Articles by "Cancer"
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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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What would motivate a 50-year old man to give up his daily life to walk 1000km across Kenya? This may sound unusual but it is exactly what Thomas Chacha did in 2016.

When he is not doing extraordinary things, this simple man is going about his life in Kehancha, Migori county, farming and doing business. However, Thomas knows first-hand what it means to suffer from cervical cancer.

He may not be a woman but he surely understands the pain of watching someone die a slow excruciating death from this monster. He has lost loved ones to the dreaded disease. He has struggled to help dozens of others as they deteriorate before his eyes. He has buried far too many in the few years he has been a cervical cancer prevention advocate. He has wept with many orphans and widowers who have suffered devastating losses.

When I first met Thomas, I was in awe. This man had led a small team of men who had walked 500km from Migori to Nairobi in an effort to raise awareness about cervical cancer. The team was exhausted, haggard and worn out but they were elated they had achieved successfully completed their walk.

The cervix is a reproductive organ that is not easily talked about. It is interesting to see the names or phrases coined to describe it. Majority of the bearers of the cervix do not even know what it is or that it is an organ they possess, until it is in real trouble. Many have borne babies through the same cervix but they do not give it the recognition it deserves.

This little part of the female anatomy that separates the lower genital tract from the upper sterile part of the female anatomy bears the responsibility of being a gatekeeper. It keeps micro-organisms within the vaginal canal, denying them access from the uterine cavity and the pelvis at large. It keeps tightly closed for 40 weeks as the baby grows in the womb without letting go, as the uterus grows exponentially to accommodate the little one.

Yet for all its significance, we only pay attention when it refuses to work. We are overwhelmed when the gate is unable to stay closed and our babies miscarry prematurely. We forget to service it by doing regular pap smears and only wake up with a start when it breaks down.

Yet we cannot afford the cost of breaking down. The physical cost is astronomical to the woman affected and her family. Cervical cancer is unforgiving, relentless and ruthless. It eats the woman up from the inside out in every sense. From bleeding, to discharging heavy foul-smelling pus to weight loss, recurrent infections and pain.

As she suffers physically, the emotional and psychological toll on her is massive. One cannot describe what a woman goes through, knowing she is dying and leaving her children orphaned. It is harrowing to know that the infected, pus-oozing mass makes her smell so bad that even her loved ones struggle to stay close. That the very man she once sexually attracted may now be repulsed at the thought.

The financial cost is a subject of discussion worldwide. It is a no-brainer that cancer treatment costs are a huge burden in any nation irrespective of its economic muscle. For this reason, it is not strange to hear the heartbreaking phrase: the patient will go back home to die.

It is these women who inspired Thomas to get up and find a way to make a difference in these women’s lives. He also realized how important to stem the tide and prevent this highly preventable cancers. Through his organization, Thomas has worked tirelessly to put a human face to the fight against this cancer. Moreso, that this face must be a male face, to impress upon all of us that there is no way we can win this war without involving everyone.

It was therefore not difficult to imagine how Thomas lit a fire in all of us to do something in this warfare. This inspiration gave birth to the Step by Step Cervical Cancer Campaign, a 34-day walk from Migori to Mombasa, traversing 14 counties and covering 1000km. This was a partnership between Smilewoman CBO, The Nation Media Group and Swiftmed Solutions with an aim of raising money to screen women for cervical cancer in Migori county and provide treatment for those who require it.

Despite not meeting the target for fundraising, the walk created massive awareness about cervical cancer as disseminated via the media. In addition, it enabled Thomas to put a smile on the face of the women he tirelessly traversed the country for. The campaign has been able to put an NHIF card in the hands of every cervical cancer patient in Migori County. Riding on the declaration made by NHIF recently, to support cancer treatment 100%, this couldn’t be more timely.

Beating the cancer challenge is an effort embodied in the campaign, one little step at a time. Thomas got us this far, we must then not fail him. As we continue to emphasize the importance of screening, we must also look at how to finance that. My humble suggestion is that if NHIF can afford to treat cancer, it can surely afford to screen the population. In the long run, this would be the best investment in reducing the overall cost of treatment!


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Every gynaecologist, in the fight against cancer of the cervix, has a critical responsibility of offering the cervical cancer screening test to every woman of reproductive age group who walks into the consulting room.
In the early 2000s when the HIV scourge was at its peak, the stakeholders were grappling with the double responsibility of providing treatment while attempting to reduce the incidence. Running after the epidemic that was moving like a tornado, trying to stem the high rate of infection, especially in the third world, was no mean feat. The disease was heavily stigmatised, and considering the highest number of infection were acquired sexually, a mode that isn’t openly discussed as it is associated with negative connotation, the work was twice as hard.

