DR MALACHY DE SOUZA PART II

 

DR MALACHY DE SOUZA PART II

Nairobi City Council (NCC)

This is what I got in July 1978. The contract I signed for three years was adequate and specified daytime working hours, generous leave (42 working days a year – which I needed, as I will relate later), average salary but a generous gratuity at the end of the contract. The NCC Public Health Department ran several Health Centres and Clinics spread around the city and the Pumwani Maternity Hospital (PMH). At first, I was posted to a Health Centre in the Westlands suburb quite close to my home. The health centre had a busy outpatient clinic and a Maternity Unit with 20 beds and a Delivery room; this latter was reserved for normal deliveries; the complicated deliveries were handled by Obstetricians at Pumwani Maternity Hospital.

The outpatient workload was fairly heavy – 60 patients a day, but the experience I got was enormous. Soon I became quite adept at spot diagnosis – making some diagnoses as the patient walks into the examination room, and confirming them on further examination and lab work, where needed. Patients who needed admission to the Hospital were referred accordingly and taken there by ambulance if needed. The Maternity Unit was handled by qualified Midwives and the doctor was called in if there were complications; a Ward round was carried out each morning to attend to both mothers and babies. The doctor also carried out the discharge, usually after 3 days, unless some complication intervened.

The honeymoon in Westlands lasted a couple of months. I was transferred to the Ngong Road Clinic some kilometres away from home. It was a busier clinic as it was adjacent to populous areas – Dagoretti on the one hand and Kibera on the other. There were two doctors, a Ugandan lady doctor and myself, two clinical officers. There was no maternity unit. Each of us saw about 100 patients per day. Spot diagnosis became imperative as the patient load was heavy. I remember a patient suffering from the Bubonic Plague staggering into the examination room, burning with fever, as I held him by the armpits to prevent him from falling, I felt large lymph nodes there. The diagnosis was complete before I even put him on the couch. There was an epidemic in Nairobi at the time. The Clinic was closed, and patients sent home or to other Clinics/hospitals, the Plague Surveillance Team from NCC HQ leapt into action after informing them. The patient was transferred to the Infectious Diseases Hospital where I had worked for two months during my Internship, the Clinic sprayed with insecticide powder (against fleas) and I was given an antibiotic for three days as prophylactic and was advised to seek immediate care in the case of malaise or fever.

From there to Karen Health Centre, in the Karen suburb a sparsely populated residential area as most houses were built by the wealthy on 5-acre plots due to the shortage of water. Their employees were the ones who would come to the Clinic for attention. One characteristic of this Clinic was that it had a delivery room as the women in labour would come from afar and would need immediate attention; also, the suburb is about 15 kilometres from the city centre and the nearest hospital. Babies ‘don’t wait for nobody!’

 It was here that I came to the attention of my immediate boss, a Polish doctor. I declined to prescribe contraceptives at the Maternal & Child Health sessions for medical, human and religious reasons. Medical, because all contraceptives have serious medical side effects; human, because one should not separate the procreative effect of intercourse from the unitive effect; religious, because I profess the Catholic faith, and the Church proscribes the use of artificial contraception for or by its subjects. So, the matter was taken to the Deputy Medical Officer of Health where I was accused of neglecting my duties and was asked to explain my grounds which I did. The matter was then referred to the Health Committee of the Nairobi City Council where the accusation was that I was not living to the tenets of my contract -nothing in it mentioned contraception. The day was saved when a senior doctor stated clearly that I was right, as one does not sign a contract to go against one’s conscience. And the matter of contraception rested there.

But the boss had her last laugh as I was then shifted from one remote Clinic or Health Centre – Langata, Kasarani, Roysambu- to the next without reason. I persevered in my work as it was a service to humanity and I loved doing Medicine, and it was fulfilling to work with other medics and with simple folk as patients.

Pumwani Maternity Hospital (PMH)

My skin was somewhat saved by the need for additional personnel at PMH, and doctors from the NCC establishment and I jumped at the opportunity, much as I had not fancied a career in Obstetrics; I had done the minimum amount of study and work in Obstetrics at Medical School and none at all during my internship. So, I was thrown into the deep end. I spoke to the boss of the Hospital during my interview regarding my position in Obstetrics and contraception. He told me that none was done at the hospital and that I should not worry.

