating out , or ordering a takeaway ask for a smaller portion.

 

Last but not least we must think about what we are drinking

We must remember that many drinks contain added sugars including alcohol and many non-alcoholic drinks. We must choose what we drink wisely or else our health will suffer.
Water contains no sugar and can be both refreshing and healthy . Failing to drink enough fluids will result in dehydration . Dehydration causes many symptoms such as headaches , body and joint pain, heart burn. Try treating these problems with water first and if not gone then see your doctor.

So how much should you drink?

We have been told in the past that we must drink 8 cups of fluids a day . The questions left unanswered are ; how big are the cups ? can I give my child 8 cups ? To be exact one must drink according to their body weight and also level of activity . If your daily activities make you sweat a lot then you will need more fluids as compared to someone who is sitting at home in shade.
If not very active and not sweating then an adult is recommended to drink 33mls multiply by body weight per day . If you weigh 70kg then the recommended fluid intake per day is 33x70mls which is 2130mls ( 2.31 litres).

Tips to improve water intake
– if it is difficult to drink pure water , try adding a slice of lemon or lime
– Keep a jug of water in the fridge so that it stays cool
– If you are sweating try to increase your water intake
– If your urine is strong couloir then try to increase your water intake as you may be getting dehydrated.
– Avoid pure juices and fizzy drinks as they contain lots of sugars which are not good for our health.

 

Those who struggle or cannot tolerate pure water
It is advisable to drink more water but we know that some of us struggle with that. The following may help to make sure that the fluid intake is better
1- If you can take tea then try that and drink as much as you can . At first it make make you go to the toilet a lot but as time goes on you will get used and will visit the bathroom less frequently .
2- decaffeinated coffee can be taken if one is struggling to take water . It is advised to take these hot drinks without sugars.
3- Squashes without added sugars can be taken to replace pure water
4- Fizzy drinks are not recommended as some of them contain 7 teaspoons of sugar per can ( adults are recommended to take a max 6 teaspoons of added sugars per day)

 

Avoid drinking alcohol excessively

Men should not drink no more than 21 units of alcohol per week. No more than 4 units in any one day . Must have at least 2 alcohol-free days a week
Women should drink no more than 14 units of alcohol per week . No more than 3 units in any one day . Must have at least 2 alcohol-free days a week
Pregnant women or women trying to conceive should not drink alcohol at all.

Read about my PERSONAL STORY ABOUT ALCOHOL

I hope I have managed to add value to your life and have empowered you to eat a healthy diet. If approached by anyone selling a diet programme you can make reference to this article and make sure that the diet being offered ticks all the boxes of the things that I have mentioned in this article .

 

As usual I welcome your comments and suggestions as we try to focus on healthy eating.

 
This article was compiled by Dr Brighton Chireka, who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way, shape or form represents the views of organisations that Dr Chireka work for or is associated with.

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Appreciating nurses week

Nurses week, appreciating work they do

By: Dr Brighton Chireka • 10th May 2016

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Nurses week May 6th to 12th

By Brighton Chireka
Nurses week started on the 6th May and will end on the 12th. I saw it fit to write something about nurses. Nurses are the frontline of all health systems world over. They are often not appreciated by both their employers and patients . Employers do not focus on whether patients received good carer , they just want to know if patients perceived they received good care . When it comes to safety , it is hoped that no patients are harmed. No one bothers to look at harm caused to the nurse who has barely drank anything , ate or went to the bathroom and was lifting patients.

Growing up in Musana rural area, Bindura Zimbabwe, I was attended to by nurses only for my medical problems. It may come to some as surprise that my first encounter with a medical doctor was when I was a medical student at the University of Zimbabwe. It is an open secret that all rural clinics are run by nurses in Zimbabwe. This means that SRBs ( Strong Rural Background ) like myself owe nurses a lot. This article is my little thank you to the profession that is not given the proper respect it deserves.

Talking to my nurse friends during this nurses week , they want a patient load that does not bring them to tears by the end of their shift. They want to go home knowing they did their best for the patients because they had the time and support to do so. They want to know that they are valued , respected and are worth more than a box of chocolates or sweets.

Nurses week !

Join me as we stand up and fight for the Nurse’s Profession, our patients and the future of health care. Health systems worldwide are understaffed, underfunded and overstretched but we have nurses who are dedicated and continue to do their work.

They work in a culture of compassionate care which is based on the 6Cs of nursing .

6Cs of Nursing

The 6Cs – care, compassion, courage, communication, commitment and competence – are a central plank of Compassion in Practice, which was drawn up by NHS England chief nursing officer Jane Cummings and launched in December 2012.

1. Care
Patients are treated well in a respectful non judgemental way. They confidentiality , dignity and beliefs should be considered first . Patients should feel that they can trust their nurse to deliver high quality care.

2. Compassion

When patients get care from health professionals especially nurses they look at how that care is given. It involves emotions more than just empathy, respect or dignity. I like the origin of the word compassion. It comes from Latin and its means “co-suffering”. Compassion looks at how care is given and it’s an intelligent kindness . Patients will always remember what nurses have done for them , how they made them feel and how they treat them or their family members.
3. Competence
The public tend to forget that nurses are professionals who have expertise , clinical and technical knowledge to deliver effective care and evidence based treatment. They keep updating their knowledge and skills to up to date with latest practices. Nurses know the limits of their practice and only undertake work in which they feel competent and confident.

4. Communications
Communication is central to successful caring relationship and to effective team working. Nurses must be good listeners and patients must be at heart of decision making . No decision about patients without patients and message must be conveyed with sensitivity and compassion.

5. Courage
Nurses work in health systems that are VUCA ( Volatile, uncertainty, complex and ambiguous) so they need courage to do the right thing for the people they care for, to speak up when they have concerns. We must remember that nurses are accountable for their actions as a nurse practitioner or midwife and they have a duty of care to their patients.

6. Commitment
Nurses are committed to these 6Cs in delivery a quality health care to the patients. Nurses build on this commitment to improve the care and experience of patients. The public look to nurses as an example even in their private lives. This means that nurses have to look after their own health and maintaining a code of conduct in their social lives in order to be that role model.

We have all been cared for or encountered nurses in our lives and we have seen these 6Cs in action. I invite you to appreciate the nurses this week in recognition of the work they do. Some of them are not being paid well, some have not received salaries for several months, some are overworked, some are frustrated, some do not feel valued or respected but in majority of cases they still smile and go an extra mile to care for the patients. This is amazing and deserve appreciation from all over.

Thank you Nurses for looking after us . We value and respect you . Have a blessed nurses week as we celebrate your work.
This article was compiled by Dr Brighton Chireka, who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog DR CHIREKA’S BLOG

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Beat disease by Bertha

Beat disease

By: Dr Brighton Chireka • 8th May 2016

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Beat Disease

By Bertha Mukodzani

Join me in welcoming our guest blogger Bertha Mukodzani who is a Nurse Practitioner and an Author. In this article she looks at how we can beat diseases. This is a very important topic that she is addressing and I urge you to read on and be empowered. Do not forget to share the article with your friends.

Beat Disease

When it comes to disease, prevention is always better than cure. However, we can’t deny the fact that diseases are here to stay. Our lifestyle choices, our genetic disposition or indeed the climate in which we find ourselves sometimes put us in a precarious position, and before we know it we have succumbed to one disease or another.

There are those diseases that silently creep upon us such as Cancer , Diabetes , heart disease and Hypertension . And then there are those diseases or ailments that we see coming. However, you do not have to feel completely powerless once disease has manifested itself inside your mind and/or body. Based on what I have experienced as a nurse, life’s experience outside of work, people’s testimonies as well as drawing from my knowledge and understanding of science, I have compiled a list of basic measures that may help you cope, alleviate, reverse some conditions and in some cases ‘overcome’ or at least improve your overall condition.

1) Know what you’re dealing with
I believe if you are going to go into battle, you are at an added advantage if you study the ways of your enemy. How they operate, their fighting strategies, preferred methods of attack and their weaknesses. Know exactly what you are dealing with. Therefore, where diseases are concerned, you will do well to study as much as you can about your condition. Doing so is to empower as well as prepare yourself. Someone once told me that ‘knowledge is not power’ but only ‘potential power’. What that means is, knowledge will only take you so far. You will need to take it a step further if you are going into this battle. Which brings me to my next point;

2) Change your mindset
This is a big one. It appeals to your psychological disposition. Your self-esteem, your confidence among other things. No matter what you are facing, I reckon it pays off to stay positive. Believe that you will and can get better, and trust that you have enough courage and determination to fight the disease. I have heard many testimonies of long-term survivors after having been given very short prognosis by the doctor. It does not mean that doctors get it wrong, the way I look at it is that there is also a higher power determining how your life turns out and that power, I reckon, begins with positive thinking!

Negative emotions are bad for your health. Acts such as forgiving keep disease at bay? When you are holding on to a grudge your body reacts each time you see the person. Your heart races, your blood pressure rises as your body prepares for a fight. You put a strain on your brain, your gut and your heart, and this only leads to further deterioration in your condition, therefore, rid yourself of this kind of negativity.

3) Surround yourself with positive people
Your environment is as important as what which is embedded deep within you. Steer clear of negative people. Avoid them like the plague. Their negativity, skepticism and gloomy demeanor can only aid in your suffering and puts you in danger of disease taking residence inside of you for good. If they do not believe you can make it that is their problem, not yours. Your job is to fight.

You may be battling a disease but do not forget to live. Your life is not over yet. Laugh, play, dance and give yourself a break! Remember to let your loved ones, those who believe in you, care and look after you too!

4) Implement
There are some basic principles in maintaining good health. Nothing replaces good nutrition, fresh air, adequate rest, exercise, sunshine, drinking water, and so on. You cannot expect to beat any disease if you do not look after your physical self. Now is the time to implement all those health principles you learnt. They are relevant no matter what kind of disease you find yourself battling.

Also, it is crucial to do what your doctor tells you. If it is medication, you need to take, then follow the prescription and report any side effects immediately. When you feel discouraged appeal to your positive mindset and do not give up!

5) Have faith
The majority of us turn to that greater being when we are tried and tested, and for most it is our beliefs that keep us going. Pray and practice what you believe, for it is a crucial source of strength you need right now.

Fighting disease is no mean feat. It requires strength that comes both from within and without. When you are fighting disease, you are at your most vulnerable state. But, with the right mindset and support, I believe anything is possible. And, if in the end you succumb to your condition, at least you would have fought a good fight!

Bertha Mukodzani is a Nurse Practitioner and an Author of the book ‘A Life Steered’ which can be purchased on Amazon. Website: BERTHA’S WEBSITE

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Bertha Mukodzani has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions.

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Miscarriage

Miscarriage can happen to anyone

By: Dr Brighton Chireka • 5th May 2016

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Miscarriage can happen to anyone

Help me I am miscarrying!

By Dr Brighton Chireka

It is a worrying time for those involved when a miscarriage happens. A lot of questions are asked and sadly at times women are wrongly blamed for it. Surprisingly miscarriages are much more common that most people realise. It is estimated that among women who know they are pregnant one in six of these pregnancies with end in miscarriage. It may be a surprise to most of us that many more miscarriages occur before a women is even aware she has become pregnant. Losing three or more pregnancies in a row (recurrent miscarriages) is uncommon and only affects around 1 in 100 women. A miscarriage can be an emotionally and physically draining experience. One may feel guilt, shocked and angry and at times hopeless. It is the aim of this article to raise awareness about miscarriage and empower all women about it. It is my hope that after reading this article women will feel empowered and also men will be enlightened so that they can be able to support their partners through this emotionally draining time. It may be please to know that most couples who experience this will go on to have a successful pregnancy next time.

A word of caution to everyone , please do not use the word abortion when referring to a miscarriage . This is upsetting to those involved. The abortion is used to mean a procedure to end pregnancy and in miscarriage this is happening spontaneously without being caused by anyone.

Miscarriage is the loss of a pregnancy at any time up to 24th week. A loss after this time is called a stillbirth. Majority of miscarriages occur before 13 weeks of pregnancy- about 80%.

What causes bleeding in early pregnancy?

Many women may have a small bleed at the time of their missed period . This is sometimes called “implantation bleed” as it happens when the fertilised egg attaches itself to the wall of the womb. This is harmless bleeding so there is no need to worry about it and it stops on its own. The most common cause of bleeding in pregnancy is miscarriage.

A less common cause of bleeding in pregnancy is ectopic pregnancy . Ectopic pregnancy is a pregnancy that occurs outside the womb. It’s not very common and occurs in about 1 in 100 pregnancies. Ectopic pregnancies are potentially serious as there’s a risk you could experience internal bleeding.

Symptoms of ectopic pregnancy may include:

  • persistent and severe abdominal pain, usually on one side
  • vaginal bleeding or spotting, commonly after the pain has started
  • pain in your shoulder tip
  • Diarrhoea and vomiting
  • feeling very faint and light-headed, and possibly fainting

Symptoms of an ectopic pregnancy usually appear between weeks 5 and 14 of the pregnancy. Ectopic pregnancy is a medical emergency condition which needs urgent need attention. One can bleed to death if not attend to properly and promptly.

Symptoms of miscarriage

The most common sign of miscarriage is vaginal bleeding. This can vary from light spotting or brownish discharge to heavy bleeding and bright red blood. The bleeding may come and go over several days.

Other symptoms of a miscarriage include:

  • cramping and pain in the lower abdomen
  • a discharge of fluid from the vagina
  • a discharge of tissue from the vagina
  • no longer experiencing the symptoms of pregnancy, such as feeling sick and breast tenderness

What causes miscarriage?

 

There are many reasons why a miscarriage may happen but in most cases the cause may not be identified.

First trimester ( first three months of pregnancy ) miscarriages

Chromosomal problems

Most miscarriages in the first three months are cause by defects in the chromosomes of the baby. Chromosomes are blocks of DNA and a baby may have less or more of these resulting in miscarriages. It’s estimated up to two-thirds of early miscarriages are associated with chromosome problems.

Placental problems
The placenta is the organ linking the mother’s blood supply to her baby’s. If there’s a problem with the development of the placenta, it can also lead to a miscarriage

What can increase the chances of miscarriage?

An early miscarriage may happen by chance. But there are several things known to increase one’s risk of miscarriage.

The age of the mother plays a role in miscarriage:

in women under 30, 1 in 10 pregnancies will end in miscarriage
in women aged 35-39, up to 2 in 10 pregnancies will end in miscarriage
in women over 45, more than half of all pregnancies will end in miscarriage

Other risk factors include:

  • obesity
  • smoking during pregnancy
  • Abuse of drugs in pregnancy
  • drinking more than 200mg of caffeine a day. How can you keep a count of the amount of caffeine that you are taking ? Here is the answer. One mug of tea contains around 75mg of caffeine, and one mug of instant coffee contains around 100mg of caffeine. Remember that caffeine is also found in some fizzy drinks, energy drinks and chocolate bars
  • drinking more than two units of alcohol a week – one unit is half a pint of bitter or ordinary strength lager, or a 25ml measure of spirits, and a small 125ml glass of wine is 1.5 units. The best is stop drinking alcohol if you are trying to conceive and also when you get pregnant.

Second trimester (between weeks 14 and 26) miscarriages

Long-term health conditions can increase the risk of having a miscarriage . These conditions are :

  • Poorly controlled diabetes
  • Severe high blood pressure
  • Lupus
  • Kidney disease
  • An overactive or underactive thyroid
  • Coeliac disease

Infections may also increase the risk of miscarriage. These infections include:

 

  • Rubella (German measles)
  • Cytomegalovirus
  • Bacterial Vaginosis
  • HIV
  • Chlamydia
  • Gonorrhoea
  • Syphilis
  • Malaria

Food poisoning cause by eating contaminated food , can also increase the risk of miscarriage. Examples of food poisoning :
Listeriosis-most commonly found in unpasteurised dairy products, such as blue cheese.

Toxoplasmosis – which can be caught by eating raw or undercooked infected meat, particularly lamb, pork or venison
Salmonella – most often caused by eating raw or partly cooked eggs
Medicines may increase the risk of miscarriage. These include :

misoprostol – used for conditions such as rheumatoid arthritis
retinoids – used for eczema and acne
methotrexate – used for conditions such as rheumatoid arthritis
non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen; these are used for pain and inflammation
Please do not take any medication in pregnancy without first talking to your doctor.

Womb structure problems 

Problems and abnormalities with your womb structure can also lead to miscarriages. Possible problems include:

non-cancerous growths in the womb called fibroids-
an abnormally shaped womb

Cervical incompetence
In some cases, the muscles of the cervix (neck of the womb) are weaker than usual. This is known as a weakened cervix or cervical incompetence.

A weakened cervix may be caused by a previous injury to this area, usually after a surgical procedure. The muscle weakness can cause the cervix to open too early during pregnancy, leading to a miscarriage.

Polycystic ovary syndrome(PCOS)

This is a condition where the ovaries are larger than normal. It’s caused by hormonal changes in the ovaries.

PCOS is known to be a leading cause of infertility as it can lower the production of eggs. There’s some evidence to suggest it may also be linked to an increased risk of miscarriages in fertile women.

However, the exact role polycystic ovary syndrome plays in miscarriages is unclear. No treatment has been proven to make a difference and the majority of women with PCOS have successful pregnancies with no increased risk of miscarriage.

Misconceptions about miscarriage

Please take note that the following does not increase one’s risk of miscarriage.

  • a mother’s emotional state during pregnancy, such as being stressed or depressed
    having a shock or fright during pregnancy
  • Exercise during pregnancy, but discuss with your GP or midwife what type and amount of exercise is suitable for you during pregnancy
  • lifting or straining during pregnancy
  • working during pregnancy – or work that involves sitting or standing for long periods
  • having sex during pregnancy
  • travelling by air
  • eating spicy food

 

Will you ever be able to get a child ?
Many women who have a miscarriage worry about whether they will get another if they get pregnant. There is not need to worry much as most miscarriages are a one off event. About 1 in 100 women experience recurrent miscarriages (three or more in a row) and more than 60% of these women go on to have a successful pregnancy.

How can one prevent a miscarriage ?

Sadly in many cases , the cause of the miscarriage is not known so cannot prevent it.
Having said that , there are ways that can lower the risk of miscarriage and these include:

  • Not smoking in pregnancy
  • Not drinking alcohol or using recreational drugs in pregnancy
  • eating a healthy balanced diet with at least five portions of fruit and vegetables a day
  • making attempts to avoid certain infections in pregnancy such as rubella.
  • Avoiding certain medications or foods in pregnancy which could make you ill or harm your baby
  • being a healthy weight before getting pregnant

Weight

Obesity increases risk of miscarriage.The best way to protect your health and your baby’s wellbeing is to lose weight before you become pregnant. By reaching a healthy weight, one cuts risk of all the problems associated with obesity in pregnancy.

As yet, there’s no evidence to suggest losing weight during pregnancy lowers the risk of miscarriage, but eating healthily and activities such as walking and swimming are good for all pregnant women.

Treating an identified causes

Sometimes the cause of a miscarriage can be identified. In these cases, it may be possible to have treatment to prevent this causing any more miscarriages. Some treatable causes of miscarriage are outlined below.

Antiphospholipid syndrome

Antiphospholipid syndrome (APS), also known as Hughes syndrome, is a condition that causes blood clots. It can be treated with medication. Research has shown that a combination of aspirin and heparin (a medicine used to prevent blood clots) can improve pregnancy outcomes in women with the condition.

Weakened cervix

A weakened cervix, also known as cervical incompetence, can be treated with an operation to put a small stitch of strong thread around your cervix to keep it closed. This is usually carried out after the first 12 weeks of your pregnancy, and is removed around week 37.

What happens if you have a miscarriage

If there’s no pregnancy tissue left in your womb, no treatment is required.

However, if there’s still some pregnancy tissue in your womb, your options are:

expectant management – wait 7 to 14 days after miscarriage for the tissue to pass naturally out of your womb
medical management – take medication that causes the tissue to pass out of your womb
surgical management – have the tissue surgically removed
The risk of complications is very small for all these options. It’s important to discuss these options with the doctor in charge of your care.

After a miscarriage

A miscarriage can be very upsetting, and you and your partner may need counselling or support. You may also have questions about trying for another baby and what happens to the miscarried foetus.

Emotional impact of miscarriage

Sometimes the emotional impact is felt immediately after the miscarriage, whereas in other cases it can take several weeks. Many people affected by a miscarriage go through a bereavement period.

It’s common to feel tired, lose your appetite and have difficulty sleeping after a miscarriage. You may also feel a sense of guilt, shock, sadness and anger – sometimes at a partner, or at friends or family members who have had successful pregnancies.

Different people grieve in different ways. Some people find it comforting to talk about their feelings, while others find the subject too painful to discuss.

Some women come to terms with their grief after a few weeks of having a miscarriage and start planning for their next pregnancy. For other women, the thought of planning another pregnancy is too traumatic, at least in the short term.

The father of the baby may also be affected by the loss. Men sometimes find it harder to express their feelings, particularly if they feel their main role is to support the mother and not the other way round. It may help to make sure you openly discuss how both of you are feeling.

Miscarriage can also cause feelings of anxiety or depression and can lead to relationship problems.

Getting support

If you’re worried that you or your partner are having problems coping with grief, you may need further treatment and counselling. There are support groups that can provide or arrange counselling for people who have been affected by miscarriage or see your doctor for help.

 

When can you have sex or try for another baby?

You should avoid having sex until all of your miscarriage symptoms have gone. Your periods should return within four to six weeks of your miscarriage, although it may take several months to settle into a regular cycle.

If you don’t want to get pregnant, you should use contraception immediately. If you do want to get pregnant again, you may want to discuss it with your doctor or the family planning clinic. Make sure you are feeling physically and emotionally well before trying for another pregnancy.

Finding why you ?

It’s natural to want to know why a miscarriage happened, but unfortunately this is not usually possible. Most miscarriages are thought to be caused by a one-off problem with the development of the foetus. Go on with your life and try for another baby. It’s better said than done but try to be positive about it . Seek help and support to overcome your loss.

 

I hope you find this article useful. As usual I welcome your comments, suggestions or experiences that you may want to share. Also if you find the article useful why don’t you share so that many people are able to benefit from it.

 

This article was compiled by Dr Brighton Chireka, who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. Dr Chireka would like to thank www.nhs.uk for the material used to compile this article. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: Some names and identifying details have been changed to protect the privacy of individuals. This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health-care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way, shape or form represents the views of organisations that Dr Chireka work for or is associated with.

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Lower back pain

Management of Lower back pain

By: Dr Brighton Chireka • 4th May 2016

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Let’s talk about lower back pain

By Dr Brighton Chireka

Back pain is a common problem that affects most of us at some point in our lives. Back pain does bring a lot of fear in some people but the fact is that the majority of lower back pain does not have specific causes , it is non specific. Most cases of this back pain get better on their own and you may not need to see a doctor. Many of us stop going to work when in actual fact we should be going to work when we get this back pain. I hope that this article will help many of us to self manage our back pain and also take action to prevent ourselves from getting it. I will also highlight some serious symptoms that we must not ignore .

Causes of back pain

Our back is made up of bones , muscles, nerves and joints and any problems with these structures will result in pain. It is a relief that most cases of back pain aren’t caused by serious damage or disease but by minor sprains, strains or injuries, or a pinched or irritated nerve.

Non specific back pain can be triggered by everyday activities at home or at work, or can develop gradually, over time. Possible causes of back pain include:

  • bending awkwardly or for long periods
  • lifting, carrying, pushing or pulling heavy objects
  • slouching in chairs
  • twisting awkwardly
  • Over stretching
  • driving or sitting in a hunched position or for long periods without taking a break
  • overusing the muscles – for example, during sport or repetitive movements ( repetitive strain injury)

 

Risk of back pain

Certain things can increase our chances of developing back pain. These include:

  • If affected by overweight – the extra weight puts pressure on the spine
  • If affected by smoking
  • If affected by pregnancy– the extra weight of carrying a baby can place additional strain on the back.
  • long-term use of medication known to weaken bones – such as steroids.
  • Affected by stress or depression

Symptoms of back pain 

Symptoms of non specific lower back pain are mainly pain in the lower back area without any other symptoms. Most people find that movement causes pain and resting relieves the pain. There are some symptoms which should not be ignored so I urge you to see your own doctor without delay if you have back pain and:

  • a high temperature (fever)
  • Unexplained weight loss
  • a swelling or a deformity in the back
  • it’s constant and doesn’t ease after lying down
  • pain in the chest
  • a loss of bladder or bowel control
  • an inability to pass urine
  • Constant or persisting numbness around genitals, buttocks or back passage
  • it’s worse at night
  • it started after an accident, such as after a car accident

 

Diagnosing back pain

Most cases of back pain do not require medical attention and can be treated with over the counter painkillers and self care. Having said that I urge you to visit your doctor if you are worried about your back pain or you are struggling to cope or you have at least one of the above mentioned serious symptoms. Most of the back pain is diagnosed by doctors without needing to carry out tests. Doctors rely on the information that they are given by patients to be able to come up with a correct diagnosis. The General Practitioner (GP) will ask you about your symptoms and then examine your back . You need to prepare yourself as the pain may make you not able to give a clear story about your back pain. Your GP may also ask you about any illnesses or injuries you may have had, as well as the type of work you do and your lifestyle. Some of the questions your GP may ask are :

  • When did back pain start?
  • Location of pain
  • If one had back problems in the past?
  • Asked to describe the pain
  • medication being used
  • What makes the pain better or worse?
  • Presence of numbness or pins and needles
  • Etc to just mention a few questions one may need to answer.

Be prepared to discuss your ideas about your back pain, concerns and expectations with your doctor and make sure you take ownership of your health. The examination by your doctor will usually assess your ability to sit, stand, walk and lift your legs, as well as testing the range of movement in your back.
If your GP thinks there may be a more serious cause, they will refer you for further tests, such as an X-ray or Magnetic Resonance Imaging (MRI) scan. Otherwise, your GP can advise you about things you can do and treatments that may help reduce your pain and speed up your recovery.

Treatment of back pain.

Treatment for back pain vary depending on how long one has had the pain, how severe it is and one’s individual needs and preferences.

Short-term back pain
We all experience lower back pain and we usually treat it with simple pain killers and do not need to see a doctor . Most people will experience a significant improvement in their symptoms within a period of six weeks.

The following has been found to be helpful in treating lower back pain:

Keep moving
In the past we used to advise people to take bed rest so as to recover from a bad back. This is wrong as we have now found that people who remain active are likely to recover more quickly. We know that it may be difficult at first if the pain is severe , but try to move as soon as you can and aim to do little more each day. You do not harm yourself in most cases if you move around . A few people are so afraid of moving their stiff backs such that they stop moving at all. This is not good as the back pain will not get better and may become a chronic one that will last several months or become permanent. Activity can range from walking around the house to walking to the shops. You will have to accept some discomfort but avoid anything that causes a lot of pain.
There is no need to wait until you are completely pain-free before returning to work. Going back to work will help you return to a normal pattern of activity, and it can distract you from the pain. You can discuss with your employer so that you can either do light duties or altered hours until you are fully recovered.
Use of painkillers
We all use painkillers such as paracetamol and ibuprofen to control the back pain but in most cases we complain that it does not “touch the pain ” at all . I agree that the pain killers may not be strong enough but there are two things that we do which can make it worse. There is need to take these painkillers religiously without waiting for the pain and if there are not taking the pain away we do not stop taking them but we go and see our doctor whilst taking the painkillers. We need to discuss with our doctors about stronger pain killers we can take. We must not forget to keep walking as this will make us get better faster. In addition to strong pain killers our doctors may give us a short course of a muscle relaxant such as diazepam to ease off the spasms in the back. This diazepam must only be taken for a short period of time as it is addictive and one can get hooked on it.
Hot and cold treatments
Some people find that heat – for example, a hot bath or a hot water bottle placed on the affected area helps ease the pain. Cold, such as an ice pack or a bag of frozen vegetables, placed on the painful area can also be effective. Don’t put the ice directly on to your skin though, as it might cause a cold burn. Wrap an ice pack or bag of frozen vegetables in a cloth before putting it on your skin.
Relax and stay positive
Trying to relax is a crucial part of easing the pain because muscle tension caused by worrying about your condition may make things worse. Stay optimistic and recognise that your pain should get better. People who stay positive despite their pain tend to recover quicker.
Change your sleeping position
The way we sleep may be causing us more problems. I advice you to change your sleeping position when in pain so as to take some of the strain off your back and ease the pain. If you sleep on your side, draw your legs up slightly towards your chest and put a pillow between your legs. If you sleep on your back, placing pillows under your knees will help maintain the normal curve of your lower back.
Exercise and lifestyle
Try to address the causes of your back pain to prevent further episodes. Common causes include being overweight, poor posture and stress. I know certain people wear high heels and look good in them . My suggestions is that do not wear very high heel shoes and if you do wear reasonably high heels , try to wear them for a short time. You can always carry two sets of shoes so that you can wear your flat shoe after the occasion as high heels are not ideal for walking long distances or to be worn for a long time.
Regular exercise and being active on a daily basis will help keep our back strong and healthy. Activities such as walking , swimming and yoga are popular choices. The most important thing is to choose an enjoyable activity that you can benefit from within feeling pain.
Treatment for long-term back pain
Any back pain that lasts for more that 6 weeks is called chronic back pain and need aggressive treatment as it can become permanent and affect your quality of life. Chronic back pain need the help of a health professional and you must continue being active and taking your painkillers.

The following is recommended to deal with this type of back pain:

Exercise classes – group classes supervised by a qualified instructor, where you are taught exercises to strengthen your muscles and improve your posture, as well as aerobic and stretching exercises.

Manual therapy – therapies including manipulation, mobilisation and massage, usually carried out by chiropractors,osteopaths or physiotherapists.
Acupuncture – a treatment where fine needles are inserted at different points in the body. It’s been shown to help reduce lower back pain.

 

Counselling
If the treatments described above are not effective, you may be offered psychological therapy to help you deal with your condition. While the pain in your back is very real, how you think and feel about your condition can make it worse. Therapies such as Cognitive Behavioural a Therapy (CBT) can help you manage your back pain better by changing how you think about your condition.
Pain clinics
If you have long-term pain, you may be able to attend a specialist pain clinic. These clinics are available in the UK but doubt if there are available in Zimbabwe.
Surgery
Surgery for back pain is usually only recommended when all other treatment options have failed or if your back pain is so severe you are unable to sleep or carry out your daily activities.
The type of surgery suitable for you will depend on the type of back pain you have and its cause.
Two procedures sometimes carried out include:
a discectomy – where part of one of the discs between the bones of the spine (the vertebrae) is removed to stop it pressing on nearby nerves . This is done fir prolapsed disc – where one of the disc is pressing on nerves causing pain that goes into legs and foot and is associated with numbness or pins and needles.
spinal fusion – where two or more vertebrae are joined together with a section of bone to stabilise the spine and reduce pain
Please remember that these procedures can help reduce pain caused by compressed nerves in your spine, but they are not always successful and you may still have some back pain afterwards.
As with all types of surgical procedures, these operations also carry a risk of potentially serious complications. In some cases, nerves near the spine can be damaged, resulting in problems such as numbness or weakness in a part of one or both legs or, in rare cases, some degree of paralysis. The best way is prevention so let’s look after our backs .

 

This article was compiled by Dr Brighton Chireka, who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog atDR CHIREKA’S BLOG

Disclaimer: Some names and identifying details have been changed to protect the privacy of individuals. This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health-care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way, shape or form represents the views of organisations that Dr Chireka work for or is associated with.

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Lorraine Chinouriri

Interview with Lorraine Chinouriri

By: Dr Brighton Chireka • 27th April 2016

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An interview with Lorraine Chinouriri

By Dr Brighton Chireka 

I had an opportunity to interview Lorraine Chinouriri as part of my endeavour to see what some of the people in our community are doing about their health. Lorraine Chinouriri is a Presenter, Model and Entrepreneur. Born in Zimbabwe, her family relocated to the UK when she was aged 10 and she quickly established her first business aged 14. At the age of 19, she was mentored by top business owners as a mentee with Croydon Enterprise and started a Youth Recruitment Agency aged only 20. Lorraine pitched her business idea to ‘o2 Think Big Project’, who awarded her a grant and enrolled her onto their ‘Think Big Project’ programme.

In 2012, Lorraine graduated with a BA Honours in International Business and Marketing.

Lorraine is a Virgin Media Pioneer, the incredible online community has given her the opportunity to meet, be mentored and interact with some influential and successful entrepreneurs such as Channel 4 ‘Secret Millionaire’ Caroline Marsh, Award Winning PR Guru Mavis Amankwah, Motivational Speaker Anthony Robbins, Billionaire Donald Trump and many more. Lorraine was named a ‘change agent’ by isthisafrica.com and listed among the ’30 Young Zimbabweans to Watch’ on its online global poll in 2012.

In late 2015, Lorraine was featured in the national newspaper, The Sun. The article was an inspirational piece about her weight gain journey and the struggles she faced, she currently runs weight gain and weight loss programs and is a Herbalife Nutritionist.

Here are the three questions that I posed to Lorraine Chinouriri;

1- how is your diet like and do you have a special diet ?

My diet varies but the calorie intake remains the same , I am on a weight gain diet so whatever I eat has to help me achieve my 3000 calorie a day target.

2- do you exercise regularly and what is your favourite form of exercise?

I do have to exercise regularly because the weight I’m gaining doesn’t always go to the right places, I don’t do a lot of cardio though as I don’t want to burn too much fat I focus on weight lifting and mainly lower body exercise and abdominal exercises.

3- how do you avoid or keep yourself stress free?

I listen to music or read a book or watch a movie or catch up with my sisters on whatsapp, one of the 4 usually does the trick !

I was impressed by Lorraine Chinouriri as she is involved in the modelling industry and a lot of people are struggling to lose weight but with Lorraine it was the opposite. She struggled to gain weight and her story is inspiring . She is now running a weight gain and weight loss programs and is a Herbalife Nutritionist.

Her weight at one point was 44kgs and her height is 168cm giving her a BMI of 15.5  which is underweight. She now weighs a healthy 57kgs and her ideal weight range is 52.2kgs to 70.8 kgs.  Being underweight can damage your health and can contribute to a weak immune system, fragile bones, fertility problems and a lack of energy.

What inspires me is that we see a lot of young girls trying to lose weight to be in the modelling industry . Here we have someone who went through that and is working on maintaining a health weight . Some people miss meals , eat very little and avoid eating any fatty foods. They get leave the table immediately after eating so they can vomit or take tablets to suppress their appetite. Sometimes they take water tablets ( diuretics) so that they can lose fluid from their body. These people can end up having depression, anxiety, low self-esteem, alcohol misuse, and self-harm.

The most important first step is for someone with eating or weight problem is to realise they need help and want to get better. Friends and relatives can help but this is a very difficult conversation because they may be defensive and refuse to accept they have a problem. However, it’s important not to criticise or pressure them as this can make things worse.

This article is not to be used to criticise people with eating or weight problems. The main purpose of this article is to motivate people to seek help . Help is available by speaking with doctor or people that have experienced the problem and overcome it.

If the eating disorder is so severe you may need to see your doctor urgently for help as it might be Anorexia Nervosa.

Anorexia Nervosa

Anorexia nervosa is a serious mental health condition. It’s an eating disorder where a person keeps their body weight as low as possible. People with anorexia usually do this by restricting the amount of food they eat, making themselves vomit, and exercising excessively. The condition often develops out of an anxiety about body shape and weight that originates from a fear of being fat or a desire to be thin. Many people with anorexia have a distorted image of themselves, thinking they’re fat when they’re not. Anorexia most commonly affects girls and women, although it has become more common in boys and men in recent years. On average, the condition first develops at around the age of 16 to 17.

See your doctor if you think you have the above problem. Do not delay.

You can contact Lorraine Chinouriri on the following website to hear further details about her story LORRAINE’S WEBSITE

This article was compiled by Dr Brighton Chireka, who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: Some names and identifying details have been changed to protect the privacy of individuals. This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health-care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way, shape or form represents the views of organisations that Dr Chireka work for or is associated with.

 

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ZANU PF MANIFESTO ON HEALTH

ZANU PF MANIFESTO ON HEALTH

By: Dr Brighton Chireka • 27th April 2016

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ZANU PF MANIFESTO ON HEALTH

By Dr Brighton Chireka

We are now about 2 years away from another general election and soon we will be reading manifestos from different political parties. I have started the ball rolling by looking at what we were promised before the 2013 general election. Very few of us and me included read these manifestos but we should read them. They give us a basis to engage with our political parties and also allow us the opportunity to influence things. This only comes if we have a committed leadership that value the contributions of its population. The general public must also be willing to be fully engaged with issues that affect their lives.

A manifesto is a public statement stating your views or your intention to do something. If you feel you should be voted “Most Likely to Succeed,” you could issue a manifesto describing all the reasons why you deserve to win. You’ll most often hear about a manifesto that’s been issued by a group, like a political party or government — for example, a set of new rules that an incoming regime is going to enforce.

It is important to note that manifesto promises are not binding meaning that political parties can decide not to do anything they said they would in their manifesto if they get elected. Political parties have to be careful , because failing to implement certain polices can leave voters feeling betrayed. This can lead to a negative backlash so we hope political parties stick to their manifestos.

Let us look at ZANU PF  MANIFESTO ON HEALTH

ZANU PF in their manifesto before the 2013 election stated the following:
Health for all

An overaching goal of the people is the improvement of the health delivery system to attain health for all. This is particularly important in view of the numerous challenges facing Zimbabwe’s health sector such as shortage of skilled professionals and health- care staff, an eroded infrastructure with ill-equiped hospitals or clinics and lack of critical medicines and commodities. As part of its policy of health for all, Zanu PF will address these challenges as a matter of top priority over the next five years.

(g) v 76(1)(2)(3) on Zanu PF’s widely acknowledged promotion of health care for everyone in Zimbabwe which provides that (1) “Every citizen and permanent resident of Zimbabwe has the right to have access to basic healthcare services, including reproductive healthcare services; (2) Every person living with a chronic illness has the right to have access to basic healthcare services for the illness; and (3) “No person may be refused emergency medical treatment in any healthcare institution”.

This is encouraging that the ruling party envisioned health for all and acknowledges that there is staff shortages, ill equipped hospitals and lack of medicines. ZANU PF made a commitment that as part of its policy of health for all, it will address these challenges as a matter of top priority over the next five years. We are now halfway into the five years and it’s the right time to see where we are now.

Staff shortages and welfare of health professionals

Dr Parirenyatwa was reported in the Herald to have said that our health system needs 8000 nurses yet we have 3000 nurses unemployed. I am also reliably informed that we have over 400 medical students doing 4th year this year at the University of Zimbabwe. This means that we are now training more health professionals than in the past . During my days as a medical student our class was comprised of about 80 students only . It’s good to train enough health professionals but the problem is that we may not be able to employ all of them as shown by the crisis we have with nurses . The country need more health professionals but posts are frozen due to underfunding by the government or are based on the population of the 80’s. This need to be addressed as a matter of priority in keeping with the manifesto of the ruling party.

Doctors have been on strike on several occasions asking for their working conditions to be improved. It seems nothing has been done to improve the moral of our health professionals. Some are going for months without their salaries and to expect them to offer a caring service is a joke to say the least .

Not enough resources by Government of Zimbabwe but donor community helping

Monday the 25th April Malaria was Malaria World day and I was surprised to learn about how much the government of Zimbabwe has been putting to fund the management of malaria. It is sad that we are relying on donor funds to run our health system . It is reported that in 2014 the government of Zimbabwe only allocated one million for the management of malaria whilst the donors paid over 17 million .

Malaria is a major health problem in Zimbabwe with 50% of the population at risk, although its epidemiology varies in the different regions of the country, ranging from year-round transmission in the lowland areas to epidemic-prone areas in the highlands. The WHO estimates that there are more than 400,000 malaria cases among all age groups each year.

Zimbabwe has seen robust declines in malaria transmission and disease burden thanks to the dedicated health professionals and the donor community . Today, malaria is the 5th leading cause of morbidity (compared to 2nd leading cause in 2009). In 2013, incidence was reported at 29 per 1,000 (down from 58 per 1,000 in 2009); 351 malaria deaths were recorded (down from 375 deaths in 2009).

Easy access and affordable quality healthcare

It is right that the manifesto talks about access and affordability but is silent on quality. It is still a dream to have free emergency medical treatment. Last week a relatively was involved in an accident and was taken to a government health institute but no treatment could be started until money was paid. I had to read the ruling party manifesto again and it states that no person shall be denied emergency medical treatment. The sad reality is that we are miles away from achieving that and sadly we may not achieve it if no lobbying is done to remind the government of its promise it made to us .

Quality healthcare

I urge the government , health professionals and patients to work together and deliver a quality healthcare in Zimbabwe. On quality we are looking at three things , is it safe ? Is it effective ? and are patients having a positive patient experience in using the system?. Patients must be at the heart of decision making so they must be consulted fully. We are the patients and we are the ones using these public health institutes so our views matters most.

Committed leadership with patients at the heart of decision making
We have got dedicated health professionals who are currently working on the ground doing a fantastic job. They need good and committed leadership that put the welfare of patients at its centre. I hope that there is going to be more emphasis on clinical leadership and less on political leadership. The people that matters most must also be involved in the shaping of our health care. These are the patients who travel the journey of our health care. We should value them by genuine engagement in decision making. We should adopt the motto ” nothing about my care without me” and ” no decision about me without me”. It is easy to have these policies on paper but if there are not fully implemented then we will continue to suffer as a nation. We are waiting patiently for this manifesto to be implemented so that lives can be saved.

Remember !

We need to remember that as we eat today and get on with our lives there are thousands Zimbabweans who wish they could afford a single meal , who wish they could afford to buy a tablet of paracetamol , who wish they could raise enough cash to be operated , who wish they could get a visa to go and get treatment overseas, who wish their fundraising efforts are not in vain and who wish to have you refocus and commit all resources to resuscitate our health system.
What can we do ?

Something has to be done to lobby our government. Instead of the war veterans only asking for more personal benefits , they should be asking for more resources to be allocated to the Ministry of Health. Very few of us can afford private health care so we have to rely on the public health system.

I call upon each individual to write to their local Member of Parliament ( MP)and ask them to support Dr Parirenyatwa in having more resources allocated to his ministry . If all MPs support the call for more resources in our health system, maybe we may have more funding. There is power in numbers and the government will listen to the voice of the crowd. If the war veterans as a group are managing to have their needs looked into, then we should also do the same . The same war veterans use the same public hospitals as us so they must join us in our call for more funding.

I also welcome to hear from those within ZANU PF to explain how they are implementing their manifesto and the milestones covered so far. We are in this together as I personal support the vision but I am seriously concerned as I am not seeing us moving forward. I need to see the evidence that we are implementing this manifesto.

This article was compiled by Dr Brighton Chireka, who is a GP and a Former Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: Some names and identifying details have been changed to protect the privacy of individuals. This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health-care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way, shape or form represents the views of organisations that Dr Chireka work for or is associated with

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Partner of patient

Partner of a patient needs our attention

By: Dr Brighton Chireka • 27th April 2016

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Partner of the patient needs our attention as well.

By Dr Brighton Chireka
I went to visit a patient who was dying and I made arrangements for end of life medication to be put in place and then took the partner of the patient aside. I could see that the partner was exhausted but was maintaining a brave face. I then said to the partner , ” how are you coping – yourself? The partner looked down and remained silent . I stretched my hand and touched the partner’s hand and looked directly into the patient’s partner’s face and said that we were there to help. The partner then told me that at one point someone had mentioned that help was available, but no one had suggested when it should be sought . I then told the partner that it was the right time to seek help and that there was never a wrong time to seek help. Seeking helping does not mean we are weak or giving up on our loved ones or renegade on our responsibilities. The patient’s partner sobbed for a few minutes and got composed. The partner thanked me for bringing the subject and also making arrangements for counselling sessions at the local hospice.

 

Do not forget to check on the partner

All the attention is rightly so put on the patient. People can visit the patient and sometimes hardly acknowledge the presence of the partner or even ask how the partner is coping. Many a times the partner suffers in silent and feels guilt to come up in the open. The partner thinks by letting the suffering known may be taken as attention seeking or selfishness. Because of this the partner decides to pretend that everything is normal and try to carry on.

As stated in my previous writing that my articles are motivated by life experiences , this one is no exception. I was partner of a patient at one point and I experienced the turmoil that comes with the diagnosis of any disease. I was not prepared for it and sadly I did not realise that I also needed help to pull through the challenging times. My focus was on my partner who was going through the treatment. I had to put up a brave face in front of her to show that ” I was coping well” . She did not even know that the week she was diagnosed I broke down crying uncontrollably in my surgery one evening. I was asking a lot of questions such as why me ? What is going to happen to the Kids , will she pull through? How is she going to cope with the side effects of the treatment? Will we manage to look after the baby? How will the baby grow up ? Will I manage to come to work and offer a safe service to my patients at work ?

