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Jones* was absolutely heartbroken when he found out that he was not eligible to join medical school in Kenya when he finished high school. Coming from a humble background, he could not afford to pursue his dream. However, Kenya was just starting to train nurses at degree level and Jones was able to get into the pioneer class.

Four years later, with a degree rightfully earned, Jones headed off to practice an art he had come to love. He took the Nightingale Pledge to heart and practiced it with his whole being. He loved his patients and worked with utmost dedication. Within a few years, he was back to school studying hard to become a critical care nurse. He had found his calling.

Away from work, Jones spent his free time playing basketball at a local club. He had played for his high school team but had been away from the game for quite a while. It felt good to be back in practice. He also started dating a young doctor he met during his specialist training. Life was turning out pretty well for a young man who had thought he would never recover from losing his dream.

However, one evening, during a basketball tournament, Jones suffered an injury and fractured his tibia and fibula, the bones of the leg. What followed was a dark period of excruciating pain and frustration at not being able to do either of the things he loved. He underwent surgery but had to remain in hospital for some time.

To manage his pain, he would receive opiod injection medication every eight hours. The shots would be a welcome relief as not only would they suppress the pain but would also knock him out and allow him to sleep away the endless hours he spent lying there. When he went home, despite having adequate pain relief from the oral tablets that he was prescribed for, he struggled to sleep.

With his girlfriend being a doctor, it was possible for Jones to get a prescription for sleeping pills  but he wasn’t quite able to get the kind of knockout he wanted. He pleaded with her to bring him prescription opioid injection medication and he would inject himself to sleep.

Five months after the injury, Jones was back to work. He was happy to get back to doing what he loved. However, despite healing well, the 12-hour shifts in the critical care unit spent on his feet were heavily taxing. His leg would throb after work and he couldn’t wait to get home and put it up and rest. However, he found himself drifting back to sneaking in a shot of the opioids to alleviate the pain and sleep.

Before Jones knew it, he was regularly injecting himself prescription medication to sleep. He began pilfering the medication from the dangerous drugs locker in the critical care unit to meet his needs. What started as a medical need was turning into a monster that Jones was having trouble taming. He did not have the capacity to face up to the magnitude of the problem.

The addiction roller-coaster had long taken off. Suffice it to say, Jones never played basketball again. His relationship with his girlfriend hit the rocks and his supervisor caught up with his pilfering. Instead of a disgraceful dismissal. Jones was offered an opportunity to hand in his resignation.

The cycle of addiction is the same irrespective of the drug of addiction. A bright young nurse who was on the path to a bright future, was instead on a downward spiral to oblivion. Seven years of moving from one job to another, one seedy apartment to the next, losing friends and family eventually culminated in finally losing his license to practice for grossly endangering patients’ lives.

There a many reasons why anyone would find themselves going down the slippery slope of addiction. Many are harshly judged, especially when they are hooked onto illegal substances. For healthcare practitioners, the easy access to prescription drugs of addiction easily fuels the addiction flames in record time.

Unfortunately, no one is usually paying attention until things get out of hand. Unfortunately in Kenya, there is no mechanism in place to deal with health workers who get into prescription drug abuse.  In the Unites States of America, there exists a robust physician health programme that is set up to support practitioners whose ability to practice safely is impaired. The impairment may be medical such as mental illness, cognitive impairment or drug addiction.

The risk these practitioners pose to patient care cannot be underestimated. Nobody wants  to be under anesthesia and the doctor responsible for your life slumps in a corner from the effect of a pethidine shot he gave himself instead of you. Of that moment when you are bleeding out and the doctor’s hands are shaking too hard to put in the lifesaving cannula required to transfuse you. Or when your teenager is writhing in pain from a sickle cell crisis and the nurse has injected him with saline since she cannot account for the pethidine via meant for him but she has already injected herself.

