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Archive for the ‘health policy’ Category

With diabetes now one of the burdens of  affluence among most Nigerians, its presence in a patient portends even greater danger as TB may just be lurking in the corner writes Kingsley Obom-Egbulem

Some diseases may not have come close to the dwelling places of most Nigerians but for a change in their  life style occasioned primarily by an increase in income and status. Diabetes is one of such diseases and its  affecting and claiming the lives of millions of Nigerians  albeit silently.

Diabetes is a disease that causes high level of glucose in the blood. People with diabetes lack insulin which is needed for the control  blood sugar.And due to inadequate insulin production they need to be on insulin injection for life.

There are two types of diabetes; Type 1 usually develops in childhood and requires lifelong injection of insulin, while Type 2  develops in middle age( causing kidney, eye, and nerve damage.) It may not  have symptoms and usually can be controlled by diet and drugs if detected early.

For those "who have arrived",it might just be wise to add a lifestyle of regular check ups to the "chop ups"

“Diabetes is both a disease of poverty and affluence especially in Africa and I can say without any fear of contradiction that some people wouldn’t have had diabetes if not  for the fact that the food they eat and how they live changed with an increase in their income”, says Dr. Anthonia Ogbera ,Head ,Endocrine Department at the Lagos State University Teaching Hospital(LASUTH),Ojo.

Consultant Endocrinologist at the Lagos University Teaching (LUTH)Dr. Olufemi Fasanmade seem to agree with her.

“Overseas ,obesity is a disease of the poor. The rich are slim while the obese are apparently poor but here one of the signs that you have arrived is your size and when you are slim it’s a sign that you are not eating well and that’s is why we have people who are really sick but would not admit it until it is too late just because of the picture our society have painted about a healthy person”, say Fasanmade.

Most Nigerians are now living in urban centres with its attendant change in lifestyle and diets. African foods ,vegetables and fruits which are readily accessible and affordable in the rural areas become a thing of the past the moment families migrate to rural areas. With that comes also a change in diet as well as lack of time to exercise and work out due to the busy nature of urban life. This perhaps explains why half a million Lagosians are believed to be living with diabetes according to information from the Sonny Kuku Foundation(KSF).

An aversion for check up

The matter is worsened by poor  health seeking behaviour as a result of high cost of accessing quality medical care and checkups. “And after several years of  not checking your  blood pressure(BP) or monitoring your blood sugar level the next thing  is that the person begins to present with signs of diabetes and  when you tell them they have diabetes they wonder and ask you ‘how come’, they hardly believe it, but that’s the fact,” says Ogbera.

According to a study carried out in LASUTH in 2006 on the burden of diabetes in Lagos alone, about 140 to 160 patients already diagnosed with diabetes are catered for on weekly basis and 25% percent of people with diabetes already have diabetes related complications by the time they are diagnosed of the disease.

It is believed that diabetes accounted for 1 in 6 hospital admissions in Nigeria and 1 in 6 persons admitted for the disease eventually die of diabetes related complications.Over half a million Lagosians are said to be living with diabetes

Unlike infectious diseases,diabetes  does not ‘jump’  on  anyone as it takes time to develop in a perosn. The tendency for it to develop can be checked or prevented. Early onset of diabetes can also be detected and complications prevented through regular checkups. However, some doctors believe that the poor health seeking bahaviour of Nigerians is responsible for this.

Dr. Femi Olaleye of Optimum Healthcare Services is of the view that the average Nigerian would ordinarily  not seek  for medical attention and when he is ill, he would not bother much so long as his appetite, sex life and bowel movement are not affected by the illness.

“This attitude is commonly seen in regions where there is poverty and lack of access to free healthcare services. The decision-making capabilities of the poor man are eroded to a point where he lives in hope that his medical condition will ameliorate miraculously as long as the condition does not affect what he considers as his primary functions which are; eating, excreting and enjoying sex. But we know that the definition of good health is not the absence of disease but the maintenance of physical and mental well-being of the body and the prevention of diseases. But it costs money to maintain health and prevent diseases”, says Olaleye.

