The Diabetes Code

Mr. Ngumbau is a man I met in a small village in the environs of Kang’undo town in Machakos. The first impression I had of him was of bravery. And as it turned out, I wasn’t quite wrong.

Our arrival in his compound accompanied by his last-born daughter and two other mutual friends found him staring blankly at his lunch plate that had a totally chewed-up bone of a chicken breast floating in a mass of chicken soup that didn’t appear tasty.

‘Welcome!’ he muttered loudly. I noticed he had crutches beside his seat. We lined up and he shook each of our hands in quick succession.

After a preliminary introduction, we had seats brought and we sat under a plum (zambarau) tree. It beats logic how people link red fruits with blood in the body. Anytime you would buy beetroot, the vendor would comment something to do with blood addition in the body. With all facts laid bare; at any point in time, a human has five liters of blood circulating in them with a plus or minus half a liter depending on size and weight, and physiology for ladies. If there was blood added to the body anytime we partake of red fruits, won’t that be a bluff towards medical science? Further, blood is manufactured in the bone marrow’s stem cells. So, how exactly do beetroots or plums or red grapes or red apples or watermelons add blood to the body?

Mr. Ngumbau, typical of all old men in the countryside, began by narrating how life was undemanding and bearable in the 70s and 80s. He narrated how as a form four leaver he got paid 200 shillings monthly to teach in a local primary school. He narrated how peace and tranquility prevailed in the world. He narrated how women enjoyed the role of being housewives. He narrated how he bought his first 10-acre land with 30,000 shillings and a Volkswagen Beetle at 3000 shillings.

I asked him what happened to his right leg that was visibly amputated.

‘That is a long story and probably the highlight of my life,’ he began.

After serving as a teacher for 35 years in the public service, I gladly retired in the year 2002. My focus shifted to the small farming investments I had for a moment until I learned of an opportunity to become a high school principal in South Sudan. I didn’t mind because we all want better every day. I set off for an interview in the Westland area of Nairobi. With 35 years of experience, there is nothing new the interviewers had to ask and so I was among the successful applicants. I was elated because the pay was in dollars and it wasn’t small money. On my way back home, I had mild pain in the smallest toe of my right foot. The pain persisted for the weeks advancing towards my reporting to South Sudan. Like anyone would do, I checked in at Machakos Hospital and told them I had pain on my smallest toe of the right foot. A resident doctor was assigned to check on the pain in my smallest toe on the right foot. I had a stenchy wound in between the smallest toe and the other toe beside it.

Initially, I thought the stench was probably due to dirty socks or shoes. Observing the resident doctor attending to me, he seemed legally clueless as to what he ought to have done. My efforts to reach other doctors to attend to me were futile as they were all somewhat busy.

Are you a doctor?’ I asked the resident.

Yes, sir. I am.’

How do we treat this wound?

Sir, I intend on cleaning the wound with saline after which I would apply antibiotic ointment every day for the next three weeks.

‘Three weeks!’

Yes sir.’

I didn’t have three weeks. I was needed in South Sudan as a high school principal the following week on Monday. We were on a Thursday.

Thinking of the Bible verse in Matthew 18:8, “If your hand or your foot causes you to stumble, cut it off and throw it away. It is better for you to enter life maimed or crippled than to have two hands or two feet and be thrown into eternal fire.” In my own words, ‘It is better for me to enter South Sudan without a toe’. I instructed him to cut off my toe.

What do you mean sir, I was bewildered. He continued:

Yes, I instructed the resident doctor at Machakos Hospital to cut off my toe so that the wound remain open and heal on its own quickly. The resident consulted a few colleagues and he came back with some papers for me to sign and a hacksaw. Looking back, the level of unprofessionalism they exhibited at the hospital was abominable.

Did he cut your small toe with a hacksaw? Were you under anesthesia?

Yes, he cut my toe with a hacksaw. And no, I was not under anesthesia. I watched my toe cut. I wanted to go to South Sudan to be a principal. The wound would heal later.

How would you describe the experience of having your toe cut?

Diabetic foot.

Pain that is second to none. The screeching sound of the hacksaw against my toe bone is a sound that lives rent-free in my memory. The toe is part of the body. The amount of blood that jetted from the foot after the toe was cut constituted 80% of the blood in the body. The bleeding persisted for slightly more than an hour. By this time, the entire fraternity of Machakos Hospital was in the room. An ambulance was called and driven to Kenyatta Hospital. By this time, the remaining toes of my right leg had turned black and all were upright perpendicular to my femur. They were biologically dead. At Kenyatta Hospital, all surgical theatres were fully booked for the next two weeks. We crossed to Nairobi Hospital where my right foot was amputated. Prior tests had indicated I had acute diabetes mellitus and my wound was diabetic. That is how to this day, I have never been to South Sudan.

He concluded with a smile while we held our chins at the blockbuster episode we had just had.

A lady appeared from the kitchen with freshly washed plum (zambarau) fruits. In compensation for the blood lost by Mr. Ngumbau during his ordeal back then, we ate the plums heartily.

Predisposing factors for Diabetes Mellitus (Diabetes Type 2)

You are at risk of developing type 2 diabetes if you are prediabetic (where the sugar levels in the body are higher than normal but not yet high enough to be diagnosed with type 2 diabetes).

If you are overweight.

If you are 45 years and older.

Genetics (where one of your immediate family members has type 2 diabetes).

If you are physically inactive for at least three days a week.

If you have had gestational diabetes or given birth to a baby who weighed more than 4kgs.

Signs and Symptoms of Type 2 Diabetes

Sores that heal slowly.

Blurry vision.

Numb or tingling hands or feet.

Tiredness throughout.

Very dry skin.

Frequent urge to pee, especially at night.

Having more infections than usual.

Frequent thirst despite constant hydration.

When you lose weight without trying.

Always hungry despite regular meals.

Complications of Diabetes Type 2

Heart and blood vessel disease including stroke and high blood pressure.

Nerve damage (neuropathy) in limbs.

Kidney disease.

Eye damage leads to conditions such as cataracts and glaucoma.

Slow healing of wounds and severe damage may lead to toe, foot, or leg amputation.

Hearing impairment.

Obstructive sleep apnea.

Dementia and Alzheimer’s disease.

Prevention of Diabetes Type 2

Eating healthy (food low in fats and calories and sugar)

Active physical lifestyle (vigorous aerobic activity)

Losing 7% to 10% of the total body weight.

Avoid inactivity for long periods.

“In 2012 about 56 million people died throughout the world; 620,000 of them died due to human violence (war killed 120,000 people, and crime killed another 500,000). In contrast, 800,000 committed suicide, and 1.5 million died of diabetes. Sugar is now more dangerous than gunpowder.”

― Yuval Noah Harari, Homo Deus: A History of Tomorrow

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