A health practitioner suffering addiction, and specifically prescription medication addiction, is not only a danger to himself but is an even bigger danger to the patients. As we strive to take care of our patients struggling with addiction, we need to set up a system to ensure the same care is extended to our health workers.

The system must work by providing a safe place for them to seek help without judgement. We must also enable fellow health workers to report their colleagues who may be unfit to practice due to addiction. However, the reporting should not be for punitive purposes but for enabling access to support and care. It is definitely time for a physician health programme in Kenya!


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The last few weeks have been chaotic in the health sector. The press has been awash with stories of medical negligence in various institutions, leading to varied responses. The public is furious; the regulators are cracking the whip while the health workers are feel besieged.

In the background of a country focused on achieving universal health coverage, the recent happenings are not encouraging. It is a fact that for universal health coverage to be achieved, there is need for multiple players to pull together to achieve meaningful health outcomes for Kenyans.

To this end, the role of the private health sector cannot be underestimated. This sector has been complementing the public health sector for decades. Most modern medical technology has been availed in the private sector first, enabling patients to access care while the government worked to achieve the same in our public institutions.

The private hospitals and diagnostic centres have enabled patients in public hospital to get expensive tests done locally to improve their care. For many years, imaging tests that are now commonplace such as magnetic resonance imaging (MRI) and computerized tomography (CT) were unavailable in public hospitals. Patients, even those admitted in the wards, would have to get them done in private hospitals and then go back for continued care.

Over time, these services have been availed all over the country, making them part of mainstream care for patients. This couldn’t be better demonstrated than by the availability of an MRI machine at Garissa County Referral Hospital. This signals positive trends in the public health sector, with ability to provide multiple and advanced treatment options for improved patient outcomes.

Despite the hiccups that haunt the sector, it is undeniable that the positive impact is a welcome relief to many. It is encouraging to know that we can undertake highly technical interventions as demonstrated by the separation of Siamese twins or the reattachment of a severed hand at Kenyatta National Hospital. Renal transplants and complicated cancer surgeries are now regular procedures at the Moi Teaching and Referral Hospital.

It is also refreshing to know that the problems that ail the public sector are mostly governance issues, which can be easily addressed with commitment and goodwill. Makueni County has clearly demonstrated what universal health coverage can do. This is the only county that one will struggle to find a thriving private clinic as potential clients gladly flock the county hospitals. Moi Teaching and Referral Hospital’s growth in the last two decades has been formidable. From a nondescript district hospital to a level six institution that is not only providing care but also driving teaching and research is no mean feat.

It is clear that we do not need to cross borders to  benchmark in health care and its management.  We have our own success stories in-house that we can learn from and make health care safe and accessible. For this reason, we cannot shy away from asking the hard questions when things fall apart in public hospital such as what was happening at Kerugoya County Referral Hospital. Most especially when these are facilities fully funded by the taxpayer who is clearly not getting value for their money.

For this reason, we need to take a hard look at the chaos being demonstrated in the sector, with special focus on middle level private health institutions. Faith-Based institutions have generally done well in alleviating the burden of care in the country. For this reason, the government partnerships with them have been very strong, to the extent of supporting these institutions with human resource for health.

The key reason for this is that for many years, these institutions provided care in hard to reach areas where even the government had not invested in health facilities yet. Missions put up facilities like Wamba Catholic Mission Hospital in Marallal, Ortum Mission Hospital in West Pokot, and AIC Kapsowar Mission Hospital in Marakwet, to fill huge gaps in health care and the government responded in kind by seconding doctors to these hospitals.

Both parties recognized the prohibitively high cost of a skilled workforce necessary for appropriate service delivery. This is the reason why the most highly qualified specialists in Kenya will be found in the high-end private institutions where they can bill for their skill, or in higher level public institutions, on the government payroll. This is a key component that perhaps many middle level privately owned health institutions fail to plan for when they are starting out or they are expanding.

