Sunday, 19 June 2016

CD4 and viral load

CD4 and viral load… Which one should you focus on? Both!  says Otieno.

Your CD4 count is a good overview of how well your immune system is working and how much damage HIV has done to it. Viral Load (VL) will show you how active the HI Virus is in your body.

It’s really important to get a number of readings of both, over the course of a year or two, rather than making a decisions based on any single test result. Results change constantly, so it’s best to get several tests and see how they compare over time. A CD4 count below 200 is an immediate cause for worry because you have a much higher risk of developing an opportunistic infections (OI’s).

CD4 Cell Count  - CD4 cells are the immune system’s leaders, issuing commands to nearly every other cell. For people living with HIV, CD4 counts are the No. 1 sign of how strong or weak the immune system is. Most experts recommend CD4 measurements every three to six months—more often if they’re lower or changing quickly. Low CD4 counts are a sign that the HIV is in need of treatment. HIV may cause other numbers (e.g. neutrophil counts) to fall as well, which may call for treatment. Talk to your healthcare provider about your options.

HIV Viral Load measures how much HIVirus is in your blood. This information will help you and your healthcare provider make decisions about starting HIV treatment (ARV’s) and will show whether the medications are working or not. Fewer than 50 copies of HIV per mL—about a teaspoon of blood—will show as “undetectable”. Results can range from undetectable up to millions of copies per mL

When should you have a viral load test done? If you can, at the same time as you get your CD4 counts done—typically every 6 months or more frequently, based upon your health care providers recommendation. —then between you, you can monitor your HIV infection and see if any change in treatment are needed. A sudden or dramatic change in viral load may call for an immediate repeat test.

An undetectable result doesn’t mean the virus has left your body, but rather indicates the success of your treatment and less chance of the disease getting worse. If you are on HAART (Highly Active Antiretroviral Treatment/ ARV’s—a potent combo of HIV-fighting drugs), an undetectable viral load is considered the ultimate prize and shows that your treatment is working.

If you’ve just started treatment, this could take several months— another test in two or three months will tell for sure. Even if the viral load is considered undetectable, it may occasionally bounce up to small but measurable amounts. Continual, detectable viral load, while you’re on HAART/ARV’s, is cause for concern, as it signals that your treatment isn’t controlling the virus. You and your healthcare provider need to talk about switching treatment.

HOW DOES DRUG USE RELATE TO HIV?

HOW DOES DRUG USE RELATE TO HIV?
Injection drug and alcohol use are a major factor in the spread of HIV infection. Outside of Africa, injection drug use now accounts for 1 in 3 new HIV infections. Shared equipment for using drugs can carry HIV and hepatitis viruses, and drug and alcohol use is linked with unsafe sexual activity.
Drug and alcohol use can also be dangerous for people who are taking antiretroviral medications (ARVs). Drug users are less likely to be adherent to their medications, and street drugs may have dangerous interactions with ARVs. Drug and alcohol treatment to stop drug use can lower your risk of HIV infection.

INJECTION AND INFECTION
HIV infection spreads easily when people share equipment to inject drugs. Sharing equipment also spreads hepatitis B, hepatitis C, and other serious diseases.
Infected blood can be drawn up into a syringe and then get injected along with the drug by the next user of the syringe. This is the easiest way to transmit HIV during drug use because infected blood goes directly into someone’s bloodstream. Even small amounts of blood on your hands, cookers, filters, tourniquets, or in rinse water can be enough to infect another user.
To reduce the risk of HIV and hepatitis infection, never share any equipment used with drugs, and keep washing your hands. Carefully clean your cookers and the site you will use for injection.
A recent study showed that HIV can survive in a used syringe for at least 4 weeks. If you have to re-use equipment, you can reduce the risk of infection by cleaning it between users. If possible, re-use your own syringe. It still should be cleaned because bacteria can grow in it.
The most effective way to clean a syringe is to use water first, then bleach and a final water rinse. Try to get all blood out of the syringe by shaking vigorously for 30 seconds. Use cold water because hot water can make the blood form clots. To kill most HIV and hepatitis C virus, leave bleach in the syringe for two full minutes. Cleaning does not always kill HIV or hepatitis. Always use a new syringe if possible.

ACCESS TO CLEAN NEEDLES
Access to clean needles and syringes reduces the spread of HIV and viral hepatitis. In some states, adults can purchase new syringes in pharmacies without a prescription. Some communities have started needle exchange programs to give free, clean syringes to people so they won’t need to share.
Programs that provide easier access to new syringes are controversial because some people think they promote drug use. However, research on needle exchange shows that this is not true. Rates of HIV infection go down where there are needle exchange programs, and more drug users sign up for treatment programs.
The North American Syringe Exchange Network has a web page listing several needle exchange programs at http://www.nasen.org/

DRUG USE AND UNSAFE SEX
For a lot of people, drugs and sex go together. Drug users might trade sex for drugs or for money to buy drugs. Some people connect having unsafe sex with their drug use. Research shows that sexual behavior is the main HIV risk factor for injection drug users.
Drug use, including methamphetamine or alcohol, increases the chance that people will not protect themselves during sexual activity. Someone who is trading sex for drugs might find it difficult to set limits on what they are willing to do. Drug and alcohol use may reduce condom use and safer sex practices.
Often, substance users have multiple sexual partners. This increases their risk of becoming infected with HIV or another sexually transmitted disease. Also, substance users may have an increased risk of carrying sexually transmitted diseases. This can increase their risk of becoming infected with HIV, or of transmitting HIV infection.

MEDICATIONS AND DRUGS
It is very important to take every dose of ARVs. People who are not adherent (miss doses) are more likely to have higher levels of HIV in their blood, and to develop resistance to ARV medications. Drug use is linked with poor adherence, which can lead to treatment failure and disease worsening.

