ISSN 2307-2849
Auscultate The Official IFMSA Publication for the African Region July 2019
IFMSA Imprint Regional Director for Africa Parth Patel (Malawi)
The
International
Federation
of
Medical
Students’
Associations (IFMSA) is a non-profit, non-governmental organization
representing
associations
of
medical
students worldwide. IFMSA was founded in 1951 and
Editorial Glory Sefu (Malawi) Enow Georges (Cameroon) Aditi Vakil (Kenya) Redscar Daniel (Kenya)
currently maintains 133 National Member Organizations
Layout Design José Chen (Portugal)
skills and values to take on health leadership roles locally
from 123 countries across six continents, representing a network of 1.3 million medical students. IFMSA envisions a world in which medical students unite for global health and are equipped with the knowledge, and globally, so to shape a sustainable and healthy future. IFMSA is recognized as a nongovernmental organization within the United Nations’ system and the World Health Organization; and works in collaboration with the World Medical Association.
Publisher International Federation of Medical Students’ Associations (IFMSA) International Secretariat: c/o IMCC, Norre Allé 14, 2200 Kobenhavn N., Denmark Email: gs@ifmsa.org Homepage: www.ifmsa.org
This is an IFMSA Publication
Notice
© 2019 - Only portions of this
All
publication may be reproduced for
been taken by the IFMSA to verify
non political and non profit purposes,
the information contained in this
provided mentioning the source.
publication. However, the published
Disclaimer
material is being distributed without
This
publication
collective
views
contains of
the
different
contributors, the opinions expressed in this publication are those of the authors
and
do
not
necessarily
reflect the position of IFMSA. The mention of specific companies or
of
certain
manufacturers’
products does not imply that they
Contact Us vpprc@ifmsa.org
reasonable
precautions
have
warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material herein lies with the reader. Some of the photos and graphics used in this publication are the property of their respective authors. We have taken every consideration not to violate their rights.
are endorsed or recommended by the IFMSA in preference to others of a similar nature that are not mentioned.
The cover has been designed using resources from Freepik.com
Contents
A Word from the Regional Director Introducing your SCOPE and SCORE Regional Page 4 Assistants for Europe 3 from the Editorial Team APage Word
Page 5 your SCOPE and SCORE Directors About Page 4
ARM2019 - Health Financing: One Strategy About IFMSA to Universal Health Care Page 6
Page 6
About SCOPE & SCORE SCOME Section Page 7
Page 8
Introducing the SCOPE and SCORE International Team
SCOPE Page 8 Section Page 10
Welcome message from your Sessions Team
www.ifmsa.org
Page 10 SCOPH Section
Page Your12SCOPE & SCORE Sessions Team Page 11
SCORA Section SCOPE & SCORE sessions EuRegMe General AgendaAgenda Page 16
Page Page 14 15
Opinion SECRETArticles BLUE MISSION Page Page20 19
Code of Poems & Conduct Short Stories Page 20
Page 28
What to bring to survive Mother Russia? Regional Page 20 Team Page 36
IFMSA Dictionary Page 22
IFMSA Acronyms
How Page 37to get involved? Page 23
Contact Information Page 23
A Word from the Regional Director
Dear IFMSA Africa, It gives me immense joy and pleasure to bring back to you all the IFMSA African Regional Publication - THE AUSCULTATE MAGAZINE after a very long 5-year period of dormancy. I, wholeheartedly, congratulate the entire African Regional Team, Editorial Board of the Auscultate Magazine, NMO Presidents of the African Region and all the member of IFMSA Africa for all the hard work they Parth Patel have put in to ensure the success of this publication! IFMSA Regional Director With every new publication, there are always topics for Africa 2018/19 that we as the region encourage our members to get involved in based on the current critical global health challenges. This time, as we all prepare to meet at the IFMSA August Meeting 2019 in Taiwan and the IFMSA African Regional Meeting 2019 Malawi, we would like to place a special emphasis to Health Financing - towards attaining a Universal Health Coverage. Health Financing systems are essential in order to achieve the Universal Health Coverage and ensure that everyone can afford and access health services when they need them and where they need them. As you read this, the number of members joining our family is exponentially rising and so are the campaigns in each NMO. It is my sincere hope that through this publication, each and every one of you will have a chance to glance into the lives of your follow members of the region, the challenges they face on a regular basis and how they manage to tackle the problems using their skills and resources. Let this magazine serve as a source of inspiration and a treasure of campaigns that you can work on to replicate in your respective NMOs. As Kwame Nkrumah once said “If we do not approach the problems in Africa with a common front and a common purpose, we shall be haggling and wrangling among ourselves�, therefore we, as medical students, not only are we privileged to have the opportunity but also blessed to be given the responsibility to work for the betterment of the health status of our citizens, our country and the entire region by positively contributing to ensure that healthcare is accessible to everyone everywhere. Let us unite all our efforts for the common good of the region and bring an everlasting impact. See you all soon in AM19 Taiwan and ARM19 Malawi! Dr. Parth K. Patel IFMSA Regional Director for Africa 2018-19
4
Auscultate | July 2019
A Word from the Editorial Team
Dear IFMSA Africa, It has been an honour and joy to serve you with regard to the initiative of reviving the IFMSA Africa Auscultate Magazine. That said, it is with pleasure that we present to you the Auscultate Magazine 2019 edition! We would like to thank all of the authors who took the time to pen down such wonderful submissions. We are sure that as you read through the pages of the magazine, you will agree that there is nowhere near a shortage of talent and finesse amongst the African doctors of tomorrow. Brace up and prepare to enjoy this display of giftedness in various forms, ranging from National Member Organisation (NMO) activity articles, poems, short stories and opinion articles we’re serving them all! Please also indulge yourselves in a few words from the sages, the IFMSA Africa alumni and of course, not forgetting the preview of what the upcoming African Regional Meeting 2019 theme entails. We have a lot to keep you hooked! Furthermore, we also hope that you will be encouraged and stimulated as you take in the thoughtprovoking as well as inspiring perspectives that are presented and that in turn, it will spur you on to maintain and create more amazing work in your respective NMOs and countries as we learn from one another. Knowing that there has been a long silence with the magazine we are certain that as it gains traction over the next few years, there will be more and more submissions coming in. We hope to see equal representation across our continent in terms of Standing Committees, sub-regions and NMOs themselves. Nonetheless, we have gotten off to a good start and our plea is that the zeal that has been shown this time continues to grow. Africa has a very unique story and we ought to lend our voices to her lest this beautiful story goes untold. We are proud of our NMOs and members and would like to continue celebrating the strides that are being made, so write on dear Africa, write on! It was an immense privilege to serve you in this capacity and we would like to sincerely thank you for entrusting us with this opportunity. Best regards from the Auscultate Magazine 2019 Editorial Team,
Glory N. Sefu Editor-in-Chief MSA-Malawi
Enow Georges Content Editor CAMSA-Cameroon
Official Africa Magazine
Aditi Vakil Content Editor MSAKE-Kenya
Redscar Daniel Content Editor MSAKE-Kenya
5
ARM2019MW - Health Financing: One
Health financing refers to the “function of a health system concerned with the mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. The purpose of health financing is to make funding available, as well as to set the right financial incentives to providers, to ensure that all individuals have access to effective public health and personal health care. Health care financing remains a challenge in many low-income countries. The Abuja declaration orders countries to ensure at least 15% of the national budget goes to the health sector. However, many low-income countries in Africa struggle to reach this target. For example, for the past 8 years, in some countries only about an average of 10.8% of the national budget was allocated to health sector. Hence, many health systems are heavily developmental partnerdependent. For example, in Malawi, during the period 2012/13-2014/15, development partners’ contributions accounted for an average 61.6% of Total Health Expenditure (THE), government accounted for an average of 25.5% and households 12.9% of the THE. With such donor reliance, the health financing systems are unreliable, unsustainable and unpredictable. The objective on financing is to increase health sector financial resources and improve efficiency in resource allocation and utilization in order to ensure quality, equitable and affordable health care with the aim of improving health status, financial risk protection and client satisfaction. This calls for a need of innovative ideologies that would help in streamlining financial resources in the health sector in order to achieve the primary health care approach which helps to remove the social gaps and ensure access to acceptable, quality, and affordable health care by even the poorest of the people in the rural areas while at the same time ensuring sustainable and self-reliant financial system in African countries. Financing the health sector cannot and should not only be responsibility of the governments as is the case in most low-income countries. Medical students are future global health leaders and hence have a big role to play now so that when they assume such positions later, they have practical ideas on how to develop and sustain stable and selfreliant health systems financially. Because of the above, ARM2019 will have “Health Financing, a Strategy to Universal Health Coverage” as the main theme of the meeting. The conference overall objective is to equip medical students with practical ideas on how develop/implement sustainable financing strategies for the health sector which can be applicable in their respective settings. We want to challenge ourselves, that as future global health leaders, “what else can we do to
6
Auscultate | July 2019
Strategy to Universal Healthcare
ensure financing of the health sector for our region?”. In addition to the theme, we have also prepared many more sessions on public health, non-communicable and communicable sessions, sexual and reproductive health and others.
