Colorectal Carcinoma and how it Affects People Living with it in Western Kenya

Date drafted: 11, September, 2012

Commonly known as colon or bowel cancer, colorectal carcinoma (CRC) is a cancer that develops in the colon or rectum. Most CRC cases arise in the colon. Only about twenty eight percent of the cases arise from the rectum. CRC mostly appears due to lifestyle, increasing age and in some cases due to genetic disorders. CRC is the third most diagnosed cancer in the world, though it is common in developed countries. As a result of increased incidences of CRC, Moi Teaching and Referral Hospital (MTRH) in Eldoret have started a colostomy clinic to address CRC cases.

Although some major risk factors have been identified, studies done worldwide have yet to establish the causative agents of CRC. Major risk factors identified include having had an inflammatory bowel disease, high alcohol consumption, cigarette smoking, high consumption of red meat, and consumption of fat, exposure to radiation, lack of physical exercises and diabetes. Approximately ten percent of the cases are linked to insufficient activity. Diabetes is said to contribute thirty percent.

Those with a family history in two or more blood relatives are also at a great risk of the disease. Furthermore, a number of genetic syndromes such as Gardner syndrome have been linked to CRC.

Symptoms can include blood in stool, abdominal pains, anemia, stool leakage, hard stool and weight loss. Treatment of CRC depends on how advanced it is. Surgery is the primary treatment although this may only be curative if CRC is detected early. Radiation is also conducted on the patients to try and reduce the tumors.   

CRC can easily go unnoticed. It has taken some patients and physicians over two years to discover it. A report on CRC in western Kenya showed that it took some patients up to five years to discover they had CRC.

As an attempt to create awareness of CRC and to establish its effects on patients, Mr. Peter Kamau, the head of screening at MTRH cancer center, took part in an assessment of CRC patients in western Kenya. The assessment took a period of almost nine months.

In the assessment, thirty five CRC patients were followed up from January to September 2012. They were invited in September with an objective of forming a psycho social support group in order to create awareness and also to boost the morale of the patients. Only twelve patients showed up. Nine out of the thirty five were confirmed dead and twelve others could not be reached via phone.

“Those who could not be reached are probably dead,” Mr. Kamau reckoned. Six of the confirmed dead had stoma – an artificial opening made in order to serve as an alternative passage of stool when the rectum of the patient is blocked by a tumor.

The assessment report, titled “Living with Colorectal Carcinoma in Western Kenya; Lessons from the follow up of 35 patients for nine months in MTRH cancer centre and qualitative interview of 12 patients,” highlighted a number of issues about the lives of CRC patients.

Out of the twelve patients interviewed, one was between the ages of 20 – 30 years; four were between the ages of 30 – 40 years, one was between the ages of 40 – 50 years, two were between the ages of 50 – 60 years and four were between the ages of 60 and 70 years.

Patients with stoma have to incur additional costs, particularly for the management of their condition.

Mr. Kamau holding colostomy bags. The one on the right
costs 45 shillings. The one on the
left costs 1000 shillings.

First, patients had to buy colostomy bags in which they store their stool in temporarily. Colostomy bags have to be replaced after some time – may be after two to three days of use. Some of the bags are too expensive for the patients to afford, forcing them to go for days, even months without one. One of the patients assessed spent twelve months without a colostomy bag. Apparently one bag costs as much as one thousand Kenyan shillings. Although there are cheaper alternatives which cost around forty five Kenyan shillings; they are not suitable in the outdoors since they are transparent. 

Some of the patients assessed used alternatives such as towels and polythene bags. Some preferred to stay home with buckets rather than buy colostomy bags. Recycling of bags was also noted among some patients. 

Monthly costs of drugs for the patients with stoma were as follows. Five of the twelve patients used between $119 and $178, two patients used between $297 and $416, two other patients used between $476 and $595 and finally three patients used between $714 and $833. Clearly it is expensive to manage CRC.

Five of the patients with stoma said their condition lowered their sexual desires. Only one of the patients did not respond to the question at hand.

Having stoma also negatively impacted how the patients worked. Out of the six patients with stoma, four claimed their condition made them to stop working completely. One said that his work output had been reduced by fifty percent and the other said that he worked normally.

The faith of patients living with stoma was also affected though from the data gathered at MTRH, five of the patients stated that their faith in God was still strong. One of the patients stated that his relationship with God was unenthusiastic.