It also pays to eat with discretion and be sure to check your waistline and body mass:Pic:CDC

Staying healthy in the face of competing demands according to Olaleye is a major challenge for most Nigerians. “We have gradually over-priced healthcare services out of the reach of the average Nigerian, and as result, the demand for our kind of healthcare services are plummeting. Our patients are now seeking ’cheaper’ alternatives, which sadly in some cases, are very fatal and continues to lead to loss of lives.”

Even for those who can pay for a checkup, there is still an attitude that is anti-checkup and this has a role to play in case detection rate of diabetes and similar disease of lifestyle.

The Link with Tuberculosis(TB)

One of the challenges of living with diabetes is the risk of being infected with TB. In 2008,a survey of TB patients receiving treatment at the LASUTH showed that the prevalence of under-diagnosed diabetes was 6%. And for most endocrinologists, this trend is a worrisome reality that needs to be given some measure of attention. Hence the SKF made it a subject of focus at its recent public seminar in Lagos.

Titled; “the Emergence of Diabetes Mellitus in Tuberculosis”, the seminar was to raise awareness on the relationship between diabetes and TB such that screening for diabetes in TB patients will be mandatory.

But Dr. Dan Onwujekwe, Senior Research Fellow and TB clinician at the Nigerian Institute of Medical Research(NIMR),Lagos said the reverse should be the case. “Most doctors would agree with me that diabetes lowers the immune system  and affects the body’s ability to cope with diseases  and so you become prone to infections; and not just that, the TB bacterial thrives in sugar environment hence, we will rather advice that those currently treating diabetes  should screen regularly for TB because they are highly susceptible”.

While it may sound like a case of which comes first;between the egg and chicken, whichever way it is tagegd, emergence of diabetes in TB patients or emergence of TB in diabetes patients are frightening combination the Nigerian healthcare system should be bothered about and starts responding to.

Sadly, most TB treatment  programmes in Nigeria are donor driven initiatives most of which do not incorporate diabetes detection and treatment, hence Onwujekwe’s counsel  for those currently treating diabetes to go for TB screening regularly since the treatment is free.

But the implication of treating TB in a person with diabetes is enormous. “TB patients with diabetes can actually have their blood sugar increased when they commence TB treatment due to the effects of Isoniazid one of the drugs used in TB treatment”, says Fasanmade.

One way to address this burden according to Fasanmade is through a co-location of treatment centers for diabetes, TB,HIV and AIDS . “That way ,we can ensure that diabetes patients  can also have the opportunity to access TB diagnoses and care within the same facility”.

Perhaps, this might just be one way out of the woods. But the greater responsibility rests on our health system as it is currently configured with no template for  such co-intervention. The potentials are there however, especially with the successes recorded in  TB/HIV co-response.

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In the midst of the frenzies of the forthcoming elections, it is imperative to warn Nigerians that our votes can either make the difference between a suicide attempt or a decision to live life “more abundantly”.

By Kingsley Obom-Egbulem

Nigerians added another term-“Toxic Politicians”  to their political lexicon recently. Thanks to the Economic and Financial Crimes Commission(EFCC), who decided to dare and “ look Medusa in the face” and release what they call “list of corrupt politicians” that must be barred from contesting the 2011 election.

I was particularly impressed at the metamorphosis the list has undergone, especially since the media began analyzing its legal, political and moral implication. For me, the name “Toxic Politicians” will forever remain apt  until perhaps, our political system stops producing and throwing up individuals with toxic tendencies.

Toxic according to the Encarta  Dictionary, has to do with something poisonous: “something relating to or containing a poison or toxin ;deadly: causing serious harm or death”. Does this describe some of our politicians? The answer as always, is blowing in the wind!

And so, for any right thinking people, there is the need to start looking at our politicians from a different perspective especially when you realize that your vote can actually be a suicide attempt or a decision to live a good life depending on who you chose to vote into office.

Let’s try and paint the picture better so we can start making up our minds where we want to be in the next four years, courtesy of our votes.

Nigeria got hit by cholera this year. While the affected states were wondering what hit them, the disease had claimed over 1500 people out of the 38,000 cases recorded. It took the efforts of the United Nations for us to know this.