Some street drugs interact with ARVs. The liver breaks down some medications used to fight HIV, especially the protease inhibitors and the non-nucleoside reverse transcriptase inhibitors. It also breaks down some recreational drugs, including alcohol. When drugs and medications are both “in line” to use the liver, they might both be processed much more slowly. This can lead to a serious overdose of the medication or of the recreational drug.
An overdose of a medication can cause serious side effects. An overdose of a recreational drug can be deadly. At least one death of a person with HIV has been blamed on mixing a protease inhibitor with the recreational drug Ecstasy.
Some ARVs can change the amount of methadone in the bloodstream. It may be necessary to adjust the dosage of methadone in some cases. See the fact sheets for each of the medications you are taking, and discuss your HIV medications with your methadone counselor and your HIV health care provider.

THE BOTTOM LINE
Drug use is a major cause of new HIV infections. Shared equipment can spread HIV, hepatitis, and other diseases. Alcohol and drug use, even when just used recreationally, contribute to unsafe sexual activities and an increase in sexually transmitted infections.
To protect yourself from infection, never re-use any equipment for using drugs. Even if you re-use your own syringes, clean them thoroughly between times. Cleaning is only partly effective.
In some communities, new syringes can be bought without a prescription. Also, needle exchange programs in some areas provide free, new syringes. These programs reduce the rate of new HIV infections.
Drug use can lead to missed doses of ARVs. This increases the chances of treatment failure and resistance to medications.
Mixing recreational drugs and ARVs can be dangerous. Drug interactions can cause serious side effects or dangerous overdoses.

TODAY IS FATHER'S DAY AND I WANT TO TALK ABOUT PROSTATE CANCER

It’s important to their sex life, yet few men know anything about their prostate or what can go wrong with it. The prostate is a small gland in the pelvis found only in men. About the size of a walnut, it is located between the penis and the bladder. It surrounds the urethra, the tube that carries urine from the bladder to the penis. The main function of the prostate is to help in the production of semen. It produces a thick white fluid that is mixed with the sperm produced by the testicles, to create semen.

Causes of prostate cancer
These figures are a cause for concern but we need to look at the causes of prostate cancer. The causes of prostate cancer are largely unknown. However, a number of things can increase one’s risk of developing the condition. The chances of developing prostate cancer increase as one gets older. Most cases develop in men aged 50 or older. For reasons not yet understood, prostate cancer is more common in men of African-Caribbean or African descent, and less common in men of Asian descent.
Men who have first degree male relatives (such as a father or brother) affected by prostate cancer are at slightly increased risk as well. It is thought that lycopene-rich foods are best in protecting one from the disease. Lycopene is an antioxidant that is commonly found in fruits and vegetables that are red in colour like tomatoes, watermelon and guavas. Chillis of all sorts are also lycopene powerhouses.

Diagnosing Prostate cancer

There is no single test for prostate cancer. All the tests used to help diagnose the condition have benefits and risks, which your doctor should discuss with you. The most commonly used tests for prostate cancer are blood tests, a physical examination of your prostate (known as a digital rectal examination or DRE) and a biopsy (taking a piece of the prostate and testing it for cancer). The blood test, known as a prostate-specific antigen (PSA) test, measures the level of PSA and may help detect early prostate cancer.

What is PSA?

PSA is made by the prostate gland and some of it will leak into the bloodstream depending on age and the health of the prostate. A raised PSA may mean that one has prostate cancer. However other conditions which are not cancer do cause raised PSA such as enlargement of the prostate, urinary infection and prostatitis. This test has problems in that 2 out 3 people with raised PSA will not have prostate cancer and the test can miss prostate cancer.
PSA test is sensitive to a lot of things hence the need to follow the instructions carefully otherwise one will get high levels due to not following the right procedure of testing. One should not have PSA testing if they have urinary infection, has ejaculated in the last 48hrs, exercised heavily in the last 48hrs , had a prostate biopsy in the last 6 weeks or had a digital rectal (anal) examination in the previous week.

What should one look for in order to see a doctor about this prostate cancer?

Prostate cancer usually develops slowly, so there may be no signs resulting in one having it for many years without knowing. Symptoms often only become apparent when one’s prostate is large enough to affect the urethra (the tube that carries urine from the bladder to the penis). When this happens, one may notice things like an increased need to urinate, straining while urinating and a feeling that the bladder has not fully emptied. However, these signs do not mean one has prostate cancer. It is more likely they are caused by something else, such as benign prostatic hyperplasia (also known as BPH or prostate enlargement).
Because of the problems highlighted above men in UK are not routinely offered PSA tests to screen for prostate cancer as results can be unreliable. However PSA testing is offered on an individual basis after a full discussion with your doctor. A lot of research is currently taking place to come up with evidence based screening that is also safe because raised PSA levels also cannot tell a doctor whether a man has life threatening prostate cancer or not ( the one that can kill you and the one that won’t.). This means that a raised PSA can lead to unnecessary tests and treatment.

What is the take away home message about prostate cancer?

