Can one breach medical ethics to save lives?

By Paul Ngurari

I was watching a medical drama a while ago set in the United States involving a female Jewish gynecologist. The medic, who we shall call Sarah, was an evacuee from Hitler’s Nazi Germany in the height of the holocaust. After painstakingly settling down in the US, Sarah applied to the American medical board to be licensed to continue with her medical carrier. 

There were serious odds stack against Sarah. She needed to appear before the board for an interview. Prior to the interview, the board had invited members of the public who had anything they could say about Sarah. A dozen people, mainly drawn from her fellow Jewish evacuees, forwarded numerous memoranda regarding her.

Apparently, as detailed in the various memoranda, her practice during the Nazi war had a mixture of experiences. 

There was what looked like obvious ethical questions on her part. Firstly, in addition to her medical training, Sarah had a natural talent that she would deploy to assist mothers during delivery. It mostly came in handy in emergency situations. She would be called in, at times in the middle of the night, to assist with emergencies.

This special talent was not a recognized medical procedure. Some of her colleagues felt it was unorthodox but they would invite her nonetheless when faced with emergency situations. Many women liked her for the relief her procedure brought and this made her very popular even among German women. Elite Germans were said to consult her in secret. She would offer her services to them for a reasonable fee. 

When Jews were finally put in concentration camps, Sarah was allowed to continue her medical practice albeit in an unregulated environment. Nazi camp administrators would pick her up to assist their pregnant women in the cover of darkness. Besides she provided free medical services to her fellow Jews often going beyond her specialty. 

 The Nazi administration had put in place strict rules for women in the camps. Among the rules, they were not supposed to get pregnant. Those who broke this rule and got pregnant were often shot dead. They would be picked up in the full view of their fellow Jewish hostages and taken to an open ground and shot dead instantly. Pregnancy was an automatic death sentence for Jewish women. Many of them met their deaths in the camps as a result.

Sarah had a better idea to beat the death trap. She assisted pregnant women to abort on her own volition. She would encourage the women to abort before authorities got wind of their pregnancies. In total Sarah was accused to have helped procure 1000 abortions. The abortions were offered free of charge. The women hardly developed complications as a result of the abortions.

During the board hearings, these issues came up. She was hard pressed to provide answers. It was obvious the interviewing panel had all the ammunition to deny her a license. Sarah occasionally broke down during the interviews. But she was forthright nonetheless. She admitted to helping many women abort. This act in the US was untenable and amounted to murder. Sarah spent many agonizing nights as she relieved the harrowing experiences in the Nazi camps and how these experiences had come back to haunt her.

In one of the hearings, Sarah got defensive. It had been put to her by one of the panelists that what she did amounted to committing murder of 1000 innocent children. She retorted that in the contrary, she had saved more than a thousand lives through the abortions. According to her, she saved 1000 women who were faced with execution. The women, she said, would later give birth to many more children.  

In tears, a distraught Sarah implored the panelists to see the good side of her actions. She explained that saving lives is the cardinal principle of medicine and appreciated that fact better than anyone. But they were as hard as a stone.   

There was one woman who had gotten wind of the ugly turn of events against Sarah. She, like Sarah, had settled and gotten married in the US. Her marriage had rewarded her with three children. Sarah had helped her abort in the Nazi camp. She approached Sarah and volunteered to testify in her favour but Sarah declined the offer saying this was contrary to professional ethics. She had already defended herself enough and felt that the medical board could do as they wished. 

But the woman had other ideas. She decided not push Sarah further but worked on a plan to walk into the venue of the next hearing uninvited. While the panel sat to read their verdict the woman walked into the room to the surprise of everyone. Sarah was perplexed. She did not want to appear to be canvassing among fellow evacuees for support. The panelists looked at each other and you could tell they were perturbed by the turn of events.

The woman told them she was not invited by anyone to the hearings. She said she thought that what she had to say could help the panel make an informed decision on the matter in question. Without giving the panel time to respond she stepped forward and started narrating how Sarah convinced her to abort and eventually saved her life. She told a harrowing account how fellow Jewish women whom she knew were executed in cold blood. In her own words, Sarah not only saved her life but also gave her the opportunity of having three wonderful children.

After the woman’s submission, the panel asked to be given time to go in camera for consultations. The matter, they said, was weighty and needed wider consultations in view of the new developments. They were gone for about half an hour. When they emerged they said that after much consideration and wide consultations the board had decided to give Sarah a license to practice medicine without any conditions.

Sarah was overjoyed. She could not believe it. She shot to her feet and hugged everyone, tears of joy rolling down her cheeks. She was full of gratitude to the panel and to the woman witness. She vowed to help millions of women deliver safely and with joy.

Be the judge. Did Sarah get away with murder? Is what she did professionally acceptable? Between her actions and the professional ethics she professed, what was on the side of life? At what point do professional ethics cease to apply?

Banza Toilet: Kenya's Lattest Innovation on Shit Management

By Paul Ngurari

You have all heard of the flying toilets of Kibera and the disgust of open defecation in urban Kenya. This has been the subject of discussion for a long time now. Our comedians have time and again cracked their audiences’ ribs depicting them on national television.