In many developing countries, cholera remains a disease only discussed in the classrooms of medical schools. But the giant of Africa is  battling with it and with casualty figures that compares only with that of countries like Haiti. Perhaps Haiti would not have appeared on the cholera fact sheet if not for the devastating earthquake it suffered earlier this year. So, how do we explain the cholera embarrassment in one of the world’s largest oil producing nation?

Cholera;humans struck by a preventable disease.How can we prevent such dehumanisation with our votes

Jonathan:can his Goodluck save Nigerians from these needless yet endless deaths?

Lets remind ourselves that cholera is not a natural disaster. It is not like the Tsunami or Hurricane Katrina that nature unleashed on the world within the last six years.

If my knowledge of integrated science serves me well, cholera is an acute and often fatal intestinal disease that produces severe gastrointestinal symptoms and is usually caused by the bacterium Vibrio cholerae.

We were taught that virtually the only means by which a person can be infected by cholera is from food or water contaminated by bacteria from the stools of cholera patients. Prevention of the disease is therefore a matter of sanitation. So, we can safely say that cholera occurs where there are poor access to safe water and basic facility…and do not forget that we are living in the world’s largest oil producing nation.

I love to think along health lines. Somehow, I  chose to see things from the health point of view-i.e. the health implications of several actions and pronouncements. So, one can easily decode how I interpret some of the  hollow and pedestrian political jingles  currently running on our radio and TV.

Each time I see the jingles of Atiku, Gusau, Jonathan and IBB, the questions that keep running in my head are obvious: “What did you guys do about these common diseases currently whipping out Nigerians especially in your part of the country? How do you ensure I don’t die of preventable diseases when I vote you in for the next four years? How would a vote for you ensure that I don’t die before my 46th birthday “celebration”?

With cholera harassing Nigerians and claiming the lives of children and women in their thousands lately, Im afraid that we may just be giving a nincompoop the mandate to wipe us out for another four years. The children, men and women who died of cholera in all the affected states in the north did not know they would die this year, let alone of a preventable albeit curable disease like cholera.

For the dead children, would it be fair to say that their parents voted in a governor; men and women who gave them bread and bags of rice in exchange for their  votes  only to turn out to be the ones who caused their death? How do we tell the ghosts of these children(whenever they starts haunting us) that their parents voted men who lacked basic understanding of what to do about taking care of their people.

I’m bothered!

So, how do we avoid these anomalies? How do we guard against the grim picture that our health sector connotes? I really don’t want us to reproduce that frightening  albeit gory images that have come to represent the Nigerian health sector. We can write an endless volume  trying to do that. But let me illustrate that if you are a Nigerian, living in Nigeria, you are expected to die at the age of 46 or 47.And just in case  you are way past that age, you are doing extra time or simply spending “dying minutes.” It sounds distasteful, no doubt! But that’s the truth.

IBB;

Atiku;

With incessant strikes by doctors as well as an untamable fake drug market, “the Nigerian health sector” in the words of former health minister, Professor Babatunde Osotimehin “is characterized by lack of effective stewardship role of government, fragmented health service delivery, inadequate and inefficient financing, weak health infrastructure, mal-distribution of health work force and poor coordination amongst key players.”

This is no doubt a recipe for continued drop in our life expectancy as any system so described can only create a big market for casket makers and undertakers.

So, how do we ensure that we use our votes to prolong our lives and live healthy lives? How do we ensure that we don’t vote for men and women who often escape sneak out of the country with our money to extract a tooth or change their glasses while leaving us at the  mercy of business centers masquerading as private hospitals or abattoirs presented as government hospitals? How can we end the feeling of knowing that sometimes you can die of a disease not necessary because the disease is terminal but because it infected you; a Nigerian living and trapped in Nigeria and there is no capacity or resources to treat the disease?

In May 2009,I woke up to a shocking reality and I’ve not recovered from its impact. It is an issue I know so well, but it has never been  so graphically presented the way Paul Thorn did .

