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.
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