My situation was unique in that being a medical doctor meant that I knew most of the things that were to come. What I did not realise was that doctors are the worst patients because of the way we think . We like to think about a rare worst scenario that we have seen or read about. I started to imagine about the worst cases that I had encountered.

I remember rushing for a home visit to see one of my patients who was undergoing treatment for breast cancer. The partner had called me because she was having temperature and was vomiting. On arrival I noticed that the patient was very toxic ( severe infection) and called an emergency ambulance for her to be admitted. One of the patient’s relative was not happy about my suggestion of hospital admission. Her reluctancy was due to the fact that she was planning to go on holiday the following day. The relative had been looking after the patient and had reached the end of her tether. The holiday was well deserved but could not go if the patient was now going to be admitted. I was vindicated when the patient arrived at the hospital and was diagnosed with severe infection called Neutropenic Sespis. The doctors in the hospital told the family that if she had not been brought to hospital that day she would have died. The family did send me a card apologising for the relative’s behaviour and also thanking me for being firm with my medical advice that the patient needed hospital admission. I can now understand that partner or relatives of patients can be under a lot of stress due to the patient’s illness. The health professionals need to understand and realise that some of the behaviour by relatives or partner of patients may be a cry for help.

Keep the lines of communication open

Being the partner of patient can be very difficult and the experience is like a “rollercoaster ride”. One goes through the highs and lows including shock , anger ,fear , anxiety , acceptance , relief and strength. The kind of relationship in your marriage or relationship will determine the way you will deal with the diagnosis. The diagnosis can bring you close together while others, especially those who were experiencing problems before the diagnosis , find it drives them apart. Your partner , family , work colleagues and even your friends may have new or different expectations of you because of the illness.

What you expect of yourself as a partner may also change. It can be a demanding time and to cope well it is important to look after yourself as much as those around you. You may find yourself isolated as everyone will be focussing on the patient. You feel that you cannot ask for help as it may be taken as a sign of being selfish. This is not the case , it is known that partners of patients are also affected by the illness in different ways. Talking to someone in confidence or a counsellor might help to lessen the stress. Failure to do that may result in you being overwhelmed with stress such that you may end up being , easily irritable , not sleeping, losing appetite and feeling tired all the time. You feel that life is not worth living anymore and at times your relationship with the patient can be stretched to the limit. Some relationships have sadly ended during these hard times but it should not be the case. What is needed is it make sure that the treatment of the patient takes into consideration the whole family.

Most partners want to be there with their loved ones all the time. This means attending all the clinic appointments and spending time with their loved ones in hospitals when admitted. We know that this is a wishful thinking as the partner will need to go to work and also look after the children. To make matters worse the hospital appointment system does not in most cases take into consideration the patient’s lifestyle later on the partner’s. Appointments are booked at awkward times which are a challenge for the partner to meet. The patient is rarely asked about their diary or work commitments by the hospital. Appointments are made without involving the patient and if the patient misses two appointments they will be referred back to their general practitioners. This means that they will have to start the process all over again.

Thoughts you are shamed to verbalise but are important

Sometimes we do not plan ahead and wait to react when it is too late. We know that one day we will all die but sadly some of us do not make any preparations about our funeral. We have several companies that are offering and delivering affordable funeral policies. We must not wait for the last day when our partner who may be the breadwinner falls ill. We should be planning for that day now . As a partner of the patient you cannot avoid having thoughts that your partner might die. This is a natural reaction as you may worry about how you will manage without your partner, the financial implications of being without them. If you have young children , you may worry about the prospect of bringing them up alone. You may feel selfish for having these thoughts but there is nothing wrong being concerned about the future. The best thing to do after reading this article is to sit down with your partner and plan your future now and not wait when one of you is a patient.

How relatives and friends can help?
One hopes that couples or individuals plan for their future but sadly not many of us do that. If a friend or a relative falls ill we must be quick to offer our help. The help must be focused on the partner and children of the patient. I assume that the patient will be in hospital being looked after by the health professionals. I see a lot of people rushing to visit a patient in hospital but not helping the partner to cope with the kids at home. There are several things that we can do to help the patient recover well . It’s not about visiting in the hospital but it’s about asking about how the children and the partner are coping and how we can help them.

Hard decisions in terminal illness
As a community we do not openly talk about death but there comes a time that we are forced by circumstances beyond our control to talk about death. The doctors may call the family to a ” hard talk ” meeting about the illness of the patient. The doctors may break the bad news that the disease is beyond their expertise and there is nothing more they can do apart from giving tender, love and care (TLC) to the patient . The patient and family are then given options about the place the patient may chose to spend the last weeks if not days of their life. If this subject was discussed in advance then it will be easier as a plan of action will be there. If not , which is the case in most instances, the partner and relatives become numb and hopeless not knowing what to do. This time is crucial especially in those that did not plan ahead. Relatives can help the partner of the patient by supporting them in decision making. For those in the diaspora, It is worth exploring whether it is possible to take the patient back to Zimbabwe alive if no funeral policy is in place. It is cheaper that way rather than having to call for help from well wishers when the patient dies in a foreign land . If the funeral arrangements are in place then the next decision is to decide if the patient can be cared at home or at the hospice. There is no right or wrong decision here. It depends on what the patient wants and what the relatives are able to offer and support. It’s unfair and not nice to force the partner to look after the terminal patient at home. It should be a voluntary offer by the partner, not to be pushed into doing it.

It’s for all us so we must take heed.

This article seem to be talking about an issue that is far fetched but one day it will become more relevant to us and sadly it will be too late . We must not regret for not reading it and taken the necessary action. There is no need to worry as you have read this article and the next step is to reflect on it with regard to your life . Adjust anything that need to be sorted and enjoy your life knowing that you have planned for your future and also you know how to react as a patient or a partner of a patient.

This article was compiled by Dr Brighton Chireka, who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: Some names and identifying details have been changed to protect the privacy of individuals. This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health-care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way, shape or form represents the views of organisations that Dr Chireka work for or is associated with.

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Children and Parental illness

Children and Parental illness

By: Dr Brighton Chireka • 8th April 2016

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Children and Parental illness

By Dr Brighton Chireka

Children and parental illness needs our attention. It may not be possible to control the reality of illness but it is possible to make a big difference in how our kids tolerate it and carry on with their lives regardless of the outcome of our illness”, says Dr Chireka

Children and parental illness is a very sensitive topic which we rarely talk about. I would like to thank team Carol for raising this issue about children and parental illness. It is important for the ill parent to understand their own feelings before they can talk to their children. Once a parent has come to terms with their own fear , anger , and sadness, they become better able to help those who depend on them. Having said that one cannot expect to be in total control of every feeling they may have but should be strong enough to open up about their illness.

Are we protecting our children?

We all want to protect our children but in doing so we may be making them suffer more by not involving them in our illnesses . Children must be given information and support so that they know what to expect as far as the illness of their parent is concerned. Whatever the outcome of the illness , children may be able to handle it if they are prepared for it . If children are not prepared they may feel confused , hurt and angry that the diagnosis was not shared with them. We know that kids rely on us parents to bring order and security into their lives. We help our children to understand the work around them and their place in it.

Involving our children

 

Not involving your children may send the message that they are not important part of the family. This may also send wrong messages to children that illness is so terrible that they will not be able to cope with it. Sadly some kids may even believe that they were not told because it is their fault that their parent fell sick. Children do know and suspect when we are unwell and not preparing them leaves them alone to make sense of a difficult situation.

Personal view about children and parental illness

I would not want to leave my children under such stress hence me writing this article about children and parental illness. I had to open up to my eight year old daughter but I was surprised at the amount of information she knew and the comfort she gave me . She even told me that we must pray for mum so that God can heal her. So from that day I started to pray with my daughter and the faith that was in my daughter kept me going. After praying she would be happy and carry on with her life leaving me the “doubting Thomas ” to have more questions than answers about the illness .

When can we tell our children?

We all wonder when can we then tell our children about our illness. There is no set time as many factors influence a child need to be told about a parent’s illness. It depends on how you interact with your children and how open you are with regard to illness. If the channels of communication are open then the child would have been involved from the beginning that mum or dad is unwell. My advice to you is that kids need to be told the truth in small amounts over several days or even weeks depending on how ill a parent is . This way they have a chance to adjust to what they can understand while still going about their everyday lives.

This school must be informed so that they can support your children and help them to come to terms with the illness. The school can involve their counsellors to offer professional help . I know that some of us parents would rather avoid or postpone this talk, but I am afraid if you wait for the “right time” it may sadly not happen at all.

 

What can I share with my children?

 

What you share with your child will depend on their age and stage of development . Make sure you have uninterrupted time to talk to them. Please get another person to be there like your spouse or close relative for support.
You may want to ask your children about what they think is going on with you . You may also ask them about what changes have they noticed and also their worst fears. Remember children may believe that because you are on tablets you will recover and because they have prayed you will be healed. They do not think that it may fail so you need to gradually explain to them if the situation deteriorates as the beginning of the end starts.

If you are on treatment , you need to let your children know that the tablets are helping you to get better. If things do change it will be easier to tell them that the tablets are no longer working and the illness is not getting better and your body is not working as it should be. It is also important to be open with your children depending on the their age and your illness . If your illness is terminal and no curative treatment is available then children must be made aware of this. It is very important that they know as it will prepare them of any outcome of your illness.

What to expect from Children?

 

Be prepared for different reactions from children, some may be angry whereas other may be in denial. We know that all children depend on their parents for security and love so a parent should explain the new arrangements in place whilst the illness is being attended to. My daughter was worried about how she was going to school as her mum used to take her . I reassured her that I would step in and also a lovely neighbour chipped in and made our lives easier .

I hope we will be able to engage our children in these hard and difficult discussions . Not engaging is not an option as far as I am concerned . Let’s start walking the talk!

 

This article was compiled by Dr Brighton Chireka, who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health-care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way, shape or form represents the views of organisations that Dr Chireka work for or is associated with.

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My Pad

Celebrating Zimbabwe, My Pads story

By: Dr Brighton Chireka • 4th April 2016

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Celebrating Zimbabwe, My Pads story

By Dr Brighton Chireka

In my research on health issues about Zimbabwe, I came across My Pads website. This website reminded me of my primary school days. It was in 1985 when I was doing my grade 6 at Chindotwe Primary School in Musana area, that I witnessed a sad scenario about the issue of “My Pad.” We were in the middle of the lesson when one girl had her first period and messed her clothes. The boys, I included; in our ignorance, laughed at the girl. The poor girl had to go home, and she missed school for the whole week. We were told that she was having a period, so she could not come to school. One would have thought that she was having period pain, but that was not the case. The problem was that she could not come to school because she did not have pads. It’s hard to believe that someone had to miss school because of not having a pad. I am touched that someone has identified this problem and come up with a solution.

My Pads website

According to “My Pads” website, they have found overwhelming evidence that many Zimbabwean girls are in desperate need of suitable sanitary products to enable them to continue with their daily lives and to complete their schooling. According to the information on their website, very often, the girl will simply stay at home when she has her period – which means she will miss some school days – every single month. I have personally witnessed that when I was doing my primary school. Growing up in that community, we accepted that some girls would miss school for about three days each month.

My Pads are made in Zimbabwe using materials sourced in Zimbabwe. My Pads is the only reusable sanitary pad in Zimbabwe to have the Ministry of Health approval to sell this product. The pads are reusable as they just need to be washed, dried and worn again. A pack of 5 re-usable sanitary pads costs US$5 and will last for more than one year.

 

My Pads wear, wash, dry icon

What is the rational to using reusable pads instead of disposables?

One size fit all does not work. It’s known disposable pads have their place. In some areas, there is inadequate water supply to wash the reusable pads. However, research that was conducted in five provinces around Zimbabwe in 2014 showed that as much as 70% of our population are using clothes to absorb monthly periods. It is very sad that girls are using clothes, a very unhygienic way of dealing with monthly periods. This puts a lot of girls in these deprived areas at high risks of infections. This will result in them missing school, which will end up affecting their performance at school. The girl child will end up disadvantaged.

According to my pad here are the Advantages of a cloth sanitary pad.

  • Cloth pads are environmentally friendly in both manufacture and ultimate disposal. Disposable pads take many many years to biodegrade – especially those with a plastic liner to prevent leaking, or those tied up in plastic bags before they are thrown away.
  • They remove the risk of TSS (Toxic Shock Syndrome) associated with tampons.
  • Save you money in the long term.
  • Drainage systems, pit latrines and dustbins are not filled with disposable sanitary pads.
  • They are comfortable and soft.
  • The perfect size can be chosen to suit individual needs (2 sizes available) which is particularly attractive to young teens who don’t need huge pads.
  • Women with sensitive skin and allergies usually find cloth pads to be more comfortable against their skin.
  • You don’t have to remember or budget to buy pads monthly.
    With careful care (gentle washing) they will last years – but we recommend they are replaced every 12 – 18 months for good hygiene.

 

Things to remember when using these reusable pads

  • Washing reusable pads requires water.
  • Pads are quickest dried hanging outside, which may cause embarrassment for the women. (A light cloth can be hung over the pads on the washing line to hide them as they dry.)
  • Special care may need to be taken if the user has a Candidiasis infection (i.e. thrush /yeast infection). Once the infection is treated, the cloth menstrual pads may need to be sanitized in order to prevent reinfection.
  • Initial cost for reusable menstrual products is typically higher per pad than for disposables, although savings over time make them more economical.

My conclusion,

This is a noble cause and if 70% of our population is struggling to get pads, then the reusable pad may be the answer. I am called to action and would like to invite you, the readers of this blog to join hands with me in supporting this initiative. Many a time I get asked by many of you as to how you can help people in our community. Here is a simple way you can make a difference. A pack of 5 re-usable sanitary pads costs US$5 and will last for more than one year. This means that a donation of US$5 will go a long way to help someone out there. Let’s do it, what are you waiting for?
For more information and ways you can donate please visit My Pad website on PADS WEBSITE

You may want to read about period pain PERIOD PAIN NEED YOUR ATTENTION

Interests to be declared – none
This article was compiled by Dr Brighton Chireka, who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health-care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way, shape or form represents My Pad company or the views of organisations that Dr Chireka work for or is associated with.

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Dr Brighton Chireka on health quotes

Dr Brighton Chireka on health quotes

By: Dr Brighton Chireka • 29th March 2016

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Interesting quotes on health by Dr Brighton Chireka

There are engaging quotes on health which I would like to share with you. I welcome your contribution to this list so that we can have an even more appealing list. I cannot claim to be the original owner of some quotes hence putting that “I have modified them.” I have also tried to find the owners of some quotes and put their names next to their quotes. Hope you find them interesting and learn something in the process.

Message from Dr Brighton Chireka:

Thank you for the debate on our health system and may I leave you with a Chinese proverb which says “When the wind of change blows, some people build walls and others build windmills.“  I can only hope that most of us are building windmills. Do not wait for the perfect moment but take the moment and make it perfect !!

 

If we do not properly plan and design effective health systems, we will continue to blame hospitals as  inefficient and patients as too demanding ~ modified by Brighton Chireka

 

If carers are part of the health equation then, they must be valued, involved, consulted , listened to and fully supported and educated~ modified by Brighton Chireka

 


“For the sad status quo in our health system to continue unabated is for concerned people like you and me to do nothing.  Remember not taking action is a decision in itself” , says Dr Brighton Chireka BIG Health Consortium (BIG HC) Clinical Lead 

 

We should be doing everything to prevent people from getting into crisis . We need to be proactive and prepare for the inevitable . Reacting to situations shows that we were not planned and in most cases we will be late . Our solutions may be the right ones but delivered not at  the right time. Failing to plan is planning to fail so they say ~ modified by Brighton Chireka

 

We are acting as “enablers ” to our leaders as we allow them to keep us focused on what they are ” doing ” rather than what they have accomplished. This is like giving another drink to a drunk person . We need to make our leaders more accountable for results~ modified by Brighton Chireka

 

The sad thing about governments is that more often they do not solve problems but perpetuates them, while convincing voters that they are doing everything possible to fix things. “Doing something ” – carrying out surveys and having more pilots than Emirates airlines, holding hearings, creating commissions, launching programs, spending money – is the coin of realm , not results . This is no way to run a business . It’s the way to run a business down”~ modified by Brighton Chireka

 

Remember when it comes to taking action about your health , do not procrastinate or say I will start tomorrow. There may be no tomorrow or tomorrow can be a disease. ~modified by Brighton Chireka

 

The greatest wealth is health so invest in it

 

The London Declaration on Patient Safety 2006
“In honour of those who have died, those left disabled, our loved ones today and the world’s children yet to be born, we will strive for excellence so that all those involved in health care are as safe as possible as soon as possible. This is our pledge of partnership”

 


Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.  ~World Health Organization, 1948

 

A sad soul can kill you quicker than a germ.  ~John Steinbeck

 

He who takes medicine and neglects to diet wastes the skill of his doctors.  ~Chinese Proverb

 

The… patient should be made to understand that he or she must take charge of his own life.  Don’t take your body to the doctor as if he were a repair shop.  ~Quentin Regestein

 

If you have health, you probably will be happy, and if you have health and happiness, you have all the wealth you need, even if it is not all you want.  ~Elbert Hubbard

 

I in illness is isolation, and the crucial letters in wellness are we.  ~Author unknown, as quoted in Mimi Guarneri, The Heart Speaks: A Cardiologist Reveals the Secret Language of Healing

 

When it comes to eating right and exercising, there is no “I’ll start tomorrow.” Tomorrow is disease. ~Terri Guillemets

 

I like the above quote and I then modified it to the following:

When it comes to getting medical insurance and paying your premium, there is no ” I will start tomorrow. Tomorrow is too late as access to treatment will be denied~ Dr Brighton Chireka

 

I think you might dispense with half your doctors if you would only consult Dr. Sun more.  ~Henry Ward Beecher

 

Health is not valued until sickness comes. ~Thomas Fuller

 

From the above I came out with the following quote:

Medical aid insurance is not valued until sickness comes and one needs to be admitted in a hospital but is asked to pay upfront ~Dr Brighton Chireka

 

He who can believe himself well, will be well. ~Ovid

 

If you have health you will probably be happy , and if you have health and medical aid cover , you have all that you need even its not all that you want~ modified by Dr Brighton Chireka

 

He who gets medical aid cover and make false claims is stealing from himself as the medical society will go bankrupt ~Dr Brighton Chireka

 

Just because you’re not sick doesn’t mean you’re healthy.  ~Author Unknown

Just because you are not sick does not mean you do not need medical aid cover~ modified by Dr Brighton Chireka

 

Just because you are not sick does not mean you are healthy. Go for a medical check up at a Well woman or Well man clinic ~modified by Dr Brighton Chireka

 

If you don’t take care of yourself, the undertaker will overtake that responsibility for you. ~Terri Guillemets

 

many people spend their health gaining wealth, and then have to spend their wealth to regain their health.  ~A.J. Reb Materi, Our Family

 

A word of caution to Zimbos in the diaspora, do not spend your health gaining wealth. You will sadly spend that wealth trying to regain your health and that may be too late . ~modified by Dr Brighton Chireka.

 

But times of stress and difficulty are inevitable in life. Mental hygiene means preparation to deal with such times. ~Mental Health Bulletin, Illinois Society for Mental Health, 1928

 

Sometimes a headache is all in your head. Relax. ~Terri Guillemets

 

Great secret of medicine, known to doctors but still hidden from the public, is that most things get better by themselves. ~Lewis Thomas

 

When it comes to coughs and colds the greatest medicine , known by us doctors but still hidden from the patients, is that most coughs and colds get better by themselves ~modified by Brighton Chireka

 

who has health has hope; and he who has hope has everything.  ~Arabic Proverb


The physician who teaches people to sustain their health is the superior physician. The physician who waits to treat people until after their health is lost is considered to be inferior. This is like waiting until one’s family is starving to begin to plant seeds in the garden. ~Author unknown, similar to statement in The Yellow Emperor’s Classic of Internal Medicine

 

A health system that teaches people to sustain their health is the superior system. The health system that waits to treat people until after their health is lost is considered inferior. This is like waiting until one’s family is starving to begin to plant seeds in the garden. We must promote health care and not sick care ~ modified by Brighton Chireka

 

Life has been reduced to getting food out of cans. ~Martin H. Fischer (1879–1962)


Sometimes I think our ancestors would laugh through their tears if they could see how we eat. We eat mostly from colorful boxes and cans. We spray our vegetables and fruits with deadly chemicals, then ship them half-way around the world before we eat them. It’s been a grand experiment in the wonders of technology, but what a price we’re paying in our health! Many scientific experiments have now demonstrated that if we simply return to eating more traditional, natural foods, the body often begins to heal itself. And, it’s becoming impossible to heal personal symptoms, unless they are understood in relationship to the need to heal the planet. ~Kristina Turner, The Self-Healing Cookbook, 2002, originally published 1987  [a little altered —tεᖇᖇ¡·g]

 

The doctor of the future will give no medicines, but will interest his patients in the care of the human frame, in diet, and in the causes and prevention of disease. ~Thomas Edison

 

To avoid sickness eat less; to prolong life worry less.  ~Chu Hui Weng

 

It is part of the cure to want to be cured. ~Seneca

 

“Let food be thy medicine and medicine be thy food.”
― Hippocrates


“The individual who says it is not possible should move out of the way of those doing it.”
― Tricia Cunningham

 

“Healthy citizens are the greatest asset any country can have.”
― Winston S. Churchill

 

Healthy clients are the greatest asset any medical aid society can have ~modified by Brighton Chireka

 

“An over-indulgence of anything, even something as pure as water, can intoxicate.”
― Criss Jami, Venus in Arms

 

These quotes were compiled by Dr Brighton Chireka, who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health-care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way, shape or form represents the views of organisations that Dr Chireka work for or is associated with.

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Unite to end Tuberculosis

Let’s Unite to End Tuberculosis

By: Dr Brighton Chireka • 23rd March 2016

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Let’s  Unite to End Tuberculosis (TB)

By Dr Brighton Chireka

Each year , we recognise world Tuberculosis (TB) day on March 24. This annual event commemorates the date in 1882 when Dr Robert Koch announced his discovery of Mycobacterium tuberculosis, the bacillus that causes Tuberculosis (TB). The theme of world TB day 2016 is “Unite to End TB” . I invite you to “Unite with me to End TB” by sharing this article with as many people as you can . We want it to reach many people. Tuberculosis can affect anyone at anytime so we need to be aware of this disease.

What is Tuberculosis (TB) and how common is it?

 

Tuberculosis (TB) is a top infectious disease killer worldwide. It is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. It can affect other parts such as the abdomen, the brain and the bones as well as the glands. Tuberculosis is curable and preventable. According to the World Health Organisation (WHO) in 2014 , 9,6 million people fell ill with Tuberculosis and 1.5 million died from the diseases. Sadly over 95% of TB deaths occur in low and middle-income countries . It is among the top 5 causes of death for women aged 15 to 44. In the same year 2014 , an estimated 1 million children became ill with TB and 140 000 children died of TB.

Global impact of Tuberculosis

According to WHO In 2014, the largest number of new TB cases occurred in the South-East Asia and Western Pacific Regions, accounting for 58% of new cases globally. However, Africa carried the most severe burden, with 281 cases per 100 000 population in 2014 (compared with a global average of 133).

In 2014, about 80% of reported TB cases occurred in 22 countries. The 6 countries that stand out as having the largest number of incident cases in 2014 were India, Indonesia, Nigeria, Pakistan, People’s Republic of China and South Africa. Some countries are experiencing a major decline in cases, while in others the numbers are dropping very slowly. Brazil and China for example, are among the 22 countries with a sustained decline in TB cases over the past 20 years.

Tuberculosis (TB ) in Zimbabwe

According to USAID, Zimbabwe is the 17th highest tuberculosis (TB) burden country in the world, and TB is the second leading cause of severe illness and mortality in Zimbabwe. The most significant contributing factor to the TB burden is the HIV/AIDS epidemic. Approximately 80 percent of TB patients are co-infected with HIV. This co-infection remains a major factor propelling the high death rate among TB patients in Zimbabwe. Most cases of TB are found in the urban areas of Zimbabwe. Over the last five years, the number of TB cases detected annually has ranged between 40,000 and 48,000.

The challenge is that Tuberculosis is a leading killer of HIV-positive people worldwide. HIV and TB form a lethal combination, each speeding the other’s progress. In 2015 , 33% of HIV death was due to TB. In 2014 there were an estimated 1.2 million new cases of TB amongst people who were HIV-positive, 74% of whom were living in Africa. The other challenge is the development of TB that is resistant to the current drugs being used. Globally in 2014 , an estimated 480 000 people developed multidrug-resistant TB (MDR-TB).

A lot of work has been done by WHO and several governments all over the world to reduce TB. I am pleased that the Millennium Development Goal target of halting and reversing the TB epidemic by 2015 was met globally. TB incidence has fallen by an average of 1.5% per year since 2000 and is now 18% lower than the level of 2000. The TB death rate dropped 47% between 1990 and 2015. An estimated 43 million lives were saved through TB diagnosis and treatment between 2000 and 2014.
I now support this year’s theme of uniting to end TB . I also support ending the TB epidemic by 2030 which is among the health targets of the newly adopted Sustainable Development Goals.

How is Tuberculosis spread?

TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they push the TB germs into the air. A person needs to breathe in only a few of these germs to become infected. About one-third of the world’s population has latent TB, which means people have been infected by TB bacteria but are not (yet) ill with the disease and cannot transmit the disease.People infected with TB bacteria have a 10% lifetime risk of falling ill with TB. However, persons with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a much higher risk of falling ill.

When a person develops active TB disease, the symptoms (cough, fever, night sweats, weight loss etc.) may be mild for many months. This can lead to delays in seeking care, and results in transmission of the bacteria to others. People with active TB can infect 10-15 other people through close contact over the course of a year. Without proper treatment, 45% of HIV-negative people with TB on average and nearly all HIV-positive people with TB will die. This means that we need to diagnose TB early and treat it as well.

So who is at high risk of getting TB ?

All age groups are at risk of getting Tuberculosis but your location plays an important role. Over 95% of cases and death are in developing countries. Underlying infection such as HIV puts one at high risk. People who are infected with HIV are 20 to 30 times more likely to develop active TB. The risk of active TB is also greater in persons suffering from other conditions that impair the immune system. Tobacco use greatly increases the risk of TB disease and death. More than 20% of TB cases worldwide are attributable to smoking.

What are the Symptoms of TB and how is it diagnosed?

Common symptoms of active lung TB are cough with sputum and blood at times, chest pains, weakness, weight loss, fever and night sweats. Please do not ignore these symptoms as you will put your health at risk and of others. Many countries still rely on a long-used method called sputum smear microscopy to diagnose TB. Trained laboratory technicians look at sputum samples under a microscope to see if TB bacteria are present. With 3 such tests, diagnosis can be made within a day, but this test does not detect numerous cases of less infectious forms of TB.

Diagnosing MDR-TB and HIV-associated TB can be more complex. A new 2 hour test that has proven highly effective in diagnosing TB and the presence of drug resistance is now being rolled-out in many countries.

Tuberculosis is particularly difficult to diagnose in children. Children do not produce sputum as they tend to swallow it. They cannot accurately tell us how they are feeling which is vital in diagnosis.

How is Tuberculosis treated ?

The most encouraging thing about TB is that it is treatable and curable. Active, drug-susceptible TB disease is treated with a standard 6 month course of 4 antimicrobial drugs that are provided with information, supervision and support to the patient by a health worker or trained volunteer. Without such support, treatment adherence can be difficult and the disease can spread. The vast majority of TB cases can be cured when medicines are provided and taken properly.

Multidrug-resistant TB

Standard anti-TB drugs have been used for decades, and resistance to the medicines is widespread. WHO said that disease strains that are resistant to a single anti-TB drug have been documented in every country surveyed. Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not respond to, at least, isoniazid and rifampicin, the 2 most powerful, first-line (or standard) anti-TB drugs. A primary cause of MDR-TB is inappropriate treatment. Inappropriate or incorrect use of anti-TB drugs, or use of poor quality medicines, can cause drug resistance.

Disease caused by resistant bacteria fails to respond to conventional, first-line treatment. MDR-TB is treatable and curable by using second-line drugs. However second-line treatment options are limited and recommended medicines may not be always available. The extensive chemotherapy required (up to 2 years of treatment) is more costly and can produce severe adverse drug reactions in patients.

In some cases, more severe drug resistance can develop. Extensively drug-resistant TB, (XDR-TB) ,is a form of multi-drug resistant tuberculosis that responds to even fewer available medicines, including the most effective second-line anti-TB drugs.

About 480 000 people developed MDR-TB in the world in 2014. More than half of these cases were in India, the People’s Republic of China and the Russian Federation. It is estimated that about 9.7% of MDR-TB cases had XDR-TB.

What can we do or what can be done ?

Tuberculosis is a worldwide problem and calls for concerted effort from all stakeholders. I call upon all governments to fully engage with the WHO strategy in addressing TB.
WHO is providing global leadership on matters critical to TB. It has also developed evidence-based policies , strategies and standards for TB prevention, care and control, and monitor their implementation. WHO provide technical support to Member States, catalyze change, and build sustainable capacity. It also monitor the global TB situation, and measure progress in TB care, control, and financing. WHO shapes the TB research agenda and stimulate the production, translation and dissemination of valuable knowledge.

I endorse the WHO End TB Strategy, adopted by the World Health Assembly in May 2014. This is a blueprint for countries to end the TB epidemic by driving down TB deaths, incidence and eliminating catastrophic costs. It outlines global impact targets to reduce TB deaths by 90% and to cut new cases by 80% between 2015 and 2030, and to ensure that no family is burdened with catastrophic costs due to TB.

Ending the TB epidemic by 2030 is among the health targets of the newly adopted Sustainable Development Goals. WHO has gone one step further and set a 2035 target of 95% reduction in deaths and a 90% decline in TB incidence – similar to current levels in low TB incidence countries today.

The WHO strategy needs integrated patient-centred care and prevention. This means that patients must be at the heart of decision making and the care of patients must be joined up. The patient must be treated as a whole person and the family must be supported. Views of the patients must be taken into consideration and reasons must be given if their views are not utilised.
The strategy needs bold policies and supportive systems so that the aims of the strategy are realised . This also calls fir intensified research and innovation as the bacteria that causes TB is getting clever and clever everyday. Drug resistance is a threat to all the gains that have been achieved so far.

WHO have said that the success of the Strategy will depend on countries respecting the following 4 key principles as they implement the interventions:

1- government stewardship and accountability, with monitoring and evaluation
2-strong coalition with civil society organizations and communities
3-protection and promotion of human rights, ethics and equity
4-adaptation of the strategy and targets at country level, with global collaboration

In conclusion

We are all called to action to end TB in our community. We all have a role to play . Let us work glove and hand with our local health leadership. We need to take ownership of our health and do our part. We must not engage in lifestyles that put our health at risk and we must also present early to our doctors for diagnosis and treatment of TB. Taking medication as instructed will see us making a quick recovery and end this disease.

Dr Chireka would to give credit to WHO for up to date information provided in compiling this article .

This article was compiled by Dr Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk  and can read more of his work on his blog ( over 80 articles so far) at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Smelly feet

Smelly feet are not fun for anyone

By: Dr Brighton Chireka • 19th March 2016

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Smelly feet are not fun for anyone

By Brighton Chireka

Smelly feet are not fun for anyone but there is no need to worry as it can be prevented. Most of us have had smelly feet at one point in our lives. We know how annoying or embarrassing it can be. Be it in the bus , commuter omnibus or a public gathering smelly feet can be off-putting. Any foot movement can let the bad odour out of the shoes. I can remember at high school having smelly feet and not knowing what to do. Shoes would have to be left outside overnight as the smell would stop anyone from sleeping. Lack of knowledge made me worry a lot and lose my confidence but now it’s over and can share the wisdom. They say sharing is caring especially when it involves getting rid of smelly feet. It is my wish that no one should have to be stressed about this problem as there are effective , simple and cheap ways of dealing with this problem.

What causes smelly feet?

The main cause for smelly feet is combination of wearing the same shoes every day and sweaty feet.

The next question to ask is, “Why do feet sweat?”

We all can get sweaty feet regardless of temperature or time of the year. But teenagers and pregnant women are especially prone because hormonal changes make them sweat more. This is the main reason why I had the problem when I was a teenager.
One is likely to have foot sweating if they are on their feet all day. Being under a lot of stress can make one sweat a lot. Another medical condition called hyperhidrosis make people sweat more than usual and the feet are not spared.
Another notorious culprit is fungal infection , such as athlete’s foot that can lead to bad foot odour.

Lets look at a typical scenario which many us can relate to
Our feet sweat into our shoes all day so they get damp and bacteria start to grow. The bacteria continue to breed even when we take off our shoes. This is especially if we put the shoes in a dark cupboard ( trying to “hide the odour”). Then , when we put them on the next day , even if we just had shower, putting our feet into still damp shoes creates the perfect environment for bacteria to flourish. That environment is one that is warm, moist and dark. Bacteria on the skin break down sweat as it comes from the pores. A cheesy odour is released as the sweat decomposes.

I have smelly feet so how can I get rid of the smell?

I am glad you asked as we have simple, quick solution to smelly feet. First we need to make sure that it’s not fungal infection ( athlete’s foot) as the treatment is different but prevention is the same. I will cover athlete’s feet in the link below.

 

ATHLETE’S FOOT

 

Treatment of smelly feet
The advice is to clean the feet with an antibacterial soap. There are lots of over the counter foot hygiene products at your local pharmacy. I would recommend Hibiscrub as it is the best. Leave on the Hibiscrub for a couple of minutes , then wash it off. Do this twice a day for a week and you will say goodbye to smelly feet. Please do not use Hibiscrub on your feet if you have broken skin, such as eczema.

Presentation is better than cure and it’s cheaper. In view of that how do we prevent smelly feet?

Preventing smelly feet

This calls for good personal hygiene and it’s not rocket science. Here are the tips for you :
Never wear the same pair of shoes two days in a row. It is advisable to wear different shoes on successive days so they have at least 24 hours to dry out.
Make sure teenage boys have two pairs of trainers so that they don’t have to wear the same pair for two or more consecutive days. ( remember that they sweat a lot).
Wash and dry your feet every day and change your socks (ideally wool or cotton, not nylon) at least once a day. I repeat do not wear socks for more than a day please.
Keep your toenails short and clean and remove any hard skin with a foot file. Hard skin can become soggy when damp, which provides an ideal home for bacteria. Men nowadays can go for a pedicure and there is nothing unusual about it . I know these days world over men can now get private and discrete pedicure away from the public. Even in Harare I know two “posh” places where men can get a good private pedicure. Not to advertise any place but I had the pleasure of having pedicure in Bumi Hills, Sam Levy Village Borrowdale Harare , Joina City in the City Centre of Harare and several places in London not forgetting at home by my better half.

 

For those that sweat a lot and have sweat feet, it’s a good idea to:

1-Dab between your toes with cotton wool dipped in surgical spirit after a shower or bath – surgical spirit helps dry out the skin between the toes really well – in addition to drying them with a towel.
2-Use a spray deodorant or antiperspirant on your feet – a normal underarm deodorant or antiperspirant works just as well as a specialist foot product and will cost you less.
3- Put medicated insoles, which have a deodorising effect, in your shoes
4-Try feet-fresh socks – some sports socks have ventilation panels to keep feet dry, and antibacterial socks are impregnated with chemicals to discourage the odour-producing bacteria that feed on sweat
5- Wear leather or canvas shoes, as they let your feet breathe, unlike plastic ones
6- Wear open-toed sandals in summer and go barefoot at home in the evenings
When should you see a doctor?
These articles are mainly for information purposes and are not supposed to be used diagnose anyone without seeing a doctor. However smelly feet are a harmless problem that generally clears up with simple measures mentioned above. Sometimes, however, it can be a sign of a medical condition. I urge you to see your doctor if simple measures to reduce your foot odour don’t help, or if you’re worried that your level of sweating is abnormally high.

 

This article was compiled by Dr Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk  and can read more of his work on his blog at DR CHIREKA’S BLOG

 

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Athlete's foot

Athlete’s foot needs our attention

By: Dr Brighton Chireka • 19th March 2016

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Athlete’s foot or tinea pedis

By Dr Brighton Chireka 

Athlete’s foot is a rash caused by a fungus that usually appears between the toes. In athlete’s foot the skin may be itchy , red, scaly , dry , cracked or blistered. Athlete’s feet is called tinea pedis medically and is usually not serious. Having said that it should be treated as it can cause smelly feet and can spread to other parts of the body or other people. Around 15 to 25 % of people are likely to have athlete’s foot

 

You may want to read first about smelly feet in general

SMELLY FEET

Signs and symptoms of athlete’s foot

Athlete’s foot most commonly affects the skin between the toes or on the bottom of the feet. Affected skin may be dry , red, scaly and flaky. The skin may also be white, doggy and cracked. It may be itchy , sore and at times covered in blisters.
The fungal infection can spread around the feet and toenails. Scratching the infected skin and then touching other body parts can also spread the infection. In severe cases, skin damaged by athlete’s foot can become infected with bacteria. This can lead to cellulitis, which causes the skin to become red, hot and swollen.

How do we then get athlete’s foot?

Athlete’s foot is caused by fungi (yeast) growing and multiplying on the skin. The fungi that cause the infection thrive in warm, dark and moist places like feet.

You’re more likely to get athlete’s foot if you:

1- Don not keep your feet clean and dry
2- Wear shoes that cause your feet to get hot and sweaty
3- Walk around barefoot in places where fungal infections can spread easily, such as communal showers, locker rooms and gyms
4- share towels, socks and shoes with other people
5- Have a weakened immune system such if you have cancer , HIV or taking steroids or medication that reduces your immunity.
6- Have certain other health conditions, such as diabetes

Please remember that athlete’s foot can easily spread to other people by touching infected skin or coming into contact with contaminated surfaces or objects.

How can you prevent athlete’s foot

You can reduce your risk of developing athlete’s foot by:

1-drying your feet gently but thoroughly after washing them, particularly the areas between your toes
2-wearing cotton socks and roomy shoes made of natural materials such as leather – this can allow your feet to “breathe”
3-wear a fresh pair of socks, tights or stockings every day
4-change your shoes every couple of days – this allows them to dry out between uses
5-not walking around barefoot in public showers and locker rooms
6-not sharing towels, socks and shoes with other people, and ensuring your towels are washed regularly
7-using talcum powder on your feet to stop them getting sweaty
8-not using moisturiser between your toes, as this can help fungi multiply

If you or your child develops athlete’s foot, there’s no need to stay off work or school. Follow the advice given here to reduce the risk of spreading the infection to others.

How can you reduce infecting others?

-avoid scratching affected skin , as this may spread infection to other sites
-avoid going barefooted in public places ( you can wear protective footwear such as flip-flops
-do not share towels and wash them frequently
-there is no need to keep children away from school
-you do not need to wait for a doctor , you can go to the chemist and get some cream without prescription.

 

Treatments for athlete’s foot

 

Athlete’s foot is unlikely to get better on its own. It can usually be treated using antifungal treatments available from pharmacies without needing to see a doctor.

Antifungal treatments work by stopping the fungus causing your athlete’s foot from growing. They come in creams, sprays, liquids and powders. Some of the recommended medications are ketoconazole cream , terbinafine cream . A short course of a steroid cream may be added if the inflammation is too much .
If the creams fail or the infection is severe , oral antifungal are used. These include terbinafine , griseofulvin or itraconazole .
Fluconazole is not recommended as it is not effective . Ketoconazole is not recommended as there is high risk of liver damage.
Also do not us tea tree oil as it is not effective .

 

This article was compiled by Dr Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk  and can read more of his work on his blog at DR CHIREKA’S BLOG

 

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Vaginal discharge

Vaginal discharge what you need to know

By: Dr Brighton Chireka • 17th March 2016

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Vaginal discharge what you need to know

By Dr Brighton Chireka

Vaginal discharge is a very common problem for most women. Vaginal discharge can be normal physiological or abnormal due to other problems. Most women get worried as they try to find answers. I have heard some saying that they are not sexual active so why should they have vaginal discharge. Some go to the extend of using detergents to clean their private parts. Is that really necessary? This article is going to address these burning questions that most women have with regard to vaginal discharge.

In the UK the most common causes of vaginal discharge are the normal physiological discharge, Bacterial Vaginosis ( famously known as BV) and candidal infections. A normal physiological discharge is white or clear , non offensive discharge that varies with the menstrual cycle.

The same applies in Zimbabwe as shown by the Zimbabwe STI Aetiology study by Kees Rietmeijer et al in 2014. The study showed that Bacterial Vaginosis and yeast infections were the most common causes of female genital discharge syndromes. You can read about the study below
Study By Rietemeijer et al

 

What are the causes of vaginal discharge

Let’s look first at causes which are not due to infection
Non infective causes of vaginal discharge

Physiological causes
Newborn babies may have a small amount of vaginal discharge. This is  due to the level of hormones from their mums still in their blood system. This should disappear by the age two weeks . No need to panic but see your doctor if it persists or there are signs of trauma or injury ( worried about missing sexual abuse in babies)

During the productive years of women , the levels of hormones (chemicals in the blood) such as oestrogen and progesterone fluctuate a lot . This fluctuation affect the quality and quantity of vaginal discharge. Initially when the oestrogen is low the mucus from the neck of the womb (cervix) is thick and sticky. It becomes clearer, wetter and more stretchy as the oestrogen rises.
At menopause ( when women have stopped having periods) the normal amount of vaginal discharge decreases. This is due to the falling levels of oestrogen.

Other non infective causes

Some growth on the cervix such as polyps can cause non effective discharge
-foreign bodies such as retained tampons
-rash on the vulva called vulval dermatitis
-cancer of the cervix , uterus or ovary can all cause vaginal discharge
-fistulae can also cause discharge to be noticed in the vagina

Non sexually transmitted infections
Bacterial Vaginosis (BV) – most commonly seen is sexual active women
Candidal infections(yeast infection) –caused by the overgrowth of Candida albicans

Sexual transmitted infection
Chlamydia trachomatis
Neisseria gonorrheae
Trichomonas vaginalis

Symptoms depend on the cause. It is very important to be very clear about the nature of the discharge. Mention its colour, whether it’s smelling, how it started and how long you have had it . Also do not forget to mention how thick it is (consistency)

Symptoms that suggest the discharge is abnormal include
A discharge that is heavier than usual
– A discharge that is thicker than usual
– Pus-like discharge
– White and clumpy discharge
– Greyish , greenish, yellowish or blood-tinged discharge
– Foul-smelling ( fishy or rotting meat ) discharge
– A discharge accompanied by bloodiness , itching , burning , a rash or soreness

Let’s look at discharge caused by BV and by Candidiasis ( yeast infection)

 

Bacteria Vagininosis – causes thin , profuse and fishy- smelling discharge without itch or soreness.
Candidiasis(yeast infection) – thick, typically curd like , white , non-offensive discharge which is associated with vulval itchiness and soreness. May cause pain on having sex and on urination.

Sexual transmitted infection vaginal discharge
Chlamydia trachomatis – may cause copious pus like vaginal discharge but it is asymptomatic in 80% of women
Trichomonas Vaginalis – may cause an offensive yellow vaginal discharge which often a lot and frothy. It is usually associated with vulval itchiness and soreness, pain on passing water , abdominal pain and some discomfort on having sex.
Neisseria gonorrheae- may present with a pus like vaginal discharge but it is asymptomatic in up to 50% of women.
In the UK the finding of STI calls for screening for other STIs including HIV and also sexual contact tracing for testing and appropriate treatment. This means all your sexual contacts will be traced so that there are screened and tested if found to be infected.

Treatment of Vaginal discharge 

Treatment depends on the diagnosis and also guidelines in your country . Your doctor will treat you with the appropriate medication so see one if you have any worrying vaginal discharge . Normal physiological discharge does not need any treatment.