I was at a satellite meeting organized by the Lilly MDR TB Partnership at the 62nd World Health Assembly in Geneva, Switzerland. The meeting was organized to provide a platform to share experiences among countries battling with Multi-Drug Resistance TB(MDR-TB) and those who have not only conquered TB but have also contained MDR-TB.
Paul Thorn, a Briton living with HIV, who also describes himself as a MDR-TB survivor (having been successfully treated of multi-drug resistance TB he contracted while on admission)was one of the speakers at the session.

“I’m alive today because there is cure for MDR-TB”, he said. “But most importantly, I’m alive because of where I was born; because I’m Briton. The British government have made provisions to ensure that no one dies of TB or MDR-TB. But many people in poor countries infected with MDR-TB will die not because they have MDR-TB which is a treatable disease but because they have governments that cannot show leadership in tackling critical public health challenges”.

That statement got me thinking seriously about my nationality and the need to get involved in health debates in Nigeria by advocating for a health system  that works with the hope of increasing the life expectancy of Nigerians.
No doubt, Paul Thorn would have died if he were in Nigeria. Those who should know won’t debate the fact that we don’t have what it takes to correctly diagnose MDR-TB let alone treat it. Need I say God help you if you get infected with MDR-TB here.

But the focus of this discuss is not TB or MDR-TB. It is about using our votes wisely in the next election to  ensure we live healthier, longer lives and ensure that our health system works. For this to happen we need to ask intelligent questions and demand intelligent answers. Armed with these questions we need to start engaging those aspiring for political offices…those  whose posters are now creating eyesores in  several towns and cities; those whose boring radio and TV jingles are offering wish lists for which they cannot articulate how they intend to achieve the promises on the wish list. Some have carefully stayed away from selling a health agenda.  We need to be sure of what they want to accomplish within the health sector.

We can’t overstate that health wise, there are no sustainable plans for today’s children let alone those of tomorrow. The aspirants are coming at us lamenting what mess we’ve found ourselves in, but with no alternative visions, no ideologies and no programmes that offer the voters clear choices about their future. No political party in Nigeria can boast of a clear road map to improve the health of Nigerians except the fact that most of them have successfully branded themselves as the ultimate platform to grab power.

A situation where someone is running for public office and does not have an idea of what to do about the health sector is suicidal. A president, governor, law maker or local government chairman who is not bothered of health bill or cannot read the National Strategic Health Development Plan Framework(NSHDPF) for instance is a disaster about to happen and we must nip that with our votes.

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By Kingsley Obom-Egbulem

I won’t forget that weekend in a hurry. I had just rounded off a 3-day meeting in Abuja and was rushing to catch my flight back to Lagos when we met this unusual traffic jam on the Abuja International Airport Road. Not sure what was going on, the driver of the taxicab I was in decided to ask the street hawkers; who apparently were making the best out of the situation.

“Oga na Yar’Adua wife dey do fund raising o”, one of them told us in pidgin English. Meaning “Sir, Yar ‘ Adua’s wife is having a fund raising event”.

In less than four hours, about N7billion was said to have been raised out of the N10billion naira needed by  Turai make the dream of the center a reality.

Most  state governors especially the PDP governors at the fund raiser were falling over themselves to impress Hajia Turai Yar’Adua. They were committing huge state funds to this project; funds one analyst said would have been enough to resurrect some of the run down public hospitals in their states and even send health workers on critical training courses. But they didn’t do that. Instead, they came to Abuja and “invested” it towards the building of Turai’s N10b state of the art of Cancer Centre.

It is over one year now and we are asking; what is happening to the International Cancer Centre project believed to have been influenced by a visit in 2008 to the MD Anderson Cancer Centre in Texas by Turai?

Turai:did her dream for an International Cancer Centre fizzle out with her "office"?

Turai, like we all know, is no more the first lady of Nigeria and any Nigerian can guess how much influence  and credibility she has that can be leveraged to either drive more funds for this project or even the vim needed for its completion. It is also not known whether or not this project was part of a larger government plan for the health sector or it was just Turai’s dream which was never accommodated either in the health budget or even the National  Strategic  Health Development Plan Framework(2009-2015). Now, if the latter was the case, then where are we in this Cancer Project? Where are the experts(assuming there were any) who formed part of the think tank for the design and implementation of this project?

