Machakos nurse wages war against kidney disease in the villages

It is 6am and in the hilly and sleepy village of Kakuyuni in the Kangundo Sub-County, Machakos County, 30-year-old Rose Gitau prepares breakfast before seeing her first-born child off to school.

She escorts her child to wait for the school van and as soon as it arrives, Gitau gives her child a passionate hug and says; “Goodbye, see you later” before she boards it to join other excited toddlers.

Gitau then quickly turns around and hurries back to the house to prepare herself to dive into her duties as a general nurse at her Kakuyuni dispensary.
Dressed in scrubs, she strikes you as just another nurse going about her general duties in a remote village where everything and residents seem to crawl to activity reluctantly.

But beyond that choreographed approach to work that defines many of her colleagues, Gitau has a passion to which she dedicated her life–a lone fighter warrior against kidney ailments. In this, she goes beyond the call of duty to not only take care of kidney patients but also preach the gospel of kidney wellness to the village and beyond.

“I dedicate my free time to teaching people how to keep kidney ailments at bay. I walk to the villages and arm them with the knowledge to stay healthy,” says Gitau, a nephrology nurse.

“My focus is on patients with those living with diabetes and high blood pressure because they are candidates of kidney chronic disease. Before a kidney fails, there are five stages, and if we advise patients on what to do while in the first three stages, their condition may not progress to the other stages”.

Her passion for what she does is evident at her workstation, where she has plastered the walls with charts with information on kidney health for those visiting the facility to read.

But when and how did the “kidney wellness bug” bite her? Seven years ago, it all began when Gitau, one of the few trained kidney care nurses in the country, was assigned to the Nairobi West Hospital Dialysis Ward.

“What I do is also personal. The loss of my close kin; my mother and father-in-law after being on costly dialysis for close to 10 to 15 years was an awakening call that prevention is better than cure,” says Gitau as she gazes into the horizon during the interview.
While at the Nairobi West Hospital, her naturally curious mind drove her to understand more about renal ailments and factors contributing to a surge in new diagnoses, especially among the youth.
“I was trained to carry out dialysis and understand renal patients, enabling me to get familiar with the procedure. In the two years I worked there, I noted a disturbing trend–a surge in the number of newly diagnosed patients more so the youth. Seeing how this condition was disrupting their lives, I resolved to understand the condition and identify the underlying risk factors,” she noted.

“I later worked with the Machakos County Government’s health department for two years and I was lucky to get a scholarship to university to specialize in nephrology. This gave me the chance to understand the theory and practical aspects of nephrology care. After completing my studies, I opted to work at the community level where I could reach locals directly and talk to them about renal health”.

During a candid interview, Gitau said there is a gap at the prevention level because “all the attention is directed towards curative measures instead of preventive healthcare”.

She added that other factors contributing to the surge in the disease, include lack of mentorship, training and creation of awareness.

“Many nephrology nurses get confined in dialysis wards after graduation rather than being sent out to do prevention, meaning our defence line in kidney disease prevention is weak. After interacting with many kidney patients, I realised that someone somewhere could have helped prevent the cases,” she observed.

At Kakuyuni, she has engaged actively with other primary healthcare workers in nearby facilities to tap the health issues early enough and perform early prevention.

At first, it was difficult, as many of the patients she found were seeking help while in the final stages of the ailment. She, however, with the support of her colleagues and other stakeholders, came up with a screening method, which is a valuable tool for detecting kidney issues. She is sharing her knowledge on kidney ailment and management with a recently launched programme–Community Health Providers (CHPs)–a collaborative initiative between the National and County governments.

Gitau has been collaborating with other health facilities, including Kangundo Level Four and Machakos Level Five hospitals, in her endeavors to spread the message of kidney wellness.

When she is not at the dispensary and out and about in the village, Gitau spends time with her family, her source of motivation. “I have learned to balance my duties as a mother, wife, daughter and my calling to fight kidney ailments,” she says.

“It is demanding, but I have a never-say-die spirit and that keeps me going. I also get a lot of satisfaction knowing that I am saving many lives”.

She says dialysis only caters for between 10 and 15 per cent of kidney functions, and doctors always advise patients on dialysis to embark on the life-saving journey of kidney transplantation, which is quite expensive as it requires lifelong immunosuppressant medication.

Gitau stated: “If I were to return to the ward where I used to nurse seven years ago, I would only find 5 per cent of the patients still there. A larger percentage of patients have passed away, while others have transferred to different hospitals or have received a kidney transplant”.

She says what keeps her going is the positive feedback she gets from the community on how their health have improved since they met her.
She wishes more people would join her cause to empower individuals with knowledge and tools to reduce the incidence of kidney-related issues through education and early intervention.

Her challenges include debunking myths surrounding the causes of disease, drug misuse, religious beliefs, under-researched herbal treatments, and lack of well-equipped facilities at the grassroots.
Gitau’s exceptional efforts have garnered recognition both locally and globally. She is the first kidney coach in the region certified by the American Kidney Fund.

In 2023, Machakos Governor Wavinya Ndeti acknowledged her as Nurse of the Year
She is currently sponsored by the Kidney Experts Patients Advocacy Academy after being nominated by the Global Patients Advocacy Alliance for Kidney Health.
Her community-based organisation–Figo Na Afya Mashinani–is the first entity to be enjoined to the alliance in Africa.

And her colleagues have praised her singular focus on kidney health, saying she has “demonstrated unwavering dedication to providing compassionate care for patients.
“We have seen her severally get into her pockets to provide transport to some of her patients needing treatment in faraway places. I can say for sure her passion is unmatched,” says a colleague.

John Mutua, the Sub-County MOH, acknowledged that the nurse has exceptionally pursued her passion despite it not being part of her duty allocation.
He adds she has not only made a positive impact on the community but has also inspired other health officers to follow her lead.

“She has enabled health workers to understand the need for preventive measures as opposed to curative ones. Although she doesn’t have logistical support, she tries her best to organise, mobilise and do sensitization with minimum help and I can say for sure her actions need to be emulated,” said Mutua.

Mary Musau narrated how she struggles with high blood pressure and diabetes but can now manage her condition without fear or complications after meeting Nurse Gitau.

“She’s been exceptional throughout my treatment – a lifeline. Her empathy, expertise, and constant support make me want to live a healthier life,” adds Musau.

For the government to achieve the 2030 health plan, she stressed the need to train community healthcare providers, adding that more emphasis should be on preventing kidney disease, which is expected to be one of the five killer diseases in the next five years.

The government spends over Sh4 billion on treating patients with chronic kidney disease. Gitau says investing more in disease awareness and mentorship programs could help reduce its prevalence.

“This is because a well-informed public can take proactive steps to maintain kidney health thus lessening the burden on the healthcare system,” she adds.

Nurse rose(in white t-shirt)poses for a photo with community health promoters outside Kakuyuni health center after being awarded certificates after a renal health program(source.courtesy)

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