BV is mostly treated with metronidazole or clindamycin but this can vary depending on local guidelines
Vaginal and oral azole anti fungal are usually used to treat vaginal candidiasis (yeast infection) . Recurrent candidiasis can be a problem and is defined as 4 or more episodes annually. There is need to rule out diabetes and also to avoid offending behaviours such as douching the vaginal, wearing tight nylon pants, long term antibiotics. 90% of women remain disease-free during treatment with 150mg fluconazole every three days followed by 150mg once a week for 6 months.
Retained foreign bodies such as broken condoms , tampoons can cause discharge and the treatment involves their removals followed by treatment with antibiotics
Complications
Untreated , some Vaginalis infections can spread to the upper part of the reproductive organs and cause more serious illness and in the long term lead to infertility.
A retained foreign body such as a tampon has the potential of leading to toxic shock syndrome. Toxic shock syndrome (TSS) is a rare but life-threatening bacterial infection caused by Staphylococcus aureus and Streptococcus pyogenes bacteri.
One theory is that if a tampon is left in the vagina for some time, as is often the case with the more absorbent types of tampons, it can become a breeding ground for the bacteria.

Should I clean my vagina

Vaginal practices (VP) which include douching with water , detergents , using fingers or inserting things into the vagina are performed by women worldwide. The reasons range from hygiene to trying to make the vagina tight. VPs may directly increase HIV risk by causing abrasions in the vaginal epithelium or mucosal inflammation that may lead to recruitment of HIV target cells. VPs may also indirectly increase HIV risk by disrupting vaginal flora, leading to bacterial vaginosis (BV); BV is an established risk factor for HIV acquisition. You can check on the research below.

 

Vaginal Practices Research In Zimbabwe
The vagina is self-cleansing, so there is no need to wash inside it (called douching). Douching can upset the natural balance of bacteria and fungi in your vagina and lead to thrush or bacterial vaginosis.

Vaginal soreness and abnormal vaginal discharge can also be caused by overusing perfumed soaps, bubble baths and shower gels. Never clean your vagina with anything strongly perfumed. Use a mild soap and warm water to gently wash around your genitals. The message is that you do not need to wash the vagina, you just need to clean the area around it (vulva) using a plain, un-perfumed soap.

I hope the article has been useful to many women and I encourage you to share with your friends and also do not forget to leave me a comment.

This article was compiled by Dr Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk  and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Sugar tax and the need to reduce sugar

A sugar tax of sugary sweetened drinks

By: Dr Brighton Chireka • 17th March 2016

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A sugar tax on sugary sweetened drinks

By Dr Brighton Chireka

A sugar tax has been announced by George Osborne the UK Chancellor on sugary drinks. Under the sugar tax plans, soft drinks companies will pay a levy on drinks with added sugar from April 2018. The sugar tax will not be levied on milk-based drinks or fruit juices. The sugar tax will be imposed on soft drinks company producing drinks containing more than a teaspoon of added sugar per 100ml.

The sugar tax will be levied in two bands:
A higher band for sugary drinks containing more than 8g per 100ml of added sugar. This includes Coca Cola , Red Bull to just mention a few drinks . 8p will be added to the price of a can.
A lower band for drinks containing above 5g per 100ml . This include drinks such as Fanta , Sprite , Dr Pepper and Tonic water . 6p will be added to a can of bottle .
Pure fruit juices and milk-based drinks including coffee or hot chocolates , are exempt because milk has ‘ health benefits’. This is controversial as some of the drinks that have been left contain shocking amount of sugar.

I welcome this move in the fight against obesity but I still think that more needs to be done. The government is doing its part and we expect the food industry to be honest in their food labelling. The last part is ourselves as we need to monitor what goes into our bodies. Having eaten we must make sure that we are burning the excess energy in our bodies.

Why talking about sugar ?
We are what we eat and do after eating so we need to have a healthy balanced diet . We are recommended to eat fewer foods and drinks that are high in sugars. Sugary foods and drinks can cause tooth decay , especially if taken between meals and can cause us to put on weight.

All sugars are carbohydrates found naturally in most foods. Their main nutritional value is in providing energy. However, sugar is also added to lots of foods such as sweets, chocolate, cakes, and some fizzy and juice drinks.

What are carbohydrates?

Carbohydrates are sugars that break down inside the body to create glucose. Glucose is moved around the body in the blood and is the primary source of energy for the brain, muscles, and other essential cells. There are two main types of carbohydrates, simple and complex.  The more refined the carbohydrate the more quickly it is converted to glucose and released into the bloodstream.  This can cause peaks and troughs in blood sugar levels and results in variable energy levels – refined or simple carbohydrates should make up only about 10% of our daily carbohydrate intake.
Complex carbohydrates, such as those found in starchy foods such as Sadza, potatoes, bread, rice, whole grains, pasta and oats release glucose more slowly into the bloodstream providing more stable and sustainable energy levels to the body.

Eating foods with high sugar can contribute to us becoming overweight. Being overweight can increase our risk of health conditions such as: heart disease , type 2 diabetes and stroke.

How much sugar should we take per day?
Added sugars must not make up more that 5% of the energy we get from food and drink every day. We are therefore advised to take about 30g ( 7 teaspoons) of sugar a day for those of us aged 11 and over. Children should have less – no more than 19g a day for children aged 4 to 6 years old (5 teaspoons), and no more than 24g (6 teaspoons) for children aged 7 to 10 years old.

(Please note a teaspoon of sugar is approximately 4g of sugar )
Fruit juice and honey can also count as added sugars, as they’re sometimes added to foods to make them sweeter. Fruit juice is still a healthy choice (one 150ml serving counts towards our 5 A DAY). However, the sugars can damage our teeth, so it’s best to drink it with a meal and no more than one serving a day. This is because sugars are released during the juicing process. Sugars in whole pieces of fruit are less likely to cause tooth decay because they are contained within the food. We should not cut down on fruit as it’s an important part of a healthy, balanced diet.

Why are we not happy that coffee and hot chocolates are left out in sugar tax?

A survey by group called action on sugar found out that 98% of hot flavoured drinks would receive a red (high) label for excessive levels of sugars per serving and 35% contain same amount or more sugar that a can of Coca Cola. This sugar tax is leaving out the worst offenders such as Starbuck’s Hot Mulled Fruit – Grape with Chai, Orange and Cinnamon Venti that contains a whopping 25 teaspoons of sugar – more than THREE times the maximum ADULT daily intake of free sugars ( 7 teaspoons a day )

See the results of sugar in hot drinks

SURVEY ON HOT DRINKS

How can we cut down on sugar?

It is important to try and make small adjustments to our diet and lifestyle in order to reduce the amount of sugar that we consume each day.
It is interesting to see that in fact it does not take a long time for our taste buds to readjust to foods with less sugar, and that once they have, the foods that we used to eat appear far too sweet.

Check food labels
I suggest that we get into the habit of just checking the nutritional information on food labels . This will help us to check how much sugar the food contains. Sugar may have several names but in most labels we tend to find this phrase “Carbohydrates (of which sugars)”. When we find this phrase we must look at how much sugar the product contains for every 100g:

  • more than 22.5g of total sugars per 100g is high.
    5g of total sugars or less per 100g is low. 
    If the amount of sugars per 100g is between 5 and 22.5 that’s a medium level of sugars. It is advisable to pick the foods with less added sugar, or go for the low-sugar version.
  • We need to cut down on sugary, fizzy drinks , juice drinks and go for water or unsweetened fruit juice. We need to remember to dilute fruit juices for children to further reduce the sugar.
  • We need to gradually reduce the amount of sugar we put in hot drinks or cereals until we have cut it out altogether. I have managed personally to cut my sugar intake in tea or coffee as I do not put any sugar at all. It’s hard at first but you will get used to it as you drink more and more tea without sugar.
  • choose wholegrain breakfast cereals, but not those coated with sugar or honey.
  • Avoid adding sugar, salt or too much butter to any of your cooking. Instead, add flavour by using herbs, spices or lemon juice.
  • Try to stay away from condiments such as ketchup or sweet chili sauce, which are very high in sugar (up to 30%).
  • Try to grill, bake or steam foods rather than frying them.
  • Try to substitute cakes, biscuits or ice cream with fruit salads, sugar-free jelly or simply a couple of squares of dark chocolate for desert.
  • Avoid choosing fruits that are canned in syrup, instead choose fruits that are canned in their own juice.

 

We have sugar everywhere so it is tempting but we must not jeopardise our health. Having indulged in these high sugar drinks we need to make sure that we do something to burn them. I recommend that we keep active and have an exercise routine. No fizzy drinks when exercising as we may end up taking more sugars that we are trying to burn out . Water remains the best and the sooner we learn to drink it the better.

I would love to hear how you are managing to cut down on sugars in your diet.
This article was compiled by Dr Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk  and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Does more money mean better health

Does more money mean better health?

By: Dr Brighton Chireka • 15th March 2016

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Does more money mean better health

By Dr Brighton Chireka 

Does more money mean better health? Governments the world over have been rightly accused of not funding their health systems well and the Zimbabwean government is no exception. A lot of debate has been taking place in social media asking the same question: does more money mean better health? I have found that there is a lot of finger pointing taking place. The patients are blaming health professionals for not having empathy, love and care. The health professionals in turn are blaming the government for not paying them well and medical aid societies for not paying on time. The conclusion that has come from these debates is that the government must pour in more money into the health system and, if that happens, all our health problems will be solved. I ask again does more money mean better health?

I have noticed the same trend in the United Kingdom (UK) just before their general elections. Politicians were promising the public that they will have better healthcare. There will be more general practitioners (GPs) and their services will be 24/7. I am a general practitioner (GP) and it took me 5 years of training in Zimbabwe and a further 2 year internship before I moved to the UK. I then did further 3 years of GP training to become qualified. This meant that it took me 10 years to qualify as a family doctor.

Well, some may say it took long for me because I moved from one country to another which is true – so let’s look at a British-born GP. The British-born GP will train for 5 years as an undergraduate and then do 2 years of foundation training and about 3 years training for GP. Not surprisingly the duration of training is about 10 years and, obviously, the training keeps changing so this may not be the exact case today but the point is that doctors are not biblical manna that falls from heaven. The promise of better healthcare soon after a general election is sadly a false promise. Politicians tend to simplify reality and in the process give people empty promises.

Sadly, the public like to hear these lies and they go in their large numbers and vote these politicians into power hoping for a new future come post-election time. Anyone who today comes and says I will pour millions into the Zimbabwean health system will be seen as the messiah but my question is, “does more money mean better health?”

Do not get me wrong, I am an advocate for proper funding of the health system and also for proper remuneration of health care professionals but I do not just end there. I will urge once again the government to seriously commit enough resources and offer effective political leadership. However, there are other things which if not corrected will result in these resources going down the drain.
We all know that no one will knowingly put money into a pocket that has holes and expect to keep that money. The same applies to our health system, a lot needs to be done to make sure that resources are not wasted. It is said in Christianity that those that are loyal with little things can be trusted with a lot of things. What are we doing with those meagre resources at our disposal? Are we siphoning the little resources available? Are we wasting instead of efficiently utilising those resources?

What are we doing with what we have in our hands? Failure to acknowledge and fully utilise what we have in our hands will result in perpetual failure even if more money is pumped into the health system. We know that culture eats strategy for breakfast so we need to address our culture. The culture of corruption, making quick buck and reaping where we did not sow and also of putting the blame on someone and not doing self-criticism must be addressed if any money is to bring value to our health.

Zimbabwe is in a better position to learn from the mistakes that were made by other countries. For example the costs of care in the United States are high—exorbitant. U.S. spends more on healthcare than any other country but it is ranked outside top 30 countries in the world as far as the health of its people is concerned.

Obviously there are so many reasons why it is like that and a detailed analysis is beyond the scope of this article. My point here is that we need to be efficient in the way we use resources and focus on quality and not quantity of care. We must move away from a system that rewards mediocrity to one that pays by results. We use a payment system that has caused problems in America and we are asking for more funding which is right but I doubt if it will bring value to our health.

Let us look at some of the issues that need to be addressed as we ask for more funding from our government. We must also remember that these cannot be tackled at the same time. I would suggest that we start now to address these issues one at a time.

Paying for More Doesn’t Always Get You More

Under the current fee-for-service system, most doctors, hospitals, and other providers receive a payment for each service, be it a visit at their surgery, lab test, or medical procedure—regardless of whether or not they help (or harm) the patient. In other words, provider payment is based on the quantity of care provided, rather than the care actually needed by the patient, or the effectiveness of the treatment. Sadly at times providers don’t feel pressure to limit themselves from prescribing services that may not be necessary.

A sad scenario of the current system is that a patient or medical aid pays thousands of dollars to have a knee replaced and is discharged home. If the patient develops complications due to the mistakes or negligence by the surgeon or his team, the patient is asked to pay more cash to be seen and to have another operation to correct the mistake. If the patient cannot raise the money, some health professionals can refuse to see that patient. That system must stop and the patient must not continue to suffer.

Personally my policy in the Free National Health Service (NHS) is that if I see a patient today and tomorrow they want to see me or speak to me about the treatment that I would have given them, I will see them even if it means seeing more patients on that day. If a lot of patients are wanting to speak to me a day after seeing me then I need to reflect on my skills as a doctor. It may mean that I am rushing patients and not explaining or sharing options with them properly. I should not be paid more for (my mistakes) doing a bad job and the same applies to any doctor.

Poorly Coordinated Care

It is well known worldwide that a small proportion of every population uses most of the resources. This relatively small slice of the population incurs such high costs because most of these individuals have complex medical problems. The problems include common but difficult-to-manage chronic diseases like diabetes and heart failure, HIV/AIDS as well as respiratory diseases such as tuberculosis (TB). Chronically ill people take more prescription drugs, undergo more tests and procedures, and are hospitalised more often than people in good health.

But the costs for these patients really skyrocket when the care they receive is poorly coordinated: when patients are referred by their primary care provider to a specialist, move in and out of the hospital, and transition from the hospital to home care or a long-term care facility, all with little oversight or communication between providers. In this environment where there is no proper primary care service, patients may undergo the same lab tests multiple times, they may get the wrong combination of medications, and serious conditions may get misdiagnosed.

This not only leads to unnecessarily high costs, it also means poor care for the patients who most need help. It’s scary that patients move from one GP to another but their medical notes are not transferred and some patients are registered with several GPs. This chaotic health service will never get better even if we pour more millions into the system. What is needed is coordination of care. I will touch on integration and coordination of health services in my next article.

Avoidable Hospital Readmissions

Research has found that in most countries without well-coordinated health care, 25% of elderly patients discharged from hospitals end up being readmitted within 30 days, costing the health system many millions. Many of these readmissions could be prevented – and billions saved – if hospitals, doctors, and community health programs worked together to assist patients who are returning home or moving on to a nursing home or rehab facility.

Discharged patients need clear instructions on how to care for themselves at home, as well as help in scheduling and keeping follow-up appointments, sticking to a prescribed medication plan, and making necessary lifestyle changes. Communication here becomes the best pill that these patients can get from their empathetic healthcare professionals.

Litigation

Litigation due to failure to treat patients well can be costly to the hospital and also to the health professional involved. If patients are treated with tender, love and care they are less likely to complain or sue. They will accept that to err is human and not sue but they expect an inquiry or audit to be carried out and lessons must be learned so that the chances of the same mistake happening are minimised. Pouring money to uncaring and not bothered health professionals will be costly for the employer in this case government as it will pick up the bill for negligence. On paper, the government may be pumping lots of money without the resources being used for the right things.

The level of corruption is unacceptable and must be addressed as soon as possible. It beggars belief that whilst we are crying for more resources from the government we have some hospital officials who are defrauding the public willy nilly. How can a hospital lose millions of dollars without quickly noticing it? The culture of putting the blame on the general economic meltdown must stop. Let us account for the little that we are receiving and go back to the government with a genuinely empty bag not because our pockets are full.

Cost of services in Zimbabwe

Does more money mean better health ?

We also need to look at the cost of health services in our country. We are now one of the most expensive countries in the world. How can that be when we have the cheapest labour in the world, not that it’s good but we need to know then who is getting all the profits. There is need to understand and acknowledge that we are using hard currency and our prices should be ethical and not to try and make our patients suffer.

I am not saying health professionals are taking all the profits in the private sector but I am calling for a review of how we are charging patients in the private sector. The debate has sadly not taken place but it must start now or else the cost of our health will remain very high. Surely, we cannot become one of the most expensive countries in the world. Does that money in the private sector equate to better health care? This needs to be looked at and a genuine debate must begin or else the public will continue to suffer.

Too Much Care

There is a trend that rich people and those on medical aid are now spending millions of dollars on medical services that do nothing to improve their health—and which may even be harmful. This “excess care” can be a by-product of poor care coordination, such as when a patient has tests in his doctor’s office and then another one two weeks later in the hospital. Some patients are sadly getting infections in the hospitals resulting in medical aid companies or families paying more. This should not have happened in the first place as some of these patients did not even require hospital admission but because they have the “money” and afford admission.

Overtreatment is also a big problem: opting for surgery when medication or less invasive procedures would be equally effective (and less risky), is just one example. Use of most expensive and “strong” antibiotics for simple conditions is a major problem. Together, the combination of overuse and misuse of medical services, along with elevated prices, helps explain why quality of health care may not match the high level of spending.

If you look at hospitals, we pay for time spent in their beds even if no treatment was received. Operations are cancelled and patients spend days in hospitals not receiving treatment but the bill will still be going up. Most of the reasons can be avoided and include things such as failure to make sure that there is blood for the patient, or fluids for the patient and also whether the patient is fit for the operation, non-attendance by a consultant and overbooking, to just mention a few. This cannot continue to be paid for. Delayed discharge costs a lot to the government, medical aid and patients and must be addressed, not to fund it by asking the patient to pay more money to the hospital that is causing the problem.

There are some in our society who think that every cough and cold must be treated with antibiotics. They go further in their demands and ask for “very strong” antibiotics such as cephalexin or Augmentin. They claim that amoxicillin does not work for them and put a strain on the resources be it from government or medical aid. There is no medical justification in most cases of prescribing brand names of drugs instead of generic ones. Yes, there are exceptions to this and each doctor is allowed to use his/her clinical judgement to decide with the patient the best treatment.

Some patients have no respect for nurses at clinics and also GPs so they got to the hospital for minor illnesses. The public need to be educated that inappropriate attendance at the hospital is expensive, time-wasting and dangerous. Th patient can get other infections and serious patients may not be treated in time because the doctors will be busy dealing with non-life threatening illnesses.

Conclusion

Government must do their part in fully funding the health systems. Then the national and local clinical leadership must look at ways of avoiding wastage to the little resources that are put into the system. There is need to look at new ways to transform how we deliver patient care and how we pay for it. It is the wearer of the shoe who knows how painful it is. In view of that when we design the systems in our health patients must be involved. Not only involved but must be at the heart of our decision making.

We need to see things through the eyes of patients. We also need to think with their mind-sets not forgetting that one day we will all be patients and will use the same services. Let’s focus on quality of our health systems and positive patient experience of the health services. Gone are the days of wastage and focussing on numbers at the expense of quality. We want more money and we call for open and transparent use of that money to bring a high quality and safe health care system.

This article was compiled by Dr Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk . Read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Vitamin D and sunshine

Vitamin D and Sunlight are we getting enough

By: Dr Brighton Chireka • 13th March 2016

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Vitamin D and Sunlight are we getting enough?

By Dr Brighton Chireka

Vitamin D is important for good health and lack of it is very common. Vitamin D is mostly made in the skin by exposure to sunlight. We take the sunlight for granted because it’s free and easily available. We sometimes complain about it being too much . Our capital city in Zimbabwe is called sunshine city because we are bound to get a good dose of sunshine. For black people the sunshine is good for our health and others with “white” skin may be too much.

The world is now a global village people are relocating to different parts of the world . Many black people have found themselves in cold countries without sunlight. Black people are likely to need more time in sunlight if they live in the northern hemisphere or very far from the Equator – like South Africa, Canada , Europe or the US. The challenge is that in some of these countries there is not enough sunlight.

Allow me to digress a bit
Sunlight is not only needed for light but does play an important role in our food. At high school we used to brag about being learned by talking about “photosynthesis ” and “phototropism” These two processes have something to do with sunlight.

Photosynthesis is the process by which plants, some bacteria and some protistans use the energy from sunlight to produce glucose from carbon dioxide and water.
Phototropism is the orientation of a plant or other organism in response to light, either towards the source of light ( positive phototropism ) or away from it ( negative phototropism ).

Back to our discussion about Vitamin D

Vitamin D is a fat soluble pro-hormone. It is obtained through the action of sunlight on skin and from dietary sources. The action of sunlight (ultraviolet radiation of wavelength 290–310 nm) on skin converts cholesterol in the skin into vitamin D. To get the final active form of vitamin D, the liver and kidney are involved in processing the vitamin D from skin. The dietary form of vitamin D also has to pass through the liver and kidney to be processed into the active form. Most foods contain no or very lite vitamin D naturally .

Food that contain vitamin D include:
– Oily fish ( such as sardines, pilchards , herring , trout, tuna and mackerel)
– Fortified foods ( added vitamin D ) such as margarine and some cereals. Cereals are not without their problems as there are over processed and have high sugar content.
– Infant formula milk has added Vitamin D so babies who are being bottle-fed may not need extra vitamin D.
– cod liver oil is another source of vitamin D
– There is little or no vitamin D in UK milk or dairy products. Egg York, liver and wild mushrooms contain only small quantiles of vitamin D.

This shows that the only answer to getting enough Vitamin D is sunlight or taking supplements.

Vitamin D and Sunlight

 

We need the sunlight to make vitamin D and for a fair-skinned person (white ) , it is estimated that around 20-30 mins of sunlight on the face and forearms around the middle of the day 2-3 times a week is sufficient to make enough vitamin D in the summer months in the UK.
People with darker skin ( Asians and Africans etc) and the elderly need more time exposed to sunlight to make enough vitamin D. This is not possible in countries like the United Kingdom(UK).
For six months of the year ( October to April) much of the Western Europe ( including 90% of UK) lies too far north to have enough ultraviolet B in sunlight necessary to make Vitamin D in the skin. This means that many people in UK are at risk of not getting enough vitamin D.

Why do we need vitamin D ?
Main action is to help the absorption from the gut of calcium and phosphorus. Calcium and phosphorus are needed to keep bones healthy and strong.
Vitamin D is also important for muscles and general health . There is evidence that vitamin D help to prevent other diseases such as cancer, diabetes and heart disease.
A low vitamin D status has been implicated in a range of diseases including osteoporosis, several forms of cancer, cardiovascular disease, tuberculosis, multiple sclerosis and type I diabetes. Osteomalacia and osteoporosis both increase the risk of fracture.

How common is Vitamin D deficiency?

The National Diet and Nutrition Survey, demonstrates that up to a quarter ( 25%) of people in the UK have low levels of vitamin D in their blood, which means they are at risk of the clinical consequences of vitamin D deficiency. The Health Survey for England (NHS Information Centre for Health and Social Care 2010) found that 35% of adults in London had low status compared to the national average of 24%. This may reflect the higher number of people from the minority ethnic groups at risk of vitamin D deficiency living in London, compared to other parts of England. In winter and spring about 1 in 6 people in the UK have severe deficiency. It is estimated that about 9 in 10 (90%) adults in UK of South Asian origin may be vitamin D-deficient.

Other evidence highlights a greater risk of vitamin D deficiency in population subgroups, particularly infants from black and ethnic minority groups. Cases of rickets and hypocalcaemia in UK children, predominantly of Afro- Caribbean or South Asian origin, are widely reported .

Recently we witnessed a tragedy in our UK Zimbabwean community where a couple lost a baby due to malnutrition and rickets . The couple is sadly in prison as I write this article. They were charged with neglect of their child and ignorance is no defence.

It is my conclusion that over 90% of black people in the UK may be vitamin D-deficient. This is the main reason why I have compiled this article. Most people affected may not have symptoms yet or they have just vague symptoms such as tiredness , aches and pains and are unaware of the problem. I hope this article will add value to those people’s lives as they will say that after reading this article they took action about their vitamin D.

Who gets vitamin D deficiency?

 

Vitamin D deficiency means that there is not enough vitamin D in one’s body. This can occur in three situations:
1-The body has an increased need for vitamin D
2-The body is unable to make enough vitamin D
3-The body is not getting enough Vitamin D in diet

1-Increased need for vitamin D
Pregnant women , growing children and breast-feeding women all need extra vitamin D. There is increased need for Vitamin D if the gap between pregnancies is short. This is because there is little time to build up vitamin D stores before another pregnancy. Since breast feeding mothers lack enough vitamin D , this means that breast-fed babies will need extra vitamin. Please do not get me wrong , there are significant advantages to breast-feeding . No mother should stop breast-feeding due to concerns about vitamin D levels . The baby can simply have vitamin D supplements as drops by mouth.

2-Body unable to make enough vitamin D
There are various reasons why the body may be unable to make enough Vitamin D. The best source of Vitamin D is sunlight so people who get little of it are at high risk of deficiency. This is more of a problem in more northerly parts of the world where there is less sun especially the United Kingdom. This is worse in people who stay inside a lot. Those in hospital for a long time or are housebound.
People who cover up a lot of their body when outside especially those who wear veils such as the niqab or burqa.
I know there is need to protect the skin from harmful effect of the sun rays but there is a need for a balance. Sunscreen use lead to vitamin D deficiency , particularly if high sun protector factor (SPF) creams factor 15 or above are used.
People who have darker skin for example , people of African , African-Caribbean and South Asian origin are not able to make much Vitamin D in countries with less sun. This has been explained in detailed above.

Vitamin D deficiency can also occur in people taking certain medicines. For example Epileptic people on carbamazepine, phenytoin and people on some anti HIV medicines ( efavirenz).

One study showed that initiating two efavirenz-based antiretroviral regimens had a significant early decline in their vitamin D levels when compared to those initiating an atazanavir-based regimen.

3-,Not enough dietary Vitamin D
We all know that diet is not the best source but we must not shun away from foods with some vitamin D. People who follow a strict vegetarian or vegan diet or a non fish diet are at high risk of deficiency.

Symptoms of Vitamin D deficiency

Many people may have no symptoms of may complain of tiredness or general aches. Because of this the diagnosis of vitamin D is often missed.

Symptoms in babes and children
Vitamin D deficiency leads to low calcium which will result in muscle cramps , seizures and breathing difficulties. This may need urgent hospital treatment as it may be dangerous.
Severe deficiency may result in soft skull or leg bones. The legs may look curved ( bow-legged). This condition is known as rickets and children may also complain of leg pain and muscle pains or weakness.
Poor growth can result due to the deficiency
There is delay in teething
Children can be easily irritable
Children may be more prone to infections
Extreme low vitamin D level can cause weakness of the heart muscle ( cardiomyopathy)

Symptoms in Adults
Common symptoms which are ignored by many of us are general tiredness, vague aches and pains and a general sense of not being well.
Severe deficiency ( osteomalacia) there may be severe pain and also weakness. People can find themselves unable to get up from the floor or low chair. It can also cause difficulties in climbing stairs and can lead to the person walking with a waddling pattern ( clumsy swaying motion )
Bones can feel painful to moderate pressure especially in the ribs or shin bones)
Sometimes people have hairline fractures in bones and also bone pain in lower back, hips , pelvis , thighs and feet.

Treatment of Vitamin deficiency

Treatment varies depending on the level of deficiency and associated symptoms or disease. Please speak to your doctor for the appropriate dose for you .

According to Dr Kem 

If you are deficient you’d need at least 10,000 IU per day till your levels normalise then you’d maintain on 2000IU per day.

— If you have insufficient levels you’d need at least 2000IU per day, normalise then maintain on 1000IU per day. You’d still have to increase back to 2000IU per day in winter months though.

You may want to read her 10 pillars of  a healthy lifestyle

DR KEM 10 PILLARS

 

* Recommendations 
All UK Health Departments recommend:
* All pregnant and breastfeeding women should take a daily supplement containing 10μg of vitamin D, to ensure the mother’s requirements for vitamin D are met and to build adequate fetal stores for early infancy.
* All infants and young children aged 6 months to 5 years should take a daily supplement containing vitamin D in the form of vitamin drops, to help them meet the requirement set for this age group of 7-8.5 micrograms of vitamin D per day. However, those infants who are fed infant formula will not need vitamin drops until they are receiving less than 500ml of infant formula a day, as these products are fortified with vitamin D. Breastfed infants may need to receive drops containing vitamin D from one month of age if their mother has not taken vitamin D supplements throughout pregnancy.
* People aged 65 years and over and people who are not exposed to much sun should also take a daily supplement containing 10 micrograms of vitamin D.

* People who have darker skin, for example people of African, African-Caribbean and South Asian origin, because their bodies are not able to make as much vitamin D. These will need supplements containing 10 micrograms of vitamins per day.
Take note of the units – 1 micrograms is equivalent to 40 international units (IU) . This means the 10 micrograms recommended is similar to 400IU.

Here are just a few tips on increasing your sun exposure by by Eden Chiuslekuda.
Eden is an ECCT Natural Health Contributor.

Just expose your bare arms and or legs while you are out and about and simultaneously get more exercise by opting to walk to work or run your errands by foot.
Exercise outdoors instead of at the gym.
Do not wear sunblock which reduces our skin’s ability to make vitamin D from sunlight by as much as 95%.
If you are concerned about sun damage – get your exposure in the early to mid morning time frame, or late afternoon to early evening when the sun is not so intense in the sky.
Use a very mildly protecting natural oil like shea butter to prevent sun damage or eat a diet very high in antioxidants. A lot of our wild indigenous fruits (like tsubvu) have high levels of phytonutrients that add a protecting quality against sun damage to the skin.
What is the take away home message ?

We know our lifestyles, we know that we are always indoors and we know that there is not enough sunlight. We know we are not feeling well, we ache all over and also feel tired. We are prone to more infections , diabetes , cancer you name it. Could it be related to lack of vitamin D deficiency? Probably yes ! So what are you waiting for ? See your doctor for further discussion.

I will leave you with my quote :
“Remember when it comes to taking action about your health , do not procrastinate or say I will start tomorrow. There may be no tomorrow or tomorrow can be a disease”, says Dr Chireka

This article was compiled by Dr Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk  and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Nothing about me without me

Nothing About Me Without Me

By: Dr Brighton Chireka • 11th March 2016

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Nothing About Me Without Me!

By Dr Brighton Chireka

Nothing about me without me Facebook page has over 26 thousand likes. Most of you have been asking me about the title of this page. I found a great article by Jacquie Foss which I will use to explain why I started this page. What does the phrase Nothing About Me Without Me really mean and how does it apply in the medical system ?

Nothing about me without me looks at how we live our lives. It also looks at how the medical profession treats its patients. It also looks at how governments treat their citizens. If I look at myself and what I want for myself. I see that I want to be included in my treatment as a patient. Who should decide on how I live my life? I know myself very well and I would say , it’s Me who decides. I am here and it’s my life . This does not change if I am poor , disabled or not . It is my life and I need to be present when those choices are made. If it does not involve me then it’s not for me. Some will say if it does not involve us then it’s not for us.

Getting involved

Do you agree with me that we should be at the heart of decision making as patients or citizens of our country ? Do you get involved in the issues that affect your life? When you go to see the doctor, do you ask questions and get involved in the discussions about your treatment? Do you just get talked to and come out of the doctor’s room without knowing the name of medication prescribed? Do you also come out clueless on how to take your medicines? Do you come out empowered knowing the side effects to expect from the chosen treatment?

ICE

As we go to see our doctors we should remember that nothing about me without me is an everyday thing. As a patient you go to see the doctor with your “ICE”. What is “ICE”? “I” stands for ideas that you have about your illness. You may be thinking that you have cancer or heart attack. These are your ideas and you should make them known to your doctor even if they sound ridiculous. “C” stands for your concerns or worries that you have about your illness . Make these known to your doctor so that you come out less stressed. Many a times we worry a lot about simple things concerning our health. Asking our doctors to explain and address our fears will help us a lot . Be bold and speak out about your worries and mention it to your doctor, for example, if you are worried that you will die. “E” stands for expectations. What are you expecting your doctor to do about your cough? Make it known that you want a chest X-ray or antibiotics. Your doctor will then discuss with you about tests to carry out and treatment options . You will be given options and make an informed decision about different treatments available.

Health professionals as cheerleaders

I liken my role in raising health awareness to a cheerleader , I do not have to play the game for the public or teach them how to play it , rather I cheer them on saying, go on you can do it and lose those kilograms” , says Dr Brighton Chireka

The health professionals, in the haste to get things done we sometimes forget that it is not our lives. We do all the things that need to be done to take care of the patient we are treating but that patient is not part of the process. We need to slow down, remind ourselves that we are here to support our patients and not to take over their lives. When we are doing this without the patient we are in effect saying it is not their life anyway. How many things do you do for the person? When what we should be always doing is with. We must never forget it is not our life, it is their life. We do not make decisions for, we make decisions with them. Just like helpers for disabled people they do not cook for, but they cook with, do not clean for, but clean with, do not shop for, but shop with. Nothing about me without me remains a challenge but we should aim to achieve.

When you google it do not forget to docbeecee it

 

And if we do enough with, soon they can do it themselves and they can do more for themselves. This is what I call full empowerment of the patient. It fulfils our way of doing things ie nothing about me without me. Google is here to stay and our patients are well informed nowadays. It’s up to us in the medical profession to keep up to date with medical knowledge and be able to “correct” any wrong information that our patients would have got from Internet or reading from Nothing About Me Without Me page. The internet is full of information which can overwhelm patients. I suggest that when you google it do not forget to docbeecee it. This allows easy pick up of articles that are on docbeecee website.

 

Our Wish Nothing About Me Without Me

 

I am sure this is no more than you would want for yourself; that you are the decision maker in your life. Those we support or treat must be honoured and respected with that same power. It is their power and we must never assume it is not. When given the control over what is rightfully theirs you see all the possibility and opportunity the person has within himself or herself. Nothing About Me Without Me is not a phrase, it is not a motto it is what we must live, every day. Go ahead and live it. What are you waiting for ?

 

This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Cervical cancer

Sharapova and medication use review

By: Dr Brighton Chireka • 10th March 2016

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Sharapova’s case and medication review

By Dr Brighton Chireka

Sharapova’s case has been in the media for the past few days. Everyone has a view on Sharapova’s case. Dick Pound the World Anti Doping Agency’s (WADA) first president said that , “Sharapova and her team were reckless beyond description” . Some have come to the defence of Sharapova focussing on the way she came out and gave a press conference. Some are saying she did not have a choice as the case was going to come out in the open anyway. I am joining into the debate from a medical point of view. I would like to take this opportunity to raise awareness about medication use review. The issue about medication review resonate well with Maria Sharapova’s case.

What is Meldonium?

I was not aware of this drug before the Sharapova’s case. I have checked in the British National Formulary (BNF) issue 70 which is the latest covering September 2015 to March 2016. I could not find this drug. I have checked formulary that we use at our practice and could not find this drug again. On further research I found that it’s not registered in Europe or UK even in America. Meldonium is also known as Mildronate . It is used to treat ischaemia in people with angina or heart failure. Ischaemia is a lack of blood flow to parts of the body. It is manufactured in Latvia and only distributed in Baltic countries and Russia. It’s properties of increasing blood flow has been linked to improving exercise capacity in athletes. The Latvian company Grindeks, which manufactures Meldonium is reported to have said that the common duration of treatment is four to six weeks. The treatment can be repeated twice or thrice a year. Physicians can follow and evaluate the patient to ascertain the need for longer period of use.
World Anti Doping Agency (WADA) and Meldonium

Wada found “evidence of Meldonium use by athletes with the intention of enhancing performance” by virtue of carrying more oxygen to muscle tissue. The decision to add meldonium to the banned list was approved on 16 September 2015, and it came into effect on 1 January 2016. Wada had spent the previous year monitoring the drug before adding it to the banned list. Anytime WADA makes some changes to the banned drug list, it gives a notice on 30 September prior to the change. This gives the athletes October , November and December to wean themselves off any “to be banned medication” they may have been taking. All tennis players are given notification of the changes. The tennis players medical teams are also made aware of it.

Maria Sharapova and Meldonium use

Maria Sharapova revealed on Monday the 7th March 2016 that she had failed a drug test at this year’s Australian Open. Sharapova admitted using Meldonium for a period of 10 years after it was prescribed by her family doctor. It is not clear where the family doctor is based as Maria lives in America. Meldonium is not authorised for use in America. This raises a lot of questions about how Sharapova was getting her medication and who prescribed it. The most concerning issue from medical point of view is about medication use review. Who was reviewing the use of her medication and why allow a fit young athlete to take medication for a heart problem for that long? Sharapova claimed she was prescribed meldonium by her doctor in 2006 to deal with health issues such as an irregular heartbeat and a history of diabetes in her family. I do not want to read too much into the reasons given for taking the medication but it raises a lot of questions. Information available about the use of the drug does not include irregular heart beat or family history of diabetes. I know that some doctors can prescribe a drug out of its licence or its usual use if it can help other conditions. Could it be the reason why she was using the drug? We will not know and it’s not the purpose of this article.

What is Medication Use Review (MUR)

This is one of the best practice service that aims to help patients use their medicines more effectively. In the United Kingdom , this service is offered for free by pharmacists and general practitioners (GP).
Aims of the service


To improve patient knowledge, adherence and use of their medicines by:
1- Establishing the patient’s actual use , understanding and experience of taking their medicines
2- identifying, discussing and resolving poor or ineffective use of their medicines identifying side effects and drug interactions that may affect adherence.
3- improving the clinical and cost effectiveness of prescribed medicines and reducing medicine wastage .

Commons questions that may be asked during a MUR
1- How are you getting on with your medicines?
2-How do you take or use each of your medicines?
3-Are you having any problems with your medicines, or concerns about taking or using them?
4- Do you think they are working?
5- Do you think you are getting any side effects or unexpected effects?
6-Have you missed any doses of your medication?
7- Are you happy with the information you have on your medicines?

 

These MURs are very important especially when patients are coming from hospitals. In hospitals medicines are changed and new ones started with the old ones stopped. On discharge some patients may get confused and start taking the old ones instead of new ones or even take both. This can result in serious problems such as low blood sugar or blood pressure as patient overmedicate themselves.

I hope if Sharapova had regular Medication Use Review she would not be in this situation. I also hope that you and I can learn from this sad story and go for our regular MUR if we are taking medication on a regular basis.
This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Fibroids explained

fibroids everything you need to know

By: Dr Brighton Chireka • 9th March 2016

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Fibroids explained

By Dr Brighton Chireka

Fibroids needs our attention as they can be present for some time without causing any symptoms. The growths are non-cancerous tumours that grow in or around the womb(uterus). They are made up of muscle and fibrous tissue and vary in size. They are sometimes known as uterine myomas or leiomyomas. I am raising awareness of these benign growth as some women may be suffering in silence. I have had a few questions about fibroids send into my inbox and this is my answer to this topic.

What are the symptoms of fibroids ?

Many women are unaware they have fibroids as they do not have any symptoms. Women who do have symptoms may experience:

tummy (abdominal) or lower back pain
Heavy periods or painful periods
a frequent need to urinate
Constipation
pain or discomfort during sex
In rare cases, fibroids can cause significant complications, such as infertility and problems during pregnancy.
How are fibroids diagnosed?

As most women have no symptoms diagnosis of fibroids can be by chance when investigating for other problems. However if one has symptoms mentioned above , she should see her own doctor for further examination. Your doctor may request a scan to assess the uterus which will confirm the presence of fibroids.

Why fibroids develop?
The exact cause of  these growths is unknown. However, they are linked to the hormone oestrogen. Oestrogen is the female reproductive hormone produced by the ovaries (the female reproductive organs).
Fibroids usually develop during a woman’s reproductive years (from approximately 16 to 50 years of age) when oestrogen levels are at their highest, and they tend to shrink when oestrogen levels are low, such as after the menopause (when a woman’s monthly periods stop at around 50 years of age).
Types of fibroids

They can grow anywhere in the womb and vary in size considerably. Some can be the size of a pea, whereas others can be the size of a melon.
The main types of fibroids are:
intramural– the most common type of fibroid, they develop in the muscle wall of the womb
subserosal – fibroids that develop outside the wall of the womb into the pelvis and can become very large
submucosal  – these develop in the muscle layer beneath the inner lining of the womb and grow into the middle of the womb
In some cases, subserosal or submucosal fibroids are attached to the womb with a narrow stalk of tissue. These are known as pedunculated.

Treating fibroids
If they do not cause symptoms, treatment is not needed. They will often shrink and disappear without any treatment over time, particularly after the menopause.
If you do have symptoms caused by fibroids, medication to help relieve the symptoms will usually be recommended first. This may include medication to reduce the bleeding during periods or painful periods.
If these medications are ineffective, surgery or other less invasive procedures may be recommended.
Surgical treatment of fibroids
Hysterectomy
A hysterectomy is a surgical procedure to remove the womb. It is the most effective way of preventing fibroids coming back. This is usually recommended if the growths are too big and also if the women no longer need to have anymore children.
Myomectomy
A myomectomy is a surgical procedure to remove the fibroids from the wall of your womb. It may be considered as an alternative to a hysterectomy, particularly for women who still wish to have children. In this procedure only the growth is removed leaving the uterus.
Uterine artery embolisation (UAE)
Uterine artery embolisation (UAE) is an alternative procedure to a hysterectomy or myomectomy for treating fibroids. It may be recommended for women with large fibroids. UAE is performed by a radiologist (a doctor trained to interpret X-Rays and scans). It involves blocking the blood vessels that supply the fibroids, causing them to shrink.
Endometrial ablation
Endometrial ablation is a relatively minor procedure that involves removing the lining of the womb. It is mainly used to reduce heavy bleeding in women with fibroids, but it can also be used to treat small fibroids in the womb lining.
The affected womb lining can be removed in a number of ways, for example by using laser energy, a heated wire loop, microwave heating or hot fluid in a balloon.
Conclusion
If after reading this article and you think you may have these growths, do not panic just visit your doctor for further tests. Kindly share the article so as to spread the message and do not forget to leave me a message or a comment.

 
This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated wi

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Period pain

Period pain needs our attention

By: Dr Brighton Chireka • 8th March 2016

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Period pain ( Dysmenorrhea )

By Dr Brighton Chireka
Period pain (dysmenorrhoea) is usually felt as painful muscle cramps in the lower tummy, which can sometimes spread to the back and thighs. Sometimes period pain comes in intense spasms, while at other times the pain may be dull but more constant.

 
The period pain usually starts when the menstrual bleeding begins, and normally lasts for 48-72 hours. Menstruation is a process in women in which the body sheds the lining of the uterus. This occurs on a monthly basis from puberty till menopause. Blood flows from the uterus , through the neck of uterus ( cervix) into the vaginal canal. Some discomfort , pain and cramps are normal during the menstrual period. However period pain that causes severe pain resulting in women missing work or school is not normal.

 
Period pain is extremely common. Some studies suggest up to 90% of menstruating women experience pain and discomfort during their period. This means that almost all women will have stories to tell about period pain. I hope this article and comments from readers of this platform will help ease the agony cause by period pain.

How do we treat period pain?

Using pain killers

Most cases of period pain can be managed at home by buying a number of pain killers over the counter .Non-steroidal anti-inflammatory drugs (NSAIDS ) such as ibuprofen can be bought over counter. If you cannot take NSAIDS then you can try paracetamol . If these are not effective your doctor can prescribe other tablets such as naproxen, mefenamic acid or codeine.
Using contraceptive pills

If the above treatment fails then the contraceptive pill can be used to ease off the pain as well especially the combined oral contraceptive pill. Combined contraceptive pills can help to ease period pain because they thin the lining of the womb and help to reduce the amount of prostaglandin chemicals your body releases. If the lining of the womb is thinner, the muscles don’t have to contract as much when it needs to shed away as part of monthly menstrual cycle. The period will also be lighter as well as being less painful.

Treating painful periods at home with no medication 
There are a number of ways one can treat her painful periods at home. Although one cannot stop the pain completely, these measures can often help to ease or reduce it.
Stop smoking – smoking is thought to increase your risk of period pain
Exercise – although one may not want to exercise while having a painful period, keeping active can help to reduce pain; try some gentle swimming, walking or cycling
Heat – one could try applying either a heat pad or a hot water bottle to reduce pain; make sure you don’t use boiling water as you could damage your skin
warm bath or shower – taking a bath or shower can help to relieve your pain, while also helping you to relax
massage – light circular massage around your lower abdomen may help to reduce pain. Partners can help here by massaging around the lower tummy area.
relaxation techniques – you might want to try a relaxing activity, such as yoga or pilates, to help distract you from feelings of pain and discomfort.
Period pain caused by a medical condition
If you have not managed to control your pain after three months of treatment with NSAIDs and/or the combined contraceptive pill, your GP may refer you to see a specialist for further investigations to rule out an underlying medical condition.
If your period pain is caused by an underlying condition, your treatment will depend on which condition you have.
Less commonly, your period pain may be caused by an underlying medical condition, such as:
Endometriosis – the cells that normally line the womb start to grow in other places within the body, usually in the fallopian tubes and ovaries; when these cells shed and fall away, they can cause intense pain.
Fibroids– this condition occurs when non-cancerous tumours grow in the womb, which can make your periods heavy and painful
Pelvic inflammatory disease – your womb, fallopian tubes and ovaries become infected with bacteria, leaving them severely inflamed (swollen and irritated)
Adenomyosis – the tissue that normally lines the womb starts to grow within the muscular wall of the womb, making your periods particularly painful
Intrauterine device ( IUD) – this is a form of contraception made from copper and plastic, which fits inside the womb; it can sometimes cause period pain, especially in the first few months after it is inserted.
I hope I have added value and relief to women’s lives as we celebrate women’s international day.

