Meet the pioneer of medical studies at Makerere

Prof Krishna Somers has had a distinguished medical career as a cardiologist. Prof. Somers was a leader in medicine studies in Makerere University medical school.  He joined the university, then known as Makerere University College in 1957.

Now in his 80s, he has kept his enthusiastic verve of medicine as in the yesteryears and remains a mentor, professional, practitioner and researcher.

His expertise, skills and pioneering efforts in teaching and training in Cardiology have won him respect and accolades all across the world.

“Makerere University was extending its program in medical education and I was recruited to join Prof Arthur Williams in the department of medicine. I was one of the two lecturers then,” he told The Observer. 

Prof. Somers

As a pioneer lecturer he embarked on aggressive research with Prof. Paul D’Abela on endomyocardial fibrosis also known as Davies disease. The disease leads to the narrowing of the right or left ventricle cavities of the heart.

When the new Mulago was opened in 1962, the medical school was given £10,000(Shs 34m) by National and Grindlays Bank in Kampala and it was used to buy basic equipment for a new heart laboratory. This became the site of all research work that they did.

The two taught cardiology with a pioneer class of 12 students whose numbers have burgeoned over the years. Prof Somers has trained numerous physicians in cardiology from Uganda and abroad. These include: Prof Charles Olweny, the Vice Chancellor of Uganda Martyrs University Nkozi, Dr Ephraim Batambuze based at Nakasero Hospital and Prof Thomas Ogada, the dean of medicine at the University of Nairobi among others.

Prof Charles Olweny hails Prof Somers as a mentor from the time he joined Makerere University in 1961.

“He was my resident tutor at North Corte hall (Nsibirwa) and even guided me during my internship at internal medicine at Mulago Hospital,” he said.

On his (Prof Somers) most remarkable moment at Makerere University, he exclaims;

“It was a joy when we produced our first research papers on endomyocardial fibrosis.”

However, challenges of dealing with a multiplicity of diseases, some of them related to poverty interfered. 

For his unique achievements and contributions, the university honoured him with a Rockefeller Foundation scholarship which enabled him to acquire skill and experience in specialised investigations in heart disease.

His career at Makerere University ended in 1974 in the Amin era. Thereafter, he took up a new job as a consultant in medical education for the World Health Organization (WHO) in Papua, New Guinea. Here, Prof Somers was involved in drafting the new curriculum of medicine at the university of Papua and New Guinea medical school.

He was later appointed physician and associate professor of medicine at Royal Perth Hospital, University of Western Australia in 1974. 

Early Life;

Prof Somers was born in Durban- South Africa and attended Sastri College in Durban for high school. Upon completion of high school, he won a scholarship to the University of Witwatersrand-Johannesburg which enabled him entrance to the university to pursue medicine. He graduated from the university in 1949.

“During my final year at Witwaters rand, I was honoured with the Craib prize,” he said.

After qualifying, he worked in mission hospitals in South Africa because it was difficult for a non white to work in a hospital where there were white nursing staffs. Thereafter, he travelled to India on a scholarship to study paediatrics and a year later, went to Britain and worked at Hammer-Smith Hospital in London between 1952-1957. This is where his career in cardiology was formed.

Achievements;

Prof Somers has been the recipient of many awards and honours including: Wellcome Foundation Fellowship (1960), German Academic Exchange Service Fellowship (1968) and World Health Organisation Fellowship (1970).

He has also been a prolific writer of medical literature in peer reviewed journals and chapters in books such as the ‘Endomyocardial fibrosis’ and Prevention of chemical accidents: the health dimension.’

Some of his editorial consultant appointments include:  Medicine Today, the East African Medical Journal and the South African Medical Journal.

He has also spent time as a visiting Professor at the University of the West Indies, Ministry of Health in the government of Pakistan, Aga Khan University College of Medicine, Karachi, Pakistan and St Georges Medical School London.