The preparations for the ARM are underway. The organising committee is working so hard to give the African region and enjoyable and yet educative regional meeting with the above theme. So far, a stakeholder identification and analysis has been done. We are happy to say that the stakeholders are excited about the development and willing to offer much support, especially owing to the fact that this has been solely organised by students and it is highly applicable in our very situations. For interest sake, the ARM is set to happen from 16 to 22 of December 2019 at Linde Hotel in the beautiful capital city of Malawi, Lilongwe. Please be on the alert for our invitation package that we are sending out on 15 August 2019. We will be so happy to welcome you to Malawi so that together we help finance our health systems. ARM2019MW: “HEALTH FINANCING; ONE STRATEGY TO UNIVERSAL HEALTH CARE”
Samuel Mpinganjira ARM2019 Malawi OC Chairperson
Official Africa Magazine
7
The Pain that Never Heals “While a murderer destroys the physical frame of a victim, a rapist degrades and defiles the soul of a helpless female “ She sat alone, bowing in disgrace, distraught and dismayed as tears rolled down her cheeks. Gasping with hate and regret, trying to make sense of the act while simultaneously casting the shadows of Alhassan Barrie blame on herself, her legs and dress blood-stained... SLEMSA-Sierra Leone this was the reality of rape culture in her society. She was just 11 years old when her childhood was abruptly ended by a family friend who sedated and raped her. From the horrific gang raping of Nirbhaya, a 23 year old paramedical student in a moving bus on the streets of Delhi to the grievous crippling of a 5 year old Sierra Leonean girl by an uncle who raped her anally and caused spinal injury, rape (physical or sexual assault) has been the plight of over 35% of women worldwide, as per statistics collected by UN Women (with some national studies showing up to 70% of women experiencing physical and/or sexual violence from an intimate partner in their lifetime). The scariest statistic, however, is the persistent increase in sexual penetration of minors worldwide. Approximately 15 million adolescents (aged 15 to 18) worldwide have experienced forced sex at some point in their lives, with 9 million victims within just the past year. According to the Freetown-based Rainbow Initiative, 76% of rape victims in 2018 were aged 15 years or younger, including babies, while the rest were 16 to 20. Furthermore, of the 8,505 rape victims in 2018 (which doubled the 4750 recorded in 2017) about one in three were minors, according to Sierra Leone police. This shocking tally is almost certainly an understatement with many cases going unreported. It is critical to understand the complexity of this issue if we are to fight a good fight against rape. The fact remains that it is an issue on the rise globally. Two women are raped every hour in India; in South Africa, it is seen as an almost acceptable social phenomenon, and in our beloved country, Sierra Leone, we are seen as a society with a culture of rape (Chernor Bah of the UN global education initiative). Rape is unarguably the most violent crime that can be committed against another human. It is a crime of violence and aggression that not only hurts a victim in that moment, but shatters their entire life. It outrages an individual’s modesty while transforming their life into one filled with fear, depression, guilt, suicidal ideation and social stigma, adding to the gynaecological, reproductive and sexual disorders, as well as unwanted pregnancies that can result from the act. Many individuals lose their health, livelihood, families and
8
Auscultate | July 2019
support networks as a result of rape. This in turn can shatter the structures that anchor the community values, translating into a disruption of their transmission to future generations. Children accustomed to acts of rape can grow into adults who accept such acts as a norm. This vicious cycle must stop. But why do people partake in such inhumane acts? In as much as there can be no justification for rape, the attitude of male sexual entitlement, witnessing of violence against women by children, and the unsafety of women in and out of the home are thought to be major causes. The narrative of a woman being sexually assaulted while walking down a dark alleyway may still play out on many TV screens, but in the real world, rape is far more likely to occur in the home, and at the hands of someone familiar: a friend, a relative or a neighbour. People rape to assert their dominance, and to maintain a position of power that they have over someone. When an attacker commits rape, it is not a gesture of love or thoughtfulness, but of humiliation of someone else in order to build their own self-worth. Surprisingly, the most important cause of rape facing our generation is the reality of rape culture in our society. Myths such as “She was asking for it” and “You were drinking, what did you expect?” are clear manifestations of rape culture being alive today. Our society’s focus tends to be on the dress code at the time of the assault, or whether the victim had done something to invite the attack. These myths about the choices of victim, as opposed to the choices made by the rapist, are as painful as the violent acts themselves. “When being raped, she shouldn’t fight back. She should just be silent and allow the rape,” stated one of the perpetrators of the Delhi 2012 attack. It’s time we stop teaching our women how to not get raped, instead of teaching our men not to rape. In conclusion, sexual violence poses as an obstacle to peace in society. It impedes women from participating in peaceful and democratic processes, and in post-conflict reconstruction and reconciliation. When used as a tool of war, it can become a way of life. And once it has become entrenched in the fabric of society, it lingers long after the guns have fallen silent. It is indeed a pain, a pain that never heals.
Official Africa Magazine
9
District Health Management and Medical Students A District Health System (DHS) operates at a District Level based on the principle of Primary Health Care (PHC): the provision of health care that is equitable, efficient as well as effective. The DHS covers all 28 districts in Malawi and is fundamental because the country’s health status depends on the performance of the health systems at district community levels. Dealing with both curative and preventive approaches, the Nellie Namale DHS is indispensable considering that most causes of MSA-Malawi mortality in Malawi are due to preventable diseases. The District Health Management Team (DHMT) is a group of personnel with various leadership roles that ensure the effective operation of the DHS. The Director of Health and Social Services heads the DHMT and reports to the District Commissioner1. The person leading the team to have extensive knowledge on the DHS as well as PHC due to the high level of organisation required. Although the DHS is the life blood of the Malawian health system, most medical graduates are yet to have any basic knowledge of its functional and administrative structure - a limiting factor because although capable, many shy away from the administrative posts due to their lack of exposure. For those that do venture into it, their performance may be limited due to their lack of knowledge in and exposure to DHMT and PHC. It is therefore a necessary initiative to educate medical students on the DHS and give them a more practical experience before they graduate into the professional field. From the 4th to 22nd of June 2018, the Standing Committee of Professional Exchange (SCOPE) of the Medical Student Association-Malawi (MSA-MW) conducted a three weeklong District Health Management Elective (DHME) under the management of the Blantyre Health Office. The DHME included medical students in different years with the purpose of cultivating medical doctors who are well versed in the functional and administrative structure of the DHS before venturing into the medical profession. It was also carried out to improve the students’ leadership skills by providing a forum where they could interact with different leaders in the DHMT and hence get motivated. During the three weeks, the students had several attachments where they gained first hand insight on PHC, implementation of specialised health programs and health care management leadership service under the DHO. By the end of the course, the students were required to come up with an implementation plan that would be beneficial to the district. The DHME, upon evaluation by the participating students had a lot of advantages. To begin with, the DHME had given the students exposure to practical experience in the DHS outside the medical curriculum. It also provided a forum where students were exposed to the day-
10
Auscultate | July 2019
to-day administrative functions of the DHS, where any of their concerns were addressed there and then. This experience cannot be substituted with theoretical knowledge. Secondly, the DHME provided a forum for collaborative teamwork among students of different years of study; from pre-medical students to prospective final year students. This arrangement fostered the sharing of knowledge and experience among the students. Additionally, the DHME fostered a leadership spirit among the students by providing them with exposure to the administrative roles of the DHO leading to the students’ comprehension on the need to build leadership skills alongside their clinical skills. Finally, the DHME managed to achieve its goal of enlightening the medical students on PHC in Malawi. The students learned how PHC works and were able to pinpoint the shortfalls and how they, as medical professionals, can help to improve Malawian PHC for an improved health system. Despite its benefits to the students, the DHME had one challenge, which was the fact that some of the departments of the DHMT had not been informed early enough to prepare activities for the students. Early notification of the staff was required for preparation of wellorganised activities to enlighten the medical students on their roles as far as DHS was concerned thereby depriving the students of potentially useful information in the operation of DHS. However, the DHO for Blantyre District Health Office; Dr Gift Kawalazira, stated that the DHME was a pilot and the upcoming DHMEs will be well-structured for maximum effectiveness. In conclusion, it is hoped that there will be future editions of DHME to continue conducting such educational experiences that foster collaborative teamwork among the medical students. Many are in agreement that it needs to be organised more strategically in order to maximise the information that the students will be exposed to. To this end, it has proven to be a vital program necessary for training doctors who are well versed in PHC and how the DHS functions. References 1. Health Sector Strategic Plan II (2017-2022) 2. Ministry of Health - MoH/Malawi and ICF International. 2014. Malawi Service Provision Assessment 2013-14. Lilongwe, Malawi: MoH/Malawi and ICF International. Available at http://dhsprogram.com/pubs/pdf/SPA20/SPA20.pdf. 3. World Health Organization (1984) . Glossary of terms used in the "Health for All" series, no. 1-8. Geneva : World Health Organization. http://www.who.int/iris/handle/10665/39565 ... 4. https://web.archive.org/web/20110615213535/http://www.hst.org.za/publications/ south-african-health-review-1999
Official Africa Magazine
11
