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70 million people live in Cholera hot spots in Africa

Irene Shone



Appropriate disposal of human waste is a basic requirement for sanitation, public health protection and good health and dignity.

Executive Director of Kenya Water for Health Organisation, Patrick Alubbe said this recently in Nairobi, Kenya at a Water and Sanitation workshop organised by CSE, India, Media for Environment, Science, Health and Agriculture (MESHA)-Kenya and Kenya Water and Sanitation Civil Society Network (KEWASNET).

Alubbe highlighted that most of the diseases which result in diarrhoea are spread by pathogens (diseases causing organisms) found in human excreta. He said there should be improved sanitation and efficient use of flush toilet, pour flush toilet connected to a pipe system, septic tank, VIP latrines and covered pit latrines.

He said this should be utilised by using improved technologies including; specific infrastructure, methods or services designed to contain and transform products or to transport products to another functional group as well as dry toilet for reuse.

Very soon, Africa will be overtaking India, as the region with the world’s largest population that defecates in the open Alubbe said that it is important for the African region to promote innovative technologies in sanitation.

He said that a significant amount of disease could be prevented through better access to adequate sanitation facilities and better hygiene practices. “Improved sanitation facilities, for example toilets and latrines, allow people to dispose of their waste, appropriately which helps break the infection cycle of many diseases,” he said.

He said that providing access to safe water and sanitation facilities, and promoting proper hygiene behaviour are important in reducing the burden of disease from sanitation and hygiene-related diseases.

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Mental Health Series

The effects of dagga on mental health



Recently the South African Supreme Court legalised the private use of dagga. Individuals are allowed to consume dagga in private and also grow for private use. The judgement brought mixed reactions on the issue and further fuelled the debate on dagga.

There are those who have used this judgement to the detriment of their own health. The crux of the matter though is that adverse effects of dagga cannot be underemphasised as far as mental health is concerned. Dagga use is quite popular amongst the youth which ostensibly explains the prevalence of dagga related disorders amongst them.

Effects of dagga are instant upon use. When dagga is smoked, it gets into the blood stream and then blood –brain barrier. This results in depressed brain activity, the end result being production of a dreamy state manifesting as delusions or hallucinations.

Delusions are altered thoughts whereby one may think he is a president when the reality is he is not. Hallucinations on the other hand is when an individual has distorted perceptions of reality like seeing a lion when it’s not there!

Others effects include:
panic attacks
Impaired coordination and balance
Impairment in learning and memory

Various research studies have shown that heavy use of dagga facilitates the development of schizophrenia and substance use disorders. The amount of the drug used and the age at first use often place an increased vulnerability to develop these disorders. This explicitly explains why there are many youth who are having substance use disorders in our country.

Those using dagga may develop amotivational syndrome which basically means they have lost the willpower to do meaningful activities in life! This is basically the stroke that breaks the camel’s back, as other mental health problems may manifest from this.

Those whom are already diagnosed with mental health disorders can have symptoms of their conditions worsening when they use dagga. Depression and anxiety are often made worse by use of dagga. The false perception that taking dagga has a calming effect often predisposes those having mental health problems to take it in order to deal with their illness burden.

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Sun Health

Lymphedema Management Part II Post Breast Cancer



Lymphedema can occur to individuals who have had breast cancer treatment with radiation and/or surgical intervention with or without lymph nodes removal usually in the arm pit.

Lymphedema is a special type of swelling that occurs when there is excessive build of fluid that is rich in protein that is to become lymph due to an impairment in the transport of this fluid anywhere enroute to its final drainage site in the neck.

Lymphedema management is divided into two phases: Phase I Congestive/acute phase whose goal is to achieve the greatest decrease in volume of lymphedema and Phase II Maintenance phase, whose purpose is long term maintenance to ensure sustenance of goals achieved in Phase I.

Components of Phase I are, a) patient education about the condition, self management strategies. The patient will be advised to avoid certain medical procedures to be done on the affected side, e.g. blood pressure readings, pricking to withdraw blood.

These procedures especially the pricking will result in minor injury which in a normal functioning system is insignificant. The normal bodily response is that the body will respond as there is injury with insignificant swelling.

In the case of someone with risk to lymphedema this can be a trigger to full blown swelling, b) Meticulous skin and nail care to keep fungal infections and cellulitis at bay, c)Manual Lymphatic Drainage (MLD).

This is specialised manual (hands-on) technique whose purpose is to improve fluid removal from congested (swollen) areas where there is impediment of flow to using alternative routes to de-congest the areas.

For example, if there is lymphedema in the right arm from right partial mastectomy (breast tissue removal) with eight lymph nodes removal in the right arm pit. The alternative routes to drain) the right swollen hand/arm is to re-direct fluid to drain into the left armpit, right groin and maybe right breast bone areas.

Following this during a treatment session, d)multi-layered Compression Bandaging is used. Here special bandages are used which come in different sizes. Which technique to use when bandaging is influenced by the degree of swelling and staging of lymphedema.

The bandage system is tighter at the wrist and progressively becomes looser towards the arm. This creates graduated compression which facilitates fluid to flow from the wrist towards the armpit.
Initially the bandages are worn 24hrs/day at a time.

If there are wounds which is not as common when compared to the leg(s) preference is to co-treat with nursing care for them to manage the wounds while I manage the swelling concurrently. Immediately the patient does, e) therapeutic exercises to further drainage of fluid from the wrist to the armpit.

This phase I duration can be anywhere from three weeks to eight weeks and more if needs be. During this time the patient is taught to self bandage, gentle self manual lymphatic drainage, prepared for wearing and taking off of compression garments.

Phase II: Maintenance phase, this is initiated when there has been maximal limb (arm size) reduction in Phase I. The patient is fitted into a compression garment. This can either be custom made or off the shelf. Compression garment may be arm sleeve, glove with or without fingers.

The compression garments come in a variety of compression (Class I to IV). The therapist advicss on the compression garment class. Most patients use compression Class II and III. Ideally the patient is encouraged to wear the compression garment all the time.

From time to time there will be a relapse, that is, swelling starts and Phase I will need to be initiated. There are a number of treatment approaches that can be taken. Factors influencing choice include cancer disease stage, type of cancer, location of lymphedema, patient mental status.

It is not just lymphedema that needs to be treated. Other things to treat include scarring, pain and decreased function. If you suspect you have lymphedema bring it to the attention of your oncologist who will refer you to someone trained to manage this condition.

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