Today, Prof Somers is still in clinical practise at the Royal Perth Hospital.

Starving for attention; kids under five wasting away

BY RACHEAL NINSIIMA

For the first time in my life, I saw a severe acute malnourished child. I will never forget his appearance. I met this toddler at Bubukwanga Health Centre III in Bundibugyo District where I had gone to report on the Congolese refugees’ influx.

He was one and half years old. His face was swollen, lips chapped, legs highlighted with open sores and was severely lethargic. He rested comfortably in his father’s bosom as if clinging onto him for life support. His little feet hang midway between his father’s calf and the floor and I noticed that they too were swollen, a visible sign of oedema. Oedema is severe wasting of the body swelling from excessive accumulation of watery fluid in cells, tissues or cavities. 

Father and son at Bubukwanga Health Centre III where the toddler was being treated for malaria. He is also acutely malnourished

“My son occasionally gets sick and a year after he was born, we tested him for HIV and found out that he had it,” he told me.

The two had spent five days in the health facility where his son had been admitted with severe malaria. When I met him, he told me that they have only one meal a day and the situation is not different at home where there are four more children.

In this region of Uganda, families mainly grow cocoa, a cash crop and live off its sale as a means of living. Majority of the households survive on less than $2 (Shs 5000) per day and are battling with malnutrition. In a report released early this year titled, ‘Food Security Eludes Households in the Ruwenzori region’ indicates that over 650 children in Bundibugyo are stunted (low height for age). Stunting is associated with higher mortality and lower cognitive development

This trend is however consistent throughout the country especially in rural areas where poverty is rife. According the 2011, Uganda Demographic Health Survey (UDHS), an estimated 2.4 million children (about 33 percent) aged less than five are stunted and about 110,220 children have died in the last five years due to malnutrition.

 By far, Karamoja, West Nile and the southern western region are leading with the highest stunted and wasted (low weight for height) children.

 The situation is worse for those afflicted with HIV.

“Children living with HIV are five times more likely to die from malnutrition before their second birth day compared to non infected children and worse, stunting is irreversible after 24 months of age,” Michele Sibide, the Executive Director of UNAIDS said.

This was during the international conference on maternal, newborn and child health in Africa that was held in South Africa between 1^st and 3^rd August.

In Uganda, more than 40% of the acutely malnourished children are HIV positive.

In fact Uganda loses 1.8 trillion shillings every year to averting malnutrition and treating its opportunistic infections according to a study, ‘Cost of Hunger’ conducted by the office of the prime minister this year. It costs the country about $120 (Shs 300,000) to treat a person affected with malnutrition and its opportunistic infections.

“Most health interventions in the country are done by development partners and yet Uganda needs only 15b from government to intervene in nutrition programs,” Florence Mutyabule, the chairperson of the Uganda Parliamentary forum for children said in an interview.

She added that consumption of mostly staple foods without a good balance of vege­tables, fruit, beans, and animal-source foods can lead to nutrient deficiencies and poor growth in children. 

Many Ugandan children like these are dying before their fifth birthday because of malnutrition

Situation across the continent;

Despite global progress in the fight against hunger and under nutrition, 165 million children globally were stunted as of 2011. This, according to report from the African Union on nutrition, new born and child health was as a result of inadequate vitamin and minerals in their food. In eastern Africa 42% under fiver five were affected as of 2011.  

In Zambia, 45% of children are stunted.

Ethiopia has over the past two years reduced acute malnutrition from 13.4% to 9.5% especially in the southern Tigre and northern Shao regions. This follows a partnership to end famine between the Ethiopian government and Food and Agricultural Organization (FAO) which supported women with agricultural income generating activities such as poultry farming and vegetable growing.

Ghana and Mauritania have also reduced hunger by 50% since 2001 thus reducing incidences of malnutrition.

In Uganda, Vitamin A deficiency has doubled among children under five over the last 10 years between 2001 and 2011 from 19% to 38%. This is according to the 2011 UDHS.