These questions are coming against recent launch of a Women for Change Initiative by Mrs. Patience Jonathan. If Nigeria  is still what is, and the first lady is not called to account, these are state funds about to be squandered. And it pays to ask what have happened to the ones used for similar projects in the past.

Before the International Cancer Centre project, Turai had mobilized female AIDS activists and advocates, women groups and wives of governors in the country  to launch the Women Coalition Against HIV/AIDS. This campaign concept was allegedly designed  by former  Health Minister who was then Chairman of the National Agency for the Control of AIDS(NACA), Professor Babatunde Osotimenhin. That project gulped a lot of money still. What is happening to that coalition today?

Shortly before Turia left the “office of the first lady”, she did  set up a skills acquisition centre at the Maitama General Hospital, Abuja, “for the training of special patients in income generating trades by the National Directorate of Employment (NDE)”. These “Special Patients” are supposed to be women and other patients affected by the HIV/AIDS. Ideas! ideas!  ideas! Sometimes, you want to wonder where these ideas are coming from considering how much they weigh on  the sanctity and sanity scale.

Patience:The new Dame on the block.A redemptive mission or another spending spree?

In a country where accountability is an alien  it may not be hasty to state that these projects have achieved their main objectives; top of which was to swell our list of venal millionaires (or perhaps billionaires)with our without necessarily putting a health system or  providing a template on which we can sustainably solve our myriad of health problems. Some of these projects certainly were not planned for the long haul else we would have been feeling the impact by now whether or not Turai is in “power”.

Expressing concerns over the Cancer Center shortly after the fund raiser, a UK based Nigerian epidemiologist, Chikwe Ihekweazu  gave an idea of how Nigeria can gauge whether or  not this project was another drain pipe or an institution designed to last.

“We hope she’s been advised on how to build cancer education programme across the country to inform people how to detect early tumours. We hope that her advisers are planning a screening programme, a referral mechanisms from primary health care centres to Abuja. We hope that she is being advised that it is necessary for the knowledge, skills and equipment necessary for Pap smears, Mammographies, Chest xrays and other means to detect tumors etc…We hope that they are advising her on the skills and capacity to manage this centre and that there is a clear strategy on how this center will interface with the rest of the country’s health system.”

Too many questions, concerns and doubts.

Please read this article by 234next.com for more updates

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By Kingsley Obom-Egbulem

Imagine this scenario: You are the governor of a state and there is an outbreak of cholera epidemic which has killed over 100 people in your state. The epidemic has not only exposed how clueless you are in dealing with minor health problems but have also exposed your lack of leadership in mobilising resources to address an emergency as a governor.

Sensing the precarious situation in which the people you claim to govern have found themselves in the face of this epidemic, several organisations have come to your rescue.

Unfortunately,(or so it seems)one of those who seem to be trying to help is one of your political opponents; in fact the man who has declared interest in your seat. The man decides to take advantage of the ugly health situation the cholera outbreak has created in the state you are governing to” assist” by donating drugs worth millions of naira to treat patients affected by cholera.
What do you?

Disgusting irony:Cholera patients in one of the world's largest old producing nation?

Rather than accept the donations,celebrate the donor and probably make him look like a good man that he is not(and then go back and work on your leadership capacity),you turn down the “gesture”  at the detriment of hundreds of lives hanging in the balance.

The governor of Yobe state definitely needs some schooling on where to draw the line when it comes to playing the game of politics. With over 188 lives lost and more not sure whether they will live or leave, this is not the time to score cheap political points.

I read the story and for me it is a frightening reflection of how a man’s short sightedness is costing his people their lives.

Any governor worth his mandate should be concerned that cholera (a disease that has been banished in poorer climes) could be linked with his state in the first place and with casualty figures as high as 100. It is simply a symptom of visionless leadership and not to accept help from a political opponent is even more infantile and petty.

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Ibrahim Umoru

At the early years of the HIV and AIDS epidemic when treatment was a mirage, a woman testing positive to HIV gives up hope of bearing a child for the fear of having HIV+ children.

