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Archive for the ‘HIV/AIDS,Reproductive Health,maternal and child health,TB,Malaria,surgery,cancer’ Category

The fourteen weeks old strike by doctors in Lagos State may have ended. But it left in its wake sorrows, tears and blood. Among the affected communities are people living with HIV and AIDS in the state. According to Ibrahim Umoru, Coordinator of the Network of People living with HIV/AIDS(NEPWHAN)in Lagos, the strike was a nightmare especially as it affected  access to life saving antiretroviral and other quality  monitoring and follow ups.

As the world marks World AIDS Day(WAD), many are celebrating  achievements recorded in the global AIDS response  especially the 2010 Global AIDS Report published by UNAIDS which indicates a reduction in the rate of new infection and as well as access to treatment. But for Lagos state, the death of PLWH during the strike by doctors should be a cause for all to be worried as their death were indeed avoidable.

To mark this year’s WAD,NIGERIAN HEALTH JOURNAL reflects on this seemingly glossed over tragedy in this interview with NEPWHAN’s Ibrahim Umoru.

As someone representing a community that was at the receiving end ,what would you consider the cost of the suspended strike by doctors in Lagos?

Umoru

The cost is enormous to the citizenry generally and particularly heavy to People Living with HIV (PLWH). You will agree with me that in the management of HIV, one gets to see a doctor quarterly. That is for patients who have been on treatment for long and are stable; while those who just started treatment would have to see their doctor say, monthly. It’s so worrisome for our secondary hospitals where our nurses have not been strongly grounded in triaging*. Many people who could not afford private hospitals resorted to taking traditional herbal medicines and those who had no choice actually died.

That means the strike led to treatment interruption for many PLWH…what is the implication of this on AIDS control in the state especially with the likely issues of drug adherence and resistance?

There can’t be anything closer to the truth than this. You know there are various categories of PLWH. Some have vast treatment literacy experience while some were just  initiated into treatment and others were  just about to start treatment . The implication is that those who have been on treatment for a long and time and are experienced and  have become very stable but within the period of the strike there can’t be  any quality evaluation of tests done .Also, there were no consultations for opportunistic Infections(OIs)  just in case any was present. Patients were just coming to pick their drug refills without doctors’ examinations that are routinely done quarterly for this class of patients. However, some are not that experienced and worst of it is OIs could just come up within that period and the only alternative is private hospitals. How well informed are doctors in private hospitals with regards to the management of HIV and AIDS? So, that becomes an issue. I lost a close client to complications resulting from opportunistic infections. I have  another PLWHA who committed suicide that period too. These are some of the numerous painful losses to us in the PLWHA community resulting from the strike.

Is it true that knowing the consequences of a strike on PLWH some doctors in a particular treatment centre tried to ensure that there were no treatment interruption despite the strike?

Yes! Very well yes. I am aware of a particular doctor that took all the risk to be available for some days to PLWH during the strike. This is very commendable as the risk was enormous if his colleagues  had found out. That to me is the height of humanitarianism.

So, what becomes the fate of PLWH who died during this strike? Are you making your case known to Lagos State has that become one of the many casualties of being HIV positive in Nigeria?

Definitely, I am going to make a case to Lagos state as am trying to collate data from the various treatment sites around. At least, we have it on record. But come to think of it, can they bring back those lives again?

What could have been done other wise to prevent these needless deaths even in the face of the strike?

There is great need to improve the skills of nurses in triaging and palliative care. However, our leaders have to be more sensitive and proactive in the welfare of workers generally and health workers particularly. What the doctors were asking for were not out of the moon. They were things they had all negotiated and agreed upon long before now.

Someone has argued that doctors should get a bit more creative when considering a strike action given the implication of a doctors strike. Do you think so?

Our leaders and policy makers should be more creative and compassionate too. The problem is when most of them get there; they care no more about the populace. This should not be so!

So what can be your advice regarding the best way for doctors to strike without downing tools especially when you consider the fact that when their needs are finally met, they cannot bring back the lives that  have been lost?

The underlying fact is we should not allow issues to get to the point of strike at all. A strike that lasted for months is a reflection of the gross insensitivity of the people at the top. They don’t attend these hospitals as they and their families get health care outside the shores of our land. The people need to ask questions. We need to engage our various representatives in the legislative arm of government. The government too need to engage with the populace as they are too far away from the people they govern. These lives as you rightly attest to cannot be brought back. We should be more proactive in leadership and be on ground with the people.

For PLWH on treatment and for AIDS support groups, what lessons have been learnt from this ugly experience bearing in mind that  workers strike in Nigeria is now a way of life and healthcare workers are not left out?