The Community needs a "Health Compass" Non-communicable Diseases NCDs account for over 70% of global deaths annually, with 85% of NCD-related premature deaths between the ages of 30 and 69 years occurring in low- and middle-income countries LMICs1. Although NCDs have highly significant global health indices in terms of morbidity and mortality, they could perNelson U. Emenogu C. haps be easily managed or totally preventUdeme-Abasia, Uchennaa ed by simply modifying or quitting harmNiMSA Nigeria NiMSA Nigeria ful individual lifestyles such as physical inactivity, tobacco use, alcohol consumption, unhealthy diet and excessive salt intake. However, most communities in LMICs are not even aware of the negative effects of these special group of diseases that is closely tied to their own way of life. This may be due to modern day healthcare facilities being too far away from the community due to urban-rural workforce inequity, inefficient health education, poverty and a bad health seeking behaviour common among most Africans. There is therefore a need to bring the hospital closer to the community through a friendlier, more flexible, and functional approach, especially by younger global health enthusiasts due to their youthful drive and passion. Hence the birth of Health Compass. Health Compass is a medical student led activity registered under the Healthy Lifestyle and Non-Communicable Diseases program of the International Federation of Medical Students Association IFMSA. With a membership strength of 25 dedicated medical students of the University of Uyo in Nigeria, it seeks to bridge the gap between the community and the hospital with an aim to lightening the burden of NCDs on the former. It does this through, weekly radio broadcasts on health awareness and preventive approaches to healthy living; blog posts and social media campaigns; community outreaches; fundraising campaigns and capacity building amongst its members to ensure sustainability, advancement, and professional development amongst its members. Thousands of community members have called into the radio show since it began in October 2017 to ask questions about their health concerns-some of which were pointers to red flag symptoms. Hopefully, the health seeking behaviour of the community should have increased as well- allowing for early diagnosis and management of most NCDs. The activity won 2nd best medical student-led activity in Africa during the An-
12
Auscultate | July 2019
nual Regional Meeting in Ghana, and was part of top 10 activities for the Rex Crossley Award of the IFMSA in Slovenia, 2019. Many more medical students have indicated interest and other universities have proposed partnership for better national coverage. The community is fast becoming distant from the modern day hospital especially in LMICs, potentially threatening the plausibility of Universal Health Coverage. As NCDs constitute a bulk of global deaths and are usually preventable with simple lifestyle modifications that are often not well communicated to the community by the hospital-being mostly busy with already established morbidities, there is a need to help reposition the community to embrace healthy lifestyle modifications. Medical students in diaspora are therefore encouraged to serve as health compasses to their communities. References 1. World Health Organization(WHO).Noncommunicable Diseases Fact sheets 2018[internet]. Geneva:WHO;2018.Available from: www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
Official Africa Magazine
13
Is Depression our next Ebola? Charmaine R Sanyika ZiMSA-Zimbabwe. "I'm going through a lot." This is a famous statement that has trended in memes and occasionally brushed our lips like a tube of lip balm. Studies show that our generation has recently been hit by a massive epidemic known as depression, which seems contagious, and flourishes well among the youth, college students and those in highly stressful work environments. Yet despite a spike in suicide rates and an increasing number of mentally ill patients being admitted, as Africans, we have not given the patients the same level of care as that given to the diabetic, epileptic and HIV-positive patients. Are we to label this as ignorance on our part, or sheer lack of knowledge? Either way, something needs to be done, and soon, before we wear this disease like a second skin. The problem is, as a society, we label the sufferers as ‘attention seekers’ and fail to accredit mental health as having equal weight as that of cardiac health. With 1 in 4 South African university students being diagnosed with depression (WHO), we can only imagine the route the world is taking. We have around a quarter of the population suffering from poor mental health, and less than half seeking treatment. As a society, we need to come to terms and take note that depression may just be as bad as diabetes, if not worse. Another point to note is, depression is high among college students - hence we may need to consider more awareness seminars and campaigns like those given for HIV and AIDS to educate our youth. For these to be effective, we need to understand the root of depression, its impact on mental health and how it can lead to suicide. What is depression? Depression is a feeling of severe despondency and dejection affecting a person’s condition with regard to their psychological and emotional well-being (mental health). The most common root of depression faced by students is their excitement of starting college, making new friends, new experiences and long-awaited freedom being crushed by the feeling of homesickness which hits when one fails to adapt in the new environment. Furthermore, our tendency to be less educated on such a core origin of depression makes us ignore major factors as family history, lifestyle and dietary needs. As mental illness are likely to occur if already present in past generations and family lineages, stress and social pressure may exert major influence. It has been noted that the youth
14
Auscultate | July 2019
of today compare and base their lives on celebrities, trends and social media appeal. Such that an individual with an already low self-esteem, when exposed to such an environment of comparison to “perfectionism”, may have increased sensitivity to criticism and be more susceptible to suicidal thoughts. The home environment is another major factor especially if the home environment is not one full of love, affection, words of affirmation and assurance. What is the next step to assist someone suffering from depression? Sympathy and empathy are usually key elements as a mental illness resembles a rollercoaster ride with strong dips and dramatic highs. Hence people should try their best to understand and be sensitive as to why their loved ones are a bit rude at times or need space. However, at times depression has some quick fixes, which include: • Getting enough sleep (6 to 9 hours) instead of pulling all-nighter, usually promoted by the “demon” that is procrastination. • Exercise may also help as it releases endorphins (the feel-good chemicals in your brain) thus helping clear an individual’s mind. • Alongside a good balanced diet, avoiding drugs and anti-depressants is best as they only temporarily mask problems. • Overall, joining support groups from either school or church is also encouraged, as other people in similar situations my share their stories and the fear of being the only one facing such will fade. The same urgency, financial support and awareness we give other illnesses and diseases such as Cancer and HIV and AIDS should be given to depression as it is fast becoming our Ebola. The only difference is, it affects everyone equally. no matter the social status. Therefore, it holds the potential to sweep out an entire generation of millennials. After reading this article I hope you are enlightened and motivated to promote mental health awareness by helping others, caring for them, checking up on them and giving them moral support. Make an impression to combat depression! Reference International Association for Suicide Prevention (IASP) http://www.iasp.info/resources/Crisis_Centres/Africa
Official Africa Magazine
15
The Stroke of Midnight I see you. Always in a short skirt and tight blouse. Always at the same time: MIDNIGHT. Always alone. A wry smile on a most sombre countenance. You no longer signal to the drivers. THEY come to YOU. I see you. Three times a week, like clockwork. On Mondays, Wednesdays and Fridays. Todays’ Monday. 10:40 P.M. Immaculate Asiyo I am way too early. I pull over to the petrol station along MSAKE-Kenya Uganda Road and fill up fuel as I wait. This part of town is usually quite empty at this time of the night. So quiet and peaceful. I take out a can of Red Bull and some left over ribs and fries, wrapped in aluminium foil, from my blue shopping bag. I throw glances at the electric pole-the one against which you love to prop your body-every time I bite off a chunk of meat from bone. I munch on the meat, and chips, crack open the can and carefully place it at the top of the dashboard. Tick! Tock! Tick! Tock! 10:58 PM. It’s not yet time but I am done eating. I reach out for the box of serviettes close to my feet; my head comes up again and I find myself staring directly at the pole. I see you there. Waiting. You’re early too. You have on, your short leather skirt, an orange crop top and leather highheeled boots. The best combination yet, I think. I can make out the tall slender outline of your body. Your hair blowing ever so slightly in the low speed wind, your beautiful darkbrown skin glowing in the moonlight. The subtlety of your mysterious demeanour is like a secret that only I know. You deserve to be treated like a queen. 11:15 P.M. I take a sip of my energy drink. Then another, and another. A black Mercedes Benz pulls over and the other girls move away. They know he only wants you. Your eyes look even sadder than before now. You clutch at your wrist and face down as the vehicle approaches. He pulls down the window of his car. You look up and your eyes meet. I do not know what you two are talking about but he looks furious. Looks like you are arguing about something. He gets out of the car and clenches your arms. You jerk and attempt to run away but seemingly, his grasp is too tight. You look like an animal cornered into a cage. You take a gander at the other girls, as if to ask for help, but they all stare at you blankly. It’s almost like he owns you. He tries to whisk you into the back seat of his car but somehow you manage to escape from his grip. I do not know why I am here and not there, trying to be your knight in shining armor, oh damsel in distress! The man gets into his car and drives in your direction. 11:40 P.M
16
Auscultate | July 2019
Bang! Bang! It’s so loud I can barely hear myself think. I do not see you run anymore. The man drives off and I see your body by the side of the road. You, writhing in pain. Your ‘colleagues’ have long gone. It’s just you and me now. I alight from my trailer and head towards you; at first walking, then I begin to sprint. I see your almost lifeless body lying on the ground, in a pool of blood and I gasp. Two gunshot wounds on the chest oozing blood. You look up at me with those big brown beautiful eyes and for the first time I catch a glimpse of something in your visage I have never seen before- relief. Tears well my eyes. Damn! If only I had come sooner. I take out my phone from my side pocket, hands shaking, and struggle dial a number I never thought I would…999 MIDNIGHT Everything I had seen so clearly before seems so murky now. It’s almost as if I am in a trance. I hear the muffled sounds of ambulances or police car sirens and people shouting. The blurred vision of the detectives, and your body being loaded into an ambulance and again, so many people. I cannot make sense of it all. I go back to my truck, staggering, and slowly drive away. Where to? I am not quite sure. I saw you. In a short skirt and tight blouse. At MIDNIGHT. A genuine smile on a pleasant countenance. This time you were not alone.
