In November last year, Fredinah Nzau walked into the Kenyatta National Hospital (KNH) hoping that the doctors at the facility would give her the kidney transplant she needed.
At the time, the facility was not conducting surgery due to Covid-19 and Ms Nzau, and many other patients like her in the country, had to wait until a time when the hospital had set up all the conditions that would enable her transplant to be done safely.
Ms Nzau, who was diagnosed with kidney failure, walked in with her son, her nephew and her sister hoping that one of them would be a match for her transplant at the facility which was planning on doing transplants in January.
When she met Dr John Ngigi, the head of nephrology unit at the hospital, she was immediately told that her son would not be able to give her a kidney because of his age. He was too young to donate.
The son is 19 and according to the law, you have to be financially independent and convince the doctors that you are not coerced into doing the transplant.
So she turned to her sister for help.
“We had done several tests but after checking her heart condition she was disqualified by the cardiology department because of a heart condition in early December. I had to seek an alternative plan and my nephew volunteered once more,” she said.
Ms Nzau, whose blood group did not match with her husband’s, went back to hospital with her nephew Mr Felix Nzomo who had to undergo the same tests to see if he would be a match with his aunt.
Kidney transplant
“He was my last hope because Dr Ngigi had informed us that the law does not allow transplantation of a non-family member. If we did not match then I would go back to dialysis for the rest of my life,” she said.
After taking the necessary tests Mr Nzomo was told that he was a match and would be able to donate his kidney in January since KNH had already set up the necessary provisions to ensure a safe kidney transplant.
On January 27, Mr Nzomo and Ms Nzau were surgery ready and so was the team at the Kenyatta National Hospital who performed the over six-hour long surgery, the first transplant in the country since the onset of Covid-19.
Surgeons at Kenyatta National Hospital insert a catheter on the back of Felix Nzomo with before he underwent surgery that involved donating one of his kidneys to his aunt.
First to go under the knife, was Mr Nzomo and as he sat on the operating table while the anesthesiologist inserted a tiny tube that put medicine directly into his back and spinal cord tears rolled down his cheeks.
A doctor who held his hand and talked him down through the painful process which took a few minutes tried as best as she could to take his mind off the procedure.
The same was happening in the adjoining theatre where his aunt was getting the epidural put in her spine.
When he was finally ready top renal transplant and laparoscopic, urologist Dr Paul Njogu and his team began the process of harvesting his left kidney. Dr Njogu would later explain that the reason for picking the left one was to ensure the donor was left with the most viable kidney.
Kidney harvest
Outside the theatre, students in scrubs watched through a screen curious to see every cut, every discussion between the surgeons, they clang to every single move made by these experts.
The harvesting process took slightly over two and a half hours and when surgeons yelled out “kidney out” the next team was already in hand waiting to transplant the kidney to Ms Nzau.
The team had opened her up 30 minutes earlier in preparation for the transplant and did not remove the non-functioning kidneys but instead placed her nephew’s kidney slightly above the other one.
With such meticulous care, the team was now busy attaching the kidney graft to Ms Nzau’s body and despite the curious students from East African countries whispers, their concentration was on this kidney, the team worked seamlessly.
The surgery took hours and no one seemed to mind the hours of standing. Only the surgeons talked, they would discuss amongst themselves what needed to be done, the students watched in awe.
While all this was happening the other surgeons where Mr Nzomo was were busy closing him up. They took their time to ensure everything was going well and the nurses counted the gauzes used in the surgery making sure that not a single one was missing since the surgeons used them to soak up blood during the kidney harvest.
Dedicated caregivers
A few hours later, both donor and recipient were wheeled back to their rooms. They were taken to special rooms and their caregivers were also specially assigned so as to ensure no chances of infection given their high risk.
Dr Evanson Kamuri, the KNH CEO said that nothing has gone to chance to ensure they are in the most sterile environment and their dedicated caregivers were tested for Covid-19
Some of the changes made are such as the extension of the stay at the hospital for the patients from at least seven days to 14 days so as to ensure patients have minimal interaction with people for as long as possible while they recover.
The medical procedure to harvest the kidney took slightly over two-and-a-half hours.
Health Principal Secretary Ms Susan Mochache said that Covid-19 has been in the country for far too long and it is time for hospitals, especially KNH, to move on and see how best to cater to patients while maintaining the services they offer.
“We cannot keep our patients waiting any longer and I appreciate what KNH has done. People cannot travel at the moment and Covid-19 has taught us that we have to build our own capacity and be self-reliant,” she said.
Health Cabinet Secretary Mutahi Kagwe said he was happy to see resumption of services especially transplants in public hospitals.
When the Nation team visited the patients the next day and we had to see them through the window, the medics took no chances to ensure their safety, the two had staff dedicated to them and they all had to wear protective gear to enter their room.
Free to breathe
A day after, aunt and nephew could meet, all she could do was thank him for his sacrifice, he had always pushed her to get the transplant done and finally she did what he wanted and the future was looking bright for both.
Going forward however, she will have to pay for the drugs that ensure the body does not reject the new kidney. This, she says, is better than the dialysis which the national insurer pays for weekly.
Dr Ngigi, the nephrologist who first saw them, expressed optimism saying that is one among the 20 pairs of patients who he hopes will have a transplants in the next few months.
Dr Ngigi said some of the would-be donors also pulled out due to psychosocial reasons.
“There were instances where a family member just changed their mind about donating their kidneys while others just lacked the proper family support,” he said.
Ms Tabitha Matekwa, of the nursing counselors’ service unit at KNH said during one of the sensitisation meeting held at the renal unit at the facility, one mother simply said she would not allow two of her children to be ‘disabled’.
Dr Ngigi explained why his was the most non-rewarding field of medicine explaining that they are bound by several ethic provisions to make it impossible for them to profit from any transplants which is why not many doctors opt for it.
At last, Ms Nzau says she is free, free to breathe, free to pursue what she wants. She says the future is in her and God’s hands.