‘A SPOTLIGHT ON HEALTH’ · medical journal a publication of the namibian 4 HEALTH is a fundamental human right and as a ministry mandated to provide healthcare to the Namibian

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‘A SPOTLIGHT ON HEALTH’

SHIfTING bIrTH PATTErNSNatural birth or the scalpel?

medicalJOURNAL

July 2019

Recovering from successful cataract surgery.

HOPE fOr rESTOrEd EyESIGHT

ASANA ANd bEyONd: The Physiology of Yoga.

medical journal a publication of the namibian

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medicalSHIfTING bIrTH PATTErNS: Natural birth or the scalpel?

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HOPE fOr rESTOrEd EyESIGHT Recovering from successful cataract surgery.

WAkING uP WITH ONE OvAry“My greatest fear is someday when I’m gone, there will be nothing to remember me by.”

LITTLE TANGI WINS HEArT dISEASE bATTLEPublic raised N$150 000 to save his life.

Medical Journal

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Tangeni Amupadhi

Theresia Tjihenuna

Arlana Shikongo, Tutaleni Pinehas, Ruth Kamwi, Adam Hartman, Tuyeimo Haidula, Ndanki Kahiurika, Hermien Elago, Justus Apffelstaedt

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HEALTH is a fundamental human right and as a ministry mandated to provide healthcare to the Namibian nation, we take serious account of that. Our operations, plans and programmes are moulded towards ensuring that no Namibian is embedded by a preventable disease or die due to lack of healthcare provision. Thus our state of health is above average when compared to our peers in the region and in the world. The ministry has multiple success stories to tell, but we take that as the positive drive to do more, as health is a very dynamic sector. It evolves continuously, thus whatever we achieved is work in progress. One thing that I pride my government for and will always be grateful for: the fact that we provide healthcare services at the lowest cost in the world, we exempt the vulnerable groups from paying a cent for services rendered. Despite the economic hardship we kept our commitment firm to the neediest, especially by providing free ARVs and other costly treatments at zero payment.Health is a very complex sphere and will always have challenges in one or other department. Yes, it is not all roses on the bed, but we are tackling problems as they come.

There are three fundamental issues in every problem:1. Lack of willingness to take accountability;2. The “don’t care” attitude and;3. The issues that are beyond your reach.

To these three, in health, like any developing area, technology is changing daily and most of our equipment and medical devices are older versions.The trouble of getting parts and experts to work on them remain the biggest challenge. There are, however, plans to get into Service Level Agreements where companies will be contracted for supplying, maintaining, upgrading and replacing of equipment.Namibia is truly a leader in many areas of healthcare provision. We made strides in significant aspects of healthcare provision. I always feel obliged to tell a

health story, a story that the media often ignores when they write about things that matter the most in our domain. As you know HIV and AIDS and malaria are part of that success, surely the success rates of immunisation coverage, the provision of free antenatal care and the provision of sexual and reproductive healthcare services are not talked about and that is our achievement too. The provision of healthcare involves many players, starting from the individual him/herself. Let me say they are the epitome of change. The sanitation that you are asking for is not our territory, but we have a stake in providing health education, for our clients to maintain absolute hygiene in order to prevent diseases. We educate them on the importance of hand washing and the appropriate preparation of food. The role played by other stakeholders, private or public and developmental partners, combined with our efforts made an enormous impact in keeping Namibia healthy.As already alluded to, up to 85% of Namibians receive healthcare at a rate of N$4,00. Taking the cost of medical care in our country into account, it is indisputable that a few Namibians with rare conditions and who need specialised care might go across the border to seek for such care. In the ministry, our approach has been consistent, heeding the call of doing more with less, therefore our priorities receive the utmost attention with whatever resources at our disposal. We are trying hard to promote the culture of saving among our staff.In conclusion, I would like to assure you that investing in health is profitable for any country. It is on this note that I would like to thank those individuals, corporate entities, public institutions and developmental partners who contribute in whatever way to our mission. The journey of achieving universal health coverage is long, but not impossible. We have already begun by modifying loose ends, so that we can provide quality healthcare that does not load any financial burden to our services, users and patients in both the private and public health facilities. This will be achieved by amending legal instruments and transforming healthcare structures in general.

No Namibian Should be Embedded with Preventable Diseases

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Juliette Kavetuna Deputy minister of health and social services

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• ARLANA SHIKONGO

WHEN a mother cannot feed her newborn baby breast milk, the natural assumption is that she will opt for using formula as an alternative. However, a new initiative by a few nurses, paediatricians and other health professionals has birthed an even more viable alternative: human milk provided by the Namibian breast milk bank. I met Sister Birgit Mayer in the foyer of Mediclinic in Windhoek on a Saturday afternoon. I was not very sure of what I was walking into because, like most people in Namibia, I had no clue what a breast milk bank entailed. Would there be mothers in pumping stations hooked up to machines being milked like cows? It was unclear to me at that

stage. The foyer of the hospital was quiet, but after going through a few doors and taking some lefts and rights around a few corners, we ascended a flight of stairs, and shortly after, a faint whirring sound caught my ear. That sound was the whir of the pasteuriser: a machine that would put the breast milk through a process of sterilisation. “It heats up to 63 degrees and then it comes down to 4 degrees and then you take it out and put it in the deep freezer,” Mayer said, pointing at the big, blue machine in the corner of the room. She further explained that once pasteurisation is completed, a small sample is sent to PathCare for further testing to ensure that there are no microbes remaining. The milk is then stored in a deep freezer before being transported to various hospitals around Windhoek. This milk could be stored for up to six months, she said. “Then it must be used. So if it’s unpasteurised,

Forward thinking with human milk

NUTRITIOUS ... Sister Birgit Mayer holds a 100 millilitre bottle of pasteurised milk that is being stored in the breast milk bank’s deep freezer

Photos: Arlana Shikongo

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Birgit Mayer

www.namibiaphysio.com

Physiotherapists are trained in developing and maintaining people’s ability to move and function throughout their lives. With an advanced understanding of how the body moves and what keeps it from moving well, they promote wellness, mobility and independence. They treat and prevent many problems caused by pain, illness, impairments and disease, sport and work related injuries, ageing and long periods of inactivity.

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Marcella Burmeister & Gabi Schurz

South Block, Maerua MallTel: +264 61 243 229 | Fax: +264 61 243 229

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91 Rhino Street, Windhoek North Tel: +264 61 255 337 | Fax: +264 61 253 813

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Ronelle Isaacs Physiotherapists

22 Locke Street, AcademiaTel: +264 61 240 676 | Cell: 081 206 7085

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Brigitta Augustyn Physiotherapist

Jenna Musakanya, Munashe Chinyama,Hannah Chirambo

7 Axali Doeseb street, Windhoek WestTel: +264 61 400 824 | Fax: +264 61 400 825

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Christine Nashenda Physiotherapy

Hidas Centre, 2nd Floor, Room 11

Tel: 061 253 446

Fax2email: 0864335129

12 Scorpio Street, Dorado ParkTel: +264 61 258 377 | Fax: +264 61 258 377

Cell: +264 81 146 6179

Bianca Niemeyer

Physiotherapists

Ronalda Duarte Physiotherapist

Khomas Medical Centre, 4758 SwartzAvenue, Khomasdal, Windhoek | Tel: 061 385 642

Fax: 061 306 220

ZENRA BUYZPHYSIOTHERAPISTRegistered Physiotherapist

BSc in Physiotherapy (University of Stellenbosch)Pr#072 000 0509027

Zenra Buys

Physiotherapypainful conditions such as arthritis, repetitive strain injury,

neck and back pain cancer womens health strokes, Parkinson’s disease and spinal cord injury

heart problems lung diseases incontinence trauma, such as motor vehicle accidents

Christiane von der Heiden

Wernhil Shopping Mall, Khomas Medical Centre(Ground Floor)



Almut Hoffmann

Cornel van Niekerk, Helgo Lange, Sitali Nyambe,19 Heliodoor Street, Helio View, Unit 3,

Eros, Windhoek Tel | + 264 61 224 696 | Fax +264 61 306 696

Sonika SwiegelaarCarpe Diem Med, Opposite Paramount Hospital

Tel +264 61 305 060.


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it must not be older than six months,” she clarified. In brief terms, Mayer said the breast milk bank works on the same principle as a blood bank. “The breast milk comes from mothers,” she explained, saying that their donors have to be healthy mothers who are producing sufficient amounts of milk. “The first thing is that their babies must be gaining good weight; and they should also be producing enough milk that they can give [some] to us.” In the same way that blood donors fill out a form indicating various illnesses or medicinal intake, donating mothers are required to do likewise as a means of quality control. “We check on their medications. We look at whether a mother was very ill after her baby was born and she maybe got blood,” she explained. “That mother must wait a little longer before we can use her breast milk because her body must also recover.” Furthermore, the questionnaire also probes into the mother’s diet ,because, as Mayer explained, diet also plays a role in the viability of the breast milk. For example, vegetarians must be on vitamin B supplements, she said. Beyond the questionnaire, mothers are also required to undergo screening. “So, we also do screenings. These days we do rapid tests for HIV and hepatitis B and if that screening is negative, they then bring us the milk, and we pasteurise it,“ she said. Mayer says there are not many contra–indications but their precautions are for the well-being of both the mothers and the “little ones”, as she refers to babies. These little ones are the small, premature babies the breast milk bank caters for. Beyond simply supplying milk for babies in general, Mayer explained that the reason for the bank is to cater for premature babies that are under 1,5kg whose mother is either underproducing or unable to

produce milk altogether. She further explained that breast milk is preferred for these newborns because formula milk is not stored in sterilised containers, leaving newborn babies at risk of infections. “With premature babies, especially the extreme premature babies, starting with formula on that stomach, which is really sensitive is not good. Those babies [can] get very, very ill,” she said. Donor milk is, however, only provided until a mother starts producing sufficient milk for her baby. “We get ill mothers. Some get sick after giving birth; but when they recover and start producing enough milk, we stop the donor milk. The donor milk is only till mother is self-sufficient,” she explained. The initiative came to fruition in April 2018, when the bank performed its first pasteurisation. It is evident that Mayer is very passionate about the work she does, explaining that she and the rest of the team behind the breast milk bank have full-time jobs and maintain the bank on a voluntary basis. Mayer’s co-director, who she heartily refers to as ‘Prof. Pieper’, is a full time pediatric neonatologist. Dr Clarissa Pieper previously practised in South Africa, where they used donor milk for premature babies, Mayer explained. “Then, when she started practising [here] she said we must start something like that; and then we took the bull by the horns,” she said. The bank is a non-profit organisation and Mayer said they do not have much funding. “I do most of the pasteurising at this stage,” she said. “There is no funding so I always do it. Mostly on Saturdays,” she said with a smile. n