Official Africa Magazine
17
Legalizing Abortion in Nigeria: a religious suicide? Sharon Igbadume Gift NiMSA-Nigeria It started with a class on maternal mortality during my Obstetrics and gynaecology posting. I listened to the consultant as he talked about unsafe abortion being a cause of maternal mortality, and that these abortions are unsafe because they are illegal and are often carried out by incompetent individuals, resulting in potentially life-threatening complications. He went ahead to blame the religious heads for standing in the way of legalizing abortion in Nigeria...which got me thinking. However, before we talk about my thoughts, let’s get onto the same page. WHAT IS ABORTION? Abortion, as we know it, is the termination of an unwanted pregnancy. However, medically, that barely qualifies for Unsafe Abortion. Abortion is the loss/termination of a pregnancy before the age of foetal viability, which is the age at which a foetus can survive outside the mother’s uterus. It varies from region to region, however, in Nigeria; it is taken as 28 weeks (about 7 months). So if a pregnancy is lost or terminated before 7 months, it is an abortion. HOW DOES OUR SOCIETY VIEW ABORTION? Societies like ours are quite wonderful. Being pregnant without a husband is a constant source of shame. Being caught carrying out an abortion is another cause to be gossiped and scorned. Being seen buying or having a condom or any other means of contraception is an avenue to be regarded as spoilt and without shame. It makes you wonder where one can go. In a society that takes pride in exalting false righteousness, fornication and its associates are regarded as sin or even the devil in flesh’. The ones that commit abortion are the murderers and therefore dying from abortion seems like a fitting punishment. WHAT IS THE PLACE OF RELIGION IN OUR SOCIETY? Religion is a powerful force in our society. It has saved, misled and contributed towards deaths of countless people. It is an important cause of uproar in the medical field. I have always nursed a respect for religion, pastors and prophets; trying never to speak against them, leaving judgment for God to pass. However, we all are aware of some detrimental things that religion is doing to the society. We have heard of pastors that rape their young members, or request for money to support their luxurious lifestyles, amongst others. No one
18
Auscultate | July 2019
is reprimanding them; no law is being passed to curtail these excesses. Yet, everyone comes together to speak against abortion as though it is the greatest of evils. NOW, MY THOUGHTS: I do not think legalizing abortion will increase the rates of abortion. It is known that abortion is illegal. Has it stopped people from trying to terminate pregnancies? I do not think the fear of getting an abortion really stops people from engaging in premarital sex. Even if it does, it applies to a small percentage of people. Yes, I agree that the proper thing would have been Abstinence. But if that cannot be achieved, does it guarantee that those who fail at it should suffer or die? In the movie Dirty Dancing, Penny is impregnated by a boy she believes loves her. He denies the pregnancy and even mocks her. The brutal doctor who comes to abort her pregnancy administers no anaesthesia and allows for no companionship. Penny would probably have died had Baby’s father had not stepped into the picture. Penny had a lapse in judgment, and the point is, it can happen to anyone. Anybody can get carried away. Why must they suffer and even die because of that? Are they the only sinners? What about the boy whom she "sinned" with? Why does he get away with it? If we legalize abortion, or at least have mini-clinics for that purpose, these people can get better health care in the hands of licensed personnel, who can at least, if not more, know when to refer. I refuse to buy into the belief that pain or death during/from abortion is some form of punishment from God for their sins. I don’t know about yours, but the God I know is not heartless. He is compassionate and full of mercy. The bottom line is, Yes! Abortion is something we should try to avoid, but legal or not, it still has its complications, and in all cases, nobody deserves to die in the process.
Official Africa Magazine
19
Opinion Articles
Non-Communicable Diseases: Africa's Silent Killer While we wage war against infectious diseases, a silent battle is rising and claiming the lives of many: the battle against non-communicable diseases (NCDs). A Non-Communicable Disease is one that cannot be directly transmitted from one person to another, and the main ones are cardiovascular diseases, cancers, chronic respiratory diseases and diabetes (1). In 2015, NCDs accounted for 33.5% of all deaths, Pemphero Munkhondia as compared to 29.4% in 2010 - and are expected MSA-Malawi to rise by 27% over the next 10 years in Africa (2). The noted trend has been associated with the epidemiologic transition most African nations are undergoing (2). Urbanization has led to a rise in risk factors such as physical inactivity, smoking, alcohol consumption and obesity. A World Health Organization (WHO) study found that one in four people in Africa have at least three risk factors (3) thus increasing the probability of developing disease. Left unattended to, NCDs will take a significant toll on Africa’s economy, consequentially leading to catastrophic results. The cost-of-illness (COI) approach is a common method used by economists to estimate the economic burden of disease. It considers the direct and indirect costs of seeking medical care, such as costs incurred during diagnosis, treatment and transportation to the medical facility just to mention a few (4). A report by the World Economic Forum and the Harvard School of Public Health showed that in 2015 the COI for cardiovascular disease globally was USD 906 billion, and was expected to rise to 1,044 billion US dollars by 2030(4). The same report showed that the COI for cervical cancer was 4,651 US dollars globally, in contrast to a study done in Kenya which showed that the COI is approximately 1,500 US dollars and 7,500 US dollars in public and private health facilities respectively (4,5). These figures give a clear picture of how costly it is to treat NCDs. As a lack of sufficient resources is the primary challenge faced by a majority of African nations, prevention is the way to go. Research has shown that a country is bound to spend more in treating, as compared to preventing development of the disease. Using hypertension, the leading silent killer, as an example, it cost an average of 733 U.S Dollars per annum to treat an adult suffering from hypertension in 2010 in the United States alone (6). On the contrary, the Copenhagen Consensus Centre projected that a country would have to spend an average of 0.09 U. S Dollars per annum for each citizen to implement voluntary salt reduction strategies (7). Of note is salt reduction is regarded as one of the WHO best buys for NCD prevention. Africa can adopt simple cost-effective strategies to arrest the increase of NCDs. Examples of such strategies include raising awareness through existing media platforms, encouraging behaviour change (lifestyle modification), screening programs for early identification of disease, aspirin therapy for those identified to be at risk of cardiovascular disease and policy formation and implementation. An example of an effective measure, which also aids
20
Auscultate | July 2019
in achieving the Global NCD Target to Reduce Tobacco Use, is implementing a policy on increasing tobacco taxation - statistics show that with each 10% price increase on tobacco, there is a 4-8% decrease in consumption (7). Another example is Argentina and South Africa who implemented a policy on salt reduction at production level, calling for bread manufacturers to reduce the amount of salt used (7). Zooming in on the Warm Heart of Africa, Malawi has made efforts to combat NCDs by educating and screening the population; however, the main challenge is the fact that these services are facility based (8) - those who do not visit the hospital miss out. Another commendable job is the adoption of the aspirin therapy: stroke patients are given 300mg of aspirin for the first two weeks as part of treatment followed by 75mg lifelong (9). More can definitely be done by engaging in mass education on NCDs, active screening by going into the communities, early identification of populations at risk to allow early initiation of aspirin therapy and invest more in facilities that will enable the health sector to provide medical services such screening and diagnosis. This is a call to Africa to wake up, do away with all misconceptions about NCDs and fight the emerging silent battle. NON-COMMUNICABLE DISEASES ARE NOT DISEASES OF ONLY THE RICH. References 1.