Today, we enjoy a space where HIV testing is commonplace and we should never take it for granted. It took a lot of hard work, dedication, heavy investment in resources, deep commitment by government, external partners, health workers of every cadre and patients who agreed to advertently or inadvertently be the test subjects of drugs, policies and systems. As doctors, we are grateful that every patient who walks into a public hospital can be offered free HIV counselling and voluntary testing irrespective of what they sought treatment for.
While HIV care may be a story of success, we have not succeeded in several other, equally devastating epidemics in our midst. Cancer particularly comes to mind and cervical cancer even closer to my heart. Every time I meet a new patient diagnosed with cervical cancer, I am upset all over again. Our failure as a nation, as policy makers, as practitioners and as individuals is essentially paraded right before me one more time.

Cervical cancer (cancer of the cervix) is the only cancer that has capacity to be fully eliminated. Compared to the cost of treating it, the cost of prevention is a drop in the ocean. This entails health education, vaccination, timely screening and early treatment. Each one of us has a role to play in achieving this.
The government, through the Ministry of Health, may not have given this matter the attention it deserves. It is unfortunate that in the 21st century in Kenya, there are women who have never heard of cervical cancer. That right there is the first sign that all is not well in the Health Ministry. The Ministry has engaged in various activities to do something about this scourge that kills over 8,000 women in this country annually but sometimes they come across as uncoordinated. There is a ‘Breast, prostate and cervical cancer prevention’ policy guideline and effort was put to train health workers on screening methods. Cheap screening options were availed at public facilities all the way to health centres in the counties to improve access to screening. The effectiveness of this has been hindered by lack of information to the women to utilize these facilities, inability to retain the trained nurses and midwives who are the backbone of this programme, frequent breakdown of equipment such as the cryotherapy machines due to poor servicing, lack of motivation to the staff and the absence of proper referral mechanisms in case of women found to have the disease. It is an exercise in futility to claim to treat cervical cancer without access to radiotherapy and the fact that we only have one such machine in the entire public sector is embarrassing.

Meanwhile, the Ministry from the year 2012, was involved in efforts to introduce the cervical cancer vaccine into the regular Kenya Expanded Programme of Immunisation (KEPI). Project piloting was done and we await the launch. While the Reproductive Health Division of the Ministry waits for implementation, the Paediatrics and Child Health Division has managed to get the Rotavirus and the Pneumococcal vaccines incorporated for better protection of our children. I commend this progress and in the same vein continue to agitate for the girl child who has survived childhood to be given a chance to survive adulthood by sidestepping cervical cancer. The government must put money where their mouth is.
At a professional level, all health care workers must never cease to offer cervical cancer screening to all eligible women they come into contact with. Doctors, especially gynaecologists, have the power to touch the life of a woman, and must display leadership in the various units they work in. The midwives, reproductive health nurses and clinical officer RCOs have been the foot soldiers despite not getting adequate recognition. These are the men and women who take care of women in Bondo, Kacheliba, Kinango and Mugumoini at dispensaries and health centres, who may never see a doctor in their adult life. We must not fail them in their efforts. They come into contact with the highest number of women and must be supported by providing them with adequate facilities and infrastructure, and robust referral systems that work. The system they have set in place must be exploited to ensure all our women get the message that screening saves lives.

At an individual level, if you are a woman who has access to health services and you keep coming up with excuses not to get your pap smear done, you are exactly what is wrong with the health system. For years, women complained that insurance will not pay for the service, yet even now when most will pay for your annual pap smear, most women will not even use the service. You owe it to yourself to avoid a preventable death, even if you must spend money to do so. This means that you will increase your chances of seeing your children graduate college. It will ensure that you will not burden your children who are trying to settle down into adulthood with having to take care of you in the end stage of the disease or fundraising to afford your chemotherapy.

The educated and more exposed woman holds a candle to the less exposed one. If you cannot pass on the message of screening to the other women you influence on a matter as important as cervical cancer screening, then you have not done much in empowering your fellow woman. Women must learn to form health clubs just like their chamas, and use these to encourage each other into healthy habits, including good nutrition, exercise and cancer screening. I encourage my younger college patients to come for screening and cervical cancer vaccinations in groups so that they exploit the sisterhood bond positively, and this has worked. They are less likely to forget their next appointment and will certainly complete their vaccination schedules. These are home-grown solutions we can adopt in spreading the screening message.
That pap smear is a five-minute procedure that could save you five years of utter misery. Remember, cervical cancer kills slowly, very slowly. You will live every day of it in pain. The life-saving treatment is expensive and uncomfortable. The complications of radiotherapy, the side-effects of chemotherapy, the feeling of violation as your doctor is forced to access the most private part of you to provide treatment, all these are not for the faint hearted.

In this respect, I take time to appreciate, commend and cheer on the strong women who have stared this disease in the face, taken it on and won. And not only that, they dedicate their lives to educating other women so as not to end up in the same situation. They have held hands of those going through treatment, wiped the brows of those sweating out the chemotherapy agents and even gotten wigs for the hairless to give them self confidence. Women like Sally Kwenda and Rose Chiedo are heroines in their own right and history will remember them well for bearing the cervical cancer advocacy banner with dedication!