There was a complement of over 25 junior doctors, some with more experience, others at tabula rasa like myself. Four full-time Consultants were in attendance and there were many good midwives some of whom had grey hair! We felt confident and this was not misplaced as the midwives handled all the normal deliveries, and sometimes even the more complicated ones. The Consultants handled the more complicated deliveries including Caesarean births, all assisted by junior doctors. We had to learn lots of things and learned fast we did. The hospital handled 70-100 deliveries in 24 hours so learning was made easy. As is usual in developing countries the junior doctors are given the immediate care of patients with minimal supervision and the process of learning is accelerated as there is so little time in the day to attend to all the patients who show up.

The Consultants were very good and came immediately they were called by the doctors. With the more senior doctors, and with the passage of the months and the experience gained, they would give instructions over the phone in some cases. Or in the case of Caesarean Sections, the order would be,” Start, I am coming.” And the baby would be delivered and handed over to the pediatrician or a senior pediatric nurse, and the Consultant would appear quickly, but as the uterus was being sutured by the doctor. This was not a short cut, as sometimes the condition of the mother or the baby required emergency Caesarean operations to save the life of either and every minute counted. I had carried out about fifty Caesarean operation in the period of about two years, and became quite adept at handling other Obstetric complications.

A success story, among others, was that of the so-named “Dr De Souza’s Infant” who was born prematurely at 22 weeks (yes, twenty-two), and was a breech (feet-first) delivery. He was not breathing spontaneously at birth but had a reasonable heart rate. After intubating him, I started him on intermittent artificial manual respiration; there were no automatic respirators in PMH then. Shortly after, I discovered the mother bleeding profusely. She had to be rushed to the Operating Theatre urgently. After alerting the Consultant and handing the manual respiration of the baby over to a student nurse, I went to the Theatre to assist him. He was able to stop the bleeding after about a quarter of an hour and we observed her for another fifteen minutes. I then rushed back to where the Infant was being resuscitated by the student nurse who was still ventilating him though he was “fighting” the ventilation. I extubated him and he was breathing spontaneously. Then I called the Pediatrician from the New Born Unit and handed over the Infant. He remained in the incubator for a couple of months, then another month in the Neonatal Unit and was discharged hale and hearty.

I cut short my 3-year contract after two-and-a-half years as I had a project coming up.

Imara Educational Foundation

My teaching experience, work as Assistant Warden of a University Students Residence and my work with a Boys Club got me interested in founding, together with three others, an institution for the Co-curricular Education for the Youth. Thus, this foundation was born and was registered in Kenya under the Companies Act as a not-for-profit organization without share capital and Limited by Guarantee. I worked at this full-time for two years, but kept in touch with Medicine though Journals and Text books and seeing the occasional patient. The first project was the consolidation of a Boy’s Club, the Hodari Boys Club, already in existence for seven years, where new premises were procured and facilities for activities improved. The next project a few years later was a small university residence, Satima Study Centre close to the Faculty of Law and not far from the main Campus of the University of Nairobi. Then Nyali Study Centre was set up in Mombasa which I looked after for 3 years. More on this below. Much fund-raising was done for these projects and this took time.

Two books authored by the Founder of Opus Dei were also published in Kiswahili by the Foundation. I took charge of the coordination of the technical work of these. After two years I began a new phase of my work as a doctor, and 10 years later retired from the Foundation to make room for new blood and ideas and to focus on my medical profession.

Private Solo Medical Practice

I had done a little private medical practice on my own before Joining the NCC, so it was easy for me to get a Licence to practice on my own. In 1983, I got premises in the Westlands Suburb quite close to where I lived at the time, with a former colleague at Strathmore College, Dr Calisto Omondi. He was an anaesthetist and required these consulting rooms for a handful of hours per week. I was glad to enter a furnished office and after some repairs, maintenance and painting I moved in. The premises were compact, with a small Reception Area, 2 doctors’ consulting rooms which were more spacious, airy and well-lit naturally.