• TUYEIMO HAIDULA at OSHAKATI

AT THE AGE of 43 years, Taimi Magongo still wants to have a natural birth but knows it could be risky due to her advanced age and high blood pressure.Magongo was one of the expectant mothers who attended the Ongwediva Medipark Safe Motherhood Campaign held at Okahao in Omusati region alongside 150 other women recently. The campaign, now in its fourth cycle this year, complements the government’s efforts to reduce maternal mortality. Over 150 women received free antenatal screening at the town. The campaign was aimed at equipping women like Magongo with information to make their pregnancy experience safer and more enjoyable. The women also received free antenatal screening. Magongo, a shop assistant at Pep Stores in Okahao, says her firstborn is 24 and the second-born is 21. She tells The Namibian that she attended the safe motherhood campaign especially to find out what causes complications in pregnancy as women get older. Magongo’s scan says she is due mid-July 2019. She tells The Namibian of her plan to give birth naturally but says she is not sure how that might turn out. “Only if no complications occur,” she quickly adds.Her advanced age could be a detriment to her desire to give birth naturally. She was advised by doctors to opt for a Caesarean section instead, which is the safest for women her age. “When I was young, I thought it was a carefree process as both my pregnancies didn’t have any complications. But this one has been a very difficult pregnancy. This is when I realised the amount of care and

education new mothers need, especially getting pregnant at this age,” she says. Magongo further tells The Namibian she has been attending her antenatal care at the Okahao District Hospital. What drew her to the Medipark campaign, she says, was her hunger for more knowledge just before she delivers.“The complications brought me here. When I thought I was four weeks, I was already at seven. Then the bleeding started in November last year, until December. And I was spotting [light bleeding] in between some months. But I have received the best care from the hospital nurses and I have been following instructions,” she says. Magongo says her partner has been supportive in her journey as he sometimes accompanies her to antenatal care check-up. When she was on leave and unable to do anything, he would cook every day. She says her children have also been very supportive. “If it wasn’t for them, it would probably have made it even more difficult. I was diagnosed with high blood pressure since the pregnancy and I have now taken two weeks off to see if I can bring it down. Every day my blood pressure goes up and I am trying to control it so I can give birth naturally. “I do not want to be operated on. Although I am scared of what natural birth could mean for me at this age, I still prefer it to the permanent scar which takes forever to heal,” she says, adding that: “It is not easy being a woman”.Magongo says although she did not experience the same difficulties as a teenage mother, she would encourage young people to use family planning so that it does not have long term effect on their future. Viktorina Kashinyenga is another expectant mother attending the campaign at Okahao. Kashinyenga is eight

Shifting birth patterns: Natural birth or the scalpel?

Photo: Lady Pohamba Private Hospital

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MAKING THE SWITCH … While many women plan a vaginal birth, the number of women having Caesarean sections, including planned Caesarean sections, has been on the rise.

Photo for illustration purposes only


9months pregnant with her first baby. She is from Iikokola, about 25 km from Okahao. The 26-year-old, who is a graduate nurse from Welwitschia University in Windhoek, heard about the campaign from a relative and decided to come and polish her knowledge on antenatal care. Like Magongo, Kashinyenga is also opting to give birth naturally, but might not be able to due to complications.Kashinyenga says she was living in Windhoek where she had received antenatal classes at Windhoek Central Hospital when she was at 16 weeks. “My pregnancy experience has been pleasant. Sometimes I am scared when I think about labour, but at times I get excited about the idea of conceiving and bringing a human into this world,” she says. Like Magongo, she says the father of her unborn baby has been very supportive. He is a nurse by profession, she says. “When I texted him this morning that I was coming to the Medipark Safe Motherhood Campaign, he told me that I should have told him earlier so that he can travel and join me,” she says, beaming with joy. Although the two women would have otherwise opted for a vaginal birth, they have both been advised that this might not be the case. For Kashinyenga, the baby is oblique. According to Spinningbabies.com, a baby is oblique when his or her head is in the mother’s hip. The baby’s body and head are diagonal, not vertical and not horizontal (transverse lie) “I was not hoping for a C-section and really wanted to give birth the natural way. The cut does not heal fast and I might experience pain in the long run,” Kashiyenga says.While many women plan a vaginal birth, the number of women having Caesarean sections, including planned Caesarean sections, has been on the rise. Namibia is no exception. Statistics from the health ministry recorded between October 2017 and September 2018 show that 66 171 children were born. Of this number, 11 040 came into the world through caesarean section.

WEIGHING THE OPTIONS

A medical doctor at Oshakati State Hospital, Elizabeth Nevonga, explains that when it comes to Caesarean, indications differ. Nevonga said it can be an elective case – which means a patient who has a set date on when they are due to give birth and come in for admission for delivery. She added that the second indication is an emergency. “For elective cases for us in state hospitals, it’s mostly people who already had previous Caesarean, especially more than two times because those have the risk of uterus rupture so they are not allowed to give birth on their own or patients who have pelvic disproportion. Nevonga said any other contraindication to a normal vaginal delivery is when the patient has a low line placenta which is usually picked up during sonar. “People who have the placenta covering the uterine opening to the vagina must have a caesarean or they have severe warts or anything that is in the way of the vaginal canal cannot give birth naturally.Emergencies of expectant mothers from those who have term pregnancy (36 weeks and above) to premature cases may also end up having a Caesarean birth.“This can be preeclampsia, (mothers with high blood pressure and they have imminent signs such as convulsing). They need to have an emergency regardless of the gestation period because the placenta needs to come out. Those who have had caesarean before and they are contracting or in labour, some because the villages are far and they were never booked also have a higher risk having the scar to open again, so they are taken to theatre as a state of emergency. “Another indication is a woman who has been in labour for the longest time but no progress made. Babies lying in awkward positions can also not be delivered through the vagina,” she stressed.Both Magongo and Kashinyenga are due this month if their scans are anything to go by.- [email protected]

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• TUTALENI PINEHAS

PETRUS Kasanga, like most millennials, favours fitness and understands the importance of healthy food to complement his regimen.Armed with these insights and observations, he uses his sprinting skills to optimum advantage. Although he was born with a hand disability, Kasanga says this does not prevent him from being physically active.Before starting his day, Kasanga (25) jogs from his home located in one of Windhoek’s informal settlements, Hakahana.“I wake up at 07h30 am and I jog along the Monte Chritso road all the way to the Lafrenz bridge; from there I head to the hills opposite Coca–Cola in the Northern Industrial Area to practise endurance, stretch and then finish my morning routine with sit-ups,” he explained.Kasanga not only has a passion for running, he has qualified for the 2020 Paralympics in Tokyo, Japan, and is currently preparing for the world championships in Doha set for November this year.“I was born at Rundu I came to Windhoek in 2014 after completing Grade 12 at Romanus Kamunoko Secondary School I didn’t do well, so I had to upgrade I managed to pass and went to college where I graduated with a diploma in office administration,” he said.The athlete explained, “In pursuit of better opportunities I started working at the Grove Mall as a general worker. That’s where my former boss told me about the opportunity to run professionally for some time. I had to juggle work and practise until I reached a stage where I had to leave work because running required my full-time attention,” he said. Kasanga told The Namibian that he used to run track when he was in primary school but gave up because there was no one to motivate him.

“I was a vulnerable child at a very young age and I had to cope with my disability too,” he said.“My trainers often have workshops for us with dieticians and nutritionists, I would like to be health conscious but my economic situation does not allow it.”So often, his breakfast consists of bread and tea, a bowl of rice and ketchup.“That’s my favourite,” he said, as his face lit up.The Paralympic said: “I spend my disability grant on necessities like food and cosmetics and for my sports gear I have to save a lot to get things done.”Breschnev Toivo, a 24-year-old sports enthusiast, said: “Running is a great form of physical exercise, and the mental benefits are what it is really about. Running helps overcome the stresses that one has accumulated during the day or week, respectively.”Tiovo was diagnosed with anxiety and depression in 2016 and says he runs because it helps clear his head.It takes him 10 minutes on average to reach his resting point before he jogs back home, a four kilometres round trip.Toivo said he has, in the last three months, jogged 32 kilometres, compared to last year where he did far more, averaging to six kilometres per week and about 48 kilometres in three months.”He is currently working on his physical fitness and muscle building. He avoids working out every day to prevent burning too many calories and losing weight.He told The Namibian that for the next three months while bulking, he will keep the same cycle, and increase it in September in order to burn more calories during his muscle cutting period.However, he is currently not racing competitively but looks forward to taking part in the future.He says his diet mostly consists of a nutritional shake.

Balancing a diet and workout

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DETERMINED... Petrus Kasanga during his early morning workout in Katutura.

Photos: Henry van Rooi


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“Because I ’am bulking up I take a protein supplement in the form of shakes with every meal, 1,9 litres of water every two days, and honestly I consume anything my mother would cook accept the occasional cake and puddings,” he said.