I have tried to present the facts to you and I apologise if l have confused some of you but the “take away home” message to my fellow African men is that prostate cancer is on the rise but rare below 45 years of age. If your father or brother was diagnosed with prostate cancer then you are at high risk of developing it. I suggest that if you have family history of prostate cancer and you are above 45 years then you must see your doctor to discuss screening options available regardless of whether you have symptoms or not.
Your doctor should be able to clearly discuss with you the advantages and disadvantages of the tests allowing you to make an informed decision about your situation. If you do not have family history of cancer and have symptoms such as constant urge to rush to the toilet to pass urine, passing urine more often than usual, especially at night and difficulty in passing urine then you should see your doctor for further tests. If you do not have family history and do not have symptoms either, but you are now worried after reading this article, l suggest that you also see your own doctor for further discussions.
If you are found to have prostate cancer, how then is it treated one may ask.
For many men with prostate cancer, treatment is not immediately necessary. If the cancer is at an early stage and not causing symptoms, a policy of “watchful waiting” or “active surveillance” may be adopted. This involves carefully monitoring your condition. Some cases of prostate cancer can be cured if treated in the early stages. Treatments include surgically removing the prostate, radiotherapy and hormone therapy. Some cases are only diagnosed at a later stage when the cancer has spread. If the cancer spreads to other parts of the body, typically the bones, it cannot be cured and treatment is focused on prolonging life and relieving symptoms.
Sadly some people are being diagnosed at a later stage when cancer has already spread. In these situations the relatives and doctors can feel hopeless but having worked in a hospice myself, I feel passionate about end of life care that we are delivering to our loved ones in their last days on this earth. No one should be allowed to die in pain.
We may not be able to cure the cancer but we should guarantee to relieve pain and I know that it can be done. Family members need to work with doctors and pharmacists to get the best pain killers. There is need for education to both doctors and the public about the safe use of strong pain killers . This will make sure that people with cancer can die with dignity and pain free.

Saturday, 14 May 2016

CONDOMS - HOW TO USE A MALE CONDOM

CONDOMS - HOW TO USE A MALE CONDOM

By practising safer sex, you can protect yourself from an unplanned pregnancy and sexually transmitted infections (STIs), including HIV. This means always wearing a condom, but first it’s a good idea to know how to use one and what to do if something goes wrong.

How do condoms work?

There are wide range of condoms and female condoms available, with varying levels of thickness, texture, material, size, colour and taste. They work by forming a barrier between the penis and anus, vagina or mouth. This prevents fluids (blood, semen or bodily fluids) being passed into, or on, each other.

The most popular type of condoms is made from a thin latex (rubber). However, if you are sensitive to latex you can use polyurethane or polyisoprene condoms instead.

Why is it important to wear a condom?

If someone has an STI this can be passed on during unprotected vaginal, anal or oral sex, or by sharing a sex toy. Vaginal sex without a condom can also result in pregnancy, even if it’s just the once. 

Wearing a condom is the best option when it comes to practising safer sex, especially because some STIs have no symptoms in the early stages, for example chlamydia.1 This means that you and your partner may not know you have an infection until much later on, which can affect your fertility and overall health. Similarly, one of the earlier stages of HIV infection may also not reveal any symptoms.2

When do you need to use a condom?

You should use a condom during any sexual activity where you may be at risk of sharing bodily fluids. The main purpose of other contraceptives such as the Pill or contraceptive injection is to prevent pregnancy, but they won’t stop you from catching an STI.

How do I use a condom?

A condom is less effective if the penis touches the vagina or anus before a condom is worn, or if it slips off during sex. Some people prefer to use a condom with added lubrication to make sex feel more comfortable, but more importantly this helps prevent condoms from breaking.

There’s no harm in practising how to put a condom on beforehand and this can help you both to feel more at ease when the time comes. You will also find instructions on the packet, but in general you should follow these rules:

•Check that the condoms are in date, in good condition and have the CE mark on it – this means they’ve been tested to European safety standards.
•The man needs to have an erection before the condom is put on. Always put the condom on before the penis touches a woman or man’s genitals.
•Open the packet carefully so that there's less chance of ripping it. There's usually an arrow on the packet to guide you in the direction you should open it. Avoid using your teeth and be careful with sharp fingernails or jewellery.
•Condoms come rolled up and need to be placed on top of an erect penis. Some people like to use a little bit of extra lubrication to help it go on easily. If you do this, use a water-based lubrication, rather than vaseline, hand cream or anything that contains oil - these can all break the condom.
•Pinch the teat at the end of the condom before you start to roll it down the penis. By doing this you will be helping to squeeze any air bubbles out and this will prevent friction that can cause condoms to break. It will also help you know if the condom is on the right way.
•Roll the condom down to the base of the penis. If it's on correctly it will roll downwards easily (or you may be able to feel the texture of the outside of the condom if it's ribbed). If you're not sure then use a new condom and try again. This is important even if the man hasn’t ejaculated because there can still be sperm on the penis (pre-cum).
•Only take the condom off when the penis is withdrawn completely from the body and while the penis is still erect. Tie a knot in the end of the condom, wrap it up, and throw it away in a bin (don’t put it down the toilet as it can block up your plumbing).
•Always use a new condom if you have sex again.
Remember: Avoid using two condoms at once or a female condom at the same time - this can cause friction and they're more likely to split or slip off.

What should I do if a condom breaks?

Condoms are highly effective if used consistently and correctly, so it's very unlikely that one will break. Wearing one is really important, but if a condom does split, break or slip off,  squeeze out as much semen as you can and avoid washing inside your vagina or anus (douching) as this can spread infection further or cause irritation.

You should always use a condom for oral sex too. It carries a low risk of HIV, but this risk is increased if there are any cuts, sores or inflammation on the man’s penis or a woman’s vagina, if you have a throat infection or there is any damage or bleeding in your mouth.3

Most sexual health professionals will advise you to have a sexual health test around 10 days after unprotected sex or if a condom breaks (or earlier if you are worried about any symptoms) and then again around three months later. This is because different STIs are detected at different times. In the meantime, avoid sexual contact or practice safer sex by always wearing a condom. 

What should I do if a condom breaks and my partner is HIV-positive?

If a condom breaks and you know you are having sex with someone who is living with HIV or who doesn't know their HIV status, you will need to visit a sexual health professional as soon as you can. You may be offered post-exposure prophylaxis (PEP) treatment.4 This is a month-long treatment of antiretroviral drugs (ARVs) that can reduce your chances of becoming HIV-positive.