 


 

 

 

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We are finally in Mombasa!!! We did it!!!!!
What a great day! What magical sensation! Our heroes have completed a 1000km walk! If that isn't seismic, I don't know what is!!!
From last evening, our supporters had already started to trickle into Mombasa. Some drove in overnight, others flew in last evening, all with one mission, to walk with our heroes through the finish line. It is truly a momentous occasion.
By 8.00am, the team is up and ready to roll. The Mombasa motocycle team are ready with their fabulously huge machines ready to provide outrider escort into town. The Coast Region Traffic Enforcement Officer has sent his team to manage traffic. The Mombasa County Inspectorate is ready to clear the roads ahead of us. Big Phil and his moving sound is already entertaining the residents of Jomvu, who have turned out to cheer on the team  thanks to Mr. Ustadh Rama, the village head. 
We set out at 9.30pm, quite a procession, moving slowly towards the finish line. The heroes are getting a true heroes escort. Family, friends, strangers all walking together with lots of cheer and good humor. Thomas is wonderfully surprised by his sons and their uncle. They have travelled overnight to be here! All my siblings in Kenya are present. And I certainly do have a huge family! They have been my pillar through this whole walk and I couldn't make it without them.
Our clinical divison is here! The Cancer Research Trust team with the colourful banner are here marching on to the finish line! Who better understands the burden of cervical cancer care than these humble heroes?
Our ambassador, Janet Kanini Ikua, bless her resilience, is on the road.  Did you hear that??? On the road walking! Walking so that fellow women could live. Just so you know, Janet had chemotherapy a week ago and is just recovering from a sore throat but she is here!!! Miracles are made of these!
5And while I am name dropping  kindly take note that Churchill is walking with us! Yes he is! And has surprised me because I never believed he would cover the final 12km stretch on  his own two feet. He has proved me wrong. He keeps us all entertained and indulges his fans along the road.
And finally Jimmi Gathu, who has walked with us on radio the whole journey, is here to walk with us to the finish line! Walking is not for the faint-hearted but the finish line has a way of turning everyone into a walker. Jimmi is doing great, catching up with Thomas on what he missed yesterday.
At the end of the Makupa Causeway,  we are met with more supporters. The Migori County Team is here to finish the walk with their sons. Oh they are so proud of our heroes! They promised to be here at the flag off and they have turned up in style, led by the Deputy Governor himself!!!
As we snake through the town of Mombasa, the crowds are jubilant. I am still absorbing the wonder if it all! THOMAS CHACHA, PHILIP ROGORO  DANIEL CHOGO, PETER CHACHA AND NYANGI NYAMOHANGA HAVE WALKED 1000KM TO MOMBASA!!! I can't quite wrap my head around that yet.
And so it is that His Excellency The Governor of Mombasa County,  Hassan Ali Joho, gives a fitting reception of the team to the finish line! True Mombasa hospitality at its best. The Governor is accompanied by the Health Committee team, The Office of the Governor team, members of his county assembly  and Mombaa residents at large. With traditional drummers setting the tempo, we finally cross the finish line at the iconic Mombasa Elephant Tusks on Moi Avenue!
If you thought that was all, you are wrong. Wonderful receptions were not in short supply. A generous well wisher hosted the whole group to lunch at his house. The governor invited the entire team to his home for Iftar. Uh huh, we shared a meal with him and his family when they broke the fast for the day! After such an exciting day, we are grateful to the famous Sarova Hospitality once more. The Sarova White Sands Resort and Spa is our home for the night!
This is definitely how heroes complete their noble task!