They fail to recognize that as they grow in capacity, their expand their scope of services and hence their patient numbers rise. In addition, by availing specialized equipment, the need for skilled manpower to utilize these efficiently for patient care increases. The higher the level of skill required, the higher the need for support services and the higher the numbers of experienced staff required.

To meet these needs, the cost of healthcare spirals upwards because the skill is ultimately expensive. Unfortunately, to manage the cost of providing the services against the cost to patient becomes a problem. These institutions, in a quest to balance the figures, must sacrifice something along the way.

Unfortunately, what has been sacrificed for the most part, has been the cost of skilled workforce in an effort to remain “affordable” to their clients. This is how we end up with facilities running on unskilled or inexperienced workforce, with a higher likelihood to attract medical negligence issues, especially when inadequately supervised. It is not necessarily a quest to maximize profits.

It is therefore important to ask yourself two critical questions the next time you walk into a middle level facility with “affordable” costs. The first is, who is subsidizing the cost of your care while the second is that if there is no subsidy, what has been compromised along the care chain. We cannot have our cake and eat it!

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In the month of May, the world turns its attention to one of the key components of woman-ness. The conversations around menstrual hygiene are here with us as we struggle to make it a normal conversation for all people, irrespective of their gender, age or background.

The emphasis on reproductive health education for the young people is so critical if we are to achieve menstrual hygiene for all. The sustained advocacy to ensure every young girl is kept in school during her menses is essential. Access to menstrual hygiene products and clean water for all women is a basic right.

However, as we address the normal challenges of this key aspect of nature, today let us also take a look at those who have unique challenges when it comes to menstruation and menstrual hygiene management.

Natalie* is a 21-year old college student with excruciatingly painful periods. Her gynaecologist says that Natalie likely has endometriosis, a condition where the tissue that forms the inner lining of her uterus has migrated to other parts of her pelvis. Since this tissue is responsive to hormones, it means it bleeds every month in places where it should not, causing painful inflammation and unbearable pain.

Seline* a 27-year old banker has menses for an average of 12 days every month. Her periods are so heavy that she has undergone repeat blood transfusions to stay alive. She was diagnosed with Von Willebrand Disease, a rare condition where her blood clots poorly, making her susceptible to heavy bleeding from any source. She wishes she could just get rid of her uterus but her gynaecologist is hesitant and is encouraging her to have children first before taking such drastic action. Seline dreads the risk of bleeding to death during delivery.

Monique’s challenges are different. She has no menstrual problems but her 19-year old daughter, Ruby*, has Down’s Syndrome with limited cognitive development, posing a significant intellectual disability. She started her menses at 15 and four years down the line, they are still struggling with her menstrual hygiene management especially during the day when she is away at school.

Painful periods (severe dysmenorrhea) are NOT normal by any long shot. The causes of painful periods are quite varied. For the young adolescents who are new to menstruation, as the menstrual cycle stabilizes, not all cycles are accompanied by ovulation. These menses without ovulation can be painful but are generally short-lived and this settles with time.

However most painful menses are associated with underlying disorders such as adenomyosis, endometriosis, polycystic ovarian syndrome, uterine fibroids, polyps, pelvic inflammatory disease or uterine synechiae (scar tissue within the uterine cavity). All these are gynaecological conditions that require a proper diagnosis and appropriate management to relieve the pain.

Menorrhagia (heavy menses) is described as periods that come regularly but the total amount of blood lost per period is more than 80mls. Alternatively, periods lasting more than seven days may be considered to be menorrhagia. Most women will not be able to quantify the amount of blood loss but are more likely to see the doctor when the blood loss causes uncomfortable symptoms.

Menorrhagia could result from a myriad of underlying medical conditions too that require urgent diagnosis and treatment. Conditions of the reproductive tract such as fibroids, polyps, endometritis (inflammation of the inner uterine lining), endometrial cancer and adenomyosis can cause the woman grief. Endocrine disorders (disorders affecting hormone systems in the body) such as thyroid disease, bleeding disorders such as platelet disfunction or Von Willebrand disease, polycystic ovarian syndrome, approaching menopause, chronic liver disease, some contraceptive methods and certain medications will also lead to heavy periods.