2. 3.
4. 5.
6.
7. 8.
9.
World Health Organization. GLOBAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES iii WHO LIBRARY CATALOGUING-IN-PUBLICATION DATA. WHO Press [Internet]. 2013;55. Available from: www.who.int/about/licensing/copyright_form/en/index.html The Rise and Rise of Chronic Diseases in Africa - Sanofi [Internet]. [cited 2019 Jun 30]. Available from: https:// www.sanofi.com/en/about-us/healthcare-solutions/the-rise-and-rise-of-chronic-diseases-in-africa Non-infectious diseases such as cancer rising sharply in Africa | Global development | The Guardian [Internet]. [cited 2019 Jun 30]. Available from: https://www.theguardian.com/global-development/2016/dec/20/noninfectious-diseases-such-as-cancer-rising-sharply-in-africa-world-health-organisation Liao XL, Deng YY, Kang Y. Value of procalcitonin in diagnosing ventilator-associated pneumonia: A systematic review. Chinese J Evidence-Based Med. 2010;10(8):910–5. Subramanian S, Gakunga R, Kibachio J, Gathecha G, Edwards P, Ogola E, et al. Cost and affordability of noncommunicable disease screening, diagnosis and treatment in Kenya: Patient payments in the private and public sectors. PLoS One [Internet]. 2018 [cited 2019 Jun 30];13(1):e0190113. Available from: http://www.ncbi. nlm.nih.gov/pubmed/29304049 STATISTICAL BRIEF #404: Expenditures for Hypertension among Adults Age 18 and Older, 2010: Estimates for the U.S. Civilian Noninstitutionalized Population [Internet]. [cited 2019 Jun 30]. Available from: https:// meps.ahrq.gov/data_files/publications/st404/stat404.shtml Nugent R, Brouwer E. Benefits and Costs of the Noncommunicable Disease Targets for the Post-2015 Development Agenda. Prioritizing Dev. 2018;231–43. Lupafya PC, Mwagomba BLM, Hosig K, Maseko LM, Chimbali H. Implementation of Policies and Strategies for Control of Noncommunicable Diseases in Malawi. Heal Educ Behav [Internet]. 2016 Apr [cited 2019 Jun 30];43(1_suppl):64S–69S. Available from: http://journals.sagepub.com/doi/10.1177/1090198115614313 Mahawish KM, Heikinheimo T. Stroke in Malawi--what do we know about it and how should we manage it? Manage it? Malawi Med J [Internet]. 2010 Mar [cited 2019 Jun 30];22(1):24–8. Available from: http://www.ncbi. nlm.nih.gov/pubmed/21618845
Official Africa Magazine
21
Opinion Articles
Rich Poverty TA! TA! TA! is all I could hear on my pillow on that chilly evening as I lay on my bed in a grass-thatched house. It was the cry of a soul, the weeping of a heart and the drop of a tear from my already flooded eyes. Follow this keenly for it is not only the cry of a man but also a picture of the bleeding Africa. I was born in a family where my father, Mr. Ramsi, had two wives and, in line with the poetry of filling Kellion Mwaura the earth, was blessed with nine sons and two Egerton University, daughters, me being the youngest child of them MSAKE - Kenya all. Ooops! You are not aware poverty was our daily song while suffering was the better part of our lyrics. The wives, or rather our mothers, couldn’t stare at profound poverty and undisputedly left home for greener pastures, leaving us in the hands of our poor dad. He was a beggar by profession and a survivor by luck. Mr. Ramsi, out of futile efforts to acquire wealth, considering our money-chewing mouths and grumbling stomachs, made up his mind to acquire treasures by setting off for a journey in search of gold around the country. To facilitate his journey, he sold our five acre inherited land to a white man, Mr Cotty, and left us with a well-meaning neighbour. The mzungu settled on our land, built a mansion and, not so many years after, saw glittering stones in the middle of the compound. Gold had been discovered there and the white man launched machines for he had found more than a fortune. Famine hit the land hard and my siblings and the neighbour who hosted us succumbed. How I survived is still a mystery. As if in line with the saying misfortunes never come singly, I received the news that my father was shot dead while trespassing in the neighbouring country where he had gone searching for gold. All I was left with was a grass-thatched house under the threat of gluttonous termites. I sobbed and thought of the riches in the poverty we had. My father searched for gold outside while it was within our premises. Suddenly, a greater picture of Africa came to my mind. It is indeed true that for long we have highly depended on the Whites who actually acquire wealth from our own land. Countries have actually set up standard gauge railways but who actually builds them? Chinese labourers. Where are raw materials acquired from? Africa. Precious tools and equipment have actually been acquired from abroad including jewellery but surely where did the gold originate from? Do we actually buy our own wealth? Factories and big companies have been set up to exploit our resources but who actually manages them? We highly rely on skills from abroad, sell our wealth cheaply and buy it at a very high cost. It is not that we lack the skills. The problem comes in when African children are raised to discover the world through a textbook; making them walk into same classes, follow same
22
Auscultate | July 2019
paths and drive them into thinking the same; actually downgrading their talents, skills and abilities to develop creative ideas. Usually, people pursue their dream careers of which I don’t remember sleeping for one. Yes, they graduate, smart to work but not good enough to utilize and make changes from their own wealth. Those who are smart enough, all head to places abroad leaving their land in a poor and devastated state. Shockingly, some best footballers abroad are Africans but do they really develop their homeland or don’t they just shine in the glory of the whites? If at all we utilized the rich part of our brains, our resources, our talents and wealth within ourselves as Africans, would we need help from abroad to invent and innovate? Would we need whites to discover resources for us in our own land and still sell them to us at a milliondollar price? Would we find any need to borrow money? Would we really need hospital help, importing doctors and professionals? Anyway, my pillow is wet enough and my tears are over. It is not only a glance on the riches in poor Africa but also an awakening call for which we should arise and bring change!
Official Africa Magazine
23
Opinion Articles
'Dustbowl of the Soul'
Kosasia O’neil Wamukota MSAKE Kenya
M y hand reaches out, touching the sky, grasping the endless crevasse of blue. Everything seems to weigh me down and my brain seems to be struggling to tell my feet to move. Darkness prevails and the pain grows intolerable. I wonder if they ever see through the simulated smile. If they ever notice the sadness in my eyes. Do they see beauty where I see ugliness? I have been drowning for years, fighting. I take a breath and listen to my heartbeat. My heart is beating, which means I must be feeling but I am not feeling - why am I not feeling? Could it be that I am fading into soundless oblivion?
Many grab the blade, the bottle, the gun and try to end it all after having such thoughts. By the time you finish reading this, at least six people will have killed themselves around the world. Occasionally they are famous people like Tim Bergling and Chris Benoit, but most of the times they are sons and daughters, fathers and mothers, friends and colleagues. All the experts in the world can talk the talk but unless they have felt it, all the books, articles, speeches cannot adequately define what a depressed person is going through. “Depression is neither sad refrains nor lonely walks. It is unwashed clothes and flaking skin, it is an empty inbox and forgotten friends, it is overeating and still losing weight, it is doubt and confusion. Depression is giving up on yourself and casting off the will to live. Depression is not tragically beautiful, it's just tragic.” Yet despite the catholicity of the issue, we are often in conflict when it comes to talking about it candidly or offering adequate care. We believe that those with mental illness are the orchestrators of their suffering. People who long for suicide most often than not want to escape unbearable torment. The depths of their emotional or physical pain knows no bounds and is always so powerful that it snuffs out their biologically
24
Auscultate | July 2019
ingrained will to live. They not only feel hopeless but are also convinced that they are indeed hopeless. They want to relinquish themselves from their mortal coil for very compelling reasons. Of importance is for people to get the message that suicide is not a cop-out on life. People who complete suicide have had the threshold of their tolerance exceeded. They have fought the valorous battle and they have lost the battle to their illness. By making death from other ailments easier to explain than death from suicide, our society fails us. We fail to understand that suicide results from an illness just like any other and that illness is mental. “In every four people, at least one of them will have to deal with a mental health condition in his or her life. Young people are particularly vulnerable, with suicide being the second leading cause of death globally in people aged 15 to 29 years.” Stigma, fear, and lack of understanding intensify the suffering and prevent the bold action that is so desperately needed and so long overdue. Some people often euphemize suicide by using the words “hurt yourself”. They don’t realize that there are people who hurt themselves intentionally yet they don’t want to die. There are also people who desperately want to die and view suicide as a means to stop hurting rather than a means to hurt themselves. Our ability to solve mental health issues lies in our choice of words. We should use words of compassion, words that show that we care, words that give hope. A society that tries to prevent suicide sends the message to people who suffer, and to those who love them, that their lives matter. That suicide is not the answer. That people care and can try to help. That things have a good chance of getting better. What is experienced today is set to become a “bleep” on the screen of history. So take a nine count if you must, but be ready to stand, and have the ref dust off your gloves. We just may discover with delight that our winning over our troubles and struggles are our greatest treasures. WHILE WE BREATHE WE MUST HOPE!