 
This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Morning sickness

Morning sickness needs our attention

By: Dr Brighton Chireka • 8th March 2016

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Morning sickness

By Dr Brighton Chireka

Morning sickness is very common in pregnant women. It affects up to 70% pregnancies so we need to raise awareness about morning sickness. The term morning sickness is often used to describe this condition when symptoms are relatively mild, temporary, and more troublesome than serious. Most sickness occurs in the early hours of the morning but can occur at any time so this term morning sickness can be misleading.

What causes morning sickness?

Although a common condition the cause of pregnancy related nausea and vomiting remains unclear, and it is likely that multiple factors contribute. Theories include high levels of hormones produced by the placenta during pregnancy, multiple pregnancy, low blood sugar and vitamin deficiency to name a few. Symptoms typically begin at 6 to 8 weeks of pregnancy and are usually limited to the first trimester (12th week), although a small percentage of women can experience symptoms for longer. Some may even suffer throughout the whole of their pregnancy.

Although there is no evidence that nausea and vomiting in pregnancy can be prevented, vomiting during pregnancy sometimes may be lessened by lifestyle changes.

How do you manage morning sickness?

Men we are called to action to help our partners during this time. We need to allow them to rest as tiredness can make the sickness worse. If the sickness is mostly in the morning then we should allow our partners time to get up slowly and give them something like dry toast or plain biscuit in bed before they get up.

We must encourage them to drink plenty of fluids, such as water, and sipping them little and often rather than in large amounts, as this may help prevent vomiting. On eating they must eat small, frequent meals that are high in carbohydrate (such as bread, rice and pasta) and low in fat. Most women can manage savoury foods, such as toast, crackers and crisp bread, better than sweet or spicy foods. They can eat cold meals rather than hot ones as they don’t give off the smell that hot meals often do, which may make them feel sick.

We have to avoid foods or smells that make them feel sick. No drinks that are cold, tart (sharp) or sweet . We should be their helper but if we cannot then we need to ask the people close to us for extra support and help – it helps if someone else can cook, but if this isn’t possible, it’s better to go for bland, non-greasy foods, such as baked potatoes or pasta, which are simple to prepare.

We need to chat with our partners so as to distract them, as much as we can – the nausea can get worse the more they think about it. We have to understand that they must wear comfortable clothes without tight waistbands. Sometimes just being there holding their hands even if we do not know what to do is better than not being there .There is some evidence that ginger supplements may help reduce nausea and vomiting so why not try ginger biscuits or ginger ale. I hope this will empower you as you honour your special woman in your life. If the vomiting gets worse then we must seek urgent medical help as the baby may be affected if the mum is now dehydrated.

When we have tried the above and the nausea and vomiting persists then we need to seek health professional advice. At times hospitalisation may be needed to treat this morning sickness. We must not ignore it as it will affect the wellbeing of the baby.

I would love to hear from you about your experiences and how you have managed to cope with morning sickness or supported your partners.

This article was compiled by Dr Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Apostolic sect in zimbabwe

Apostolic sect communities in Zimbabwe

By: Dr Brighton Chireka • 7th March 2016

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Apostolic sect communities in Zimbabwe

By Dr Brighton Chireka

Apostolic sect communities in Zimbabwe are a large population that need full engagement. I have been reading a lot of bad things being said about certain members of the apostolic sect communities. In these writings and discussions all the apostolic sect communities get attacked and called all sorts of names. Apostolic sect communities are said to be backward, unlearned and retrogressive, child molesters and criminals that must be arrested. We see half baked solutions being implemented but sadly failure is inevitable. The end result is that the police will be involved to arrest some of these members.

Firstly reporters need to be responsible in their reporting. One cannot say certain Christians do this and that because there are so many . It’s fair to be particular about which group of Christians one will be referring to. The same applies to the apostolic sect communities. There are several apostolic sects and all have names. A responsible reporter should be able to name those groups so that innocent ones are not painted with the same brush.

I have to declare my interests here so that readers can make their judgement about what I am writing about. I am a member of the apostolic sect community. The views that I am expressing here are personal and do not represent the response from the church. I am presenting my views as a concerned member of the apostolic sect community. I practice modern medicine and my children are vaccinated and my church or religion does not stop me from doing that. I am instead encouraged to make full use of modern medicine.

I am aware that they are certain apostolic sects that do not embrace modern medicine. However the majority are embracing it. The problem that we have is at times our leaders do not know how to reach the so called “hard to reach” groups. I personally do not believe that we have a group that should be called hard to reach. It only means that the leadership has not found yet methods of reaching that group . It’s not that the group is hard to reach but it’s the leadership that has not yet find ways and means of reaching the group.

We have medical professionals in all these apostolic sects who must be engaged and helped to become health champions. A health message coming from the leader of a church will easily be received by the congregation. And a health message coming from a fellow apostle will similarly be well received. I have heard of initiatives that are being done to have health champions within the apostolic sects but it seems it was a one off exercise.

Initiatives to engage with the apostolic sect communities must not be reactionary but proactive. One cannot expect full engagement when you approach the apostolic sect community at the last minute about vaccination. Sadly you find some of the misguided people in the apostolic sect community hiding their children. Measures are needed to engage with these communities in advance so that their fears are addressed. Community health champions must be a permanent thing. They must also be supported to continue daily engagement with their communities.

I know a research was carried out by Dr Brian Maguranyanga and he made some good recommendations . I was privileged to have a quick discussion with the learned doctor. He challenged me to champion the cause for the apostolic sects. This is the main reason why I am writing this article.

Research by Dr B MAGURANYANGA

People are not being difficult at times but they are resisting the process being implemented . We need to understand the cycle of change. We also need to appreciate that we may not be at the same stage of change . Some may be at the stage of pre-contemplation whilst some are at various stages such as contemplation, preparation, action and maintenance. We need to move with them until they complete the full cycle of change. Let us join hands and influence one another in raising health awareness.

This article was compiled by Dr. Brighton Chireka. He is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Does Sadza cause diabetes

Does Sadza cause diabetes ?

By: Dr Brighton Chireka • 4th March 2016

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Is sadza bad for you ?

By Dr Brighton Chireka 

So is sadza bad for you ? We have recently had articles linking sadza to diabetes and many people are now wondering if sadza is bad for them. I have been asked on several occasions by concerned people. They want to know if sadza is bad for them. Does sadza cause diabetes ? Should we stop eating sadza? Before I start to answer these questions let us look at sadza and define it .

What is sadza?

Sadza in Shona is a cooked cornmeal that is the staple food in Zimbabwe and other parts of Southern Africa. Sadza in appearance is a thickened porridge and is commonly made with white maize (Mealie-Meal). This maize meal is referred to as hupfu in Shona. Despite the fact that maize is actually an imported food crop to Zimbabwe, it has become the chief source of carbohydrate and the most popular meal for most of us. Before the introduction of maize, sadza was made from ‘zviyo’ finger millet flour . Sadza is generally eaten with hands without the aid of cutlery. It is rolled into a ball before being dipped into meat, sauce/gravy, sour milk or stewed vegetables to name just a few relishes.

What does Sadza contain?

Sadza contain mainly carbohydrates and it is advised that it should make approximately one third of our diet.

What are carbohydrates?

Carbohydrates are sugars that break down inside the body to create glucose. Glucose is moved around the body in the blood and is the primary source of energy for the brain, muscles, and other essential cells. There are two main types of carbohydrates, simple and complex.  The more refined the carbohydrate the more quickly it is converted to glucose and released into the bloodstream.  This can cause peaks and troughs in blood sugar levels and results in variable energy levels – refined or simple carbohydrates should make up only about 10% of our daily carbohydrate intake.
Complex carbohydrates, such as those found in starchy foods such as Sadza, potatoes, bread, rice, whole grains, pasta and oats release glucose more slowly into the bloodstream providing more stable and sustainable energy levels to the body.

Sadza also provide fibre which is essential for good digestion and elimination. However, all maize meal is not created equal. The more refined the maize meal (Ngwerewere) , the more simple carbohydrates and less fibre it contains. The coarser the grain such as roller meal (mugaiwa) the better the fibre content and complex carbohydrates. Ideally we should be having our Sadza made from sorghum/millet based meals or the less refined maize meal ( mugaiwa).

So is Sadza bad for us ?
We need to remember that we are what we eat and do after that. There is a lot of misleading information about how bad carbohydrates are and our Sadza is not spared as well. Weight control is about ensuring a balance between calories consumed ( what we eat) and calories burnt ( what we use). Too many calories ( a huge portion of Sadza) equal weight gain, too few calories ( small portion of Sadza) result in weight loss and just the right balance between what we eat and what we use equals weight maintenance.

It’s not only what we eat that matters most ,it’s also what we do after eating. Our lifestyles promotes laziness as we are no longer walking or exercising. We are spending most of our time sitting and we hardly walk as we now drive everywhere. Just try to recall the time you spend sitting watching television or on social media chatting to friends. Another issue is that we are taking a lot of simple sugars unknowingly in our diets. We may have our portion of Sadza but what we are eating in addition to this is very important. A lot of us do not drink water but juices and fizzy drinks. It may be shocking to know the amount of sugar in a can of Coca-Cola.

Coca-Cola contains 10.6g of sugar per 100ml – so that’s 35g in a 330ml can (equivalent of 7 teaspoons) and 26.5g in a 250ml can (equivalent of 5 1/2 teaspoons).
We are recommended to take only 30g ( 6 teaspoons) of added sugar per day .
This means that we will have take more than the recommended sugar if we just drink one can of Coke a day(contains 7 teaspoons of sugar). We have not looked at our breakfast, lunch and supper to find out the amount of added sugars we will be getting. The juices that we drink have added sugar and if we drink tea or coffee several cups daily and put sugar in these hot drinks then we are going over the top with our sugar intake. Let’s say for example one drinks 4 cups a day of hot drink and puts one teaspoon of sugar in each cup. This means that per day that person is taking 4 teaspoons of sugar and if that person drinks 2 cans of Coke then their intake of sugar per day becomes frightening.

Zimbo way of eating

So let’s look at ourselves in Harare at lunch time. We drive to Mereki for lunch and because we are still at work we decide to have soft drinks. One can of coke before the Sadza . Sadza is cooked with refined maize meal which is simple carbohydrates which will increase the already high blood sugar from the Coke . We down our Sadza with another can or cans of Coke . We also hardly look at the portion of Sadza that we take but we all know that it is a big portion. We do not walk at all as we have our runners who buy meat and drinks for us whilst we enjoy music in our cars. We then go back to work with our tummies full of food and proceed into the lift to get to our offices. We are back to sitting at our desks and do some work. We have hardly walked yet we have consumed lots of sugar. I deliberately left out alcoholic drinks but you can read about dangers of alcohol in my article below

Drinking Alcohol

The Large servings of sadza on the plate, the added caloric intakes from meat with the lack of adequate physical activity result in weight gain. This is especially true for those of us in the diaspora where meat is always available and often reasonably priced. The maize meal we use here is highly refined and has low fibre which is not good for our health. The weight gain sadly puts us at high risk of developing diabetes.

Conclusion
It’s not Sadza that is bad for us, but it is the maize meal that we use , the size of portion and what we do after eating it as well as other sugary drinks that we end up taking. We must enjoy our Sadza but we need to be fully informed on the healthy lifestyle.
We must remember that several risk factors have been associated with type 2 diabetes and include: family history of diabetes, overweight, unhealthy diet , not exercising, increasing age as we get older, high blood pressure, certain ethinicity, history of diabetes in pregnancy called gestational diabetes and poor nutrition in pregnancy, all increases one’s chance of developing type 2 diabetes. Changes in diet ( to western diet ) and physical activity ( no longer walking , now using cars) related to rapid development and urbanisation have led to sharp increases in the number of people developing diabetes. Addressing these factors will reduce our chances of developing this disease. As you can ” see ” It’s not the Sadza as such but a lot of factors as outlined above , so we can enjoy our Sadza and stay healthy.

Here is what you can do to cut down on sugar and stay healthy.
These tips may help you cut down on sugar:
* instead of sugary, fizzy drinks and juice drinks, go for water or unsweetened fruit juice (remember to dilute fruit juices for children to further reduce the sugar)
* if you take sugar in hot drinks or add it to cereal, gradually reduce the amount until you can cut it out altogether
* check nutrition labels to help you pick the foods with less added sugar, or go for the low-sugar version
* choose tins of fruit in juice, rather than syrup
* choose wholegrain breakfast cereals, but not those coated with sugar or honey
* As a rule of thumb, vegetables should cover half your plate, meat a quarter of the plate and sadza the other quarter.
* If you make a relish combines meat with vegetables, make sure that there are more vegetables than meat in your pot.
* Make your sadza using higher fiber, unrefined maize, sorghum or millet meals.
* Enjoy your traditional foods (including sadza) but remember that portions matter and exercising as well.

You may want to check on the following articles.

PUMPKIN SEEDS AND OKRA

DIABETES MELLITUS

This article was compiled by Dr Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk  and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Why is my doctor running late

Why is my doctor running late?

By: Dr Brighton Chireka • 2nd March 2016

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Why is my doctor running late?

By Dr Brighton Chireka

Why is my doctor running late? Some of the readers here have been asking me why is it that their doctor is running late. I always encourage readers of this blog to go and see their doctors if they are worried about their health. I am humbled by the response as many of the readers here have reflected on my articles and taken the right decisions. I am afraid some of the readers have gone to see their doctors at scheduled appointments but were inconvenienced as some were seen 30mins past their appointment times. Some had to pay more for parking fees and some missed their other appointments. The big question in all this has been , “why is my doctor running late ?”

Firstly I would like to apologise on behalf of your doctors that we are all human we mess up. I am sorry as some ( though very few) doctors came to work late hence the clinics were running 30 mins behind. Sometimes as doctors we get distracted by some unessential, not patient related, things.

Having admitted our mistakes that would have caused the clinic to run late, I must now address the most crucial issue that we must not overlook. The majority of doctors arrived in time and some came an hour before the clinics started. Regardless of these doctors arriving early the clinics still ran late and patients were inconvenienced. We owe patients an explanation but we can not fully give them the details on the day of their appointment. If we did on the day of the appointment then the clinic would run late by an additional hour. This would annoy a lot of patients.

I am one the culprits as some of my patients end up waiting longer that I would like if I were a patient. Oh yes I have been a patient and I hate waiting .

In rare occasions I may arrive late for my clinic but in most cases I am on time but still end up running 20 to 30mins late . Before giving some of the reasons beyond my control let me give a general breakdown of how I use my time in general.

From patient’s side, it may look very straightforward and simple: you go to the doctor, tell your story, have an examination, set up a treatment plan and hopefully are good to go home. Here is the reality: In the UK general practitioners are given 10 mins per patient per appointment. Within this time the GP must :
Establish rapport ( a good understanding of someone and an ability to communicate well with them ) with the patient
– Allow the patient to tell what has been bothering them
– Ask further questions about the patient’s complaint
– Health promotion (alcohol, smoking, weight loss advice)
– Examine the patient
– Treat the patient (eg steroid injection into the shoulder)
– If it’s flu vaccine season consent and give the vaccine
– Prescribe new medications
– Review the patient’s current medications
– Issue repeat prescriptions
– Order further tests within the practice
– Write referral letters to other specialists
– the doctor must document everything they have done (if it is not written you might as well not have done it – legally speaking)

Patients sometimes wonder why l may not call them when I do not have a patient with me. At times I may be reading their notes before I call them or reviewing the results of tests or referring other patients to the specialist. Reviewing patient’s notes and investigations just before seeing them allows the doctor to be prepared for upcoming consultation.

Another thing that is forgotten is that after each consultation a doctors need to do “housekeeping ” to make sure that they are ready for the next patient. A doctor must make sure that effects of the previous consultation do not affect the coming consultations. It is better for a doctor to pause and even have a cup of tea so as to prepare well for the next appointment.

Occasionally patients may wait whilst the medics take a break. This may feel unfair to the patient but doctors work very long shifts and would struggle to function effectively if they were not allowed to take a break. Doctors do a lot and try to be as quick as possible without forgetting safety or being at risk of making mistakes.

If you were waiting in the Accident and Emergency department the likelihood is that the medics would be dealing with other patients who may have a more pressing need than your own. Sometimes this will be patients who are clinically unwell but equally, it can be dealing with a patient who is in pain or distressed.

Patient factors in the delay
What I have also found out is that there are certain patients that will require extra time and attention. These patients include:
screaming children who will need special skills to calm them down so that l can properly assess them.
– Elderly patients who can hardly walk or get up and down the couch for examination.
– Patients who have mental health issues like stress , anxiety and depression will need more time. It can be worse if they are suicidal and it’s not safe to let them go home.
– When breaking bad news to a patient , a doctor needs more time . Life changing or threatening diagnoses need to be fully explained without hurrying the patient but this will make the doctor run late if not well planned. Patients will need time to adjust, to ask questions, and maybe even to cry.
– Patients who are hard of hearing will require more time .
– Patients who do not speak the same language as the doctor’s. They will need an interpreter to be either present in person or via phone. This will require more time to arrange and then use the service.
– Some patients talk very slowly and there is nothing a doctor can do to hurry them.
– Some patients may bring family members and friends who will also want to ask questions.
– Some patients have complicated medical history that may take time to understand .
– Some patients may need urgent referral to the hospital or urgent medical intervention. It takes time to get a patient accepted at the hospital by the specialists. Some patients may require urgent nebulisation ( treatment for asthma) due to flare up of their asthma.

– Sadly as doctors we know time management but we are not exactly in a position where we could just rush things and hope for the best. You must remember that if we mess up, people could die.

– The problem is that in some cases doctors do not know which patient is going to needing more time. We sometime make some educated guesses but we do have patients that turn up needing to be seen urgently. We try our best to fit them in because of the seriousness of their medical condition . And if you happen to be following one of these patients, then you are out of luck.

– I will not forget to mention some of the unexpected things that can happen to mess up the clinic schedule that we cannot do much about: an emergency case shows up , that no-show patient comes in 30 minutes late but insists , in tears that he must be seen. As a doctor I cannot turn that patient away so the delay keeps getting worse and worse.

What can be done to address these delays

There are things doctors can do to mitigate the wait for patients who follow. For example, the doctor arriving on time and also booking double appointments for patients who are likely to require more time. Even with these measures a doctor can still run late. Other things can be done of course, while not directly addressing the wait, many doctor’s offices have TV monitors sometimes with educational programs, WiFi availability… and hopefully some decent magazines to make the wait bearable!

Patients have to do their part by arriving in time for their appointments. We cannot ask why our doctor is running late when we are also turning up late for our appointments.

From my own experience if a particular patient is angry because of a long wait , after apologising , I reassure them that I will spend as much time as needed with them. Interestingly many of these patients end up taking much longer than expected making me run more and more behind.

Bottom line:  in many situations, good healthcare can’t be rushed. I urge you to allow a bit of extra time when you visit your doctor or hospital for treatment. Please feel free to send me your comments or observations. I would love to hear from you.

This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk  and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Health effects of smoking

Health effects of smoking tobacco

By: Dr Brighton Chireka • 25th February 2016

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Health effects of smoking

By Dr Brighton Chireka

“Health effects of smoking ,our Zimbabwean students are burning as 20% of  them are using tobacco products. 

Health effects of smoking are not well highlighted and I thought I should address this sensitive topic. Health effects of smoking should be addressed to everyone including our students. We need to catch them young before any damage is done by smoking cigarettes. I was surprised to read that 20% of Zimbabwean students are using tobacco products. What is worrying about these results is that only 22% of adults are estimated to be using the tobacco products according to the 2011-2012 Zimbabwe Demographic and Health Survey. These findings were revealed in the summary report of the Global Youth Tobacco Survey (GYTS) country report for Zimbabwe which was launched on Wednesday 27th January in Harare. The GYTS was conducted in 2014, and involved a representative sample of grade 7 pupils and forms 1—3 students aged 13 –15 years. It was a questionnaire based survey that consisted of 6,427 eligible students drawn from randomly selected classes from 100 sampled schools with a response rate of 70.4%.

It is said in the bible for those that are christians, “my people perish for lack of knowledge. For they have ignored knowledge” . I would like to share the knowledge with everyone and hopefully it will make our students pause and reflect on their use of tobacco products. We need to realise that smoking will have health and non health impacts on the smoker and others who do not smoke. Asking the smokers to stop is not easy as smokers do not appreciate the health effects of smoking. The fight is sadly made difficult by tobacco companies. These companies are still sending out misleading data that distort the true things about health effects of smoking.

Tobacco use is the leading preventable cause of death in the world and it kills half of all lifetime users and half of those die in middle age (35-69). Tobacco is a risk factor for six of the eight leading causes of death in the world ( Ischaemic heart disease, Cerebrovascular disease, Chronic obstructive pulmonary disease, LUNG CANCER, Lower respiratory tract infection, Tuberculosis). Tobacco kills nearly six million people each year. More than five million of those deaths are the result of direct tobacco use while more than 600 000 are the result of non-smokers being exposed to second-hand smoke. Approximately one person dies every six seconds due to tobacco, accounting for one in 10 adult deaths. Unless urgent action is taken, the annual death toll could rise to more than eight million by 2030. Approximately 80% of the deaths would occur in low- and middle-income countries like Zimbabwe.

Tobacco products are made of extremely toxic materials. Tobacco smoke contains more than 7000 chemicals. At least 250 of these chemicals are known to be harmful and at least 69 are known to cause cancer. All tobacco products are harmful. Tobacco smoking can damage every part of the body, causing many actual medical conditions such as shortness of breath, exacerbation of asthma and respiratory infections as well as many chronic diseases including heart disease, strokes, cancer and chronic respiratory diseases.

Smoking is responsible for one in every five deaths in adults aged over 35 in England, and half of all long-term smokers will die prematurely due to a smoking-related disease.

Health effects of smoking among young people

Smoking tobacco leads to nicotine addiction and associated risk of other drug use. Sadly long term health effects of smoking in youth are reinforced by the fact that most young people who smoke regularly continue to smoke throughout adulthood. Cigarette smokers have a lower level of lung function than those persons who have never smoked. Smoking reduces the rate of lung growth. In adults, cigarette smoking causes heart disease and stroke. Studies have shown that early signs of these diseases can be found in adolescents who smoke.

Smoking hurts young people’s physical fitness in terms of both performance and endurance—even among young people trained in competitive running. On average, someone who smokes a pack or more of cigarettes each day lives 7 years less than someone who never smoked. The resting heart rates of young adult smokers are two to three beats per minute faster than nonsmokers.
Smoking at an early age increases the risk of lung cancer. For most smoking-related cancers, the risk rises as the individual continues to smoke. Teenage smokers suffer from shortness of breath almost three times as often as teens who don’t smoke, and produce phlegm more than twice as often as teens who don’t smoke.
Teenage smokers are more likely to have seen a doctor or other health professionals for an emotional or psychological complaint. Teens who smoke are three times more likely than nonsmokers to use alcohol, eight times more likely to use marijuana, and 22 times more likely to use cocaine. Smoking is associated with a host of other risky behaviors, such as fighting and engaging in unprotected sex. This can lead to the rise of sexual transmitted infections among students.

Health effects of secondhand smoking

Does anyone smoke around you ?

There is no safe level of exposure, it is important that you avoid exposure to second hand smoking (SHS), which may dramatically reduce your respiratory symptoms.”

Smoking puts the smoker’s family at risk. Secondhand smoke exposure increases the risks of having diseases in children such as sudden infant death syndrome, acute respiratory illnesses, middle ear disease and chronic respiratory symptom. In adults it increases the risk of coronary heart disease, nasal irritation, lung cancer and report ductile effects in women (low birth weight).

So what can you do if you smoke ?

Let’s first look at the benefits of stopping smoking and remember that it never too late.

There are immediate and long term health benefits of quitting for all smokers. When one stops smoking , the heart rate and blood pressure drop down. The carbon monoxide level in the blood drops to normal. The circulation improves and the lung function increases. Coughing and shortness of breath decreases and the risk of coronary heart disease is about half that of a smoker.

5 years after stopping smoking the stroke risk is reduced to that of a non-smoker. 10 years after quitting smoking the risk of lung cancer falls to about half that of a smoker and the risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decreases. 15 years after smoking cessation the risk of coronary heart disease is that of a non-smoker’s.

It’s never too late to stop smoking but it’s best to stop early. If one stops at the age of 30 then they will gain almost 10 years of life expectancy as compared to those that continue to smoke. If stops at 40 they will gain 9 years of life expectancy and stopping at 50 years of age they will gain 6 years. If stops by age 60 they will gain 3 years .

After the onset of a life threatening disease, people who quit smoking after having a heart attack reduce their chances of having another heart attack by 50 per cent.

Quitting smoking decreases the excess risk of many diseases related to second-hand smoke in children, such as respiratory diseases (e.g., asthma) and ear infections.

Quitting smoking reduces the chances of impotence, having difficulty getting pregnant, having premature births, babies with low birth weights, and miscarriage.

Thank you for reading this article and as your health awareness advocate, I need you to know that quitting smoking is the most important thing you can do to protect your health now and in the future. We are here to help you. Let’s meet in the next article entitled stopping smoking.

This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk  and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

 

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Strike by doctors

Strike by doctors ,what are your views?

By: Dr Brighton Chireka • 23rd February 2016

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Strike by doctors, what are your views?

By Dr Brighton Chireka

Strike by doctors is always controversial worldwide as views differs on whether doctors should go on strike. The problem in most cases is that strike by doctors is only seen as being caused by doctors. There is sadly a failure to listen or to look at the root cause of the problem. In some countries like Zimbabwe , you find that the leaders of doctors are either arrested or suspended when strike by doctors take place. There is a general consensus internationally that emergency care should always be provided during a strike by doctors. However other considerations also come into play when doctors consider the justification for a strike.

The doctors’ leaders are often accused of inciting other doctors to go on strike . Who is the culprit in these situations , doctors or the government? Suspending or arresting the leaders is similar to a father who beats a child because he complains that his school fees is not paid. We know who is supposed to pay the fees. If the father squandered all the money meant for fees at the night club or at the “small house” then beating the child is not the solution. The solution is for the father to take his responsibilities seriously and deliver and not to divert attention by accusing the children for being disrespectful towards him. The child is just highlighting his predicament that he cannot go to school if the fees is not paid . The same applies if doctors are hungry they cannot go and care for others. We need to first care for them so that they can care for others.

I welcome the intervention by the Minister of Health in Zimbabwe Dr David Parirenyatwa on the dispute between four Parirenyatwa doctors and the Health Services Board (HSB). HSB suspended the executive committee members of the Zimbabwe Hospital Doctors Association (ZHDA) on the 5th February 2016 on allegations of inciting fellow doctors to go on strike.The members suspended are Dr Fortune Nyamande (president), Dr Hugh Manyere (vice president), Dr Gadzirai Edson Makoni (secretary general) and Dr Rusununguko Kanyongo (treasurer).

Strike by doctors worldwide

A look at the United Kingdom first.

On the 23rd February 2016 the British Medical Association (BMA) announced that it is now set to launch a judicial review . This follows the embarrassing revelation that the UK government appears to have failed to undertake an Equality Impact Assessment (EIA) prior to its decision to impose a new contract on junior doctors in England. In trying to push through these changes, the government is sad it to have failed to give proper consideration to the impact this contract could have on junior doctors.

The judicial review will seek to overturn the decision to impose the new contract and provide a declaration that the secretary of state had acted unlawfully.
The BMA’s view is that imposing this contract will seriously undermine the ability of the NHS to recruit and retain junior doctors in areas of medicine with the most unsocial hours, where there are already staffing shortages. As a result, the BMA has announced three further dates of industrial action:
* 8am on Wednesday 9 March to 8am on Friday 11 March
* 8am on Wednesday 6 April to 8am on Friday 8 April
* 8am on Tuesday 26 April to 8am on Thursday 28 April
Over each of these 48-hour periods, junior doctors will offer emergency care only.
In the United Kingdom the registration body of doctors – General Medical Council ( GMC) made its position clear when junior doctors were considering to go on strike. The GMC has said that doctors contemplating industrial action must follow its guidance. “Doctors must make sure arrangements are in place to care for their patients,” its guidance says. “Their actions must not harm patients or put them at risk.”

The GMC does not only address the doctors but also raises the issue of strike by doctors with the employers. Employers have responsibilities that they must not neglect. These include making sure that rotas are designed to minimise the adverse effects of fatigue and workload. Not forgetting to make sure that any patient safety concerns are acted upon immediately. Doctors must also be protected from unfair criticism or action, including any detriment or dismissal.

My experience with strikes

I remember in 1998 doing orthopaedics as a junior doctor at Harare hospital in Zimbabwe. I would be on call from Friday to Monday afternoon without any break. One night a patient I was suturing his wound reminded me that I was dosing. I had to go and take a quick break but I could not rest for much longer as I was called back to the ward. I lost any patience left  with our health system in 1999 when I was doing my paediatric rotation. Paediatric on calls at Harare Hospital were very busy and after working 48 hours non stop I was exhausted. I went to my on call room to take a nap and I overslept only to be awaken by a bleep. It was my registrar ( middle grade doctor) who was calling me for the ward round. He was on call with me but did not have to stay in the hospital . I had to call him if I needed senior help and that night I had not called him as I managed to deal with the children that came during that shift. The registrar was not happy that I was late for the ward round. He also got angry when I told him that I was very tired. He reported me for ” being tired” at work to the head of paediatric department and I was punished by being asked to do another three months of paediatrics rotation.

That year the whole health system continued to collapse and at one point we had no gloves to use. We would hide the gloves so that we had something to use when carrying out our duties. We decided to down our tools and this was a last resort and no one persuaded or incited me to do so. The state of our health system forced every doctor to down their tools. The doctors did not need anyone to incite them and I do take offence with the suggestion in Zimbabwe that doctors are incited by certain people.

In view of the problems in our health system in 1999 we went on strike from September to the first week of November. Our industrial action coincided with the launch of the first strong opposition party in Zimbabwean history -MDC. Our strike gave the opposition free publicity as they highlighted our industrial action as an example of the collapse of the health system. Surprisingly no one from the opposition approached us but the government became paranoid suspecting that we were being supported by the opposition. I remember the then doctor’s leadership trying to call off the strike but we refused. I was very vocal in that meeting and we also travelled to Bulawayo to show solidarity with our colleagues there but we were outsmarted by the government intelligence. One by one we started to go back to work without achieving anything. I realised that it was time to broaden my horizon and look west ! The rest is history so they say. Today I am sadly compiling this article as a local of south kent coast in the United Kingdom.

Other countries

I have read an interesting article by Marika Davies looking at the ethical aspects of strikes by medical professionals around the world. The article looked at several countries in the world like India, Israel , Pakistan, Nigeria , South Africa and the United Kingdom. The general consensus was that emergency care should always be provided during a strike.
India has not been spared as doctors have repeatedly engaged in strike action. The statement by researchers at the Lokmanya Tilak Municipal Medical College in Mumbai recommended that a strike must be a last resort. “As doctors, our duties towards our patients [are] of the highest importance, but people must not forget that doctors are human beings, they have a life, a family, responsibilities and bills to pay like all of us,” they said. “We must remember that human dignity and respect must be preserved from a doctor towards a patient, and the converse also holds true.”

Arguments have been put forward that strike by doctors contradicted their responsibility to act in the best interest of patients. Others have pointed out that medicine could not function without the financial support and that responsibility for the patient did not rest solely on the doctor. It has also been argued that depriving doctors of proper wages constitutes a breach of contract and justifies a walkout. Therefore, society must take measures to prevent such a situation from occurring. In view of these arguments I find it unfair for the leaders of the ZHDA to be singled out. The whole country should be ashamed that it has let our health system deteriorate to that level and stop using a few doctors as a scapegoat.

Frank Frizelle, editor of the New Zealand Medical Journal, said that the short term inconvenience of a strike must be balanced against an improvement in care. “If doctors (and others) truly believe it is important for patient care, then they must sometimes have the courage to do things that are unpopular and difficult,” he wrote. “If the conditions that doctors work under put patients at risk, then (on balance) they are morally obliged to strike.” Should we say then that strike should be allowed if it is going to bring better care for the patients? These are challenging questions that we face as doctors and we expect the public to understand that strike is a last resort in most cases.

Other interesting comments came from Nigeria; “Doctors’ strikes have become “a part of normal existence” in Nigeria, said Olufemi Omolulu, a consultant in obstetrics and gynaecology in Lagos. Shima Gyoh, editor of Nigeria Africa Health, said that a strike by health workers was the worst option in the business of negotiating for higher wages. “The pawn is the public, with human lives and limbs as the bargaining chips,” he wrote. He warned that doctors who abandoned their patients were likely to be found guilty of misconduct if tried by the Medical and Dental Practitioners’ Disciplinary Tribunal. But he added that he had not heard of anyone reporting any striking doctor to the Medical and Dental Council on grounds that a patient suffered distress or death as a result of a strike. “Doctors must avoid the temptation of extremism by protecting the weak and the vulnerable during their quarrels with their employers,” he said.

Sadly doctors do not control the media and in most cases their grievances are not fully publicised. A lot of focus by the media is on patients’ suffering leaving out how the doctors will be suffering . It will be best to make sure that the views of all stakeholders in a situation are fully publicised for the public to decide who to support. Doctors are seen as uncaring and selfish when it is not the case.

Gboyega Ogunbanjo, professor of family medicine at the University of Limpopo in South Africa, said that advocacy, dissent, and disobedience should precede strike action but that when a situation arose that was ethically catastrophic then exit from professional duties could be justified. “In such situations patients are likely to be harmed so the justification . . . must be made on moral grounds,” Ogunbanjo wrote. “The only moral ground is that health care will overall be substantially improved for the greater population. Can strike action by doctors ever be morally justifiable? Yes it can. But always at a cost.” Can we then support the action by the leaders of ZHDA in Zimbabwe and the BMA in the United Kingdom? I await to hear your views on this so kindly email me or post your comments below.

Marika Davies also wrote in the article that doctors’ strikes are rare in the United States and went on to highlight that in January 2015 doctors across 10 campuses of the University of California staged a one day strike to protest about resourcing of students’ healthcare. David Kemp, a lawyer and columnist, said that healthcare providers might ethically leave their patients’ bedsides to go on strike only when the benefit of the patient was the ultimate goal and only after all other avenues of negotiation had been exhausted. “If we as a society allow those who care for our sick to abandon their oaths and their duties any more readily than this, then we too have abandoned our sick,” he said.

The debate continues unabated as to whether our doctors should go on strike. Is it only the doctors to blame or shall we include governments and the rest of the public? I think we all have a role to play in making sure that we fund our health systems well and make sure that our health professionals are well looked after. We do not want to push kind people to do unkind things so as to get our attention. Remember the only thing necessary for the triumph of evil is that good men do nothing.

This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk  and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Women's health

Women’s health and men’s involvement

By: Dr Brighton Chireka • 21st February 2016

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Involve men in women’s health

By Brighton Chireka

Women’s health is of particular concern in many societies. Men should also be involved in women’s health so as to fully appreciate or understand women’s health issues. Being a man or a woman has a significant impact on health, as a result of both biological and gender-related differences. The health of women and girls is of particular concern because, in many societies, they are disadvantaged by discrimination rooted in sociocultural factors.

I am pleased that there is a concerted effort by women’s pressure groups to raise awareness about women’s health. I applaud this and urge them to go further by involving men in championing their cause. We know there are unequal power relationships between men and women. These relationships severely impact on women’s health.

Every opportunity should be used to raise awareness about women’s health. March is a special month as there are several activities lined up focussing on women. Sadly at times men are excluded from these activities. We all know that man and woman are “one flesh ” and trying to separate them is to go against the laws of the creator. The creator saw how lonely the man was and decided to create a helper. The helper was created from the ribs of the man signifying the oneness involved from creation. Women’s health is men’s health as it is impossible for a husband to be mentally and social well when the wife is bedridden with a sickness.

I have been discussing with a lot of people on social media about women’s health issues and I think it’s also appropriate to share with a wider audience that read this column. As we were discussing women’s health a feminists questioned why men were taking a lead in discussing these health issues. I know that several women groups do discuss these health issues but I think it’s not effective to focus on men or women alone.

Men are capable of reflecting on their experience and are interested in making changes in their lives for the benefit of women as well as themselves. Involving men in discussing women’s health issues acknowledges that for any change to take place it requires all members of the society – women and men working towards a common goal. A change that is sustainable will come from an approach that fosters cooperation among all community members. I know that some women fear that if men participate , they will take over and focus less on women’s health. Regardless of this risk I think there is more to benefit in engaging men as we all know that men and women live together , share the same bed and are in relationships as well. The wellbeing of the woman will directly or indirectly have an impact on the man.

By engaging men we help them to change their attitudes towards women who are not feeling well. Men need to know or appreciate how it feels to have period pain ( dysmenorrhea ) , morning sickness ( hyperemesis gravidarum) or how painful labour is. We must not also forget that most men still play crucial roles through their responsibilities as decision-makers and leaders within their families and communities .

Society has to recognise that there are men out there who are caring for their women and are more involved in their wives’ health and well-being and are advocates for women’s well -being . There is need to make sure that these men can influence other men to be involved in the health of their partners. It’s good to see men accompanying their wives to labour wards and going through the whole process of labour supporting their wives. In my training in the maternity department I saw men who were “so caring” that they could not bear the pain of watching their wives going through labour. I remember having to help one caring men who had fainted as he could not bear the “labour pains” – (remember when married we become one flesh).

Finally , excluding men from getting involved in women’s health can provoke male hostility and retaliation. It will create more problems for women and leave them with more work to do among unsympathetic men. It is better to involve them so they understand when a woman cannot perform the conjugal duties due to the period pain. They will be able to give a woman the hot water bottle and buy her ibuprofen to ease the pain . They will be able to get the woman some ginger biscuits to help ease morning sickness. They will even go further and cook for their loved one.

Let’s be fair, men and women interact on a daily basis in their households and public lives. The involvement of men in women’s health issues makes interventions more relevant and workable. This will create lasting changes. Male inclusion increase their responsibility as they will not hide behind lack of knowledge. They will also see themselves benefiting in the long term as they will work in partnership with their wives.

In view of the above let’s continue champion the wellbeing of everyone regardless of their gender, sexual orientation,race, or political affiliation. I urge you to join hands with me in this cause. Feel free to share this article so as to reach a wider audience.

This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at Dr Chireka’s Blog

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Ovarian cancer

Ovarian cancer easily missed

By: Dr Brighton Chireka • 20th February 2016

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Ovarian cancer easily missed

By Dr Brighton Chireka

Ovarian cancer is notorious of mimicking other conditions. This makes it difficult to diagnose. A delayed diagnosis of a life threatening condition such as ovarian cancer is one of the most feared events in a doctor’s career. Failing to diagnose ovarian cancer can bring guilt and at times the doctor may not recover from the incident. The patient may also lose their lives due to delayed diagnosis. This article is about ovarian cancer and I hope that at least one life will be saved by reading this article.

Ovarian cancer is the fifth commonest cause of cancer-related deaths among women worldwide. It  accounts for 4% of all cancer deaths in women. Death from ovarian cancer is strongly related to disease stage. Stages 1 and 2 are associated with survival rates of more than 70%. Stages 3 and 4 are associated with survival rate of 0% – 20%. In most patients, diagnosis of ovarian cancer is made at an advanced stage. This is because of its non-specific clinical symptoms.

Let’s look at the organ called the ovary.

The ovaries are a pair of small organs in the female reproductive system that contain and release an egg once a month. This is known as ovulation. The egg is one of the many things that is needed together with sperm from the male for pregnancy to take place. Every time an egg is released into the reproductive system, the surface of the ovary breaks to let it out. The surface of the ovary is damaged during this process and needs to be repaired. Each time this happens, there’s a greater chance of abnormal cell growth during the repair which can result in ovarian cancer. This may be why the risk of ovarian cancer decreases if you take the contraceptive pill or have multiple pregnancies or periods of breastfeeding. It’s  because at these times, eggs aren’t released and the ovary is not damaged.
What causes ovarian cancer?
The exact cause of ovarian cancer is unknown. There are certain things thought to increase a woman’s risk of developing the condition. This includes  age ( Ovarian cancer can affect women of any age but is most common in women who have been through menopause usually over the age of 50.), the number of eggs the ovaries release as explained above and whether someone in your family has had ovarian or breast cancer in the past. However, only 1 in 10 cases of ovarian cancer has a genetic link.
Women who take hormone replacement therapy ( HRT) for example to treat menopausal symptoms , have been shown to have a small increased risk of developing ovarian cancer. However, if HRT is stopped, after five years the risk is reduced to the same level as women who’ve never taken HRT.
Endometriosis may also increase your risk of ovarian cancer. In endometriosis, the cells that usually line the womb grow elsewhere in the body.

Symptoms of ovarian cancer

The symptoms of ovarian cancer  can be difficult to recognise. This is particularly in its early stages as there are the same with conditions such as irritable bowel syndrome or pre- menstrual syndrome.

We have three main symptoms that are more frequent in women diagnosed with ovarian cancer. There are given below and to remember them we use the word BEAT.
B- stands for bloating . This is persistent bloating not the one that comes and goes. It is also associated with increased size of the tummy.
E – stands for Eating difficulties and feeling full quickly or feeling nauseous (kuda kurutsa)
A – stands for Abdominal ( tummy) pain and pelvic pain . This pain is persistent in the lower tummy area.
T – stands for Talking to your doctor if you have the above symptoms

Other symptoms,
Other symptoms such as back pain, needing to pass urine more frequently than usual, and pain during sex may be the result of other conditions in the pelvic area. However, they may be present in some women with ovarian cancer. Other symptoms include unexplained weight loss fatigue or changes in your bowel habits, such as diarrhoea or constipation. The challenge is that these symptoms are very common and can be caused by several conditions. It requires good doctor patient relationship to tease out the symptoms pointing to a possible ovarian cancer.

 

Diagnosing ovarian cancer

I advise you to see your doctor if you have any of the symptoms mentioned in this article.
Your doctor will gently feel your tummy (abdomen) and ask you about your symptoms, general health and whether there’s a history of ovarian or breast cancer in your family.
They may carry out an internal examination and may have a blood test to look for a protein called CA125 in your blood. CA125 is produced by some ovarian cancer cells. A very high level of CA125 may indicate that you have ovarian cancer. You may be referred for an ultrasound scan of your lower tummy area.
If needed, you may also be referred to a specialist (a gynaecologist or gynaecological oncologist) at a hospital.

How can you help your doctor to diagnose your problem?
If you have any of these types of symptoms, try keeping a diary to record how many of these symptoms you have over a longer period. Please remember that ovarian cancer is rare in women under 40 years of age. More than 8 out of 10 cases of ovarian cancer occur in women who are over 50 years of age.
Go and see your doctor if you have these symptoms regularly (on most days for three weeks or more). Although it’s unlikely they’re being caused by a serious problem, it’s best to check.
If you’ve already seen your doctor and was reassured but now the symptoms are continuing or getting worse, you should go back and explain this. You know your body better than anyone. You should explain that you are worried about ovarian cancer so that your doctor can rule it out. The earlier the ovarian cancer is diagnosed the better as the survival rate is high in early stages.
Treating ovarian cancer
The treatment you receive for ovarian cancer will depend on several things, including the stage of your cancer and your general health. Chemotherapy is the main treatment for ovarian cancer. This treatment will usually involve a combination of surgery and chemotherapy.
As with most types of cancer, the outlook for ovarian cancer will depend on the stage it’s at when diagnosed – that is, how far the cancer has advanced. The best is to get it early before it has spread anywhere. I hope this article will help at least one person to have their diagnosis not delayed.

You may want to read about other common cancers in women.

Breast Cancer

Cervical Cancer

Feel free to share with friends and relatives and also send me your comments. I look forward to reading your inputs .
This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at Dr Chireka Health Talks

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Student nurse bursary must stay

student nurse bursary to be scrapped

By: Dr Brighton Chireka • 18th February 2016

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Student nurse bursary to be scrapped.