Menorrhagia, left unchecked, will lead to anaemia, which in the long run, can result in heart failure and even death. Therefore, the cause must be aggressively sought and treated, to avert unnecessary complications. Women must be aware that changing the pad hourly is a sign that something is not right. Bleeding until one passes out is an emergency.

Treatment options for these complications may be surgical (such as in removal of fibroids or polyps) or may be medical (using non-steroidal anti-inflammatory drugs, hormones or hormone-receptor blockers). Treatments resulting in heavy bleeding may need to be stopped, adjusted or replaced.

What of special category ladies like Ruby? Ruby’s periods may be regular, non-painful and of normal volume. However, her incapacity to change her own pad is a challenge when she is away from her mother, who is her primary caregiver.

Despite Ruby’s intellectual disability, her reproductive health rights must be fully protected and solutions for her challenges must align with the law. Monique was never prepared for this eventuality, especially as Ruby’s development was slower than her agemates. This, coupled with Ruby’s child-like appearance, means that even the doctors taking care of Ruby did not remember to discuss with Ruby’s mother on alternatives to help make womanhood for Ruby easier.

It was such a relief for Monique to know that there were safe options for Ruby. We settled on putting Ruby on a ‘Menstrual Holiday’ through the use of hormones. Now Ruby can have periods once every three months, which coincides with her school breaks. Monique only has to worry about her baby’s menstrual hygiene at her convenience. No more soiled skirts in class, no more stained P.E. shorts, no more burdening Ruby’s caregivers in school with such personal matters as Ruby’s menstrual hygiene!

Menstrual holidays are not a new thing in gynaecological care. While for Ruby, the only concern is the inability to deal with the menses on her own, for some women, this is the only way to deal with heavy menses or with painful ones. Keeping the periods away for a given duration helps the anemic woman build back her blood to normal levels. For the one suffering pain, no periods means no pain.

In the world of sports, periods are kept on hold during major competitions. Women have learnt not to compromise their rise to stardom in swimming, gymnastics or tennis when that tournament is scheduled at the same time as the period. It would be impossible to win a marathon, running 42km while bleeding!

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Doris* was sitting on her hospital bed lost in thought. It was a cold, rainy, Tuesday morning that seemed to dampen the mood in the ward. Even the usually jovial professor with his dry British humour was a tad subdued.

Doris was on her second post-operative day. She had undergone surgery to remove a vulval tumour. This was the first phase of her treatment. She still had radiotherapy up ahead but the immediate battle was the prolonged confinement as she recovered from the surgical wound. She was still coming to terms with having to wear a urinary catheter for 21 days.

With the medical students away on recess, the ward round was not crowded. My colleague took us through a summary of Doris’ medical condition and her recovery from surgery. The professor took us through the discussions around vulval cancer diagnosis and treatment options but the whole time, my mind was stuck on the Doris’ psychological response to what she was going through.

Right up until 35, Doris had lived a full life. She was a science teacher who loved her job and away from work, she was a free spirit who loved the outdoors. She had just added another feather to her cap by scaling Mount Kenya at 34 and she felt so proud.

Then her woes began. She started noticing a persistent itch in her vulva (external genitalia). At first it was mild, coming on and off and she ignored it. As it persisted, she walked in to a pharmacy and was given a cream across the counter. She used it for a while with some relief while another two months flew by.

One day, after participating in a charity half-marathon, her itch overwhelmed her and she sought medical help. She was seen at the emergency department and the doctor prescribed some antifungal capsules and a steroid cream. She faithfully used her medication but she did not get much relief.

