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Archive for the ‘tertiary health care’ 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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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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Ibrahim Umoru has been living with HIV for over a decade. He is the coordinator, Network of People Living with HIV/AIDS in Nigeria (NEPWHAN)Lagos Chapter, a peer health educator and currently engaged in some form of advocacy that seeks to address the issue of HIV among sero-discordance couples.

Ibrahim Umoru

Not a few people will admit that one of the things HIV does most times to any family is that it rips it apart by first breaking the marriage and setting couples against each other. This has especially where there have been cases of established or suspected infidelity. But Umoru feels this shouldn’t be.

“I think couples can still live happily ever after even with HIV”, he says. If a man who is HIV negative can decide to marry an HIV+-and vice versa,I don’t see why any marriage should break up because one of the couple tested positive to HIV.” Is he alone in this reasoning? Does anyone really share such audacious optimism?

Beginning from this week, Umoru will be coming your way with updates on HIV sero-discordance and how families affected by HIV can cope and still stay strong together. Most of his articles will based on his personal experience of living openly with HIV form more than 12 years .You can always visit this blog and click on ThisCORDANT Notes for regular updates.

Best regards.

Kingsley Obom-Egbulem

Moderator

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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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