Saturday 26 May 2012
Thursday 24 May 2012
God's Children in Nigeria's Health System
A pregnant woman gets ultrasound
One World
The babies were delivered at 5-month of pregnancy.
The mother had a scan early in the pregnancy which showed the womb was
opening up. This necessitated admission to hospital and the usual tests
and investigations. The doctors tried tying up the womb to no avail.
They used various medications to quieten the womb to no avail.
Eventually, they gave up and prepared to deliver the babies. It seemed
that the babies (twins) were in a hurry to come into this world. Just in
time for the Olympic Games, 2012. The delivery was smooth and the
babies came out weighing little more than a big mango. They were
immediately put into incubators and on a ventilator to breathe for them.
Each day, a team of doctors and nurses review them and do numerous
little acts to keep them safe and sound. Sometimes, an ultrasound of the
brain, sometimes an operation on the heart and other times this and
that drug. Two months on, these babies are alive and well and still only
really “seven months of pregnancy”. Still incredibly premature and
largely immature in all aspects of the word!
Another World
The parents brought in their child to see me on a
warm afternoon. The beautiful baby boy, born only a day previous, has a
swelling on his back they said. I unwrapped the baby to examine him and
see this swelling for myself. Behold, it was a soft, squishy, membranous
swelling on his lower back. This we call myelomeningocele and spina
bifida. Big words for big problems! It means that the spinal cord is
protruding through a hole in the bones of the back and therefore exposed
to injury. Normally, as you know, the brain and the spinal cord are
protected by bone (skull and spine bones respectively). They are also
wrapped in a “nylon” as you find bread wrapped up to protect it. That
nylon is called meninges and this is what often protrudes through the
hole in the bone. The baby’s legs were weak and the ankles were twisted
inwards. It was obvious the legs were paralysed and this means that the
spinal cord in the “swelling” at the back was already damaged. There was
also a deformity of the bones with parts missing and other parts folded
on top of each other. The hole in the bone was so wide you could drive a
bus through it.
“Did you do antenatal”, I asked. “Yes”, the mother
replied. “Did you do ultrasound scans of the pregnancy and did they tell
you about this swelling”, I asked. “Yes”, the mother replied. “We did
scans on many occasions but, nobody said there was anything wrong”. The
baby would need an operation to repair the swelling and protect the
spinal cord from further damage. But, the reality was that the paralysis
was likely to be permanent and the baby would have difficulties in
walking, passing urine or passing stool normally. The bent ankles would
also need to be straightened in plaster casts over the following few
months and maybe even years. Big problems from such a young age!
Avoidable problems
Myelomeningocele, Spina Bifida and Hydrocephalus are
congenital abnormalities that occur in children and need to be treated
very carefully. They are also often preventable. Prevention is with
folic acid taken by the woman. This vitamin is recommended for all
pregnant women because it is important in the formation of the brain and
spinal cord in humans. The brain and spinal cord develops within the
first 2 months of conception and so it is vital that folic acid is
available during this period. The woman should therefore, ideally, have
been taking folic acid long before getting pregnant. Soon as you decide
you want to get pregnant or that you have put yourself through the risk
of a pregnancy, start taking folic acid, to ensure the normal
development of the baby’s brain. In some countries, flour, bread and
even water are fortified with folic acid in attempts to reduce the
occurrence of this problem.
One of the vital aspects of antenatal care is the
performance of an abdominal ultrasound scan to confirm the age of the
pregnancy. Some women have early miscarriages that may be due to the
womb opening up and not able to contain the baby. This type of problem
can lead to women being childless if not sorted. The ultrasound can also
and should detect abnormalities such as meningomyelocele. It can and
should also discover any particular problems with the baby, the womb and
the location of the placenta. But, it has to be performed by someone
who has been trained in the procedure and who is certified proficient in
the skill. That person must be able to detect this type of problems and
therefore advice the parents. The ultrasound scan is a vital part of
the antenatal care and is to be taken very serious.
“Who performed the ultrasound scan for you”, I asked
the mother. “It’s the doctor in the hospital where I registered”, she
said. I shook my head and knew that the doctor may have been doing this
ultrasound scan but he is unlikely to be qualified, nor skilled in the
interpretation. If he or she had seen this problem early enough in the
pregnancy, it is an important reason for termination of the pregnancy.