With the growing impetus to end under and malnutrition, Hon. Sarah Opendi, the state minister for primary health care advises mothers to exclusively breastfeed their children.

“A non breastfed child is 14 times more likely to die of malnutrition and related illnesses such as anaemia in the first six months of life than an exclusively breastfed child,” Hon Opendi said in an interview.  

Using therapeutic foods as drugs;

At the government run hospital of Bundibugyo, RECO industries ltd is providing malnourished children with ready to use therapeutic foods commonly known as RUFTs. RUFTs are high energy foods fortified with macro and micro nutrients such as vitamins and minerals. It is a combination of locally grown foods such as maize, rice, cassava.

While one of the most renowned international nutritional products for malnourished children is Plumpy Nut for children and Plumpy Sup for adults, these are not always available.

Reco Industries together with United Nations Children’s Fund (UNICEF) is currently using RUFTs to treat 20,000 children against severe acute malnutrition. Since the beginning of the year, they have reached over 17,000 children and adults in 103 health facilities across the 62 districts with RUFTs.  

“Our target is to integrate nutrition in agriculture and livelihood and our aim is to train 150,000 small holder farmers on what crops to plant, post harvest handling among others,” Brian Rwabogo, Reco Industries’ chief of party said. This was during the recent launch of the production for improved nutrition project that is working to provide therapeutic and supplementary foods to treat malnutrition.  The project is funded by the United States Agency for International Development (USAID) and is being implemented by RECO industries.

RUFTs are now on the World Health Organization (WHO) essential drug list.

However, challenges still remain. Agnes Baku Chandia, the head, nutrition unit in the health ministry says most foods used are prone to afflatoxins (naturally occurring poison) produced by a fungus. There are also inadequate storage facilities and limited community involvement in adopting and distributing this product country wide.

To avert these challenges, there is need for wide spread awareness.

“As leaders, we owe our communities knowledge. To educate them that they need to cultivate food because therapeutic is a drug and not everyday food,” Hon Janet Museveni, minister for Karamoja affairs said during the launch. 

Hon Janet Museveni signs the production for improved nutrition paper during the program launch last week

Momentum builds country-wide to end malnutrition

In April this year, the Uganda Action for nutrition (UGAN) launched a tow year campaign dubbed, ‘Commit to scale up nutrition, Food for all.’ Its aim is to increase awareness of the importance and how to achieve proper nutrition among schools across the country.

Earlier in 2011, the government adopted the Uganda Nutrition Action Plan (UNAP) as the framework for scaling up nutrition in Uganda between2011–2016.

The goal of this plan is to improve the nutrition status of all Ugandans, with emphasis on women of reproductive age, young children, and infants. The plan is intended to reduce the magnitude of malnutrition in Uganda and its impact on the individual, the household, the community, and the nation at large.

“The strategic challenge at hand calls for increased financial and human resource investment in all relevant sectors for nutrition and food security; adequate institutional structures to scale up nutrition, reporting and supervision,” Hon Amama Mbabazi, Uganda’s prime minister said during the launch of the cost of hunger report on June 18 at Imperial Royale Hotel.

He also called for wide social movement to rally support for nutrition services among the public and stakeholders a robust monitoring and evaluation framework, and an enabling legal and policy framework for nutrition and strengthened coordination among stakeholders.

With Africa’s population projected to reach 2 billion by 2050, the unprecedented challenge of feeding the continent’s children looms large. Nutrition interventions are among the best investments that African countries can undertake.

The secret life of an intersex person Choice between being male or female

When most people are born, the doctor shouts out, ‘it’s a boy!’ or ‘it’s a girl!’

It is assumed a child should be either female or male at birth, with one peep at its genitalia by the midwife.

But what do you do when confronted with a baby whose body is not easily categorized as male or female? A baby with both male and female genitalia. Or a man who menstruates. Or rather a woman without breasts…

Unlike typical girls and boys, there are no guidelines telling society how intersex people are supposed to be treated.