PEP has a high success rate; however, it is not a replacement for condoms. PEP is a powerful drug that has side effects and it's not an option available to everyone.

How can I talk about condoms with my partner?

Some people feel embarrassed bringing up the subject of using condoms, especially in the early stages of a relationship. But it’s important to remember that the other person won’t think any less of you for wanting to practise safer sex – and if they do, it’s worth asking yourself if they are the right person to be with.  

Talking about condoms with your other half isn’t about you saying that you don’t trust them – it’s as much for them as it is for you. Be firm and confident in your decision and prepared for any excuses that you may hear. If someone loves and respects you, or wants to get closer to you, they will want you to enjoy sex and feel safe at the same time.

Sunday, 24 April 2016

MAASAI AND THERE CULTURE

Maasai
PRONUNCIATION:MAH-sigh
LOCATION:Kenya; Tanzania
POPULATION:Over 150,000
LANGUAGE:Maa (Olmaa)
RELIGION:Traditional beliefs

1 • INTRODUCTION

The Maasai are thought of as the typical cattle herders of Africa, yet they have not always been herders, nor are they all today. Because of population growth, development strategies, and the resulting shortage of land, cattle raising is in decline. However, cattle still represent "the breath of life" for many Maasai. When given the chance, they choose herding above all other livelihoods. For many Westerners, the Maasai are Hollywood's "noble savage"—fierce, proud, handsome, graceful of bearing, and elegantly tall. Hair smeared red with ochre (apigment), they either carry spears or stand on one foot tending cattle. These depictions oversimplify Maasai life during the twentieth century. Today, Maasai cattle herders may also be growing maize (corn) or wheat, rearing Guinea fowl, raising ostriches, or may be hired by ecologists to take pictures of the countryside.

Prior to British colonization, Africans, Arabs, and European explorers considered the Maasai formidable warriors for their conquests of neighboring peoples and their resistance to slavery. Caravan traders traveling from the coast to Uganda crossedMaasailandwith trepidation. However, in 1880–81, when the British unintentionally introduced rinderpest (a cattle disease), the Maasai lost 80 percent of their stock. The British colonizers further disrupted Maasai life by moving them to a reserve in southern Kenya. While the British encouraged them to adopt European ways, they also advised them to retain their traditions. These contradictions resulted, for the most part, in leaving the Maasai alone and allowed them to develop almost on their own. However, drought, famine, cattle diseases, and intratribal warfare (warfare among themselves) in the nineteenth century greatly weakened the Maasai and nearly destrtoyed certain tribes.

Since Kenyan and Tanzanian independence from Britain in the 1960s, land ownership has changed dramatically. Modern ranching, wheat cultivation techiques, and setting of grazing boundaries in the Maasai district are becoming common. A wage and cash economy is replacing the barter (trade) system. Consequently, the Maasai have begun to integrate themselves into the modern economies and mainstream societies of Kenya and Tanzania, albeit with considerable reluctance.

2 • LOCATION

The Maasai are thought to have originated in the Upper Nile Valley. Their myths speak about climbing up from a broad and deep crater bounded on all sides by a steep, long cliff. By the 1600s they had begun migrating with their herds into the vast arid, savanna-like (grassland) region of East Africa straddling the Kenya-Tanzania border. Today, their homeland is bounded by Lake Victoria to the west and Mount Kilimanjaro to the east. Maasailand extends some 310 miles (500 kilometers) from north to south and about 186 miles (300 kilometers) at its widest east-west point.

Estimates of the Maasai population include more than 150,000 in Tanzania, and close to 150,000 in Kenya.

3 • LANGUAGE

The Maasai are speakers of the Maa language, which is also spoken by the Samburu and the Chamus living in central Kenya. The origins of Maa have been traced to the east of present-day Juba in southern Sudan. More than twenty variants of Maa exist. The Maasai refer to their language as Olmaa.

4 • FOLKLORE

Maasai legends and folktales tell much about the origin of present-day Maasai beliefs. These stories include their ascent from a crater, the emergence of the first Maasai prophet-magician (Laibon), the killing of an evil giant (Oltatuani) who raided Maasai herds, and the deception by Olonana of his father to obtain the blessing reserved for his older brother, Senteu (a legend similar to the Biblical story of Jacob and Esau).

One origin myth reveals much about present-day Maasai relations between the sexes. It holds that the Maasai are descended from two equal and complementary tribes, one consisting strictly of females, and the other of males. The women's tribe, the Moroyok, raised antelopes, including the eland, which the Maasai claim to have been the first species of cattle. Instead of cattle, sheep, and goats, the women had herds of gazelles. Zebras transported their goods during migrations, and elephants were their devoted friends, tearing down branches and bringing them to the women who used them to build homes and corrals. The elephants also swept the antelope corrals clean. However, while the women bickered and quarreled, their herds escaped. Even the elephants left them because they could not satisfy the women with their work.

According to the same myth, the Morwak—the men's tribe—raised cattle, sheep, and goats. The men occasionally met women in the forest. The children from these unions would live with their mothers, but the boys would join their fathers when they grew up. When the women lost their herds, they went to live with the men, and, in doing so, gave up their freedom and their equal status. From that time, they depended on men, had to work for them, and were subject to their authority.