By Dr Brighton Chireka

The likely impact of scrapping the student nurse bursary in 2017 by the UK government .

 

The UK government is proposing to scrap off the student nurse bursary in 2017. Currently those training to be nurses receive a student nurse bursary. The student nurse bursary has played an important role in motivating some people to join the profession. What is going to happen if the move to scrap the student nurse bursary goes ahead?

The National Health Service (NHS) has a huge shortage of nurses so one wonders the wisdom of scrapping the student nurse bursary. A poll done by the trade union UNISON found that 91% of the 2000 nurses polled would not have applied for their nursing degree without access to student nurse bursary.

 

Scrapping student nurse bursary

Scrapping student nurse bursary

 

The most worrying thing is the debt that the newly qualified nurse are going to accumulate. According to UNISON the new nurses could end up with more than £50 000 worth of debt , but earning only £22000 per year . This scenario does not entice anyone to take up nursing and could worsened the already shortage of nurses.

I know people from our Zimbabwean UK community who have embarked on nursing and are doing a fantastic job in the NHS. The majority of these nurses would not have embarked on the training if it was not funded. Figures shows that half of student nurses already have children or other caring responsibilities. We all know that ” everyone ” from Zimbabwe who is in the UK is at least supporting a family back home . No one would embark on a course that will leave them worse off . Even the locals are not entertaining that prospect of having no student nurse bursary. I am still baffled at the wisdom or non of it of this move by the UK government.

Chancellor George Osborne made the announcement last year claiming that scrapping student nurse bursary for loans and removing the cap on student nurse numbers would result in more people being able to study to become nurses.

This to me is a short sight on the chancellor’s part because he is assuming that people will run to grab loans without thinking about how they will pay for them in future. One need to look at the amount of debt one will accrue and the future salary. If the two does not make economic sense then no one will bother applying for training.

Support for student nurse bursary

Support for student nurse bursary

 

The NHS is already struggling with staff recruitment and retaining and any move that reduces the numbers of student nurses is going to collapse the overwhelmed system. We wait and see but I hope the UNISON, NHS , Royal College of Nursing and the rest of the public will voice their concerns and hopefully the government will listen and reverse the decision. It’s not a lost cause as the implementation is for 2017 so there is time for it to be changed. Sometimes governments get it wrong and listening to the people on the ground will make them get it right so let them listen .

I have added my voice as an individual who is just concerned. I welcome your views on this issue and suggestions on the way forward.

This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.

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Government hospital in Zimbabwe

Government hospital in Zimbabwe

By: Dr Brighton Chireka • 16th February 2016

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Part 2 My visit to a government hospital in Zimbabwe

By Dr Brighton Chireka

Welcome to part two of my visit to a government hospital in Zimbabwe. I urge you to first read the first part of my visit to a government hospital in Zimbabwe so that you get the full picture of the discussions taking place here.

Part 1 of my visit

Part 2

What I liked about the government hospital in Zimbabwe
1- The staff at the information desk treated us nicely and gave us directions to the radiotherapy department.
2- The corridors were fairly clean
3- When we could not find the exit from the casualty department on our way to the radiotherapy department we asked the busy staff in the department and they showed us the way out .
4- On arrival at the radiotherapy department we were promptly attended to by the reception staff and put into the queue waiting to see the doctors.
5- As we were waiting we noticed that the queue was moving and we could hear patients being called out to see the doctors.
6- The doctor that we saw was accommodative as he allowed me to be present and was open to discussions. The doctor answered most of our questions and explained how the process worked and apologised for the shortcomings of the system.
7- As we left I saw that the queue was almost gone and soon realised that there were 4 doctors that were running the radiotherapy clinic on that day.
8- When we arrived at the out patient department, there was only one member of staffing manning it. As soon as she saw the queue getting longer she called for help and another member of staff came to join her. We were attended to within 10 minutes.
9- We got an appointment in the next clinic which unfortunately was not until the following Wednesday due to Easter holiday. I was pleased that we got an appointment that soon.
10- When I was planning to visit the government hospitals I was told to prepare for a long wait so I was relieved and impressed when the whole process was over before 1pm.

What I did not like about the government hospital in Zimbabwe.


1- The saying that ” there is no hurry in Africa” seems to be true . I did not see a sense of urgency in attending to patients and no patient was given an appointment time. We were just told to join the queue and we will be seen as soon as the doctor was free.
2- No one told us roughly how long we were going to wait to be seen or how late the doctors were running.
3- No one kept any eye on very ill patients who were in the queue. One would expect the nurse to keep a close eye and call for medical help if needed.
4- Different departments do not communicate well with each other so the patients have to repeat their stories several times to different doctors.
5- The patient is now being given tests to keep instead of the hospital to be responsible for that.
6- The attitude of the nurse running the clinic was not good as she shouted at me for being late to get into the doctors room.
7- Transporting of car accidents victims in private cars is not safe .
8- Lifting of injured persons being done by untrained people.
9- Porters in the Emergency department not helping relatives or friends to ferry injured patients.
10- Hospital pharmacy not stocked with most drugs resulting in patients being asked to go to far away pharmacies which at times are expensive .
11- No one bothers to ask where the patient is coming from and how ease it will be to attend clinics
12-Patients being asked to leave a copy of their tests but no photocopying machine service in the hospital .

Let’s look at Part 3 which discuss suggestions on way forward after my visit to a government hospital in Zimbabwe.

Views after visit to a government hospital .

Government hospital in zimbabwe

Suggestions After visiting government hospital in Zimbabwe

The voice of the patient is silent and things are done to patients and not with the patient . The patient is like a bag of cotton that must be put on a conveyer belt and pushed from one end to the other. Things are done to the patient and their views are not invited and also patients do not want or fear to voice their concerns. There is a lot of talk going on in buses and on social media about how bad things are in government hospitals in Zimbabwe but no effort is made to capture that and use the formal channels to address these issues.

I would suggest that the health system embrace the vision that sees things through the eyes of patients and think with a mindset of a patient and to treat these patients as if it was themselves.

Patients are experts in how they feel when not well so must be involved in any medical decision that involves their medical care. It’s high time each and every hospital should have patient participation groups that work with the hospital officials . There are certain things that have got no direct link with the government and can be sorted out by the hospital leadership . Things such as cleanliness of the hospital , quality of food , attitude of the medical staff, arrangement of clinics , running of clinics , professionalism of the staff etc can be dealt with locally by the hospital leadership working on collaboration with patients.

In the UK we have what we call POST CODE lottery in the National Health Service (NHS) Post code means simple an address so post code lottery would mean that people get different services under the NHS depending on where one lives. You may have your knee operation paid for in one area and another area declines it . Why should this be the case when it’s one NHS ? I want to use this example so that you realise that we need both committed and responsible political leadership as well as well informed, well engaged and intelligent patients to work together .

The postcode lottery in the UK came about largely from the practice of GP fundholding during the 1990s, a system which enabled GPs to receive a fixed budget from which to pay for primary care, drugs, and non-urgent hospital treatment for patients. The concept of a postcode lottery is also a by-product of patients and consumers becoming more aware: patient groups have become more adept at lobbying for their consumer “rights” to drugs and services.

The lobbying by patients resulted in better services in those areas that have strong and vocal patient participation groups. The same can happen in Zimbabwe. I hear of sad stories of patients lying on trollies for hours, missed or delayed diagnosis. A delayed or missed diagnosis must be addressed locally by the medical team. Patient groups must be involved and a route cause analysis must be carried out. Mistakes must be identified and systems must be put in place to make sure that it does not happen again. The process must not be for witch hunting but must be used as a learning exercise however if there is gross negligence then the registration board must investigate and take appropriate action.

The medical profession has nothing to hide and will welcome working with patients as equal partners. This will help with the identification of issues that need political engagement with the government and those that are academic or administrative that can be addressed locally. This will also give clout to the arguments by the health professionals as they will be speaking with one voice with the patients. Some of the patients are councillors , members of parliament or ministers who can help in influencing things and some may have connections who will make donations to the hospitals or can use their personal money to help buy equipment for the hospitals.

Patient participation groups can help to fund the hospital in simple ways . You can boost the moral of ward staff by buying them a microwave to warm their food , a refrigerator , a bread toaster or an electric kettle to just mention a few things. These simple things will go a long way to boast the moral of staff and will go an extra mile in providing medical care to patients as the staff will feel valued. The problem at the moment is that patients blame medical staff and medical staff blame the government but no one looks at the route cause of problems and try to come up with solutions . Failure to analyse a problem will result in coming up with a good solution but for the wrong problem . One can suggest that medical staff must be paid a decent salary but that will not address the problem of poorly organised clinics, medical negligence etc. My point is let us analyse the problem and find solution for it. I have a lot to say on that but will end here for now as I think you got the gist of my point.

Let me also touch on the issue of medical aid in Zimbabwe . Some are not happy that medical aid companies are monopolising the health system as there are now the funders and providers of health care in Zimbabwe. This brings in a lot of issues about conflict of interest and also issues about lack of competition in the medical system. The medical aid companies argue that they need to be viable and be able to continue to provide qualities services at low premiums. If that works and is the main reason then I would welcome it. Private doctors are forced to agree to tariffs set by the big medical aid companies and this is unfair for the individual doctors. The doctors associations need to work with these medical aid companies and involve patient participation groups to reach an acceptable agreement that will benefit all the stakeholders.

On another note patients need to be educated about their medical aid benefits. Most medical aid schemes put a cap on how much can be used by the patient per year on certain services such as drugs and tests. I have noticed that patients may quickly exhaust their budget in one area and often assume that their medical aid is completely exhausted. Little do they know that the budget on other services such as CT scans remains unspent. One need to always consult their medical aid company before paying cash or before they stay at home because of not having enough resources for further tests.

In conclusion may I say that at times we need to look at the lens that we are using to look at things. A certain person was always complaining that his neighbour’s curtains were dirty. He would look through the glasses of his windows . What he did not realise was that his windows were so dirty that his vision was affected. The neighbour’s curtains were clean after all. Let us have a closer look at our lens maybe we need to adjust them for us to see and appreciate some of the good things that our medical teams are doing in Zimbabwe. Stephen Covey says if we are to change a situation we need to change ourselves first . To change ourselves effectively we have to change our perceptions.

This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at Dr Chireka’s blog

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal.

Feel free to share this article but do not forget to state that it appeared first on wwww.docbeecee.co.uk/blog

 

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Addison disease introduction

Addisonian crisis – reflection by Dr Chireka

By: Dr Brighton Chireka • 6th February 2016

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What is one of the most compelling and incredible experience that you’ve had while being a doctor?

Answer by Dr Brighton Chireka

Let me share with you  the case of Addisonian crisis. It was on the Christmas Eve of 2015 when I tried to sneak into the surgery unnoticed to start my morning clinic ( I was late), when I was stopped by our receptionist. She said , “come here!, come here!”, as she pulled me into the patient waiting area. Initially I thought there was an emergency so my adrenaline started to run preparing to resuscitate someone.

I was pleasantly shocked to see the patient that I had sent to the hospital the previous week , carrying a fruit hamper and a card. She was also accompanied by 3 members of her family.

She had come in person to thank me for “saving her life”. She was told that if I had delayed in calling an ambulance she would have died. She had presented to me the previous week complaining of vomiting and not able to keep anything down. She was also feeling dizzy and sleepy as well being unsteady on her feet. I quickly examined her and I could not get her blood pressure. I tried several electronic machines and also tried taking the blood pressure manually without any joy. The rest of examination was fine but she did not look right. She wanted me to give her an injection to stop the vomiting so she could avoid going into hospital. I remember her reluctance to go to hospital and me explaining my worries that she was in an “Addisonian crisis” since she was on long term steroids but could not take them due to vomiting. She had been on a long term steroid called prednisolone for her inflammatory tummy problem called colitis ( inflammation of the colon).

This was a patient on long term steroids tablets but could not take them as she was vomiting. This meant that she was not getting her steroids and her body was not making any because of long term use of steroids tablets. See a detailed explanation below of Addisonian crisis.

I was humbled by that experience and reflected on it . It was incredible as I remembered that at one point in my mind I was about to give in and defer referring the patient or even calling the ambulance. In the medical field I have always learnt that my gut feeling or initial instinct must come first. This is one of those incredible experience as a doctor that you cherish if you get it right . You cannot explain how you got it right but you just know that you had to act and act very fast as every minute matters most in those situations.

The card is in my office and it reads ” because of you I can enjoy Christmas and because of you I am alive” . My eyes get wet when I look at the card and I just say everyday , “thank you Lord for using me as a healing vessel and may you be praised!!”

More on Addison disease

Symptoms of Addison disease

In Addison’s disease, the adrenal gland is damaged, and not enough cortisol and aldosterone are produced. The adrenal glands are two small glands that sit on top of the kidneys. They produce two essential hormones: cortisol and aldosterone. These hormones are needed for the body to fight illness and cope with stress.

Why it happens
The condition is usually the result of a problem with the immune system, which causes it to attack the outer layer of the adrenal gland (the adrenal cortex), disrupting the production of steroid hormones aldosterone and cortisol. We are not sure why this happens.

Stopping steroids can cause Addison disease.

Synthetic steroids (corticosteroids) such as prednisolone which are similar to the natural cortisol, are used to treat several medical conditions. If one takes prednisolone for more than a few weeks, the adrenal glands will decrease cortisol production and can even stop completely. So, one will be living with a body that’s relying on a drug to get enough cortisol to function properly. This means that those that are taking steroids tablets must not stop them abruptly as this will not give enough time for the adrenal gland to resume the production of cortisol. A gradual reduction in prednisolone dosage is advised as it gives the adrenal glands time to resume their normal function. Please note that if you take steroids for just a week at most you do not need to reduce them gradually,it’s fine to stop abruptly in these situations.
If steroid tablets are then suddenly stopped there may be a problem, as the adrenal glands won’t have had time to make the cortisol needed. This problem is called adrenal insufficiency.
Signs of adrenal insufficiency include weakness, fatigue, fever, weight loss, vomiting, diarrhoea and abdominal pain. If one experiences any of these problems, they should seek medical help immediately.

Addisonian crisis.

Adrenal or addisonian crisis

If Addison’s disease is left untreated, the levels of hormones produced by the adrenal gland gradually decrease in the body. This causes the symptoms to get progressively worse and eventually lead to a life-threatening situation called an Addisonian crisis.
During an adrenal crisis, the symptoms of Addison’s disease appear quickly and severely.

My patient presented with a crisis as she was vomiting and not able to keep anything down for a few days meaning that she was not able to take her steroid tablets and her adrenal gland was not producing any cortisol.

Signs of an adrenal crisis include:

* pale, cold, clammy skin
* Severe dehydration resulting in low blood pressure ( unrecordable)
* sweating
* rapid, shallow breathing
* dizziness
* severe vomiting and diarrhoea
* severe muscle weakness
* Headache
* severe drowsiness or loss of consciousness

An adrenal crisis is a medical emergency. If left untreated, it can be fatal. If you think you or someone you know with Addison’s disease or on steroids is having an adrenal crisis, call an ambulance urgently. In United Kingdom dial 999.

If an adrenal crisis isn’t treated, it can lead to a coma and death. There’s also a risk your brain won’t get enough oxygen if treatment is delayed, which can cause permanent disability.

Looking back I can say it was the right call but could have been easily missed.

This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk  and can read more of his work on his blog at www.docbeecee.co.uk/blog 
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal.

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Zika virus

Zika virus threatening the whole world

By: Dr Brighton Chireka • 3rd February 2016

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Zika virus threatening the world health

By Dr Brighton Chireka

It’s barely a month after the world celebrated almost eliminating Ebola virus that we are now faced with another virus . The World Health Organization (WHO) reports that the Zika virus has now spread through both South and Central America. WHO expects 3-4 million people to be infected in 2016. Experts agree that future outbreaks and potential pandemics may occur, but the lessons learned from previous ones should enable a faster response. The key is to identify the virus, estimate its threat and its potential to spread across a population as quickly as possible. Having done that there is need  to then put a pandemic preparedness plan into action. Is this happening with this new virus ? The virus will reach other countries like China and even South Africa. What should we do when a case is confirmed in our area? The message is that we should not panic and here is the reason why?

Before I answer that we need to look at this new virus called Zika.

What is the Zika virus?

The Zika virus is a mosquito-born infection, which is not harmful in most cases. However it may be harmful in pregnancies as it is linked to birth defects – specifically microcephaly.

What is microcephaly?

Microcephaly

 

Microcephaly is a condition where a baby’s head is much smaller than expected. During pregnancy, a baby’s head grows because the baby’s brain grows. Microcephaly can occur because a baby’s brain has not developed properly during pregnancy or has stopped growing after birth, which results in a smaller head size. Microcephaly can be an isolated condition, meaning that it can occur with no other major birth defects, or it can occur in combination with other major birth defects.

More on Zika virus

It was first detected in the Zika forest of Uganda in 1947, and has circulated in Africa and South and South East Asia without many documented outbreaks reported. In the last few years, Zika outbreaks have been reported in the Pacific region, and the virus has now spread to South and Central America, and the Caribbean. WHO has warned that Zika virus is likely to spread to all countries in the Americas where the climate is suitable for the affected mosquitoes. Currently, this is thought to be all the countries in the Americas (including the Caribbean) with the exception of Chile and Canada.

What symptoms does the virus cause?

Zika virus

Most people don’t have any symptoms. If symptoms do occur, they are usually mild and last around two to seven days. Commonly reported symptoms include:

a low-grade fever
joint pain (with possible swelling, mainly in the smaller joints of the hands and feet)
itching
rash, which is sometimes itchy
conjunctivitis (red eyes)
headache
eye pain

So how does the Zika virus spread ?

Spread of Zika virus
Most cases of the Zika virus are spread by infected mosquitoes biting humans. Unlike the mosquitoes that spread malaria, affected mosquitoes (the Aedes mosquito) are most active during the day (but especially during mid-morning and late afternoon to dusk).

There has been ONE case where Zika virus may have occurred through sexual intercourse and a small number of cases have occurred by transmission from an expectant mother to her unborn child via the placenta.

So how can we reduce our risk of contracting the Zika virus?

Our world has become a global village with people travelling from one continent to the other daily. This increases the risk of spreading the virus and it’s partly the reason why I have compiled do this article. Special mention goes to the WHO and National health services (NHS ) UK for the detailed up on Zika virus.

Before travelling, seek travel health advice from your General Practitioner (GP)/practice nurse or a travel clinic ideally six to eight weeks before you go.

To reduce your risk of infection with Zika virus, you should avoid being bitten by an Aedes mosquito. The most effective bite prevention methods, which should be used during daytime and nighttime hours, include:

using insect repellent that contains N, N-diethyl-meta-toluamide (DEET) on exposed skin – the repellent is safe to use during pregnancy and should be applied to skin after sunscreen is applied
wearing loose clothing that covers your arms and legs
sleeping under a mosquito net in areas where malaria is also risk

What risks does the Zika virus pose in pregnancy?

There is evidence to suggest that pregnant women who contract the virus during pregnancy (at any stage) may have an increased risk of giving birth to a baby with microcephaly.

Current advice is that women who are pregnant or planning to become pregnant should discuss their travel plans with their doctor and if already pregnant to consider postponing travel to any region where a known outbreak of the Zika virus is occurring. If travel is unavoidable then they should take scrupulous insect bite avoidance measures.

I am pregnant and have visited a country where there is an ongoing Zika virus outbreak. What should I do?

If you are pregnant and have a history of travel to a country where there is an ongoing Zika virus outbreak, see your GP or midwife and mention your travel history even if you have not been unwell. Your midwife or hospital doctor will discuss the risk with you and will arrange an ultrasound scan of your baby to monitor growth.

If you have experienced Zika symptoms either during or within two weeks of returning home, see your GP or midwife or mention your travel history. Your midwife or hospital doctor will discuss the risk with you and will arrange an ultrasound scan to measure your baby’s growth and brain development. If there are any problems you will be referred to a specialist fetal medicine service for further monitoring. If you are still experiencing Zika symptoms your GP will arrange for you to have a blood test to check for Zika virus.

I am trying to get pregnant and have visited a country where there is an ongoing Zika virus outbreak. What should I do?

If you are trying to get pregnant and have a history of travel to a country where there is an ongoing Zika virus outbreak, see your GP or midwife and mention your travel history even if you have not been unwell. It is recommended that you take folic acid supplements for 28 days before trying to conceive.

If you have experienced Zika symptoms either during or within two weeks of returning home it is recommended that you wait at least six months after full recovery before you try to conceive.

Even if you have not been unwell, it is recommended that you wait at least 28 days after you return home from a country where there is an ongoing Zika virus outbreak before you try to conceive.

My partner has visited a country where there is an ongoing Zika virus outbreak. What should I do?

Sexual transmission of Zika virus has occurred in a small number of cases, but the risk of sexual transmission of Zika virus is thought to be very low. If your partner has travelled to a country where there is an ongoing Zika virus outbreak, condom use is advised:

for 28 days after his return home if he had no Zika symptoms
for six months following recovery if he experienced Zika symptoms or a Zika virus infection has been confirmed by a doctor
For advice on the options available to you on other methods of contraception, speak to your GP or community sexual health clinic.

What if I am worried that my baby has been affected by the Zika virus?

Speak to your midwife or doctor for advice. If you are still concerned after receiving assurances from your healthcare professional and feel anxious or stressed more than usual, you can ask your GP or midwife for referral to further counselling.

How is the Zika virus diagnosed and treated?

The Zika virus can be diagnosed with a blood test in people who are currently/actively displaying symptoms of Zika virus infection.

There is no specific treatment for the symptoms of the Zika virus. Drinking plenty of water and taking paracetamol may help relieve symptoms. The use of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen is not recommended, as there is a potential risk they could trigger excessive bleeding.

If you feel unwell on return form a country with an ongoing outbreak of Zika virus, but which also has malaria, you should seek urgent (same day) advice to help rule out a diagnosis of malaria.

If you remain unwell and malaria has been shown not to be the cause, seek medical advice.

I hope I have managed to answer most of your questions and hope that WHO and all stakeholders are working together to combat this virus.

You may want to read about Ebola as well.

Ebola Virus

This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at Dr Chireka blog

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal.

Information to compile this article came mostly from www.nhs.uk

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Zimbabwe health system

Visit to a Zimbabwean government hospital

By: Dr Brighton Chireka • 1st February 2016

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Part 1 My visit to a government hospital in Zimbabwe

By Dr Brighton Chireka

I visited a government hospital in Zimbabwe as I had heard that the health system in Zimbabwe is bad and had collapsed. I have always agreed and the evidence I have is sad stories that have been narrated to me by close friends . I have also lost close friends and relatives and the blame has been on the collapsed health system. I visited the government hospital in Zimbabwe in April 2015 to try and find out first hand information about the situation . My mini fact finding mission of the situation in a government hospital has a lot of pitfalls. One would need enough time, and carry out interviews with all stakeholders in order to carry out a proper study . So I would say that my findings in this particular government hospital are not the gospel truth but can be a starting point for all of us to discuss about our health system in Zimbabwe.

There are so many people that are working on the political front to engage the politicians and some are putting their names forward as the alternative to the current government. There are enough players and those that know me, know that I was involved some years ago and I hanged my boots in that field. I am now a patient engagement advocate and believe in the statement that says : “Nothing About Me Without Me”. My writing is to call patient to action and be involved in issues about themselves. I believe that we may have a change of leadership but if us as patients do not get involved and take ownership of our health then nothing will change.

government hospital

My first day which was a Wednesday, I took a patient to a government hospital to see a consultant. We arrived at the information desk and asked for the directions to the radiotherapy department. The two members of staff were very polite to us and gave us the directions. I was happy when they told us to pass through the casualty area ( Accident and Emergency department ) . As we were walking I kept on looking at the level of cleanliness in the corridors. The corridors were fairly clean from just looking at them without proper inspection.

I was surprised as I passed through the casualty of this government hospital and found it almost deserted. I soon realised that it was around 9 in the morning and it was quiet. We then proceeded to the radiotherapy department which was fully packed with patients . We got registered and had to wait for our turn to be seen. No one told us how long we were going to wait or how late the doctors were running. I looked around and saw very sick patients being helped by their relatives . I said to myself I must stay in queue until our turn comes. We waited for about an hour and I decided to take some fresh air outside. When I was outside I saw a nice car driving very fast into the casualty area.

Parirenyatwa hospital

As soon as the car stopped two people came out quickly , one looked fine but the other one was covered in blood. They both rushed inside the department and I saw the other one now coming out pushing a trolley covered with a brown blanket. I did not see a medical personnel or even a porter coming out to help the person with a trolley. I soon realised that there was a more seriously injured person who was lying in the back seat. Passerby came to the rescue of the person pushing the trolley and helped the injured person onto the trolley . These people did not mean any harm but I feared for the poor injured man as he was likely to sustain further injuries from being pulled out of the car. There was no neck support and someone was pushing the head so that the injured person could come out of the car. I almost rushed to stop them but I was too late as they quickly threw the man on the trolley and whisked him into the casualty department . I do not know what happened next but was told that the people that were injured , was as a result of road traffic accident . I was soon called as it was our turn to see the doctor.

I rushed inside and the lady who was controlling the clinic started shouting at me for delaying. I did not answer her and went straight to see the doctor who was waiting for us. I introduced myself and asked if it was ok for me to be present throughout the consultation. The doctor agreed and looked at the scans that had been done the previous day at the private hospital . The doctor explained everything and told us that the next step was for us to see the surgeons for operation. We were then given a prescription to go and buy the medication. The doctor stopped in the middle of writing the prescription and confirmed if it was fine for her to put all the necessary medication needed to treat the patient without worrying about money. “Money is not a problem” was my answer without much thinking.

We then left the radiotherapy department and there were now a few patients left. I soon realised that there were 4 doctors running the radiotherapy clinic . We went back to the out patient department to book an appointment with the surgeons. There was a small queue and we were attended to within 10 mins. An appointment was booked for Wednesday the following week due to the Easter holiday otherwise we would have been given an appointment for Friday the same week or Monday the following week. We were advised to go to a private pharmacy because the one in the hospital did not have most of drugs.

We went to Avenues hospital pharmacy and were cheerfully received and had a good discussion about the quantities of the medication needed. I paid $110 dollars for the medication and left the pharmacy . I was now tired and went back home for some food.

I then decided to reflect on my experience at the hospital and also read all the comments that are being made on my articles. A colleague of mine once told me that there is wisdom in the crowd so I should read all comments. Reading yes I read all the comments and I am always fascinated about what my friends write.

You may also want to read my other article on Zimbabwe health system

Wounded healer

My View of Health System in Zimbabwe

Same themes came up and the one on whether we should compare Zimbabwean health System with UK or USA , be it private versus private or public versus public came again. There are merits on all sides of discussions but we have to accept that the health systems are totally different and it seems we all agree that the health system in UK or USA is better than Zimbabwe. If we agree on that then we should make sure that our system can learn from the NHS and modify it to suit local needs. The NHS has its advantages and problems so the best way is to come up with a system that addresses the problems caused by the NHS and then implement such a system in Zimbabwe. I accept that it’s inappropriate to compare a private system to a public system. That said, the point is to show that there is a system (private health system) that is working well in Zimbabwe.

In life human beings have a tendency to only give negative feedback easily and hardly give positive feedback as we take it for granted. We expect a good service and if it delivers we hardly praise it but if a mistake happens we are quick to raise it and at times we paint the whole system with the same brush. I tried to avoid that and try to look at positive things coming from our system. Having looked and acknowledged the positive things on our health system I will look at things that are not happening as they should and also give my suggestions on how we can address these issues. In so doing I will ask you readers of this website to chip in with your suggestions, criticisms and comments on this article and the health system in Zimbabwe.

Why don’t you read why people are going to Karanda ?

Dr Chireka at Karanda hospital

Why Are People Going to Karanda Hospital ?

Join me in Part 2 where I am going to give my honest feedback of my experience and my suggestions.

This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOCK
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal.

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Realistic weight loss

Realistic weight loss is recommended

By: Dr Brighton Chireka • 1st February 2016

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Realistic weight loss goals better than quick fixes

Compiled by Dr B Chireka

It is the 4th day  into the new year and I hope we are still on track with our resolutions. One of the most common new year resolution is about weight loss. I thought I should share with you what the experts have been saying about weight loss. I would like to highlight the guidance that was published by National Institute for Health and Care Excellence( NICE ) in UK. NICE guidance supports healthcare professionals and others to make sure that the care they provide is of the best possible quality and offers the best value for money.

NICE

It reinforces the message that l am trying to send out to all readers of this platform. There is something that you can do about your health and a little bit of your action will make a huge difference,

Nice on weight loss

When it comes to weight loss, shedding  even a small amount of weight can help to improve the health of people who are overweight or obese and lower their risk of developing type 2 diabetes, heart disease and cancer, says NICE.

People attending a lifestyle weight loss programme should look to make gradual, long-term changes to dietary habits and physical activity levels and aim to lose around 3 per cent of their body weight

This is what some of the specialist from NICE are saying about weight management:

Professor Kate Jolly, professor of public health at the University of Birmingham and NICE guidance developer, said: “By losing even a small amount of weight and keeping it off, overweight and obese people can improve their health.
“We all know that eating less and being more active will help us in weight loss, but it can be quite hard to put it into action especially in the long-term, which is why some people need additional support. Lifestyle weight loss programmes can help people to identify strategies which suit them to help maintain these changes in the future.”

Professor Mike Kelly, Director of the Centre for Public Health at NICE, added: “Lifestyle programmes are one part of the solution. An environment that makes it easier for people to be active and eat well is also crucial, as are services for people with other issues that affect their health and wellbeing. The guidance isn’t about quick fixes. There is no ‘magic bullet’. It is about ensuring effective services are there to support people in the long term.”

Weight management

 

I then say the take away home message for you all reading this article is that if you weigh 100kgs then you should aim to lose at least 3kgs. This is achievable by most overweight people. The problem is that the wrong message is being circulated that one has to have a ” stick-thin figure” to be healthy. Some have unfortunately wasted their hard earned cash on quick fixes that are not long lasting . I urge you to follow a programme that is safe and sustainable. Be proud of your figure and work at your pace. Do not be discouraged if you do not initially achieve to lose at least 3% of your weight. Not trying is no option because you will continue to pile up more and more kilos which is detrimental to your health.

The statistics are not good , it seems we are becoming more and more overweight and that is not good for our health. The number of people who are overweight or obese in England continues to rise with more than a quarter of adults now classified as obese and a further 42% of men and a third of women classed are overweight. This trend seems to spread throughout the world so this message does apply to everyone regardless of where you are.

You may want to read the article on how healthy you are.

Knowing Your Health Status

This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at www.docbeecee.co.uk/blog

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal.

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Continuity of care

Continuity of care in primary care

By: Dr Brighton Chireka • 29th January 2016

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Let’s stick to one general practitioner(GP)

By Dr Brighton Chireka

 

Continuity of care contributes importantly to patient experience, whether it’s continuity of a relationship, by seeing the same GP, or management continuity, that coordinates an individual’s care across the wider health care system.

In Zimbabwe general practice is private unlike in the United Kingdom where it is covered by the government. This means that patients can registered with any general practitioner (GP) regardless of location . In this system patients can registered with several GPs and can even visit two doctors in a day to get ” second opinion”. GPs are the gatekeepers of any society such that a country with a well coordinated primary care will result in better health care for its population. The Zimbabwean system allows patients to pick and choose GPs without any hassles but this can come at a price to the patient.

Continuity of care

Continuity of care is very important and for it to work patients must stick to one GP. This builds a good relationship with one doctor and avoids unnecessary tests to be carried out and the patient will not have to repeat their medical history all the time. In Zimbabwe GPs do not easily transfer the patient’s medical notes to each other as the patient moves from one GP to another. Patients are also partly to blame as at times they do not mention that they have been seeing another doctor. This means that the new doctor will start afresh even requesting tests that may have been done by the previous doctor. This is costly and may delay the diagnosis of serious health problems such as cancer. We know that delay in cancer diagnosis is of great concern as the success of treatment depends on early detection.

VISIT YOUR DOCTOR ON TIME

We have to do our part to make sure that we benefit from the care we get from our doctors.

HOW TO BE A GOOD PATIENT

Electronic records

I would encourage every person in Zimbabwe to register with a local GP and try to stick to that particular doctor. If they decide to change the doctor they should inform their GP and request that their medical notes be transferred to the new doctor. Patients may have to carry the notes themselves as there is no proper system of transferring medical notes from one GP to another. Medical notes in primary care are still in paper form and I hope that soon the profession will move to electronic records in keeping with the rest of the world.

Doctors can run late at times and it’s not a reason to change your doctor.

WHY IS MY DOCTOR RUNNING LATE ?

In conclusion I would say sticking with one GP does not take away your autonomy . You can change the doctor if you are not happy with the relationship or if you relocate to another area but make sure that your medical notes follow you to your new doctor. The medical notes are yours so your doctor should give you if you request them . You may have to pay for photocopying the records as your doctor cannot pay for those costs. The take away home message is the need for continuity of care by sticking to the same doctor. Feel free to share with me your experiences in trying to stick to one doctor or when you tried to change doctors .

Here is a list of doctors in Zimbabwe

FIND A DOCTOR IN ZIMBABWE

This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal.

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gallstones

Good practice in prescribing medicines

By: Dr Brighton Chireka • 26th January 2016

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Should doctors prescribe medicines for family, friends or themselves?

By Dr Brighton Chireka

TIMES have changed in prescribing medicines and I think it’s for the better. This reminds me of 1998 when I was a junior doctor and I would see my senior colleagues prescribing medicines for their families, friends and even themselves. These senior colleagues had free access to medicines at the hospital and all they needed was to sign in a book and they would get any medication they wanted. I remember seeing my senior colleagues walking into a pharmacy and asking for a prescription pad so that they could prescribe for their loved ones. I am glad to say it is unheard of now as it is unethical and bad practice as well.

Today I get a lot of requests from close friends and social media “friends” for medication which, unfortunately, I cannot prescribe. I am at pains to try and explain why it is unethical and bad practice as well as dangerous to do so. I hope this article will be read and shared by a wider audience so that doctors are not inundated by these inappropriate requests. We may sound uncaring and not sympathetic to desperate people making these requests but there are reasons why it is inappropriate to prescribe medicines under those circumstances.

I will start by looking at good practice in prescribing medicines as recommended by reputable registration councils like the General Medical Council (GMC) in the UK. A doctor should prescribe medicines only if they have adequate knowledge of the patient’s health and are satisfied that they serve the patient’s needs.

GMC guideline on prescribing for family

The doctor must have or should take adequate medical history and must find out if the patient is taking any other medicines or if he/she had adverse reactions to medication in the past. There are certain drugs that interact with each other and must not be given together and this also includes alternative remedies, illegal drugs that the patient may be taking. The full medical conditions of the patient must be assessed and past medical and current history must be known before any medication can safely be prescribed.

A doctor must discuss different treatment options with the patient and reach an agreement on the best option for the patient. The discussion must include the likely benefits, risks and burdens, including serious and common side effects. Patients must be made aware of what to do in the event of a side effect or recurrence of the condition. It should be made clear as to how and when the medicine should be taken and how to adjust the dose if necessary. The duration of treatment must be clear and arrangements for monitoring, follow up and review must be put in place.

Sometimes patients do request treatments that a doctor considers inappropriate, the doctor should discuss the issues with the patient and explore the reasons for their request. If, after an open discussion, the doctor still considers that the treatment would not be of overall benefit to the patient, they do not have to provide the treatment. The doctor should explain their reasons to the patient, and explain any other options that are available, including the option to seek a second opinion.

Patients must understand instructions regarding how to take their medicines and must be encouraged to ask questions to clarify anything that is not clear to them. Patients must also be honest with their doctors by revealing any medicines they are taking including recreational drugs or herbal medicines.

The above are some of the good practices in prescribing medicines and must be done in all circumstances unless it is an emergency or life threatening situation such that following of good practice may compromise the health of the patient.

This brings me to the main reason for writing this article. Should we prescribe for family, friends and ourselves? If one is to look at good practice, one will see that we should not be doing that. There are dangers associated with self-medication or prescribing controlled drugs to family, friends and colleagues. There is risk of addiction and misuse of the medication by doctors and relatives as well as friends.

There is no record keeping and inadequate communication with regular General Practitioner (GP). The friend may not reveal a complete medical history resulting in a high potential for drug interactions which can be fatal or prescribing of drugs that may worsen other medical conditions the friend may have. We know that most of us doctors struggle to remain objective when trying to self-diagnose and self-treat. We feel this even more when dealing with family or close friends.

This reminds me of a time when my daughter developed high temperature. I knew it was a viral illness that was going to end in a few days but I could not trust my judgement when it comes to my family. I then took my daughter to her GP and was happy to be reassured that it was a viral illness and there was no need for antibiotics. I know that I would not have forgiven myself if I had sat whilst my daughter’s health was deteriorating.

Doctors need empathy in their work but emotional attachment is not good. As a GP, I see several patients and they present with a variety of problems. Some come to see me to hear bad news that they have cancer and some come to hear good news that they have been cured. I have to be prepared for each patient and not let the situation of the previous patient affect my next patient.

I like what my colleague Dr Achyut Valluri said, and I quote; “Having empathy is good as a doctor; having an emotional attachment is not – it’s bound to affect your judgement or focus. Being husband, dad and son is responsibility enough, without having to be the doctor too! And I know I’d never forgive myself if I missed an appendicitis that one time my daughter complained of a tummy ache.”

Dr Valluri’s statement resonates well with me and I agree that doctors should not prescribe for themselves and their loved ones. It is also dangerous, irresponsible and bad practice to prescribe any medicine without having access or taken a full medical history of the patient involved.

Dr Valluri’s article

I know that there are very rare occasions when doctors have to “break the rule” and this only happens when no other person with the legal right to prescribe is available to assess and prescribe without a delay which would put your, or the patient’s, life or health at risk or cause unacceptable pain or distress, and the treatment is immediately necessary to: save a life, avoid serious deterioration in health, or alleviate otherwise uncontrollable pain or distress.

As usual I urge you to share this article; comment on it, as I also learn from your experiences but remember to see your regular doctor to discuss your medical problems.

You may want to read the following related articles on medicines;

Buying Medication

Antibiotics are not the answer

 

This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at www.docbeecee.co.uk/blog

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal.

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Lumbar puncture

lumbar puncture nothing to fear!

By: Dr Brighton Chireka • 23rd January 2016

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Lumbar puncture nothing to fear

By Dr Brighton Chireka

I was touched when someone send me a message asking about a procedure called lumbar puncture. The person was concerned because someone she knew had just taken their child from hospital against medical advice. The reason was that the parents were afraid that their child would die from the procedure. I was surprised to hear that there are people who think that lumbar puncture is dangerous and results in death of patients. May I take this opportunity to explain this procedure and hopefully convince one or two people not to run away from health professionals each time a lumbar puncture is suggested.

I can sympathise with these parents as they do not mean harm to their children but in their actions they may end up losing that child due to the worsening of infection. Health professionals do not request a lumbar puncture randomly without a reason however it seems at times not enough time is given to educate patients on the benefits of the test. We must remember that this test is done in patients who are seriously ill and their survival depends on the speed with which medical intervention is started. If there is severe infection such as sepsis ( infection of the blood) any delay in starting treatment will increase the risk of that patient dying.

What is a Lumbar puncture?

A lumbar puncture (also called a spinal tap) is a procedure to collect and look at the fluid (cerebrospinal fluid, or CSF) surrounding the brain and spinal cord. During a lumbar puncture, a needle is carefully inserted into the lower part of the spine to test for conditions affecting the brain, spinal cord or other parts of the nervous system. During the procedure, pressure is measured and samples of cerebrospinal fluid (CSF) are taken from inside the spine. CSF is a clear, colourless fluid that surrounds and supports the brain and spinal cord. Analysis of CFS can often reveal a good deal about some conditions that affect the brain and spinal cord.

The fluid can be tested to help diagnose conditions, such as:

Meningitis – an infection of the layers (membranes) surrounding the brain and spinal cord . This is a serious infection that must be treated without any delay.
Subarachnoid haemorrhage – a type of stroke, caused by bleeding in and around the brain
Guillain-Barre syndrome – a rare condition that causes inflammation of the nerves in the arms and legs.
A lumbar puncture doesn’t necessarily mean you have one of these conditions; it may be used to rule them out. A lumbar puncture can be used to treat some conditions , such as injecting antibiotics or chemotherapy medication into the CSF.

 

How is a lumbar puncture carried out?

Under local anaesthetic or without it ,a hollow needle is inserted into the base of the spine and into the spinal canal, which contains the spinal cord and the nerves coming from it. The pressure within the spinal canal is usually measured and some CSF is removed either to reduce the pressure or for a sample to be sent for testing. Patients will normally be lying on their side, with their legs pulled up and chin tucked in, but sometimes the procedure is carried out while they are seated and leaning forwards. It usually takes around 30-45 minutes or less to complete. Results on CSF samples can be available within 48 hours, but specialised tests can take several weeks.

 

Lumbar puncture

 

Are there any risks?

A lumbar puncture is generally safe and the risk of serious complications is very low.
Serious side effects are generally uncommon, although many people experience headaches caused by CSF leaking out through the needle hole in the spine. This occurs internally, so you won’t see it. The headaches are typically worse when in the upright position and can usually be relieved by lying down. Drinking plenty of fluids and taking simple painkillers will also help. It can take up to a week for the hole to heal and the fluid to stop leaking.

Sadly the infection being investigated may result in the death of the patient if it is not treated properly or treatment was delayed. My advice to the readers of this article is that lumbar puncture is a safe test and we should allow the doctors to explain the procedure to us and let them carry out the test. Feel free to ask your doctor any questions that you may have rather that taking your child away from hospital.

I would like to hear your experiences and may you also share with your friends this article so that it reaches to those in desperate need of this advice.

This article was compiled by Dr Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal.

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Brilliant Pongo with beard

Growing beard is actually healthy?

By: Dr Brighton Chireka • 22nd January 2016

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Growing beard is actually healthy ?

By Dr Brighton Chireka

A lot has been said about growing beard from hygienic to biblical point of view and it seemed the jury was out but not anymore. I have always wanted to grow a beard and was told that it’s not advisable because of infection control fears. No one showed me the evidence that growing beard increases the risk of infection. It was an assumption and it seemed to make sense so we followed the advice blindly.

It was always a debate of mind that one had between hygienic and biblical implications of growing beard. Charles Spurgeon who is considered by many to be one of the greatest preachers of the ages said the following, “Growing a beard ‘is a habit most natural, scriptural, manly, and beneficial.’” In the bible we know that Joseph, Samson and even Jesus grew beard and also the bible encourages christians to grow beard. Having said that let me hasten to say this, God is far more concerned with the inward instead of the outward. God looks at the heart, not external things. Nevertheless, the Bible does have a lot of advice on outward appearances too. So it is important to avoid asking “Can’t I do what I want due to grace?” Rather, we should ask, “What would God have me do?”

Spurgeon on beard

Hospital acquired infection is a cause for concern and a lot of measures have been put in place to reduce the risk of getting infections in hospitals. We go to a hospital to be cured and not to acquire infections and get worse. Health professionals especially doctors no longer wear white coats, ties and are encouraged to wash their hands before and after touching a patient. Reports suggest that about 25 to 50 % of doctor’s white coats harbour bacteria such as staphylococcus aureus. There has been debate as whether facial hair can harbour more bacteria that can be passed on to patients.

A recent study by The Healthcare Infection Society published by Elsevier Ltd in 2014 which tested swabs from the faces of 408 hospital staff with and without facial hair showed that, clean-shaven men are more than three times as likely to be carrying methicillin-resistant staph auerus (MRSA) on their cheeks as their bearded counterparts. Clean-shaven men were also more than 10 per cent more likely to have colonies of Staphylococcus aureus on their faces, a bacterium that causes skin and respiratory infections, and food poisoning. Researchers suggest this may be due to micro-abrasians caused by shaving in the skin, “which may support bacterial colonisation and proliferation”. The report reads: “Overall, colonisation is similar in male healthcare workers with and without facial hair, however, certain bacterial species were more prevalent in workers without facial hair.”

Healthcare Infection Society Study
Another interesting “study ” by Dr Adam Roberts, a microbiologist based at University College London showed that actually “beards fight infection” . Following the interest from the above study men were randomly swabbed and the swabs were sent to Dr Roberts. He managed to grow over 100 different bacteria from the beards. Among the bacteria that he grew was the “silent assassinator” bacteria called Staphylococcus epidermis. The most interesting finding was that when he tested this bacteria against a particularly drug-resistant form of Escherichia Coli ( E. coli) the type that causes urinary tract infections, it killed this bacteria . This finding shows that beards may be carrying a bacteria that kills other bacteria that we are struggling to treat .