WHAT FOOD GOES WELL WITH EXERCISE

Samantha du Toit, a Windhoek-based dietician at Eat Clean Namibia told The Namibian that the most important nutrients for physically active people like Kasanga and Toivo are carbohydrates.She said sports drinks and gels contain carbohydrate but are less nutritious. She said they can be helpful if your exercise is intense and food is hard to eat, or if your exercise lasts longer than one hour.Du Toit said: “It is very important to consult a registered dietician for specific advice as to how much and what type of food are correct for your body and for your requirements. A registered dietician can help make dietary advice more personal and practical according to your lifestyle, work and budget. “Once you have this information and help, it will be very easy to consistently stick to your prescribed meal plan in order to achieve long-term success in your sport.”She said the guidelines for people who are trying to lose weight while training is that: “If you are running, it is likely that your running performance will be slightly compromised in the short-term”.This is because a calorie-deficit is required to lose weight and therefore you will not be able to consume the high carbohydrate recommendations for optimal running performance. Once you have achieved your goal weight it will be possible for you to consume the maximal amount of carbohydrates required and your performance can increase significantly provided that you put in a significant amount of training time.When training, we use a variety of our muscles to a certain extent, depending on the type of training you do. This use of muscles combined with a diet with sufficient calories, causes muscles to increase in size and weight. However, if you train in conjunction with a low calorie diet, then it is virtually impossible to gain weight.Du Toit said that the optimal fuelling windows before and after workouts is to “include carbohydrates in your pre-exercise meals or snacks.”Plan to eat a meal or snack one to four hours before you exercise so that you’re not too hungry or too full. This will help keep your blood

glucose (sugar) levels stable and give you the energy you need to exercise. Focus on lower fibre choices as these are easier to digest; choose smaller meals closer to the time you will be exercising.Eat a carbohydrate-rich meal or snack after intense exercise lasting more than an hour. This will help refill your glycogen stores for the next time you exercise. This is important if you exercise or compete twice on the same day, or exercise on back-to-back days. Try to eat this meal or snack within the first 30 minutes after your activity. To rebuild your glycogen stores, you may need to eat again within four hours of your first event.All nutrients required for running short and long distances can be obtained from food alone. Sports drinks can be very beneficial to use during running if the run lasts more than an hour. If you buy a sports drink, look for one that includes: Water as its first ingredient. Water is essential for rehydration. Carbohydrates: 4 to 8 grammes (g) carbohydrate per 100 ml. Choose drinks that include a mixture of different carbohydrate sources such as glucose, fructose, sucrose and maltodextrin. They are absorbed quickly during exercise to give you the energy that you need. Sodium: 45 to 70 mg sodium per 100 ml. Sodium is lost through sweat and needs to be replaced. While the sodium in your regular diet will replace most, having sodium in a sports drink helps replace some as well. Having enough sodium will also increase your thirst and the drive to drink, which will help you drink more and stay hydrated. Potassium: 8 to 20 mg potassium per 100 mL. Potassium is lost through sweat and works with sodium to help restore fluid balance in the body. Flavour: improves taste which can help you drink more. A good sports drink does not need to include added amino acids, oxygen, caffeine or herbal ingredients,” she said. She cautioned: “Full strength 100% fruit juice, fruit drinks, sodas or energy drinks are not recommended during exercise. They contain about double the amount of carbohydrates that is recommended. The carbonation in sodas and energy drinks could lead to bloating and discomfort making it hard to drink enough to keep up with loss of hydration due to excessive sweating.”“In general, runners do not require any commercial nutrient supplements (e.g. creatine, whey protein, essential amino acids, etc.). These commercial nutrient supplements are not regulated and they are often contaminated with forbidden ingredients or they often do not contain what they claim they contain,” she said.

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14 • JUSTUS APFFELSTAEDT

MOST people have heard of the thyroid gland, but if you haven’t got a clue what your parathyroid is for, you are not alone. These tiny glands, the size of a grain of rice, are neighbours to the thyroid gland and have a distinct function. And, when things go wrong, the symptoms are also quite different.

It is easy to confuse the thyroid and parathyroid. Some people even believe they are part of the same gland.

This is a misconception. Both are part of the endocrine system, but they serve different purposes. And when they become dysfunctional, the symptoms differ. Located at the base of the neck (below the Adam’s apple in men) the thyroid and parathyroid glands both produce and release hormones into the bloodstream to send messages to many organs, which in turn affect multiple functions in our bodies. Here’s what you need to know about these glands:

THE THYROIDThe thyroid is a butterfly-shaped gland at the base of the neck. It

affects many functions in our body, as it secretes two key hormones, triiodothyronine (T3) and tetraiodothyronine (T4), both of which are made with iodine extracted from our food. These two hormones regulate general metabolism and therefore affect our health in many ways: the growth of our bones, the transformation of sugar and fats, our mental development, the stimulation of tissue, reproduction and fertility, oxygen consumption and our digestive systems.

Thyroid hormones influence the function of multiple organs, among them major organs like the heart, kidney and liver. When there is thyroid dysfunction, our bodies are affected in several noticeable ways.

Symptoms of a dysfunctional thyroid include high anxiety or depression/moodiness, significant gain or loss of weight, sensitivity to hot or cold temperatures and joint and muscular pain.

THE PARATHYROIDThe parathyroid is not in fact one gland, but four. Though they are small,

it is quite normal for them to be up to pea-sized. The parathyroid glands operate in a similar fashion to the thyroid gland,

but on smaller scale. While the thyroid releases two key hormones that influence many organs, the parathyroid secretes only one: the parathyroid hormone, which regulates calcium, phosphorous and magnesium levels in our bloodstream.

As soon as the hormone is released and regulation is balanced in our body, we function as we should. But when either the thyroid or parathyroid is dysfunctional, problems develop. A broad range of symptoms may appear.

PARATHYROID DISEASE: HYPERPARATHYROIDISMParathyroid disease is usually related to the ‘over functioning’ of one

or more of the parathyroid glands, referred to as hyperparathyroidism. Hyperparathyroidism manifests itself in symptoms such as fatigue, abdominal pains, mood swings, kidney stones and back aches which can often be ascribed to aging. It is therefore important to test for it. Hyperparathyroidism can be easily diagnosed by simple blood tests which test for calcium and parathormone.

WHAT CAUSES HYPERPARATHYROIDISM? In the vast majority of cases, only one of the four parathyroid glands is

diseased and the condition can be cured with the removal of this particular gland. In most cases, the reasons why the gland started hyperfunctioning remains unknown. In rare cases, however, it can be part of multiple endocrine neoplasia (MEN) syndromes where there is an inherited disorder of several hormonal gland systems.

PREvENTION AND TREATMENTWhile there is no known prevention of hyperparathyroidism, a cure is

almost certain if treated correctly. The treatment consists of the surgical removal of the offending gland(s) which is usually performed in a minor, minimally invasive operation via a small incision in the neck. The surgical challenge of the operation lies in identifying the offending gland in order to remove it. Although technical investigations can identify the offending gland in between 80% and 90% of cases and an experienced parathyroid surgeon will be able to identify it during the surgical exploration of the space behind the thyroid gland. It is therefore of utmost importance that patients are referred to surgeons who have extensive experience in thyroid and parathyroid surgery. If left untreated, the hormone overproduction leads to changes in a number of systems–some of which can become irreversible and lead to premature death, such as the demineralisation of the skeleton with multiple fractures (especially of vertebrae with no or little trauma), hypertension, depression, kidney failure and life-threatening hypercalcemia. Since the thyroid and parathyroid act on different functions in our body, an isolated symptom does not prove that either of these glands are malfunctioning. In combination, however, the above symptoms must be taken seriously. If you have developed a cluster of relevant and persistent symptoms, see a specialist. Further tests may be performed to arrive at a diagnosis and assess the appropriate treatment.

*Dr Justus Apffelstaedt is a specialist surgeon with an interest in breast, thyroid and parathyroid health management, as well as soft tissue surgical oncology. He is based in Cape Town, South Africa.

Differences and similarities between thyroid and parathyroid

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15• RUTH KAMWI

IT CAN STRIKE anyone at any age and can linger years after a traumatic experience.

Windhoek-based psychologist Lani de Kock says the first defining characteristic of Post-Traumatic Stress Disorder (PTSD) is that there is always a traumatic event that was experienced, witnessed or happened to a loved one, that can leave the victim traumatised for years. De Kock says the causes of the disorder range from exposure to violence, including crime and war, accidents and natural disasters.

“Exposure to accidents is particularly worrisome as Namibia has the highest per capita deaths on the road in the world and our rates of motor vehicle accidents leave many with crippling PTSDs,” she observed.

Violence, especially sexual violence, and violence during childhood are also particularly concerning in Namibia, the psychologist adds.

De Kock says people who are vicariously or frequently exposed to aversive details of traumatic events like first responders, police officers and medics, often develop serious PTSD.

She says some survivors attempt to avoid internal reminders of the event, such as distressing thoughts, feelings or memories as well as external reminders, including people, places and situations related to the traumatic event.

This avoidance, she says, often perpetuates the intrusive symptoms survivors experience which include upsetting memories, nightmares and flashbacks as well as emotional distress and physiological reactivity (like heart palpitations, nausea, dizziness, shortness of breath, etc.) after exposure to traumatic reminders.

Survivors also often undergo changes in their cognitive ability and this emotionally impacts them.

“This can take the form of memory loss or an inability to recall key features of the traumatic event,” De Kock explains.

She added that the survivors often blame themselves and or others and that their thoughts become overly negative.

The survivor can become engulfed in erratic behaviour, anger, fear, shame, guilt, sadness as well as difficulty when experiencing positive affect. There can also be feelings of aloneness and isolation, de Kock adds.Further, the psychologist said survivors often experience a loss of pleasure from the activities and interests they used to enjoy.

“PTSD is one of the most prevalent cases we treat in a psychiatric setting,” she points out.

A SURvIvOR’S STORY

Valde Haikali’s first encounter with PTSD started 41 years ago when he witnessed the Cassinga massacre on 4 May 1978 in Angola.

More than 600 Namibian men, women and children were killed after their camp was attacked by apartheid South African troops.

Haikali was just an 11-year-old boy at the time, and although he survived the attack, the memories of that day still haunt him. Scores of people who were killed or injured in the massacre had mostly been assembled at an outdoor area, where a parade was held daily.

“I still have that picture of the massacre in my mind which I will not forget,” Haikali said. The chairperson of the Cassinga Survivors Organisation, Ignatius Mwanyekange, says most survivors of the brutal event of 41 years ago are in dire need of counselling.

“The end result is that some are having traumas and need counselling. Some are severely affected because they lost limbs.

Some experience terrible nightmares and sleeping problems.” He added: “These scenarios exposed survivors to horrific scenes which will remain with them for the rest of their lives. It took some of us years before we could eat meat because of the horrific scenes we saw at young ages of between 12 and 14. This [picture of the massacre] remains in many of us today.”

MANAGING PTSD

Although PTSD can subside naturally over time, its symptoms can be alleviated by the use of medication. De Kock, however, cautions that untreated PTSD can often become a chronic condition with symptoms persisting for years or a lifetime. Keeping the disorder at bay includes stress management; identifying as well as strengthening positive coping methods, and having a social support structure.