5 • RELIGION

Unlike the predominantly Christian populations of Kenya and Tanzania that surround them, the Maasai traditionally place themselves at the center of their universe as God's chosen people. Like other African religions, the Maasai believe that one high god (Enkai) created the world, forming three groups of people. The first were the Torrobo (Okiek pygmies), a hunting and gathering people of small stature to whom God gave honey and wild animals as a food source. The second were the neighboring Kikuyu, farmers to whom God gave seed and grain. The third were the Maasai, to whom God gave cattle, which came to earth sliding down a long rope linking heaven and Earth. While the Torrobo were destined to endure bee stings, and the Kikuyu famines and floods, the Maasai received the noble gift of raising cattle. A Torrobo, jealous of the Maasai's gift of cattle, cut the "umbilical cord" between heaven and Earth. For many Maasai, the center of their world remains their cattle, which furnish food, clothing, and shelter.

6 • MAJOR HOLIDAYS

The traditional Maasai calendar has no designated holidays. It is divided into twelve months belonging to three main seasons:Nkokua(the long rains),Oloirurujuruj(the drizzling season), andOltumuret(the short rains). The names of months are very descriptive. For example, the second month of the drizzling season isKujorok, meaning "The whole countryside is beautifully green, and the pasture lands are likened to a hairy caterpillar."

Maasai ceremonial feasts for circumcision, excision (female circumcision), and marriage offer occasions for festive community celebrations, which may be considered similar to holidays. As the Maasai are integrated into modern Kenyan and Tanzanian life, they also participate in secular (nonreligious) state holidays. In Kenya, these include Labor Day (May 1), Madaraka Day (June 1), and Kenyatta Day (October 20). In Tanzania, these include Labor Day (May 1), Zanzibar Revolution Day (January 12);Nane Nane(formerlySaba Saba—Farmer's Day, in August); Independence Day (December 9); and Union Day (April 26), which commemorates the unification of Zanzibar and the mainland.

7 • RITES OF PASSAGE

Life for the Maasai is a series of conquests and tests involving the endurance of pain. For men, there is a progression from childhood to warriorhood to elderhood. At the age of four, a child's lower incisors are taken out with a knife. Young boys test their will by their arms and legs with hot coals. As they grow older, they submit to tattooing on the stomach and the arms, enduring hundreds of small cuts into the skin.

Ear piercing for both boys and girls comes next. Thecartilageof the upper ear is pierced with hot iron. When this heals, a hole is cut in the ear lobe and gradually enlarged by inserting rolls of leaves or balls made of wood or mud. Nowadays plastic film canisters may serve this purpose. The bigger the hole, the better. Those earlobes that dangle to the shoulders are considered perfect.

Circumcision (for boys) and excision (for girls) is the next stage, and the most important event in a young Maasai's life. It is a father's ultimate duty to ensure that his children undergo this rite. The family invites relatives and friends to witness the ceremonies, which may be held in special villages calledimanyat. The imanyat dedicated to circumcision of boys are callednkang oo ntaritik(villages of little birds).

Circumcision itself involves great physical pain and tests a youth's courage. If they flinch during the act, boys bring shame and dishonor to themselves and their family. At a minimum, the members of their age group ridicule them and they pay a fine of one head of cattle. However, if a boy shows great bravery, he receives gifts of cattle and sheep.

Girls must endure an even longer and more painful ritual, which is considered preparation for childbearing. (Girls who become pregnant before excision are banished from the village and stigmatized throughout their lives.) After passing this test of courage, women say they are afraid of nothing.

Guests celebrate the successful completion of these rites by drinking great quantities of mead (a fermented beverage containing honey) and dancing. Boys are then ready to become warriors, and girls are then ready to bear a new generation of warriors. In a few months, the young woman's future husband will come to pick her up and take her to live with his family.

After passing the tests of childhood and circumcision, boys must fulfill a civic requirement similar to military service. They live for up to several months in the bush, where they learn to overcome pride, egotism, and selfishness. They share their most prized possessions, their cattle, with other members of the community. However, they must also spend time in the village, where they sacrifice their cattle for ceremonies and offer gifts of cattle to new households. This stage of development matures a warrior and teaches himnkaniet(respect for others), and he learns how to contribute to the welfare of his community. The stage of "young warriorhood" ends with theeunotorite, when a man ends his periodic trips into the bush and returns to his village, putting his acquired wisdom to use for the good of the community.

8 • RELATIONSHIPS

Each child belongs to an "age set" from birth. To control the vices of pride, jealousy, and selfishness, children must obey the rules governing relationships within the age set, between age sets, and between the sexes. Warriors, for example, must share a girlfriend with at least one of their age-group companions. All Maasai of the same sex are considered equal within their age group.

Many tensions exist between children and adults, elders and warriors, and men and women. The Maasai control these with taboos (prohibitions). A daughter, for example, must not be present while her father is eating. Only non-excised girls may accompany warriors into their forest havens, where they eat meat. Although the younger warriors may wish to dominate their communities, they must follow rules and respect their elders' advice.

9 • LIVING CONDITIONS

By Western standards, Maasai living conditions seem primitive. However, the Maasai are generally proud of their simple lifestyle and do not seek to replace it with a more modern lifestyle. Nevertheless, the old ways are changing. Formerly, cowhides were used to make walls and roofs of temporary homes during migrations. They were also used to sleep on. Permanent and semi-permanent homes resembling igloos were built of sticks and branches plastered with mud, and with cow dung on the roofs. They were windowless and leaked a great deal. Nowadays, tin roofs and other more modern materials are gradually transforming these simple dwellings.

A few paved trunk roads and many passable dirt roads make Maasailand accessible. Much like their fellow Kenyan and Tanzanian citizens, the Maasai travel by bus and bush taxi when they need to cover distances.

10 • FAMILY LIFE

The Maasai are apatriarchalsociety; men typically speak for women and make decisions in the family. Male elders decide community matters. Until the age of seven, boys and girls are raised together. Mothers remain close to their children, especially their sons, throughout life. Once circumcised, sons usually move away from their father's village, but they still follow his advice. Girls learn to fear and respect their fathers and must never be near them when they eat.

