Unhanging my stethoscope

There is nothing easy about going to war with an enemy you cannot see.

Unhanging my stethoscope via @theMagunga

Everyone watched as the world slowed down to a silence. At the time, nobody really cared that it was happening. There was no way a virus chomping up a portion of Asia could survive the voyage across the Indian ocean and land here – or anywhere close. That is why in the earlier hours of 13th March, I had already undergone my usual travel rituals, and was waiting for my driver – Kevo – to pick me. The suitcases and bags were packed and leaning by the wall next to the door. Earlier, I had already told little TJ that his mummy was going to be away. It is a conversation we have made a habit of having, to inform him I will not be making breakfast for a while.

“Where are you going?” TJ asked, food swelling up his left cheek.

“New York. Via Paris. Then perhaps drop down to DC.”

“Are you going to be treating people?”

“Well…sort of.”

It is difficult explaining to my six year old son that I am a doctor who does not treat people anymore. His budding brain may not appreciate big words like ‘healthcare advocacy” or “sexual health and rights initiatives”. I could explain, but I needed him to finish his food first. By the time he was done, we were well past the subject of my impending trip. I was getting him to promise not to disturb the nanny while I was away.

 

I have never been able to sleep on the night before a travel, either. Paranoia has led me to believe that I would oversleep and find my plane had already taken off. I decided to sit on the couch and practice insomnia till 4 am- the time Kevo was to pick me. I was playing a game on my phone. On the TV, CNN was droning on in the background. They were talking about what everyone else had been talking about since the start of 2020 – the coronavirus outbreak in China and now Italy. A few cases in New York, all of them imported cases. Nothing about it being locally transmitted, not yet. So there was nothing to worry about. It justified why I was still opting to travel.

At about 3am, I turned up the TV volume. BREAKING NEWS was written in big bold white letters against their red background. The report said the newest case was a child who had contracted the virus. Sad, I thought, but not alarming. The part that made my eyes wide and my body sit up on the couch is when they said this kid- this child, had been going to school and back home.

Soon as the anchor said that, I reached for my phone, logged on to the KLM website and cancelled my flight. Then I texted Kevo, told him not to come. He called back.

“Daktari, what is the problem?”

“There is no problem, really. This Corona does not look good.”

“You know, even me I wanted to tell you hii kitu ni hatari usiende. Lakini sasa sijui kama hawa watu wa ndege watakurudishia fare yako.”

 

Here is what they tell you in epidemiology class. When dealing with a virus like this, and you are dealing with imported cases only that are caught early enough, then there is nothing to skip your lunch break about. But the moment a case leaks into a neighbourhood, and children are going to school to meet other children and teachers, the best time to panic was five minutes ago! Aerosol viruses spread like the gospel. And as soon as New York announced that school going kid had tested positive for coronavirus, I knew shit had passed close to the fan.

The only way I was going to see TJ again, was to never leave in the first place.

Hours after my cancelled flight to NYC, a sullen man in a sky blue kitenge shirt lined with beaded embroidery from the neck down to his chest, stood at a press conference. Behind him was a cast of people, standing silently. You couldn’t see their faces when the camera zoomed in on the man standing in front of the microphones. You could only see this gentleman, his stubble of beard surrounding his mouth like a live fence.

Mr. Mutahi Kagwe, the new Cabinet Secretary for Health, announced the first coronavirus patient in Kenya. And with his words, he sent the entire country on a spin.

“You’re not going back.”  I told TJ when he came back from school. I would talk to his teachers, I said. His face lit up like a Christmas tree. It was a day of good news for him – first, he woke up and found that I hadn’t travelled, and now here I was saying to him that he wouldn’t be going to school.  So blissfully unaware, he couldn’t understand.

By God, I hope that he never has to.

 

***

When you ask a primary school kid what she wants to be when she grows up, chances are high that she will say “doctor”.  Because that is the one profession we were always led to believe we should aspire to. It does not matter if they are from Kibera or Kileleshwa – that answer is the SI unit. The same way ‘fine’ is the answer to ‘how are you’. Doesn’t matter if you are not actually fine, the textbook says you are supposed to respond like that.