At first there were few patients and I spent many an hour reading medical text-books and Journals and catching up on the latest up-dates in Medicine. I also did some “marketing,” among friends and firms making my skills known, to attract a small clientele. Soon a small group of patients were seen on a regular basis. The practice was in General Medicine and Allergy.  There were few Allergists in the country so I had a growing number of patients with allergic conditions from the Eyes, to the Nose and Throat, Chest, Gastrointestinal Tract and Skin- Allergology was a multi-organ specialty on the European continent and the U.S.A. & Central and S. America.

The commencement of my private practice coincided with a number of the Goan Doctors either passing away or leaving the country. Since I am a Goan, my practice was soon patronized by the Goan Community in Nairobi and I found myself so busy that I seriously considered taking on a partner/associate or a locum. My usual Locum Tenens was from the Coast, and the more conservative of the Goans would be hesitant to be seen by him – not a question of racism, but of trust & confidence in a fellow-country man. This lasted a couple of years and then many of the Goans suddenly emigrated as quickly as they had come to me. The reason for the emigration was the withdrawal of the automatic citizenship of children born in the county and whose at least one parent was born in Kenya. It was made retroactive - a bad law, as a senior Kenyan lawyer mentioned to me.

Another set of colourful patients I had under my care were European ladies, all widows, living in Harrison House, a project of the East African Women’s League. I made house-calls there as necessary. The patients were all geriatric and a varied lot. Most were British, -there was a larger-than-life size portrait of Queen Elizabeth II occupied a whole wall above a internal ramp- some came from South Africa, Australia, others were of German extraction or at least spoke German. The latter were probably from German East Africa – Tanganyika. One was Knighted and had a rich past but had fallen on hard times when she was abandoned by her family and friends. She was bedridden and worn with the years and a bohemian past life. I treated her gratis until she passed away of a massive stroke. Another, the wife of a famous surgeon refused any further medical attention, and passed away peacefully of cancer after six months. A third an alcoholic, had a perforated duodenal ulcer and was saved in a nick of time by an expert surgeon and myself.

After refusing to be attended to by my Coastal Locum – on racial grounds, I got to know later -- I declined to see any more patients there as my Locum substituted me several times a year and was more of an Associate then a Locum. And he was a decent sort.

I had a number of patients from NGO’s and soon developed a lasting doctor-patient relationship with some of them. They continued seeing me after changing jobs and many brought members of their family who were not employees of the firm.. One was a Borana lady from North Eastern Kenya. She was in her early thirties but had multiple pathologies; one of them was cancer of the Thyroid Gland. She was operated on twice by a good surgeon, with whom we had become good friends, and was put on Thyroid hormone for life and was checked by me every 3 months to verify any metastases – she developed none. She was still alive twenty years later when I had retired from active practice.

A highlight of my medical career was when Pope John Paul II visited Kenya in 1980, 1985 and 1995; on the latter two occasions I was a member of the Health Committee of the events. These involved organizing matters to deal with health issues of the crowds which gathered there with the assistance of the St. John Ambulance Brigade, setting up First Aid posts, and a Local Medical Team for the Holy Father, including a “chase” Ambulance. I was appointed together with Dr. Andrew Kiura, a surgeon to be part of this team and we went wherever the Pope went. The Pope travelled with his own physician and we liaised with him. The ambulance was a mini-CCU (Critical Care Unit) and was equipped to be so, with 4 units of the Pope’s Blood group and all the necessary equipment and drugs for medical or surgical emergencies.  I got a commemorative Medal from the Holy Father and certificates from the Kenya Episcopal Conference for services rendered to the Holy Father. I have some precious pics with the Pope.

