''I pass waste through the stomach''

SUNDAY VISION

When Emmanuel Kato got involved in an accident, some of his friends thought he had passed away. However, he survived, but with life-changing injuries. The car crashed his rear end and he can only pass waste through a hole on his stomach.

By Gladys Kalibbala

Emmanuel Kato’s current state can easily make you shed tears, but his determination to accept his condition sobers you.

At 26 years of age, he should be wearing the latest pair of jeans, but that may never happen as he can only wrap a lesu [light cloth] around his tiny waist because he has no buttocks to hold up the jeans.

Kato left Sekanyonyi village in Mityana in 2009 with high hopes of making it in life. He stormed Kampala to make his dream come true.

His father, Michael Nkunda, had no money to send him to school, forcing him to drop out in P.4 from Sekanyonyi COU Primary School and concentrate on digging.

When a friend introduced him to a road construction company in Kampala, he bade his friends farewell and came to the dreamland of many rural youth. true

Later, another friend, Abbas Kakoba, bought him a boda boda motorcycle to operate around the city.

“After getting the motorcycle, I thought the sky was the limit for me. That year, I would save at least sh10,000 a day. I was sure that the many plans I had were soon to be implemented,” Kato says. Unfortunately, the experience of paradise was short-lived.

Kato’s story

The accident that shattered my dreams occurred on September 17, 2010 at Ndeeba, a Kampala suburb. I can only remember that as I slowed down to give room to a vehicle that had overtaken another from the opposite direction, a trailer that was behind me crashed into me. I remained unconscious for long and stayed in Mulago Hospital for two years.

I was discharged in May 2012.

The girlfriend I had got six months before the accident never checked on me, although I recently learnt she still vends katogo in Nateete market.

The Police, who took me to Mulago Hospital, never returned for my statement; maybe they thought I had passed way. Friends told me that by the time I was picked underneath the trailer, they believed that I had breathed my last as a Police patrol pick-up rushed me to Mulago.

But God was with me, I was still alive and doctors put me on oxygen for some time. However, I already had a pelvic fracture and the flesh around my buttocks had disappeared; it had been eaten off by the big tyres of the trailer, which also broke my pelvic bone.

As I started the healing process, I was horrified to find that I could no longer pass waste normally since my anus had been blocked.

That is when I learnt that the hole made on my abdomen was to pass out my waste, which collected in a colostomy bag. Fortunately, I can pass urine normally.

The sh800,000 I had saved in order to buy a plot of land came in handy, for I needed to buy colostomy bags which had become part of me as I fought for dear life. My father, who The dilemma

I lack funds to purchase colostomy bags, which cost sh5,000. The bag can only work for a day, but presently I am forced to use white kaveera, which burns my skin, especially when it is hot and the bag is not strong enough to carry the waste for a long time.

After the burns, I get sores near the place where the intestine protrudes from the stomach and the kaveera produces a foul smell. This is very embarrassing, especially when I am in a public place.

I need to apply a tube around this area which costs sh11,000 as it helps protect the skin. I did not only lose flesh on my buttocks, but also one of my thighs was eaten up.

The flesh that was later grafted there dries up so much and doctors recommended another type of tube, which costs sh5,000 in order to relieve me, plus other pain killers. All this is too much for the boss who feeds me.

Appeal

Doctors tell me that little can be done to change my state, so I have accepted it. I am willing to adjust to the new life and engage in profitable work that can enable me meet my needs.

As I need medication and constant review in hospital, I plan to stay around town. I therefore appeal to good samaritans to help me start a business that can support me, which is estimated at sh3.5m. A fridge and a container can enable me sell soft drinks and provide telephone services, sell airtime and charge phones.

To assist Kato, contact 0782811445

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Asking expert Dr. John Bosco Mundaka, a physician at Mulago Hospital

Q: Can one wear a colostomy bag while bathing?

A: Yes, because it bears a waterproof material, so a patient can wear it while showering or bathing without any problem.

Q: My worry is that someone with a colostomy bag is likely to smell all the time. How can I handle that smell if they are living with me?

  A: The colostomy bag does not smell because it has a deodorised filter, which prevents the awful smell that worries many people in this condition. The filter also releases the wind from the bag such that it does not get swollen.