Official Africa Magazine
25
Opinion Articles
MSAKE’s 3rd SRT The Third Annual MSAKE Sub-Regional Training was held between May 10, 2019 and May 13, 2019 at Baobab Beach Hotel in Diani, Kenya, with the theme of 'Nurturing Effective Leadership Among Medical Students for Stronger Health Systems Tomorrow.’
Aditi Vakil MSAKE-Kenya
Sarah Maitho MSAKE-Kenya
A total of 153 delegates from all across Africa participated in one of the seven trainings, namely:
• Ipas: Maternal Health and Safe Abortion – with an alarming 13% of maternal deaths worldwide being attributable to unsafe abortion, it is important for everyone in the medical field to be aware of the issues that surround this sensitive matter. Ipas: Maternal Health and Safe Abortions enabled participants to get a deeper understanding of contemporary problems and their potential solutions as related to abortion. • Capacity Building for Mental Health – designed taking into consideration the importance of addressing mental health, especially in medical professionals, this training provided delegates the platform to learn about and engage in discussions pertaining to mental illness. It also covered soft skills such as self-care and self-development to help participants take better care of themselves. • Violence to Victory / Gender-Based Violence – a workshop centred on helping participants understanding what exactly entails gender-based violence, as well as its causes and consequences, its relationship to fundamental human rights, and how to identify and support victims. • From Idea to Impact: Activity and Project Management – the overall goal of this workshop was to empower medical students to lead projects and activities that positively and tangibly impact their communities. It explores all the important stages in project management, right from the conception of the original idea to execution of the final project. • Public Health Leadership Training – PHLT is a training focusing on enabling delegates to be avenues of change on matters pertaining to public health, as well as inspiring them on being innovators in health. This year, the focus was on geriatric health and the specific issues that concern this critical and growing population
26
Auscultate | July 2019
• Training New Trainers (TNT) – a workshop that helps participants learn and improve on soft skills like public speaking, communication and time management, which can be applied not only during professional interactions with colleagues and doctors, but throughout all facets of day-to-day life. • Emergency Medicine – Headed by the Emergency Medicine Kenya Foundation (EMKF), this course covered the basics of what one should do should they find themselves in commonly-arising emergency situations such as road traffic accidents, as well as management of mass casualty incidents. • As is the standard with all IFMSA-certified trainings, the group sizes were restricted to an average of 20 participants, which provided adequate opportunity for delegates to intimately interact in a relaxed setting with one another and their trainers. The sessions were spaced out throughout the course of the event and involved group discussions, live demonstrations and hands-on practicals. The SRT was graced by representatives from a number of key partners including Kenya Medical Association, Mentor Medics, Daktari Online, GEMx and Kenya Medical Practitioners and Dentists Union (KMPDU). Key highlights included addresses by Dr. Were Onyino from Daktari Online and Dr. Mwachonda Chibanzi and Dr. Ouma Oluga from KMPDU, who talked to participants about various issues pertinent to the medic including labor and working conditions. Information about a number of opportunities and upcoming projects was also disseminated to the delegation, such as options for electives and acquiring continuous professional development points through online sessions It wasn't all just serious business, however! A number of social programs and events were hosted to make sure participants had an allrounded experience with both knowledge and fun aplenty! Competitions such as Beach Survivor, a team-based obstacle course (think Survivor meets The Amazing Race), pitted delegates from the different trainings against each other till just one team remained, while more relaxed gatherings like a Glow-In-The-Dark party served as the perfect setting for delegates to bond with each other and overall let loose and relax. Overall, the 3rd Annual MSAKE Sub Regional Training was a resounding success. It was an ideal opportunity for medical students from all fields to come together, network, learn new skills and broaden their horizons, and it is our hope that more students take advantage of such events in the future.
Official Africa Magazine
27
Poems & Short Stories
Free Convict
Thomas Edwin Williams SLEMSA - Sierra Leone A prisoner of the mind though may seem unbound. A member in the queue yet feels unfound. The fear of doing something and joy of doing nothing at all, Always seem to cloud the mind undecided and thus there’s a stall. The feel of unease often sprouts whenever one tends to do. The ply of irresolution greets the discomfort of morning flu. A clear eye follows a face-wash yet a blurred mind Strolls all day with the body unhindered till the hour to dine. The relevance of staying sober-minded slowly fades away. A period nonetheless comes of the need to get oneself better au-fait With the battle of supremacy between “will” and a force “not to choose”. A conflict that wears one out and is sure to leave a man in the blues. Battling voices within contesting every decision to be made. For every outcome, one of which craves to be the foundation to be laid. Trading blow-for-blow the sounds within are even louder than the ones without, And they keep getting more and more so making life a journey filled with doubts. Sleep tends to be used as a grievous means of escape. Yet equal hours are spent in bed with eyes wide-open listening to the tape. The need for coming out and settling in amongst peers gradually vanishes, Instead the fiercely contesting voices within become more lucid companies. Never a healthy company-these voices; one is assured to take note of. In as much as a ferocious contest between them leaves a man fickly obscure. The assent of unchecked dwell given to them is certainly hazardous. And no aspect of life is left without being impeded or worse.
28
Auscultate | July 2019
These chains of bound hinged to us by our own selves Would by no means yield any affirmative result out of the whole process. Along with it are stress, depression, fear, obscurity, anxiety and a self-inflicted curfew. One as a result of the other, many other undesirable plights included; to name but a few. Apparently a free man can’t be freed any further. But convicted by one’s own mind ought to be a reason to get bothered. And for this, the synchrony of “will” and a force “not to choose” must be stern. One of which a being can only attain when he achieves peace with the inner man.
Official Africa Magazine
29
Poems & Short Stories
\ how the world wishes you fixed it and even if your subjects sought a pastime you fixed it, had deejays make bruce lee speak
Redscar Daniel MSAKE-Kenya
local lingo in ching-chong movies, and in similar fashion when the genitalia of maasai girls get cut we wish you fixed it, the rugs they use when they terribly flow each moon, the maladies of matrimony, the regrets of missing clits, missing orgasms, the spilling of blood we wish you fixed it, the rebuke of kisii girls who won’t be touched if they skip clipping, aren’t cut, the borana tragedy of being tethered to antiquity, fix it. the shame of cultures, the cloud of stigma enveloping kipsigis girls, the pus dripping upon the depth of mau, fix the puberty tears eroding banks of aberdare rivers, the unsterilized blades, the ravines echoing screams of adolescent girls, how the world wishes you fixed it. background: this little poem, itself a call to action, was conceived upon visiting the olmalaika home in sekenani, a remote village at the heart of maasai mara. so touching was a story of a nine-year old girl, let’s call her nepanoi, who had been rescued from the wraths of forced marriage. her twin sister died of complications of the cut. after survising circumcision, nepanoi was married off to a 49-year old clansman who even forced rungus into her to open her up enough for him to fit in. she fled (and was rescued) after her ninth rape ordeal.