Or otherwise, early delivery via a Caesarean section to avert some of
the problems this child and the family will now face.
But of course, she may be lying all along and did not
attend a hospital for care. Perhaps she had gone to the ubiquitous
traditional healer or birth attendant, or even to church. These people
do more harm than good, but because we have priced medical care out of
the reach of ordinary Nigerians, business is booming in these places.
Business and such problems as above are on a linear trajectory.
Maternal and infant mortality is high in Nigeria.
Similarly, there seems to be an increase in the rate of disabilities in
children. Children with epilepsy, paralysis, blindness, deafness and
other lifelong disabilities are increasing in number. Since, the
individual families bear the brunt of the problem, there is very little
statistics on it and it is largely ignored by Government. Are you living
with a child that has autism, cerebral palsy, mental retardation,
epilepsy or weakness of an arm or a leg? Is any Government body or
agency aware of the child’s condition? Is there support from anyone? Or
you just rely on God! Those who rely on God continue to live with the
children and do the best they can. Some parents however cannot and so
either kill or abandon the children in churches, mosques or the few
orphanages and motherless babies’ homes in Nigeria.
Now, let me bring this together for you.
There is a role for you and for the Government. There
is also a role for God; after all, these are God’s children…in Nigeria.
Your role, as a MOTHER or a FATHER is to provide a safe environment for
your children. This means a safe womb, free of germs and disease and
with all the nutrients your baby needs. Then, you must seek out
knowledgeable people to look after your pregnancy and ensure all is
well. Information is power and you must empower yourself by taking an
interest and asking the right questions.
David came to me with his wife, who I was treating
for back pain. He said she was now pregnant and would like to know if
the medications I had placed her on might affect the baby. I quickly
checked the drugs and immediately stopped some of them that could cause
harm to the pregnancy. If he did not tell me, how would I have known
until maybe the baby gets harmed? Doctors are not psychic and need to be
given information to help you.
Secondly, avoid traditional healers and preachers.
Pastors especially must be allowed to minister on the spiritual plane
and not the physical. We should stop compromising the ideals of religion
on the altar of money. Do not go to them for medical treatment. Allow
them to connect you with the powers of God and pay your tithes so they
do not stray. They should pray for you, not play with you.
Doctors and nurses should not step outside the
boundaries of their skill levels and training. Many people have been
hurt and killed by people who practice outside their comfort zones. Some
doctors, nurses, chemists, laboratory scientists perform sham studies
and give reports they are not qualified to give. It is up to you to
avoid them and report problems to the appropriate authorities. We must
deal with this. Each professional association must monitor its members
and weed out the quacks.
Finally, the Government must provide an enabling
society and the right conditions for children to thrive in Nigeria. The
first story at the beginning of this article occurred in the United
Kingdom. All the care and cost of care for the twins are borne by the
state and all future management to ensure the sacred life of the
children is assured. Those children would not have survived an hour in
many of our best hospitals in Nigeria. Even if they did survive, what
happens next? A country that relies on foreigners and foreign aid to
help her with immunisation of her children against diseases such as
polio and chickenpox is not serious.
The second story of course is about a Nigerian child. A CHILD OF GOD!
Dr Biodun Ogungbo, MBBS, FRCS, FRCS (SN), MSc, is a Consultant Neurosurgeon at Cedarcrest Hospital, Abuja and Director, Stroke Action Nigeria.
Thursday 10 May 2012
Killer breasts as published by THISDAY newspapers
Jacqueline
Ado (fictional name) has big breasts and she came to inquire about reducing the size of her
breasts. They were so huge she could not bend forward to sweep the house
without toppling over due to the massive shift in her centre of gravity and the
weight redistribution. She walks bent forward, by force, due to her mammary
glands. Her neck and back aches.
Her
boobs (breasts to you) came into the room minutes before she actually appeared.
They were right there in your face and unavoidably present. They seem to take
up all the space in the room and all the strength of her body. Mind you, she
was not exactly a lean woman, but the size of her breasts qualifies for huge.
Julius Berger cranes may be required for providing a lift and holding up the
breasts requires steel brassiere.
