THE HIGHRISE TRAPS OF DISEASE AND DEATH

Brandon* was a chubby seven month old infant admitted through our paediatric outpatient department in critical condition. He had severe pneumonia with impending respiratory failure. He urgently needed admission to the critical care unit.

Unfortunately, our overstretched public referral facility could not accommodate him due to lack of an intensive care unit bed. I begged the unit doctor on call to work a miracle and he stared at me in despair. He was discharging a patient who was barely stable, to take in one from the operating theatre who had undergone emergency brain surgery following a road traffic accident. I was crushed.

The best the anesthesiologist could do for me was to put a tube in Brandon’s little airway to allow us to mechanically help him breathe ourselves as we prayed for a miracle. In the ward, we took turns to act as ventilators for hours on end. Eventually at three o’clock in the wee hours of the morning, Brandon gave up on us and passed on.

To say his mother was crushed is an understatement. She had just lost her first born child. She was barely 24 herself. She wept bitterly on the cold bench and nothing we said could ease the pain she felt. The cold grip of death had robbed us of yet another angel.

A hush fell across the entire ward. Every mother clung tighter to their little baby, instinctively trying to protect them from a similar fate. Mothers who had little ones on oxygen support became even more anxious as they feared that before the sun rose, they may be next to experience such dreaded loss.

How did we get here? One word; greed. In our country ight now, nothing is more precious than a piece of land. All over our major cities and even smaller towns driven by devolution, the green is fast fading, replaced by concrete jungles. Unplanned, awkward concrete monstrosities in the name of apartment buildings that are breeding illness and death.

Every single open space taken away from us means we have lost access to free, God-given sunlight that feeds our bodies with vitamin D. lack of vitamin D ultimately results in development of rickets. To the lay person, rickets has always meant bow-legged or knock-kneed children. This is how I recall the illustrations in my science books in my primary school days.

Studying medicine opened a pandora’s box for me. I appreciated rickets was more than leg problem. That it could strike early on in infancy leading to a myriad of skeletal abnormalities, poor muscle function, convulsions and life-threatening recurrent respiratory infections complicated by respiratory failure.

Brandon was a victim of greed, and absence of regulation. He grew up in what is commonly referred to as the Eastlands area of Nairobi in an apartment of the 5^th floor of a building that was so dark, it was impossible to tell the time of day when indoors. The lights in the house were always on. With apartments lined up back to back, the natural sun had long been obscured. The poor boy had never experienced the simple joy of basking in the morning sunshine.

With the congestion of the area came pollution and insecurity. While his mother struggled to keep him safe by restricting him to staying indoors, this monster called rickets had quietly crept in and was endangering him from the inside. This was his second admission in the space of four weeks. He had recovered from his first bout of pneumonia and despite having been diagnosed with rickets and started on treatment, he got a second attack soon after, that proved fatal.

Babies like Brandon are currently numbering the thousands living in these death traps all over our cities. The parents have no information on the dangers posed by absence of sunshine in their children’s lives. Gone are the days when apartment buildings had a concrete slab at the top where families hung their laundry and babies got exposed to the morning sunshine, uninterrupted by smog.

The question then is, who authorizes these constructions? Where is the outcry from our public health department? Who is speaking for the little voiceless ones? Are we so tired of fighting infections, cancer and metabolic diseases that we have forgotten about such an easily preventable disease?

When it comes to health, we seem to grossly underestimate the cost of corruption. Year in year out we witness substandard buildings collapsing, burying lives underneath the rubble and we shrug it off and forget. For every collapsing building, there are a thousand others still standing that are slowly killing our babies. For every landlord smiling all the way to the bank because he managed to squeeze into every inch of his eighth of an acre and add one more level of apartments to his name, is a dozen babies who may never live to see their first birthday.

We must resist from turning into a country that kills its children. This cannot be the cost of urbanization. It is not right that 40% of our paediatric ward admissions in the city hospitals and its environs are a result of rickets.

Nature has provided us with vitamin D for free. We cannot be working this hard to to deny the general population from accessing it. It is immoral!