We need to address our positive living lessons more creatively and increase the treatment literacy efforts in the support groups. Most importantly, we need to engage the government particularly in Lagos state to make sure we are heard at the right quarters. To this we have started restrategising to engage with government. You would recall  that the Lagos state government has a law in place protecting PLWH and a section of that law provides for a board and PLWH are supposed to  be part of that board that focuses on fund for drug buffer for people living with HIV. Furthermore, we wish to engage with Lagos State AIDS Control Agency( LSACA) to find out the composition of their board as the law that sets up such agency up to NACA provides for our representation there. That way we can be heard.

 

*prioritization of patients for medical treatment: the process of prioritizing sick or injured people for treatment according to the seriousness of the condition or injury: Microsoft® Encarta® 2009.

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By Kingsley Obom-Egbulem

A couple of weeks ago, Ted Turner-the founder of CNN and some of his colleagues in the United Nations Foundation visited Nigeria. The main objective of their visit was to evaluate how the nation is responding to polio and other deadly childhood diseases affecting children mostly in northern Nigeria.

As Turner and his team were deliberating with some of our leaders , I wondered to myself, “where are our Turners and what are they doing about the problems of childhood diseases in Nigeria?”, “where are the big boys  and big girls of northern Nigeria; and what have they done about ending child marriages and maternal mortality?”

Do they even know that these problems exist right in their domain?

Now, just in case you are not aware, northern Nigeria is among the very few parts of the world where polio have not been eradicated. The sad side of the story of polio in the north is that its eradication have been given several religious albeit political colouration yet the facts are there to be seen.

With the help of nothern elites Nigerians will stop being the image of polio in Africa

Imagine these scenarios: an illiterate peasant farmer and his wife are stuck with 5 children-all of them crippled by polio with its attendant consequences. And on the other side of the divide, we have the home of an influential northern politician; he is pictured with his 5 children playing football and cycling around the garden ;all five children purportedly born in high brow hospitals and immunized against the childhood deadly diseases including polio.

Just for the records, Bill Gates have spent no less than N114billion in eradicating Polio in Nigeria. (Gates have spent N1.2 Trillion Naira on polio eradication globally. This amount is 1/3 of Nigeria’s 2010 budget of 4.079 Trillion Naira).

And you ask, what are the Bill Gates of northern Nigeria doing about childhood diseases? What are they doing about child marriages and its consequences such as vesico virginal fistula(VVF),obstetrics complication and even death? How are the Bill Gates of northern Nigeria responding to the rate of infant and maternal mortality which appears to be the highest in northern Nigeria?

What about cholera-a disease that broke out this year in most part of northern Nigeria and claimed about 1,550 lives? So, what did the Bill Gates of northern Nigeria do about cholera-a disease that even some poorer countries only read about in newspapers or see on CNN?

The power brokers:These men would live a more fulfilling life eradicating childhood diseases

It is imperative to state that this discourse is not about polio, cholera or the north-south dichotomy. It is actually a lamentation about how we leave undone the little but fundamental things that makes all the difference and pursue bigger things which we end up making nonsense of ;it is a reflection on the current campaign for the presidency of Nigeria vis a vis the burden of the north and what ought to be the primary concern of some of those dying to rule this country albeit by force.

This discourse is borne out of what could be described as an urgent need to redirect the thinking and wisdom of the northern elders forum such that they can truly become the much needed oasis  in northern Nigeria’s desert of underdevelopment and vane quest.

I have always bothered about the irony that  northern Nigeria represents. Northern Nigeria remains the most backward by every standard yet Nigeria have been ruled mostly by presidents from this part.

It won’t be out of place to ask how these men have helped the fate of  northern Nigeria-a region that continues to wallow under the burden of diseases ,mass illiteracy as personified by the ubiquitous almajiris(street urchins) who are all over the place and making nonsense of whatever achievements made by northern political leaders in the name of governance.

And while I was still bemoaning the way mothers(especially teenage girls) are dying in the north, the children that died of lead poisoning early this year, the cholera outbreak, the embarrassing impact of river blindness, diarrhea, guinea worm, vesico virginal fistula, poor enrolment of children in schools, the existence of a northern elders forum brought smiles to my face. I was shocked to know about these “wise” old men and how influential they are even to extent to deciding who becomes the president of Nigeria-the world’s most populous black nation.

Gates:demonstrating the difference between being wealthy and being "possessed by wealth

I am still wondering where these elders stand in the face of the worrisome under development in the north. Im really troubled why these men have not met and arrived at a consensus on how to confront the problems of street urchins in the north.