 

Dr Roberts Study reported on BBC

 

In view of the research above , shall we start a beard revolution? One musician has sung a song ” Chengetai ndebvu varume mufananane naAbraham” ( Men grow beard to look like Abraham). I think I am convinced now to grow my beard like my brother Brilliant Pongo below.

growing beard

 

This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal.

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World cancer day

World Cancer Day 4th February

By: Dr Brighton Chireka • 19th January 2016

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Let’s talk about world  cancer day with Dr Brighton Chireka

World cancer day , we can. I can.

On World Cancer Day, we have an opportunity to collectively examine cancer control strategies to identify winning formulas that will accelerate progress. The goal for all of us is to ensure fewer people develop cancer, more people are successfully treated and that there is a better quality of life for people during treatment and beyond,” says Heather Bryant, VP, Cancer Control, Canadian Partnership Against Cancer

On world cancer day we must take time to reflect as we all know or have heard of someone who has had cancer. Some are alive and some unfortunately are no longer with us. Cancer is one topic that is not talked about by many people and also is not fully understood . There is a lot of fear of the unknown due to the lack of knowledge . Sometimes people perish because they lack knowledge about cancer. I hope that this article is a first step in addressing some of the educational needs that we all have about this important topic. Information that is covered here is of general nature and the purpose of it is to encourage everyone to go and see their doctor for further medical advice.

I would like to join the campaign by World Cancer Day ( 4th February ) . It is taking place under the tagline ‘We can. I can.’, World Cancer Day 2016-2018 will explore how everyone – as a collective or as individuals – can do their part to reduce the global burden of cancer. Just as cancer affects everyone in different ways, all people have the power to take various actions to reduce the impact that cancer has on individuals, families and communities.

World Cancer Day is a chance to reflect on what you can do, make a pledge and take action. Whatever you choose to do ‘We can. I can.’ make a difference to the fight against cancer.

4th FEBRUARY

I have chosen to compile this article and circulate it to as many people as possible.

Last year in September I was privileged to receive the ZIMBABWE NATIONAL CANCER REGISTRY (ZNCR) 2013 ANNUAL REPORT from the ZNCR Registrar Mr E Chokunonga. This report comes barely 10 months after the release of the 2012 report . I must commend the ZNCR for working so hard to effectively clear the reporting backlog and to provide us with a more up-to-date information on the incidence and pattern of occurrence of cancer in Zimbabwe. I am passionate about cancer as I have lost very close relatives from Cancer of the Gallbladder, Cancer of the Prostate, Kaposis’ sarcoma to name a few and I also have very close people that that have suffered from breast cancer as well.

The registry with its limited resources is achieving a lot due to committed and determined leadership by using what it has in its hands. The government must make full use of this resource from the registry and make sure that cancer is fully addressed in Zimbabwe. Avoidable death should not be allowed to happen and this calls for joint working between the government and the population at large. No decisions about the public should be taken without the involvement of that public . If it is for the public then the public must be fully involved from the beginning and must have full ownership of the strategy.
According to ZNCR the total number of new cases of cancer recorded among Zimbabweans in 2013 is 6548 ( males 42.4 % and females 57.6%). The five most frequently occurring cancers among Zimbabweans of all races were cervical cancer (18%) , Kaposi Sarcoma (10%), Breast cancer (7%) , Prostate cancer (7%) and Non-Hodgkin Lympoma (6%).The leading cause of cancer among Zimbabwe black men in 2013 was prostate cancer followed by Kaposi Sarcoma. In Zimbabwean black women the most common cancer was cervical cancer followed by breast cancer.

The sad thing from the report is that people are presenting very late when the cancer has spread to other parts of the body. The outcome is very poor when people present to their doctors too late . I hope by compiling this article I am helping in raising awareness on the need to take cancer seriously and see our doctors as soon as possible.

How does cancer begin?

Cancer begins in cells and cells are the body’s basic unit of life. Let me expand on what normally happens in our bodies and what can go wrong . The body is made up of many types of cells. These grow and divide in a controlled way to produce more cells that are needed to keep the body healthy. When cells become old or damaged, they die and are replaced with new ones. However, sometimes this orderly process goes wrong. The genetic material (DNA) of a cell can become damaged or changed, producing mutations that affect normal cell growth and division. When this happens, cells do not die when they should and new cells form when the body does not need them. The extra cells may form a mass of tissue called a tumour . These cancerous cells can invade and destroy surrounding healthy tissue, including organs and spread to other areas, for example cancer of the bowel (tummy) can spread to the liver or lungs. This process of spreading is known as metastasis.

There are over 200 different types of cancer, each with its own methods of diagnosis and treatment. Most cancers are named for the organ or type of cell in which they start – for example, cancer that begins in the colon is called colon cancer; cancer that begins in melanocytes of the skin is called melanoma and cancer that begins in breast is called breast cancer.

Cancer is a common condition and in some countries such as UK it is estimated that more than one in three people will develop some form of cancer during their lifetime. In the UK, the most common types of cancer are: breast ,prostate, lung, bowel ,bladder ,uterine (womb) cancer.

It’s important to know your body and recognise any changes, such as lumps or unexplained bleeding, and to get advice about whether they might be serious.
There are so many symptoms associated with cancer and I do not have the space to include them all and the article will be too long to read. I would advice you to see your GP ( doctor ) if you have some of these symptoms listed in this article. Please remember that these symptoms are often caused by other, non-cancerous illnesses, so it does not mean having these symptoms is a sign of cancer, but it is important you see your GP so they can investigate.

Other potential signs and symptoms of cancer are outlined below.
1See your GP if you notice a lump in your breast, or if you have a lump that is rapidly increasing in size elsewhere on your body.
2- You should visit your GP if you have had a cough for more than three weeks.
3- Go to see your GP if you have experienced one of the changes listed below and it has lasted for more than a few weeks: blood in your stools, diarrhoea or constipation for no obvious reason, a feeling of not having fully emptied your bowels after going to the toilet, pain in your abdomen (tummy) or your anus (back passage) and persistent bloating
4- You should also go to see your GP if you have any unexplained bleeding such as:
blood in your urine, bleeding between periods, blood from your back passage, blood when you cough, blood in your vomit
5-Go to see your GP if you have a mole (skin lesion) that: has an irregular or asymmetrical shape, has an irregular border with jagged edges, has more than one colour (it may be flecked with brown, black, red, pink or white), is bigger than 7mm in diameter, is itchy, crusting or bleeding, Any of the above changes means that there is a chance you have malignant melanoma (skin can
cer).
6- You should also go to see your GP if you have lost a lot of weight over the last couple of months that cannot be explained by changes to your diet, exercise or stress.

There are no proven ways to prevent cancer, but you can reduce your risk of getting it. There are some cancer risk factors we can’t do anything about, such as our age, family history and medical history. The aim of this article is to highlight some of the things we can do something about, for example leading a healthy lifestyle can help lower your risk of developing certain cancers. You can do this by: eating a healthy balanced diet, maintaining a healthy weight, drinking less alcohol, stopping smoking, protecting your skin from sun damage.

We are slowly becoming obese and In England, over 60% of the population is overweight or obese. Being overweight or obese can increase your risk of some cancers, such as: bowel cancer, pancreatic cancer, oesophageal cancer, breast cancer if you are a woman who has been through the menopause, cancer of the womb (uterus) and kidney cancer. Being a healthy weight can reduce your risk of developing cancer so let’s start losing weight today!

Drinking alcohol is known to increase your risk of some cancers, including:
mouth cancer,pharynx and larynx cancer, oesophageal cancer, colorectal cancer in men and breast cancer. Drinking is probably a cause of other cancers such as colorectal cancer in women and liver cancer. Women shouldn’t regularly drink more than 2-3 units of alcohol a day, and men shouldn’t regularly drink more than 3-4 units a day. “Regularly” means every day or on most days of the week.

Lung cancer is responsible for around a quarter of cancer deaths in the UK, and 90% of lung cancer cases are related to smoking. We know that stopping smoking greatly cuts the risk of developing cancer and the earlier one stops, the greater the impact. But it’s never too late to quit. People who quit smoking at 30 live nearly as long as non-smokers, and those who quit at 50 can still undo half the damage.” There is support to help you stop smoking so take advantage of it and quit smoking today!

Each specific type of cancer has its own set of treatment methods.
However, many cases of cancer are treated using chemotherapy (powerful cancer-killing medication) and radiotherapy (the controlled use of high energy X-rays). Surgery is also sometimes carried out to remove cancerous tissue. Early diagnosis of cancer increases the chance of surviving so please do not procrastinate. What are you waiting for? See your GP today please!

You can read about specific cancers below;

Let’s Talk About Cervical Cancer

Let’s Talk About Prostate Cancer

Let’s Talk About Breast Cancer

For more information and support please please click below ;

The Cancer Association of Zimbabwe

Cancer Research UK

This is a huge topic and I have tried to summarise it and hope that you have learnt something. Please feel free to share , comment or like this article . The message to take home is that you should see your doctor without delay if this article resonate with you.

This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at www.docbeecee.co.uk/blog

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal.

 

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Gallstones

lets talk about gallstones

By: Dr Brighton Chireka • 14th January 2016

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Let’s talk about Gallstones

By Dr Brighton Chireka

Question – ” Doc I was told I have gallstones. Is there any way I can remove them or do that will help me not get the attacks without going for an operation? Thanks for your help.

Answer: Thank you very much for your question about gallstones. I will address the whole topic about gallstones and in the process make sure that I answer your question in full. Gallstones in the UK are the most common cause of emergency hospital admission for people with abdominal pain. About 8% of the adult population has gallstones and 50 000 people a year have operation to remove their gallbladder.

 

What are gallstones?

 

Gallstones are small stones, usual made of cholesterol (fat) , that form in the gallbladder. In most cases they do not cause any symptoms and do not need to be treated.

What is a gallbladder ?

A gallbladder is a small , pear-shaped pouch in the right upper part of your tummy right below the liver. It stores bile , the digestive fluid produced by liver that helps to break down fatty foods. After a meal , bile is released by the gallbladder when the small intestine secrets a hormone (chemical) called cholecystokinin. Then the bile flows into small intestine and helps to break down fats – for example the bacon you will have just eaten.

What are the symptoms of gallstones?

One may not have any symptoms and may be unaware that they have gallstones unless there are detected during tests carried out for another reason .
Symptoms can develop when a gallstone temporarily blocked one of the bile ducts . Bile ducts are the tubes that carry bile from liver to the gallbladder and then to the intestines.

The most common symptom is sudden , severe tummy pain that usually last one to five hours but sometimes can last just a few minutes.

The pain can be felt:
in the centre of your abdomen, between your breastbone and belly button
just under the ribs on your right-handside, from where it may spread to your side or shoulder blade
The pain is constant and is not relieved when you go to the toilet, pass wind or are sick. It is sometimes triggered by eating fatty foods, but it can occur at any time of day and it may wake you up during the night. This pain can come and go such that one may have several months of pain free.
Other symptoms
In a small number of people, gallstones can cause more serious problems if they obstruct the flow of bile for longer periods or move into other organs (such as the pancreas or small bowel).
If this happens, you may develop:
a high temperature of 38°C (100.4°F) or above
more persistent pain
a rapid heartbeat
yellowing of the skin and whites of the eyes (jaundice )
itchy skin
Diarrhoea
chills or shivering attacks
confusion
a loss of appetite

The above mentioned symptoms are for severe condition and we call it complicated gallstone disease’.

 

When to seek medical advice?
One should make a routine appointment with the doctor if experiencing on and off tummy pain.
Contact your doctor immediately for advice if you develop:
abdominal pain lasting longer than eight hours
Jaundice ( yellow eyes)
a high temperature and chills
abdominal pain so intense that you cannot find a position to relieve it
Gallstone disease can also cause inflammation of the gallbladder (cholecystitis). This can cause persistent pain, jaundice and a high temperature (fever) of 38°C (100.4°F) or above.
In some cases a gallstone can move into the pancreas, causing it to become irritated and inflamed. This is known as acute pancreatitis and causes abdominal pain that gets progressively worse.

Causes of gallstones.

It is thought that gallstones develop because of the imbalance in the chemical make- up of the bile inside the gallbladder. It is still unclear exactly what leads to this imbalance, but it is known that gallstones can form if:
there are unusually high levels of cholesterol inside the gallbladder – about four in every five gallstones are made up of cholesterol
there are unusually high levels of bilirubin (a waste product produced when red blood cells are broken down) inside the gallbladder – about one in every five gallstones is made up of bilirubin
The chemical imbalances cause tiny crystals to develop in the bile, which gradually grow (often over many years) into solid stones that can be as small as a grain of sand or as large as a pebble. Sometimes only one stone will form, but there are often several at the same time.

 

Who is at risk? ( who is likely to get gallstones)
Gallstones are more common in the following groups:
women, particularly those who have had children
overweight or obese people – people who are overweight with a Body Mass Index of 25 or above
people aged 40 years or older (the older you are, the more likely you are to develop gallstones)
people with cirrhosis (scarring of the liver)
people with the digestive disorders Crohn’s disease and irritable bowel syndrome .
people with a family history of gallstones (around a third of people with gallstones have a close family member who has also had gallstones)
people who have recently lost weight, either as a result of dieting or weight loss surgery such as gastric banding
people who are taking a medication called ceftriaxone, which is an antibiotic used to treat a range of infections.
Women who are taking the combined oral contraceptive pill or undergoing high-dose oestrogen therapy also have an increased risk of developing gallstones.

 

Treatment
If the gallstones are not causing any symptoms then the best options is to leave them alone.
If your symptoms are more severe and occur frequently, gallbladder removal surgery will usually be recommended. The gallbladder is not an essential organ and most people notice little difference without it.
In most cases, keyhole surgery will be used to remove your gallbladder if surgery is recommended. This is known as a laparoscopic cholecystectomy.
In some circumstances, a laparoscopic cholecystectomy may not be recommended. This may be due to technical reasons, safety concerns or if there is a stone in the bile duct that cannot be removed another way. In these circumstances, an open cholecystectomy may be recommended. Open surgery is just as effective as laparoscopic surgery, but it does have a longer recovery time and causes more visible scarring. Most people have to stay in hospital for up to five days and it typically takes six weeks to fully recover.

An endoscopic retrograde cholangio-pancreatography (ERCP) is a procedure that can be used to remove gallstones from the bile duct. However, the gallbladder is not removed during this procedure so any stones in the gallbladder will remain unless removed using the surgical techniques mentioned above.
Medication to dissolve gallstones
If your gallstones are small and don’t contain calcium, it may be possible to take ursodeoxycholic acid tablets to dissolve them.
However, these are not prescribed very often because they are rarely very effective, they need to be taken for a long time (up to two years) and gallstones can recur once treatment is stopped.
Preventing gallstones

From the limited evidence available, changes to your diet and losing weight (if you are overweight) may help prevent gallstones. Avoiding fatty foods and eating a healthy diet is recommended and will help to prevent gallstones.

more information on gallstone can be  found in the link below.

MORE INFORMATION ON NHS

This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal.

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Types of hernias

Testicular torsion and types of hernia

By: Dr Brighton Chireka • 12th January 2016

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Hernia part 2

A look at different types of hernia and also testicular torsion

By Dr Brighton Chireka


Types of hernia

Hernias can occur throughout the body, but they most often develop around the abdomen. Some of the more common types of hernia are described below.

Inguinal hernias

This is the type of hernia that I had and is fully described above . It is the most common type of hernia and it mainly affects men. It is often associated with ageing and repeated strain on the abdomen. In my case it was a defect which I was born with and not infection as wrongly suggested by one health professional.

Femoral hernias

This occur when fatty tissue or a part of one’s bowel pokes through into groin at the top of the inner thigh. They tend to affect more women than men and inguinal hernias, femoral hernias are also associated with ageing and repeated strain on the abdomen.

Umbilical hernias (Guvhu -dende)

Umbilical hernias occur when fatty tissue or a part of one’s bowel pokes through the abdomen near the belly button (navel). This type of hernia can occur in babies if the opening in the abdomen through which the umbilical cord passes doesn’t seal properly after birth. Adults can also be affected, possibly as a result of repeated strain on the abdomen.

Hiatus hernias

Hiatus hernias occur when part of the stomach pushes up into the chest by squeezing through an opening in the diaphragm (the thin sheet of muscle that separates the chest from the abdomen). This type of hernia may not have any noticeable symptoms, although it can cause heartburn ( chirungurira) in some people. It’s cause is not clear, but it may be the result of the diaphragm becoming weak with age or pressure on the abdomen.

Other less common types of hernia

Other types of hernia that can affect the abdomen include:
Incisional hernias – these occur when tissue pokes through a surgical wound in your abdomen that has not fully healed.
Epigastric hernias – these occur when fatty tissue pokes through your abdomen, between your navel and the lower part of your breastbone (sternum).
Spigelian hernias – these occur when part of your bowel pokes through your abdomen at the side of your abdominal muscle, below your navel.
Diaphragmatic hernias – these occur when organs in your abdomen move into your chest through an opening in the diaphragm. This can affect babies if their diaphragm does not develop properly in the womb, but can also affect adults.
Muscle hernias – these occur when part of a muscle pokes through your abdomen. They can also occur in leg muscles as the result of a sports injury.
What are the symptoms of a hernia?

In many cases, hernias cause no or very few symptoms, although you may notice a swelling or lump in your tummy (abdomen) or groin. The lump can often be pushed back in, or will disappear when you lie down. Coughing or straining may make the lump appear.

When should one seek medical advice?

You should see your GP if you think you have a hernia, so they can determine whether you need to be referred for surgical treatment.
You should go to the accident and emergency (A&E) department of your nearest hospital immediately if you have a hernia and you develop any of the following symptoms:
sudden, severe pain
vomiting
difficulty passing stools (constipation) or wind
the hernia becomes firm or tender, or cannot be pushed back in .
These symptoms could mean that the blood supply to a section of organ or tissue trapped in the hernia has become cut off (strangulation), or that a piece of bowel has entered the hernia and become blocked (obstruction).
A strangulated hernia and obstructed bowel are medical emergencies and need to be treated as soon as possible.

There is another condition which I need to discuss as it is an emergency and must be treated as soon as possible without any delay. This condition is testicular torsion.

 

Testicular torsion
Testicular torsion is a benign but serious condition caused by the spermatic cord (the cord that supplies the testicles with blood) becoming severely twisted.
Unlike the other types of benign testicular lumps and swellings, testicular torsion is a medical emergency.

You should contact your doctor immediately or visit your nearest accident and emergency (A&E) department as soon as possible if you suspect you have testicular torsion.

Signs and symptoms of testicular torsion include:
a sudden, severe pain in one of your testicles
swelling of the scrotum
nausea ( kuda kurutsa)
vomiting
abdominal (tummy) pain


If the spermatic cord becom
es severely twisted, the blood supply for the affected testicle can be interrupted. If this is not treated quickly with surgery, there is a risk of losing the affected testicle. You should aim to present at the hospital within 3hrs as the testicle can “die” if not repaired within a period of 6 hours. If the blood supply to the testis is cut off for more than about six hours, then permanent damage is likely to occur.

 

Testicular torsion can occur at any age, but is most common in boys aged 13-17 and is rare in men over 30. It can also affect newborn babies and even unborn babies in the womb. Most cases happen for no apparent reason, although the problem can occur in boys who are born with an unusually loose spermatic cord and it can develop after an injury to the testicles. You may also be at a higher risk of developing testicular torsion if you have a history of undescended testicles (where a boy is born without both testicles in their scrotum).

 

Visit your doctor for assessment of your lump or hernia
If after reading this article and you notice a swelling or a lump, please do not ignore it. Visit your doctor or Emergency centre if you have severe pain or you have some of the symptoms mentioned above. Your doctor will usually be able to identify a hernia by examining the affected area. In some cases, they may decide to refer you to a nearby hospital to have an ultrasound scan (USS) to confirm the diagnosis or assess the extent of the problem. This is a painless scan where high-frequency sound waves are used to create an image of part of the inside of the body. Once a diagnosis has been confirmed, your GP or hospital doctor will determine whether surgery to repair the hernia is necessary.

 

Treatment of hernias
There are two main ways surgery for hernias can be carried out:
Open surgery – where one cut is made to allow the surgeon to push the lump back into the abdomen.
Keyhole (laparoscopy) surgery – this is a less invasive, but more difficult, technique where several smaller cuts are made, allowing the surgeon to use various special instruments to repair the hernia.
Most people are able to go home the same day or the day after surgery and make a full recovery within a few weeks.

 

If your doctor recommends having surgery, it is important to be aware of the potential risks, as well as the possibility of the hernia recurring. Make sure to discuss the benefits and risks of the procedure with your surgeon in detail before having the operation. I had an informed discussion with my surgeon Mr Harrid and he performed open surgery on me to repair my inguinal hernia and it’s now 22 years since the operation and I have had no problems with the repair. I hope you will see your doctor about your lumps and have them sorted.

 

This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at www.docbeecee.co.uk/blog

 

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal.

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Inguinal hernia

Hernia

By: Dr Brighton Chireka • 11th January 2016

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Hernia part 1

Inguinal hernia, personal experience by Dr Brighton Chireka
” Ba -Ba, But eh doctor”, I protested to no avail as I was handed over a packet of antibiotics to take for a week. This happened in 1993 when I was a first year medical student at the University of Zimbabwe.

Since birth I had been aware that something was wrong with my groin and I remember being ashamed of bathing in public at school. I would try to bath when they were few students for fear of being teased. It was not until I started studying medicine that I realised that I needed to do something about my groin problem . I self diagnosed after studying anatomy ,that I had Congenital Inguinal Hernia.

A hernia is when there is a hole or weakness in the tummy muscles. This means that organs or tissues inside the tummy can poke through the hole and cause the skin to bulge. An inguinal hernia is a hernia that occurs in the groin region. “Congenital” meaning that the defect is present from the time one is born. During development in the womb, all babies normally have a tunnel that connects the tummy to the groin. In boys, this connects the tummy with the scrotum. The testicles initially grow inside the tummy and descend through this tunnel to end up in the scrotum. This tunnel is supposed to seal off prior to the baby being born. If it fails to close before birth, then the child is at risk of having an inguinal hernia.

Having suspected that I had congenital inguinal hernia I made a trip to see a doctor at the University Medical Centre. I saw doctor ( name withheld ) and I told him that I had a groin swelling and was worried that I had a hernia . The doctor did not listen to what I was saying but kept on asking me about my sexual life which was nonexistent at thattime. He did not even bother to examine me. I was surprised when he told me that he suspected that I had sexual transmitted infection. My plea that I was a virgin was not heard as I was given antibiotics to take for a week. I had so much respect for doctors and took the antibiotic as instructed as I thought maybe I got the infection from using one of the public toilets.( that was silly thinking).

I finished the course of antibiotics but my groin swelling remained there. I then sought second opinion and went to see Dr Ndiweni ,the physician who reassured me that I had no infection but a hernia and he referred me to Mr Harrid ,the surgeon who eventually carried out the operation to repair the hernia in December 1993.

Looking back I resent the first doctor for not listening to me , but I am grateful to the other two doctors who addressed my ideas, concerns and expectations. There is no doubt that the age of the paternalistic, “doctor knows best” model of health care is gone. We say here , “Nothing About Me Without Me” and if it does not involve us then it’s not for us. I think that every doctor-patient relationship should represent a collaborative effort in which patient needs and wants need to be taken into account and, wherever it doesn’t conflict with science- and evidence-based medicine, patients’s wishes should be paramount.

Doctors do a fantastic job and there are so many good stories that we should acknowledge. The issue is to make sure that you are involved in the decision making about your health. From my experience I think doctors and carers, we need to slow down, remind ourselves that we are here to support and not take over. When we are doing this without the patient we are in effect saying it is not their life anyway. How many things do we do for the person? When what we should be always be doing is with the person. We must never forget that it is not our life, it is their life. We do not make decision for the patient , we make decision with the patient. As for carers , we do not clean for disabled people, we clean with them. We do not shop for them but we shop with them.

Feel free to share your experiences, comment or like the article if this resonates with you.

Let’s meet tomorrow as I publish the part 2 which looks at different types of hernias.

This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at www.docbeecee.co.uk/blog

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal.

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How to be a good patient

Being a good patient- here are the tips.

By: Dr Brighton Chireka • 8th January 2016

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How to be a good patient

By Dr Brighton Chireka

How to be a good patient ? I thought I should compile an article on how to be a good patient so that the doctors are able to diagnose some of the complicated problems that we may have. Doctors are professionals that are taught to do deal with different sorts of patients. They are trained to deal with a wide variety of patients starting with those that do not want to talk about their problems to those that come knowing exactly what they want from the doctor. In as much as these doctors are professionals who are trained to deal with any situation , we must understand that they are human who have emotions and feelings. We may push them to the limit and the end result is that the doctor and patient relationship can suffer to the extent of becoming irreparable. The sad end result will be the termination of that relationship with the patient having to find another doctor.

Here are some of the things that will make a difference when you visit your doctor;

1- Arrive in time for your appointment
It annoys most doctors if you turn up late for your appointment. It is always advisable to be at least 10 minutes early for your appointment. This will help if the doctor is running on time . Many a times doctors run late due to various reasons and my advice to you is that , do not let your timekeeping be the reason why the whole clinic end up running behind time. It frustrates the doctor and other patients who may have to reschedule their other appointments. Some other doctors will refuse to see you if you arrive late for your appointment so try to be in time. If you are running late it’s better to phone ahead and let them know at the surgery . Most doctors will see you if you do that as they know that we all get held up in traffic or by other life commitments. Do not make it a habit and be known for coming late for appointments . It is not in your best interest to be attended to by a frustrated doctor even if they might not show it.

2- Try to keep a diary for your problems
A doctors is not a ” prophet ” who has powers to know the hidden things about your problems. A doctor is able to come up with a possible diagnosis from just talking with you. Examination and tests will be done to confirm or rule out certain diagnosis that the doctor will have come up with from just talking with you. It makes the life of the doctor difficult if the patient does not know when the symptoms started , cannot explain the symptoms , does not know what makes it better or worse , cannot remember most things about the problem that has made him or her to come and see the doctor. At times the patient does not even answer the questions being asked by the doctor. I know the patient may have things that he or she want to get out of the chest . My advice in such situation is to answer the question asked by the doctor and then go on to add other issues that you want addressed or worried about. If the doctor is not giving you time to speak , feel free to ask for permission to say something . The doctor in most cases will realise his or her mistake of not allowing you to speak and will allow you to speak . In order to be able to answer most of the questions that your doctor is likely to ask I suggest that you keep a diary of your symptoms. The diary is for you to remind you and please do not just dump that diary to your doctor and expect him or her to give you a prescription. You do not need to present your diary , I suggest you read it before coming to see your doctor and only refer to it if you cannot remember certain things .

3- be honest
If ever there is a time to tell the truth, the whole truth, and nothing but the truth so help you God, it’s when you are with any doctor. In the same line with having a diary , you need to be honest and admit if you do not know something. It’s better to say that you do not know when your cough started than lying that it started yesterday when you have had it for more than 3 weeks. That lying may appear harmless to you but can result in the doctor making a wrong diagnosis or offering you wrong treatment. Many patients when in pain ,tend to overplay their symptoms and say that “nothing is touching ” their pain. A detailed discussion will usually reveal that they have not even taken their pain killers regularly . Some would have just taken their pain killers in that last hour and are expecting quick results . If you exaggerate your symptoms the doctor may end up over investigating you. This may not be good for your health as some of the tests may put your health at risk. Also underplaying your symptoms is not good as well . Some people underplay their chest pain only to collapse with a heart attack later. My message is that just be honest about how you are feeling and answer all the questions truthfully not being afraid to say that you cannot remember certain issues. Keep things you cannot remember to minimum as the diagnosis depends on the information you give the doctor.

4- Be assertive but not rude
No one wants to work under duress so do not be rude to your doctor even if he or she is wrong. Doctors are human so at times they may miss or not get what you are trying to say. My message is that try to put your case clearly without shouting or being vulgar. The doctor can terminate the consultation if he or she feels threatened or that the consultation is no longer achieving its purpose apart from raising tempers. Most doctors if running late will inform their receptionists to warn you about the delay. There is no need to have a go at the doctor for running late. It’s better to use that time to have your medical problems sorted first and then make a complaint about the incident later. You cannot shout at the doctor, even calling him or her names and then expect to get proper treatment soon after the incident. Some patients know what they want but they get it wrong sometimes. One comes in and says to the doctor , “doc I have chest infection and I need some antibiotics”. Some will be reluctant to answer any more questions the doctor may want to ask. A doctor will want to take a detailed story of your “chest infection ” and even examine you before deciding on treatment. It is in your best interest to be able to answer the doctor and explain your symptoms as well as your views on the diagnosis and treatment. Feel free to tell your doctor your ideas about your symptoms and your concerns or worries about it. You should also tell your doctor what you expect him to do even if he may not agree with your plan. The doctor with discuss with you the possible diagnosis and treatment options allowing you to make an informed decision about the treatment plan to follow.

5-Know your medication
Please try to keep a list of medications you are taking and bring them to you doctor especially if it is a new doctor who do not have your records. As a Gp I cannot tell you how many patients I talk to who say, “Oh well I take a little square white pill and a pink one too” but cannot tell me what they are , what the dose is. It makes my life difficult but nowadays it’s getting better as medical records are now slowly being shared in some places. Whichever way it is good to know what you are taking and why you are taking it.

In conclusion – do your part !
Most health problems are caused or made worse by our diet and lifestyles so we must take ownership of our health. We all struggle with bad habits such as smoking , alcohol abuse , eating junky food and lack of exercise. Doctors struggle with people who know the cause of their medical problems but are in denial. There are some who struggle with recurrent chest infections and come for antibiotics all the time but make no effort to stop smoking . Help on stopping smoking is usually denied making the doctor helpless. Some may struggle with breathing difficulties, arthritis of the joints and or diabetes but are not keen on exercise or eating a health diet. They just want tablets to do the “tricky” for them . It frustrates the doctor but they cannot say much as the patient will complain about being told off. My message is that as patients we need to do our part and compliment what our doctors are doing with us . There are simple things that we can do such as eating a health diet , exercising , cutting on alcohol, stopping smoking, giving paracetamol to our feverish children before seeing a doctor, if we can afford we should buy a thermometer and take the temperature of our ill children or even trying to give small amount of fluids more often to our children who are suffering from diarrhoea .

I know we are the ” microwave” generation we want instant results. We change internet providers because their internet speed may be a few seconds slow. We must learn to accept that our bodies will take time to fight a viral illness . The illness will take its course which can be a week and we may feel unwell even if we try to take antibiotics. It’s not helpful to demand antibiotics for viral infections as they do not work . We end up suffering from the side effects of the antibiotics. What is needed in most of these viral infections is for us to drink plenty of fluids, eat more fruits and vegetables and have enough rest waiting for the body to clear the infection.

This article was compiled by Dr. Brighton Chireka who is a GP and a Patient Engagement Advocate (PEA) in Folkestone Kent, UK. He is also an NHS Certificated Change Agent (CCA). You can contact him at: info@docbeecee.co.uk or visit his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.

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Visit your doctor on time

Visit your doctor on time

By: Dr Brighton Chireka • 4th January 2016

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Visit your doctor on time

By Dr Brighton Chireka

IN my articles so far I have been advising everyone to visit their doctor and I have also been studying the research that has been carried out in countries such as South Africa, the United States of America and the United Kingdom on the use of healthcare by black people. I do not want to generalise and paint all black people with the same brush but I feel the results cannot be ignored.

I take the results as a feedback that we should reflect upon and take the necessary action to better our health; our health, yes because I am a black person and I do identify with some of the findings in these studies. Instead of being defensive about the findings I call upon those concerned to positively engage with the findings and come up with personal solutions to their health. Let us use this opportunity for our learning and growth in our healthcare.

Some of you know my page on Facebook which is called “Nothing About Me Without Me” which has got more than 28 thousand likes now. “Nothing About Me Without Me” meaning that no decision about you should be taken without you being involved. You should be at the heart of decision making of things that affect your health. Nothing About Me Without Me is not a phrase, it is not a motto it is what we must live, every day. My call is for you to get fully involved in decisions about your health and see a doctor in good time. Part of the reason why I am writing these articles is to make you visit your doctor and get treated.

Not so long ago the Zimbabwe Registrar General Tobaiwa Mudede was quoted to have said that contraceptive pills were dangerous. It’s worrying when those that have influence use their skills to present a one-sided debate and take advantage of our ignorance. Sadly there are some who will take this wrong advice and stop using contraceptive pills. In life, there is nothing that is risk free even sunshine or eating sadza but we do not stop using these things.

There was a scare in the UK about immunisation, wrongly claiming that a certain vaccine for measles, mumps and rubella causes autism (behavioural disorder in children). The doctor behind such falsehood was struck off the register and we are now picking up the pieces. The same will happen in Zimbabwe and doctors will soon be picking up the pieces.

Debate is healthy but is dangerous if it’s one side and must be stopped. I think people must know their areas of expertise and not embarrass themselves whilst putting people’s lives at risk. I am always keen to share good news such as the operation of the Siamese twins by our own Zimbabwean team led by the humble Mr Mbuwayesango than getting news that takes the country back to the Stone Age. It is this kind of misinformation that also make some people shun visiting their doctors.

In the USA, African Americans still lack overall confidence in the healthcare system and believe they are less likely to receive the same medications, treatments, or quality of care as whites. Black men are less likely to use healthcare on a regular basis whilst black women are less likely to have the time and energy for their own health needs due to family responsibilities and other stressors. Elderly men and women delay seeking care until activities of daily living are affected. This is against the background of the worrying statistics that diabetes is two to four times more prevalent in blacks than in whites. The highest incidence of prostate cancer and the greatest mortality is seen in black men and black women present with more advanced stages of breast cancer than white women.

In the UK, studies have shown that among African communities, recourse to health services is often delayed through a system of ‘lay referrals’ where friends and kin are consulted and one turns to a medical expert as a ‘last resort’, when the illness becomes unbearable. African migrants may be more concerned about immigration and socio-economic issues than about their health eg HIV status: as can be seen from a response by one african immigrant in the research: “I’m not worried about the virus – my worry is whether I will be allowed to remain here in this country”. CJ Riley Funeral Services is repatriating at least one body per month from the UK to Zimbabwe and at times the cause of death is easily preventable.

In South Africa there is a tendency, especially among the black people, for the diagnosis to be made late or if made early, there tends to be non-compliance with the proposed management including follow up. A study conducted by Hacking, Gudgeon and Lubelwana (1988) in the Western cape found that Xhosa women often presented with advanced breast cancer, having first sought assistance from traditional healers.

The results are not encouraging and the reasons for them are not simple but very complicated. It is beyond the scope of this article to go into details about the causes but I have a few questions that I need to discuss with you. Are you registered with a general practitioner (GP) or a family doctor? When did you last visit your doctor? Do you attend for routine check-up and participate in screening for cancer? When you last saw your GP, did you feel listened to and are you following the instructions as directed? Have you gone for the next appointment? What is it that is stopping you from making full use of your GP? What are you doing about it?

Worrying symptoms

Do you have any of the following: unexplained weight loss, persistent cough for more than 3 weeks, coughing up blood, shortness of breath, chest pain, passing blood in stool, lump in your breast or another part of your body, and swollen glands to just mention a few symptoms. If you do have any of the above symptoms, you must see your GP for further advice. Please do not ignore these symptoms as there may be something sinister causing these symptoms.

Having made a call to patients, I want also to make a call to every health professional regardless of race to change their culture of stereotyping people. The race of a person does not tell you much about their behaviour or lifestyle and later on their health. Everyone has a right to health and the medical community must give people, especially black people that confidence. There should be mutual trust for the relationship to work properly. As a patient I am willing to give my story in confidence to a non-judgemental and fully concerned health professional. I also expect mutual respect from patients towards their GPs. Violence against health professionals does not help and is unacceptable.

Black people seek the same components of caregiving from doctors that other patients seek: kindness, sympathy, respect, an earnest attempt to assess their ailments, explanations in basic terms, and a shared approach to management. I also know that the health community is fully committed to engage with all people regardless of race so everyone should make use of their doctors. Nothing about black people without them and if it is for them, then it must be discussed with them.

I hope that this article will make at least one person pause and reflect about their health and visit their GP. Please feel free to share this article, comment or email me.

This article was compiled by Dr. Brighton Chireka who is a GP and a Patient Engagement Advocate (PEA) in Folkestone Kent, UK. He is also an NHS Certificated Change Agent (CCA). You can contact him at: info@docbeecee.co.uk or read more of his work on DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.

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Waist trainers and high heel shoes

A look at waist trainers and high heel shoes

By: Dr Brighton Chireka • 2nd January 2016

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A look at Waist trainers and high heel shoes

By Dr Brighton Chireka

We all want to lose weight and look good in the clothes we wear . We go and see our doctors and the advice we get is not pleasing to us . We hear the same old story that we need to eat a healthy diet and exercise regularly. The challenge we have is to find the time to exercise and how to find the healthy foods. We just hope for a magic pill that will do all the work for us and the weight is gone in a few seconds. Weight management is a big business so companies bombard people with their products. We all appreciate that we need to shade a few pounds off but at times we do not know how to do it or the will power to even attempt to do so.

Some women have jumped on to the waist trainers in the hope of losing weight and looking good. It is claimed that wearing these “corsets” for a certain amount of time daily will help you lose weight and shed off the fat around the waist line. We are told to wear a corset-like contraption to cinch the hips and back. Celebrities like Jessica Alba claimed that the waist trainer helped her to lose the baby weight. Other celebrities like Khloé and Kim Kardashian , Kylie Jenner, and Amber Rose have posted selfies wearing these waist trainers. This sounds very good if it works but the whole truth is not being told and sadly some people have had severe medical problems after using these corsets.

One does not need to be a doctor to understand the flaws of the corset. One is asked to wear an outfit that will press the abdomen, the ribs and the chest wall hoping to lose weight. How can squeezing your body help it to lose weight ? How safe is it to squeeze your body especially the chest area when your body need to move the chest wall to breathe properly . This is very dangerous especially those people that have breathing problems such as asthma or chronic obstructive pulmonary disease . There is no scientific evidence that these corsets work in reducing the weight so they must not be used for weight management.

Is there any place for waist trainers? 

The aim of this article is to provide you with information so that you make an informed decision. Like with many lifestyle issues people will do as they wish regardless of medical advice. There are some who feel that the waist trainer will boost their confidence at a party as they look trimmed. If you are one of them then my message is that wear it wisely. Get the right size for you as a too tight one will press your tummy and chest too much which can result in you failing to breathe properly that may need a trip to the hospital . You must not wear it for a long time and your body will guide you on the duration. Listen to your body if it starts to feel uncomfortable , too tight or restricted then it’s best to remove it . If you are at a party go to the bathroom with someone as you may need help to remove it. Do not sleep wearing a waist trainer and also do not wear it very often. A one off use or a once in a while use may be a better compromise but if you want to lose weight the the old message is still the same. The best way of losing weight is by healthy eating and regular exercise.

I have heard of people that are being advised to exercise whilst wearing a corset. This is dangerous and you must not try it. It is advisable to wear sports clothes when exercising to avoid any injuries. Exercising wearing a corset is like jogging whilst wearing high heeled shoes. You will injury your feet , legs , knees and back so wear flat comfortable trainers. When you exercise you are challenging your body , heart and lungs and depending on your level of fitness you may find yourself gasping for breath. The last thing you would want is to be restricted by a corset. The restriction may be too much resulting in one collapsing because of lack of oxygen. Those who have used these corsets know how challenging there are to put on and one can imagine how more challenging it is to remove them in case of a breathing restriction. In emergency every second counts so any restrictive clothing is dangerous as it will result in further delay in getting oxygen to the vital organs of the body.

Looking at high heels

In the quest to look good and be confident women wear high heels and I get asked whether its safe to wear heels. I appreciate women who dress up and I am amazed about how determined women are in their battle to look good. We all want to look at our best and some of us want to look like some of our role models. We tend to forget that we are created in different form and shapes and we are all beautiful or handsome in one way or another . There is no one size that fit all of us. Before one thinks of wearing high heels one needs to look at the shape of their feet and body weight. Sadly the medical advice on heels is that they are not good for our feet. We know people want to wear them then the advice is that do not wear very high heel shoes and if you do, wear reasonably high heels , try to wear them for a short time. You can always carry two sets of shoes so that you can wear your flat shoe after the occasion as high heels are not ideal for walking long distances or to be worn for a long time.

The take away home message (THM) after reading this article is to avoid waist trainers and very high heel shoes altogether. If you cannot then the best advice is that wear them less often and for a short time only to look good for that important occasion. If you need long term weight management then stick to health eating and regular exercise. To avoid back pain and sore feet then wear flat or small “heeled” shoes that are comfortable to your feet.

Next article will look at hundreds of the diets being promoted. Do they work or is just money making business?

This article was compiled by Dr. Brighton Chireka who is a GP and a Patient Engagement Advocate (PEA) in Folkestone Kent, UK. He is also an NHS Certificated Change Agent (CCA). You can contact him at: info@docbeecee.co.uk . Read more about his work on his blog DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr. Chireka has used all reasonable care in compiling the information, but makes no warranty as to its accuracy. Consult a doctor or other health care professionals for diagnosis and treatment of medical conditions.

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Colour brave

Betrayal of health professionals in Zimbabwe

By: Dr Brighton Chireka • 31st December 2015

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Betrayal of health professionals in Zimbabwe

I have a moral duty to be involved!

By Dr Brighton Chireka

The medical professionals currently working in Zimbabwe are working under difficult conditions. Their wages cannot sustain them and to make matters worse the Zimbabwean government has now failed to even pay these hardworking health professionals their December salary on time. This is unacceptable and there is no excuse for this to happen. We are critical of our health professionals when they down their tools but we treat them as if we can do without them. It is an open secret that health professionals are well sort after world over and each and every country is doing its best to retain its professionals but not our government.

We need to act sooner rather than later as we will lose these professionals. I am sadly one of them that left and I am offering my services to people of Kent in UK. I am still Zimbabwean and have my heart there but I have been away for the last 16 years meaning that I may be slowly becoming a lost generation. I do not want that to happen but the news coming from home is not pleasing to hear. I am really disappointed at the way we are treating our health professionals who have sacrificed their lives and careers to be in Zimbabwe. They could have been in UK like me but chose to put up with the harsh conditions in our country. We cannot make the conditions more harsh by failing to pay our doctors on time. This is disaster to say the least and the leadership that is presiding over this chaos must ask themselves serious questions about their leadership. How can you invest millions of dollars into training medical professionals that you are not going to look after? Why become a training ground for other countries? Why are you failing these doctors that have stood by you through thick and thin?

A lot of people will ask why am l involving myself with Zimbabwe. I am Zimbabwean even if I may not be local I have a moral duty to be involved.

Read below my detailed response as to why!
Zimbabwe has witnessed the largest brain drain in the last decade and estimates are that over 3 million Zimbabweans are scattered all over the world. I am one of the millions that left Zimbabwe and settled in the UK . Each and everyone of us who left our country has a story to tell but that is a talk for another day . I want to look at what investment was put into people like me by the government of Zimbabwe and the returns if any that there are getting from us in the diaspora.

I am a generation that started school the same year that we got independent. We had free primary school education and our parents complimented the government efforts by paying building fund or providing bricks to build extra classrooms. As a rural boy in Musana communal land I had a vision and looked forward to a bright future . On finishing my primary education I was fortunate enough to secure a place at Runusunguko high school. My first choice was Goromonzi but I was not ” bright ” enough to secure a place there . I made sure that I studied very hard to compete with students at Goromonzi and it paid as I got good grades at O level .

Rusununguko is a school with a history in the Zimbabwean liberation struggle . It is one of the 8 schools that were opened soon after independence to allow the war vets to further their studies for free. As I was not a war vet , my parents had to pay for my school fees . My time at Rusununguko was interesting as I had the opportunity of learning together with the war veterans . My interests saw me joining the war vets in marching as they put up the Zimbabwean Flag. ( This was called Gosawo) . The whole school had to stand at attention whilst we march and raise the flag or lower it down at the end of each day . Anyone who did not respect the raising of the flag was ” dealt with” severely by the war vets. The punishment was severe and involved being asked to put one finger of your left hand into the left ear and then touch the ground with one finger from the right hand. Having done that you will be asked to move around in a circle without removing your fingers. You would then be asked to stand at “attention” after moving around in a circle . The moving around in a circle would cause you to feel dizzy and when asked to stand at “attention” one would fall down. It was not a pleasant experience so everyone made sure that they did as there were told.

