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Archive for the ‘maternal mortality’ Category

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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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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By Kingsley Obom-Egbulem

The burden of infertility, especially in Africa is borne by women. This is not arguable. Aside being the one to carry the pregnancy(whenever it occurs) ,she is also the evidence of  infertility in the relationship. Even in churches,what you  hear most times is “sisters trusting God for the fruit of the womb”.But  it takes someone to plant the seed that bears the fruit there. How about “brothers also trusting God for a seed for the womb” for a change?.

So, whenever a woman’s tummy is not protruding, she is infertile irrespective of the fact that she needs someone(yes a man) to get her pregnant. And it doesn’t matter if that man in question has impediments that  appears to have limited his reproductive capacity.

Now, when the man is apparently the  source of infertility in a relationship, the African society tends to cover it up and protect him from the  ridicule that most women  suffer even when it has not been medically proven that she has problems conceiving.

The sad side of the story is when  the woman is subjected to all forms of physical and emotional abuses- a problem she is not  even responsible for.

In my interactions with organizations dealing with issues of domestic and gender-based-violence  not a few of them confirmed that infertility among couples have contributed to cases of battery and physical abuse in some homes. Leading eventual to divorce.

I was told the story of a woman whose husband was  diagnosed with aspermia (a medical condition in which no spermatozoa are present in the seminal fluid). For years, this woman suffered dehumanization from her in-laws because she couldn’t conceive. Of course she couldn’t have been able to conceive given the problem with her husband. She wasn’t too sure whether her husband knew he had this problem before they got married but what was clear was that the man was always brandishing his clean bill of health whenever she demands that they both see her doctor.

She was always doing one medical tests after the other just to be sure she wasn’t the problem. During some of her appointments her doctor will tell her “your eggs are ok and would be released between now and mid-day tomorrow; please make sure you have sex with your husband during this period”.

Unfortunately for her, this is the period the man chooses to “travel” for one business engagement or the other just to conceal his problem.

After several of such suspicious strips which often coincides with her ovulation period, the woman insisted on eithertravelling with him or stopping him from travelling. That was when the man restored to violence and physical abuses.

Sometimes he will beat her to pulp, lock her up in the house for days and “travel”.

But there was this trend that made her suspect that either there was something fundamentally wrong with her husband

Women:always at the receiving end of every infertility-related humiliations:But would our patraichal society turn the table in her favour?

or that she was in for a nightmarish relationship. She noticed that whenever her husband goes for these phony trips, his younger brother will visit the house.

He comes in close to midnight; feigning ignorance of his brothers purported trip. Since it is too late to go back home, he would opt to pass the night and throughout the night he would make passes at her, hoping that it will culminate in sex.

Her husband’s younger brother is apparently aware her husband is suffering from aspermia and his regularly visits especially when she’s ovulating (and the brother is “away”) is an orchestrated move to get her pregnant and save the husband the shame of being seen as sterile or not being man enough.

Being her ovulation period, the thinking is that her chances of accepting her brother in-laws overtures will be higher and her chances of getting pregnant will be  higher too. Ultimately ,the baby that would come out of this arrangement may have some resemblance with her husband since he looks so much like his younger brother.

The plan never worked. The woman didn’t fall for it. At a point the brother in-law almost raped her. That was when she reported to her husband what has been happening each time he “traveled”.

The husband’s remark was a frightening wake up call albeit a critical flash point .

“So what, if my brother decides to sleep with you? What is the problem with that? Don’t you know that what belongs to me belongs to my brother too and when Im not around it is his duty based on tradition to “take care” of you?”.

That was all she needed to decide whether or not to remain in the marriage. And the fact that the beaten from her husband had assumed a rather brutal and senseless dimension at this stage was  also a deciding factor. For him, not accepting to sleep with his brother frustrated his game plan and continues to expose him to ridicule. So the beating was an expression of his frustration and a way of making her pay for her stupidity.

Eventually, she escaped from the house-back to her family house and never went back till date.

Why should society continue to torment a woman for a problem she is not responsible for? Even if she responsible for the problem there are some that she couldn’t have done anything about especially if it is congenital. Why should couples live in hatred and violence or be torn apart  due to cases of infertility that can be medically resolved?

The answer to  any of these posers is definitely anybody’s guess.

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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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A s part of its 2010 Women’s Week programme, a church in Lagos offered opportunities for subsidised screening for breast cancer and cervical for women. Interested women were to pay N1000 for both tests.

Just in case we’ve forgotten both diseases kill no less than 100,000 women per year. Late presentation of patients at advanced stages when little or no benefit can be derived from any form of therapy is the hallmark of breast cancer in Nigerian women.

Most women will rather buy Aso ebi, recharge cards, hand bags to match than go for medical screening. I accompanied my wife to do this screening and her results were negative.(she had done some test earlier on her ovaries and they results were encouraging too).

But I was indeed surprised and disappointed that every few women took advantage of this opportunity to know how they weigh on the cancer scale. Most women who die from these diseases ,according to clinical research evidence either get to know about it very late or they don’t know at all until it is revealed by a post mortem.

So, why would a woman shun such a test when it can go long way in determining a lot of possibilities for her in the future? Many say the current global economic situation has distorted our priorities in Africa and that had affected our perception of critical issues such as the need for periodic checkups as disease prevention mechanism.

People would rather eat junk meals at fast food outlets, buy Nokia E71 Series, Blackberry and travel to Dubai for shopping but would choose not to spend N1000 to find out whether or not they are at risk of cervical or breast cancer. What a strange wisdom?

You can find out more about cervical cancer by clicking on this link. “This cervical cancer is killing our women softly”.

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