Concerned about the fate of those who may not know they are suffering from CRC, Mr. Kamau urged people to go for screening. “I am coming out to create awareness that CRC is with us here and people should rise up and come for screening,” Mr. Kamau stated.

Note:

This is an unabridged news story done during the author’s internship spell at the Kenya News Agency (KNA). A modified version of the story may have been published under KNA or an associated media firm(s), and if so, the reader is urged to treat this story’s ownership as that of the media firm under which it is published. Thank you.

A Critical Review of Museveni's Letter to Britain dated 25th March 2005

Both as a university student in Tanzania and in his early years as president of Uganda, Museveni was well known for his outstanding articles about various socio-political and economic issues in Africa. His views were then considered Marxist – Maoist and Leninist since he had socialistic ideologies.

In reply to a letter (dated 25^th March 2005) by the then British secretary of state for development and corporation, His Excellency President of Uganda Yoweri Kaguta Museveni wrote what has been described as “damning” by Business in Africa Online. In his letter, Museveni writes of an agreement between Ugandan and British governments – how the British were to give the Ugandan government funds to be used in development but instead withheld the funds after a unilateral “governance assessment” by the British government.

Although the letter was in reply to a letter sent to Kampala over the withholding of donor funds, Museveni expounded on it, writing more about donor – Africa relationship.

Donors have the credence to question how the recipients of their funds intend to use it. Museveni agrees to this and other limited parameters. It is however not ethical to conduct unilateral assessments of recipient governments in order to impose some forms of control over them. One of Museveni’s concerns is the alleged government assessment that was conducted on the Ugandan government before it was denied promised funds. It is indeed right to question the British government’s credence in conducting ‘governance assessments’ of governments they intend to give funds. No foreign government assesses the British government. Why would it then unilaterally assess foreign governments?

Museveni was committed to making Uganda economically independent, a belief that he held since he took power and maybe before. Since, however, he has been receiving funds from imperialist donor countries, he has not been consistent with his ideologies therefore policies.

I adore Museveni’s efforts in rehabilitating and reconstructing Uganda. Considering the problems Uganda has faced since her independence up until the end of Tito Okello’s reign, Museveni has made notable developments in Uganda but if he truly believes Uganda can achieve economic independence, how come that has not happened during his long reign? Well, Museveni claims that donors meddling in Uganda’s internal affairs are part of the reason why development in Uganda is impeded. It is indeed true that donor countries interfere with development strategies in less developed countries (LDC’s): it has been their habit to meddle in the affairs of LDC’s hence sometimes impeding their development. An example is western involvement in the Libyan and Ivorian conflicts. Although the two countries have ‘functional’ governments, they experience frequent conflicts. Without peace, no development can take place.

Western countries have vividly shown that they would not like foreign countries to meddle in their internal affairs. For instance, questions were raised when it was allegedly found that former French president Nicholas Sarkozy’s campaign money was partly given by the late Libyan leader Muammar Gaddafi. Museveni cites the plight of an American politician whose campaign was allegedly funded by the Chinese government. From the two examples, it is clear western powers don’t like other countries to meddle in their internal affairs yet they do meddle in other countries’ affairs. This is not ethical.

Under-development in Uganda cannot entirely be blamed on imperialist countries. Museveni agrees with this statement. Apart from blaming donor countries, Museveni blames African leadership during colonial times and some post-independence leaders for the plight of backward states like Uganda. Although Museveni says his movement has only made tactical mistakes, and not strategic mistakes, this statement is too vague and this is why.

Museveni fails to look at how his policies back home may have affected the possibility of development. For instance, if Museveni knew the western donors practiced suzerainty over aid recipients, why did he accept their funds? He cites how donor countries interfered with Uganda’s counter-terrorism effort by constraining her modest defense expenditure, how they forced Uganda to scrap tax holidays and how they interfered with Uganda’s energy development by forcing her to sequence the construction of dams rather than her preferred option of building two dams simultaneously. Although it’s not clear which (Uganda’s or the donor’s) plan is better, why, despite being aware of donor suzerainty, did Museveni decide to accept donor funding yet he yearned for economic independence and independence in decision making for Uganda? He has not been entirely truthful.

