The People

Dr. Gitobu: On Urology and Why Cancer is so prevalent in Meru

Gitobu Mburugu is a renowned urologist from Meru. We had this insighful chat with him on his medical journey, urology and cancer in Meru.

Who is Dr Gitobu Mburugu?

I am an urologist aka plumber at Kenyatta National  Hospital and I have a private practice at Agha Khan, I admit in other hospitals but my office is in Agha Khan. I also have a practice in Meru, because its home and I am getting a lot of patients from Meru, so I thought I would open a practice there as it will save costs for them and I will get to visit home more often.

What is urology?

Urology deals with the treatment of the conditions of the urinary system. The urinary system in both sexes this is from the kidneys to the urethra and the male genital system. I have mostly male patients so people like calling the male gynecologist. Medicine is always growing so there is urogynaecology which is a developing subject that mainly deals with the female urinary system. It’s a grey area but urologists are leaning in harder.  It deals with clinical problems associated with dysfunction of the pelvic floor and bladder. Pelvic floor disorders affect the bladder, reproductive organs, and bowels. Common pelvic floor disorders include urinary incontinence, pelvic organ prolapse and fecal incontinence.

Why did you decide to get into medicine?

When I was young I decided to be a surgeon or so I am told. This one time my mum was unwell and was operated on by an Italian doctor in Nyeri. I am told, I have said that already “he chuckles” I walked up to him and told him when I grow up I want to be like you. Urology came by as a default. I wanted to specialize so while I was practicing general surgery I was working under an urologist who advised me to apply for scholarships in urology. I got three offers, one in Tanzania, one in Israel and one in Britain. I went to Britain.

Speaking of Britain where did you go to school?

After high school, I went to University of Nairobi for medical school after which I did my internship in Meru Hospital, then there was a strike just after I finished my internship and I had just got employed. I got three sacking letters after that strike. He chuckles. I mention that he’s always been controversial and he confirms and chuckles louder. I quit the government and went to work at Tigania Mission Hospital. After a while I applied to University of Nairobi for a Postgraduate in General Surgery. I was accepted and did it for three years. My mum and the late professor Meme went to school together, so one day at a parking lot when we met and I didn’t have a job my mother said to him, “Employ this boy for me.” He didn’t even argue too much he gave me a job at that parking lot on a piece of paper. Gone are the days

I worked there until 2003 then I left for the urology scholarship in Britain and came back in 2007 and went back to Kenyatta National Hospital.

 How is it being a doctor at Kenyatta National Hospital?

Working at Kenyatta depends on your initiative, if you want to do nothing and get paid you can, if you want to overwork yourself to death you also can. So it’s really up to you to strike a balance and be an ethical person. Urologists are about 32 in Kenyatta, it’s not a small number but it’s also not sufficient because that’s more than one million patients per urologist, “gasp”.

Do you get a lot of patients as an urologist?

Yes, once you hit 50 years you must see an urologist. Also lifestyle diseases have driven even the young people to see urologists.

Is there stigma associated with seeing an urologist, you know men and visiting doctors?

Oh yes there is so much. I am a member of the Kenya Association of Urological Surgeons, every year we have workshops and conferences, during these conferences we have clinics and try to create awareness around male sexual reproductive. This year it’s going to be in Malindi, we consult and create awareness around urological issues especially in males because most men never talk about them.

Which are some of these issues?

Leaking urine, if you can’t pass urine, if there is pain when pass urine, if you are passing blood, if you have kidney stones, there is so many issues that crop up so my advice if you feel like your tools aren’t operating at optimum just see a doctor. There is no shame in being unwell, it’s what human bodies do, and that is why we have doctors.

Have you found a patient who leaks and he doesn’t talk about it?

Oh yes, a lot of my patients are sent to me by their daughters – sons are scared of their fathers so they don’t explain much- but daughters will go into details of exactly what they think might be happening to their dads, or they call me and go like, “This Mzee is smelling urine, so tutamleta halafu wewe umwangalie, na ujue atakudanganya.” And true to their daughters words they’ll deny and then when we go to the exam room, I’ll see his underwear is stained and wet so I will slowly explain what is going on and then we’ll begin treatment after some convincing. Some people will not open up and they’ll die because of the complications that come with their symptoms. They are embarrassed their friends and relatives will know what is wrong with them. It’s improved lately but not as much as I would love. When Prof Anyang Nyong’o was treated for prostate cancer it helped so many people come seek treatment, but so many people have lost their lives to prostate cancer. Including very well-known figures because they are embarrassed to seek treatment.

 Can you detect Prostate cancer early?

Yes, after you hit fifty years you should go for constant screening. If you have a family history after get to forty years. But lately cancer has become so common place it’s a bit unnerving even for us doctors. In the 90’s we used to say cancer is a disease of the old, that is why prostate cancer was known as “murimo jwa akuru” in meru.