Myriad NGO officials have made a name for themselves out of an event or another talking about the problem. A community toilet here and another one there have popped up in the informal settlements. Yet the problem of sanitation has persisted and with it a collection of infectious diseases.

But as they say, every cloud has a silver lining. This human poopoo menace is once again in the throes of placing Kenya on the world map in the same way Safaricom’s Mpesa has done courtesy of a unique toilet designed and developed by a Kenyan Industrial Design Engineer. Besides being targeted at people  living in informal settlements, Banza toilet comes as a big relief to people and organizations caring for people who require assisted living as well as safari lovers.

The Banza toilet is a foldable multifunctional unit designed for in-home use in places where sewer systems and proper sanitation methods do not exist. The toilet allows the users to hygienically dispose of human waste in the security and privacy of their homes. Waste is then collected in a compostable bag that can be stored odour-free in the toilet for up to 24 hours.

“The idea of Banza toilet came about as a result of a conversation I had a couple of years ago with a friend of mine who is a Professor at the University of Nairobi,” says Patrick Kiruki, the Chief Executive Officer of Banza Limited. Mr Kiruki explains that the Professor was involved in an ongoing sanitation research project in Kibera at the time.

The Professor, according to the Banza CEO, was of the opinion that the project was not good enough in addressing the problem of sanitation in Kibera. He felt that there was need for a hardware solution that could help the people in more realistic way.

“As an industrial Design engineer I thought coming up with a hardware ware would be a great idea,” he says adding that at the time, he thought that conceptualizing the whole idea was a good start.

Mr Kiruki previously had an exciting career designing phones for name brand manufacturers like Samsung, adding new features here and there. But, he says, every new design would be exciting but never quite gave him that satisfaction he was craving for. He craved to do something that would help people in a different way by impacting lives in a meaningful way.

“I felt that I had throughout my career only designed consumer products that only affected 10 percent of the world’s population. I wanted to come up with something that would positively impact the lives of the other 90 percent of the world population.”

Mr Kiruki followed his passion and completed the first design. He was so excited with it that he submitted it to an international design competition dubbed The Index Award based in Europe. To his surprise, the design managed to get a nomination but was not among those that finally won the award. This nomination, he says, was to him a big achievement in spite of not getting an award.

But there were to be some dull moments. Buoyed by the nomination, Mr Kiruki started writing proposals to variousorganizations for funding to execute the project. At the time sanitation and lack of toilets was not seen as a key factor to poor health in the developing world. The tide would later turn. There was suddenly a surge in the number of people looking for projects that would help address sanitation challenges.

Since initiating a pilot project in Mathare, we have received enquiries from people with bed-ridden relatives and dependents. “One person’s inquiry on our Facebook page was about her mother; she is eighty years old and has complications arising from a chronic disease. She cannot stand or walk on her own. We are now informed that there is no one happier than her since she started using the Banza toilet,” notes Mr Kiruki.

Banza toilet project which incorporates waste collection services is being piloted in Mathare to test improvements in health and sanitation. An initial batch of twenty households are on the project but will be scaled up to 90 households in coming weeks. The pilot project will run for six months. A successful project will lead to scaled-up distribution of toilets and waste collection services country wide.

The project has so far received good support from the Ministry of Health, and recently the Technology Working Group (TWG) under the Ministry of Health voted unanimously to adopt and recommend the Banza Toilet System as the countrywide standard and model for personal sanitation.

“There was a complete consensus that this solution represents a remarkable prospect for improving personal hygiene and public health throughout Kenya,” says Mr Kariuki. Besides this, he adds, Banza Limited has received requests from Haiti and a German organisation on possible supply of the Banza toilet system.

Isolate the SOS ‘doctor’ saga from the nursing profession

A nurse working in Nairobi is due to face criminal charges as a result of posing as a medical doctor while he is not one. The nurse had been hired as a medical superintendent for a health facility run by an NGO. He had plied his trade for a number of years before he was finally discovered.

Fortunately, there have not been any cases of medical negligence filed against him. The health facility’s administration says that they did not know that the nurse had lied about his medical qualifications. They added that they had invested a lot in the nurse by sponsoring him to attend CME courses locally and abroad to enhance his medical skills.

The Medical Practitioners and Dentists Board nabbed him, one, for operating as a doctor without requisite training and, two, for operating with forged university qualification documents. That the board decided to take the matter to the police for prosecution means they have a strong case against the man. We do not want to speculate on the likely outcome of the matter before court. As for the guilt or innocence of the accused, only a court of law can determine.
In any case it was wrong in the first place for the nurse to present forged documents while seeking employment. That, in our opinion is something he must provide answers for. 

However, we wish to clarify here that nursing is a very noble profession. Since the days of Florence Nightingale the nursing profession has evolved in many aspects. Currently, it is not just a certificate course in some middle level college, but institutions of higher learning have developed degree, masters and even PhD programmes in nursing. Furthermore, in most rural settings it is nurses that provide primary healthcare services to the majority of people where doctors are hard to find. There are also private clinics being run by nurses across the country with licenses from the Ministry of Health.