My motivations to study medicine weren’t quite different, they were just italicized by something else. I wanted to fix my mother. I wanted to grow up to be the doctor that opens up people heads and rearranges things, so that I could set my mother straight.

She did not have a good head, my mother. That is what our neighbors in Katwekera used to say. They said she had a bad head or her head had jumped. So if she was not walking around Kibera naked, she would poop into a Kasuku container and then put it back on the shelf for days, and our one roomed house would – for a long time – stink of feces. That is why I wanted to be a neurosurgeon, long before I even knew how to pronounce and spell it correctly. But then I got to med school and quickly realized my mother’s brain was closed for repair.

Schizophrenia – it turns out – was not like a broken clock you open up and mend. It is not an organic disease.

That is how I ended up being an MD, but then four years into the profession you start noticing things. In this case, lack of things. It is not easy being a doctor in this country, because Kenyans expect you to perform miracles. Practicing medicine for doctors in the public sector, does not come as advertised. You work twice as hard with half the pay, a fraction of the resources and none of the thanks.

Eventually, I hang my stethoscope and went into advocacy. Yeah, I became one of those people. The noisemakers that task their governments and international NGOs to alleviate the environments in which doctors work. I figured, if I couldn’t get fix my mother, then perhaps I would try fixing healthcare system.

 

This will be my fourth year since I last handled a patient. But that does not mean that I stopped being a doctor. Nobody ever stops being a doctor just because you took off your stethoscope. There will always be a time when you are called to duty. For me, it’s now two times. When on an aeroplane and a hostess took to the speakers to ask if there is a doctor on board. Two, was almost a decade later, finding myself in Dr. Davis Ombui’s house, sitting around a fireplace with another doctor, and you start talking about the new coronavirus. How it has eaten everything it could lay hands on in the public healthcare system. From the number of healthcare providers, to bed space, to attention, to medical supplies. The virus is way ahead of us.

On that Friday night in South C, the three of us decided we couldn’t stay dormant. We had to go back to active duty. Truthfully, there have never been enough healthcare workers in the country, but with this new virus ravaging everything the way it has, perhaps it was time for those of us who had taken off our lab coats to put them back on. And we would sign up anyone else who was willing to come back and join this fight.

 

It sounds like an easy decision to make, doesn’t it? Far from it. There is nothing easy about going to war with an enemy you cannot see. A microbe you know almost nothing about, yet leaves such devastation in its wake.

See, I am just as afraid to die as you are. As a human being, there is always that deep seated yearning to keep breathing. If Jesus himself – the son of God – was afraid of death, then would I be so selfish if I was petrified of it? There is also my little TJ. If there was one reason I did not want to sign up to go be on the frontlines of COVID-19, it would be him. The consequence of death does not scare me as much as the idea of being away from my son for so long.

The numbers say one in every ten patients in Italy was a healthcare provider. There is a story told of a doctor in Italy who saw a patient with a cough and fever (long before this thing became a pandemic). His disposition was to treat this patient, and just as he did, he signed his own death sentence. Italy. They are blessed with one of the most profoundly efficient healthcare systems, rivaled only by the likes of Cuba. Who would have thought? 1 doctor for every 200 people and it’s all gone to the pits.

In Kenya, we have 1 doctor for every 10,000 people. Some would argue that the actual ratio is around  1: 16,000.

It is because of these inadequacies that I left the medical practice, to delve into advocacy. And now, as we sat around the fire with these two doctors, the irony could not have slapped me any harder. The reason I hang my stethoscope becomes the reason I am tossing it back on.

There are simply not enough doctors.

Dr. Stellah Bosire

 

***

 

The day the Cabinet Secretary announces to the rest of the world that there has been a positive Coronavirus case in Kenya, you call your friend who works at Mbagathi Hospital. You know that this place they keep talking about in Mbagathi as a quarantine center is a new wing that had been built as a maternity ward, but this virus got here quicker than the first pregnant case could. So it was repurposed.

Your friend tells you that some of them woke up one day and found their names on a list of first responders. They are to be trained on how to deal and handle COVID-19 cases. For many of them, the gloves, masks, and suits were nothing more than diagrams on a board and pictures on a screen. Now they have to touch and feel and use them the correct way. It’s happening so fast. She calls you later. They are being told to proceed to the ward, the first patient awaits.