Museveni doesn’t give his reasons for accepting donor funds. By failing to stop asking for donor funds, Museveni seems to be admitting that Uganda is helpless - that it cannot develop without donor funds - hence raising questions of why he has stayed in power for over 25 years yet has not achieved economic independence. Furthermore, Museveni’s way of leadership is controversial.   

Museveni also says that no development can occur as result of aid by western countries. This statement is very true indeed. Development, apart from funds, also requires proper planning, leadership, peace, among other variables.

In conclusion, Museveni, judging from his statements, seems to be a proponent of the dependency theory of underdevelopment. Dependency theorists suggest that underdevelopment is not the fault of LDC’s and their traditional values but rather stemmed from foreign domination and exploitation. Some proponents of the dependency theory believe that a country can still develop while still depending on banks and multinational corporations for loans, investment and technology. Handelman, in his book the challenge of third world development writes “the recent economic miracles in East Asia (especially South Korea, Taiwan, Hong Kong, and Singapore), however have confounded dependency theorists. These countries have tied themselves very closely to the developed world through trade, credit, investment and technology transfer. Contrary to what the more sophisticated dependency scholars had predicted, however, they have achieved impressive economic growth coupled with comparatively equitable economic distribution.” Despite this, causes of underdevelopment still remain contentious. 

Good and Bad in Advertising

The inception of advertising is not exactly known but since it was traced, advertising has evolved in many ways. Some say it has indeed become virulent while others claim it hasn’t. Criticisms and support focus on whether it is ethical to advertise to children and/or whether modern day advertising has crossed ethical lines. All these arguments are vividly trying to address advertising ethics. What is an ethical ad? How should an ad be executed? Etc.

Marc Jacobs Ad featuring Dakota Fanning

Advertising ethics is so sensitive in some countries and once an advertiser crosses what is considered ethical lines, he or she is likely to face harsh consequences. An example: in November 2011, British Advertising Standards Authority banned Marc Jacob’s perfume ad that featured a 17year old actress. The ad standard authority said the ad sexualised a child citing how the actress positioned the perfumed bottle on her body.  In Kenya, ethical lines have been considered crossed during the mobile phone price wars where two major competitors, AIRTEL and SAFARICOM, are seen to be sacrificing advertising ethics. These examples and many others seem to strengthen the stand of advertising critics.

Critics assert that advertising lures us into confusing dreams and reality, as Klempner (2004) puts it. They claim that, for example, an advert features a famous celebrity driving a Sport Utility Vehicle (SUV), entices those cannot afford it into believing that they can. Critics therefore hold that advertisers sell people dreams, dreams that are in reality literally inconceivable.

Advertising advocates on the other hand defend this art strongly. They assert that advertising doesn’t entice people into believing in inconceivable dreams. They hold that advertising is directed into many forms of need fulfillment ranging from basic necessities like food and shelter to psychological phenomena like self esteem and self actualization (Dominick, 2011, p 344).

Advertising advocates further claim that critics have no authority, have no right to tell consumers what they need and what they do not. They also assert that most heavily advertised products and services fail in the market; therefore refuting claims that adverts make people buy things they do not need.

Klempner (2004) says that advertisers ponder for our desires for things that are bad for us. Other critics have also asserted that advertisers never give us consequences of consuming their products. Just to illustrate their point, a chocolate company sells people chocolate but never tells them that over consuming chocolate could be harmful. Critics also claim that although modern day advertising is governed by codes of ethics these codes aren’t being adhered to.

In reply to this criticism, advertisers claim that it is not entirely true since they do issue warnings for certain products like beer and cigarette ads as stipulated in the law.

Criticisms hold that advertising encourages materialism. According to critics, advertising makes people disapprove moral believes apart from emulating celebrities featured in adverts, whether their character is ethical or not. Critics, as Dr. Dominick puts it, also charge advertising with stimulating avarice and envy. Just to illustrate, a man is lured into buying Liquid Crystal Display (LCD) TV yet his Cathode Ray Tube (CRT) TV works fine. Extreme greed makes the man buy an item that he doesn’t even need.

To counter this criticism, advertising advocates claim that advertising presents what exists in a particular society. They further defend advertising by claiming capitalist economies emphasize on production and consumption. This therefore means advertising in a capitalist system will present what capitalism stands for (Dominick, 2011, p344).