Her discomfort was beginning to affect her life. She lost interest in sex, which strained the relationship with her boyfriend. She spent all her time online trying to find solutions for her itch. She tried all manner of remedies. She discarded all her fancy sheer underwear in favour of cottons, she tried different types of sanitary towels, she ditched her denims and resorted to wearing dresses, to no avail. She adjusted her diet, went vegan, changed her toilet soap and replaced her bathing flannel but it was all in vain.

Repeated treatments for candidiasis did not help Doris. She visited various outpatient clinics that her medical insurance permitted but never quite got an answer to her problem. She even attempted the old wives therapies of applying natural yoghurt to her vulva  at bedtime, using aloe vera therapies that she purchased online and even traditional herbs from herbal clinics in town. Her efforts were all in vain and the itch soldiered on unperturbed.

Doris suffered in complete isolation. Having grown up without sisters and had never quite formed strong bonds with her female friends. Due to her love for the outdoors, most of her close friends were men. She realized she did not have anyone to talk to about her issues, which are viewed as private. She silently suffered her nightmare.

She noted that her vulval skin was dry, flaky and was becoming indurated. She failed to appreciate the developing mass underneath as she attributed these changes to the prolonged itch-scratch cycle that had become her life.

One day, Doris‘ church hosted a free cervical cancer screening camp. Doris decided to consult the screening nurse. By this time, Doris had developed an ulcer in her genitals. The nurse referred her straight to the teaching hospital where she had a biopsy done and a diagnosis of vulval cancer was made.

Doris was devastated. She had no idea how to explain this to her loved ones. Yes she had cancer but she had no way of even putting a name to it. She could not even explain it to her mother. She could only show her the lesion. The fact that the vulva is a private body part that isn’t publicly discussed remains a hindrance to many when it comes to talking about this uncommon cancer.

She was grateful she had a female headmistress who was very understanding and allowed her off work to go and seek medical care. The next week she was admitted to the ward and underwent surgery. No amount of counselling prepared her for the mutilation occasioned by the surgery. To fully excise the tumour, a large chunk of flesh had to be taken out of her vulva, extending all the way to the inguinal area.

The healing was slow and exhausting. She spent her days sitting on her bed, legs together to prevent tension on the sutures and avoid the risk of the wound breaking down. She was on antibiotics for weeks to prevent infection and had to keep the dreaded urinary catheter for a month.

Her wounds healed but the scars remained as a testimony for what she had undergone. She survived the radiotherapy and despite the odds, Doris survived the cancer. Five years on, she has gotten her life back but she hasn’t quite found the words to describe her experience.

Doris is a true representation of the average Kenyan woman. Vulval itching is   not a normal event. A majority of cases will be due to candidiasis (yeast infection) but this is a cardinal sign of vulval cancer. Stop rationalizing it. No, it is not your underwear, it is not your tight jeans, it is not your sanitary towel. See your gynaecologist and get proper diagnosis. It will save your life!




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The dreaded cholera is back! Or more accurately, it never really went away. But because the people afflicted were treated in facilities that do not draw attention, it did not quite make the news.

When Nairobi County Department of Health released a circular to the public, warning of a cholera outbreak in the city, few people even looked up from their smartphones because this did not affect them.

The notion that cholera is a disease of the poor is a fallacy. However, cholera is a disease of poverty. As long as 29% of Kenyans continue to live below the poverty line (living on less than $1.9 a day) cholera will continue to haunt us.

Individual people may live below the poverty line but if they are provided with access to basic needs, a right that they deserve from a responsible and responsive government, then poverty just might be a little bearable.

Top on the list of these basic rights is access to clean water. At the rate we are going, clean water is becoming a myth. This has never been more obvious as in has in the past year where we have been riddled with outbreaks of cholera in Nairobi and its environs, Kajiado, Narok, Garissa and Machakos. Coupled with the drought that we have experienced as a country, an unacceptably large number of Kenyans are at risk.

