In sickness and in health, until death do us part
On February 25 this year, a man logged onto his Facebook account at 4:55am and posted a most heart-wrenching message.
His wife had died just a few hours earlier, and in that trying moment he felt compelled to vent out the emotions coursing through his veins.
“My wife, the late Janet Ciru Akolo, was experiencing severe attacks that made it difficult for her to breathe, stand or walk,” Walter Akolo typed.
“They resembled the attacks she gets with her mental health condition. They got so bad Monday evening that we had to rush her to hospital. The doctors did the best they could but on Tuesday, February 24, 2015 at 2:30pm, she had another nasty attack and breathed her last. Cause of death, cardiac arrest. I loved her more than anything else on earth. I believe I’ll soon meet her again in heaven.”
I was trawling through the Internet when I came across that message, and immediately I contacted Walter and asked him whether he was willing to share his story to a larger audience. He agreed.
A few days later, we met at his Buru Buru home, where friends and family had gathered to condole with him. He wore a brave face, but I could see he was a tormented man.
His wife, he explained, had lately become withdrawn and lonely, somehow convinced that she was unworthy and a bother. As such, and probably as a way of trying to pass across a message about her value, she had sought to hurt the feelings of everyone around her, including their four-month-old son.
Just three months after giving birth to her son in 2012, Janet Ciru Akolo had attempted suicide twice, all because she wanted to teach her loved ones a lesson.
“I just wanted everyone, including my son and daughter, to suffer the consequences,” Janet said in a TV interview in November last year.
Her husband kept a keen eye on her. He had learnt to detect any change of emotions and behaviour, just as the doctor had advised.
Janet was to later be diagnosed with Post-Partum Depression (PPD), a condition that affects some women soon after giving birth.
“She would lack sleep, be extremely irritable, have hallucinations and sometimes even experience episodes of psychosis,” Walter told us last week.
“She also complained of unclear pains in her body. That is the time you now become the for-better-or-for-worse husband that people always promise to be.”
Janet had, nine years earlier, been diagnosed with a different illness called Major Depressive Disorder, but the couple had managed to keep her condition under control. Her husband was aware of the condition and, through the help of doctors and online research, the couple had kept it under control.
He had to quit his job when he discovered that he could stay at home, care for her while at the same time doing some online jobs to support the family.
“By the time the second child came, she was not even under medication and had not experienced any attacks for a very long time,” Walter said. “She was very stable.”
He had learnt to observe her for the most subtle emotional changes, which always indicated an impending descent to depression.
Her last and fatal attack began with signs of stress, her not wanting to talk to anyone, and not wanting to wake up in the morning. The ever jolly and ever smiling Janet soon became the exact opposite of herself.
“I could not understand her because, to me, we had been happy,” Walter said. “We had what she wanted, we had been in constant communication and I just could not understand how she changed that rapidly. I had never seen her act like that, even with her chronic illness, and so I was worried.”
A few years earlier when the doctor diagnosed Janet’s condition, Walter, a blogger and online marketer, had started researching about it and its implications.
As a result, he says, he was “already familiar with her pre-existing chronic illness, which we managed to manage very well”.
“It was now mandatory for me to learn about PPD, as the doctor had already told me that someone suffering the extremes of such a condition could hurt her loved ones,” he said.
“In her case, I was not even worried about the possibility of her hurting our children; I was more worried about her own welfare.”
She first attempted suicide one night by massively overdosing on an analgesic but her husband heard her choking, quickly searched for first aid solutions online and managed to save her.
“It was at night, she suddenly became so jovial, kissed everyone goodnight, told everyone how much she loved them, closed the children’s bedroom and went to the sitting room,” Walter said.
“And then, after a short while, I heard some noise. She was chocking and so I rushed to the sitting room, saw an empty drugs container and instantly knew she had done it.
“She told me she had taken 30 pills. I made her comfortable, called the doctor, reached out for my laptop and just googled for the remedies of neutralising that specific analgesic’s overdose and I applied the tactics on her.”
In the second attempt, Janet drank some bleach and he had to again google for directions to save her. “Even before the PPD attacked, I had learnt to keep the doctor and the Internet close. We had a very good doctor whom I would call at 3am and he would respond to our distress or advise us. He attended to my wife even when I did not have the cash to pay him,” he said.
He had learnt to not just be a husband, but a constant care giver as well. For better, or for worse.
“When she experienced psychosis, I played along. If she called me Rihanna, I became Rihanna. If she saw a doctor in me, I became the doctor. Sometimes she asked me to call Walter to her side, and I would go out, come back as Walter, and talk to her.
“Whenever she was stable we would talk about it, laugh about it and even discuss what would happen if she experienced the same attack the next time. With time, it became easy for us. We just improvised coping mechanisms and I tried my best to understand her.”
Janet coped well with her condition because she became open about it and did not allow it to put her down despite having to constantly take medication.
“She had so much self-confidence. She was a singer, a counsellor and a wonderful mother to our children. She was ever jovial. Let’s just say, she was flawless. I loved everything about her,” Walter said.
On March, 26, 2013, a few days after her doctor unsuccessfully tried to treat her using cognitive behavioural and exposure therapy — which involves exposing the patient to the things she fears — Janet was put on electro-convulsive therapy (ECT).
