No, Mr Murugu, you can’t cure cancer in 6 weeks

By Lukoye Atwoli
Sunday Nation 16 June 2013

Lately there has been a focus in a section of the media on medical malpractice, with some even referring to “killer doctors” and “killer hospitals”. Some of the claims have been factual, but many have been exaggerated. The Medical Practitioners and Dentists Board has eventually been jolted into action, revisiting cases filed several years ago and handing out harsh penalties.

All this is probably symptomatic of the direction the practice of medicine is headed in these litigious times. Medical practitioners will just have to learn to evolve with the times, and engage in what in other jurisdictions is referred to as “defensive medicine”.

It would be even better had the media and the Board also directed their attention at some practitioners of so-called “traditional and alternative medicine”. One such person who should be in their cross-hairs got a big splash in the newspapers, in which he made several claims, some outright dangerous.

Going by the name “Dkt Murugu”, he claimed that he is able to make several conditions “disappear” within a set time-frame. He suggested that he can cure cancer in six weeks, cerebral palsy in two months, hypertension in 25 days and diabetes in five weeks. He even claimed to do “HIV management” in four months.

This same person and several others are given prime airtime every weekend on several television channels to advertise their wares and their prowess. They explain illness using obscure terms that mean nothing to the expert, but are calculated to wow their audience with their supposed brilliance.

It is time someone took up the responsibility of protecting Kenyans from such shameless charlatans, and the law ought to punish these people who are preying on the ignorance of the masses. The Medical Practitioners and Dentists Board is, by dint of its own title, expected to regulate all those who present themselves as medical practitioners.

In my view, a medical practitioner is anyone who claims to possess the knowledge and ability to treat or cure an illness. The Board is, therefore, failing in its mandate when it ignores these charlatans who advertise and ply their trade in broad daylight.

Ludicrous “healing” claims by religious and traditional practitioners have been brought to the Board’s attention in the past, but they are brushed aside with the assertion that these practitioners do not fall within the regulatory ambit of the Board. In actual fact, there is no other regulatory authority for “religious healers” and “traditional” or “alternative” practitioners.

Shall we then let Kenyans to continue suffering unknowingly at the hands of these unregulated practitioners? If the Medical Practitioners and Dentists Board cannot stop these people from exposing Kenyans to death-threatening “treatment”, who will?

If anyone had discovered a cure for cancer, diabetes, hypertension and other chronic diseases, we would not be investing so much money on these conditions in this country or elsewhere. Further, the discoverer of these elixirs would become an instant billionaire, even if they protested about their philanthropic intentions. In health care, any claim of cure must be backed by a large body of research on safety and effectiveness before it can be tried on humans.

And there is nothing like “alternative medicine”, since any medicine that works against an illness cannot be considered “alternative”. It would become the standard of care.

Dr Lukoye Atwoli is a senior lecturer at Moi University’s school of medicine Lukoye@gmail.com; twitter @LukoyeAtwoli

We are a traumatised nation in need of healing

By Lukoye Atwoli
Sunday Nation 09 June 2013

The Kenya Psychiatric Association (KPA) holds its fifth Annual Scientific Conference from Thursday. This year the theme focuses on trauma and post-traumatic stress disorder, and several experts are lined up to make presentations in this specialised area. Although this theme was agreed on several months ago, it seems appropriate that we tackle it at this point in time for several reasons.

Firstly, the British Government is finally owning up to its colonial excesses and is discussing compensation with Kenyan liberation veterans. Previous work with these veterans uncovered a stunning magnitude of psychological scarring that far outweighs the visible wounds they may have sustained during the Mau Mau struggle. That this remains unaddressed to this day is a testament to our skewed national priorities, and leaves us exposed to the consequences said to follow those that forget their past.

Secondly, we are just emerging from the first General Election after the 2007 debacle that resulted in massive loss of lives and destruction of property ostensibly due to political differences. Similarly, studies carried out among those affected by post-election violence have shown high rates of mental disorders such as post-traumatic stress disorder, depression and substance use. Tragically, we do not have an organised mechanism for helping people affected in this manner.

Thirdly, there is overwhelming evidence that our population has over the years been so brutalised physically and psychologically that we are collectively suffering from the group equivalent of post-traumatic mental disorders.

For instance, traumatised people tend to re-experience the traumatic event in distressing ways, and also do everything they can to avoid memories, events or even people related to the traumatic event. They also tend to be easily startled and overreact to trivial stimuli.

If this description does not fit our collective national behaviour, then I don’t know what does. We are the nation of “forgive and forget”, or as the song goes, tusahau yaliyopita tujenge taifa (let’s forget the past and build the nation). We are the nation led by people who exhort us to “avoid opening up past wounds” due to the fear that they could cause upheaval.