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I have always been drawn to athletics. I can sit alone for over two hours following a marathon race cheering alone like a woman possessed.
I've learnt just how resilient the human body can be, but in  the same vein, appreciated just how that resilience is highly dependent on the mind. Once the mind gives up, nothing, and I mean nothing can push the body that extra 100m. On the other hand, when the mind is focused on the finish line, there is no stopping the body.
A brilliant example is the 2008 Beijing Summer, where our very own Samuel Wanjiru not only won the 42km Marathon race in the men's category but also set a new world record of 2hr, 6min, 32sec. The country was thrown into frenzied jubilation as we screamt ourselved hoarse in front of the televisions. The finish line for the race was inside the Bird's Nest stadium. Wanjiru had set a brilliant pace throughout the race but when he entered the stadium amid the cheering from the fans, a new force inside him was reawakened. If you had missed the rest of the race, you would be forgiven for thinking that he was doing a 400m sprint. He sped to the finish line with such speed, we were on our feet screaming like mad people.
It is in the same olympics that our wonder girl Pamela Jelimo made a statement. That 800m race for women was not the preserve of the Ethiopians. This girl had just won the Diamond league gold bullion, never losing a single race in the entire circuit! She brought that ooomph to the Beijing Olympics a d casually strode away with the gold medal. Watching her run was a moment of rapture. Nothing could distract me. One did not breathe for the entire race.
Our Golden Boy David Rudisha broke into the world record dormain in 2012 at the London Olympics. We all went crazy watching this tall sculpted athlete take the race like he owned the world platform. Indeed he did. He was the first man ever to run the race in under 1min 41sec. By the 200m mark, he would have pulled away from the pack, looking like he was not part of the race. His mind was so focused  he never paid attention to his competition. His competition was the standing world record.
I compare our great heroes to these men and women of greatness. Today they see the finish line. Today they set foot in county number 14. Their walk across Kenya is done. Tomorrow's walk is short and ceremonial. For them  today is when the walk comes to a close. The burst of energy in them as they close in on the end is amazing. They are exercising the 'finish line kick'!
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Two more days to go!!! Two two two.... We are truly almost there.
I must admit I am excited. I have spent sleepless nights worrying about the safety of the team on the road. Praying for their safety and health, worrying about malaria and fatigue and of course the blisters. It feels like I'm permanently holding my breathe and scared to exhale lest something bad happens. So you can understand my excitement about the finish line.
As we cross from Kwale County into Kilifi County,  we can appreciate the palm trees  the coastal foodstuff sold by the street vendors on the roadside, humbling prayerful modesty of a people in Ramadhan and the frequent calls for prayer from the mosques.
Mariakani is a busy town with a major weigh bridge and truck stop. The town is split in two, the weigh bridge end and the main town. We camp at Mariakani Secondary School and I am totally surprised. These gentlemen who just walked 25km like it was a stroll in the park, with the exception of Thomas, head off to the  pitch and play a game of football with the students!! I am still recovering from the shock! I am totally challenged here, I guess I need to do a lot more to come close to this level of fitness.
The school boys are refreshingly curious about this camping lifestyle. They serve their dinner and come to the campsite to eat as they watch us go about our business,  setting up tents,  cooking, washing up, it's all new to them. In the process, I hope they learn a bit about why real men must stand up for women in society. It is the beginning of greatness!
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Three more days to finish line!!!! Three!!!
Rearing to go is the best description of the team. People are up early, getting ready and having breakfast amid cheerful banter. Our destination is Samburu, 25km away. Just so you know, Samburu township is in Kwale County!
We are currently covered by the Taveta Red Cross team and they comprise of an energetic youthful duo, Vincent and Said. Vincent is a man of numerous talents, extremely outgoing, very helpful and sociable. He makes friends with all kinds of people, age notwithstanding.  He makes a fantastic EMT. Said is extremely dedicated. He is currently fasting as it is the holy month of Ramadhan. Despite that, he is committed to his work, and still walks with the team to encourage them! What a blessing these two are!
It's yet another dusty walk but the mission before us is bigger than the temporary discomfort. That is the level of commitment here. Right this moment, as the team trudges on, a wife somewhere is distraught  wondering how to tell her husband that she is slowly dying of cancer. That in a short while, he is going to be a widower, raising their four children alone. That in a few months, she won't be able to do much around the home but will instead require full time care. That the end won't be pleasant. She will be in pain, with foul smelling discharge,  having lost weight and having no appetite. That she will leak of urine and stool, that even her own children will not be able to tolerate the stench. That she will cry for death to take her, even if it means leaving her children orphaned.
Death from cervical cancer is the most undignified of deaths. It is a psychological nightmare for the woman and for her kin. This is the reason the team is walking. This is what drives them on. This is why we must all unite to prevent this from ever happening to any woman, whether we know her or not. She could be your sister, mother, wife or daughter. Come on, get on your walking shoes and walk this walk with us. It is that important!!
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Four more days to the finish line! Four!!! It has been a full month on the road!

We bid farewell to the Tsavo and start to feel the full coastal environment. The humidity is beginning to weigh in. The road is tough. The highway is under construction and  because of that, the team is walking along a diversion billowing with dust. The truck drivers are impatient and on edge with the traffic and the team must be extra careful to avoid accidents.

The destination is  Mackinnon Road. A little dot on Google map with a rich history. Apparently it gets its name from the fact that it was the junction of the Uganda Railway and the Mackinnon ox cart road at the end of the 19th centuary. It has a little mosque which houses the tomb of Seyyid Baghali, a Punjabi foreman at the time of the building of the railway who was renowned for his strength, believed to provide safe passage to travellers from the grave!

During World War II, Mackinnon Road acquired an airfield for the Royal Navy. Later, between 1947 and 1950, it became the site of a large British Engineering and Ordinance Depot for holding 200,000 tons of military stores to replace Egypt that was experiencing an uprising. The depot was abandoned and eventually became a detention camp for Mau Mau suspects until 1955.

Who thought a nondescript little township could hold such detailed history. Well, now it is home to schools, churches, business enterprises, gas stations and a pretty ordinary existence. I bet it is prettier when there is no dust from road construction. The team is happy to be able to wash off the layers of red dust at camp and have a rest.