This form of treatment is used commonly on people with severe depression, particularly those who are delusional and at risk of committing suicide or murder.
It involves passing an electric current through the brain to intentionally trigger a brief seizure. Doctors believe the procedure causes changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses.
With the support of the doctors and her husband, Janet defeated PPD, later telling a TV interviewer that she was lucky to be among mothers who had a caring husband and a supportive family and friends.
“Walter’s support is priceless… you know… just legally, he is allowed to leave,” she had said. “One can legally divorce a spouse on grounds of unsound mind, but Walter has chosen to stay. It just shows the whole aspect of what love is. It is big!
“The ‘in sickness and in health’ phrase has been real. He has not left at all. I do not know what I would do without his support. It would have been crazy.”
And now, as we talked to Walter at his buzzing Buru Buru home, he was mourning the death of his wife, who had died from what doctors described as “cardiopulmonary failure due to massive pulmonary thromboembolism”. Simply put, her heart-lung system had failed due to massive blood clots in the lungs.
“I really miss her,” Walter told us. “She was the strongest woman I have ever known. I have never been this lonely. She has stayed with me since we were just friends and in high school and so I do not know any other life without her.”
According to doctors, Post-Partum Depression occurs in non-specific people, between the third week and twelve months after delivery.
Prof David Ndetei of the African Mental Health Foundation says approximately one out of every 100 women in Kenya gets PPD, which he termed as a “major form of depression”, after delivery.
Women who have had PPD as a result of prior deliveries are 25 per cent likely to experience it again.
“Mostly, it is caused by the rapid changes in the body. After delivery, the body lacks its normal equilibrium. Giving birth is a major life event, just like the loss of a mother or a loved one. People respond differently to these events everywhere around the world,” Prof Ndetei said.
Trigger factors include a bad social circle, pre-existing mental health conditions, difficult marriages, and age.
“Young mothers tend to be depressed more, mostly because they still are not stable in their relationships and are not mature enough to handle small problems; and sometimes because they simply have a feeling that they are not good enough to be mothers,” said Prof Ndetei.
Every mother, he said, should be closely monitored by, mostly, her husband, close relatives and friends who knew her well before she gave birth.
“The care giver should look out for the attitude of that mother towards the child, how she takes care of herself, her environment, and just a general change in her character and moods,” he said.
Sometimes PPD goes away by simply understanding the mother, talking to her well, helping to care for the child and simply being there for her.
His views were supported by Dr Josephine Omondi, a Nairobi-based psychiatrist who added that the first step to overcoming PPD is “compassion and understanding”.
In some cases in Kenya and around the world, mothers suffering from PPD have committed suicide or even killed their own children. Just three weeks ago, American Christiana Booth, 29, angered by the fact that her children just could not keep quiet, called the Washington police and complained that she could not calm them down.
About ten minutes after the call, she grabbed a kitchen knife from the dishwasher and slashed her toddler’s throat, then covered her with a blanket so that she would be quiet. She then slit the throats of her twin six-month-old daughters as well.
Upon interrogation by the police, the depressed mother said she had killed her children to shut them up because her husband, a soldier, “gets very annoyed” whenever they make noise.
She also told the police that her husband never helped her with the children, kept breaking down during the interview and vomited once. “They will be quiet now,” she kept saying.
Closer home, and exactly 21 days after Christian shocked the world, a similar story unfolded at the Korogocho slums in Nairobi. Catherine Muthoni, 20, pounced on a one-week-old child she had delivered through Caesarian Section, killed him, slit open the tummy and ate his heart. She then placed the remains of her son on the table before going to her friend’s house and killing two other infants.
The local chief said Catherine had admitted that she had killed the children, while a neighbour we met at a nearby police post told us Catherine did not seem shaken “and was even asking for a soda”.
Although she is yet to plead in court as she is still undergoing mental checkup, her crime is classified under section 210 of the Penal Code as infanticide.
The law defines infanticide as “where a woman, by any wilful act or omission, causes the death of her child… but at the time of the act or omission the balance of her mind was disturbed by reason of her not having fully recovered from the effect of giving birth to the child or by reason of the effect of lactation consequent on the birth of the child”.
The law adds that such a person may be punished “as if she had been guilty of manslaughter of the child”, which explains the reason the justice system in Kenya has been lenient to offenders.
Although data from the Kenya Police Service hardly establishes recent incidents of infanticide, in 2011 alone 45 cases were reported.
Post-Partum Depression was commonly cited when civil society groups were advocating for fathers to be given paternity leave, stating that it would be necessary for them to watch the mothers’ behaviours more closely.
A new study, published in the journal The Lancet Psychiatry, finds that not all women experience PPD in the same way, and that new mums with the severest forms of the condition may actually be able to trace the beginnings of their depression back to pregnancy itself.
These findings are important because they can help doctors better understand the cause of the different types of PPD and find better ways to screen, prevent, diagnose and treat the condition.
For now, Walter Akolo just wishes there was something, anything, he could do to save the life of her beloved Janet, whom he believes he will “meet soon in heaven”.