With the advent of robust treatment, care and support; our women folks taking advantage of Prevention of Mother to Child Transmission(PMTCT) services smile with relief for the ability to have babies who are HIV+. What a wonderful world!

However, as a father, a husband and somebody living positively and constructively with HIV, I sure do have a role, in fact a bold and big one at that, in my wife’s effort at accessing PMTCT. I play strong roles in supporting my wife on treatment to attain a robust CD4 count and undetectable level of HIV in her blood. It is my responsibility to make her have a good nutrition and maintain a good health as well as encouraging safer sex to the time of peak ovulation. This is to reduce re-infection.

One of the ways to prevent mother-to-child transmission of HIV involves a long course of antiretroviral drugs and

Make sure she sees a midwife:Living up to his responsibility beyond just getting her pregnant:source:africanfathers.org

avoidance of breastfeeding, which reduces the risk to below 2%. In developed countries ,the number of infant infections has plummeted since this option became available in the mid-1990s.

Since 1999, it has been known that much simpler, inexpensive courses of drugs can also cut mother-to-child transmission rates by at least a half. The most basic of these comprises just two doses of a drug called nevirapine – one given to the mother during labour and the other given to her baby soon after birth. These short-course treatments, combined with safer infant feeding, have the potential to save many tens of thousands of children from HIV infection each year.

However, for the whole robust course of a full ARV regime, opting for elective CS, alternative infant feeding; men’s roles are obviously essential and we MUST be there for our female partners.

It is important to note that as husbands we have a role to play to make the period of pregnancy less stressful for wives and always be there for them and for the union too. In encouraging my wife to consent to elective caesarian section, I continued with such support and was in the theatre by her side when she had her baby.

This is my opinion about men being part of the solution rather than the problem. We played a role in the pregnancy and since we cannot carry it (the pregnancy) we should be responsible enough to support and  encourage the woman till she enters the labour room.

If we all agree with this summation, then we can collectively agree that the term PMTCT which is Prevention of Mother To Child Transmission of HIV  should  be broadened to  read PREVENTION OF PARENT TO CHILD TRANSMISSION OF HIV (PPTCT). We all should work for that success as I and  my darling wife continues to celebrate the birth of our latest baby born HIV free baby.

Have a pleasant day!

Ibrahim Umoru

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A Caesarean section is a form of surgery in which one or more incisions are made through a mother’s abdomen and uterus(womb) to deliver her baby(ies).It is usually performed when a vaginal delivery would put the baby’s or mother’s life or health at risk, although in recent times it has been also performed upon request for childbirths that could otherwise have been natural.

While this life saving innovation is helping to save the lives of women and contribute to reducing maternal mortality, it is often a source of stigma especially in Nigeria where some women are sometimes “ashamed” to say they were delivered by CS. Kingsley Obom-Egbulem engaged an expert on this issue . The interview featured questions you’ve always wanted to ask about Cesarean Section with answers presented in a down to earth manner by Oliver Ezechi, Consultant  Obstetrician and Gynecologist and Chief Research Fellow at the Nigerian Institute of Medical Research(NIMR),Lagos.

What are we not doing right with respect to CS in Nigeria and what are your recommendations in addressing these ills?

Presently there are lot of negative perception about CS, with local myth that only weak women deliver by CS. CS is also termed as unnatural. There is also the believe that CS limits the number of children you want to have. With special reasons and in the hand of a qualified obstetrician  4th and 5th CS can be done. The cost of CS is also a major barrier to acceptance of CS. My recommendation is that we need to intensify public enlightenment  on dangers of having children too early, too close and too many children. We need to educate the public on the reasons for embarking on CS. Maternal health services should be free including CS.

What specific  gynecological or obstetrical problems was CS invented to solve and what is the state of this problem before the advent of CS?

Caesarean section was originally invented to save the life of the mother from dying or sustaining injuries from prolonged labour. Later, it was extended to save the baby too.

