Beware of endless coughs, wheezy breathing

Breathing was a nightmare for Mary Wairimu Ndung’u even as various medications left her devastated.

The 65-year-old from Gitare village in Embu County was oblivious she was developing chronic obstructive pulmonary disease, a condition she would manage for the rest of her life.

Wairimu began experiencing its early stages with severe long-standing coughs, wheezing and breathing difficulties way back in 1999.

Unfortunately, as her condition worsened, she was misdiagnosed with asthma and put on wrong medication.

She was later forced to drop her cereals business when her health continued to deteriorate.

“I had unbearable pain,” she recalls. “I gasped for air and could barely walk, irrespective of being on treatment. After about five years of sickness, I was found to suffer from chronic obstructive pulmonary disease.”

Before being diagnosed, she started using fabric facemasks for safety from environmental pollution, which triggered the disease.

“I did not know that I could use a mask, but nowadays, I use a mask, to avoid being infected,” said the now small-scale farmer who avoids a dusty environment and wears facemasks during general house chores.

The condition is also managed using inhalers and medicines of which she spends about Sh500 every month.  

Dr Joseph Aluoch, a pulmonologist, explained that chronic obstructive disease is associated with difficulties in breathing out. 

For example, if someone breathes in 10 litres, they should breathe out the same, but with chronic obstructive disease, breathing out is obstructed.

The commonest cause is smoking which presents individuals with at least a 10 percent chance of contracting it.

“If you smoke 20 cigars per day for 20 years, you stand high chances of contracting chronic pulmonary disease,” said Dr Aluoch adding smokers should quit the habit and those married to smokers “just divorce him or her.”

Paul Mbaria in Gitumbere village in Kanja, Runyenjes sub-county was diagnosed with the disease in 2019, though symptoms were apparent from 1992.

Mbaria, 58, attributes the disease to smoking, a habit he was introduced to at 19.

The casual laborer now regrets “had I known that smoking would put me on long term medication, I would not have attempted it.” 

Medication costs Sh1, 500, but Mbaria accesses free medication from Doctors without Borders (MSF) who are sensitizing the community of the silent killer disease.

Dr Jemimah Kamano, a hormone specialist (endocrinologist) and disease researcher noted that though smoking is a major contributor, indoor pollution is a major contributor in rural communities and slums due to use of biomass fuel like charcoal, paraffin stove.

“Using firewood and stoves releases not only smoke visibly seen, but there are particulate matters that are poisonous,” said Dr Kamano, also a lecturer at Moi University School of Medicine.

The particulate matter lands in the airways and causes inflammation and changes the structure of the airways.

Patients with the condition have long-standing coughs, wheezing during breathing, difficulty in breathing and increased production of red cells, or hemoglobin levels.

“There is little oxygen getting to the blood. The body compensates by increasing the number of red blood cells that can carry the little oxygen, so that it can pick more, when passing through the lungs,” explained the researcher.

Other symptoms include pinkish mucus membrane- including the tongue, eyes and inside of the mouth and also fingers, due to lack of adequate oxygen.

The problem with the disease she added is that pressure in the lungs increases and as a result, they get right sided heart failure that results in leg swelling, liver enlarging because it is engorged with blood, and fluids in the tummy.

If picked early, it can be treated. Those who quit smoking in early stages also have their lungs recovering quickly.

“Using biogas and special jiko would be a bigger savior for families,” observed Dr Kamano.

Other contributors are emissions from vehicles, factories, and working in gold mines.

Currently, in rural areas and slums there are a lot of cases of women aged 60  and above, who die of heart failure because of cooking in ‘kienyeji’ kitchen with huts without windows and chimneys.

A lot of cases are reported in highland parts of the country because of the cold weather where houses are warmed with charcoal and firewood.

At least 10 percent of patients she attends suffer from the disease, but cardiologists see a bigger proportion of women, especially the elderly group- more than 50 percent.

“In our rural setup, our mothers are dying a painful death, because they have no alternative to cook, as men dictates that food must be prepared with firewood to taste good. Let us be considerate by providing them with clean fuel,” she pleaded.

Doctors Without Borders (MSF) is sensitizing locals in Embu, on chronic obstructive pulmonary disease, and use of clean energy.

 Martha Mundi, a clinical officer mentor, working with the entity noted that the initiative was rolled out in 2017, after a number of locals reported to hospitals with symptoms related to the disease.

Though, there is no comprehensive data for the country on the disease, at least 64 patients suffering from the disease are managed under the Non Communicable Disease program, carried by Doctors Without Borders.

As per MSF data of October last year, there are a total of 6, 802 patients with NCDs, all who are above 40-years.

“Every week, at least two patients suffering from chronic obstructive pulmonary disease are reviewed as compared to asthma, where only one patient can be reviewed in a month.”

Adds Mundi: “People are asked to stop cooking using firewood, but because of rural settings where firewood is the main source of energy, we encourage them to cook from outside their houses.”  

 Indeed, indoor air pollutants are responsible for cardiovascular and respiratory diseases, according to a Ministry of Health report titled, Household Air Pollution: A Silent Threat to Health and Environment.

The report released in November last year notes that “the number of electric cook stoves is extremely low, with around three percent of all households owning an electric appliance.”  

In Kenya, exposure to household air pollution is ranked among the top ten risk factors for deaths despite the country making significant progress over the past decades.

And though Kenya has adopted use of clean energy, solid biomass remains the primary cooking fuel and environmentalist Tito Kodiaga, attributed laxity in adopting clean energy to cost and lack of sensitization.