Does anyone remember South African Caster Semenya – the champion of the women’s 800 metres world track-and-field championship in Berlin 2010?

Some felt cheated, speculating that they had competed with a man in a women’s heat. 

Her enviable six-pack, tight abs, masculine voice and arms were confusing, yet hormone tests revealed she has internal testes – the male sexual organs that produce testosterone – and has no uterus or ovaries.

To bring it closer to home, remember Juliet Kaggwa, the young student at Gayaza High School in the late 1980s, who caused quite a stir in the media when it was revealed she was not only woman, but in some aspects a man too?

Yet such is the secret life 30-year-old Gloria Kanyesigye has had to live through and heal from.

She has Congenital Adrenal Hyperplasia (CAH) a condition that has enlarged her clitoris making it resemble a small penis, closing off her vagina in the process and preventing her from menstruating all her life. 

Shrouded in controversy

At the age of nine, Kanyesigye begun to suspect something wrong – she was not developing breasts like her two sisters. In fact, they kept telling her that she may never have breasts but countered it by telling them she was still young.

While in P.6 at Lugazi Primary School in Mbarara, she learnt about the reproductive cycles of both men and women. Developing breasts and menstruating were among the character traits girls developed at puberty. Kanyesigye had neither.

“When I heard this, I got scared and my friends started pointing at me as abnormal and thinking that I might probably be a boy,” she recalls.

However, she knew she was female because her birth certificate said so. She grew up an orphan under the guardianship of her grandmother, Janat Nabikoowa in Mbarara.

She completed P.7, still with no breasts, joined Lugazi Secondary School in 2000 and nothing changed. Inferiority complex confined her in its prison so much so that whenever the school carried out pregnancy tests, she would escape.

Her siblings thought she was abnormal and her elder brother once told a cousin to cut off part of her (big) breasts and give them to his sister. 

Kanyesigye at the SIPD offices

Yet despite the fact that she didn’t get her menstruation periods and had a flat chest, her puberty seemed normal to her. But her story was just getting started.

Noticing a penis-like organ

She joined St Peter’s Secondary School Mbarara for her senior two and because of her state, feared to bathe with others.

“I would wait for the rest to bathe, but one time a girl saw me and her first reaction when she looked at me was, ‘What is wrong with you… you are the only one without breasts in the whole school’!” she recollects.

Then came time for elongating the labia minora called okukyalalira ensiko (visiting the bush) in Buganda. Usually young girls in boarding schools do this communally. When Kanyesigye pulled up her skirt, she noticed a dreadful difference between her and the other girls. Her clitoris was pointed like a penis, where other girls had the tiny, bean-like feature known to be feminine. In fact some students baptised her ‘boy’.

“My observation and their ridicule made me draw a painful and bitter conclusion that I might not be a real girl,” the soft spoken Kanyesigye, who was then nicknamed ‘kawala’ said.

Although she felt she should face the world brazenly as a girl, that moment traumatised her and made her retreat from the frontline of fighting for her identity as a girl.  

She went back to the dormitory and starved herself to sleep. Attending classes became optional and steadily, her performance declined. Stifled by limited finances at home, she was forced to drop out of school altogether in S.3.

After this cocktail of embarrassing incidents, Kanyesigye confronted her grandmother Nabikoowa about it.

Nabikoowa reportedly said: “Your parents were supposed to take you for surgery at a tender age but because of lack of money, they didn’t.”

Those words painfully gnawed at her so much that she told her cousin, a nurse to help her. When she was taken to see a doctor, she was told that she had a complicated condition that could only be rectified by surgery at Mulago hospital or in South Africa.

But that help came at a price. Her once beloved cousin now changed her attitude towards her and even started gossiping about her. Kanyesigye decided to solely find help.