The four years quickly went and it’s was time to move to another school for A level. I then secured a place at Kutama College to do my A Level. Whilst there I witnessed the funeral of the then First Lady Sally Mugabe as her body was flown to Kutama and this marked my third and last time that I shook the hand of President Mugabe. The first was in 1986 when I was in Musana and the second was in 1991 when he visited Kutama College with the Australian Prime Minster. I soon realised the privilege of being at Kutama College when a few days before our final chemistry practical exam the college discovered that it had no special scale for the exam. The school had to secure a special scale to weigh chemicals in the Chemistry exam and the challenge was that it had to be imported from United kingdom. There was not enough time for this to be done in normal ways but thanks to the Presidential Office the scale was ordered and delivered to the college within 3 to 5 days. The exam came and we passed with flying colours as we were using first class technology.

I then moved on to the University of Zimbabwe Medical School to study medicine . On arrival we were greeted with $300 cash for initial upkeep whilst paperwork was being sorted for our full government funding. We had one week of orientation and beer was being sold at ridiculous low prices. ” Everyone ” was drinking and I found myself tasting my first beer a habit that took me 10 years to shake off . Within a few weeks we received a pay out of $2000 which was difficult to manage as some of us had been used to handling only $10 per term . There were lots of funding streams and some of us were good at exploring those avenues . At one point I was being funded by the Ministry of Health, Ministry of Higher Education and Harare City council . This multiple funding was then stopped and I was asked to choose one funding stream and I chose to remain with the Ministry of Health cadetship.

During my training I prepared for my time as a District Medical Officer. I enjoyed my attachment in Mt Darwin, Gokwe, Zvishavane and Tshelanyemba in Kezi. I then completed my training and worked for 2 years at Parirenyatwa and Harare Hospitals. I used to laugh at my colleagues who were preparing to go and work overseas. I saw myself as a District Medical Officer but things soon changed and sadly found myself at Heathrow airport explaining to the immigration officers that I had come for holiday which has now turned out to be the longest holiday ever taken.

I have taken this time to narrate my journey so that my critics will know that I am a product of Zimbabwe and I have a moral duty to be involved. I was funded by tax payers funds and in an ideal society I should be working in Tshelanyemba in Kezi not Kent in UK. We cannot allow to continue to be the training ground for the developed countries. We need to be able to retain our health professionals. There is need for an open debate as to why people leave our hospitals. Some of the problems are obvious to see but a genuine enquiry will unravel a lot of issues that are not so obvious . That enquiry should involve those professionals in the diaspora as well, as some may want to come back. Addressing the reasons why some of us left will result in a double win for the country as it will result in retaining of the local doctors and also the coming back of some doctors who are working overseas. Sadly there is no tangible effort from the government to reach out to the professionals in the diaspora. Some of us do not have to wait to be invited as we are Zimbabweans and have a moral duty to be involved.

I am one of the many professionals in the diaspora that are passionate about our country and want to get involved. Our involvement does not mean we are superior or we know it all .We do not have solutions but we feel that the coming together of local ideas and our own will bring a much needed change in our health system. There is a lot of discussion in the social media and I take it as a start and what is needed is to harness that into something tangible. The debate on social media need to move away from a “complaints” forum to a “solution” forum.

Let’s work together to bring change into our health system. For too long, we Zimbabweans have concentrated on the problems, needs and deficiencies within our communities. How we understand health and wellbeing determines the way we respond to it. Typically a community is seen from the perspective of its largest deficit. (Looking mainly at what it does not have ). Assessing and building the strengths of individuals and the assets of a community opens the door to new ways of thinking about improving health and of responding to poor health. We need to look at the health professionals that we currently have and make sure that we create a conducive environment for them and give them the necessary tools to use as well as paying them a decent wage. That decent wage must be paid on time as well!

The glass tends always to be presented as half-empty, emphasizing what is missing, rather than being labeled half-full and thus conveying a message that progress has been made. I see our country as having something that we need to work on. As a community we must learn how to use what we have to create what we need. This calls for everyone to join the debate about our health system looking at ways we can use what we have to create what we need. We have dedicated health professionals that we must look after and then move on to get more not forget us in the diaspora.

This article was compiled by Dr. Brighton Chireka who is a GP and a Patient Engagement Advocate (PEA) in Folkestone Kent, UK. He is also an NHS Certificated Change Agent (CCA). You can contact him at: info@docbeecee.co.uk

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr. Chireka has used all reasonable care in compiling the information, but makes no warranty as to its accuracy. Consult a doctor or other health care professionals for diagnosis and treatment of medical conditions.

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Chaperone

Chaperone in medical examination

By: Dr Brighton Chireka • 29th December 2015

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Chaperone in medical examination

By Dr Brighton Chireka

It was recently reported that a male nurse from Chizvirizvi Health Centre in Chiredzi Zimbabwe was sentenced to 8 years in prison for fondling a pregnant patient’s clitoris while pretending to be carrying out a medical checkup. The pregnant patient had gone to the health centre for medical check up and was attended to by the male nurse. There was no one present in the consultation room except the male nurse and the patient. The male nurse is accused of inserting cotton wool into the patient’s privates , rolling it until it became wet. He is alleged to have went on to fondle the patient’s clitoris instead of just taking blood samples from patient by pricking her finger and also asking the patient to provide urine in a container for testing.

This behaviour by the male nurse brings the medical profession into disrepute so appropriate action must be taken to send a strong message to all the bad apples among health professionals. The judge did take it seriously and the sentence shows that this behaviour is not tolerated in our society. I have been reflecting on this case and have decided to compile an article on chaperoning in intimate medical examinations.

What is a chaperone?

A Chaperone is an impartial observer present whenever possible when a health professional is carrying out intimate examination of the patient. The role of a chaperone is predominantly to comfort and protect the patient but they also serve a secondary role to protect doctors from false allegations. In the case of the male nurse who was imprisoned , a chaperone will have helped to protect the nurse from false allegations. It will also have protected the patient as the health professional will not have carried out unnecessary intimate examinations. It is advisable that health professionals should offer a patient the option of having a chaperone present during intimate examinations.

Trust is an integral part of the doctor–patient relationship. Nowhere else in society will a person allow a stranger to have access to his or her body. According to the General Medical Council ( GMC) intimate examinations are likely to include examinations of breasts, genitalia and rectum, but could also include any examination where it is necessary for the doctor to touch or even be close to the patient. Intimate examinations can be embarrassing or distressing for patients and whenever a doctor examines a patient they should be sensitive to what the patient may think of as intimate.
With the increasing recognition of homosexuality, it could also be argued that a male doctor examining a male patient should be chaperoned, and likewise for a female doctor examining a female patient. In other words, a chaperone should be present regardless of the sex of the doctor.

To have a chaperone or not ?

As patients we differ in our desire for a chaperone so feel free to discuss your preferences with your doctor. Most women want the offer of a chaperone and feel uncomfortable asking for one if not offered. In the case above one can assume that the patient was not comfortable being examined alone by a male nurse but could not stop the examination. I urge all women to be bold and ask for a chaperone if there are not comfortable being examined without one. Most teenagers want a chaperone during intimate examinations, and a family member may be the preferred choice. Many women prefer having a third party present when the examining doctor is male, fewer if the examining doctor is female. For women a female nurse is generally the preferred choice as chaperone. Men, however, particularly teenagers, find the presence of a female nurse as observer during genital examination unwelcome. Interestingly, studies have shown that a substantial proportion of patients in primary care do not mind if a chaperone is present or not, although this finding may reflect an older patient sample and familiar doctors. Failure to offer a chaperone deprives patients of support they may want, and non-availability is an unacceptable excuse. It is unacceptable for a teenage woman to be alone with an unfamiliar male physician for genital examination. Moreover, it shouldn’t be assumed that a female nurse will be an acceptable chaperone for a man.
Chaperoning

The hospital, surgery or clinic should have a policy on chaperoning and patients must be informed that they can ask for a chaperone. The health professionals must clearly explain beforehand what they will be doing during the intimate examination and at each stage of procedure and encourage questions. The following is unprofessional behaviour and is not tolerated; overexposure of the patient’s body, inappropriate comments, gestures, or facial expressions; sexual humour and examining patient in an unusual position.
The identity of the chaperone must be documented clearly in notes and also if patient refuses to have one. It is advisable to use a chaperone of the same gender as the patient unless the patient objects to it. The chaperone must hear the explanation of the examination and the patient’s consent. They must be positioned where they can see the patient and how the examination is being conducted. The examination must not continue if the chaperone leaves the room, unless the patient agrees

The health professional must not assist the patient with undressing. It is advisable that they either leave the room while patients are undressing, or draw a curtain around them to give them privacy. A patient should be provided with a sheet to keep them covered before the health professional starts and when they have completed the examination, and only expose the part of the body they are examining at any point. There is need to be alert to any signs of discomfort or distress shown by the patient. The health professional must stop immediately the examination If the patient asks them to stop.

The patient should be allowed to get dressed in private before a health professional can talk to them about the findings and management plan. Once the patient is dressed or the examination completed, the chaperone is politely asked to leave to allow one-to-one communication to take place between the patient and doctor.

I hope I have managed to add more knowledge to your understanding about chaperones and you will act wisely from now onwards. As usual feel free to leave me your comments or share your experiences with me as I would love to hear from you .

This article was compiled by Dr. Brighton Chireka who is a GP and a Patient Engagement Advocate (PEA) in Folkestone Kent, UK. He is also an NHS Certificated Change Agent (CCA). You can contact him at: info@docbeecee.co.uk and read his work on in blog DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr. Chireka has used all reasonable care in compiling the information, but makes no warranty as to its accuracy. Consult a doctor or other health care professionals for diagnosis and treatment of medical conditions.

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Operating theatre

Operating theatre, instrument on the floor

By: Dr Brighton Chireka • 29th December 2015

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Operating theatre

Dr Brighton Chireka

I thought I should share with you my first week in operating theatre as a medical student . This was in 1995 when I was a 3rd year medical student at the University of Zimbabwe. I had to do a rotation in general surgery and this involved going to theatre and observing surgeons operating on patients.

Those days we used to have theatre matrons who were the bosses in theatre . They used to call the shots so everyone had to toe the line otherwise entry into the theatre would be denied.

When it was my turn to go to theatre I was given a quick induction on infection control and how to scrub in theatre ( washing hands and wearing of theatre gowns ). I was quick to learn and was soon ready to observe and even assist the surgeons in theatre.

On one occasion I was in the operating theatre and the surgeons wanted an extra pair of hands. They asked me to scrub and assist them . I was excited as at last I was becoming a “real doctor ” who can operate on people.

After washing my hands and putting on the theatre gown under the supervision of the theatre matron I went to the operating table to assist the surgeon. The team was very nice and gave a running commentary as they carried out the operation. I was fascinated with what I was seeing the surgeon doing . As I was concentrating on what I was seeing , I accidentally dropped an instrument on the floor .

I heard the nurse who was assisting the surgeon shouting on top of her voice ” instrument on the floor!” . I then saw the theatre matron coming to the operating table . I knew that I was going to be told off so without thinking I just bend down and picked the instrument on the floor.

Chaos in operating theatre

There was chaos in theatre as everyone was shocked about what I had just done . I was immediately send away to wash again and put on new theatres gowns. I later on realised my mistake that when you are scrubbed you are sterile you must not touch anything that will make you dirty. Me picking up the instrument on the floor meant that I made myself dirty and could not assist in the operation until I had scrubbed again.

It was the talk of the week in that theatre and I was laughed at by the theatre staff. I felt embarrassed but this was the norm during my training that medical students were humiliated in front of patients and nurses. We would work hard and spend hours in the library to avoid being found clueless during ward rounds.

Looking back I can see that I have come a long way and can laugh about it but then it was a humiliating experience.

Do you have any humiliating or fun experience to share with us here about your profession ? Please feel free to share !

This article was compiled by Dr. Brighton Chireka who is a GP and a Patient Engagement Advocate (PEA) in Folkestone Kent, UK. You can contact him on info@docbeecee.co.uk or visit his blog DR CHIREKA’S BLOG

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Tooth decay

Let’s talk about tooth decay (dental caries)

By: Dr Brighton Chireka • 23rd December 2015

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Let’s talk about tooth decay (dental caries)

By Dr Brighton Chireka

Tooth decay is our discussion today. I do listen to your feedback about the size of some of my articles. It’s difficult at times to make them short as there is a lot to cover. I have tried to compile a short and precise article on tooth decay. As usual I welcome your comments so keep them coming.

Tooth decay is a common problem that occurs when acids in our mouth dissolve the outer layers of our teeth.

It’s estimated that around one in every three adults in England have tooth decay and a survey of five year old children carried out in 2012 found that more than one in four had some degree of tooth decay. Of great concern is the decay in the five year olds as they do not buy food but are provided for by parents. As parents we must ask ourselves as to what foods are we giving these kids.

A study in Zimbabwe by Brighton Tasara Mafuvadze et al concluded that there was a high prevalence of dental caries among 12 years old school children in both urban and rural areas of Zimbabwe. They called for early preventative strategies and treatment services . They also recommended the incorporation of oral health education in the elementary school curricula.

Signs and symptoms of tooth decay 

Tooth decay may not cause any symptoms until it has reached an advanced stage. As the problem develops, symptoms of tooth decay can include:

Toothache
tooth sensitivity – you may feel tenderness or pain when eating or drinking something hot, cold or sweet
grey, brown or black spots appearing on your teeth
Bad breath
an unpleasant taste in your mouth

If left untreated, tooth decay can lead to further problems such as a cavities (holes in the teeth) gum disease or dental abscesses (collections of pus at the end of the teeth or in the gums).

When to see your dentist?
Toothache is a warning that something is wrong and that you should visit your dentist as soon as possible. If you ignore the problem it may get worse, and you could end up losing a tooth.

Even if you don’t have any noticeable problems with your teeth, it is still important to have regular dental check-ups so your dentist can check for early signs of decay. Tooth decay is much easier to treat in its early stages.

Adults over 18 should have a check-up at least once every two years and people under the age of 18 should have a check-up at least once a year. Your dentist may suggest having more frequent check-ups if you have had a history of dental problems, or you are thought to be at a higher risk of developing tooth decay.

What causes tooth decay?
Your mouth is full of bacteria that combine with small food particles and saliva to form a sticky film known as plaque.

When you consume food and drink high in carbohydrates – particularly sugary foods and drinks – the bacteria in plaque turn the carbohydrates into energy they need, producing acid at the same time.

If the plaque is allowed to build up, the acid can begin to break down the outer surface of your tooth and can eventually enter and damage the soft part at the centre of the tooth.

How to prevent tooth decay
Although tooth decay is a common problem, it is often entirely preventable. The best way to avoid tooth decay is to keep your teeth and gums as healthy as possible.
To do this, you should:

brush your teeth with a fluoride toothpaste twice a day, spending at least two minutes each time
use floss or an interdental toothbrush at least once a day to clean between your teeth and under the gum line
avoid rinsing your mouth with water or mouthwash after brushing because this washes the protective toothpaste away – just spit out any excess toothpaste
cut down on sugary and starchy food and drinks, particularly between meals or within an hour of going to bed.

Remember that brushing your teeth as directed and cutting down on sugary foods will help you to reduce the problems of tooth decay . Stay healthy and stop the bad breath!

This article was compiled by Dr Brighton Chireka, who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health-care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way, shapes  or form represents the views of organisations that Dr Chireka work for or is associated with.

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Merry Christmas

Christmas and our health

By: Dr Brighton Chireka • 22nd December 2015

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Christmas and our health

By Dr Brighton Chireka

“Kari mubhokisi babamukuru. Nyarara zvako ndichakubaira huku” (Christmas box uncle; relax I will slaughter a chicken for you). People of my generation will remember this statement as it was in our Grade Two Shona book story about Christmas. As someone who is from a strong rural background (SRB) I can remember those days as we celebrated Christmas by having rice and chicken. Christmas Day was and is still a special day and a lot of money is spend preparing for this day. We meet our families and food will be in abundance as we eat, drink and be merry. In so doing, our health does suffer a great deal and the damage can be permanent or take long time to undo after the festive season.
I would like to share a few tips with readers of this column and hope that the knowledge will empower them. We must remember that knowledge is only powerful if we act upon it. We will perish if we ignore knowledge which is freely being given on this column. There are three conditions that I am going to talk about because they are likely to increase among us during this festive season.

The first condition is Obesity. Obesity is a term used to describe somebody who is very overweight, with a lot of body fat. The second condition is indigestion. Indigestion can be pain or discomfort in your upper abdomen (dyspepsia) or burning pain behind the breastbone (heartburn); Chirungurira in Shona).The third conditionis Gout, which is a type of arthritis where crystals of sodium urate form inside and around joints.

Let’s look first at Obesity

Obesity is a term used to describe somebody who is very overweight, with a lot of body fat.

Body Mass Index (BMI) is a measure of whether you’re a healthy weight for your height. For most adults:

a BMI of 25 to 29.9 means you are considered overweight
a BMI of 30 to 39.9 means you are considered obese
a BMI of 40 or above means you are considered severely obese
Causes of obesity

This is caused by lifestyle habits such as eating more calories, particularly those fatty and sugary foods, than you burn off through physical activity. We are eating more and more and we are not exercising as we are spending a lot of time sitting. We rarely walk nowadays and rarely cook proper, healthy foods. We like “take aways” and we like to drive everywhere instead of walking. We are likely to over eat this Christmas and pile up more weight on top of what we have already.

We need to take steps to tackle obesity. We will perish not because we do not have knowledge but because we decide to ignore knowledge. The information is here for you for free. Obesity can lead to a number of serious and potentially life-threatening conditions such as: Diabetes Mellitus

Heart Disease
Breast and Bowel cancer
Stroke
Obesity can also affect your quality of life and lead to psychological problems, such as low self-esteem or depression.

Obesity can also cause indigestion as discussed below. Remember that there are no “quick fixes” for obesity

Treating obesity

The best way to treat obesity is to eat a healthy, reduced-calorie diet and to exercise regularly. One needs to stick to the good habit otherwise one gets back those excess kgs if they go back to the lifestyle of eating and sitting too much.

Remember that even losing what seems like a small amount of weight (such as 3% or more of your original body weight), and maintaining this for life, can significantly reduce your risk of obesity-related complications like diabetes and heart disease.

Secondly, let’s look at Indigestion

Indigestion can be pain or discomfort in your upper abdomen (dyspepsia) or burning pain behind the breastbone (heartburn or Chirungurira in Shona). Symptoms usually appear soon after eating or drinking.

Common associated symptoms include:

feeling full or bloated
feeling sick (nausea)
belching
bringing up (regurgitating) fluid or food into the gullet (oesophagus)
Why it happens

Indigestion may be caused by stomach acid coming into contact with the sensitive, protective lining of the digestive system (mucosa). The stomach acid breaks down the lining, leading to irritation and inflammation, which can be painful.In most cases indigestion is related to eating, although it can be triggered by other factors such as smoking, drinking, alcohol, pregnancy, stress or taking certain medications.

Treating indigestion at home

One can treat indigestion at home by changing their diet and lifestyle and then try antacids medication which one can buy over the counter. Losing weight if one is overweight will help reduce indigestion. Cutting or stopping smoking will help as well.

Diet and alcohol

Make a note of any particular food or drink that seems to make your indigestion worse, and avoid these if possible. This may mean:

eating less rich, spicy and fatty foods
cutting down on drinks that contain caffeine – such as tea, coffee and cola
avoiding or cutting down on alcohol (We are likely to drink more alcohol this festive season but my advice is – let’s cut down so as to stay healthy).
At bedtime

If you tend to experience indigestion symptoms at night, avoid eating for three to four hours before you go to bed. Going to bed with a full stomach means there is an increased risk that acid in your stomach will be forced up into your oesophagus while you are lying down.

Also relaxing and avoiding stress can help with the management of indigestion. This means there is a lot one can do about indigestion before they see a doctor. Very rarely, a serious underlying health condition is the cause of indigestion. If this is suspected, then further investigation such as an endoscopy will be required (see below).

When to see your doctor?

Most people will not need to seek medical advice for their indigestion. However, it is important to see your General Practitioner (GP) if you have recurring indigestion and any of the following apply:

you are 55 years old or over
you have lost a lot of weight without meaning to.
you have increasing difficulty swallowing (dysphagia)
you have persistent vomiting
you have iron deficiency anaemia
you have a lump in your stomach
you have blood in your vomit or blood in your stools

This is because these symptoms may be a sign of an underlying health condition, such as a stomach ulcer or stomach cancer. You may need to be referred for an endoscopy to rule out any serious cause. An endoscopy is a procedure where the inside of the body is examined using an endoscope (a thin, flexible tube that has a light and camera on one end).

Last but not least, let’s look at Gout

Gout is a type of arthritis where crystals of sodium urate form inside and around joints.The most common symptom is sudden and severe pain in the joint, along with swelling and redness. The joint of the big toe is commonly affected, but it can develop in any joint.

What causes Gout?

Gout is caused by a build-up of uric acid in the blood. Uric acid is a waste product made in the body every day and excreted mainly via the kidneys. It forms when the body breaks down chemicals in the cells known as purines. If you produce too much uric acid or excrete too little when you urinate, the uric acid builds up and may cause tiny crystals of sodium urate to form in and around joints.

Factors that increase your risk of gout include:

age and gender – gout is more common when you get older and is three to four times more likely in men
being overweight or obese
having high blood pressure or diabetes
having close relatives with gout (gout often runs in families)
having long-term kidney problems that reduce the elimination of uric acid
a diet rich in purines, such as frequently eating sardines and liver
drinking too much beer or spirits – these types of alcoholic drinks contain relatively high levels of purines.
Treating Gout

There are two main goals in treating gout:

relieving symptoms – this can be done by using ice packs and taking non-steroidal anti-inflammatory drugs (NSAID), painkillers; in some cases, alternative medications such as colchicine or corticosteroids may also be needed
preventing future gout attacks – through a combination of lifestyle changes, such as losing weight if you are overweight, and taking medication such as allopurinol, which lowers uric acid levels.
So cut down on BBQ (Gochi Gochi) and alcohol this festive season to reduce your chances of getting a gout attack!

Complications

Complications of gout are uncommon but can include:

tophus formation – tophi are small to large firm lumps sometimes visible and easily felt under the skin
permanent joint damage – caused by ongoing joint inflammation between the acute attacks, and by formation of tophi within the joint that damage cartilage and bone; this is usually only a risk if gout is left untreated for many years .
Kidney stones – high levels of uric acid can also lead to stones (uric acid and calcium stones) developing inside the kidneys.
As this is our last article before Christmas, may I take this opportunity to wish you a Merry Christmas and a Healthy New Year. Do not let food kill you and no more excuses as the information has been made readily available to you for free, thanks to www.docbeecee.co.uk website.

This article was compiled by Dr Brighton Chireka who is a GP and a Patient Engagement Advocate (PEA) in Folkestone Kent, UK. He is also an NHS Certificated Change Agent (CCA). You can contact him at: info@docbeecee.co.uk

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr. Chireka has used all reasonable care in compiling the information, but makes no warranty as to its accuracy. Consult a doctor or other health care professionals for diagnosis and treatment of medical conditions.

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Suicide

Let’s talk about Suicide as we are here for and with you !

By: Dr Brighton Chireka • 18th December 2015

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Let’s talk about Suicide as we are here for and with you !

By Dr Brighton Chireka

Every year on the 10th October we commemorate World Mental Health day. Soon it will be Christmas time and how some of us wish we could have our loved ones with us to celebrate. Sadly they could not take life anymore , sadly they could not see any point of carrying on with their misery. They decided to take their own lives as the solution but today we are still in pain asking several questions as to what happened and why it happened. We keep on asking but no one has the answer and at times we wish our loved ones had written letters or even shared with us their life problems. Sometimes we wish we had take them seriously and listened to their cry for help.

We all have heard or know of someone who has tried to commit or committed suicide. It’s not easy to lose a loved one through suicide be it a daughter , a son , parent , partner or a friend. Our views about the situation varies as most of us do not know how to react or help out someone in such a situation. Our statements with good intentions may make things worse and I hope this article will make all of us pose and reflect on this issue of suicide.

My first encounter with suicide was at tender age when I was at high school and one of my friends ended his life. We were in form two and one Saturday night we saw our late friend taking some tablets . We asked him why he was taking the tablets and he told us that he wanted to lose weight. In our ignorance we just left him taking the “slimming tablets”. He came to join us later in the hall to watch the television and I remember him wearing my new green tracksuit jacket . As friends we would share clothes and little did I know that he will die wearing my tracksuit jacket.

Early hours of Sunday morning he started to cry in pain and was taken to the school clinic and an ambulance was called . He confessed to having taken an overdose of anti – malaria tablets and sadly he died before the ambulance could arrive. It was difficult for us students who shared the same dormitory with him . It was a huge blow to me as I was very close to him and the fact that he never told me that he was having problems. A lot of stories were said about why he took his life but the truth is that no one knows why he ended his life.

Our headmaster told us not to alert other students of what had happened until breakfast time. The headmaster was visibly shaken and when he stood up to break the bad news to the rest of the school one could see how shaken he was. With hindsight they should have waited for all students to finish their food and then break the news. No they did not do that , they went to announce as soon as all students had gathered and some were starting to have their breakfast already.

The problem was that our late friend was well known by the whole school as he was a footballer and played for the school first team although he was in form two. When the headmaster made the announcement that our friend was no more the whole dining hall became like a funeral parlour and chaotic as some girls fainted and some were crying on top of their voices. Most students could not eat their breakfast as the news was too much for them. Teachers and prefects had a hard time trying to control the situation in the dining hall.

That following week any student who wanted to go home was easily given a pass to do so . It used to be difficult to get permission to go home from our boarding school. Later that week a school bus was then arranged and we went for the burial of our friend in Chitungwiza and it was chaotic again as some girls continued to faint . When we came back I was called by the headmaster and was given my green tracksuit jacket but I refused to take it as I was scared. I do not know why I refused to take it and I also stopped wearing the tracksuit bottom as well.

Several years later I am a medical doctor and I am seeing more and more people who have reached the end of their tether and want to end their lives. Majority are not successful as the measures that we put in place to help them do work sometimes. Sadly some die regardless of the help available but it’s a very small number so my message is that we can do something to help each other as a community.

What is suicide? 

 

It is the act of intentionally ending one’s life.

Why do some people take their own life?

There is no single reason why someone may try to take their own life.
There are certain things that increase that risk such as;

A person may be more likely to have suicidal thoughts if they have a mental health condition, such as depression, bipolar disorder or schizophrenia . Misusing alcohol or drugs and having a poor job security can also make a person more vulnerable. Divorce, death of a loved one, or blackmail may tip someone over the edge . Naming and shaming of people as well as being too critical of someone can sometimes result in them contemplating ending their lives.

It’s not always possible to prevent suicidal thoughts, but keeping one’s mind healthy with regular exercise, healthy eating and maintaining friendships can help one to cope better with stressful or upsetting situations.
What can you do if someone is suicidal ?

If you’re worried that someone you know may be considering suicide, try to encourage them to talk about how they are feeling. Listening is the best way to help. Try to avoid offering solutions and try not to judge. We tend to try and offer solutions but our statements may make things worse. Statements such as , ” I know how you feel ” must not be used as we know that you do not know how that person feels. First listen to them. Do not panic or rush to call an ambulance unless they are threatening to jump off the bridge.

Some will say to the person trying to end their life that there are so young and have every reason to live for but we tend to forget that if someone is in misery and you tell them that they have more years to live for . They will be annoyed by you because what you will be saying is that they should look forward to more years of misery. The reason why there are trying to end their life is their perception that it’s terrible and unbearable.

Sometimes we tell them that we hope they will not do something stupid. This is judgemental and will not allow someone to open up . Already you have concluded that their intention is stupid and do not be surprised when they do not listen to you . It would be better to say that you have heard or seen that there are suicidal and you are concerned. You can ask if there are safe and offer to help if that will make their situation better.

We tend to tell our loved ones that their situation is temporary so they should not think of suicide as it is a permanent solution to a temporary situation. This can be true to some people but others may be suffering from a chronic condition making them depressed all the time so this statement may be an insult. It’s better to listen first before we come up with our judgements.

Some advise their loved one to stop worrying or thinking about their problems but fail to provide them with means and ways of doing that. It is better and helpful to offer to take out that person , write them a story , send them a card , lend them a book or pay for them to go to the gym or take them to your church if you are a christian.

Many a times I have heard people saying that these people who try to commit suicidal are attention seekers. I hope that this statement does not reach the person who is suicidal at that moment . Crying for help is good and if someone does self harm only without ending their life then we should be able to reassure them that we are there and we are there for them and we are not going away . That reassurance will make them less likely to seek more attention as they will know that they have support around them. We need to keep in regular contact with our loved ones. We can take turns to take them out , accompany them to the gym or church.

We must remember that people who talk about being suicidal do commit suicide. The sad thing is that the public wrongly think that those who talk about it will not do it. We must take seriously any threats of ending life and we must not panic but calm down and listen first to the person feeling suicidal. Do not rush into false promises like tomorrow or next week you will be fine. The person may have been feeling like that for three months so your reassurance will come up as not making sense. If you listen first and ask how you can help to make the situation better and that you are there to help and you will not leave , will make the situation better in most cases.

Let’s meet on Monday as I go into part 2 which will look in detail into how we can identify people who are at increased risk of suicide and what we can do to help and prevent loss of life. I will also present figures and research done on suicide.

You may want to read about depression

DEPRESSION

Kindly share and leave me a comment.

This article was compiled by Dr Brighton Chireka who is a GP and a Patient Engagement Advocate (PEA) in Folkestone Kent in UK. You can contact him on info@docbeecee.co.uk  or read his work on DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.

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Sexually transmitted infections

Sexually transmitted infections among students

By: Dr Brighton Chireka • 16th December 2015

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Is it just poverty causing the rise in sexually transmitted infections (STIs) ?


By Brighton Chireka

I read on Newzimbabwe.com that at least 67% of university students around the country were infected with sexually transmitted infections (STIs) in the just ended academic year. It got the report from Student Union and councils from the universities around the country. According to the report, most sexually  transmitted infections ( STIs) cases were recorded in the Masvingo province where Great Zimbabwe University is situated.

The reasons given in the report are that students are forced by poverty to engage in prostitution and the solution is for the government to properly fund our education system. If the government properly fund our education system then students will stop engaging in prostitution and the level of sexually transmitted infections (STIs)will decrease. I partly agree with this but to end here will be criminal as this is not the only reason why we have the rise in sexually transmitted infections.

I was a student at the University of Zimbabwe (UZ) some years ago and during our days we were “overfunded”by the government. One would look after his or her siblings with the payout that we were getting from the government. Night clubs , restaurants and clothes outlets in Harare were aware of the dates when students would get their payouts and they would offer huge discounts to students. The UZ student ID was a special card in those days as it would allow us free entry into several places. The only time you would not want it was when the riot police was beating students for demonstrating in town and they would beat any student with a UZ student ID.

Even in those days of reasonable funding into our education system , we would see several cars visiting the ladies hostels. Sugar daddies were very common and they would take out female students at the campus and some female students would look down upon us . Some would swear that they would never go out with UBA ( a term which was used to mean male students at the university and the letters stood for University Bachelor Association). The point I am try to put across is that there is nothing new about female students going out with older men . There is also nothing new about female students being supported financially by older men from outside the campus. I used to overspend my payout as I liked my green bottle (beer) but knew where to get a soft loan when l got broke– a female student. Female students were always loaded as they were more responsible in the way they spend their money and some of them had other well wishers from outside the campus who were helping them financially.

The rate of sexual transmitted infections did not rise even to half of the level of the current figures yet sugar daddies were visiting female hostels. We need to look at the reason as to why now the figures are rising . The behaviour is the same but the outcome is different . I must admit that l do not have the figures of sugar daddies that visited then and today’s figures. More research need to be done to look into the causes of this rise but myself as an advocate of patients and the public I have a few comments to make .

Metro newspaper in the UK on the 15th December 2015 reported that if you are a student and want to get laid head down to Nottingham. One student boasted of having bedded a dozen girls in 2 weeks and another one is reported to have said it only takes two hours of “groundwork ” to get lucky . Mr Thurlow , who launched ShagAtUni in 2012 is reported to have said it was good thing students were being more sexually adventurous , but encouraged safe sex. My point here is that being sexually adventurous is worldwide among students, black or white , in Zimbabwe or UK. We need to look beyond poverty and look at the ways we can help our young students .

How do we prevent sexually transmitted infections ?

Promiscuity is rampant worldwide and our children are becoming sexually active at a young age. Parents are shocked by the amount of sexual knowledge in their children and their reaction is sometimes worsening the situation. Parents rightly teach their children to abstain from sex and they teach them not to have sex before marriage. Sadly very few parents talk to their children about what to do if they fail to abstain from sex. Our children only know one method and that method is to abstain from sex . This is a safe method if it is practiced but we have all been kids and we know what we did “kumahumbwe” ( children’s playgrounds). We all have “sinned and fell short of God’s glory , if we say we are not sinners then we make the one that died for us on the cross a liar”.

It is that moment of failure that we are not prepared and we have sadly not prepared our children. How do you expect a young lady that has been taught to abstain from sex and is lured into the act to respond in the hour of need? Will she be able to ask for a condom to be used when she does not know about sex ? Will she be able to negotiate with sugar daddy who claims to know everything ? The young lady is let down by the parent who did not talk about sex fully apart from saying do not do it. The young lady is let down by her parents who beat her if they see a condom in her wallet . The young lady is let down by the society who calls her a prostitute because she is carrying a condom in her purse. The young lady is let down by the government that keep free condoms at the hospital and not at nite clubs. The young lady is let down by a church pastor who prays for condoms before there are used for sexual activity as if the prayer will make the condoms work.

We now need to think outside the box and empower our female students . Yes we can preach to them that old men like myself are not good for you and also that sex before marriage is not good for them but we must not end there. We now need to have open discussion about the hazards of sex if not done properly . We need to be free to talk to our children. I want to go further to even educate our children that in these days treat every person as infected until proved otherwise. If you fail to abstain then as a last resort make sure that you use a condom. We have to warn our young ladies not to accept to be put into compromising positions without having a condom. Gone are the days when young ladies would be fooled that there are just doing foreplay and nothing more.

Foreplay leads to something and that something is a “play” and when you are dealing with a “player” the best advice is that you must have a condom. I am not promoting promiscuity but I am addressing reality . If at least 67 % of our students at the Universities in Zimbabwe were diagnosed with STIs this last academic year then we have a serious problem that need new ways of thinking.

Free condoms must be available at the right time , right place and to the right people. It’s pointless having condoms at family planning clinics that is only open Monday to Friday 8am to 5pm. Most sexual encounters sadly they happen after 5pm and also at weekends so it beggars belief that condoms are not available these times. Free condoms must be available in each and every nite club and the message to those that frequent these places is that they should have one in their pockets.

Churches must preach about abstinence but must not end there . There is need to accept other ways of preventing infections if one falls into sin. Pastors must not mislead their congregants by praying for condoms. Praying for condoms is wrong as it mislead people into thinking that there are now free to be promiscuous using the “holy condoms” and also some may think that only “holy condoms” work in preventing sexual transmitted infections when the truth is that all condoms if used properly do prevent the spread of STIs. Having said that I must emphasise that those that are Christians must seriously pray for their children and must also be open minded if they have a prodigal son or daughter. You must have the “father’s” love which is unconditional and is prepared to embrace our sons and daughters as there are.

Let us not give the reasons for our children to curse our graves for refusing knowledge and our refusal would have caused their downfall in life. Let us be open to them and let them make informed decisions with full facts about sex. Let us explain to them all the tricks we know that old men like me use to lure ignorant young ladies. Ladies need to be aware that they can say no to having sex and must not be forced. If forced they must report that perpetrator to the police without delay.

I welcome your views on this issue and I know that I will be shot by several people who will say , ” How dare you ?” My response is , “so who should speak about the unspeakable?”

 

This article was compiled by Dr Brighton Chireka, who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health-care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way, shape or form represents the views of organisations that Dr Chireka work for or is associated with.

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Pumpkin seeds

pumpkin seeds and okra for lunch

By: Dr Brighton Chireka • 14th December 2015

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Pumpkin seeds (mhodzi dzemanhanga) and Okra (derere) for lunch !

By Dr Brighton Chireka

“Today Okra and yesterday it was pumpkin seeds this is not fair “, says me some years ago when I was a kid. I remember coming from Chindotwe Primary School in Musana area near Shamva in Zimbabwe one afternoon and finding my mother having prepared sadza (thick maize porridge) with okra(derere). The previous day it was sadza and roasted pumpkin seeds. I was doing my primary education in Musana rural area and each time I came home there was a lot of food for me to eat. My father used to joke saying that our home was a “mandodya zvipi farm” ( what can I eat farm ) because there was variety of food available . The variety did not impress me as I had mine which did not include okra or pumpkin seeds.

As a kid I had foods that I wanted but my parents would not allow me to eat them. I was not allowed to eat potato crisps, sweets , chocolates or fizzy drinks. I thought my parents were cruel as they prohibited me from eating those foods and advised me to drink plenty of water or diluted orange juice popularly known as “Mazowe”. Now this afternoon in discussion, I was shocked when after having roasted pumpkin seeds the previous day , I was now faced with sadza and okra.I was not amused by that as I wanted meat. However I remember enjoying the okra and roasted pumpkin seeds even if it was not my first choice. My mum told me that okra and pumpkin seeds were good for my health . I just said to myself , “oh that’s what all mums say when they want you to eat the food they would have prepared”.

I later on found myself liking okra and pumpkin seeds as a teenager but when I grew up and moved out of my parent’s house I started to eat anything forgetting the nutritional lessons that my mum had given me. I never took my mum’s 5 minutes lessons on food seriously as to me she “knew nothing ” as she was not a medical doctor. Now that I am a medical doctor and have made a research into these foods that my mum was persuading me to eat has made me to change my mind. I have found that pumpkins seeds and okra are highly recommended to be part of our diet .

Let’s look at pumpkin seeds first;

Pumpkin seeds can clear parasites from the tummy such as tapeworms . These parasites can damage our intestines and prevent us from absorbing the nutrients we want from the food we eat. Amazingly pumpkin seeds can clear these worms from our bowels within a short time . No wonder why my mum kept persuading me to eat these seeds.

Pumpkin seeds are high in Zinc. Zinc is needed to maintain bones, skin, and nails . It is needed to support our immune system and reduce inflammation. Zinc also regulates carbohydrate and protein metabolism as well regulating hormones and balancing glucose levels . If one lacks Zinc they will feel weak , low mood and gets prone to simple infections and can get brittle bone disease – osteoporosis.

Pumpkin seeds contain magnesium:

Magnesium improves the motility of the gastrointestinal tract and colon thereby promoting the elimination of toxins and impurities.

Pumpkin Seeds Promote Heart Health

Different pumpkin seed varieties have a range of health benefits associated with a decreased risk of developing cardiovascular problems. Pumpkin seeds contain nutritional sources of antioxidants and healthy fats which do not only promote digestion, but also improve heart health by cleansing toxic waste that has accumulated in the cardiovascular system.

Pumpkin seeds are a powerhouse source of antioxidants known as phenolic compounds which support heart health and prevent disease. Studies indicate that the common antioxidant which gives fruit and vegetables an orange color, carotenoids, are found in large quantities within pumpkin seeds

In fact, the World Health Organization lists pumpkin seeds as a phytochemical-dense food source because of its high phytosterol content which may improve cholesterol levels . Pumpkin seeds are a source of a healthy fat known as alpha-linolenic acid (ALA). ALA is an essential fatty acid which must be absorbed into the body from food. ALA is also beneficial in recycling antioxidants in the body such as vitamin C, vitamin E and various enzymes for use.

Pumpkin Seeds Improve Blood Sugar

Poor blood sugar control can be a result of increased refined carbohydrates and sugar. Lifestyle changes such as adding pumpkin seeds to our diets may not only help lower blood sugar levels but also reduce inflammation of the gastrointestinal tract and manage cravings. Pumpkin seeds are suggested to regulate glucose metabolism and prevent against high sugar in our blood.

Let’s look at Okra now;

Okra is rich in dietary fibre and this help to stabilise the blood glucose by slowing the rate at which sugar is absorbed from the intestinal tract . This is very important in people who are diabetic as it helps to control their blood sugar without the need for medication. Obviously this includes lifestyle changes that focuses of health diet and regular exercise as well as maintaining a healthy weight .
Other health benefits of Okra

These include:

Preventing and improving constipation
Lowering cholesterol
Reducing the risk of some forms of cancer, especially colorectal cancer
Improving energy levels and improving symptoms of depression
Helping to treat sore throat, irritable bowel, ulcers and lung inflammation

We can see from the above information that our elders had lots of knowledge about the diet they wanted us to follow. Let’s go to the basics and include okra and pumpkins in our diet. We can either have the seeds as roasted or even to grind them into a powder. We do have good websites that have our Zimbabwean recipes which include okra and pumpkin seeds so try some and you will enjoy the food as well as help to improve your health. Okra and pumpkin seeds are available in Zimbabwe, South Africa , United Kingdom so no excuse for not including them in your diet.

This article was compiled by Dr Brighton Chireka who is a GP and a Patient Engagement Advocate (PEA) in Folkestone Kent in UK. You can contact him on info@docbeecee.co.uk or read more of his articles on DR CHIREKA’S BLOG

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. He would like to thank Dr Jocker for information on pumpkin seeds and diabetes uk for information on okra.

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Sare, Real or myth

Is SARE real or a myth in Zimbabwean community

By: Dr Brighton Chireka • 11th December 2015

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Is “SARE” a myth or real ?

By Dr Brighton Chireka

The day we refuse to learn is the day we die. We have some traditional practices that need to be challenged and if not fit for purpose then we should discard them. I have done my research on SARE and got worried with what I found out. I am bringing the discussion in the hope that this belief in SARE  is done away with. I know it is not easy as some strongly believe in its existence.

What is SARE ?

SARE according to our tradition is believed to be a growth that is located at the mouth of the vagina, slightly or just between the vaginal entrance and anus and is said to be very itchy. It is thought to cause children to die and also women to miscarry. It is also believed to be the cause of divorce as the women with SARE are rejected by their partners. There are several things said to be associated with SARE such as causing bad temper in women or decreasing libido or increased libido in some women. Sometimes women are called witches because of this SARE .

I have had heated arguments with several people about this issue and I must admit that it is difficult to dismiss a phenomenon that most people in our community across class and occupation vouch for. Having said that I think we must question this belief as it could be one of many gendered myths that blame women for all misfortunes that happen in marriage. Interestingly this SARE does not affect men , it’s only found in women.

Those who believe in it say that it must be cut off . What baffles me is that the ” sufferer” goes to untrained people in backyards to have ” operation ” to remove this growth. We are seeing self claimed prophets and traditional healers removing these so called growth in women. My question is why are these women not going to see medical doctors?

The sad and frightening thing is that these “backyard surgeons” are not trained in infection control and in human anatomy or physiology. There is risk that they may reuse the same blades to cut several women which can result in the spread of infections such as HIV and Hepatitis B and C. There are no measures taken to prevent women from bleeding to death or facilities to give blood to women if they lose blood during the “operation”. Women anatomy down below comes in different forms and shapes and this can confused untrained people who may end up cutting normal anatomy mistaking it for abnormal growth. This has sadly resulted in some women suffering from severe infections or being left with permanent damages resulting in them leaking urine or faeces for the rest of their lives.

Talking to gynaecologists who have specialised in the study of female genitalia , they tell you that from their several years of studying and examining several women , their conclusion is that there is nothing called SARE , it is a myth. They advised women to see them first before subjecting themselves to these “backyard surgeons”. Women must value their private parts and must not allow anyone to experiment with their most valued body parts.

My message to everyone reading this article is that the anatomy of the female genital area can be confusing to the layman so please see your doctor and not a prophet or a traditional healer for an “operation” when they do not even know what is a wart or a skin tag on your vaginal area. Several growths can occur down below and these may be polyps, piles, skin tags, warts, cysts or abscess or even ulcers which require different treatments. Your doctor and not a layman will help you in finding the right diagnosis for you and the right treatment.

Female genital mutilation has no place in this modern day era . It is I am afraid barbaric and must not be allowed. Women must take an active role on this issue and not allow ignorance to continue unabated. Divorces are taking place everyday and have nothing to do with the size or shape or structure of women’s private parts. I find it demeaning to women to be accused of causing divorces when men are not included.