These elders must be next to Elohim if they can ask Babangida, Gusua and Saraki  to step down for Atiku. And  I said to myself, how come these same elders have not been moved to the point of asking their subjects to award special scholarships to medical students of northern origin so as to strengthen the quality and quantity of  manpower rendering healthcare services in the north.

Perhaps, you would expect these men to speak up against the devastating impact of polio on the future of children. You would expect these men to become icons and advocates against child marriages and regularly engage their brothers and sisters about the need to protect their children from possible disability in the future if they don’t respond positively to polio eradication.

These men(and even women) would rather fly around the country campaigning for the presidential ticket, when there are more than enough work to do in their home state. It took a young man from far away America; a man who had no business doing what he is doing in the north to fight the polio epidemic.

I want to see a Babangida campaigning for an end to maternal mortality and offering to grant women free access to cervical and ovarian cancer screening and treatment, a Gusau advocating for prevention of  mother to child transmission of HIV and access to quality HIV education among young girls and women. I want to see a Bukola Saraki, an Abdul Ogbe, an Adamu Chiroma spend the rest of their lives advocating and pushing for bills that will guarantee access to affordable(if not free)quality health care service for everyone, particularly women and children in the north.

Ciroma:Leader of the "wise men" from the north

All these are  worthy causes any man can spend the rest of his life working for and the good thing about such causes if that you don’t need to rent a crowd to achieve them; you don’t have to pay Nollywood actors, footballers or musicians to sing your praise and you can’t heat up the polity trying to achieve them; it has nothing to do with a zoning formula either.

It is simply about doing things that would make the next generation believe that the word elder is not about senile dementia but about the sanctity and sanity of our redemptive decisions and consensus.

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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

I read an amazing story published on Tuesday, October 12, 2010 on 234next.com. It was the story of Oluwadamilola Olusola,a 25 year old law graduate currently serving in the National Youth Service Corps programme in Ogun State. Damilola facilitated renovation of the children’s ward at the General Hospital in Abeokuta.

One can arguably say that the corps member had no business embarking on such daunting task especially when she is not serving in the hospital; neither is she a graduate of medicine pharmacy of any of the science course. But the leader in her could not just stand and do nothing. She is just another Nigerian with the spirit of excellence who believe we must do things right.

“I am naturally very passionate about children,” Ms Olusola told 234next. “I came to the children ward with a couple of friends that have kids, and I saw that the condition was bad, then I decided that as a youth corps member I will use the platform to carry out personal community development project to do something about the condition.”

Please note the words “DO SOMETHING.”

She added, “I just wanted to do something to influence the community, so I embarked on this project to renovate the children’s ward at least to make the ward conducive for the sick children. I was very sad when I first saw the state of the ward, but I thank God that makes it possible for me to do something about it and make it better and conducive.”

Now, what exactly did Damilola do? It is worth analyzing because Nigerian politicians have a penchant for making little problems look so herculean that you think solving it would require rocket science.

According to the 234next story, she gave the ward a facelift by “re-painting the walls, providing new mattresses, window blinds, pillow cases, ceiling fans, new bed sheets, fixing of electrical and light fixtures, installation of wall notice board, installation of mosquito nets, decorations, and other aesthetic arrangements.”

The renovated ward.Poof that it really doesnt take a lot of silver to look as good as gold.Pic:234next.com

Although the total cost of the renovation was not disclosed, one can simply guess by estimating how much you spent the last time you painted your house, bought a ceiling fan, bed sheets and window blinds for your office. But you can tell that would not be the real amount Ogun State ministry of health would have spent if they were to renovate that ward.

So,why was the ward (a children’s ward for that matter) left in such a deplorable state? The answer is not far fetched. Why did it take the foresight of a corps member to wake up the sloppy and slumbering top government officials and, civil servants in the state to do something about the hospital? How many wards in that hospital is desperately begging for attention with everybody looking away and not willing to do anything? And you would want to also ask “don’t they have a chief medical director in that hospital? If they do, would he allow his or child to be on admission in such a ward?

Too many questions!

I’m particularly amused at the people Damilola went to while raising funds for the renovation. I even try to imagine what was going on in their minds as they made their donations. These are men and women whose responsibilities it is to put in place policies that would guarantee access to quality health care for the people of Ogun state .But they are all went asleep, leaving a 25 year old youth corps member to wake them up from slumber.

Just in case you are wondering, find below a list of those who donated to Damilola’s fund raising effort and you’ll understand what I mean:

“I generated the funds from corporate bodies and individuals like the state Commissioner for Local Government and Chieftaincy Affairs, Permanent Secretary, Ministry of Justice, Permanent Secretary of Local Government and Chieftaincy Affairs, Permanent Secretary Ministry of Environment, Permanent Secretary Bureau of Cabinet and the Redeemed Christian Church of God, Soul Winners Chapel, Lagos state and the Attorney General of Ogun state also donated generously.”