The Board of Governors of the Parklands School, Kenya Medical Association & The Medical Guild of St Luke

While in practice I engaged in a number of social and professional activities. One was the appointment to the Board of Governors of my former School in 1987. It was a pleasure to be of service to my Alma Mater. Unfortunately, the standards had fallen drastically since we had left, both academically and physically. The state of repair of the school was in a pathetic state and continued in this way for many years. The cause was partly a lack of awareness of the need for continuous maintenance on the part of the school Administration and part of the cause was insufficient funding on the part of the Ministry of Education. The student capitation was low and the little sent was transmitted a year or so delayed. The academic standards too were gradually elevated to the stage where more and more students proceeded to Universities or Higher Education. I served on the Board for 21 years before retiring to give room for new blood. I am still in touch with the school actively through the Alumni Association.

The other was an Elective post to the Council of the Kenya Medical Association, the professional body for doctors in the country. I served on this for two years ,1987-1988, and in one of the years I was part of the organizing team of a Medical Conference. It was hard work coordinating papers and meals and accommodation for the doctors, but it was a successful conference. I then ceased to be a member when I left Kenya for a Sabbatical in 1988, eleven years after I began practice.

Then there was the Medical Guild of St Luke, a body formed by a group of like-minded doctors to promote Medical Ethics. We prepared the Constitution, applied for Registration under the Societies Act, and began giving lectures on various aspects of Medical Ethics following Codes of Ethics and Medical Deontology. Unfortunately, after three years we got a communication from the Registrar of Societies saying that Registration was denied, no reason was given. We were disappointed as the Medical Guild was growing and the work done was good, and we had not stepped on any toes. We later learnt that the Registrar was suspicious we might be or might become politically motivated, which was far from the truth. The political situation in the country was not favourable as there was an autocratic government and there was much corruption. So it ended there, but members moved to other fora and societies to exercise a positive influence in this field.

Refresher Courses & Specialization

In 1987 I went to the Teaching Hospital of the University of Navarre, I Pamplona, Spain, to attend a three-month Refresher Course in Cardiology. It was truly refreshing to be in a Teaching and learning hospital once again and at a top hospital in Spain. The course involved a few lectures, but it mainly involved daily teaching ward rounds conducted by the Professors of Cardiology or their Assistants and of course the ever- present Registrar; there were also Seminars on specific monographic topics and joint Cardiology-Cardiovascular Surgery session with “live” patients who would be operated on within the week. These were fascinating and I learnt aa lot in the three months there. I had the opportunity to swim a lot in the Campus pool and visit museums and monuments and a few towns around Pamplona. I also saw for myself how Boys Clubs and Agricultural schools were run. I have an interest in both for Kenya.

Having had a positive experience in 1987, I decided to take a Sabbatical Year and to go deeper in my specialty of Allergy at the same hospital in 1988. The pattern of instruction was similar to that of the Refresher Course the previous year. The only exception was a period of three months spent in the Allergy & Immunology Lab doing analyses and assays.  I also read widely and prepared a paper on “Allergic Conditions in Kenya” with material I had carried with me from my practice in Nairobi. This paper formed the basis for a series of articles I had written and got published in the East African Medical Journal and also read one paper at an Ear & Nose and Throat Conference in Nairobi. My practice became largely an Allergy one.

Kenyatta National Hospital

With my experience in Allergy I became, with other Chest Physicians, a Founder Member of the National Asthma Association of Kenya.  I was invited to offer my services as a Sessional Consultant at the Infectious and Respiratory Diseases Division of the KNH, where I had done the Internship 18 years earlier. The work involved diseases of the Chest, including Tuberculosis (TB) and other infectious conditions, HIV included. It was a busy Clinic and the opportunity to see patients of the more chronic conditions was an eye opener for me and I gave a lot of my knowledge of Allergy as I received & learnt a lot in diseases of the Chest. I convinced the Head of the Division to introduce the use of Inhalers in the treatment of Asthma and Chronic Obstructive Pulmonary Disease – tablets or injections were used prior to that. He in turn succeeded in convincing the Hospital Administration to introduce these. It was successful and the treatment of these two conditions which formed the bulk, after TB, of the conditions seen at the Clinic.