The government has demonstrated great effort to provide access to clean water. However, the Ministry of Water and Sewarage cannot work in isolation. Its efforts will only bear fruit if they are intimately linked with urban planning. The explosive growth of towns that we are witnessing in Kenya, accelerated by devolution is a time bomb, if not well managed.

 Very few towns in Kenya have a functional sewerage system. It is becoming a norm to see exhauster vehicles taking over many towns. Considering cholera is transmitted via the feco-oral route, the infection is politely but unapologetically reminding us that we are eating raw, unprocessed sewage.

The second basic right we all require is access to health care. As we speak, the universal health coverage (UHC) pilot is on-going. I sincerely hope that we are not missing out on these lessons. UHC in Kenya intends to shift the focus in health care from just a curative-based approach to a more comprehensive preventive and promotive approach, with curative services as a safety net where the rest have failed. 

I would hope that one of the take-home points will be the need advocate for expansion of the current provisions of immunization by the Kenya Expanded Programme of Immunization (KEPI), to include vaccines that are currently not catered for. With our current challenges, cholera vaccine, the human pappilomavirus vaccine (for prevention of cervical cancer) and the typhoid vaccine would be an immediate consideration.

This is a defining moment on putting the community health extension workers to good use. Working in conjunction with the public health team, they will, not only help identify populations at risk, but also help with supporting appropriate health education, distribution of water treatment solutions, making timely referrals for the sick and advocating for proper waste disposal to curb the spread of cholera.

In addition, the public health facilities will require adequate resources to deal with the disease burden. This does not just end with provision of drugs and fluids but also space for appropriate isolation, proper medical waste handling, and the training of the health providers on the most current infection prevention and control practices.

Therefore, while the more privileged sit in their ivory towers and assume that a poverty problem will not touch them, please take note, we are all at risk. As long as your office tea girl lives in Kibera without access to a proper toilet, she will surely bring the infection to your office and you will take it home to your child.

While you sit in the coffee shop enjoying a latte with your girlfriends, remember the girl who served you only earns enough to afford her a one-room house in Majengo and she has to buy water by the jerrican and has no idea where the vendor got it from.

While you faithfully honour your nanny’s weekends off and she goes to visit her family in Machakos, she will drink unboiled water from the local stream and bring the cholera to your house.

The day-scholar housekeeper at your furnished apartment will bring cholera from Kayole where her tap water got contaminated with sewage when an irresponsible contractor damaged the sewer lines during an unauthorized construction.

While you are at it, remember that nearly every highrise apartment complex in Nairobi is now serviced by its own borehole. A simple accidental contamination of the borehole means an entire complex of patients who are potential distributors of the infection in their workplace, the schools their children go to and even the church they attend.

It should not be a wonder that hospital employees have been felled by cholera. It is a highly infectious disease that spreads extremely easily, just like ebola, only not as deadly. How would a sanitation officer in the hospital, cleaning the toilets used by the cholera patient, escape the infection, yet this is what he does for a living? Unless he is vaccinated against cholera, his risk of infection is astronomical!

These at-risk populations are still a part of your society, you mingle with them more intimately than you think. If you want to be safe from cholera, speak up about their safety too!

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Sandra* lay still in her hospital bed looking frail. She had lost track of days. She couldn’t even remember whether she had taken a shower or not. The only time she moved was when she leaned over to spit in the receiver the nurse had put beside her.

Three weeks before, Sandra was over the moon. After three years of trying to conceive, she had found out she was finally going to be a mom. She couldn’t wait for her husband to get home from work so she could tell him. Though she always imagined how she would take her husband out to a fancy dinner then break the news, it never came to pass. By the time he came through the door, she couldn’t hold back and she blurted out the news before he could even put his coat down.

Tim* was overwhelmed. He was beside himself with excitement. That night the couple could not sleep. They talked endlessly about their baby and planned for the future of a six-week embryo! The next day, they went to see the doctor and start the antenatal care. Things went quite smoothly for the next two weeks. Sandra’s tests were all good and the first ultrasound showed that the little one was growing fine.