She calls you back to tell you she has been given instructions for her children to be taken to shags. Going back to them henceforth would be putting them in danger. The thought of this stays in your head rent free.

You think about it a lot as you make a call for doctors who had stepped out of the practice to join you in coming back. You think about what it means to you and TJ. Because how this works is that, in the end, you submit your names with the Licensing Board. And then you await deployment. If you are lucky, you will be stationed here in Nairobi, closer to home. But not quite. Because you will be in contact with patients, you will not be able to go home to TJ every day like you are used to. You will have to move into the hospital quarters. You will only be able to see him at least 14 days after your last interaction with a patient.

If the virus doesn’t knock you for six, then the separation from your son will.

A week and change passes and you get word that one of your friends is in quarantine after suspected exposure. And it kills you to imagine just how people out here do not understand the sacrifice healthcare workers are making on their behalf. They are being asked to work from home (if possible), now that Safaricom has provided fixed data for customers and double the bandwidth. To wash their hands while singing the happy birthday song, avoid meeting people unnecessarily, maintain 1.5m away while at the supermarket, pay via MPESA instead of cash coz they already slashed sending rates to encourage cashless transactions, spare the n95 masks for healthcare workers and sick people.  And most importantly, sanitize.

Basically, to do their easy part so that yours (and your friends’) doesn’t have to be so hard. In between work, you slip into the internet and wonder if that is too much to ask.

 

Meanwhile, you sit and wait like a ticket-number holder for the call which will give you instructions about your deployment. You dread having to tell TJ that you will be going away again. You dread the one question, “When are you coming back?”

And for the first time, your answer will be “I don’t know, baby.”

 

***

 

If you have watched any genocide movie, you must have seen that crude weapon. I do not know it by name, but it is basically a rungu with spikes on all around its head, and it looks like a balled-up porcupine. You’re picturing it? Great! Well, every time I see a picture of the coronavirus, it reminds me of that thing. It is kind of metaphorical, just how similar they are in devastating the human body.

The difference is one finishes you in an instant, while the other will take its time. First, it will gain entry through your nose or eyes or mouth. Once inside, its spikey tendons latch on to your cells. It will reproduce, kills the cells and then spread down your respiratory tract. At this point, your body says it is not going down without a fight. It releases cytokines in your defence, and in turn your the part of your brain that acts like a thermostat – the hypothalamus – reacts by releasing certain chemicals to regulate your body temperature.

This warfare in your body manifests in a cough or sore throat, or you run a fever, or all of them. Feels like get malaria and homa at the same time.

Many people will recover from this like they would a normal flu. The virus gets knocked out in the first round. But others won’t be that fortunate. It spreads down to the lungs and attacks the alveoli. When that happens, then damn, your airways swell and your lungs begin to fill with liquid. You might hear the word ‘inflammation’ mentioned when the nurses do their rounds around your bed. Meaning you cannot breathe properly. You are – in a sense – drowning.

Hopefully, you can recover from this with intubation. If you don’t heal then your body will keep up the good fight until it turns ugly. Your immune system stages a full frontal attack to kill the virus, but in so doing it starts up killing some healthy cells too.

When you find yourself in a ventilator, lying on what feels like your death bed, breathing through an oxygen mask with one foot already in the grave, it is not the virus that kills you. It is the betrayal of it all – the sense of your body being a war with itself. You are dying -in part – from what is supposed to be friendly fire.

And just like a country falls during a genocide,  your body folds itself in.

 


as told by Dr. Stellah Bosire to Magunga Williams.

Unhanging my stethoscope via @theMagunga

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  1. 6th April 2020

    I read Roses for Jean-Pierre and I could not get over how amazing of a writer you are. Now after reading Unhanging my Stethoscope, I am in awe of your work.

  2. 6th April 2020

    I paused and paused 😭 here we are…

  3. 9th April 2020

    Thank you for telling your story. A brilliant eye opener and encouraging that Dr. Bosire quite literally put her life on the line for others.It inspires me to ask what can I do with what I have to fight back

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