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Thursday, July 27, 2017

Cover: Rape ordeal haunts woman more than 20 years later

More than 20 years ago, Joyce* (not her real name) was gang-raped by street boys at the Nairobi River bridge near Gikomba.

She was a young, innocent school girl walking home at around 7pm. "My mum had a house in Gikomba and that is where I was going before a group of about seven street boys approached me. They caused a commotion before dragging me down the river and to an abandoned house nearby," she remembers.

As she was being dragged, Joyce was screaming on top of her voice but passersby never came to her rescue. When her attackers got to their safe zone, they threatened to kill her and dump her in the river if she continued to scream.

Three of them went ahead and removed knives which they placed on her neck. "By this time i was on the ground and they started raping me in turns while the others kept watch and placed knives on me," she remembers as she tried to balance tears.

Before the third one took on her, there were head lights directed where the act was happening and all the seven boys took off leaving her helplessly lying on the ground. "Luckily there was a watchman who heard my screams and had to get others to come to my rescue. Unfortunately the damage was already done but they took me and walked me home," she says.

Joyce did a mistake that has come to haunt her so many years later. She never shared her ordeal with anyone and even never went for a medical check-up, not even after developing a small, painless sore on her vagina. "I wish i knew what awaited me," she regrets.

As time passed, Joyce withdrew and stayed away from men and she slowly healed. She even convinced herself that the incident was now history and chose to never talk about it. "I lost my innocence to dirty rapists and it was killing me inside. Being an adolescent, I knew it was shameful to share but it was killing me inside. It did for many years," she says.

She never got intimate with any man until five years ago, when she met a man she felt she truly loved and was by now in need of children. "He was the first person I ever shared my ordeal with."

Sharing with her husband was the best thing she ever did since two months ago, Joyce was tested positive for syphilis latent stage.

During the more than 20-year period, Joyce had been developing a non-itchy rash on different parts of her body that would disappear untreated but she never imagined or connected them to the rape incident.

She had even been treated several times for urinary tract infection (UTI). "Never had I imagined that i had contracted the disease."

When she visited a clinic at Kangemi two months ago, Joyce had signs of a UTI, a problem she deemed common with her, apart from that this time the vaginal itching was excess and she had sores all over.

When the clinical officer who received her said he was going to test for syphilis, Joyce developed an attitude towards him. "How could he even think a married decent woman like me would be having such a shameful disease?" she wondered.

But results were to send her shockwaves 20 minutes later. "He called me back to his office and announced that the results were positive. I could not believe it. I denied it at first, telling him those cannot be my results," she said.

The clinical officer, whom she termed as 'not friendly', sent her away, telling her to go 'find out where she got infected'. "I walked out of that clinic a very confused woman."

In the matatu back home, Joyce activated her bundles and went to the internet to google syphilis. It was then that she learnt of the symptoms and that the disease can stay within the body for even 30 years. "My mind raced back to that evening I was raped and the vaginal sores that I had been having and the infections that kept recurring."

She got home and called her husband to break the bad news. "At first my husband was mad and accused me of cheating but I reminded him of the rape story I had told him about."

The UN World Health Organisation (2011) estimates that globally, two million pregnant women each year are infected with syphilis. 1.2 million will transmit the infection to their newborn. Globally, it is estimated that syphilis in pregnancy contributes to 650,000 foetal and neonatal deaths each year in developing countries; 10 high-burden countries – including Kenya – account for 40 per cent of pregnancies and newborns affected by syphilis. In Kenya, the prevalence of syphilis in the general population is 1.8 per cent, but is higher among people infected with HIV.

As Joyce continues with her treatment journey, she is thankful that the 'unfriendly clinical officer' thought of taking the test. "He might have been unfriendly but he is the one person who has helped me more in this."

She will be going back for a test after a month.

SIDEBAR: Stages of syphilis

An untreated syphilis infection develops in stages, primary, secondary, latent and tertiary stages.

Primary stage is characterised by small, painless sores in the mouth or on the genitals between three weeks and three months after exposure.

The primary stage is an important time to get tested and treated for the disease because the sores typically heal within six weeks. This makes it possible to have syphilis without being aware of the infection. It is in this stage that syphilis infections are more infectious and easier to spread. This explains why Joyce's husband did not get infected since the disease had passed primary stage.

Secondary stage of syphilis lasts between one and three months and usually begins between six weeks and six months after exposure to the bacteria. This stage is characterised by non-itchy rash that usually covers the palms of the hands and soles of the feet. In some cases, the rashes may occur on other parts of the body.

Just like in primary stage, the symptoms associated with secondary syphilis eventually go away with or without treatment.

Without treatment in the first two stages, syphilis progresses to the latent stage, at which time the infection becomes dormant and does not cause symptoms for an extended period of time, up to 20 years. There are no symptoms at this stage though the infection is detectable by blood test.

The infection can be treated and cured at this stage, but any damage done to internal organs is irreversible. If the syphilis infection progresses through the latent stage without treatment, it enters the terminal tertiary stage.

This is the last stage of the disease and occurs between 10 and 30 years after the initial infection.

At this time, entirely new and life-threatening symptoms occur.

Debilitating side-effects include, but are not limited to blindness, loss of motor skills, dementia and damage to the central nervous system and internal organs, such as the heart, brain, eyes, kidneys and bones. In most cases, tertiary stage syphilis is distinguished by a descent into mental illness, followed by death.

Last year, Health CS Cleopa Mailu endorsed the global action plan on antimicrobial resistance, which binds the country to adopt new strategies to fight resistance of drugs used to treat STIs including syphilis. Mailu said Kenya began to fight against the resistance in the 1990s.

The world is facing a growing number of “superbug” infections that are resistant to commonly used antibiotics. Countries are now fighting to stop a future where treatable diseases become pandemic and deadly.

Currently, syphilis patients must get an injection in the buttocks or upper thighs, close to their groin, as part of the new regulations to tackle resistance to antibiotics.

The Ministry of Health said this should not be viewed as punishment but a response to the growing resistance to antibiotics.

Previously, syphilis sufferers used oral tablets, but the World Health Organisation recommends an injection of benzathine penicillin.

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