A person's peers (age-mates) are considered extended family and are obligated to help each other. Age-mates share nearly everything, even their wives. Girls are often promised in marriage long before they are of age. However, even long-term engagements are subject to veto by male family members.

11 • CLOTHING

Maasai clothing varies by age, sex, and place. Traditionally, shepherds wore capes made from calf hides, and women wore capes of sheepskin. The Maasai decorated these capes with glass beads. In the 1960s, the Maasai began to replace animal-skin with commercial cotton cloth. Women tied lengths of this cloth around their shoulders as capes(shuka)or around the waist as a skirt. The Maasai color of preference is red, although black, blue, striped, and checkered cloth are also worn, as are multicolored African designs. Elderly women still prefer red and dye their own cloth with ochre (a natural pigment). Until recently, men and women wore sandals made from cowhides; nowadays sandals and shoes are generally made of tire strips or plastic.

Young women and girls, and especially young warriors, spend much time on their appearance. Styles vary by age group. The Maasai excel in designing jewelry. They decorate their bodies with tattooing, head shaving, and hair styling with ochre and sheep's fat, which they also smear on their bodies. A variety of colors are used to create body art. Women and girls wear elaborate bib-like bead necklaces, as well as headbands and earrings, which are colorful and intricate. When ivory was plentiful, warriors wore ivory bands on their upper arms much like the ancient Egyptians. Jewelry plays an important role in courtship.

12 • FOOD

The Maasai depend on cattle for both food and cooking utensils (as well as for shelter and clothing). Cattle ribs make stirring sticks, spatulas, and spoons. Horns are used as butter dishes and large horns as cups for drinking mead.

The traditional Maasai diet consists of six basic foods: meat, blood, milk, fat, honey, and tree bark. Wild game (except the eland), chicken, fish, and salt are forbidden. Allowable meats include roasted and boiled beef, goat, and mutton. Both fresh and curdled milk are drunk, and animal blood is drunk at special times—after giving birth, after circumcision and excision, or while recovering from an accident. It may be tapped warm from the throat of a cow, or drunk in coagulated form. It can also be mixed with fresh or soured milk, or drunk with therapeutic bark soups(motori).It is from blood that the Maasai obtain salt, a necessary ingredient in the human diet. People of delicate health and babies eat liquid sheep's fat to gain strength.

Honey is obtained from the Torrobo tribe and is a prime ingredient in mead, a fermented beverage that only elders may drink. In recent times, fermented maize (corn) withmilletyeast or a mixture of fermented sugar and baking powder have become the primary ingredients of mead.

The Maasai generally eat two meals a day, in the morning and at night. They have a dietary prohibition against mixing milk and meat. They drink milk for ten days—as much as they want—and then eat meat and bark soup for several days in between. Some exceptions to this regimen exist. Children and old people may eat cornmeal or rice porridge and drink tea with sugar. For warriors, however, the sole source of true nourishment is cattle. They consume meat in their forest hideaways(olpul),usually near a shady stream far from the observation of women. Their preferred meal is a mixture of meat, blood, and fat(munono),which is thought to give great strength.

Many taboos (prohibitions) govern Maasai eating habits. Men must not eat meat that has been in contact with women or that has been handled by an uncircumcised boy after it has been cooked.

13 • EDUCATION

There is a wide gap between Western schooling and Maasai traditional education, by which children and young adults learned to overcome fear, endure pain, and assume adult tasks. For example, despite the dangers of predators, snakes, and elephants, boys would traditionally herd cattle alone. If they encountered a buffalo or lion, they were supposed to call for help. However, they sometimes reached the pinnacle of honor by killing lions on their own. Following such a display of courage, they became models for other boys, and their heroics were likely to become immortalized in the songs of the women and girls.

Over the years, school participation gradually increased among the Maasai, but there were few practical rewards for formal education and therefore little reason to send a child to school. Formal schooling was primarily of use to those involved in religion, agriculture, or politics. Since independence, as the traditional livelihood of the Maasai has become less secure, school participation rates have climbed dramatically.

14 • CULTURAL HERITAGE

The Maasai have a rich collection of oral literature that includes myths, legends, folktales, riddles, and proverbs. These are passed down through the generations. The Maasai also compose many songs. Women are seldom at a loss for melodies and words when some heroic action by a warrior inspires praise. They also improvise teasing songs, work songs for milking and forplasteringroofs, and songs with which to ask their traditional god (Enkai) for rain and other needs.

15 • EMPLOYMENT

Labor among traditional herding Maasai is clearly divided. The man's responsibility is his cattle. He must protect them and find them the best possible pasture land and watering holes. Women raise children, maintain the home, cook, and do the milking. They also take care of calves and clean, sterilize, and decorate calabashes (gourds). It is the women's special right to offer milk to the men and to visitors.

Children help parents with their tasks. A boy begins herding at the age of four by looking after lambs and young calves, and by the time he is twelve, he may be able to care for cows and bulls as well as move sheep and cattle to new pastures. Girls help their mothers with domestic chores such as drawing water, gathering firewood, and patching roofs.

16 • SPORTS

While Maasai may take part in soccer, volleyball, and basketball in school or other settings, their own culture has little that resembles Western organized sports. Young children find time to join in games such as playing tag, but adults find little time for sports or play. Activities such as warding off enemies and killing lions are considered sport enough in their own right.

17 • RECREATION

Ceremonies such as theeunoto, when warriors return to their villages as mature men, offer occasions for parties and merriment. Ordinarily, however, recreation is much more subdued. After the men return to their camp from a day's herding, they typically tell stories of their exploits. Young girls sing and dance for the men. In the villages, elders enjoy inviting their age-mates to their houses or to rustic pubs(muratina manyatta)for a drink.