Then came the ninth week and their lives suddenly turned upside down. Sandra suddenly developed intolerance to everything. She could not stand smells. It did not matter whether it was soap, perfume, lotion, detergent of fabric softener. She couldn’t tolerate the smell of meat and she turned vegetarian. She would sit in the garden while dinner was prepared since she could not tolerate the smell of frying onions.

One evening, in an effort to cheer her up, Tim came home with a bunch of fresh roses. One look at the beautiful flowers and Sandra took off to the bathroom to throw up. She threw up so hard, Tim found her on the bathroom floor, a soiled mess. The flowers were tossed out immediately.

What followed was a non-stop cycle of spitting up saliva, wretching and vomiting. Sandra was confused. She had heard of morning sickness but this was an all-day sickness. She went to see the doctor and he prescribed medication to reduce the vomiting and gave her a sick-off. It did not work. She threw it up the medication as soon as she swallowed it. She was unable to retain anything, including water and her pregnancy supplements.
One night, as she sat on the bathroom floor, exhausted after a bout, she noticed that the vomit was blood-streaked. She broke down and started sobbing. Tim, who had gone to the kitchen to refill her water bottle, could not get her to calm down. He carried his wife to the car and drove through the quiet city to the hospital. He only realized he was still in his pajamas at the emergency department reception.

During the admission process, Sandra could not even remember the last time she had passed urine. The doctors swiftly ordered for a battery of tests and set up fluids to rehydrate her thirsting body. Though the tests done revealed that she was going into acute renal failure, aggressive rehydration was able to correct this in the subsequent days she was in the ward.

However, no medication could stop the urge to spit. She would spit up all day and only got respite when she was asleep. She only tolerated a liquid diet and citrus fruits. She could not comprehend how a natural process of procreation could end up being life-threatening. Tim knew she was on the path to recovery when she asked the doctor if he had confirmed that she had not thrown up her baby.

Everyone told her that the vomiting would settle down after the first trimester but this did not happen for Sandra. She threw up until the baby came. It took another three weeks before the urge to spit would settle. Her daughter is now nine years and Sandra has not gathered enough courage to board the rollercoaster of pregnancy again.

Sandra epitomized the worst case scenario of hyperemesis gravidarum. Several mothers have to undergo admission or at least daily intravenous fluid administration to survive it. The Duchess of Cambridge, Kate Middleton, caused quite a stir in 2012, when she had to be admitted at The King Edward VII's Hospital in central London for three days.

Just what is this condition? It is excessive vomiting occurring during pregnancy as a result of the pregnancy hormone, human Chorionic Gonadotrophin (hCG), which is made in the placenta. It is generally at its worst between nine and twelve weeks of pregnancy for most moms. The vomiting is so severe that it leads to upset of the body’s normal physiologic equilibrium.

Hyperemesis gravidarum negatively impacts on the pregnant mom by causing dehydration due to inability to keep down fluids. Neglected dehydration leads to kidney injury and resultant renal failure. Then, hunger sets in as the body gets starved for lack of sugar and other essential nutrients. It begins to break down the fat stores to utilize this as an energy source, resulting in accumulation of ketones, a by-product that causes acid to accumulate in the body. The weight loss is inevitable.

This condition is more likely to happen in multiple pregnancy, in molar pregnancy (an abnormal pregnancy which does not result in a live baby) and in pregnancies complicated by urinary tract infections. The doctor actively seeks to rule out these complications as part of care.

Treatment comprises aggressive dehydration, controlling the vomiting using intravenous medication. Supplementing vitamins and minerals that may be deficient and managing the stomach irritation by reducing the stomach acid.

The baby may be doing just fine in the midst of this storm but mommy needs to be taken care of in order to survive the incubation period!




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