WOMEN MOST AFFECTED

According to a study by Kaplan and Sadock titled ‘Synopsis of Psychiatry‘, about 10% of women and 4% of men meet the criteria for PTSD in their lifetime. Women are therefore disproportionally affected by PSTD, usually as a result of domestic and/or sexual violence. “PTSDs can occur at any age, but is most prevalent in young adults, because they tend to be more exposed to precipitating situations. Furthermore, PTSD is most likely to occur in people who are single, divorced, widowed, socially withdrawn, or of low socio-economic level,” De Kock says.

SUPPORTING A LOvED ONE

Family and friends can provide support for someone living with PTSD primarily through learning about the symptoms of the disorder and understanding how these symptoms may influence their loved ones’ behaviour.

An example noted by De Kock is understanding that irritability, anger and episodes of unexplained fear are normal experiences for someone living with PTSD.

“This helps family and friends support their loved one better,” she suggests. However, the best support possible is to ensure that they get professional help from a psychologist as soon as possible, she says.

“The earlier the trauma is treated, the better the outcomes. Untreated trauma can often last for years and even a lifetime, so waiting for things to get better on their own, even with an incredible support network, could also do more harm than good.”

WORST-CASE SCENARIO

Due to the severity of the symptoms, people living with PTSD often struggle coping at work or at home. The extreme changes in their personality and behaviour can lead to a loss of support and social isolation, which can reduce their ability to cope and recuperate.

“People who suffer from PTSD are significantly more likely to also suffer from depression, anxiety, substance abuse or to die from suicide, especially if there are severe, chronic intrusion symptoms, like flashbacks and especially if the symptoms are chronic and intense.” she says.more exposed to precipitating situations.

Coping with post-traumatic stress disorder

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16

with one ovary

Waking up

• TUTALENI PINEHAS

NATALIA Prussel remembers the day she woke up from surgery and her doctor told her they had removed her ovary.

The 34-year-old Windhoek resident and eye-care assistant said she was gutted by the news. She knew that having one ovary meant the chances of her having a baby were slim.

“A child is your own, family and friends move on to build lives but a child will always be a gift to yourself and humanity, but life was cruel to me, it punished me for unknown sins, will I die alone?” she lamented during an emotional interview with The Namibian.

Prussel’s infertility nightmare started when she was 16 years old. Doctors would tell her that her painful menstrual cramps were a normal part of being a woman and “it gets better once you give birth.” But the pain only worsened.

“I was diagnosed with endometriosis when I collapsed with [period] pain so severe in 2012, I was rushed to hospital, a doctor then did a sonar and the results came back two weeks later. The scan showed that I had a cyst on my left ovary,” Prussel explained.

Endometriosis is a painful condition in which endometrial tissue grows outside the uterus, often in the pelvic area, scar tissue and adhesions form as a result, which can lead to anatomical changes.

Prussel added, “Shortly after my diagnosis, I booked for an appointment with a gynaecologist, at a private hospital, (in Windhoek) where he told me he had to remove the cyst. I was not given any further explanation, even though I had never heard of endometriosis before.

“To my dismay when I came to, the gynaecologist told me that he had removed my left ovary, and I was gutted,” she lamented.

She then started to see a therapist because there were prior attempts to fall pregnant. With only one ovary left, she knew her conception journey would be a difficult one.

The pain persisted and she had to get surgery on her right ovary and uterus. Prussel underwent so many surgeries that the scars on her stomach could pass for someone who had too many Caesarian sections.

“But I had to make peace with the fact that I might never bear children naturally. I swear this illness is my personal hell,” she said, wiping tears from her eyes.

Prussel added that she lost her job because she had to stay away from work due to painful periods, the constant appointments with doctors and falling ill during work.

“At my age, I am not financially stable. I live at my boyfriend’s parents’ house because of the setbacks from my job. I can’t have babies. I can’t seem to build a life and it is shameful. It seems so easy for everyone else, I mean what have I done wrong? I just want a fair chance at life,” she lamented.

Prussel told The Namibian her insecurities run so deep, the illness has been a ‘medical menopause’ for her, as it disrupts her hormones, personality, mental, and physical health.

“The irony is that my sister is blessed with seven children of her own. God does really have a sense of humour, doesn’t he?

“Life easily becomes what we lack. See how unforgiving I have become to women who have abortions. I fully understand that it is their right all in all, but they have a choice, whereas I never have one,” she said.

Prussel says she had looked into other means of falling pregnant, like in vitro fertilisation, adoption and surrogacy.

“I cannot afford any of the procedures,” she said, adding that the costs range from N$60 000 to N$150 000.

“I don’t even qualify to adopt. At this point, I’m indifferent to my situation because for 17 years I had to carry this burden. I will not allow it to take away from me any more. My greatest fear is someday when I’m gone, there will be nothing to remember me by,” she said.

WHAT IS ENDOMETRIOSIS?

Dr Adriaan van der Colf, a gynaecologist at the Windhoek In Vitro Fertilisation Clinic, said endometriosis is a condition in which the endometrium (uterine tissue) flourishes outside the uterus.

Lesions of the endometrium can block the Fallopian tubes or interfere

My greatest fear is someday when I’m gone, there will be nothing to remember me by.– Natalia Prussel

‘‘

Natalia PrusselPhoto: Garwin Buekes

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Waking up

17with ovulation. This can be painful and cause damage that can lead to infertility.

Van der Colf said: Statistics show that about 70% of women with endometriosis suffer from infertility.

“Common endometriosis symptoms include chronic pelvic pain, pain during menstruation, pain during sexual intercourse, and bladder or intestinal pain.”

“Treatment for endometriosis depends on the stage of the disease and other personal and biological factors, such as the desire for children, the presence of nodules or cysts. Typically, surgery is conducted possibly in combination with hormone therapy,” he added.

Van der Colf said: “Endometriosis surgical removal of body tissue increases the chances of pregnancy.”

The specialist explained: “Infertility is the inability to conceive after 12 months or more of well-timed, unprotected intercourse.”

He said this delineation applies to couples where the woman is under 36 years old, where both partners have not had histories of fertility-related issues.

If the female partner is over 35 and has been unsuccessful in getting pregnant for over six months, a consultation with a fertility specialist for investigation and treatment should be considered. Women over age 39 should begin investigation and treatment after three months of well-timed intercourse.

In some cases, infertility may only be temporary; it can be caused by

a number of factors, such as lifestyle (bad habits), poor nutrition, toxins, environmental influences, or just poor timing.

The doctor further explained that in some cases, infertility in women is caused by the following factors: ovulation disorders, damage to the Fallopian tube, cervical and uterine factors, immune factors, polycystic ovary syndrome (PCOS), early menopause, uterine fibroids, thyroid problems, cancer treatments, and hyper-prolactinemia.

Van der Colf, however explained that there are ‘assisted reproductive treatments,’ such as an in vitro fertilisation (IVF) procedure that is performed in the laboratory.

A TYPICAL IvF PROCEDURE IS AS FOLLOWS:

• The physician first induces super-ovulation using fertility drugs so that several eggs can be harvested from the ovary before they have been released from the follicles.

• To harvest eggs, the physician generally inserts a probe into the vagina and is guided by ultrasound. A needle is then used to drain the liquid from the follicles, and several eggs are retrieved.

• The eggs and sperm are combined in a dish. Between 48 and 72 hours later the eggs are usually fertilised.

• The resulting embryos are re-implanted into the woman’s uterus. • It takes about two weeks to determine if the process has been

successful. n

18

• TUTALENI PINEHAS and NDANKI KAHIURIKA

CANCER survivor Ovaua Katjipuka says she was fortunate that the disease was discovered in its early stages, which increased her chances of survival.Katjipuka was 21 when she started experiencing abnormal vaginal bleeding and severe pain in her lower abdomen. She would later discover that she was experiencing the first signs of uterine cancer.“I did tests and the results showed that I had a molar pregnancy that contained cancer fluids,” said Katjipuka, who lives in Windhoek’s Ombili settlement. She said she was not aware that she was pregnant at the time as she continued to have her monthly menstrual cycle.A molar pregnancy is an abnormal form of pregnancy in which a non-viable fertilised egg implants in the uterus and will fail to come to term. This will grow to a cluster that resembles grapes. Katjipuka, who was diognosed in 2017 with uterine cancer said she discontinued her nursing studies at the Katutura Community College to focus on her treatment.“Although I was in the first stages of cancer, I immediately started chemotherapy. “I was tired all the time because of the chemo. I lost my hair, I would bruise easily, I had diarrhoea, my skin and nails were dry and my colour changed, my weight changed and even my mood changed,” she said.“I went through chemo treatment for four months [at the Windhoek

Central Hospital]. I started treatment in May 2018 and ended in August 2018. I went back for my last check–up in January this year, and the doctor told me I was cancer–free.”The charismatic 23-year-old young lady told The Namibian, “I was ecstatic, I called my grandmother just before I walked out of the hospital, we literally just cried together for a good 15 minutes. She raised me for the good part of my life.“I am a survivor,” she said in excitement.Katjipuka explained that being diagnosed with cancer was the scariest thing she had to go through. “But by God’s grace, I pulled through,” she said.“I had to be intentional with my thoughts. I would encourage myself, speak positivity to my life, and I had to woman up, because this battle came to test my whole life and I knew I had to win,” she said.Katjipuka, who resides with her mother and six other relatives, said she could not have done it without the support of her family.“My family has been my pillar of strength through this difficult period in my life. My greatest fear was that cancer will rob me of my womb and I would never be able to fall pregnant, but I fought and now I’ am pregnant, I couldn’t be more proud of myself, it feels like my baby is a gift from God,” she said.Katjipuka’s mother, Gersoline Katjipuka (39), told The Namibian that she was in utter shock when the news came that her daughter had stage one cancer. “That is not news any parent would expect to ever hear about their children. I was broken. That news broke me,” she said.

Early detection helped me BEaT CanCER


My family has been my pillar of strength through this difficult period in my life. My greatest fear was that cancer will rob me of my womb and I would never be able to fall pregnant, but I fought and now I am pregnant, I couldn’t be more proud of myself, it feels like my baby is a gift from God– Ovauva Katjipuka

‘‘

GLOWING ... Ovaua Katjipuka has survived stage one cancer; she is pregnant with her first child.

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Photo: Henry van Rooi

19

“But I knew I had to be strong for my daughter; I had to be her pillar of strength, so I pulled myself together.“All worked out in our favour. Glory be to God, I gained a grandchild, and I am going to watch my only daughter get married soon,” Gersoline said.

