Monday, 2 September 2013

From digging out jiggers to treating children’s hearts

Dr Dan Gikonyo and Dr Betty Gikonyo.  PHOTO/Courtesy
The heart surgeon trudged out of the operating theatre severely heartbroken.
She had watched experts desperately trying to save a five-year-old child’s life.
As she stood there, the young life suddenly ebbed, way beyond the reach of the specialist team fighting to keep her alive.
Children’s heart specialist Betty Gikonyo says the moment will remain indelibly imprinted in her memory.
The previous evening, Dr Gikonyo had enjoyed dinner and played with the child. Little did she and the parents know it would be their last evening together.
Before the sudden and permanent parting of ways, Dr Gikonyo had twice operated on her little patient – and a bond had formed.
But the patient still needed a third surgery and, Dr Gikonyo had worked out that this would cure the problem.
She had prescribed that the third surgery be conducted at a hospital in the United Kingdom. Parents, patient and Dr Gikonyo had booked an appointment at the selected hospital and flown there.
On the night before the surgery, the little girl looked up at Dr Gikonyo and asked, “Why are we here?”
She did her best to infect the curious child with the same specialist optimism that had brought them many thousands of miles away from home: “So that the doctor can fix your heart and you don’t have to be feeling as tired as you have been feeling.”
The following day, the little patient went into theatre as planned. Parents are supposed to wait outside but Dr Gikonyo went in.
“And then, before we could do anything her heart just stopped. Everyone tried to do anything that could be done but nothing worked,” Dr Gikonyo told Lifestyle last week. “The hardest part was to break the news.
When I walked out, the parents were all expectant, waiting for good news. I felt weak at the knees …”
Breaking the news and having to fly the body home is marked in her memory as the second most difficult moment of her 38-year-old career. It is only superseded by one other as she records in her new book, The Girl Who Dared to Dream: Betty Gikonyo – an autobiography.
This time, the patient was younger. A baby actually, she recalls.
The baby patient had developed a heart condition that Dr Gikonyo had fought with only some measure of success. She prescribed that they travel to Britain with the parents and hopefully cure the problem.
It fell on her again to trudge out of the operating theatre and face expectant parents with the worst possible news; their baby had died on the operating table. She joined them as they cremated the little body before returning to Nairobi, heartbroken.
“Medicine is not a pure science,” Dr Gikonyo said, a disturbed look on her face. “It’s not the kind of science where one procedure must necessarily give you the exact same results.”
Not that the lot of a surgeon is all bad news.
Dr Gikonyo, a consultant paediatrician, swings to life when she describes the joys of treating children and watching them bounce back to life.
The most fulfilling was when she conducted what would turn out to be one of the most difficult procedures she has undertaken yet. She bills it as difficult because it was almost needless and yet a young girl’s life had been suddenly put at risk by a nurse who should have been more careful.
Dr Gikonyo had been called in by a colleague to see a patient. The doctor who was treating the patient for diarrhoea and vomiting was dissatisfied with the progress and suspected there was a problem that might need specialist attention.
“It wasn’t a heart problem but I was called in anyway and went to see the patient,” Dr Gikonyo said. “The primary doctor and I then determined that the girl was on the road to recovery and discharged the patient.”
As they retreated to the doctor’s room to review the records, they left a nurse inside the ward preparing notes that the patient’s mother, also a nurse, would take home along with the prescription medicine.
“And then the nurse came running through the door. She announced that something had gone wrong and we needed to go in and see the patient,” Dr Gikonyo recalls.
It turned out that as the nurse removed the tube used to administer drugs through the patient’s neck vessels, a piece of the tube inserted into the veins cut off and had been sucked into the heart.
“We X-rayed the patient and actually determined that the piece had gone all the way into the heart.
That gave us two options,” Dr Gikonyo said. “We either had to conduct an open heart surgery or, using technology that was brand new at the time, insert a little net attached to a wire and fish out the piece.”
Open heart surgery is heavily invasive. Surgeons have to open the chest and rib cage to access the heart and yet, the young girl lying on the bed was not sick at all – only that an object that had mistakenly or accidentally been sucked into the blood stream had lodged in the heart and could prove life threatening at any time.
Dr Gikonyo and her colleagues made a decision that they would fish out the object rather than perform the heavily invasive open-heart surgery. But the procedure they were to employ was new and highly delicate.
The “fishing” involves inserting a wire through the sole, up the foot, into the leg and into the torso. The little net at the tip of the wire is then directed into the targeted site.
It’s not a blind procedure because doctors direct the insertion while monitoring it on specialised equipment, only that it’s extremely delicate.
“It took us three hours to finally fish out the piece. It had taken us 15 minutes to get in and three hours to finally get the piece in the net and then pull it out,” Dr Gikonyo told Lifestyle.
The procedure is marked in The Girl Who Dared to Dream as one of the most fulfilling.
Dr Gikonyo and her heart specialist husband Dan Gikonyo would also battle with a speech and hearing problem their third born child, Eric, was born with.
She goes into great detail in her book; how they fought the problem with numerous surgeries in Kenya, the UK and the United States, and the toll it took on her motherhood, having to be away from the family while she minded Eric.
The surgeries had begun when Eric was only a month old and when they were prescribed, looked so numerous that they would last a lifetime. She decided to pray.