The impression created by the news reports on the saga of the said nurse is that nurses are not supposed to treat patients and those doing so are quacks. Nurses are empowered by law to examine patients that present themselves to them. Accordingly, in practice, the nurses are required to keep necessary treatment records for appropriate monitoring by authorities. They are obligated by law to refer those cases that they cannot handle to government referral facilities. 

While the concerned nurse battles to clear his name in court, it is important that we do not criminalise the good actions undertaken by those in the noble profession of nursing. It is also important to point out that if by treating patients, this nurse observed the nursing code of ethics, that bit is correct. However, forging documents and calling himself a doctor is itself criminal.
 
Importantly, there is no alternative to nursing when it comes to professional patient care. It is very central to any healthcare system. That aspect needs to be emphasised in a more objective way as we look at this matter contrary to what has been portrayed in the media.

HPV Vaccine

Our current edition of Nafuu Magazine's cover story is HPV vaccine and the war against cervical cancer. We have highlighted a number of issues that have come up since Kenya
started on a demonstration programme thast is currently underway.

Some concerns have emerged in some countries about the vaccine's efficacy. It has been 
said that in Japan for example although the vaccine is available in the country the government 
does not support its use. There were reports that similar concerns have been raised in Israel
although with muted publicity.

Those against the vaccine say that it causes infertility in women. However experts say that
the critics are getting it all wrong. It is noted that the vaccine has been in use for the last 7 
years and is given to girls in the ages of 9 to 14 years. They estimate that the first reciepients
of the vaccine are probably aged 23 years at the moment. They may or mar mot be married
at the moment but are well within marriageable age bracket. 

The argument is that those are the people who say that the vaccine causes infertility should
be following to prove their case. They say the cricks should undertake medical research on
this group to confirm their position other than going out in the public without proof to cause
alarm among vulnerable populations.

An HPV expert based at the University of Nairobi Medical School says that while it is true that all pharmaceutical products have one side effect or another, experts say, these while looked at against the benefits of a product. Furthermore, she adds, a vaccine is not like your regular cup of coffee that brew in seconds and is ready for intake. 

There is a lot of Science that goes into the making of a vaccine, she says. A lot of medical research with primates and painstaking clinical trials for take many years to observe a product goes into development of a vaccine. And unlike other pharmaceuticals, line pain killers for example, vaccines are biological products whose raw materials have to harvested and and nurtured for a period of time before one could say they have a product.  She says that it is unfortunate that those who critisise do not seem to appreciate the many approvals that have to be met before a vaccine is put in the market. 

Hi Everyone.

Today marks the third day of the horrific siege at the Westgate Shopping Mall.
It is believed that a dozen people are are held hostage to by the marauding
terrorists. There were sporadic gun shots emanating from the building early this morning.
It is our hope that no bullet landed in the body of any of the hostages or our gallant
soldiers trying to rescue the hostages.

Many Kenyans, just like yesterday are queuing to donate blood in several centres.
This is a good sign that if the terrorists thought they had managed to humiliate Kenyans
they have not seen anything yet.

Let me also say that those scribe investigators who have habitually splashed the
so called extrajudicial killings by anti terrorist police units should think twice before
they fall for a narrative designed to deflect attention from the real terrorist threats.

May be we should also begin to ask ourselves the whole moral of a story told by
an investigator who from time to time features himself and his story line as the
subject of his own investigations. Where is objectivity in that regard? But make no
mistake. I am not saying that our scribes are terrorists. I am only saying that may
be they should be a bit more professional with their investigations in future not to
to be influenced by terrorist elements keen to create a smoke screen while they plot
to kill our people.

A word of advise. For heavens sake, When you discover that you have suddenly
become the subject of your own investigations meant for public consumption then
that is the point you quit the whole thing and let someone else carry on with the
investigations. In any such probe, it is worth noting that there is no story worth
your life no matter the public interest. I rest my case for now.

We are proud Some Kenyans are playing their part in keeping Disease at bay.

The Ministry of health is set to administer the second dose immunisation of girls against
Human Papilloma Virus responsible for the development of Cervical cancer this month in
Kitui. The immunisation is a GAVI supported demonstration programme that is targeted
at opening the door for the vaccine to incorporated in the routine immunisation prgramme.

Elsewhere Banza Limited is piloting a unique toilet project in Mathere informal settlement
that will provide households with a solution to the menace of open defecation. Patrick
Kiruki brains behind the project says that project will also come handy for people who
need assisted living.

These stories are featured in our current edition of Nafuu magazine.

Need copy? write to us through commwideconcepts@gmail.com   

Nafuu Magazine is here to promote health and encourage debate on matters health, particularly the Kenyan audience.

We have witnessed many incidents of poor health and related services. It is time to turn the tide. It is time to offload the burden of disease in society. We have a firm belief that some of the disease occurrences plaguing the country and its people can be reversed and or avoided if necessary steps were taken.

Why would a family have to spend an entire livelihood catering for a sick patient? Why would an entire country's development agenda be placed at the mercy of disease and infection?

Please loin us in this noble agenda to rid our people and country of disease.