Only four more days left to finish line!!!
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The geography of our country will never cease to amaze me. Today we officially complete the Tsavo crossing. I made a mental note to self to learn everything I can about this exotic natural resource.
The Tsavo National Park is largest national park in Kenya and one of the largest in the world, covering over 22,000km2. It was gazetted in 1948, making it one of the oldest parks in Kenya. It was split into East and West by the railway line and the Nairobi-Mombasa highway. It borders the counties of Tana River, Taita Taveta, Kitui and Makueni, with a migration route connecting it to Amboseli National Park.
Tsavo East, the larger of the two, is 13,747sq. Km. It is accessed through Manyani, Voi, Buchuma and Sala Gates. It is generally flat, with dry plains through which the Galana River (a merging of Athi and Tsavo Rivers) meanders. It is the home of the Yatta Plateau and Lugard Falls. It supports a massive ecosystem of the big five among others and is the habitat of the Red Elephant, derived from the red Tsavo soil that coats the beasts, and infamous for their temper!
Tsavo West occupies 9065sq.km. with a more varied landscape, rocky, mountainous and hosting Lake Jipe and the Mzima Springs (the source of Mombasa's water).  Its swamps support a host of fauna, from bird life to large mammals such as black rhino, Cape buffalo, elephant, leopard, hippo, Maasai giraffe and Masai lion  to smaller animals like dik dik, bush baby, hartebeest and lesser kudu. It is accessed through Mtito, Man Eaters, Chyulu and Maktau Gates.
To be able to experience this wonder on foot, driven by such a noble cause is surreal. I look at these selfless gentlemen walking with such single minded focus to save a woman's life. A faceless woman they may never personally know. A woman who embodies the representation of our society as we know it. I truly have to wonder if they have any comprehension of the depth of their sacrifice. I sure hope the public does!
Buchuma Gate is our stop for the night. We rest the body as the spirit soars on.
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Today is a good morning! It may be freezing in Nairobi but it is bright and sunny in Taita Taveta county,  and best of all, the team has brand new shoes!! Still thanking Mr. Mohammed and his team! And the shoes get to go with brand new sports socks in a rainbow of colors!
I happen to have spent a good amount of my teenage years around a professional athlete. I could never get over how many pairs of shoes he had to have. There were different ones for regular training, some for competition preparation, competition shoes for tarmac, stadium, snow and rain...you name it. There were fancy expensive shoes all over. I thought they were that many for company endorsement but I now realize that the hundreds of pairs were out of necessity.
I have watched our heroes' shoes transform from new to used to old before my eyes. I would be keen to know how many steps a person makes to wear out a shoe. In three weeks, two pairs were history. And guess what, old shoes worsen blisters and cones.
Our heroes are in quality walking shoes. They are safe from injury and that makes me so contented. My shoes are still in great shape, a testimony of the distance walked. So I guess that's why I am still far from being as toned as they are! Lessons learnt: you wanna  shape up, your shoes are evidence of the quality of your workout!
Mombasa seems closer now.  Our feet are lighter and more agile. We are sprinting to the finish line but for today, we shall stop over at Maungu!
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I seem to wear the rough and tumble of the wild pretty well. Seems difficult adjusting back to the hustle of city life! I drove over 350km back to Nairobi last night and after six hours of sleep, I am still struggling to ease back.
The champs are on the road by 9.00 o'clock,  ready to tackle the 25km to Voi. It's Sunday and while everyone is in church or in bed, these gentlemen are already counting the miles. But I do begrudge them the warm temperatures, I am a sucker for heat. Can't handle cold weather. And it is freezing in Nairobi!
Today I wanna give a huge thumbs up to Jimmi. Jimmi has been the number one cheerleader for the Step by Step Campaign. He has been updating the public about the team's progress from the beginning. He has had these gentlemen in his studio just so Kenyans could meet them. He knows their names, their background, the things they hold dear, the love they have for their families, their low moments and the high ones. He has walked this walk with them. Every single step.
Today he goes a step further. He has taken time out of his weekend to spend Sunday morning with them. He may have missed church but I bet he is more blessed than those who are dozing on the church pews! I must thank him for a fabulous gospel collection that he's put together today. It is totally in keeping with the spirit of the campaign. As we catch up on the walkers trail, I am touched that he remembers that Nyangi's baby is now two months old. I guess when you are a dad, you understand a comrade.
I am extremely happy to meet Mr. Mohammed of Bradleys, his CEO, Jim and Jayne. These guys came through for us at a moment's notice without hesitation. They are at work on a Sunday. I receive the new shoes, socks and cartons of bottled water for the team. They are still willing to donate to the campaign during the medical camps. I am touched. On behalf of the Step by Step campaign, I can only say a big THANK YOU!
I am happy to hear that the team have been well received at The Tsavo East  Gate, Voi. Thanks to Mr. Dickson Too, acting Deputy Director, Tsavo; and the Senior Warden,  Mr. Wambua. Captain O'Brien, the Assistant Director, Tsavo, runs a tight ship and in his absence, his team are more than capable. They have set up a hostel for the team. There shall be no tents allowed. Tsavo East is home to the big five and more, and security is top notch. Thank you once again Kenya Wildlife Service!
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Last night I had two patients at camp; Thomas and Barry. They were to get injection painkillers to help alleviate the pain on their blistered feet. I left them telling stories sitting around the camp and went for a shower. When I came back with my medical kit, they had all disappeared to bed!
