A mother stands at the desk in paediatric casualty, insisting her child's two episodes of vomiting earlier that morning are the emergency. Kenneth Rintaari is assessing the situation when another emergency arrives, a child mid-convulsion, wheeled in past her. In the space of a breath, he has to triage the room, reassure a parent whose sense of urgency doesn't match the situation, and act on the one that does. "What caregivers understand about an emergency," he says, "is different from how health care workers understand an emergency."

It is this kind of moment, repeated in different forms every shift, that defines paediatric casualty for Rintaari, a department he calls "emotionally, physically, and intellectually demanding." No two patients ask the same thing of him. A teenager might need a calm, honest conversation while a toddler might need him to become "kind of like Mr Bean" just to get through an exam. And always, underneath the clinical task, there is a second patient in the room, the anxious parent, whose fear he has to manage without ever losing focus on the child.
It is also, as it turns out, where a book began to take shape.

Rintaari, a paediactric casualty nurse at the Aga Khan University Hospital, Nairobi and an alumnus of the Aga Khan University’s School of Nursing and Midwifery, East Africa (SONAM, EA), has just published Beyond the Symptoms. 

Despite its clinical-sounding title, he is quick to clarify what the book is not. "This is not a medical book," he says. "It's a book for everyone." What it is, instead, is an extension of something he has practiced since his nursing training, reflection. After every resuscitation, regardless of outcome, his team debriefs,  what worked, what didn't, what could be done differently next time. That same instinct, he says, shaped the book. "I learn better with reflection... you're able to synthesize and come up with superior ideas."

The book's real subject is what lies underneath the obvious. "Most of the things that people call problems," he explains, "are not the problem, they are manifestations of other underlying issues." A person struggling financially, or in their marriage, may look fine on the surface. "That person is not healthy," he says.
For him, looking beyond the visible symptom to understand its underlying cause is still nursing, just beyond the walls of the hospital. Rintaari sees his book as health education, health promotion and primary care in a different form, the same purpose, he says, simply not confined to the bedside.

None of it came easily. Balancing fatherhood, marriage, and full-time clinical work meant chapters written late into the night, often past the point his wife thought reasonable. "There are times when she can tell me, I think you need to go and sleep," he recalls, "because you feel like you don't want to stop." Looking back, he's candid about what he'd do differently, chiefly, planning further ahead for contributors and forewords, since "some of these people are busy," and patience, he learned, has its own timeline.

His advice to current nursing students echoes the conviction that carried him through.

"Your job is what they pay you to do, but your work is what you were actually created for." 

For Rintaari, nursing was never the ceiling, just the ground he stood on to reach further.