The Caesarean operation was thought to have originated in Roman times. It is known that Caesar had made a decree under Roman laws that all women who were dying in childbirth should have their baby delivered by cutting open their belly. This was meant as an attempt to save the child and increase the low population at the time. Hence the word ‘Caesarean’ was derived. In the 1500’s a French midwifery text referred to the operation as a ‘section’, making common the term ‘Caesarean section’. Later it became a tool not only to save the life of the  baby but that of the mother too.

Some women by their physical make up  and based on some medical reasons are supposed to have their babies through CS. Could you shed some light on this?

Oliver Ezechi:We must embark on constant education of women and their families what CS really does for them and their babies

The reasons for carrying out CS could be maternal or fetal or both.  For the baby to pass through the birth canal , there needs to be enough power to push it down- uterine contraction, baby small enough (passenger) to pass through the birth canal (passage).

If there is a problem with either the power, the passenger or passage, the baby will not be able to be delivered vaginal. In some women, because of their small size, or injury to the passage ( fracture of the pelvic bone during accidents), deformity from e.g. polio or congenital abnormality of the pelvic bone, the passage is small, a normal sized baby will not be able to pass through. The labour is stalled. Unless  CS is performed to remove the baby, the mother or baby  may die from injury or exhaustion. Also if the baby is too big, or presenting in an abnormal way  it will not be able to pass through a normal passage. Also some women for medical reasons in may not tolerate labour and delivery e.g. hypertension in pregnancy, previous injury to the womb will not be allowed to labour and push as this may cause severe morbidity and mortality.

Within the religious parlance delivery through CS attracts some form of stigma and you hear some women say “when the Doctor told me I am going to have my baby through CS,I rejected it and we started praying and the next thing the baby came out”. What’s behind this  perception of CS?.

In Nigeria some pregnant women will not mind losing a baby than having a CS. If the baby is not doing well during labour, a doctor will recommend CS for the woman to be able to have quality baby . A lot of babies are born compromised. The effects are not manifest until years later when the child starts having problems with learning . At that time it will not be attributed to the difficult delivery.

Do you have a personal experience in this regard?

Sometime ago, I had advised a couple about having a CS because the baby’s heart rate was not doing well during labour. The labour got prolonged as she had a borderline pelvis. They rejected it and discharged themselves against medical advice. Days later the couple came back to the clinic and boldly told me that God did it for them despite my recommendation. She proudly said ‘I had a normal delivery’. They were making mockery of me but  I professionally told them that  if  I have a situation again like theirs, I will do the same thing. As they were leaving I noticed that they did not come in with their baby and I innocently asked ,’were is the baby?’They shamelessly answered that they believed that the baby was not their own as they lost the baby soon after birth. That God will give them their own. The couple lost two other babies in quick succession. They later came to their senses and now have three kids from CS.

There is also the cultural dimension to this CS issue, where women who didn’t  go through vaginal delivery often hide the truth about how their baby was born some even lie and we are told they are said not to have the normal experience of child bearing? What’s your take on that and how can we deconstruct this mindset?.

We need to step up public enlightenment campaigns on the reasons for CS. Empowerment of women to be able to take decisions and free maternal health care. People need to know that CS is life saving option aside helping you have your baby safely and we should not be clapping for people who were told to go CS and they eventually had vaginal delivery, we are sending wrong signals about CS and women who opt for it.

How many times can a woman go for CS?

There is no fixed number. However, for every one after three deliveries ( whether vaginal or CS)  the risk of maternal morbidity and mortality increases. The ideal family size scientifically is two. The safest pregnancy is the second one. However, we generally advise women not have more than 3 CS but in the hands of  qualified obstetrician you can go as high as 5 or 6. I have done a 7th CS. The woman came to me after 5th CS and she had no child and she been advised not  have any more pregnancy. When she came to us we knew if we ask her to go, she may end up in the hands of unqualified persons and get killed. We counseled her on the dangers and agreed with her that she will be admitted in the hospital at  28weeks and delivered at 36weeks instead of 38weeks. We didn’t want her to contract at all because she may rupture her uterus and bleed to death. She has two kids now. After the 7th CS we tied her tubes.

How can we make CS safe or safer given our setting where unsafe surgery is contributing  to medical accidents and swelling the rate of needless deaths?