KNOW YOUR BODY

The executive director of the Cancer Association of Namibia, Rolf Hansen said that early detection of cancer is vital for one’s survival and that knowing your body is crucial to spot any abnormalities. He said contributing factors to uterine cancer can be hormonal changes, lifestyle or hereditary but it can also be brought on by obstructions during birth. He said symptoms of uterine cancer include chronic abdominal pain, irregular discharge and vaginal bleeding. “Once you exhibit these symptoms, you will be directed to a Pap-smear to rule out vaginal discharge and if not, then it means the problem is further [into the uterus],” he explained. He said uterine examinations should be performed by a gynaecologist. “This is not your normal medical sister that can do a Pap-smear (for the cervix). Tests for uterine cancer involve blood work and a scrape and a scan,” he said.He explained that a molar pregnancy like the one Katjipuka experienced, is normally due to complications from the development and birthing cycle, which lead to cancer.“Most often, the cancer will develop in the lining of the uterus, usually because along that cell is where the fetus will be forming

so there might be a tear or irregularity in those cells or irritation against the lining.He said treatment of uterine cancer could include a hysterectomy (removal of the uterus). He said once the uterus is damaged due to a complicated pregnancy, it is advisable to remove the uterus to prevent cancer.

HOW EARLY DIAGNOSIS CAN INCREASE CHANCES OF SURvIvAL

Although Katjipuka was fortunate to have warning symptoms of cancer during the early stages, symptoms are not always experienced early. The Cancer Association of Namibia says finding and treating cancer at an early stage can save lives. According to the association, cancer that is diagnosed at an early stage, when it is not too large and has not spread, is more likely to be treated successfully. If the cancer spreads, effective treatment becomes more difficult, and generally a person’s chances of surviving are lower.Hansen said one of the biggest problems in Namibia is that people assume that there is one test for cancer. There are more than 400 different types of cancers and all of them are tested differently, he said.“That is why we always say you should know your own body to detect if something is wrong. It is so important that we know our own bodies. If you have an abnormal discharge that becomes chronic for example, your body is telling you that there is something wrong. Early diagnosis can save your life,” he said.n


20

SKIPPED ... Skips are situated at Swakopmund’s DRC informal settlement, but not always cleaned on time.

Photo: Adam Hartman

We are scared of hepatitis E, and we know we must stay clean, but we need soap and water and toilets to stay clean.– Nasi Thomas

‘‘

• ADAM HARTMAN SHE cannot recall the precise date in early May, but Nasi Thomas

remembers what they were told to do to avoid contracting hepatitis E. The importance of washing hands every time she uses the toilet and

to always use soap when doing so. For Thomas and her neighbours in the Twaloloka informal settlement

of Walvis Bay, the message of hygiene seems to be lost somewhere between using an open air toilet and walking miles to get water. It is mission impossible, she tells this reporter.

“Of course we would love to have taps for fresh water, and baths or showers and electricity for warm water, but we cannot. Of course we want to be clean, because it feels good to be clean; and it protects us against these diseases, but how can we maintain the cleanliness?” askes the frustrated single mother of five children.

Every day, Thomas makes the long walk with two 25-litre containers to a public tap where she gets her water at N$2 a container. This has to be used to cook porridge and clean fish; to wash the dishes, clothes and the five children; and to keep hands clean.

The only soap she can afford, she says, is a green bar. She says officials from the Walvis Bay municipality had brought the residents some soap and delivered a message about hepatitis E in May.

They were also shown how to maintain personal hygiene, but that was only once, she says.

“We are scared of hepatitis E, and we know we must stay clean, but we need soap and water and toilets to stay clean” she said.

As for going to the toilet, Thomas says she and the children use a mobile toilet if it is clean, in useable condition, otherwise she has to walk into the dunes, where she may even get bitten by sand-lice, she adds.

The Namibian takes a drive through some of the coastal informal residential areas to understand why the Erongo region is one of the hardest hit by hepatitis E, second only to Khomas.

Elsewhere in the Twaloloka informal settlement, residents tell the same story. Twaloloka means ‘We are tired’ in Oshiwambo and ironically the name echoes the frustrations of the residents over their lifestyle of poverty. The first shacks of Twaloloka were erected in 2016. They quickly grew from about 300 people to 4 000.

Residents live in a tight network of shacks divided by narrow alleys. The majority of these residents are women and children. In this dusty

location, refuse removal is infrequent. The residents have one water point. A second one is being installed

and should be working soon. The result is limited water for various household chores ranging from cooking to cleaning, laundry and bathing.

There are about five municipal mobile toilets, and a defunct flush toilet paid for by the squatters, but destroyed by the same soon after.

Mobile toilets are broken, so residents revert to using buckets. They then dispose of the contents in pits around the camp; or to take a walk into open spaces, or the dunes across the road.

Meat and fish are preserved without electricity, flies feast among the people after landing on several filthy pits around the camp in which human waste, nappies, dirty water, left-over food and cut-offs, and any other rubbish are dumped.

Two toddlers relieve themselves in an open space near the camp while two men take a shower in an open makeshift cubicle.

Filthy pits of waste are nearby, swarming with flies. There are spots that are always wet – even in the street or next to the shacks – where dirty water is thrown out. Residents complained that urine is also disposed of in a similar fashion.

Open toilets and dirty water,not what the doctor ordered

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22

“Are we pigs? Are we refugees? No, we are Namibians, but look at how we live,” says Twaloloka community leader and activist Kassie Shilongo. “This is supposed to be our home and we are supposed to be clean, but how?”

DRC The DRC informal settlement at Swakopmund is not different from Walvis

Bay’s Twaloloka, it is just larger. Although formalisation of the oldest part of the DRC settlement has begun with services being installed, two suburbs at the settlement are a growing concern. These being the DRC ‘seaside’ and the DRC ‘airport’, where shacks are without water or ablution services.

Single father of four, Naftali Shaningwa,services who lives on the ‘seaside’ of the settlement, says there are a few points where residents can get water for washing and cooking.

Holes are dug for toilets, he says, and people just walk into the desert when nature calls. He said that he managed to build a bucket flush toilet and a pipe that expels the waste into a hole. Neighbours are welcome to use it, he adds. “I’m trying to set an example. People can’t just relieve themselves anywhere and throw their sicknesses out anywhere. The children can’t tell the difference between chocolate and human waste and then they play with it and then put their hands in their mouths and get sick. We must protect our children,” says Shaningwa.

Many people share a single shack, which also aggravates the rate of infections, but a lot of blame is shifted to shebeens and ‘tombo-houses’ whose patrons start drinking early and urinate a lot.

“One shakes hands with another, and so the contamination continues – if one is sick, then the whole community gets sick,” saiys Shaningwa.

DRC community activist Ambrosius Marsh commends the municipality and the government for coming to the community to raise awareness about hepetitis E and hygiene, but laments that not all residents are on board. He says shebeens need to operate and adhere to conditions set by the health department, specifically when it comes to ablution facilities.

“Patrons drink and just pee where they want. This is not healthy,” he says. He says due to Swakopmund’s usually cold misty whether, human and

other organic waste stay wet, so when it is disposed of in an improper way and in areas where there are people, it can become a messy and unhealthy affair. Kapande Kaputeni, a single mother of four, said the community has been informed of the hepatitis E virus and the need to be clean, but like Thomas, also asks how residents can stay clean if there is not enough water or ablution facilities.

“We first have to wash ourselves before we wash anything else. We try, but it is not easy,” she says.

Since the outbreak of hepatitis E on 14 December 2017, the ministry of health has launched a nationwide campaign to promote hygiene among the urban poor to curb new infections.

Thousands of squatters living in conditions such as Twaloloka and DRC are vulnerable to hepatitis E. hepatitis E is a viral infection causing inflammation of the liver. It is primarily acquired by drinking water contaminated with human waste and is transmitted from person to person through the faecal-oral route as a result of poor body hygiene.

The Ministry of Health and Social Services declared an hepatitis E outbreak on 14 December 2017 in Windhoek. The outbreak has spread

to other regions since. Until 16 June (based on the latest statistics presented to The Namibian by the ministry), a total of 5 423 suspected hepatitis E cases were reported, of which 1 041 were confirmed. Khomas remains the most affected region, accounting for 3 529 (65%) of the reported cases, followed by Erongo 1 267 (23%). Seven other regions account for 627 (12%) of the reported cases. There were 45 deaths, of which 20 (43%) were maternal.

Health executive director Ben Nangombe told The Namibian that the latest statistics reveal a steady increase of reported cases. In fact, during the two weeks prior to 16 June, 113 cases were reported countrywide, compared to 56 during the preceding two weeks.

Cases were reported mainly from informal settlements such as Havana and Goreangab in Windhoek, DRC at Swakopmund and similar informal settlement settings in other regions where access to safe water, sanitation, and hygiene is limited.

Nangombe says, the National Health Emergency Management Committee and the response team continue to engage partners, particularly the UNDP, City of Windhoek, and the Ministry of Information and Communication Technology to support awareness raising for individuals and collective responsibility, including coordination in fighting the disease in the country.

He said the United Nations Children’s Fund and partners have also expressed willingness to support the City of Windhoek and other municipalities to implement community-led total sanitation “tailor-made to suit the urban setting, without compromising the standards of cities”. n



26

• ARLANA SHIKONGO

YOGA, in popular culture, has come to connote a spiritual practice which many people associate with an ‘Eat. Pray. Love.’ type of experience. Windhoek-based psychological counsellor and yoga instructor Beauty Boois recounts that her own intrigue of the practice was stirred when she saw it in a movie. “A few months later, a friend came back from the (United) States where her stepmother had taken her to a teen yoga class, and I asked her to show me how to do the sun salutation,” she relayed. A sun salutation is a basic yoga warm-up form, she explained, adding that when she was shown how to execute it, she felt a rush. “I just remember being in a state of complete and intense awareness,” she said. Boois has since trained in one of the many branches of Indian medicine, having studied yoga psychology at an ashram in Nasik, India, after first obtaining her certificate in teaching yoga through the Africa Yoga project based in Nairobi, Kenya. There, yoga is approached from a more psychology-based angle, she said. “We looked at different personality types, the development of personality types according to yoga philosophy but also looking at it from the Western psychology perspective,” Boois explained. Furthermore, she tethered yoga to holistic living, emphasising that the idea of holisticity in yoga is more than an abstraction. It is a practical culmination of physical practice, psychological and

emotional well-being. Boois is no stranger to the ‘New Age hippie’ perception associated with the practice, adding that that is the first thing that comes to mind at the mention of the word ‘holistic’. In clarification, Boois expounds on the interconnectedness of various ailments, and acknowledges that when one’s health is impacted on the physical or physiological level, the effect extends beyond just that single level. She gives the example of a broken leg, a physical impediment, affecting both the mental and emotional states of one’s well-being as well. “Doctors actually are sending people more and more to yoga teachers and for ‘alternative’ types of healing,” she explained. “By the time people come to me, they have already gone that route [and] that’s the first thing I want to establish; whether they have been to a medical doctor.” This said, Boois ascertains that amid the physical and psychological benefits achievable through yoga, it is best used as a complementary approach to healing alongside certified medical treatment. Her reasoning is that much of the practice is rooted in locating and

DEEP BREATHS...Practising various asanas (posture techniques), pranayama (breathing techniques), dharana (concentration techniques) and dhyana (meditation practice) can be beneficial for the mind and body.