18 • CRAFTS AND HOBBIES

The Maasai make decorativebeadedjewelry including necklaces, earrings, headbands, and wrist and ankle bracelets. These are always fashionable, though styles change as age-groups invent new designs. It is possible to identify the year a given piece was made by its age-group design. Maasai also excel in wood carvings, and they increasingly produce art for tourists as a supplemental source of income.

19 • SOCIAL PROBLEMS

The greatest challenge the Maasai face concerns adaptation to rapid economic and social change. Increasing encroachment on Maasai lands threatens their traditional way of life. In the next decade, Maasai will need to address integration into the mainstream modern economies and political systems of Kenyan and Tanzanian society. The Maasai may fear losing their children to Western schooling, but a modern education has increasingly become a necessity for the Maasai in order to remain competitive with their neighbors and survive.

20 • BIBLIOGRAPHY

Africa South of the Sahara. 26th ed. London, England: Europa Publications, 1997.

Bentsen, Cheryl.Maasai Days. New York: Doubleday, 1989.

Halmi, Robert.Visit to a Chief's Son: An American Boy's Adventure with an African Tribe.New York: Holt, 1963.

Spear, Thomas, and Richard Waller.Being Maasai: Ethnicity and Identity in East Africa. London, England: James Currey, 1993.

Spencer, Paul.The Maasai of Matapato: A Study of Rituals of Rebellion. Bloomington: Indiana University Press, 1988.

Read more:http://www.everyculture.com/wc/Tajikistan-to-Zimbabwe/Maasai.html#ixzz46o3wOqWL

Wednesday, 20 April 2016

CANCER STAGING

Stage refers to the extent of your cancer, such as how large the tumor is, and if it has spread. Knowing the stage of your cancer helps your doctor:

Understand how serious your cancer is and your chances of survivalPlan the best treatment for youIdentify clinical trials that may be treatment options for you

A cancer is always referred to by the stage it was given at diagnosis, even if it gets worse or spreads. New information about how a cancer has changed over time gets added on to the original stage. So, the stage doesn't change, even though the cancer might.

How Stage Is Determined

To learn the stage of your disease, your doctor may order x-rays, lab tests, and other tests or procedures. See the section on Diagnosis to learn more about these tests.

Systems that Describe Stage

There are many staging systems. Some, such as the TNM staging system, are used for many types of cancer. Others are specific to a particular type of cancer. Most staging systems include information about:

Where the tumor is located in the bodyThe cell type (such as, adenocarcinoma or squamous cell carcinoma)The size of the tumorWhether the cancer has spread to nearby lymph nodesWhether the cancer has spread to a different part of the bodyTumor grade, which refers to how abnormal the cancer cells look and how likely the tumor is to grow and spread

The TNM Staging System

The TNM system is the most widely used cancer staging system. Most hospitals and medical centers use the TNM system as their main method for cancer reporting. You are likely to see your cancer described by this staging system in your pathology report, unless you have a cancer for which a different staging system is used. Examples of cancers with different staging systems include brain and spinal cord tumors and blood cancers. 

In the TNM system:

The T refers to the size and extent of the main tumor. The main tumor is usually called the primary tumor.The N refers to the the number of nearby lymph nodes that have cancer.The M refers to whether the cancer has metastasized. This means that the cancer has spread from the primary tumor to other parts of the body.

When your cancer is described by the TNM system, there will be numbers after each letter that give more details about the cancer—for example, T1N0MX or T3N1M0. The following explains what the letters and numbers mean:

Primary tumor (T)

TX: Main tumor cannot be measured.T0: Main tumor cannot be found.T1, T2, T3, T4: Refers to the size and/or extent of the main tumor. The higher the number after the T, the larger the tumor or the more it has grown into nearby tissues. T's may be further divided to provide more detail, such as T3a and T3b.

Regional lymph nodes (N)

NX: Cancer in nearby lymph nodes cannot be measured.N0: There is no cancer in nearby lymph nodes.N1, N2, N3: Refers to the number and location of lymph nodes that contain cancer. The higher the number after the N, the more lymph nodes that contain cancer.

Distant metastasis (M)

MX: Metastasis cannot be measured.M0: Cancer has not spread to other parts of the body.M1: Cancer has spread to other parts of the body.

Other Ways to Describe Stage

The TNM system helps describe cancer in great detail. But, for many cancers, the TNM combinations are grouped into five less-detailed stages. When talking about your cancer, your doctor or nurse may describe it as one of these stages:

Stage
What it means
Stage 0 Abnormal cells are present but have not spread to nearby tissue. Also called carcinoma in situ, or CIS. CIS is not cancer, but it may become cancer.
Stage I, Stage II, and Stage III Cancer is present. The higher the number, the larger the cancer tumor and the more it has spread into nearby tissues.
Stage IV The cancer has spread to distant parts of the body.

Another staging system that is used for all types of cancer groups the cancer into one of five main categories. This staging system is more often used by cancer registries than by doctors. But, you may still hear your doctor or nurse describe your cancer in one of the following ways:

In situ—Abnormal cells are present but have not spread to nearby tissue.
Localized—Cancer is limited to the place where it started, with no sign that it has spread.
Regional—Cancer has spread to nearby lymph nodes, tissues, or organs.
Distant—Cancer has spread to distant parts of the body.
Unknown—There is not enough information to figure out the stage.

Tuesday, 19 April 2016

Indigenous milk preservation technology among the Kalenjin of Kenya

Kenya is famous for its world conquering athletes who traverse the globe bringing in medals and cash prizes.

Making mursikThe Kalenjin community from the Rift Valley is famous for giving returning champions a drink of traditionally fermented milk known as Mursik from a colourful gourd or sotet. This article highlights the process of making the nutricious Mursik.