“In my years of medical practice, I have assisted countless parents and children. But nothing in this world could have prepared me for my own experience with Eric,” she writes. “It was my turn to be on the receiving end.”
Eric, who went through numerous surgeries since shortly after birth, is today a family man who is a published poet and who has his own set of academic accomplishments both in Kenya and the US.
Dr Gikonyo’s successes in the operating rooms, in academia or philanthropy are repeatedly punctuated by the phrase “grateful to God,” a sign of the Christian signature that is central to her life.
And so it was when she told Lifestyle the story of her life from the boardroom on the top floor of the 100-bed Karen Hospital fitted with state-of-the-art equipment that she and her husband run.
In her book, she tells the story of her humble beginnings and the brutal colonial rule she witnessed as a child. She tells what is perhaps the simplest of surgical procedures she exercised in her rural Mathira childhood home – removing jiggers using a safety pin.
Her father – a quintessential disciplinarian who wasted no time using his walking stick to instill the fear of God in his children – saw to it that his children got an education.
Young Gathoni, as Dr Gikonyo was named at birth in 1950, excelled in primary school and joined the Alliance Girls’ High School where she left six years later with high flying qualifications that took her to medical school.
She was among the pioneer crop of Kenyan women doctors when she graduated in 1975 and her husband, Dr Gikonyo, the first student to score a distinction in the final examinations in the Department of Internal Medicine.
In her book, she describes her struggles in teenage, the most devastating of which was losing her mother to cancer when she was in Form Two.
She weaves in her romance with a high school sweetheart she would later drop and joining the University of Nairobi’s Medical School where, in her second year, she met and grew fond of Dan, the man she would later marry in June 1974.
Her narration has servings of humour. A rural girl in her upbringing, she knew nothing of birthdays and only heard about it from other girls at Alliance Girls.
She had chosen her baptismal name and as well, she thought, it was no big deal determining her own birthday with all the pressure from the other students.
“How the date came to be October 21 escapes my memory. No premeditation was required and it did not matter. When my brother told me later that my birthday was on May 27, it was too late,” she writes in The Girl Who Dared to Dream.
She had always wanted to be a doctor, inspired by a warm glow that appeared on her mother’s face every time she talked about young Gathoni’s elder brother, Dr Wallace Kahugu.
“My dream was not to build a hospital. It was to be a doctor, but once you conquer one hill, you have a clear view of what lies beyond,” she told Lifestyle.
It was while undertaking specialist studies in Massachusetts in the US that Dr Gikonyo and her husband dreamed up building in Kenya a hospital, highly powered with skilled manpower and the latest equipment, back home in Nairobi.
They returned home from studies in 1986 and laboured through a treacherous journey, including official red tape, a series of well-meaning and ill-meaning naysayers, before their dream to build a hospital would come true two decades later.
“The naysayers’ voice was against our soaring spirits that yearned to sail and discover new lands. The drumbeats were beckoning us to act before the cacophonous spirit of discouragement extinguished the flaming fire that was roaring inside us.
“Medicine is not a pure science,” Dr Gikonyo said, a disturbed look on her face. “It’s not the kind of science where one procedure must necessarily give you the exact same results.”
Some laughed it off, others plainly said no, yet others walked away and said it could never work. But it came together when Kenya Commercial Bank agreed to finance the building of the hospital. Today, she looks back at the longevity of the struggles with a glow of fulfilment spread across her face.
“People expect us to be very expensive but our consultation fee is Sh1,200. And we are not just a heart hospital; we have maternity, children’s, kidney and orthopaedic departments.
And because we were not formed as an association or a foundation, it is not religious based but a medical business, we pay corporate tax,” she said.
The hospital now has branches in Karatina, Meru, Nyeri, Nakuru, Chester House in the city centre, Kitengela and Mombasa. They are also set to open the Betty Gikonyo School of Nursing in Ngong.
“My regret is that it has taken a very long time. But it’s something that I’m grateful to God for; to be able to dream, execute the dream and live the dream.”
Not that business has at all been an easy ride, she says because of outstanding loans, keeping up with the 400-strong payroll and paying suppliers and consultants.
“At times, consultants have abandoned their patients because they don’t understand that we are not paid upfront by all the patients and so on,” she said with a worried look on her face. “Such are tough times but we have to soldier on.”
She says that the motivation to tell her life story is to inspire readers to dare to dream and that anyone can achieve great feats despite humble beginnings.
“Life is not a lottery. You cannot sit back and wait to win the jackpot. Life is a journey best suited for those prepared and armed with knowledge, skills and a passion for conquering. What you give to the world is what you get back,” she writes in her book published this year.
Former head of medical division at Karen Hospital Faith Malavu says Dr Gikonyo does not allow distractions.
“We started Karen Hospital together. I was her manager then. We were so close and she was my friend. She would encourage me when I was in low spirits,” said Dr Malavu.
“She is a hard working woman who set her eyes on the endgame; she is also a great professional, an administrator and someone who has changed many people’s lives. She made me who I am.”
And when it’s all said and done, Dr Gikonyo writes, she wants to be remembered as the woman who refused to go with the flow even when it was easier to do so.
Additional reporting by SAMWEL BORN MAINA (@Bornmaina,

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