I don’t know what other definition we have for leadership if not what Damilola has demonstrated. And if we are concerned about increasing the life expectancy of Nigerians from the current 46years to 70years and above like in most oil producing nations, the leadership demonstrated by Damilola must be a way of life here especially among public office holders.

It is frightening to note that Nigeria like most countries in sub-Saharan African has a health systems crisis; a crisis made worse by lack of capacity to handle the disease burden and a wicked political class that is not just insensitive but clueless when it comes to solving very simple health problems. We have not forgotten the recent Cholera epidemic.

Damilola has just shown that our problem is not an absence of leadership or lack of capacity but the fact that our politicians have lost their sense of shame; nothing can embarrass them no mater how grave.

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As we conclude our discussion on the role infertility is playing in swelling cases of violence against women and the attendant health implication especially the spread of sexually transmitted infection, perhaps it won’t be out of place to ponder on the words of Dr. Oliver Ezechi.

In a recent interview with NIGERIAN HEALTH JOURNAL, Ezechi who is consultant Obstetrician & Gynaecologist and Chief Research Fellow and in the Sexual and Reproductive Health Research Unit of the Nigerian Institute of Medical Research, Lagos said:

“The pressure from society forces men infertile relationships to engage in extramarital affairs to prove their manhood. Now, because of the intense pressure, some women will also go out searching for pregnancy especially if they suspect the fault is from the man. This is so that the woman can be at peace, save her head and shut the mouth of everyone because sometimes the torments from family members can push people to unimaginable length.”

This is puzzling, to say the least. To think that there is a married woman somewhere, currently having affairs with other men(with the approval of her husband; by the way) so she can get pregnant and protect him from society’s ridicule is  one of the weirdest thing to imagine let alone do.

It doesn’t make sense to any observer who is not too conversant with the African society and how it is dealing with

African women:when will your jubilee come?

issues of infertility. But these stories are real and like some public health physicians and epidemiologists may have realized, have added to the list of harmful cultural practices believed to be driving the HIV/AIDS epidemic in most African societies.

Part of what this reality suggests is that  perhaps, marriage is becoming particular risky and dangerous for an average African woman as it appears that she is even more exposed to HIV in marriage than as a single woman.

Doesn’t this provide the basis for interrogating some of the cases of HIV sero-discordance we’ve had to deal with in Africa?

Dr. Ebun Adejuyigbe, consultant pediatrician and associate professor, Obafemi Awolowo University, (OAU) Ile Ife, Osun State would rather say an emphatic yes to that poser and she has a strong case to support her stand.

Just  in case you are wondering “HIV discordance refers to a pair of Sexual partners in which one is HIV positive and the other is HIV negative.”

After studying several cases of pediatric HIV infection she and her colleagues have had to deal with over a period of time  and the fact that only the mothers of the children were the ones with HIV, Adejuyigbe soon discovered that sterility or sexual impotency and infertility were all at the root of the whole problem.

“We discovered that these women  with HIV positive babies apparently were encouraged by their husbands to go out and be impregnated by another man. The choice of man the woman decides to opt for would be determined by the possession of certain physical features that could clear any possible doubts about the child’s paternity. No one would ever imagine that a man irrespective of his medical condition would allow his wife to go out and get pregnant by another man and pose as the father when the child is born”, said Adejuyigbe.

That is the norm in some parts of Nigeria and the women in a bid to shield their husbands from social stigma that comes with sterility or impotence would actually go and have sex with another man and come back pregnant for her husband. But these days, the women are not only coming back pregnant. They are also coming back infected with HIV. And their husbands may  never get infected especially for those whose husbands are sexually impotent.

“I never knew this was happening until we started noticing an unusual trend at the pediatric ward in OAU. We were seeing several sick children, infected with HIV and expectedly ,you will have to talk to the parents of such kids and after encouraging the mothers to go for HIV counseling and testing; the result is usually positive”.

That is often the beginning of several revelations according to Adejuyigbe, especially if the clinician insists that the father of the child should also be tested for HIV.

“The women involved would wonder at our display of naivety if we conclude that the man probably would also be infected with HIV. But they will tell us emphatically that their husbands cannot be HIV positive. Of course, you want to ask is he not infected and the women would tell you their husbands can never get infected because “he doesn’t, and can’t have sex with them. If you probe further they will tell you because he is impotent”.