We are a people plagued by so many unspoken “historical injustices” that even the Truth, Justice and Reconciliation Commission only managed to scratch the surface. And more recently, we have become the oversensitive nation that must be constantly reminded to “accept (any event we consider unpleasant) and move on”.

The KPA conference, therefore, provides an ideal opportunity for us to start a national conversation on what ails us as a nation, and how we can begin to conclusively address our traumatic past and embark on a journey of healing. The association is ready to provide the expertise necessary to point us in the right direction.

In this connection, it is gratifying that the Cabinet Secretary for Health has graciously agreed to open the conference and interact constructively with mental health experts during this meeting. One hopes that this sort of positive engagement will continue in the coming years if we are interested in guaranteeing the mental health of our people.

We have already presented the Health ministry with information on problems that need fixing in order to improve mental health services. A mentally healthy population will also be happier, healthier and more productive. 

Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association and a senior lecturer at Moi University’s School of Medicine lukoye@gmail.com; Twitter @LukoyeAtwoli

We must become our brothers’ keepers again

By Lukoye Atwoli
Sunday Nation 02 June 2013

Almost three weeks ago, I received the following message from a medical doctor who is also a good friend:

“Hello Lukoye, hope you are well. I text with great sadness. Depression took my friend on Saturday. She hanged herself. It was chronic and she was in treatment for so many years. Still no one understands and there will be many more like her.”

As if to drive the point further home, a teacher suffering from mental illness emailed me last week to thank me for writing about the plight of people living with mental illness and, specifically, for trying to reduce the stigma society attaches to such illnesses. Here is an excerpt from that email:

“Am a graduate teacher living with a mental illness ... Am not even very sure of what I suffer from. It all started in 2007 while outside the country as an expatriate teacher ... It is the worst thing that can happen to a person and one needs love and care.

“Luckily for me I have a very loving wife and I generally live a near normal life. She monitors me in love and cautions me in case of an abnormal behaviour and I follow her advice religiously. However, I pass through humiliation everyday and so are my sickmates (sic).

“Before 2007 the term mad was like any other word in the dictionary. After my traumatic experience that had me repatriated, I became very sensitive to the term. 

Switch off

“Any time I am in a conversation and someone says ‘don’t be crazy’, which is ordinarily normal in a Kenyan conversation, I switch off. One day the principal of the school (where) I teach, while addressing the heads of departments, said: ‘leave that teacher alone, he is crazy, he was brought here to just grow old, retire and die.

“If you give him any class he will just butcher the learners.’ I felt so humiliated (even) though he was referring to another teacher.”

These stories illustrate just how pathetically we treat our compatriots suffering from mental illnesses.
We need to be aware that people with mental illnesses do not have signs on their foreheads proclaiming their diagnoses. The assumption we tend to make that everyone around us is just fine, and that mentally ill people are those “crazy” fellows safely “locked up” in Mathari Hospital is completely wrong.

Based on research estimates, one would not be mistaken to argue that anything between 25 and 40 per cent of Kenyans will have significant symptoms of a mental illness at some point in their life. This suggests that almost all of us have interacted with a person suffering from mental illness, and chances are that this person is closely related to us.

We must, therefore, be sensitive about our language, given the potential pain we cause daily as illustrated in the cited teacher’s case. 

Early signs

We must also be on the lookout for early signs and symptoms of mental illnesses both in ourselves and in our loved ones in order to get early interventions that often improve the prognosis. For instance, what happened to my colleague’s friend may have been prevented if we all understood the pain she was going through and provided a supportive environment in which to recover whenever she had an episode of illness.

We must become our brothers’ keepers again. 

Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association, and a senior lecturer at the Moi University’s school of medicine  lukoye@gmail.com; Twitter @LukoyeAtwoli

Medical negligence reports grossly exaggerated

By Lukoye Atwoli
Sunday Nation 26 May 2013

Last week, a local newspaper carried a series of stories whose thrust was that medical malpractice was rife in the country and was causing untold suffering and loss of lives in our hospitals. An opinion piece carried during the series indicated that “doctors, pathologists and medical industry players concur that misdiagnosis is running at almost 30 per cent of cases, across both public and private hospitals”.

It was claimed that one in ten patients who suffer medical malpractice die. The writer further made the sensational claim that: “Doctors, it seems, are killing more of us, all the time, than our police and all our criminals put together ever have.”

In my view, the opinion piece did not do justice to a complex problem in the health sector, and only served to increase negative sentiment towards many doctors who are already burdened with an inefficient system.

First, the claim that 30 per cent of all patients are misdiagnosed is not only unsupported by evidence, but is also impossible to ascertain. Not all patients who go to hospital end up dead, and not all patients who die undergo an autopsy. In fact, only difficult cases, or cases where there was no diagnosis or a wrong diagnosis, are likely to end up at a pathologist’s table. It would therefore not be very surprising if there is a higher rate of “misdiagnosis” in this setting. 