30
Auscultate | July 2019
The Emergency Room He came in running next to the stretcher. He was in shock. How could Mary, sweet Mary, be on the stretcher fighting for her life? Everything felt so surreal. He was used to running next to the stretcher in his scrubs. It was he who was supposed to be holding the oxygen mask to some stranger’s face, not some stranger holding the mask to Mary. At the door to the ER they stopped him. He tried to reason with them and explain that he was also in the profession, but it was to no Rudaviro Mundora avail. The nurse just looked at him expressionless and told MSA-Malawi him to go and sign Mary in, then go sit in the waiting area. He tried to reason with her, but she just sighed and reminded him of his oath. He couldn't work on his relatives, for obvious reasons. The nurse just turned around and closed the door in his face. The audacity! Did she know who he was? He would make some phone calls that would make sure she would be jobless by the end of the night. It seemed today fate was against him. All his contacts didn't answer his call. There was no way they would let him in to Mary's room now. He felt so helpless and didn't know what to do. He sat there for almost an hour until a man came out of the emergency room. He frantically got up and asked him if he could go in to see her. The man just looked up from the papers he was holding and asked him if he was Mary's husband. When he said no, he was then asked if he was her brother or anything of that sort. When he again said no, the doctor just told him to go and sit down and not bother trying to get in. Only family was allowed in to see her. When he tried asking the doctor how she was, he just stared blankly at him before walking away without answering the question. Tears of frustration filled his eyes. How could the doctor be so cold? He began to wonder if he also acted in the same way when dealing with patients. He was a cocky man, everyone knew that. He didn't like it when people wasted his time, and he liked things done his way. He was thus nicknamed Doctor Strange after the famous Marvel character. With a sigh he realised he had just answered his own question. He guessed he was even worse than the rude doctor he had just encountered. Now he was getting a taste of his own medicine. The irony. He didn't know how Mary was doing and it killed him not knowing. He never thought he would experience life on the other side, and so far his experience was horrible. He had never thought about how his arrogant ways might affect the patients and their relatives. The man sat there for almost three hours, his thoughts plaguing him. A nurse came and found him sitting with his head in his hands, and she pitied him. From the scene he had made earlier, demanding to see the sick woman, she figured he was used to having things done his way. She let out a loud sigh and proceeded to tell him the woman's bed number. He looked up at her in shock. He was surprised that she was letting him in. He thanked her profusely and proceeded to move quickly to the emergency room. With the way he had felt over the past four and a half hours, he was seriously considering if he should change his arrogant ways when addressing people in the hospital. He had been made to feel small and useless, and it was a terrible feeling. He wasn't promising anything, but he had a lot to think about. Official Africa Magazine
31
Poems & Short Stories
On the Road It is 6:45am and the route 58 minibus pukes us at the commercial area just where Accra Road seems to begin. We are thankful to alight having not suffered convulsions for these Buruburu estate mats are known for their screech and shrill, the loud hip-hop jams within and the kill-me-quick speed. Somewhat dizzy, I try stifling the throbs of the ear drums and dilated forehead capillaries. A street kid asks for coins to have his tin of intoxicating gum and glue refilled. I oblige then advances past, Redscar Daniel trying to ease my way through the shocking sea of humanity. MSAKE-Kenya In Nairobi, if you are not up by 6:30am then you are the only one asleep and the very reason why Kenya’s economy remains in tatters. The craze of the streets below fluorescent lights that grow dimmer with the rising Sahara sun is a marvel. Hawkers litter the side-walks, beckoning multitudes to their splattered wares. I walk to the Tea Room stage in search of countryside-bound vans. I had not booked prior for it is an impromptu journey to Nakuru. I am just glad that the Equity Bank branch at which I intern has given this day off and I need to make the best of it. So here am I, clad in my signature regalia, skinny khaki pants and matching blue jacket, armed with a borrowed camera that dangles off my black backpack and one may mistake me for a black tourist from Tennessee. I am going site-seeing and places in mind include the level-5 Rift Valley Provincial General Hospital, the Lake Nakuru National Park and the Njoro-based Egerton University. All else will be a plus. The Nairobi morning chill breezes past. Hoots and honks are deafening and the yellowdressed city council officials can be seen manhandling traders who won’t part with the 50-shilling bribe. The touts – and bus- booking agents – are a bully. A gang of them approaches me, each shouting out names of different towns. I figure they are asking me if I’m heading to their respective destinations, but the push-and-pulls are just too much. I wrestle my backpack from one of them and, to shake them off, I tell them I’ve just disembarked and I’m not leaving Nairobi any time in the near future. I walk down River Road, branching along the Price Road that empties me into the less-tended Nayamakima Stage. Here I stand from a distance as I scan through the fleet for a vehicle of interest, beating the scavenger touts at their game. I spot a Mololine Shuttle with the front seats unoccupied and I’m all jubilant. I speed towards it and hop in even before booking lest someone else occupies the seat. A uniformed booking agent with a heavy kikuyu accent offers to help with the booking. He asks for the KShs 400 fare, which I fish out from my jacket’s inner pocket and hands him. He asks for my name and I tell him it’s Redscar. Despite prompting me to repeat it seven times, he still seems not to get it. He leaves anyway for the counter to do the registration. As I wait for the agent to bring my ticket, I celebrate my decision to board this shuttle. So far, things seem alright: first, I have secured a front seat, right within the driver’s cabin. When traveling, I always look for the front seat next to the window. I find it more adventurous –
32
Auscultate | July 2019
having a wider field of view and getting to learn more from the driver by observing the driving skills and chatting about their road experiences. Also, I always get to roll down the window and stick my elbow out or hold the upper handle like some rich politician being chauffeured. Second, I have picked an almost full 14- seater shuttle. This means I won’t have to wait for too long for it to get filled and start the journey. I am a little thrifty with my time, always trying to spend the least time doing the most. Also, for today, mine is a case of once beaten twice shy. I don’t want to relive the horrors of last weekend when I was traveling to the Thika-based Mount Kenya University. See, I had boarded an empty vehicle to get my desired front seat. An hour later, the vehicle was still struggling to fill up. I vowed never to be the first to board a vehicle. So you understand my joy at being the eleventh passenger to board this shuttle today, having my treasured seat no less! I see the booking agent coming back from the counter, wooing other would-be passengers in his waking. I am elated that all is set and we are soon to be off to Nakuru. A hawker bangs on my window to distract me. He is selling assorted stuff, ranging from nail cutters to mobile phone power banks. I am disinterested, for my last experience with bulk buying wasn’t so good. Back then, they had sold to me a beautiful, slim iPhone that turned out to be a dummy case with frozen clay stuffed within. This hawker is an insisting one. He mentions an item and I point at mine, choosing to say I’ve left at home anything I fail to point at. He becomes particularly odd while pitching belts. Despite showing him my leather belt that has served me dearly for years, he insists that I pick another for a different use in future, like, say, hanging myself when I descend into an irredeemable depression. I understand him; he is trying to push sales. I appreciate him for his effort and suggest I will buy everything on our future encounter. He leaves just as the booking agent sticks in a ticket through the unclosed upper portion of the window. He mumbles something to do with the name being misspelt, apologizes profusely, and consoles that the name won’t be an issue; what’s important is that I have paid. I unfold the ticket and, behold, they wrote LEDKA! How on earth did ‘Redscar’ so quickly metamorphose into, wait, LEDKA of all names?! I get resigned to the fact that people will always panel-beat my name into a pulp. I am getting used to it. If anything, I’ve been called red skirt and red sky and red scarf before. Then there is a pun guru, a fellow ELP scholar called Mwai, who will always come up with horrendous renditions of the name, which itself is a story for another day. Shiru, a petite lady in her mid-thirties, boards the shuttle and chooses the seat between mine and the driver’s. She is wearing a very expensive lavender perfume, I can tell. I wonder why she is using public transport. We hi-hi each other and set about getting to know what each is up to. She travels a lot, she trots. Me too, I coo. She is in business and I am a tourist today. She is so experienced and one can tell by how she sashays and talks. We learn we share antecedents: both of our biological fathers hail from formerly Kikuyu District of the larger Kiambu County. We talk about our urgency to get to Nakuru and express optimism at the shuttle getting filled soonest. Then, one by one, some ‘passengers’ disembark. Shiru explains to me that this was a ‘set’, that the ones getting off were mere placeholders, paid to
Official Africa Magazine
33
Poems & Short Stories
dupe would-be passengers that the shuttle is about to fill up and set off. How mischievous! We wait. We wait some more. I take out a tab and gets online. I download digital versions of daily newspapers shared by blogger Cyprian Nyakundi on Telegram. I get drowned in the swamp of wowing articles on college education and relationships and witchcraft and parenthood. I turn to Instagram and Twitter to see what’s new on Harvard’s timeline. I evade quizzical eyes of hawkers who occasionally tap on my window to display sausages and mosquito coils and all manner of merchandise. I love their spirit and how enterprising they are. Recollections about jobless university graduates complaining on end crisscross my mind and I wonder how the university education and the entrepreneurship classes have not been put to practice. I shift to WhatsApp to find everyone in the ELP boot camp 2018 group had gone bonkers yester night. I find it hard to reconcile the posts with what’s expected of the much celebrated 142 Matian’gi A’s. The group had almost evolved into a porn classic and back to a repentance platform. The clarion call is that we are human after all and to err is human. Still, I celebrate the diversity in dispositions. At last, the shuttle seats are fully occupied. The driver engages the ignition and meanders through the thick of traffic into Kirinyaga road. Today’s Nairobi isn’t any different; a beehive of activity punctuated with zeal and optimism. Carts are drawn past and traffic police wave hysterically at bodaboda riders who never seem to care for their lives. Mortals are rushing like crazy. The skyline rises as we advance towards Kipande road past the Globe Roundabout. In the yonder, the University of Nairobi Tower lies prostrate, rising so high in its neighborhood, commanding surrounding skyscrapers to squat. Racing past Chiromo along Waiyaki Way, the rumble and thunder of the city wane and the aura and calm of outskirts take the baton in this well-developing relay. I turn to my SAT and ACT exam preps, burying my head into the Barron’s SAT Math II Level 2 PDF file where I am keen on learning something new about functions, permutations and combinations. Whoever says that Math has no notes is wrong. Shiru pleads with the driver to switch on the radio. They tune to Standard Media’s Radio Maisha and it sounds like Christmas here! See, I like music alright, but I like conversations more: here, one gets to hear varied opinions of hosts and callers and learn a lot. It’s like in the unrehearsed reality TV shows where you get to be wowed by folly and creativity alike, that freshness from which you eke the most. The radio people are interviewing the fluent Bahati MP Kimani Ngunjiri and I fall in love with how articulate and jovial he sounds. He talks about cartels and development and his journey into politics. He leaves soon after and the discussion shifts to masturbation, a topic brought forth by a caller who has struggled with it. So Paul, 29, a masturbation addict from Limuru, testifies and asks for help and the mix of people here in the shuttle flinch and cower and comment in hushed tones. He says it started in 2007 after he parted ways with his only ever girlfriend and has been at it ever since. Boychild has tried
34
Auscultate | July 2019
stopping, including joining rehab, using witchcraft, consulting doctors and seeking prayers and cleansing to say the least. In response, some callers wonder how many children he has lost to the act. A doctor calls in and suggests counseling and confined rehab followed with an open relationship with opposite gender. A pastor is reached. Practically croaking, he prays and prays and prays until time does not allow any longer. This becomes the topic of discussion among fellow passengers for the most of the journey, spanning from Limuru through Naivasha, Gilgil, Lord Delamere Farm, Eldama to Elementaita. We even fail to talk about the monkeys that hover along the stretch past the Naivasha weighbridge, little ones strapped around their tummies, hanging so precariously that I shudder. We don’t even talk about the cliffs rising above the sides of the road, or the fog that envelops the hanging highway between Kimende and Gilgil. We forget to talk about the five police stops and how, strangely, no bribes have been collected.