I couldn't help laughing. See, Barry is quite a big guy, and extremely fit. Without any preparation, he joined the team and has walked with them this past week throughout the whole distance, including the 49km for yesterday.  His feet are now blistered and some of those blisters are painfully red. It is absolutely hilarious that he can tolerate that kind of pain, yet he runs from a needleprick. Let's just say that my four year experience injecting babies came in handy and I did corner my quarry for that ever-important shot.
One more night that I am thankful for, I did not get a scopiorn bite and I did not share my sleeping bag with a snake. We've got to be thankful for the little things, right? It's a beautiful sunrise and I am enjoying a hearty breakfast served by Dan. You'd think the team would be sluggish this morning after the long walk yesterday but they are so chipper it's amazing. And they have taken cold showers!!! I want some of whatever it is they are eating!
Today we are walking to a wiped out little shopping centre called Ghazi. It pretty much shouldn't even be existing as it is within the park but a few people tried living there and doing business during the road and rail construction. Many have been harmed in animal-human conflict.  Once the team achieves its mileage for the day, they will ride back to Man Eaters Gate for the night. Tomorrow they will be ferried back to Ghazi to continue their walk into Voi. That is how seriously KWS takes security! I love these guys. They live their work and are really good at what they do. They understand the animals like their babies. I am learning so much from them.
I received great news this morning. Mr. Mohamed of Bradleys, and his team, have gotten shoes for the team!!! They've even thrown in socks and drinking water!!! How cool is that! Blessings blessing...So off to Nairobi I go, to receive the donation and make our walkers' feet happy!
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The team is finally taking our biggest challenge yet. The Tsavo Crossing!!
We camped at the Tsavo West Gate last night after a warm reception by the KWS team. We even had the pleasure of a guided tour through their information centre. It's kinda hard to fall asleep in your tent after seeing the preserved puff adder in the information centre, which apparently was captured at the very place you have set up camp.
I finally meet Captain Kenneth Ochieng, a hulk of a man, who is the Senior Warden in charge of Tsavo West Park. I have only spoken to him on phone but today I finally get to shake his hand. He is a wonderful man who makes us feel welcome and flags us off with pomp. He has two of his game rangers accompany us throughout the walk until we reach Tsavo East.
The walk is tough. The pace is high, the heat is searing but thankfully there is some breeze and a few smattering of clouds that keeps away the direct sun.  Thankfully the only animals we encounter are dik dik hopping around in the bushes. Thomas's feet are wrapped up in cotton and gauze paddings to minimize pressure on tbe blisters. He is in pain but the stoic look on his face warns me to butt out. He won't dignify my pleas  to ride this walk out with an answer. All I can do is keep my mouth closed and fall in step behind him.
Our Kenya Red Cross E-Plus team is with us, and Yusuf the paramedic has decided to walk with the team. We are escorted by the Serena Kilaguni Lodge team too. They turned up to flag us off. Even Dan, our beloved chef is on the road! It's a jolly crowd as we set off amidst friendly banter. But as expected,  as the pace picks up and the distance stretches out, the crowd dwindles down. I keep up for 15km before I bow out. One of the rangers makes 20km and Yusuf suprises us all by hitting the 25km mark. Only my brother Barry triumphantly limps into camp with the heroes!
49km and dozens of empty water bottles later, the team arrives at the Tsavo River Gate, popularly known as Man Eaters Gate. It is still part of Tsavo West, the halfway point. The rangers welcome us and help us settle in. Yusuf is doing his rounds,  checking the team's feet. Thomas and Barry are sitting with their feet soaked in cold water. He dispenses pain medication and massages legs as he goes.
We hurriedly prepare dinner as the walk ended late, and by 8.00 o'clock, everyone is filling their tummies with goodies from  Dan's kitchen. It is interesting to observe how the body handles physical stress. Despite all the energy expended in the walk today, these gentlemen are eating less and less every day. They are generally slender well toned people,  but weeks on the road have made them leaner and now they drink more and eat less. I can't wait for the finish line. These heroes need a spa moment in Mombasa. They deserve it!
A hot shower and  place to lay my head is all I need. As I lie in my tent listening to Lydia's soft breathing on the next  mattress, I say a prayer of thanks for a safe crossing.
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Hot hot hot!!! That is all that can be said for the weather this side of Kenya. Throw in the red dust and things are pretty rosy!
Kambu to Mtito Andei is the target for the day. 17km is the distance. That alone is enough to make us all smile. There is some apprehension because tomorrow is the day we start the Tsavo National Parks crossing. It is a 49km stretch traversing the home of the big 5, collectively one of the largest parks in Africa. It is therefore necessary to rest adequately before then, hence the relatively short walk today.
I am doubly worried about Thomas. His blisters are still horrible, and he is going to put them through 49km of hard tarmac and hot weather. I don't even want to think about it.
So today we focus on the road ahead of us. One step at a time,  heads slightly bowed to keep out the direct glare of the sun, hourly water breaks to prevent dehydration and keep marching forward towards the finish line.
Does the team ever consider not finishing the walk? It is not even a remote possibility. It wouldn't even make for a sixty second conversation! The deep conviction they carry within cannot even be described. When I look at their faces,  I know that I am priviledged to know such men.