Big
breasts are desired by many women and admired by most men. However, mammoth
breasts are actually pathological and should be avoided like a plaque. They can
cause a lot of problems for the sufferer and are definitely not for play. Some
men may disagree.
Huge
breasts, are on their own, a source of discomfort, pain, ill health and they
increase the risk of disease. With killer breasts like this, you do not need
enemies.
Risk
of Diabetes
Girls who are
obese experience earlier onset of puberty and possibly greater breast
development. Several studies have also found that a woman's breast size in late
adolescence is associated with an increased risk of type 2 diabetes mellitus in
adulthood. A Canadian study reported that after taking into
consideration numerous established risk factors such as physical activity,
smoking, diet, family history of diabetes, body mass index and waist
circumference, among others, it was shown that in a graded fashion, the bigger
the bra cup size – the greater the risk of developing diabetes. Specifically,
in comparison to women with an A cup, women with a B, C, and D or greater bra
cup had increasing risk of developing diabetes. This is a disease well worth
avoiding.
Obesity
There is evidence of
an association between breast volume and other body fat depots. Women with
larger breasts have more fat everywhere else than other people. In other
words, large breasts appear to indicate a body type characterized by the
increased deposition of fat in depots, such as inside the muscles and in (and
around) many body organs. This all increase their cardiometabolic risk.
Arthritis
Women with large,
heavy breasts sometimes experience back pain and neck pain. The added weight of
the breasts increases the rate of wear and tear around the joints in the back,
neck and knees. This accelerated degeneration leads to arthritis. Women with
arthritis of the spine and shoulders may also have more disabling symptoms than
usual because of the extra weight of heavy breasts. Lumbago, lumbar
spondylosis, lumbar disc prolapse and lumbar nerve compression are some of the
many diagnoses that overweight predisposes people to. These may require
surgical intervention. However, before you rush to the neurosurgeon, consider
the following facts.
Breasts are a
major contributor to the higher incidence of neck pain in women. In 1996, a
court in America established that breast reduction surgery was indeed medically
necessary to relieve headache, neck pain and shoulder pain. This verdict
established the cause and effect relationship between breasts and neck pain.
The way your breasts are and their size affect your posture and influence the
way you position your spine. How big is your bust size? Well, if your breasts
are too big, neck pain may be your portion. Try strapping on two five pound
sacks of sugar all day. Even just thinking about it hurts, and I am a man.
According to Dr
Christina Lasich, an American pain specialist, how you feel about your breasts
can also affect your posture in a negative or a positive way. If you like your
breasts, your posture might be confident and the spine well aligned with your
chest out. If you hate your breasts, your posture might be shy and slumped with
your chest sunken behind the shoulders.
Breast cancer
Of all the
possible problems one could have because of huge breasts, by far the worst is
breast cancer. The size of the breasts makes it difficult to discover cancer in
time and at a time when it might be curable. A study reported in 1989
found that women with large breasts experienced a delay in the detection of
their cancer due to the bulk of the breast and consequently presented with more
advanced tumours compared with women with small breasts. On presentation to
hospital, patients with big breasts had larger tumours and more involved lymph
nodes than women with small breasts. Women with large breasts may therefore be expected to fare worse than those with small breasts.
A breast
specialist and plastic surgeon in Abuja, Dr Amina Abubakar is understandably
concerned about the plight of women with massive breasts. She describes her
concerns and some more of the problems patients face. "Patients with large
breasts can inadvertently suffocate their babies and even their husbands", she said. "The
condition can also lead to paralysis of the hand due to stretch injury on the
nerves in the armpit".
Solution
There are women
who desire bigger breasts and opt for breast implants. However, they should
ensure that the size is a source of joy and not discomfort or a lifetime of
misery. Women who have naturally big breasts should consider breast reduction
surgery. The operation can be done safely and efficiently to produce a better
fitting and sexy breast. You could also breast feed without worry if the
operation is done efficiently by a competent hand.
Whose breast it, anyway? Be breast aware. Do
not let your breasts kill you.
Sunday 6 May 2012
Best article I read this week
Speeches
Ambassador John Campbell
(Former US Ambassador)The Harvard Law School Nigerian Alumni Reunion Dinner
Friday, June 25, 2005
Muson Center, Onikan, Lagos
PROTOCOL
· The President and Executive of the Harvard Law School Association of Nigeria,
· Distinguished guests,
Ladies and Gentlemen:
Good evening and thank you for that warm reception.