Asana and beyond: The physiology of yoga

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Beauty Boois



addressing the cause to any ailment, more so than looking to cure symptoms. Dr Nikhila Hiremath, a teacher of Indian culture and yoga at the Indian high commission in Windhoek, and a doctor of medicine and PhD candidate of the Indian system of medicine, namely ayurvedic medicine, speaks about this interconnectedness of mind, body and soul in yoga; which she further attributes to ancient Indian practice. Ayurveda has been used in India for thousands of years, and it prioritises treatment and prevention of illnesses through lifestyle-based practices and herbal medicines. In many ways, the practice of yoga is a holistic achievement of those three attributes and cultivates an experience that intertwines personal well-being through all three streams. Hiremath says, yoga is a method of personality development that sees both physical and mental health complementing each other in achieving healing. While the practice of yoga is often seen as either an isolated approach to physical or mental well-being, Hiremath stresses those holistic benefits. “It works both ways: they become physically active; and physicality and mind work in the way that if one becomes active the other gets influenced by that and also becomes active,” she said. Over the years, the perception of yoga as a practice has evolved and Namibia, too, has seen a great deal of that evolution. However, not many people would initially be inclined to necessarily associate yoga with medical healing. Hiremath is not wrong in saying that “what we see is what we believe” when she explains that first-timers come into a class hoping to achieve flexibility because they’ve observed people doing postures that contort their bodies in whichever direction. “Many people who don’t know yoga who come for the first time want to become more flexible,” she said. However, Hirameth explains that many of her patients come to her with physical ailments, most of which are joint-related, to find relief. Her patient list ranges from sufferers of partial paralysis, spondylosis, various joint pains, to depression, anxiety and sleep disorders, among others. Yoga is able to aide with these types of ailments because it includes meditation and breathing practices that also have an effect on the mind and helps one gain control of their own mind. In fact, most people are amiss in thinking of the practice in abstraction, as much of its science is rooted in physicality. Many yogis person highly proficient in yoga, say yoga science originated from nature and is basically the practical application of nature to human physicality and mentality. Hiremath is among these thinkers. “The people who developed them were very good observers. They observed nature and how it has an effect on us, on the human being and the science developed on the basis of this observance,” she explained. “All yoga postures are similar to nature, they are very parallel to nature; and we have different things that we mimic.” When translating the names of the various asaanas (posture techniques), pranayama (breathing techniques) or dharana (concentration techniques) the relationship to nature becomes very evident. Hiremath gives the example of shvanasana, the downward-facing

dog pose, where shvan literally translates to ‘dog’, and another popular pose, vrksana, tree pose, where vrksa means tree. As a doctor of social and preventive medicine in the non-clinical sense, Hiremath looks to establish biological root causes when creating a yoga flow approach for a patient. “When a person comes in with a specific back pain, for example, I enquire what kind of pain they have and where all the particular pain is, whether it is related to backbone or whether it is muscular or whether it is related to ball movement,” she explained. Beyond that, Hiremath interrogates what a person does all day; whether they’re seated in front of a computer or on their feet, lifting weights or straining their eyes. Once the cause is established, she is then able to customize the approach. “We have a specific set of asanas for specific things. We modify the asanas so that they suit that person,” she clarifies. Addressing physiology, Hiremath touts yoga’s ability to aide in healing physical ailments to its propensity to increase blood circulation at the local level and repair damage at the microcapillary level. “What this means is that when fresh blood is coming in, whatever degeneration has happened [in a particular area], it starts to repair and reconstruct,” she said, specifically citing joint problems, which are caused by the under–or over-nourishment of a joint area that results in the destruction of the membrane. Hiremath also relates this regenerative system to the anti-ageing qualities associated with the practice. In many ways, the medicinal practice of yoga begins to sound like a variant of other physiological medical practices like physiotherapy, because of its alignment with dedicated physical practice. However, Hiremath would differentiate yoga from physiotherapy in many ways. To start, she notes that it is a non-invasive therapy with no medicine involved, which is foundational to the herbal approach of her specific qualification in ayurveda. Once again circling the practice back to its holistic framework, she emphasises that beyond the flexibility, stability and strength to the physical body, yoga is largely about discipline and personality development. Lulu Motoomull, an academic who practises with Hiremath at the high commission agrees that yoga is not just about physical health and that there’s more to it than the muscle, stretches and poses. “The muscles are just a plus,” she laughs, pointing at her biceps while joking that yoga is not just about bending her bones. Speaking on her work as a teacher, Motoomull said the high stress of her job requires a stable mind. “You have to deal with different kinds of students and you have to give your best to them. In order to have that mental stability, you must have appropriate mental health and I think yoga is there to keep you focused and positive,” she said. Both Boois and Hiremath described yoga as a tool, and by the sound of it, Motoomull also sees it as such and in essence, its holisticity lends itself in that capacity. In the words of Boois: “Awareness is invisible, and it might be difficult for somebody to grasp, but if I give you a tool, if I tell you your body is a tool towards that self-awareness and that you can actively use your body, and your breath to reach that level of self-awareness, where you can actually see, more people understand that.” n

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• ARLANA SHIKONGO

IN the ongoing debate of the benefits of cannabis and whether it should be legalised, the medicinal benefits of the plant are always weighed. However, in that comparison, one important aspect of the plant’s medicinal significance comes out missing: recognition of the bodies natural endocannabinoid system. Most people have heard about the immune system, the nervous system, and the digestive system, amongst the 11 major organ systems in the human body. However, few, if any, have heard about the endocannabinoid system, explains cannabis activist *Mary Jane. She chooses this pseudonym to protect her identity in order not to jeopardise her efforts in providing ‘food’ to the masses, to aid them through various physiological ailments. She sells various oils, lotions, balms and honeys that are products of cannabis and can address issues such as headaches, joint pain or skin problems, among others. Mary-Jane describes her products as food because she does not believe in calling them medicine. She even winces when she says the word, but there is a reason for her word choice. “People love to call it medicine, I don’t believe that it’s medicine. I believe it’s food,” she explains. “I believe that [using cannabis] is like feeding your system what it needs and that your food is your natural medicine.”To Mary-Jane, the idea of calling a naturally produced substance medicine is pretty much absurd, and medicines, in her perception, refer to artificially made chemical products.“The whole idea of medicine is hoohaa to me. Medicine to me is drugs. Those are the real drugs, and those are the things you need a prescription for and you can find those at your local pharmacy.” Mary-Jane weaves between not addressing cannabis as a medicine because it’s more of a food, and not addressing it as a medicine because of the institutional implications of the word; however, most significantly, it is her understanding and explanation of the endocannabinoid system that frames the choice to call the plant food. “The reason that I think it’s food is because, in my design as a human being I have a system, which is similar to your nervous system, similar to your immune system. You have another system, called an endocannabinoid system,” she said.

This endocannabinoid system is shorthand for ‘endogenous cannabinoid system’. Referencing the many peer-reviewed articles and self-taught information she’s picked up over the years of reading up on, using and learning about cannabis, the cannabis activist briefly explains that this physiological system is made up of cannabinoid receptors intended to receive naturally produced endocannabinoids. “Your body, all your organs, are either CB1 or CB2 receptive,” she explained. “They are either receptive to CBD or THC.”CBD is the acronym for cannabidiol, a non-psychoactive ingredient in the plant, while THC is tetrahydrocannabinol, the psychoactive and illegal ingredient of the plant.“Your body produces cannabinoids, itself,” Mary-Jane said, explaining why cannabis is more like a food than it is a medicine.Furthermore, she explained that homeostasis —the tendency to maintain interdependent elements by physiological processes is what cannabinoids try to achieve, and for this reason it should further be looked at as a food: a natural and necessary ingredient for the functionality of the human body. This said, Mary-Jane stressed the need to refrain from separating and isolating parts of the plant and allowing all of the cannabinoids in the plant to play their role in healing. “The idea of trying to separate and isolate parts of the plant, and say you can have these but you can’t have that, is totally ridiculous. It’s because they know, the thing that cannabis is abundant in, it’s the real magic. And that’s the part that they’re trying to criminalise,” she said. The part they’re trying to criminalise is tetrahydrocannabinol (THC), the principal psychoactive ingredient of the plant. Another local cannabis activist who has been working on the fronts of fighting for the legalisation of the product, Borro Ndungula, would tend to agree, having been in and out of prison for possession of the so-called drug. “I’ve been in and out of prison. I haven’t killed or raped anyone, I have not beaten anybody. I’ve been arrested and kept in jail maybe 20 times and all of that was because of marijuana,” he recounted.A member of the Ganja Users of Namibia (GUN) activist group, Ndungula explained that cannabis is illegal because of the THC content in it, however, he explains that when the laws criminalizing the ingredient were being created, lawmakers didn’t know about CBD.