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The Kibwezi I knew was a little highway township. I didn't know that for the past 12 years, that changed and Kibwezi is no longer on the highway. Our home for the night was a homely place called Kambua Resort. The proprietors,  Mr. and Mrs. Makwattah, are a lovely couple who warmly welcomed the team. Together with their staff, it was certainly a great reception. 
The heat is increasing and the ground is getting sandier. The fauna is changing, there are more and more insects buzzing loudly everywhere especially at night,  around the lights. Certainly not a scene for those with arachnophobia.  For me  it's the creeping animals that raise my hairs. The colorful lizards are best observed from a distance. I certainly won't want to share  tent with one.
It has been many days spent traversing the county of Makueni.  I am still in awe of the vastness of the place. It is also very sparsely populated. As a doctor, it is not lost on me the  challenges the county must be experiencing in delivering health services to its people. With such sparse populations, making services accessible is certainly a huge challenge.  Every sign I see indicating a health centre warms my heart.
I recall nine years ago, I had a patient in my care from  this region. She was with us for a few days before passing on. She came with end stage breast cancer which had spread to all her organs. She told me she had sought care in the neighbouring Tanzania as it was closer to get to a hospital there, than attempting to get to one in Kenya. I was horrified. How could our people go through such experiences,  as if they were not Kenyan!
As we close the inequality gap by putting up more health facilities,  my prayer is that we don't just pay lip service. Let these facilities have the requisite human resources, drugs, diagnostics and support services to care for our people. Then and only then, will we be truly one as a nation.
The team is finally at Kambu, a tiny little township that is two kilometers off Mombasa road. They shall spend the night at the common compound housing the police post and the administration unit. And guess what? In this little place that's a tiny dot on the map, an angel from my past, Rose Museo  and her friend Josephine, are the first to welcome the team from the highway, with applause and donations to the campaign! What blessings!!!
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Everyone seems to be suffering from withdrawal today! The team can't get over the Sikh temple hospitality! Well, the Kenya Red Cross E-plus team and the Kenya Police are here ready to escort our team to Kibwezi. It's time to hit the road.
The team is off to Kibwezi, 24km away. The walk is going well, and our men in blue from the National Police Service are flanking the team, ensuring they are secure. I observe how the highway is busy with small scale business people going about their trade  selling fruit, vegetables and charcoal. It is well worth noting that majority of them are women. They are on the roadside ensuring their babies are fed and clothed, with a roof over their heads.
These are the very people who inspired the Step by Step Campaign! They are the reason why Thomas Chacha, Nyangi Nyamohanga, Daniel Chogo, Philip Rogoro and Peter Chacha are pounding the tarmac, day in, day out, to raise Ksh. 50, 000, 000. They mean  business. They appreciate the very vital role that Wanjiku,  Mwende, Anyango, Farida, Kerubo, Amina, Chebet, Nalei and Amreet have equal opportunity in seeing their tomorrow by eradicating cervical cancer in Kenya.
Our women-folk are so engrossed in seeking daily sustenance for their loved ones, they hardly pay attention to their own bodies. As they go about their business, cervical cancer creeps in silently, taking residence in their bodies and quietly taking over their lives. By the time the woman is even remotely aware that something somewhere is not right, the cancer is too far gone.
As the miles tick by and the finish line draws closer,  I pray that the statement made by these five indomitable men is loud enough to make us all rise up to the occasion.
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It has been ages since I was on Mombasa road. I keep getting amazed at how things changed when Mombasa road was rebuilt by Straberg, the German company. More changes are still happening with the standard gauge railway construction that is on-going. Flyovers like the one at Emali have been redone, some towns were abandoned by the highway as the new version was re-routed outside town, and new townships have sprouted that were not there ten years ago.
The team spent the night at Kiboko police station. The police officers here are the friendliest we have encountered so far. They actually waited on the road for the team to arrive yesterday afternoon. They ensured the team was comfortable at camp and this morning, gave a complete outrider escort all the way to the next stop, Makindu!
The team is very well received at one of Kenya's most hospitable little gems one can ever think of, the Makindu Sikh Temple (Gurdwara). This little haven of peace was founded in 1926 by the Sikhs who were constructing the Kenya-Uganda railway. It is well known for its open-door policy, providing a haven of peace for weary travelers irrespective of their background. Everyone is provided with food at no cost.
The team is warmly received and everyone is provided for a room. The manager of the premise himself welcomes them and invites them to dine at the huge dining facility. As the men don headgear and sit to lunch, one can't help but wonder about the level of hospitality in this Gurdwara. The kindness is extended to all, irrespective of their origin, religious beliefs or duration of stay. Despite the first class service and great food, there are no charges. Well wishers donate to the temple and this partly contributes to keeping the place running.