Physical exam

Majority of patients visiting our health facilities suffer from conditions that probably do not need any investigation beyond a proper history and physical exam. It is preposterous to claim that when one goes to hospital with a common cold they could be misdiagnosed and end up maimed or dead. All the patients diagnosed with depression or anxiety, and are treated with psychotherapy and medication, are unlikely to end up at a pathologist’s table for an autopsy.

Secondly, the allegation that a tenth of those that suffer malpractice die is premised on the assumption that all those that suffer malpractice are known, and have an opportunity to get a second opinion when still alive, or undergo autopsy if they die. This is simply not true. The author of the piece asserts rather sensationally that there are no statistics in our hospitals, or even at the Medical Board, on such cases. Where she gets her own statistics is therefore suspect.

Sadly, the Saturday Nation also carried an alarmist story about a purported link between a life-saving vaccine against mumps, measles and rubella (MMR) and a pervasive developmental disorder also known as autism. The story was based on discredited research by Andrew Wakefield, whose publication has already been retracted by a prestigious medical journal.

After reading these pieces, a group of my non-doctor friends confronted me and asked me to convince them why they should ever go to hospital again. My answer was simple. 

Risk of dying

Not going to hospital when you’re sick definitely elevates the risk of dying from whatever it is that is bothering you.

Secondly, most doctors you see at hospitals know enough medicine to take care of a majority of the commonest ailments in your vicinity. One is therefore safer taking chances with the doctor than with the untreated illness.

Finally, we must take medical opinions proferred by non-medical personnel with a healthy dose of salt. 

Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association and a senior lecturer at the Moi University’s School of Medicine lukoye@gmail.com; Twitter @LukoyeAtwoli

Mental patients: Media could have done better

By Lukoye Atwoli
Sunday Nation, 19 May 2013

“Kenyan patients escape from Nairobi’s Mathari hospital,” the BBC reported on its website some time last week. The Daily Nation reported that “40 mental patients escaped from Mathari Hospital”. And “Nine escaped mentally ill patients return to Mathari Hospital”, reported The Star.

This narrative was repeated in all news outlets last week when mentally ill patients absconded from the country’s national psychiatric referral and teaching hospital. The Daily Nation editorial on Thursday stated: “... all indications are that the escape was pre-planned and meticulously executed. People who are deranged cannot have the capacity to do that ...”

This same thinking was widely reflected on social media, with many deriding mentally ill people as being zombies, always sedated, incapable of independent thought, “mentally challenged”, or just outright stupid to the extent that any intelligible thing they do should be considered a sign of wellness or conspiracy.

From these examples, it is clear that many view mental illnesses as exotic stuff that only happens to others, never to oneself or to loved ones. They are also viewed as conditions that always result in grossly deranged behaviour, and many people believe that they would recognise a mentally ill person on sight if they met one.

Stereotypes have been created that view making fun of mentally ill people as being a harmless pastime, and everyone, including politicians, refers to their opponents as being mentally ill. The problem, of course, is that this public perception is completely misguided.

First, mental illnesses are not a homogenous condition that can be discussed collectively. Depending on the classification system one uses, there are dozens of different mental disorders, many of which do not share any common symptoms. They range from mild anxiety disorders to the more severely disabling disorganised type of schizophrenia. Painting every mental illness with the same brush is akin to saying that illnesses as diverse as malaria and hypertension are actually the same condition.

Secondly, not all mental illnesses disrupt an individual’s ability to think, plan or organise their own lives. The vast majority of people with mental illness are not in hospital, and are going about their lives oblivious of the fact that the difficulties they are encountering may be due to a mental illness that is amenable to treatment.
They are our politicians, our businesspeople, our health workers, industrialists, drivers and street people. A mental illness is not necessarily a disability.

Thirdly, mentally ill people are not criminals by virtue of being mentally ill, and mental hospitals are not prisons. It is therefore inappropriate to refer to them as having “escaped” whenever they leave the hospital before being officially discharged. In all medical settings, whenever a patient leaves the hospital in this manner, they are said to have absconded. Why it suddenly becomes “escape” in the case of mental illness is beyond me.

Finally, mentally ill patients do not suddenly lose their humanity and become fair game for dehumanising treatment. The Constitution of Kenya guarantees them the right to equality and freedom from discrimination, the right to privacy and the right to be treated with dignity.

Kenyans and the media should should respect the rights of these vulnerable members of our society. 

Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association, and a senior lecturer at the Moi University’s school of medicine lukoye@gmail.com; Twitter @LukoyeAtwoli