This development was confirmed following further survey and interview of several women visiting the pediatric ward with children infected with HIV. The women are counseled to go for HIV test and if the result turns out positive, they are usually not in doubt as to the source of the infection.

It all started as a problem of infertility and the need to shield themselves from the social stigma that  infertility attracts. One partner decides to cover the shame of infertility they both will have to live with and it turns out that she is actually laying down her life.

Again, the question many would want to ask is ‘how can men protect their wives from society’s ridicule if indeed she is medically confirmed to be the one with the problem that has caused the couples infertility?’

Marrying a second wife or even divorcing the woman has been the norm for most men. If a woman could decide to get pregnant by another man just to protect her husband from the shame of sterility(and eventually get infected with HIV)then men should start thinking of a better sacrifice to make when the table is against their partners.

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In continuation of our series on Women, infertility and the price for saying ‘I do’, Kingsley Obom-Egbulem spoke with Dr. Oliver Ezechi who is consultant Obstetrician & Gynaecologist as well as a Chief Research Fellow and in the Sexual and Reproductive Health Research Unit of the Nigerian Institute of Medical Research, Lagos, Nigeria. Ezechi in this revealing interview shares his perspective of infertility as one of the causes of domestic violence  and sheds some light on what society can do to reduce the pressure felt by women whenever a couple is faced with infertility.  Excepts.

Is it true that infertility is not defined within the context of individuals…and that there cannot be an infertile man or woman. Can you clarify this?

Yes. Infertility is a couples thing as it takes two to make a baby. Infertility is defined as the inability of a couple to achieve pregnancy after regular and unprotected intercourse for a full one year. One partner may not be a able to achieve conception in one union but can succeed in another union. So it takes two for pregnancy to occur  and it takes two also in the case of infertility.

Given this definition why is it that men, especially in Africa don’t identify with sterility or infertility. Where is the origin of this norm?

It is purely a cultural thing. In patriarchal societies like most African setting, men never do wrong. In this setting, they have traditional ways of handling infertility when it is confirmed that the man has a medical issue. A brother or relation may be arranged to impregnate the wife and the child bears the name of the husband. But if the problem is with the woman, it is very obvious as she will not be able to get pregnant. The man just remarries. But if it’s the man, nobody

Dr.Oliver Ezechi

will ever know. Some women even protect their husbands and suffer the ridicule.

What is the implication of our perception of masculinity and infertility?

Because in our setting, we believe that infertility is always the fault of the women, a lot of women are violated even when it is not there their fault. We need to re-educate the populace that either party could be the cause of infertility in a relationship. Men and women contribute equally to infertility. Male – 30%, Female – 30%, Combined – 30% and unknown -10%. We have been wrongly socialized to accept  that men are superior to women and as such cannot be the cause of infertility in any union. Hence the man would not even want to see a doctor because he has been absolved of any problem by society in the first place. So, it is the woman that should ‘go and find out what is wrong with her.’

A lot of women have suffered various forms of violence perpetrated by their husbands due to infertility. Can you identify with this?

Yes. Because of the perception , even when the man is the cause he will except his wife to go out there and get pregnant. And when she refuses both him and his family will continue to inflict both psychological and physical violence on the woman.

What would push a man to this point?

To prove that he is a man after all. The male ego is at play here and the need to meet society’s expectation even if it means hurting your wife.

How can such domestic violence hinder a woman’s chances of conception?

With the psychological trauma the woman is very unlikely to ovulate as this affects the higher centres that regulate the reproductive hormones and signals. Also abusive men are more likely to engage in extramarital affairs with associated sexual infections. When he infects his wife, it leads to damage of the reproductive tract and infertility. Even in non abusive men , the pressure of the society forces them to engage in extramarital affairs to prove their manhood. Now, because of the intense pressure, some women will also go out searching for pregnancy especially if they suspect the fault is from the man. So, she can be at peace, save her head and shut the mouth of everyone because sometimes the torments from family members can push people to unimaginable length.

How can one address cases of domestic violence apparently resulting from infertility?

We need cultural reorientation and education of the populace on the causes and contribution of partners to infertility.

A black eye;a broken arm:the price to pay sometimes for saying I do?

We also need to address issues of assisted reproductive treatment and making adoption culturally acceptable as an alternative to having a biological child. In the case of assisted reproductive treatment, it should be made affordable for families given the implication of divorce and multiple relationships in a bid for couples to prove they are fertile.

Some men see it as a sign of weaknesses to go for fertility checks especially before marriage…can this be encouraged so as to prevent the pressure on their would be wives?

This should be encourage but we need  a reorientation before this happens.

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