For example colon cancer was known to affect those of sixty years and above, but I have seen a nineteen year old die of colon cancer. Some cancer patients also die of the cancer medication because cancer treatment immunosuppresses your system. A patient can develop an infection that can kill them in the course of the treatment. Also chemotherapy is the delivery of toxic drugs into the body with the sole purpose of killing rapidly dividing cancer cells. Unfortunately, it also destroys other cells that divide quickly, including those that comprise hair, nails and skin.

Is prostate cancer common?

It is the most common type of cancer in males, in terms of occurrence and number of deaths. If you live long enough you will get prostate cancer. Not all of them will be clinically apparent but if you do a postmortem of any male over eighty who has died of whatever, you will find some traces of prostate cancer. For most of them it might be insignificant in their lives but it is still there. No wonder it’s called “Murimo jwa akuru”. It’s also more common now because medicine has advanced and we have better diagnostic tools. The occurrences of prostate cancer are also increasing and no one can tell why. It’s always been there but the prevalence has increased due to lifestyle and the environmental factors surrounding us now.

Prostate cancer in black men and prostate cancer in white men is very different. In the black man it’s more aggressive.

Explain that last sentence?

Compared with white men, black men are twice as likely to develop prostate cancer in their early fifties and twice as likely to die of the disease. They are also more likely to be in an advanced stage of the disease when diagnosed. Also the process of following up prostate cancer occurrences is tedious, time consuming and expensive but with the right equipment active surveillance is recommended, which is easily available to white men as compared to black men.  Also African prostate cancer is more aggressive and it starts earlier. People are trying many theories to explain the high rate of prostate cancer occurrence in black men, like black men have higher testosterone levels. Prostate cancer feeds off testosterone which is why in the past doctors used to do surgical castration aka remove the testes. In the district hospitals we still do surgical castration which limits the rate of spread, “my mouth was on the floor at this point”. It’s not a cure though; it’s just management not treatment. For the majority of patients we see with prostate cancer, it has already spread and eventually it escapes the sac and reoccurs which is why treatment is very recommended. If it’s diagnosed early it can be healed.

By the way, not all prostate enlargements are cancerous, benign enlargements can be shrunk through medication.

Where can one find you?

In Nairobi, I have a practice at Agha Khan Hospital on Doctors Plaza, Room 408, you can reach the practice on 0713 417 633. In Meru, we have a clinic at Sarah Plaza, Room 5 & 6 on the first floor. Sarah Plaza is at the main stage, next to Maathai supermarket you can reach the clinic on 0798 000 609. I travel every Friday and see patients on Saturday. Roughly I see eight to ten patients per week in Meru. We have a receptionist who books patients referred to the clinic.

One impediment is that I have to purchase the surgical equipment for the procedures I will be doing in Meru because they are not available. I intend to just consult at the clinic then do surgical operations at Kiirua Hospital as compared to people coming all the way to Nairobi. I am doing this because we as medics have a very funny greed that creeps up and ends up breeding corruption and misdiagnosing patients. For example if one has a practice with a lab and a pharmacy, we will diagnose you with diseases that you do not have. Case in point there is outbreaks of diseases like typhoid that have become money makers. Typhoid kills but you find patients who have had typhoid for like three months consecutively – that make no sense. If you use the widal test to test for typhoid it will always turn out positive – it’s an old out dated test. Then there is Brucella – that disease that occurs from taking raw milk/meat. The unfortunate thing about Brucella is it is mostly treated with streptomycin which has very dire side effects. Streptomycin will leave you deaf, it will knock out your kidneys and it should not be given to pregnant women but sadly it is, “I am inconsolable at this point, no I was not crying but I was scared shitless”.

Why is India very popular with Kenyans especially when one is diagnosed with cancer?

Most people go to low cost hospitals because it’s cheaper. Indian hospitals are run like businesses not like hospitals. Most Kenyans go to low cost clinics, one is better off in Kenya if you look at the odds. There is a case where a young girl lost her life after giving a kidney to her uncle; we have never lost a donor in Kenya. As terrible as our health sector is not all is lost, most doctors give their best with the circumstances.

If you go to India go to the best Indian hospitals because they are at per with the best hospitals in the world.

Do you think cancer is very prevalent Meru?

It is but it’s not just Meru, it’s everywhere. There is no scientific explanation but probably it’s all the farming chemicals we are using for horticulture, for our farm animals, pets etc. These are released into the air and we end up breathing them or eating these crops.

The pesticide levels in our products are very high such that they are banned in Europe. You are not safe eating meat either because of the growth hormones we use on kuku and other so that they mature faster.

Anything you can tell any young person who wants to go into medicine?

Medicine is a passion. You just don’t do it because you are smart, well you have to be smart but you do medicine because you love it. That way you will be good at it and you will enjoy your job.




Leave a Comment

Your email address will not be published. Required fields are marked *