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February 20, 2019

Why Kenyan drivers have symptoms of brain swelling

When it comes to comparing the size of a crisis-stricken African country, the international standard used is France. Why this is so is a bit of a mystery. By European standards, France is a large country covering a total of 547,030 square kilometres.

Yet by African standards it is not a particularly large country. Central African Republic, in the news lately for wrong reasons, covers a land area of about 620,000 square kilometres and is similar in size to Somalia at 637, 540 square kilometres.

If Kenya were in Europe it would be the third largest country at 580,370 square kilometres but by African standards it is not even in the top 10. However it is not as small as Rwanda, which at just 26,338square kilometres is 10 times smaller than the United Kingdom, which many would guess, given their history of world domination, would be the standard for comparison.

Perhaps the reason for the French comparison is that they invented the standard of measurement used today. In the 1790s, they defined a metre as one ten millionth of the distance from the equator to the North Pole along a meridian through Paris.

They made a metal bar representing this measurement, which naturally they kept in Paris. It follows therefore that if you want to measure distance, the place to verify your plot size would be Paris, France.

The problem with this form of verification is that it requires a visa and we all know the issues Europeans have with Africans with regard to that. Luckily in 1984, the definition of a metre was redefined as “the distance light travels, in a vacuum, in 1/299,792,458 seconds with time measured by a caesium-133 atomic clock”.

This solved a problem in a typical non-third world way. Caesium atomic clocks are scarce in this part of the world. Yet, we are not Africans for nothing and everyday we see attempts at defining distance without using an atomic clock. The thinking goes something like this.

We have enough light, living in the tropics so that part of the equation is fine. A vacuum is a space devoid of matter so any gap I see ahead of me has nothing, which is the same as a vacuum, so I am sucked into the space.

This thinking permeates our driving, our dealings with other people’s land, jobs and even simple queues to pay a bill. What is missing in this thinking is the element of time, recognising that someone is already in that space and that therefore it should not be available in such a simple fashion. How this fact escapes people is a mystery.

Whenever there is a mystery in behaviour the place to start looking is the brain. The human brain is contained within the skull, which is a cavity that in an adult measures on average between 1,200 and 1,700ml.

For those still thinking French, that is the content of about two bottles of wine or three bottles of beer for a rugby fan. The brain fits vey snugly within the skull cavity.

The problem for a human being with this arrangement is not the possibility of a vacuum, but the opposite — when as a result of injury or illness the brain swells and then there is no room within the skull to cater for the expansion.

Brain swelling increases pressure within the skull known as intracranial pressure, which can prevent blood from flowing into the brain and therefore oxygen, which is vital for its function. Damage or death of brain cells may result.

Common causes of brain swelling include traumatic injury like a fall or vehicle accident, a stroke following high blood pressure, infection like meningitis, TB, cancer and high altitude sickness. Symptoms of brain swelling depend on which part of the brain is feeling the pressure most.

But it is not uncommon to have cognitive issues such as poor mental processing, lack of attention, poor reasoning and difficulties in learning. Communication becomes a problem, in deciphering non-verbal signals. Such people are likely to have difficulty with self-control, a lack of awareness as to their abilities and exhibit risky behaviour.

Testing for brain injury is often an emergency and a clinical assessment followed by x-rays and CT scans are needed. Treatment depends on the cause but the first concern is to relieve pressure before damage becomes irreversible.

The problem for doctors is where very many people in our society carry symptoms of brain swelling. Can we really afford to CT scan everyone? The solution perhaps lies in understanding that knowledge, skills and memory are not physical attributes that make the head bigger.

There really is enough space in the head to learn decent behaviour that improves public health for everyone. If we all were to learn that there are no vacuums in front of use, eventually we might not need constant references to France.

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