All maternal deaths in the country should be reported and inquiries made about how the woman died. We should insist that CS is not be performed by people not qualified to do so. Government should improve the capacity (human and infrastructure) of our hospitals to deliver quality services.

How do you prepare a woman who might require CS for surgery?

The woman should be counseled and educated on the reasons for the surgery. She need assurance and support. To increase acceptance, they do not need to be kept in the hospital for 7 days. After CS, I discharge the woman on the third day like any other woman. They come back on the 7th day for me to review the site of operation. This will reduce cost as well as prevent the relations from knowing she had a CS. We did a study in Ile-Ife which showed that our women prefer it and will accept CS in such situation.

The issue of cost  and affordability verses the need to save a woman’s life and that of her child will always pop up whenever we discuss CS in context of reducing maternal mortality. If a doctor knows quite well a woman will require CS and the husband obviously  can’t afford it, where is the fair point to stand?

Government should declare free maternal health  and improve public hospitals. Women who cannot afford the bills of the private hospitals will have a choice. If you go to a private hospital you will have to pay your bill because they receive no subvention from government.

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The production and sale of counterfeit drugs is definitely a global problem. But the sad side of this problem is that it can never be discussed without our beloved country “Nigeria” popping up. And that was exactly what happened at the 63rd World Health Assembly (WHA) in Geneva.

You can still recall the “My Pikin” saga and all the “Pikins”* whose lives it ended in a rather tragic albeit inexplicable manner. Now, with over 8 years of constant raiding and burning of seized drugs, Nigerians simply rely on God to help them choose correctly when buying medicines with their hard earned money.

Before examining the outcome of the 63rd WHA and what progressive countries are doing about fake drugs, would it be out of place to know what is happening to the war against fake drugs since Professor Dora Akunyili left NAFDAC?

It hurts to think that sometimes a tree can actually make a forest. But that is almost becoming the truth about NAFDAC and the war against counterfeit drugs in Nigeria. Even though many of us who argued that Professor Akunyili’s tactics in prosecuting the war would not yield any sustainable result, the war right now appears to have gone to the bed as most Nigerians can’t even remember who the current NAFADAC DG is, let alone feel his presence.

Dr.Paul Orhil,NAFDAC DG:Sir this war needs some verve and creativity and we are yet to be convinced your agency has an effective strategy to prosecute it.

Well,just in case you are one of those who don’t know him and can’t feel him either, the current Director-General of NAFDAC is Dr Paul Orhii.If his doctorate degree in medicine is anything to go bye, we would have seen a renewed vigour in the fight against counterfeit drugs. Or is it too early to start asking questions?

While you are trying to make up your mind, lest find out what’s news about counterfeit drugs.

The World Health Organisation(WHO) during the 63rd WHA promised to assist Nigeria deal with the issue of counterfeit drugs. But my take is, would it be a lasting solution beyond giving loans and sending experts to access how these drugs get into the country and make recommendations on how to block such routes?

Drug counterfeiting we gather often involves expensive hormones, steroids and anti-cancer medicines and pharmaceuticals related to lifestyle in developed countries. But in developing countries, especially Africa, counterfeit medicines are commonly available to treat life-threatening conditions such as malaria, tuberculosis and HIV/AIDS.

So, you can appreciate why there must not be any lull as we make plans to wage a sustainable war against this enemy beyond the drama of raiding Alaba and Onitsha markets, seizing goods worth millions of naira and burning them for the next day’s cover headline.

Recently, we gathered that mPedigree a Ghanaian SME is working towards providing a sustainable solution to the problem which Nigeria is still struggling to overcome.

This is how the mpedigree concept works

Pharmaceutical companies will emboss  a special codes on drug packaging that are recorded in mPedigree’s database. When you  purchase a drug, you scratch off a panel(like the type on a recharge card) to reveal the unique code and send it via text message to a universal four-digit number. The request is routed to mPedigree’s servers, located in New Hampshire. After sending the code, consumers get a response by text, usually within five seconds, indicating whether the product is genuine or fake.
I hope Dr. Orhii is keeping tab of this cheering trend?

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