Q: Does one have to change it after every bowel movement?

A: No. It should be changed about one to three times a day, depending on how much it has collected. It is necessary to create a routine for changing the bag.

Q: When is the best time to change the bag?

A: Choose a time when it is inactive, for instance, first thing in the morning. It is not wise to change it when it is active, especially after a meal.

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Coping with a colostomy

By Elizabeth Namazzi

Living with a colostomy bag stuck to your tummy is not easy, although one can lead a normal life. “In the beginning, patients with colostomy bags need a lot of assistance and support to cope with the new situation.

The patient and caretaker should discuss with the surgeon or nurse how to manage the colostomy before discharge,” Dr. Edward Ddumba, a senior consultant neurologist at Nsambya Hospital, explains.

“The advice given will vary according to the type of bag available, type of patient routine, the underlying condition and the resources available to the patient,” he adds.

Often, the overriding factor for patients is the cost of colostomy bags since they need to be changed often.

“Some colostomy bags can be cleaned and such bags can stay on the stoma (opening) for a week. The disposable ones are changed after a shorter period,” Ddumba says.

If one cannot afford the colostomy bag, a kaveera (polythene bag) is an alternative.

“The kaveera is attached to the stoma by means of a rubber band. However, the kaveera causes some irritation, but using medical lubricants and good hygiene can help reduce the irritation. The patient is always advised to consult the surgeon for advice in difficult situations,” Ddumba adds.

Other patients worry about wearing the colostomy bag all the time. Fortunately, one can enjoy ‘no colostomy bag’ moments and wear them only when they have to.

“With adequate training of the bowel, one does not have to wear the colostomy bag all the time, but can attach it when the desire to pass stool comes just as it would be for a normal person.

As the patient adjusts to life with a colostomy bag, they will need a lot of support and understanding, especially if it is irreversible. A positive attitude will go a long way in pushing the patient along and will actually help the healing process.

Whether one is to live with the colostomy bag for the rest of their life or not, Ddumba recommends counselling “in order to avoid psychological complications like depression.”

One can also get medical complications after a colostomy. These include a non-functional colostomy, intestinal obstruction, parastomal hernia, skin irritation and infections around the opening. In such cases, see your doctor immediately.

Life after a colostomy

Living with a colostomy bag is a life most of us have never envisioned, but for some, it is a choice between life and death. Either you live with a colostomy bag stuck to your side or you die.

This was Emmanuel Kato’s fate after he got an accident in September 2010. With his buttocks crushed by a trailer, he lost the normal use of his anus and a colostomy had to be performed to cater for this.

What is a colostomy?

According to Dr. Ddumba, a colostomy is a surgical procedure in which a stoma (opening) is formed by drawing the healthy end of the large intestine or colon through an incision in the (front) abdominal wall and stitching it into place.

This opening, in conjunction with the attached stoma appliance, provides alternative means for the faeces to leave the body.

Signs and conditions

It is not often that people need a colostomy, for sometimes there are other surgical options, depending on the surgeon’s skill and the condition that they are dealing with.

However, sometimes a colostomy is the only way out if the patient is to survive. The medical conditions that call for a colostomy, which may be reversible or irreversible, depend on the circumstances and condition of the patient.

Ddumba explains that the conditions that call for a colostomy include:

nWhen a section of the colon (large intestine) has been removed due to cancer, diverticulitis (formation of pouches within the wall of the large intestine) or injury caused by trauma.

nWhen a portion of the colon has been operated upon and needs to be rested before it is healed. This is usually temporary and is reversed at a later date.

nChildren undergoing extensive surgery for pelvic tumours are given a colostomy in preparation for the removal of the tumour.

“These conditions present with lower abdominal pain, change in bowel habits, whereby you could have constipation alternating with diarrhoea, passing blood in stool or bleeding of the rectum.

"These conditions can be confirmed by endoscopy (colonoscopy) or barium meal x-ray studies and stool can be examined for occult blood (small quantities of blood in the faeces that can be detectable only by chemical tests or by spectroscopic or microscopic examination) in suspected cases,” Ddumba explains.