Critics also point out a very interesting fact that advertising interrupts ones’ private life. For instance, in some countries, one can receive adverts in his or her mobile phone once in a particular locale. In my opinion, these text messages can be at times annoying since they come frequently.

Advertising practitioners partly agree with this fact that adverts can be hard to avoid (Dominick, 2011, p344). Interestingly they defend advertising by claiming it brings greater societal benefits, citing cheaper TV& Radio services and cheaper newspapers & magazines.

As I earlier cited, arguments on the good and bad of advertising have taken a new dimension. Is advertising to children ethical? Just like earlier cited arguments, advertising to children has brought both criticisms and backing.

Advertising critics claim that children are unsophisticated and therefore vulnerable to advertisers’ persuasive tactics and somehow immoral tactics (e.g. the earlier cited advert banned in the UK).

In reply to this claim, advertising practitioners assert that children are sophisticated than parents and critics think. They further say that children are capable of seeing through the lies in adverts and are therefore capable of making sound choices.

Criticisms also hold that advertising encourages children to pester their parents therefore creating rifts between the two parties (Dominick, 2011, p360). Just to illustrate, now that we are approaching the festive season, most children will frequently ask their parents to buy them nguo za krismasi (Christmas attire) among other paraphernalia for celebrating Christmas. When parents combine this and the tough economic situation in Kenya, they are likely to feel disturbed.

On the other hand, advertising practitioners claim that children get valuable information from adverts, information that could help them in their adulthood (Dominick, 2011, p360).

A controversial art it is but advertising plays a positive role in society: we are able to know about new products in the market and we are also updated on sociocultural opportunities, all because of advertising. All in all, the art of advertising will always be subjected to aspersions, genuine criticisms and support from every sphere of the society.

Rationalize expenditure on democratic practice

It is extremely unlikely that Kenyans are happy about our current constitution simply because it promises greater democratic opportunities. I think majority expect that the constitution will make possible to have good politics and good life for the people of Kenya.

As we pass laws to implement the constitution, let us ensure rationalization of expenses associated with the practice of democracy to avoid, for example, a situation where the country appears democratically advanced yet the citizens live poor quality lives due to lack of finance for basic services. Good life should take priority at all times. From Busia to Faza Island, from Mandera to Migori, the state should accept responsibility for influencing the distribution of material goods to ensure that people get a certain minimum below which no person is allowed to sink while encouraging all to raise their status above the minimum by their own effort (Leslie Lipson).

As part of rationalization of the cost of democracy, I am happy that members of parliament are proposing that recall of MP’s as per constitution be made very difficult. If we make it very easy, managing by elections in Kenya will be a major problem.

In addition, in any election petition, if a re-count of votes is made and it is found a politician “A” got more votes than “B” who was declared a winner, why not just declare “A” the winner and have him sworn as MP rather than go through a by-election? A by election corrupts the whole issue as the dispute has to do with the most popular in the circumstance the elections took place and not in the current circumstance.

Also any project started by an MP using Constituency Development Funds should be completed. Due to puerile hatred of previous MP’s new MP’s abandon projects that would have otherwise been useful to the residents of the constituency. The state would continue to have a lot of funds held by white elephants due to bad politics.

Let us be guided in our constitutional implementation by a sound moral principle and never make it appear that democracy is an end in itself. More national income should be directed to human welfare. 

Featured article.
By

J. M. Mugeni

josephat.mugeni@yahoo.com

People and Nature: earthquakes

A number of cities e.g. Christ Church, San francisco, Portland, Los Angeles, Seattle, Vancouver etc are located near plate boundaries. I find it dangerous to establish a city near plate boundaries and this is why:

Japan quake 2011 (Science Cheer Leader)

• If tectonic movements trigger a strong earthquake, the cities near plate boundaries will be hard hit- loss of life and destruction of property.
• A tsunami might be triggered and if so, it will sweep anything on its way and once it makes a landfall, it will destroy life and property. 

Haiti Quake (BBC)

The world has seen a number of earthquakes in the recent past the most recent being the magnitude 6.7 earthquake that hit the Canadian city of Vancouver (9/9/2011), the worst being the magnitude 9.0 quake that hit Northern Japan triggering a 10metre high tsunami (March 2011).

After reflecting on these accounts, it would therefore be logical not to establish cities or any human settlements near earthquake zones, especially plate boundaries, unless buildings that could withstand earthquakes and tsunamis are put in place.  

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