Food for thought on the Endocannabinoid system

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“CBD, you can say that it’s legit,” he said. “And the people who have knowledge when it comes to law they are selling this CBD oil.” Ndungula argues that the abuse of Dependence-Producing substances and Rehabilitation Centres Act 41 of 1971, the legislation that prohibits the abuse of dependence-producing substances, is both obsolete and racist.“We have came to discover that the law we have concerning drugs or cannabis, is obsolete. It’s from 1971,” he said snappily. This said, the advocacy work he does with GUN calls for the repeal or amendment of this law; or, at the very least, the removal of cannabis from the list of drugs.“We don’t believe cannabis is a drug. Drugs are drugs, and many drugs are man-made, as far as I understand. There’s no natural made drug,” he said. Although Ndungula refers to cannabis as a medicine, which seems contradictory to Mary-Jane’s interpretation of the product, their ideologies, are in fact, very much in line with each other. To Ndungula, cannabis is a medicine because of its ability to heal. By definition, at least according to the Oxford English Dictionary, a medicine is “a drug or other preparation for the treatment or prevention of disease”.“In whatever way [you use it], there’s still a medicinal part to it... whether knowingly or unknowingly,” he said. “Medicinally speaking, your body as it is already made, there is cannabinoid in your system. So it shows you, that medically your body is already made to receive cannabis, per say.”In describing his personal use of cannabis though, Ndungula, unknowingly, associates the product to nutrition, detailing that he uses it as spice on food or drinking it.“There are days I don’t smoke it. I drink it, like in green tea or pour it over fish and eat it like that. Drinking it and eating it is better health wise, as opposed to smoking it,” he adds. Ndungula is not shy to share that he is an avid user of cannabis-products, going on to admit that much of his intake is of products with the THC ingredient. However, if it were up to him, he’d prefer to use CBD. The only problem with that, he said, is that it’s expensive. “It’s like they’re selling real drugs. They’ll sell you a drop for N$800,” he said, speaking about CBD oil.Mary-Jane, who herself sells CBD and THC healing food products, said the same thing. She explained that those facilities that do sell CBD products (*remember, this being the non-psychoactive, non-criminal ingredient of cannabis) surcharge customers by easily 100-200% market price. “CBD oil, a legal product, will be sold for something like N$1200 when it costs N$600 in South Africa or abroad,” she said. To her, this is just an indication of what the medical industry will do with the product if they were to change the laws, and this further accentuates her disdain for classifying the product as a ‘medicine’

GREENS... Mary Jane’s cannabis product range includes various lotions and balms, like the ones pictured above. She says that the lotions and balms can help with joint pain, and various skin conditions like psoriasis and eczema.


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“The thing is, if they change the law and they affect it; and they say cannabis is medicine, then it belongs to them and we can do nothing. Then it will cost millions to get a licence, and to do a medicinal grow,” she said. To her, this effectively means that the average person would be fully stripped of access to the healing powers of a product that should be used by all. “I believe cannabis belongs to the food industry. To the growers, and the farmers and it should be treated the way you treat biltong,” she laughed, reiterating her stance. Drawing from their own experiences with cannabis, both Ndungula and Mary-Jane are in a tug-of-war to try and eradicate misinformation about the product and providing more insight into understanding the natural, physiological need for cannabis in the human body. And, whether it’s called food or medicine, being aware of and understanding that the human body has a whole endocannabinoid system that needs to be maintained just the same as any other system in the human body, is foundational to their activism for the decriminalised use and consumption of cannabis. * Not her real name n

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• OKERI NGUTJINAZO

JOHANNES Ntsamba sits on a bed on the sixth floor of the Windhoek Central Hospital, recovering from successful cataract surgery. The condition had left Ntsamba (78) blind for six months. His son, Immanuel Johannes, helps him to sit comfortably with the support of a pillow before our interview begins. With his son translating from Nyemba into English, Ntsamba narrates how he lost his eyesight. He had gone to visit an uncle at Mpora village, Kavango West in January for a casual chat. After returning home, he did not sleep well that night. The next morning, he could not see from both eyes and he thought that “this is a big problem.” With nobody to help him get to the clinic as he lived alone, Ntsamba staggered blindly to the clinic using his knowledge of the area as a guidance of where to go. He says the medical staff at the clinic took him to Rundu hospital, however, they could not do much to assist him because his blood pressure was high. They only gave him medication which they told him to use for three weeks and then return for a follow–up. When he returned to the doctor, Ntsamba complained to them again that his eyesight was not improving. He believed that someone had bewitched him.Johannes also questioned why they had discharged his father

as he could not see and wanted him helped. “My father could only see the colour red but not make out any objects,” he said. Fortunately Ntsamba was brought to eye specialist doctor Helena Ndume, after months of struggling at his home. Throughout the interview his eyes remained closed although he occasionally opened them to look around the room. Asked whether his eyesight is improving, Ntsamba says he can see the three bars on his bed. He slowly moves his hand to touch each bar as proof that his claim was genuine. Ntsamba adds that he can see an object in the hallway but cannot make out what it is, however, he notices the nurse who quickly passes by the door. A thankful Ntsamba say he felt low when he could not see but now that his eyesight is improving, he is happy to return home. Doctor Olga Tchekashkina, who operated on Ntsamba says cataract surgery is common for patients his age, adding that she simply removed the old lens from his eye and replaced it with a plastic one.Cataract surgery is a procedure where the lens in the patient’s eye is removed and, in most cases, replaced with an artificial one. Normally, the lens in the eye is clear but a cataract causes it to become cloudy, which eventually affects vision.In one of the rooms, doctor Sven Andreas Obholzer, who has


Hope for restored eyesight

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Cataract operations are very dramatic because a person can go from being totally dependent on somebody to lead them around, to eat and go to the bathroom and in the end being able to see again and take care of themselves.– Sven Andreas Obholzer

‘‘Sven Andreas Obholzer

Johannes Ntsamba

worked on the outreach programmes with doctor Ndume can spare a few minutes for an interview before he returns to work. Doctor Obholzer explains to The Namibian that the common issue they encounter at the outreach programmes is mainly cataracts.“Cataract operations are very dramatic because a person can go from being totally dependent on somebody to lead them around, to eat and go to the bathroom and in the end being able to see again and take care of themselves,” he says. He says the average age of patients who undergo the operations is 50, although they see the occasional patient over 90 years of age and a few younger than 50.The specialist says they mostly do their outreach programmes in the northern parts of the country as that is where their largest patient population is based.“Every second or third year we go to Keetmanshoop to service the southern areas but we have a cataract service running in Windhoek all the time so we do get referrals all the time, especially from the south,” he says.He says permanent fixtures are at Oshakati State Hospital, Rundu and Engela in the Ohangwena region.

They plan going to Oshakati this month, then to Engela and Oshikuku in Omusati region, in August and September, respectively.The outreach programmes were started in August 1997 by doctor Ndume, with the help of ophthalmic medical assistant Flashman Anyolo, with Namibia’s first eye camp at Rundu.Obholzer adds that during the outreach visits they dedicate a week in an area where patients are screened with the help of overseas doctors. “The foreign doctors work with non-governmental organisations (NGOs). They bring a lot of equipment and consumables as well,” he adds.He further said they assisted 382 patients at Rundu last month, and more are expected at Oshakati.Obholzer notes that they face staff shortages and space in the operating theatre. “The number of patients who need surgery is always more than we can offer. I think the outreach programmes make a big impact on those big numbers that we can manage in a week to decrease the burden but even here in the state [hospital] our waiting list to get an operation is over six months,” he says.

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• RUTH KAMWI

ILSE Eiseb, a school secretary and co-founder of Epilepsy Namibia, does not remember the first time she had an epileptic seizure. “I don’t know when I get one, I am not prepared when I get one,” said the 42-year-old who works at the Chairman Mao Zedong High School in Windhoek’s Otjomuise location. According to her parents’ account, their daughter, then aged 12, just stared blankly into the distance and seemed ‘brain-dead’ when she experienced her first seizure at their family home in 1989. Eiseb recounts that she was fortunate enough, however, to have parents who are both nurses. Their profession helped to quickly pick up that something was not right with their daughter and so were able to act on time. Epilepsy is described by the World Health Organisation (WHO)as a chronic non-communicable disease of the brain that affects people of all ages. WHO lists temporary symptoms of epilepsy to include loss of awareness or consciousness, disturbances of movement, sensation (including vision, hearing and taste), mood or other cognitive functions. Currently, Eiseb experiences grand mal or petit mal seizures. Her diagnosis has not held her back from living a normal life, however. She has been married for 16 years and has two children, and is currently a third-year education student at the University of Namibia.

Ilse Eiseb’s story:

Eiseb has learnt to manage her medical condition so to keep her unexpected seizures at bay. Triggered mostly by stress, having her meals late or not taking her medication – only in rare instances Eiseb says her seizures do not last more than a minute. “When I wake up from a fit I have a massive headache which I sleep off,” she says, reminiscing that her most recent seizure was on I7 June. Although epileptics are stigmatised in some circles, Eiseb has come to terms with living with her condition. She says she refuses to associate the condition with witchcraft as is the belief among some African cultures. Besides religiously taking her medication (600ml of Tegretol in the morning and 600ml in the evening), she mentions that she does a lot of exercise through activities she engages in with her children as well as eats up to five small meals a day. In addition to that, she is also into bead-making and crotchet making (taught by her father) as recommended by a neurologist. Harmiena Riphagen, the chairperson of Epilepsy Namibia, an organisation of and for people living with epilepsy, says there are more than 100 types of epilepsy and epilepsy syndromes. “Each individual has a unique manifestation of their seizures,” Riphagen says, adding that there are three categories used to generally describe seizures. “Absence seizures are when the person looks ‘blank’ and stares which lasts a few seconds. Complex partial seizures, happen when there are no loss of consciousness but parts of the brain and the body is influenced which results in jerking movements, wandering and irrational behaviour. “The-best known category is tonic clonic seizures where there is loss of consciousness, falling to the floor, jerking movements and spasms. All seizures are self-inhibiting and will stop by themselves within a minute or two,” she says. Epilepsy is diagnosed when more than two unprovoked seizures of similar type are experienced, as most seizures are dramatic events. Signs of epilepsy and seizures are normally easily recognised and reported, says the chairperson. “In young children, absence seizures, where the child loses consciousness for a second or two, are often missed and therefore undertreated,” she explained. She, however, cautions that: “to identify a trigger for seizures can be very difficult. For many epilepsies no trigger can be identified.” Preventable epilepsy, Riphagen explains, is caused by factors like injury at birth, illnesses that involve the brain, trauma to the head, alcohol and substance abuse and worm infection in children.