The generosity and kindness displayed here reminds me of my childhood. I grew up in the small town of Kericho. Back in the 80s, it was the most cosmopolitan little town in the whole of Kenya. We had people from all communities in Kenya living peacefully in harmony. We had a large Asian and Nubian community too and we all went to the same public school as kids. What is stuck in my memory though is how we spent religious festivals as a town. During Ramadhan and its culmination to Idd-ul-fitr, all kids spent the evenings in the Muslim homes enjoying the culinary delights prepared. During Diwali, we were found in the Hindu homes, eating chevda and setting off fireworks. Christmases were spent in the Christian's homes staying up late enjoying the excess food prepared specially for the occasion. The town was the safest in Kenya and we could walk home at 10pm without fear. Everyone knew their neighbor and one did not get alarmed to get home and find their kids were not yet home.
The Makindu Gurdwara sent me back to my blissful childhood. I wonder what it would take to reclaim that lifestyle. I am thankful that at least, the Sikh community has invested seriously in preserving that memory. Stop by sometime, even if to just meditate...
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Today the day started on a bit of a low note. Thomas's feet are HURTING!!! He has nasty blisters that he has been concealing from his team because he does not wish to dampen their spirits. I mean! Who does that??????
His feet are on fire. And he does have delicate feet. They have blisters on the underside where he steps! Oh they are painful! But the stamina of the man!! He won't give in to them. He refuses to let them hold him  back. He won't even hear of a suggestion to ride in the truck for a day to rest them.
The E-Plus team from Kenya Red  Cross are doing the best they can. Pain medication is dispensed and cotton padding for the feet is done and our gallant hero hits the road without once looking back! Emali get ready, a champ is on the way.
I have seen team captains motivate their teams, I haven't seen this kind of motivation. I am lost for words. I know his daughters at home are in tears. They are devastated by what he has to endure but deep down, their hearts swell with pride. He is doing this for women. He is doing this for them!!! His sons will put a  brave face but the sacrifice he is making is not lost on them. I don't even want to imagine what his wife thinks. She must be one tough cookie. In her place I would be bawling my eyes out.
I have never been so glad to see our next campsite! It may be next to the railroad but it is the best thing I have seen all day!!
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Emali to Kiboko!!!
I am sitting on a camp chair having sweet potatoes for breakfast, basking in the sweet morning sun as the Magadi Salt train rumbles by behind me with its massive cargo, towards Mombasa.
I am watching the team going about their business and I am certainly amazed at their adaptability. They have become adept at camping. We are breaking camp in readiness for our departure and everyone is going something to contribute. The tents are down and are getin packed in the truck's lower compartment by Chenze, the camp aide who can put up a tent in 60 seconds flat. He is such a treasure! Dan, our chef, and Barry, my brother, who has decided to spend his week off work with the team to encourage them, are washing dishes and stowing them in the kitchen compartment. Dennis, our IT manager is cleaning up the truck, wiping tables and mopping the floor. John, the truck's driver is carefully storing away the foodstuff. Peter is collecting rubbish, Philip is storing the water containers and buckets, Daniel is putting out the charcoal fire, Thomas is putting out water and snack supplies for today's walk and Daniel is keeping away the cooking gas.
This group has become a tightly knit family unit. Spending this past month together has led to new bonds being forged. Probably lifelong friendships are setting root right here. Last night we talked about family. It is clear just how much family means to them. Peter Chacha misses his little girl. She's three and clearly the apple of her daddy's eye. His eyes light up just mentioning her. Nyangi is hoping his now seven-week old son won't forget him. You can see the longing in him to hold his infant boy. Daniel is contented to talk to his family and that his baby is currently healthy. Thomas worries about his wife, who has got high blood pressure and on daily treatment, and his daughter who has been unwell for quite a while. Philip thinks about going back to school to complete his studies once he can afford to.
I regard these men as heroes, but in moments like these, I am reminded that they are also human. This just demonstrates the depth of their sacrifice. Underneath their determination,  they are simple warm loving husbands and fathers who are doing extraordinary things in their space. I hold them in awe.
Let me find my toothbrush, Kiboko awaits us...
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The new dawn is here, with warmth and sunshine and warm hearts all around. The ACK Guest house team continued to extend their hospitality and gve the team a warm send-off.
The walk today is fair, 21km in all, to Sultan Hamud. The team covered it in under three hours and left me amazed. These gentlemen have gotten so used to the road that they are unable to tame their pace even when the distance is  not so punishing. They forge on with such purpose, its humbling.
I must say I love the Makueni community. These must be the friendliest lot in Kenya. They are so welcoming it is overwhelming. Everyone is ready to welcome the team even with no prior notice, and go the whole nine yards in giving their best in hospitality,  irrespective of whether it is a school, a hotel or even a police post.
Today we are hosted at a roadside boarding primary school called Three Bells. The director himself was already at the school awaiting the team's arrival. It is moments like these that melt my heart, remind us that deep down, we are truly Kenyan. That what unites us is the common  good.
Makes me remember that cervical cancer does not discriminate. It does not choose color, race, background, lifestyle or level of education. If you don't tame it, it will devour everyone. That is why this coming together to fight back this monster demonstrates our unity towards a common goal. I am happy to be a part of this noble cause!
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