The Sessions took place once a week on a Friday afternoon for 3 hours, or until the last patient was seen. Most Chest conditions worsen in the cold months – June to August- in Kenya and we worked longer hours then. Again, the issue of spot diagnosis came in handy. Though I did make a mistake on one occasion: it involved a young lady: she was a university graduate, a teacher, comely and had a serious lung condition. As she got onto the couch she kept her shoes on and had one leg hanging down. I asked her to take off her shoes and to put both legs up; she said she could not as the right leg was an artificial one! It was so perfectly done that the stocking matched the healthy leg and she could walk perfectly without a limp. I apologized profusely to her. I saw her in review several times and we had a good laugh at my faux pas.

The other incident of note was the bomb-blast of the American Embassy on Moi Avenue, opposite the Railway Headquarters, on August 7, 1997. All the Clinics were closed and the patients sent home or to the wards, if necessary. The hospital was converted into one big Accident and Emergency Unit and surgical ward. The Infectious and Respiratory Diseases Division Clinic was converted into a minor Operating Theatre. I got busy suturing cuts and lacerations of people affected by flying glass or other debris. Soon I was joined by senior medical students as the doctors were called elsewhere to ICU or Operating Theatres. I then limited myself to suturing facial wounds or the more serious wounds, leaving the minor wounds to the medical students. I also dealt with those who had Shock, mainly psychological.

Retirement

I had been in the practice of Medicine in one form or another since 1967 and I was getting weary and there were many things I liked doing for which I had little time for during my medical practice. I took an early retirement in 2004. I still keep my hand in Medicine reading Manuals, Text-books, giving advice to those who ask for it, accompanying some members of my Centre on their visits to doctors for one ailment or another. I read a lot – History, General Knowledge and Culture, Novels, Literature and of course the dailies. I walk for an hour each day religiously on medical advice. I am still involved with the Dr. Ribeiro Parklands School on the Alumni Association and keep I touch with Alumni, besides working on some day-to-day matters which require attention. I spent three years at the Coast, in Mombasa and Vipingo (40 km north of Mombasa). The first was at Nyali Study Centre which I helped to expand to cater for the formation of the Coastal people. This was a Centre of Opus Dei; I have been a member for fifty- five years.

Opus Dei is an institution of the Catholic Church with the sole aim of helping its members become good Christians and help those relatives, friends or colleagues of theirs who wish to do the same – personal sanctity and apostolate- in other words.  The crux of Opus Dei is the sanctification of one’s ordinary duties and the secret of tis efficacy is the rich spiritual life of its members. Members come from all walks of life: Farmers, University Lecturers and Professors, Plumbers, Carpenters, Doctors, Lawyers and so on. That is, any honest occupation. The majority of its 95,000 or so members are married and they live with their own families. A smaller percentage about 10% are celibate, like myself, and the majority of these latter live in Centres of Opus Dei. Approximately 2% are secular priests. Some members may join with others to set up educational or social institutions and may request Opus Dei to look after the spiritual activities therein. Contrary to belief, Opus Dei does not run Banks or other commercial enterprises. Its members may own them or work in them.

The activities I carried out At Nyali Study Centre were Classes of Catholic Doctrine, Talks on Professional Ethics, Human Virtues, engaging in personal counselling, and so on; the priest gave Talks in the Chapel, Retreats and Recollections, Spiritual Guidance and heard Confessions of those who want to. As usual people came from all walks of life.

Jahazi Conference Centre is at Vipingo on Kuruwitu Beach, and caters for Spiritual Retreats and Seminars. while I was at the Coast, I would spend there a few days each week, looking after the garden and supervising the work of the Gardeners. It was a loving task and we converted some areas which were barren coral rock into decorative rock gardens and others into flourishing flower gardens with soil and manure brought in from a nearby farm. We also improved the lawns which were initially overgrown and full of weeds. I usually spend a period of 25 days attending an Annual Seminar on Ethics or Theology each year there. Jahazi is looked after by the women of Opus Dei who also run nearby Tewa College, a Training School of Institutional Management, Tailoring and Agriculture for girls from the area.

After three years I returned to Nairobi to continue my retired life and I am enjoying it. 

  

Nairobi

9 April, 2023

Easter Sunday.