Life with epilepsy

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Photo: Henry van Rooi

Ilse Eiseb has not allowed her epilepsy diagnosis to hold her back from living a normal life

medical journal

MANAGING LIFE WITH EPILEPSY Riphagen says people living with epilepsy are able to, for the bigger part, manage their own lives with the support of a variety of medical and social elements. “What people with epilepsy need most is understanding and acceptance from the public. The biggest problem they face is other people’s attitude to epileptics. “What people with epilepsy don’t need is stigmatisation and discrimination because of their condition,” she said. Medical treatment and therapy improve the health condition of epileptics, while social support enables them to obtain an education, play sport, follow a career, have a family and contribute to society, she suggests. Further, Riphagen adds that early diagnoses and effective medical care is essential for all people with epilepsy as these form the basis of the holistic care of people with epilepsy to enable them to lead a full and productive life with this chronic condition. “Most seizures are controlled by anti-epilepsy medication which needs to be taken daily and exactly as prescribed, as they control the chemical levels in the brain. Failure to take the medication can cause severe seizures and can be fatal. After diagnoses and establishing a treatment, people with epilepsy only see the doctor for renewal of prescriptions or in emergencies, which a seizure is not,” she says.

CAUSES: Genetic influence. Some types of epilepsy, which are categorised by the type of seizure you experience or the part of the brain that is affected, run in families. In these cases, it’s likely that there’s a genetic influence. Researchers have linked some types of epilepsy to specific genes, but for most people, genes are only part of the cause of epilepsy. Certain genes may make a person more sensitive to environmental conditions that trigger seizures. Head trauma. Head trauma as a result of a car accident or other traumatic injury can cause epilepsy. Brain conditions. Brain conditions that cause damage to the brain, such as brain tumours or strokes, can cause epilepsy. Stroke is a leading cause of epilepsy in adults older than age 35. Infectious diseases. Infectious diseases, such as meningitis, AIDS and viral encephalitis, can cause epilepsy. Prenatal injury. Before birth, babies are sensitive to brain damage that could be caused by several factors, such as an infection in the mother, poor nutrition or oxygen deficiencies. This brain damage can result in epilepsy or cerebral palsy. Developmental disorders. Epilepsy can sometimes be associated with developmental disorders, such as autism and neurofibromatosis.

–Source: Mayo Clinic n


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• HERMIEN ELAGO

I WILL NEVER forget that 1 September 2013, because that was the day I stepped onto the scale, looked down and saw I had finally reached the triple digits.The 100 kilogrammes that I then weighed were a representation of my poor lifestyle choices and years of binge-eating and having accepted that my lot in life was that I would always struggle with my weight because, as I was repeatedly told from childhood: “It is in your genes and there is nothing you can do about it. You will never change!”But something did change that day.Caroline Schroeder wrote: “Some people change their ways when they see the light; others when they feel the heat. I was feeling the heat.”I felt it in my inability to tie my own shoelaces without losing my breath, I felt it in the way I struggled to breathe even while simply sitting in a chair because I was overweight, I felt it in how tired I always felt and in how little confidence I had. My issues with my weight had consumed and affected almost every single area of my life and when I saw that number on the scale, I knew that I had to do something. And this time around I wanted to see what would happen if I started and did not quit, if I went against all the negative words that had been said to me not only by others but also by myself. I wanted to see what would happen if instead of going the quick fix route, I chose the road less travelled and stood the test of time?It took a lot of courage and bravery because this time, I was going against human nature and EVERYTHING that I knew.I made small, sustainable changes and took it one day at a time. I started by limiting refined sugar from my diet, increasing my

water intake and walking for 45 minutes, three times a week. These small changes had me losing five kilos in my first month and those results and the way that I felt made me want to keep on going. And so, I did!The following month, I limited the amount of refined carbohydrates I was consuming too and, voila!... another 5kg loss, I was in business. LOL! And so it went. After three months and having lost 17kg, I wanted to up the ante so I added a little bit of bodyweight training to my routine, I started doing strength workouts at home and that is when I started seeing more dramatic changes to my body.I am a sucker for results and the more I got them, the more I wanted more of them.I then lost a total of 30kg in a year and I guess this is the part in the journey where people would expect me to say, “And then I lived happily ever after!” Sorry to disappoint you folks, there is no happily ever after! Not on my journey.But I will tell you what there is:There is a lot of having to constantly overcome the limiting beliefs that I hold; there are challenges and obstacles that must constantly be faced in order to build the kind of character that it takes to keep on showing up and doing the work. There is a lot of falling and subsequently, having to deal with the shame of having fallen and having to rise despite it because quitting just is not an option.There is the constant struggle against the hands that both genetics and poor choices have dealt me; there is choosing to eat healthily instead of fast food and combating decades of negativity, not just from the outside but from myself too.Someone in-boxed me the other day and asked: “How do you keep showing up for yourself?”I replied: “By not relying on motivation and, or my emotions. And

My weight-loss journey

‘‘My issues with my weight had consumed and affected almost every single area of my life and when I saw that number on the scale, I knew that I had to do something.– Hermien Elago

CHALLENGE ACCEPTED ...Before and after my weight-loss journey

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Photos: Contributed

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please, do not get me wrong, motivation has its place and emotions are important–but they are fickle and cannot sustain change and transformation if that is what you are relying on to show up for yourself. So, I guess what I rely on is the small habits that I have built consistently and SLOWLY over a five-year period. I rely on the discipline that has shaped my character and I rely on my Why! I have been showing up for myself in this way for almost six years and now it has become a matter of principle. Not emotions. Not motivation. James Wilson said: “At the end of emotion lies nothing, at the end of principle, lies promise.” It’s hard at the start because you are literally going against human nature. But once you learn to just

keep taking action - it starts becoming WHO you are. And it is who you transform into that will sustain the changes.”No matter the reason, the condition, or the circumstance, everyone is able to take charge, take control, and change their lives for the better. Everyone. All it takes is self-belief and the ability to put one foot in front of the other. It is progress over perfection and becoming 1% better than you were yesterday.It is understanding that though it is not easy, you are worth it! And you are capable of so much more than you think you are. Be brave and keep showing up.*Hermien Elago is a fitness awareness creator at the Body Experience. She is also a motivational speaker.

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42 • TUTALENI PINEHAS and NDANKI KAHIURIKA

LITTLE Tangi Joseph Makambuli (5) now enjoys his childhood after undergoing a successful heart operation

in April this year.Tangi’s aunt and guardian, Omma Itembu, told

The Namibian in Windhoek, that following the operation, Tangi, who used to be timid and in and out of hospital, has now become playful and is always in a jovial mood.Tangi was diagnosed with congenital heart

defect (CHD) in August 2017. The complex heart disease would block blood pathways to

his body. Open–heart surgery was his only chance of survival, and it had to be done within a stipulated period, despite financial constraints his immediate family experienced.

The Namibian published the story on Tangi’s plight in 2017 when his family appealed for financial help to save him. At the time, his family said they had applied to the special fund in the ministry of health meant to assist disadvantaged patients with complex medical issues, but had been informed the fund was depleted.The family later opened a ‘go fund me’ page for Tangi and raised about N$150 000 for the operation. The difference was then covered by the government. Tangi finally had a successful operation in April 2019 at the Christiaan Barnard Memorial Hospital in Cape Town, South Africa. His uncle, Risto Ashikoto said: “The operation had to be done at a hospital with highly specialised care.”Ashikoto explained: “Although Tangi was diagnosed with CHD at the age of three years, most of his life he did not look sick, and one would not tell him apart from other children.” “But his scars were still very real. He faced more in his life than any person should,” Ashikoto lamented.Overwhelmed by emotion, Ashikoto explained: “Beneath his shirt are battle scars, and a constant reminder that he had won, we won.”Ashikoto accompanied his nephew to the hospital in Cape Town. The doctors spent five days before the operation just monitoring him.The nine hours Tangi was in the operating theatre were the scariest, Ashitokto explained.“I was frightened, I kept asking myself if he was going to make it. My sister trusted me to accompany her son,” he paused. “On the other side of the border in Namibia, my family spent 48 hours praying for Tangi,” Ashikoto said.“The doctor finally emerged from the theatre and told me he was in the clear.” Even though Tangi spent a week covered head to toe with pipes, tubes and sensors, the surgery was successful, said Ashikoto.Ashikoto explained that Tangi is recovering well.

Little Tangi wins heart disease battle...public raises N$150 000 to save his life

HEART DEFECTS IN CHILDREN

One of Namibia’s first paediatric cardiologists, Fenny Shidhika, who is based at the Windhoek Central Hospital, told The Namibian about various types of heart defects affecting children and how parents can cope with them.She said the common types of heart defects facing children Namibian children derive from congenital heart diseases or acquired heart diseases which include acute rheumatic fever and rheumatic heart disease (RHD).According to her, more Namibian children suffer from these defects than the estimated number of a global prevalence of 1 in a 100.Defining congenital heart disease, Shidhika said it presents itself as a hole in the heart or persistent pipe. She said it can also be complex malformations that distort the internal strength of the heart itself and, or the greater arteries and veins that are important to it.“All these simple and complex phenotypes have an exaggerated incidence and prevalence in Namibia, in isolation and/or as part of a syndrome or association with other organ malformations. We believe Namibia has more affected patients than the estimated global prevalence of 1 in a 100,” said Shidhika.She said acquired heart disease presents itself after birth and in children who are under the age of 18 years. “Acute rheumatic fever with its chronic sequelae RHD, though preventable by merely treating sore throats, is also highly prevalent in Namibia, just like congenital heart disease, causing significant disability and death,” said Shidhika. She said most families suffer emotional and financial trauma from all the frequent trips and hospitalisations. According to her, some parents receive disability grants on merit but there are not enough resources to cater for everyone in need. “The cost per operation depends on the type of pathology with regional private rates averaging N$500 000 and even more per patient,” she said, adding that although it is expensive, it is worthwhile.She explained that the government is the sole funder but that it cannot afford to maintain such a service ensuring that the majority of patients who are mostly the uninsured/state patients ,are covered.“Up to mid-late 2018, these patients were sent to South Africa through a public-private outsourcing agreement [...] Now we have started treating these patients locally and that means some millions could be saved per annum but there is still a lot of investment,” she said. Shidhika said for better services, more investment in terms of human resources, infrastructure and paediatric cardiac practitioners, among others, are needed.

SYMPTOMS FOR CONGENITAL HEART DISEASES:• Fatiguability with feeding• Inability to keep up with peers in bigger children• Exaggerated sweating with feeding or any exertional activity• Persistent faster breathing and a faster heartbeat than normal• Turning blue when drinking or crying or during activity• Failure to gain weight

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Documents

‘A SPOTLIGHT ON HEALTH’ · medical journal a publication of the namibian 4 HEALTH is a fundamental human right and as a ministry mandated to provide healthcare to the Namibian