Official Africa Magazine
35
Africa Regional Team
36
Auscultate | July 2019
IFMSA Acronyms
AM August Meeting (General Assembly) ARM African Regional Meeting CB Capacity Building DA Development Assistant EB Executive Board FA Finances Assistant GA General Assembly or General Assistant LME Liaison Officer for Medical Education issues LOSO Liaison Officer for Student Organisations LPH Liaison Officer for Public Health issues LRA Liaison Officer for Sexual and Reproductive Health and Rights including HIV and AIDS LRP Liaison Officer for Human Rights and Peace Issues LWHO Liaison Officer to the WHO MM March Meeting (General Assembly) NGA National General Assembly NMO National Member Organisation NOME National Officer for Medical Education NPO National Public Health Officer NORA National Officer for Sexual and Reproductive Health and Rights including HIV and AIDS NORE National Officer for Research Exchange NORP National Officer for Human Rights and Peace OC Organising Committee PHLT Public Health Leadership Training RA Regional Assistant RD Regional Director SupCo Supervising Council SCOME Standing Committee on Medical Education SCOPE Standing Committee on Professional Exchanges SCOPH Standing Committee on Public Health SCORA Standing Committee on Sexual and Reproductive Health and Rights including HIV and AIDS SCORE Standing Committee on Research Exchanges SCORP Standing Committee on Human Rights and Peace SWG Small Working Group TMET Training Medical Education Trainers TNT Training New Trainers TNHRT Training New Human Rights Trainers TO Team of Officials VPA Vice President for Activities VPCB Vice President for Capacity Building VPE Vice President for External Affairs VPF Vice President for Finance VPM Vice President for Members VPPRC Vice President for Public Relations and Communication
Official Africa Magazine
37
IFMSA
International Federation of Medical Students’ Associations
Dominican Republic (ODEM)
Lebanon (LeMSIC) Libya (LMSA)
Senegal (FNESS)
Ecuador (AEMPPI)
Lithuania (LiMSA)
Serbia (IFMSA-Serbia)
Egypt (IFMSA-Egypt)
Luxembourg (ALEM)
Sierra Leone (SLEMSA)
Malawi (MSA)
Singapore (SiMSA)
Aruba (IFMSA-Aruba)
El Salvador (IFMSA-El Salvador)
Malaysia (SMMAMS)
Slovakia (SloMSA)
Australia (AMSA)
Estonia (EstMSA)
Mali (APS)
Slovenia (SloMSIC)
Austria (AMSA)
Ethiopia (EMSA)
Malta (MMSA)
South Africa (SAMSA)
Azerbaijan (AzerMDS)
Finland (FiMSIC)
Mexico (AMMEF-Mexico)
Spain (IFMSA-Spain)
Bangladesh (BMSS)
France (ANEMF)
Montenegro (MoMSIC)
Sudan (MedSIN)
Belgium (BeMSA)
Georgia (GMSA)
Bolivia (IFMSA-Bolivia)
Morocco (IFMSAMorocco)
Sweden (IFMSA-Sweden)
Germany (bvmd)
Bosnia & Herzegovina (BoHeMSA)
Ghana (FGMSA)
Nepal (NMSS)
Greece (HelMSIC)
The Netherlands (IFMSA NL)
Syrian Arab Republic (SMSA) Taiwan - China (FMS)
Nigeria (NiMSA)
Tajikistan (TJMSA)
Norway (NMSA)
Thailand (IFMSAThailand)
Algeria (Le Souk) Argentina (IFMSAArgentina) Armenia (AMSP)
Bosnia & Herzegovina – Republic of Srpska (SaMSIC)
Grenada (IFMSAGrenada)
Brazil (DENEM)
Guatemala (IFMSAGuatemala)
Brazil (IFMSA-Brazil)
Guinea (AEM)
Bulgaria (AMSB)
Guyana (GuMSA)
Oman (MedSCo)
Switzerland (swimsa)
Pakistan (IFMSAPakistan)
Tanzania (TaMSA)
Panama (IFMSAPanama)
Trinidad and Tobago (TTMSA) Tunisia (Associa-Med) Turkey – Northern Cyprus (MSANC)
Togo (AEMP)
Burkina Faso (AEM)
Haiti (AHEM)
Burundi (ABEM) Cameroon (CAMSA)
Honduras (IFMSAHonduras)
Canada (CFMS)
Hungary (HuMSIRC)
Paraguay (IFMSAParaguay)
Canada – Québec (IFMSA-Québec)
Iceland (IMSA)
Peru (IFMSA-Peru)
India (MSAI)
Peru (APEMH)
Catalonia - Spain (AECS)
Indonesia (CIMSA-ISMKI)
Uganda (FUMSA)
Chile (IFMSA-Chile)
Iran (IMSA)
Philippines (AMSAPhilippines)
China (IFMSA-China)
Iraq (IFMSA-Iraq)
Poland (IFMSA-Poland)
China – Hong Kong (AMSAHK)
Iraq – Kurdistan (IFMSAKurdistan)
Portugal (ANEM)
United Arab Emirates (EMSS)
Colombia (ASCEMCOL)
Ireland (AMSI)
Costa Rica (ACEM)
Israel (FIMS)
Republic of Moldova (ASRM)
United Kingdom of Great Britain and Northern Ireland (SfGH)
Croatia (CroMSIC)
Italy (SISM)
Cyprus (CyMSA)
Jamaica (JAMSA)
Republic of North Macedonia (MMSA)
United States of America (AMSA-USA)
Czech Republic (IFMSACZ)
Japan (IFMSA-Japan)
Romania (FASMR)
Jordan (IFMSA-Jo)
Democratic Republic of the Congo (MSA-DRC)
Kazakhstan (KazMSA)
Russian Federation (HCCM)
Uruguay (IFMSAUruguay)
Denmark (IMCC)
Korea (KMSA)
Dominica (IFMSA Commonwealth of Dominica)
Kosovo - Serbia (KOMS)
Kenya (MSAKE)
Kuwait (KuMSA) Latvia (LaMSA)
Qatar (QMSA)
Turkey (TurkMSIC)
Ukraine (UMSA)
Uzbekistan (Phenomenon)
Russian Federation – Republic of Tatarstan (TaMSA)
Venezuela (FEVESOCEM)
Rwanda (MEDSAR)
Zambia (ZaMSA)
Saint Lucia (IFMSA-Saint Lucia)
Zimbabwe (ZIMSA)
www.ifmsa.org
Yemen (NAMS)
medical students worldwide