Origin of Mursik

Mursik technology originates from the Kalenjin community for whom milk is a staple diet. The community developed the unique milk preservation technology using indigenous tree species about 300 years ago. The technology evolved as a result of the need to avoid wastage by preserving and storing excess milk for use during the dry season.

Mursik preparation

Milk treatment is traditionally the preserve of women; however men do sometimes practice the art. Extreme care must be taken during the gourd preparation and milk fermentation processes and high hygiene standards must be observed to avoid potential food poisoning.

Depending on the availability of milk, a large quantity of Mursik can be prepared at once or alternatively small quantities of milk can be poured into a prepared gourd on a daily basis until it is full. The fermented milk provides the culture for the new milk and accelerates the process of fermentation. The flavour of Mursik is determined by various factors including the quality of milk used, technique of cleaning the gourd, time taken before the milk is served, and to some extent the tree species used to treat the gourd. Factors determining the quality of a cows’ milk include: stage of lactation; cow breed and; the cow’s diet.

Materials and Tools for Making Mursik

•Gourd (preferably dry), fresh one can also do so long as it is fully ripe.
•Sharp machete or large knife
•Palm tree branches
•Cow urine
•Clean water
•Dry ash
•A piece of cow hide
•Several dry sticks from a milk preserving tree species (preferably Cassia didymobotrya)
•A bow shaped palm stick (sosiot) without bristles
•Fire
•Milk in a clean container with a lid
•Water

Steps in Making Mursik

Preparing the gourd:
Cut the top of the gourd systemically using the machete or knife. Remove the seeds and pour a mixture of water and ash into the gourd. Cork the gourd and put it aside for a few days. Pour out the water in readiness for cleaning and treating the gourd.

Cleaning the gourd:
Take some branches of the palm tree and hit them on a firm surface such as a tree trunk until the edges form brush like bristles. Using the stiff bristles remove the inner lining of the new gourd in order to ensure that the milk does not acquire the bitter taste of the gourd. Pour some cow urine into the gourd and put it aside for a few days for curing and seasoning. Pour out the cow urine and use a bow shaped palm stick (sosiot) to clean the gourd again.

Treating the gourd:
Take a few sticks from the selected milk preserving tree species and burn the tips them into charcoal. Put the burning embers inside a clean and dry gourd, shaking it to avoid burning. Using the bow shaped palm stick grind the embers by pressing them against the walls of the gourd using the sosiot in a methodical, circular in and out movement of the hand. Repeat the grinding movement until the inside of the gourd is evenly covered with fine dust. Pour out any large particles and excess coal dust and allow the gourd to cool down.
Preparing and treating the gourd lid: Prepare a well designed, tightly fitting lid for the gourd using animal hide/skin. Test the lid to make sure it its tightly into the mouth of the gourd. Treat the inner side of the lid with charcoal dust using the method for cleaning and treating the gourd.
Milking, boiling and cooling the milk: Milk the cow and boil the fresh milk immediately. Cover the boiled milk to avoid contamination and allow it to cool down. Traditionally the cow was milked directly into a treated gourd and the milk would be mixed with some blood and stored in a cool place to ripen. However this practice has since ceased due to a change in lifestyles and widespread awareness of the need to improve hygiene standards.

Fermentation:
Pour the cold boiled milk into a treated gourd or sotet. Cork the gourd tightly with the treated lid. Store the Mursik in a cool dry place for about one week to allow it to ripen until it achieves the consistency of sour milk.

Shaking and serving the Mursik:
Shake the Mursik well to ensure it has a smooth, uniform consistency. After thorough shaking, good quality Mursik is a clear liquid with a sharp taste that is almost bitter in some cases, in which white globules of butter float. Systematic tapping on the skin lid produces a popping sound, allowing excess air to escape. Mursik is best taken during the dry season or on a sunny day and served cold with hot ugali, a Kenyan staple food made of maize/corn lour, millet, sorghum, or a mixture of different types of flour.
Steps in Making Mursik

Milk treatment and Environmental Conservation

The use of some tree species for milk preservation and flavouring is part of indigenous knowledge that also helps in conservation of biodiversity. Cassia didymobotrya is native to Eastern Central Africa and the most preferred tree species for milk treatment.

Cassia didymobotrya is locally known by different names, for example senetwet (Kipsigis); Inyumganai (Kamba); Mwino (Kikuyu); Lubino (Luhya); Obino (Luo); Osenetoi (Maasai) and ndimu or limau (Swahili). The shrub grows well near cattle bomas (sheds) especially near decomposed cow dung. It prefers well-drained soils, can withstand occasional drought and is propagated through seeds, which readily germinate. Its leaves are evergreen with elliptic to oval leaflets and yellow ornamental lowers, which appear for prolonged periods in warm climates (Mureithi, 1997). Animals rarely feed on cassia leaves; therefore it has a survival rate of almost 100 percent.

Other tree species used for milk preservation

Other tree species used for Mursik preparation are: Lantana kitu (Muokiot), Olea afrikana (Emitiot) Rhus natalensis (Natal Rhus), Olea capensis, Acacia meansii and Prunus africana’ among others.

Conclusion

Milk is a locally available and easily accessible commodity and value addition through the use of Mursik technology has proved highly successful. Adoption of Mursik technology by non-pastoralist communities has introduced the element of its commercialization as a viable source of income for livestock farmers.

As a valuable tree species Cassia didymobotrya deserves the attention of researchers to ensure its conservation and to explore its anti-bacterial effects, among other useful characteristics. There is need to preserve gourd planting, cutting and cleaning technology since gourds are cheap and easily accessible, making them ideal storage containers for farmers.