We know children do die and the major causes of death are malnutrition and infection and not women’s fault . The society should put its energy and efforts in alleviating poverty instead of subjecting women to torture and anguish. Women must also liberate themselves from this mentality of accepting to be the scapegoat of everything to do with problems in families. Women do have miscarriages and it’s not their fault that these things happen. Couples must support each other and must go together and see a qualified health professional for medical help.

For those of us that read the bible , it is sadly written that my people perish for lack of knowledge as they have decided to ignore the knowledge. I have presented the facts here that SARE is a myth but I know that there are some who will not take heed . They will continue to go to these backyard places for ” operations “. Sadly infection will be waiting for them and some of it may be their cause to bid farewell to this earth. In Shona there is saying; “kwadzinorohwa matumbu ndiko kwadzinomhanyira ” (literally translation ; “where their abdomen are beaten , that’s where they run to”) meaning that people like to get themselves into trouble.

Once again if you have been wrongly “diagnosed ” by street “doctors ” that you have “SARE” please go and see your qualified registered doctor for assessment because you may be keeping a growth that may turn up to be cancerous or there is no need to worry it’s your normal natural body structure. You can only know this if you seek advice from the right people- your doctor .

 

This article was compiled by Dr Brighton Chireka, who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: info@docbeecee.co.uk and can read more of his work on his blog at DR CHIREKA’S BLOG

 

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health-care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way, shape or form represents the views of organisations that Dr Chireka work for or is associated with.

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Febrile convulsions

Febrile convulsions

By: Dr Brighton Chireka • 8th December 2015

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Help me!! My baby is dying”

By Dr Suleiman Makore

Talking about febrile convulsions with Dr Makore. Take a moment and imagine this: you are in your office, putting finishing touches on that monthly expenditure report your boss, the finance manager, is eagerly awaiting when you get a phone call. It’s one of your daughter’s preschool teachers and she advises you that your little girl is unwell and has not been participating in usual play activities today. After getting permission from your boss you head out to pick up your daughter and on the way you recall how she seemed a bit “fluey” this morning and didn’t finish a bowl of her favorite cereal. Well you arrive at the creche and find her sleeping on a tiny mattress in one of the siderooms.. a perfectly normal activity for a 4 year old, except that its 10.30 in the morning! You wake her up gently and immediately notice that she feels like she’s been sleeping in an oven, so out of concern you decide to take her to be seen by the doctor at the 24 HR medical centre thats located a few streets from your house.

As you drive there you recall that her medical aid card is at home and take a detour to go pick it up, all the while you are speaking gently to your daughter reassuring her that “things are gonna be okay sweetie” and just to reinforce this you stop by the ice cream parlour and get her a small vanilla cone, which she makes an effort to eat. As you pull into your drive-way it happens.. at first it you hear what sounds like gurgling sounds coming from the back seat and you calmly look behind to see what your little girl is up to and to your horror you see her lying across the backseat with her eyes wide open but seemingly rolled upwards leaving just the whites visible and her body is trembling uncontrollably. You immediately slam the brakes and jump out of the car, open the back door to help her and you frantically call out her name and hold her to try stop the shaking but she remains unresponsive and neither does the trembling stop. At this point you are panic stricken, you don’t know what’s happening to your little angel.. Are you watching your daughter’s life fading away right in front of you??

An alert, passerby notices you acting strangely in your driveway and stops to investigate and on realising the trouble that has befallen you, he reminds you that there is a medical centre very close to your house and he even offers to drive you. By this time theres a familiar pungent smell filling the car that suggests she may have soiled herself. The good samaritan jumps in the driver’s seat and floors it whilst you sit at the back with your daughter and soon you arrive at the medical centre and you rush out carrying your still shaking child and enter the reception area screaming “help me!! My baby is dying”..
Well this hypothetical scenario I have narrated above is actually quite common and some reading it may even relate to particular aspects of it and it will form the basis of a topic i will be discussing today. The child in our story suffered a seizure or convulsion and in particular, a special type that is unique to small children called a febrile convulsion. Before we delve deeper into this phenomena however, i would like to give some basic definitions and background information as well as some historical perspective on convulsions so as to try put us all on the same page. Some of the medical terms may be complex but i will do my best to explain them as i go along.

Seizures have been described for 1000s of years throughout human history. An event that matched the classic description of a seizure was recorded over 3000 years ago in ancient Mesopotamian texts but according to prevailing beliefs and knowledge at the time it was attributed to a manifestation of the Moon god. Other cultures (Chinese, Egyptian, Indian etc) have also recorded through their written and oral history similar events but invariably the seizures were linked to some divine (usually evil) origin. Hippocrates wrote a manuscript about 2500 years ago about seizural disorders where he rejected ideas of an underlying divine cause but his views were widely rejected by other scholars and religious leaders of the day. For those who studied english literature like me at high school and in particular read the book “Julius Caesar” you will also recall a number of occasions when he was said to have “fallen and became weak in his limbs and frothed at the mouth”… On this one though debate is still raging as to whether this “falling sickness” was a seizural disorder or infact a series of mini strokes. Even up to the 19th century some leading researchers even considered excessive masturbation as a cause of seizures (as well as being a cause of blindness ofcourse :-) ).

It was only in 1929 when a researcher by the name of Berger discovered that electrical brain signals could be recorded using scalp electrodes, a discovery that eventually led to the use of the Electroencephalogram (EEG) to study and classify seizures. Despite advances in the field of science and medicine, the issue of seizures is still shrouded with some form of fear and mysticism, particularly in religious circles with some still considering a convulsion as being a sign of demonic possession as opposed to being an external manifestation of an internal pathology.

A seizure is best described as “an abnormal, paroxysmal discharge of cerebral neurons due to cortical hyperexcitability”. The term paroxysmal refers to a “sudden, random and violent outburst of any nature”, cerebral neurons are the specialized cells that make up the bulk of our brain and cortical hyperexcitability speaks of excessive activity in a particular region of our brain know as the cortex. So basically a seizure can also be described as a sudden, uncontrollable outburst of electrical activity in the brain manifesting itself as a variety of sometimes very physical symptoms.

Seizural disorders may be classified into 2 broad groups according to the INTERNATIONAL CLASSIFICATION OF EPILEPTIC SEIZURES (ICES) and these are a) Generalized onset seizures and b) Partial onset seizures. Generalized seizures originate from a region of the brain known as the thalamus or may be triggered simultaneously in both cerebral hemispheres and typically manifest as symptoms involving the whole body and tend to be associated with varying degrees of loss of consciousness. Detailed explanation is beyond the scope of this article but is available on request by emailing me.

Various forms of seizural disorders are known to exist in children and a number will overlap with the conditions seen in the adult population. However its important to note that whilst most of the definitions and classifications used in adults also apply to children, peadiatric patients are a special group that need to be dealt with care. As one of my medical school professors always used to say, “children are NOT little people/humans, you need to think of them as being almost a different species to the rest of us when it comes to managing their illnesses”. That is to say, we cannot just take principles of adult medicine and “scale them down” to suit a peadiatric patient, when you are dealing with a child you have to approach them from a totally different angle.

Remember an 8 month old baby cannot tell you where it hurts or why they are refusing to feed but as the attending clinician you have to solve this riddle and usually time will be your worst enemy. Unlike in adults where the patient or other witnesses can give clear and typical reports of the kind of convulsions they experienced, in children, particulary the younger ones it maybe very subtle things. Small children may not experience the dramatic grand mal type seizures we typically see in adults but rather the child may just go unresponsive and start blinking or smacking their lips uncontrollably.. though not as frightening as the whole body fits, these subtle forms are still jus as dangerous if left uncontrolled. Some children experience what are known as “absence” seizures and these may manifest as just brief lapses in concentration lasting a few seconds or minutes or the child suddenly appear to “stare into space” for a minutes before resuming, seemingly unaware of what just happened, with their normal activity.

For children in school these absence spells may happen frequently but still remain unnoticed by the parents or teachers but will have the unfortunate consequence of falling grades which they may just attribute to the child not being serious with school or being a slow learner. The discussion of convusions in children is VERY broad and many books have been written on them but as mentioned earlier, the focus of this article will be to shed light on a particular kind of seizural disorder and those are febrile convulsions.

Febrile convulsions

Febrile seizures are also sometimes called febrile convulsions. During a febrile seizure, the child’s body usually becomes stiff, they lose consciousness and their arms and legs twitch. Some children may wet themselves. This is known as a tonic clonic seizure.

By definition, a simple febrile seizure occurs in a child who is between the ages of 6 MONTHS TO 5 YEARS OLD, develops a FEVER and then has a SINGLE SEIZURE (which typically occurs around the onset of the abnormal rise in body temperature). The seizures are usually of the generalized tonic-clonic variety, lasting less than 15 minutes and they occur in a child who was otherwise healthy, save for the fever which may be caused by an acute illness such as an attack of tonsillitis, otitis media (ear infections), “flu”, or even a bad “tummy” infection with diarrhea & vomiting, known as gastroenteritis.

Febrile convulsions are the commonest childhood seizural disorders and occur in association with an elevated body temperature. The exact mechanism by which this plays out is still unclear however but studies have pointed to a genetic predesposition, that is to say they tend to occur in families. They can be divided into simple febrile seizures and complex febrile seizures.
Types of febrile seizure
There are two main types of febrile seizure.
It is essential to note that in order for a child’s seizure to be classified as a simple febrile convulsion, they must not have any preexisting neurological abnormality (a deformity involving the brain or spinal cord) and the fever should not have been caused by any infection or disease that specifically targets the brain or spinal cord such as meningitis or encephalitis or a brain abscess (pus accumulated in portion of the brain).

Complex febrile seizures are also defined using the criteria above but in this case the seizures may be focalized, prolonged (extending beyond 15 minutes) and may be multiple seizures as opposed to just one at the onset of symptoms.
Simple febrile seizure
A simple febrile seizure is the most common type of febrile seizure, accounting for about eight out of 10 cases. It’s a fit that:
is a tonic clonic seizure (see above)
lasts less than 15 minutes
doesn’t reoccur within 24 hours or the period in which your child has an illness
Complex febrile seizure
Complex febrile seizures are less common, accounting for two out of 10 cases. A complex febrile seizure is any seizure that has one or more of the following features:
the seizure lasts longer than 15 minutes
your child only has symptoms in one part of their body (this is known as a partial or focal seizure)
your child has another seizure within 24 hours of the first seizure, or during the same period of illness
your child doesn’t fully recover from the seizure within one hour

It is important to note at this point that the diagnosis of a febrile convulsion is one of exclusion, that is to say a qualified clinician should only make it AFTER ruling out all other possible causes of child in a particular age range, with fever presenting to hospital with fits. For example, amongst the multitude of known causes of seizures, one of the main ones in children especially is what is termed as hypoglycemia (this is when the blood sugar levels drop below the acceptable lower limit at which the body’s cells can function properly), now if a child is very sick with a feverish illness it is very likely that they will refuse to feed which in turn results in their blood sugar falling.. A child like this may have a fit because of the fever itself or because of the low sugar or both and so its essential for the clinician to determine this quickly.

No specific blood tests or imaging (scanning) tests exist for diagnosing febrile convulsions but when facing a child with suspected febrile convulsions the focus should be finding the cause of the fever and hence treating.. i.e. treat the cause (the infective agent) not the symptom (the seizure). If, as was the case with the child in our hypothetical case at the beginning, the child is actually still experiencing a fit when they arrive at the hospital/medical rooms, the initial management is the standard emergency protocol. That is to say, the first responder should call for help from other trained colleagues (teamwork), they should check the patient’s A B Cs (Airway, Breathing & Circulation) and if any of the above are compromised they should respond appropriately including putting an oxygen face mask or nasal prongs for the smaller children, they can give a type of sedative drug known as a benzodiazepine via the rectal route to suppress the current fit or any recurrent fits but use of such drugs will also depend on factors such as age and weight of the patient and as such should only be used with care by skilled staff. Once the patient has been stabilized, investigations should begin (though in reality these things should occur simultaneously.. stabilization,investigation treatment etc), the exact choice of tests will depend on availability of appropriate lab suppport, cost and also location (certain conditions are more prevalent in certain regions or countries than others). Examples of basic tests a clinician may run in our African setting are: i) glucometer for a rapid assessment of blood sugar; ii) blood for malaria parasites + rapid malaria paracheck so as to check if malaria infection was the primary cause of the fever; iii) blood cultures to detect specific bacteria in the blood that may have caused the infection and also to help in treating appropriately; iv) widal test to check for infection by the bacteria that causes typhoid (another so called febrile illness); v) urea & electrolytes so as to rule out electrolyte derangements as the cause of the fits; vi) urine sample to look for signs of an ongoing urinary tract infection; vii) if they are having diarrhea, they can take a stool sample and it can be examined further at the lab for the causative organisms; viii) if theres reason to suspect another cause of seizures such as poisoning, drug overdose or toxic substance ingestion the clinician may also to a toxicology screen; ix) in children less than 18 months of age but above 6 months it may be prudent for the clinician to perform a lumbar puncture and send the child’s cerebrospinal fluid (csf) sample for further investigation because at this age, even if the child has meningitis, the signs are not always as clear as in the older population and x) for the older children and especially for us in Africa with the high HIV burden, if the child has other signs of meningism, a lumbar puncture should be done and the csf analysed; xi) throat +/- pus swabs where appropriate to determine the exact infective organisms.

Remember as well that when the patient initially came in the clinician should have thoroughly examined the patient so they would have picked up any other obvious signs pointing to the cause of the fever such as inflamed tonsils, a runny nose, a pus-like discharge from one of the ears or a nappy that contains very foul smelling stool or urine. Imaging studies such as a brain CT scans are rarely needed nor would they be helpful unless the patient came with suggestive history such a report of recent head injury or gradual loss of visions (things that point to a focalized problem in the brain), whilst an EGG is unlikely to yeild any beneficial results unless done whilst the patient is actually fitting.

Once the clinician gains a clearer picture as to whats going on, as emphasized earlier the thrust should be to treat the cause of the fever.. if it was an ear infection or tonsillitis they should commence the child on a course of antibiotics empirically (based on knowledge of the common infective organisms in that country/region) whilst awaiting definitive blood culture/ throat swab etc results for example.. If results show malaria or typhoid, they should manage as per national guidelines for these conditions. If the child’s other results show that they have indeed got meningitis, though now falling outside the definition of a true febrile convulsion, the clinician should now treat it appropriately. An anti-pyretic drug (a drug that lowers temperature) should also be given, the commonest and probably most widely available in our setting being paracetamol.

A convulsion, especially a grand mal type, is a distressing event to watch, more so for parents of a young child, so it is also very crucial that the clinician reassures the caregivers, especially where a likely cause has been identified, that their child IS NOT dying and that they are unlikely to have a permanent brain abnormality or that they there is very little chance of them having seizures throughout the rest of their lives. Children who experience one or 2 episodes of febrile convulsions rarely require long term anticonvulsant therapy, i.e. once you treat the causative infection, life goes back to normal.

The take home message is that febrile seizures occur in young children at a time in their development when their so called “seizure thresh-hold” is low (the “trigger” for them having a fit is set very low) and this happens to coincide with the time in their lives when they are affected the most by ear, throat, chest, urinary infections etc most of which cause a rapid rise in temperature.

We cannot end this discussion without touching on epilepsy. Now as a form of seizural disorder, epilepsy is also very broad and would require a separate discussion by itself in order to do it justice but i will very briefly mention the condition here so as to contrast it with what we have been discussing.

Epilepsy is a brain disorder characterised by an ENDURING predisposition to generate seizures and by the neurobiologic, cognitive, pyschological and social consequences resulting from it.. A mouthful i know. The hallmarks of epilepsy are the RECURRENT and UNPROVOKED seizures that are associated with it. A key feature in making a diagnosis of epilepsy is the history that is usually given by the caregiver or person who has closest contact with the patient and typically epileptic seizures are very STEREOTYPICAL (the patient may act in certain fashion, then have the fit which may take a specific characteristic fashion such as jerking of one side of the body for 3 – 5 minutes etc). This is very important to note because the seizures seen in patients who have febrile convulsions are preceded by feverish illness (”provocation”), they tend to be isolated events, although they may recur at a later date but almost always in association with a fever and may not follow any prescribed fashion (the first episode may be a full blown grand mal fit whilst the 2nd episode may consist of just continous blinking and lip smacking).

I will emphasize again, A SINGLE SEIZURE DOES NOT EQUAL EPILEPSY and as such long term anticonvulsant therapy should not be commenced after a single or even 2 unrelated events in the absence of sufficent supporting evidence from either the patient or competent witnesses (usually adults in a sober state). Anticonvulsants carry many side effects and so should only be prescribed by a suitably qualified clinician who has been provided with information that strongly suggests that the patient has a seizural disorder whose progression can be halted or at least controlled by pharmacological agents only.

Well allow me to close by giving some “feedback” on the story i shared at the beginning. After bursting into the reception area of the medical centre carrying the shaking body of your little girl, you were immediately directed into the treatment room by one of the nurses whilst they raised the doctor on duty. A quick temperature check showed her to be spiking at 39.8 0C whilst a glucometer prick test had a normal value of 4.9 (mmol/l). When the doctor arrives, the fitting has stopped but the girl is still in a drowsy state and she (the doctor) orders a rapid malaria test (after hearing that you had gone with your daughter to visit her grandmother in Mutoko about 2 weeks prior), the rapid test is negative for malaria but she also takes a blood sample which will be examined further at the lab just to be certain with results later expected that afternoon. The doctor examines her further whilst you frantically try and get a hold of her daddy and as you do this you hear the doctor say to the nurse assisting her, “there’s our problem”. Whilst checking inside her mouth with a wooden spatula she catches sight of 2 bright red tonsils, a sign of inflammation.. your daughter has acute tonsillitis. The doctor informs you of the most likely diagnosis and that she wishes to admit your child into their observation ward for the rest of the day and probably overnight whilst they commence injectable antibiotics, painkillers as well as something to lower the temperature. The doctor also gives you option to contact the on-call peadiatrician if you so wish but you opt to wait to see her progress through the rest of the day.

By the end of the day, after the initial doses of meds, your daughter looks a bit more livelier, her temperature has started coming down (38.2 0C, still above normal but much lower than the dangerous levels it had reached), helped in part by the fact that the doctor also advised you to remove most of her clothing down to just her underwear. Her first set of blood results are starting to come in and they have confirmed that its definitely not malaria and the doctor advises you that she feels more comfortable to keep your daughter admitted overnight to give her another dose of injectable antibiotics and will most likely discharge her in the morning on liquid medicine.

Well as you narrate the day’s events to your hubby who is now sitted next to you, you can’t help but chuckle when you hear your daughter ask in her sweet little voice “mhamha, ndinoda macartoon” (mummy, i want to watch cartoons).

May I in conclusion say, if your child is having a febrile seizure, place them in the recovery position. Lay them on their side, on a soft surface, with their face turned to one side. This will stop them swallowing any vomit, keep their airway open and help prevent injury. Stay with your child and try to make a note of how long the seizure lasts. If it’s your child’s first seizure, or it lasts longer than five minutes, take them to the nearest hospital as soon as possible, or call for an ambulance. While it’s unlikely that there’s anything seriously wrong, it’s best to be sure. If your child has had febrile seizures before and the seizure lasts for less than five minutes, phone your doctor for advice. Don’t put anything, including medication, in your child’s mouth during a seizure because there’s a slight chance that they might bite their tongue. Almost all children make a complete recovery after having a febrile seizure.

This article was compiled by Dr Suleiman Makore who is a Senior House Officer in anaesthetic department at Mpilo Central Hospital in Bulawayo, Zimbabwe. He is now a guest writer on our website www.docbeecee.co.uk and can contact him via our usual email info@docbeecee.co.uk

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr. Makore has used all reasonable care in compiling the information, but makes no warranty as to its accuracy. Consult a doctor or other health care professionals for diagnosis and treatment of medical conditions.

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Doc Suli and Grant

Introducing other writers to our health blog

By: Dr Brighton Chireka • 6th December 2015

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Introducing other writers to our health blog

By Dr Brighton Chireka

“I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.”- Hippocrates oath modern version.
The above part of the modern version was not found in the original Hippocrates oath.
This was inserted probably because of the advancements in medical knowledge. “I know not” is an acknowledgement of the limits of my knowledge. It is the wise and honest doctor who peppers his speech with this phrase.

Sometimes when I say “I know not” I will then spend the evening reading up and speaking to my colleagues about this vexatious problem of a patient and get back to him or her the following day with an answer.

I would welcome this as it is refreshing compared to the doctor who blunders through the consultation giving vague answers, all the while refusing to say “I know not” — three words that make him feel mortal and fallible.

“I know not”, I use it as I look into the BNF ( British National Formulary) for the dose, and side effects of drugs. It would not be useful for a doctor to cram 5000 useless facts into his brain. Things that can easily be checked should be checked. Memory can fail and the result can be disastrous for a patient if the doctor does not know that he does not know .

Some patients find it not reassuring if a doctor checks things but it’s better to be safe than sorry.

We know that so much knowledge has been unearthed about diseases and their treatment. No doctor can hope to know more than a tiny fraction of all there is to know. “I know not” is most important in this context. When a doctor knows not, shouldn’t he ask for help? This is perhaps the most important part of the modern Hippocratic Oath.
“I know not.” It resonates well with the medical adage, “First, do no harm.”

In view of the above I have the pleasure of introducing two of my colleagues who will from time to time be guest writers on our blog.

Dr Suleiman Makore

I have the pleasure of introducing Dr Suleiman Makore popularly known as Doc Suli.
Doc Suli is the first born in a family of 3, grew up in Gweru, Zimbabwe and attended Midlands Christian College for high school, then went on to the University of Zimbabwe in 2001 and graduated with a Bachelor of science honours degree in biochemistry in 2004 and worked as a chemist in an industrial lab for about 2 years.

He later enrolled again at the University of Zimbabwe Medical School in 2007 to study medicine which had always been his dream and graduated in 2013. He then went on to do his internship at Harare Central Hospital for 2 years and now he is working as a senior house officer in anaesthetic department at Mpilo Central Hospital.

He has an intention of pursuing a specialty in anaesthesia. He is an avid fan of jazz and contemporary rock music and also loves aviation.

Dr Grant Murewanhema

I have the pleasure of introducing Dr Grant Murewanhema popularly know as Doc Grant. He is a General Practitioner who is currently a Public Health trainee at University of Glasgow in Scotland , UK . He did his Residence at Parirenyatwa Group of Hospitals from 2007 to 2010. He was the HIV/OI treatment doctor and lead mentor, Medecins sans Frontieres from 2010-2012. He then was a Clinical Investigator, UZ-UCSF Collaborative Research Programme, focusing on Microbicide Research and Sexual and Reproductive Health from 2012-2015.

The first article by my colleagues will be out this week and I hope you will learn more as we are now combining our efforts to raise health awareness in our community .

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Stopping the spread of AIDS /HlV

AIDS is no longer a death sentence; Getting to Zero transmission is our aim!

By: Dr Brighton Chireka • 3rd December 2015

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AIDS is no longer a death sentence; Getting to Zero transmission is our aim!

By Dr Brighton Chireka


“We have to stop the spread of HIV and it begins with me, Dr Brighton Chireka and begins with you reading this article and also begins with the whole Zimbabwean Community.”

December 1 is World AIDS Day, a day dedicated to commemorate those who have passed on and to raise awareness about AIDS and the global spread of the HIV virus. It has been marked since 1988, after health ministers from around the world met in London, England, and agreed to such a day as a way of highlighting the enormity of the AIDS pandemic and nations’ responsibility to ensure universal treatment, care and support for people living with HIV and AIDS.
Led by the World AIDS Campaign organization, the theme for World AIDS Day 2015 is ”Getting to zero.” Zero New HIV Infections. Zero Discrimination and Zero AIDS-related deaths.
I would like to join hands today in promoting this year’s theme of “Getting to zero”. Raising awareness about AIDS, that it is no longer a death sentence. I welcome the statement by the Executive Director of UNAIDS, Michel Sidibé, in which he said, “Fifteen years ago there was a conspiracy of silence. AIDS was a disease of the “others” and treatment was for the rich and not for the poor. We proved them wrong, and today we have 15 million people on treatment—15 million success stories.”
This week, Zimbabwe hosts the 18th edition of the International Conference on AIDS and STI’s in Africa at The Rainbow Towers Hotel and Harare International Conference Centre from 29 November to 04 December 2015. In his welcoming speech, the Zimbabwean Minister of Health, Dr David Parirenyatwa, had this to say:
“Zimbabwe has a long history in the response to HIV and AIDS. As one of the countries severely affected by the pandemic, we have recorded some internationally acclaimed milestones particularly the reduction of both HIV incidence and prevalence and scaling up access to treatment under difficult conditions as well as our leadership role as a pathfinder in domestic financing for HIV through our AIDS levy, which has now been recorded and shared as an international best practice”
I am a self-proclaimed patient engagement advocate and believe in the patient being at the heart of decision making. I believe in the education of patients on health issues so that they make informed decisions about their health.
Despite the great strides taken so far in raising awareness about HIV/AIDS, there is still a lot of misinformation that is being spread by misguided people. As one who has lost close relatives to AIDS, I find some of the content of this misinformation repugnant. In my practice, I see many people presenting themselves for treatment late. On the other hand, I am also seeing people benefiting from treatment.
I wish everyone could pause, reflect and think about the information that is being spread about HIV/AIDS, and respond proactively. We cannot fold our hands and just blame others for having unleashed “AIDS on us in their endeavour to wipe out black people”. Little knowledge is dangerous and many people are perishing not because they do not have knowledge, but because they decide to ignore knowledge. I make no apologies for saying that it’s high time we stand up as Africans or Zimbabweans and face the issue of AIDS openly and stop scapegoating. HIV/AIDS is no respecter of people and knows no boundaries. It affects the rich and the poor, black or white, African or European.
Having said that, one has to look at the statistics in order to focus the resources so that there are no health inequalities. When resources for combating a certain disease are targeted at a particular group, it becomes easy to to develop the notion that the disease is for one ethnic group, in this case the idea that HIV/AIDS is an “African disease”. HIV/AIDS is a worldwide problem, affecting all races. However, there are interesting facts about this problem that need to be addressed candidly, though they may cause us discomfort as Africans.
Let me answer a few questions and then conclude this discussion.

What is HIV/AIDS ?

AIDS stands for Acquired Immune Deficiency Syndrome and is cause by a virus called the Human Immunodeficiency Virus ( HIV). This virus attacks the body’s immune system that fights off infections. When this defence system breaks down, the body loses its natural powers of protection against diseases and some infections take advantage of that, which is why they are called opportunistic infections. I know many of us have heard that someone “died of AIDS.” This is entirely inaccurate, since it is potentially fatal opportunistic infections, such as pneumonia, that cause death. AIDS is the condition that lets the opportunistic infections attack the body.
Like the one responsible for the common cold, HIV needs a living cell for it to make more viruses, and to do all of the other nasty things that viruses do. HIV mostly infects CD4 cells, also known as T cells, or T-helper cells. These are the body’s soldiers, coordinating the defence system against infections. Once inside the cell, HIV starts reproducing into millions of little viruses, which eventually kill the host and then go out to infect other cells, weakening the whole defence system. All of the drugs (ARVs) marketed to treat HIV work by interfering with this reproductive process.

Was HIV created in a laboratory to kill off blacks, gays and junkies?

Creating a complicated retrovirus like HIV was way beyond scientists’ abilities in 1959, which is the date of the first confirmed case of AIDS, in Kinshasa, Africa. It is probably beyond their abilities now, too.

We know where this fear is coming from. It’s not an entirely irrational one, considering not only social prejudices of recent history, but also the history of experiments on live, uninformed human subjects. Between 1932 and 1972, for instance, a Tuskegee, Alabama study left 400 black men untreated for syphilis, long after they could have been cured with penicillin—just to see what would happen.

Theories abound on where HIV came from, but one thing and one thing only turned HIV from a disease of the West African bush into a global epidemic. No, it wasn’t changes in sexual behavior; it was international travel. AIDS spread along trucking highways and airline routes.

I have heard that HIV doesn’t cause AIDS.

If you take a cross-section of people with HIV worldwide, nothing else connects an African baby, a Thai housewife who has only had sex with her husband, an Indian transsexual, a San Francisco gay man and a Russian IV-drug user but having the virus.

How is HIV Transmitted?

HIV enters the body through open cuts, sores, or breaks in the skin; through mucous membranes, such as those inside the anus or vagina; or through direct injection. There are several ways by which this can happen:
● Sexual contact with an infected person.
● Sharing needles, syringes, or other injection equipment with someone who is infected.
● Mother-to-child transmission. Babies born to HIV-positive women can be infected with the virus before or during birth, or through breastfeeding after birth.
● Transmission in healthcare settings. Healthcare professionals have been infected with HIV in the workplace, usually after being pricked with needles or sharp objects containing HIV-infected blood. As for HIV-positive healthcare providers infecting their patients, there have only been six documented cases, all involving the same HIV-positive dentist in the 1980s.
● Transmission via donated blood or blood clotting factors. However, this is now very rare in countries where blood is screened for HIV antibodies.

HIV is NOT transmitted by the following :

HIV is NOT transmitted by the following circumstances so you don’t have to worry about because they will not put you at risk for becoming infected with HIV:

● Being bitten by a mosquito, other insects or an animal.
● Eating food handled, prepared or served by somebody who is HIV positive.
● Sharing toilets, telephones or clothing with someone who is HIV positive.
● Sharing forks, spoons, knives, or drinking glasses.
● Touching, hugging or kissing a person who is HIV positive.
● Attending school, church, restaurants, shopping malls or other public places where there are HIV-positive people.
● HIV cannot be transmitted through urine, faeces, vomit, or sweat. It is present, but only in negligible quantities, in tears and blister fluid. It is present in minute amounts in saliva in a very small number of people.

More information on how HIV is transmitted

The reason why sexual activity is a risk for HIV transmission is because it allows for the exchange of body fluids. Researchers have consistently found that HIV can be transmitted via blood, semen, and vaginal secretions. It is also true that HIV has been detected in saliva, tears, and urine. However, HIV in these fluids is only found in extremely low concentrations. What’s more, there hasn’t been a single case of HIV transmission through these fluids reported in the world.
If semen leaks out during intercourse and the insertive partner is HIV positive (or his HIV status is not known), contact a healthcare provider or hospital emergency room to discuss the risk and the possibility of post-exposure prophylaxis (PEP).
PEP involves a 28-day course of antiretroviral (ARV) drugs that needs to be started within 72 hours of possible exposure to the virus. Generally speaking, only people who have had a high-risk situation (e.g., condomless receptive anal or vaginal intercourse with someone known to be HIV positive) are considered to be good candidates for PEP.

I do not know my HIV status, should I go for testing?

When it comes to HIV testing, the old cliché “knowledge is power” still holds true. Knowing your HIV status, whether negative or positive, puts you in the best position to protect your health and the health of your sexual partner(s). At present, there is no cure for HIV/AIDS, but there are medications available that allow HIV-positive individuals to live a normal, healthy life. And being aware of your HIV status makes it less likely that you will pass the virus to others. My advice is; yes, go ahead and get tested as HIV is like any other chronic condition and has treatment available.

What are the types of HIV tests?

There are several different tests that can be used to determine if you have HIV. The first test developed is still the most frequently used for the initial detection of HIV infection: the Enzyme-Linked Immunosorbent Assay, or as it’s more commonly known, the ELISA or EIA.
The time it takes the body to produce antibodies after HIV infection has begun is known as the “window period.” For the vast majority of those who contract the virus, antibodies to HIV will develop within four to six weeks after exposure. Some people will take a little longer. Until antibodies are present, an ELISA test will come up negative for HIV. So if someone has contracted the virus, but hasn’t yet developed antibodies at the time of taking an ELISA HIV test, this can result in a false negative.
The newer HIV tests will detect an infection by about three weeks following exposure to the virus; with the older HIV tests, the window period could be as long as three months. Correctly identifying acute cases of HIV is crucial for HIV prevention because viral loads are typically very high during that period of infection, making someone much more likely to pass on the virus.Because of this window period, it is important to know what type of HIV test your healthcare provider is using. With the older tests, getting tested before three months may give you an unclear result or a false negative.
No diagnostic test will ever be 100 percent reliable, but if you test negative at the appropriate time (i.e., 3 weeks after possible exposure to the virus with the newer HIV tests or 13 weeks after possible exposure to the virus with the older HIV tests), you can consider that to be dependable confirmation that you are HIV negative. This means that if you are not sure about when you may have got exposed, you must have the test twice 3 months apart to confirm that you are HIV negative.

I have tested positive for HIV, does it mean I am dead?

Do not panic just because you have tested positive for HIV. Testing positive is not the end of the world, neither is it the end of your sexual relationship or the end of you. Testing positive should make you strong, even if you first feel numb about it. It will be a challenge to yourself and to the people in your life, but it will also be an opportunity to grow. Nowadays, HIV is like any other chronic disease, such as diabetes or high blood pressure, in that you can control it by taking your medication regularly and can live a normal life.

Do I have to tell everyone that I am HIV positive?

Disclosure should be at your speed and to whomever you choose. Disclosure can be a relief, and it can even be empowering, but there may be reasons why you would want to keep it a secret to anyone or everyone. I would strongly recommend that you tell your sexual partner as it is unfair, and criminal in some countries, to fail to tell your sexual partner if you are HIV positive. Remember there is no requirement for you to tell all members of the public.

If I am HIV positive can I have children who are HIV negative?
HIV positive women who control their virus with medication during pregnancy, have a Caesarean section and do not breastfeed, reduce the risk of passing on HIV to their baby to a mere 1 percent.
A positive man hoping to conceive with a negative woman can avail himself of a technique called “sperm washing” that separates HIV from sperm.
Sperm washing

Sperm washing involves the man giving a semen sample to a clinic, then a special machine spins it to separate the sperm cells from the seminal fluid. (Only the seminal fluid contains HIV; sperm cells themselves do not carry HIV). The washed sperm is then tested for HIV. Finally, a catheter is used to inject the sperm into the woman’s uterus. In vitro fertilisation (IVF) may also be used, especially if the man has a low sperm count. The good news is that there has been no cases of HIV transmission to women from sperm washing.

If I am positive can I have sexual intercourse?

If one is HIV positive and takes ARVs as instructed and the viral load is undetectable then the chances of transmitting HIV will be very low but that person can still infect others. In view of this, an HIV positive person must practice safe sex regardless of the level of viral load. Also, the HIV negative partner can also take medication daily, usually Truvada (tenofovir plus emtricitabine)—before, during and after possible high-risk exposures to reduce the risk of becoming infected with HIV, in case the condom fails. The treatment that the HIV negative partner can take is called Pre-exposure prophylaxis.

What does undetectable viral load mean?

When you test positive for HIV, you will be offered treatment and the drugs are called Antiretroviral (ARV). Typically, if your HIV medication is working, and you take them exactly as prescribed, your viral load should reach undetectable levels within 3-6 months after you begin treatment.
There has been a lot of confusion over the issue of viral load and testing positive for HIV. I will try to explain this so that it becomes clear to everyone and should help people to stay safe and not let ignorance kill us.
Viral load is only tested in those that are HIV positive because they have the virus so checking the amount of the load is important in monitoring their treatment.
The term “viral load” refers to the amount of HIV in a sample of your blood. When your viral load is high, you have more HIV in your body, and that means your immune system is not fighting HIV as well.
A viral load test is a lab test that measures the number of HIV virus particles in a milliliter of your blood. These particles are called “copies.” A viral load test helps provide information on your health status and how well antiretroviral therapy (ART – treatment with HIV medicines) is controlling the virus. ART can’t cure HIV, but it can help you live a longer, healthier life and reduce your risk of HIV transmission.
The goal of ART is to move your viral load down, ideally to undetectable levels. In general, your viral load will be declared “undetectable” if it is under 40 to 75 copies in a sample of your blood. The exact number depends on the lab that analyzes your test.
Having an “undetectable” viral load doesn’t mean that the virus is completely gone from your body, just that it is below what a lab test can find. You still have HIV and you are still HIV positive and need to stay on ART to remain healthy.If one is HIV negative, then they do not have the virus in their body and there is no need to check the viral load because it will be ZERO.
If my viral load is undetectable, does that mean I am cured?

No, “undetectable” does not mean you are cured or that the virus is gone from your body. It means that the virus is below the level that a lab test can find. You still have HIV and need to stay on ART to remain healthy.

Can I infect anyone with undetectable viral load?

Having an undetectable viral load greatly lowers your chance of transmitting the virus to your sexual partner who is HIV-negative. However, even when your viral load is undetectable, HIV can still exist in semen, vaginal and rectal fluids, breast milk, and other bodily fluids. For this reason, you should continue to take steps to prevent HIV transmission. So, the answer is; yes you can infect other people even if your viral load is “undetectable”. Remember “undetectable ” means that the virus is below the level that a lab test can find, i. e. below 40-75 copies in a sample of blood. This explains why a person with undetectable viral load can have unprotected sex with different partners and not all of them will be infected. This practice is wrong and the advice is that an HIV positive person should have protected sex regardless of the level of viral load.

What are the statistics “saying?”

Unfortunately, what was true last year, the year before, and the decade before that, remains true today: the Black community is the racial/ethnic group most affected by HIV in the USA and in the UK. In fact, it is not overstating the situation to say HIV is a crisis in the Black communities in both the US and the UK.
Black people accounted for an estimated 44 percent of all new HIV infections among adults and adolescents aged 13 years or older in 2010, despite representing just 12 percent of the US population. In Massachusetts, Black people are just six percent of the population but comprise 30 percent of those living with HIV/AIDS.
Black Africans living in England are disproportionately affected by HIV. A third of new HIV diagnoses in the UK are among this group, which makes up only approximately 1% of the UK population. For example, during 2009 there were 2206 new diagnoses of HIV infection among black Africans, representing 33% of all new diagnoses in the UK (Health Protection Agency 2010a).
It is estimated that a total 4% of black Africans living in England have been diagnosed with HIV, compared with 0.1% of the white population (Health Protection Agency: personal communication 2010). Of the 23, 288 black African people who received care for HIV in the UK in 2009, 91.3% reported having acquired the infection through heterosexual intercourse (Health Protection Agency 2010b). Most black Africans (80%) who were newly diagnosed in that year acquired their infection heterosexually in Africa (Health Protection Agency: personal communication 2010).

What does this mean?

There are multiple and complex reasons for the disparate rate of HIV infection in the Black community. Black people do not engage in risky sexual behavior at higher rates than people of other ethnicities. (That said, throughout the AIDS epidemic—thanks to racism or the temptation to engage in “blame the victim” thinking (or both)—it has been posited that black gay and bisexual men engage in more risky sexual behaviors than white or Latino gay and bisexual men and that this accounts for the disparities in infection rates. But, this theory has been thoroughly debunked by numerous studies. Some of these studies, in fact, have found the opposite: black gay and bisexual men actually engage in lower levels of risky behavior than their racial counterparts.)

However, Black people as a group (as with any other racial/ethnic group) are more likely to have sex with other Black people. Given that a higher percentage of us are living with the virus compared to other racial/ethnic groups and our risk of infection increases with each new sexual partner. Additionally, factors such as higher rates of poverty and incarceration (especially in America) contribute to disproportionate HIV rates in Black communities.
I support the theme that: “I Am My Brother’s and Sister’s Keeper. Fight HIV/AIDS!” We are infecting each other and the sooner we recognise this and take action the better. I am calling for action in our communities so that we stop the spread of the disease. There is hope out there and let us fully engage and protect ourselves from this pandemic.
There is some positive news, though. HIV testing is one of the most important tools we have to stop the spread of the virus. Knowing your status and promptly seeking treatment if you are diagnosed with HIV is the best way to maintain your health and stop the spread of the virus. Treatment is prevention as we now know that people receiving effective HIV treatment are 96% less likely to transmit the disease to their sexual partners.
I encourage HIV testing for all people especially Blacks. Over 50% of HIV transmissions are from people who are undiagnosed. People diagnosed with HIV are likely to pay greater attention to reducing risk of HIV transmission, and once on treatment, their viral load will reduce and they will become significantly less infectious. Without intensified testing efforts, the number of people infected with HIV will continue to increase. In the UK, there is evidence that we are infecting each other within Black communities. It is reported that there is evidence of significant rates of UK- acquired HIV infection amongst Africans, including amongst those who have previously tested HIV negative. What this means is that there are many HIV negative people who are leaving parts of Africa where there are very high incidents of HIV transmission, only to get infected during their stay in the UK.

This has to stop and it “Begins with me, Dr Chireka and Begins with you reading this article and also Begins with the whole Black Community”.

Knowing your HIV status does change your behaviour and helps in the fight to reduce infection among our community.

We need to make sure that we get tested today, because it is estimated that someone aged 35 who is living with HIV in a developed country (e g UK and USA) is likely to live for a further 37 years with treatment. Also, the same evidence shows that late diagnosis increases the chances of morbidity, mortality and onward transmission. This late diagnosis results in significant ill health for people with HIV, increases rates of hospital admission. In the UK, of those with HIV who were reported to have died in 2010, two thirds had been diagnosed late. This late diagnosis leaves an individual 10 times more likely to die within a year, while a 20 year old diagnosed very late with HIV is thought to have a life expectancy at least 10 years shorter than somebody who starts treatment early.
In conclusion, my message to you all today is: please know your status, and promptly seek treatment if you are diagnosed with HIV. This is the best way to maintain your health and stop the spread of the virus. Remember, the testing is for your benefit and treatment is free. It is your life at stake and it’s all up to you to waste it or save it. If you accidentally have unprotected sex, for example if the condom burst, you must seek urgent medical advice so that you can get what is called post exposure prophylaxis (PEP).

This article was compiled by Dr. Brighton Chireka who is a GP and a Patient Engagement Advocate (PEA) in Folkestone Kent, UK. You can contact him at: info@docbeecee.co.uk or read more of his work on DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr. Chireka has used all reasonable care in compiling the information, but makes no warranty as to its accuracy. Consult a doctor or other health care professionals for diagnosis and treatment of medical conditions.

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Ebola explained

Ebola virus, a year later well done WHO

By: Dr Brighton Chireka • 30th November 2015

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Ebola, a year later , Well done  World Health Organisation (WHO) and Well done Zimbabwe !

By Dr Brighton Chireka
One year ago, the West African Ebola outbreak shocked the whole world and was generating so many new cases which were spreading to so many countries. We feared that it will reach our country Zimbabwe and overwhelm our health system. Irresponsible journalists made us panic last year by lying to us that Ebola cases had been confirmed in Zimbabwe.

Unknown to most members of the public is that journalists were at one point taken to Wilkins Hospital for a tour to show how the country was preparing for Ebola. Sadly they did not publicise the preparation enough instead they were busy spreading the false rumours about fictitious cases of Ebola.

Now , one year later that terror has been replaced by confidence that strong leadership, adaptation of the response to cultures and environment and innovation have turned the tide. Liberia has interrupted transmission and Sierra Leorne is close to achieving that milestone. Guinea is still recording cases but in low numbers.

No case has been recorded in Zimbabwe – well done !!

Worldwide, there have been 28,637 cases of Ebola virus disease and 11,314 deaths at 22 November. On 7 November 2015 World Health Organisation ( WHO) declared that Ebola virus transmission had been stopped in Sierra Leone.

I was impressed by the measures taken by the Ministry Of Health in Zimbabwe in deploying screening at Airports. On my recent visit to Zimbabwe this October I saw that there is now a permanent structure built within the Harare airport for screening purposes. I have been to South Africa, Botswana, Zambia, Holland and UK and I must say Zimbabwe is ahead of all these countries in screening people entering its land.

I think we need to acknowledge good practice and celebrate small victories. I invite you to join me in celebrating a job well done by the Ministry of Health in Zimbabwe.

Let’s us look in detail at the virus that caused us all to panic last year.

Ebola virus

The Ebola virus first appeared in 1976 in two outbreaks at the same time, one in Nzara, Sudan and another near Ebola River in Democratic Republic of Congo, from which the virus takes its name. There have been several outbreaks since 1976 and the current one in West Africa started in March 2014 and is the largest and most complex.
How is Ebola virus spread?

This is very important to understand as an informed population will play an important role in preventing the spread of this virus. I urge you to spread this information to your friends and if each person reading this article can pass this information on to at least three other people and each person continues to reach three more new people then we will get this message to a wider audience.

It is thought that fruit bats are natural Ebola virus hosts. Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.

Ebola then spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people,