Finding Help

One day while Kanyesigye watched UBC TV, Betty Tibaleka a counsellor who used to host a talk show, The Untold Story, hosted Julius, the “only boy who attended Gayaza High School”.

He narrated his tale – from Juliet Kaggwa to Julius Kaggwa – how for the first 17 years of his life he was a girl.

In his autobiography, From Juliet to Julius; In search of my True Gender Identity, Kaggwa writes that he developed breasts, hairy legs and found himself attracted to girls. Also, while in Natale Primary School in Kyaggwe, the girls went out to ‘visit the bush’ and it was here that he noticed he urinated through a penis protruding through his vagina, while the rest had normal vaginas.

The pressure of trying to be a real girl made him take hormonal pills and other herbal concoctions which he bathed and drank. When these did not seem to work, Kaggwa sought refuge in the school chapel where he prayed, hoping that God would answer his prayer to become all-woman.

When the mounting pressure seemed to go nowhere, Kaggwa left Gayaza High School for Makerere High, a mixed school for his A’ level.

It took lots of physical and psychological effort to change from Juliet to Julius – complete with surgery and hormone treatments to get proper male genitalia and lose the boobs and vagina.

Today Julius is married with two children and the director of Support Initiative for People with atypical sex Development (SIPD) located in Rubaga-Wakaliga. SIPD ensures that the rights of intersex persons are recognised and respected.

After watching Kaggwa’s story, Kanyesigye called Tibaleka for help.  

“She told me that my life would never be the same and took me to Nsambya hospital for hormonal tests, but my [nurse] cousin instead complained about my decision,” she recalls. “I tried to kill myself.”

However, Kanyesigye continued in her quest for help and this brought her to Kibuli hospital in 2010 where a team of Egyptian surgeons were visiting. Although she was offered free surgery at Ain Shams university hospital in Egypt, she had to fund her travel and upkeep, money she did not have. 

Doctors at Nsambya offered her Premarin pills (these have conjugated estrogen) to help her develop breasts. Kanyesigye now has small breasts on her chest and is receiving counselling at SIPD.

Demystifying intersex conditions

When Suzan Nansamba, a resident of Mukono in June 2001 gave birth to Allan Mwebe, all seemed a rosy affair. However, two days after, she noticed that her son did not have a penis and was instead passing urine like girls. He is afflicted with penile agenesis, an intersex condition where one has no penis.

Like Mwebe, an estimated one in 2,000 babies (www.pflagdetroit.org) are born with a reproductive or sexual anatomy and/or chromosome pattern that doesn’t seem to fit typical definitions of male or female.

Dr Reuben Kiggundu, a medical officer at Mulago hospital describes intersex as a medical condition where one cannot determine their sex due to chromosomal or atomical (physical) alterations. It can also refer to someone who has one ovary and one testicle, or someone whose chromosomes are, say, XXYX instead of XX for a male or XY for a female.

Tom Makumbi, the program officer at SIPD says intersex conditions manifest in more than 30 forms including CAH, Klinefelter's Syndrome (People with this condition are usually raised as males and have breast development, low androgen production and small testes and Vaginal Agenesis - no vagina.

“One myth I want to [set straight] is that intersex people are not hermaphrodites; a hermaphrodite will depict complete sets of the male and female genitalia but for the intersex person, it’s ambiguous,” Makumbi says.

He adds that many intersex persons have dropped out of school because society does not recognize them and discriminates against them and many are killed at birth. In a research conducted by SIPD, it was identified that many cases of intersex babies are from eastern Uganda.

Makumbi appeals to government to establish a central registry where babies born as intersex can be recorded and avail information to create awareness.

So far 302 people from 25 Ugandan districts have been helped by SIPD since its inception in 2008. 

A call to help;

Although she has developed small breast mounds on her chest, Kanyesigye is fundraising for money for corrective surgery in Egypt. She can be reached on 0703767489/0783806250. She has a fundraising account no. 3620001994 in Centenary Bank.