I must say, I was thoroughly delighted to receive your invitation.
I am always fascinated and pleasantly surprised by the ways in which our two countries intersect.
This is my second tour of duty in Nigeria.
Indeed, I fancy myself somewhat of a Lagosian.
I know the markets, love the art and listen to highlife, jazz and juju music.
So when Mrs. Adekoya contacted my office asking me to address the Nigerian Chapter of the Harvard Law School Alumni Association, I had to contain both my curiosity and enthusiasm.
Harvard University occupies an august and some might even say rarified position in the pantheon of American higher education.
Harvard prides itself as the oldest corporation in the Western Hemisphere.i
Established in 1636, just 16 years after the Pilgrims landed at Plymouth, Harvard University is America's first institution of higher learning.
Harvard's size and influence has grown exponentially from its original nine students and one master to an enrollment of 18,000 degree candidates.
In addition to the 10 principal academic units, approximately 13,000 students undertake coursework in the Harvard Extension School.
The University employs over 14,000 people including more than 2,000 faculty members.
To date, Harvard's faculty has produced 40 Nobel laureates.
Seven presidents of the United States - John Adams, John Quincy Adams, Theodore and Franklin Delano Roosevelt, Rutherford B. Hayes, John F. Kennedy and George W. Bush - were graduates of Harvard.
As members of the Harvard Law School Alumni you represent an important and growing constituency among the Law School's 37,000 alumni worldwide.
Your international network of legal practitioners is dedicated to advancing respect for the rule of law.
The pursuit of justice and the respect for the rule of law under gird Nigeria's quest for national development.
Rule of law is an essential ingredient in the democratic mix.
Nigerians, like freedom-loving people the world over, hunger and thirst for leaders who will develop her tremendous human capital and manage her vast material wealth transparently.
I served here in the 'bad old days' of military dictatorship - tyranny, I am pleased to say, Nigerians will no longer tolerate.
Indulge me as I tell you the story of ray deer, an ancient West African tale.
All of the animals were invited to a feast.
As usual, ray deer was hungry and decided to take a short cut through the forest.
En route to the party, he encountered leopard.
In uncharacteristic fashion leopard said to ray deer, if you tell me three truths I'll set you free.
Ray deer responded, I'll tell you four.
Truth number one, if I had known you were going to be here, I would have taken a different path.
Truth number two, if you let me go, I will never pass this way again.
Truth number three, if I tell the others that you let me go - they will never believe me.
Leopard marveled at ray deer's reasoning; I suspect he graduated from Harvard Law.
Finally, ray deer said truth number four, you must not be hungry, because if you were, we would not be having this conversation.
There are two morals to this story.
Don't take short cuts and the truth shall set you free.
Clearly this story has application for Nigeria in the 21st century.
The road to democracy and development is fraught with dangers and setbacks but with perseverance, transparency and accountability the journey is well worth it.
But remember the two prescriptions from our story -- do not take short cuts and remember that the truth shall set you free.
If Nigerians seize the opportunities afforded by its emerging democracy, she will soar like an eagle, a national symbol our two countries share.
With your indulgence then I would like to take just a moment to share a few insights from President John F. Kennedy's Inaugural Address.
Delivered over 44 years ago, shortly after Nigeria's birth as an independent nation, the wisdom and relevance of his words resonate at a profound level today.
He observed that 'man holds in his mortal hands the power to abolish all forms of human poverty and all forms of human life.'
This paradox continues to confound and perplex us at the beginning of this new century.
Members of my generation recall President Kennedy's stirring appeal to service with the words 'ask not what your country can do for you; ask what you can do for your country.'
But Kennedy did not stop there. As a leader educated at America's oldest university, he went a step farther and addressed the international community saying '(m)y fellow citizens of the world; ask not what America will do for you, but together what we can do for the freedom of man.'
Ladies and gentlemen, I am here to assure you that the United States of America remains fully committed to deepening the very partnership that President Kennedy championed.
As international stakeholders, Americans work in tandem with Nigerian governmental and non-governmental agencies and institutions on several key policy priorities, such as, arresting the spread of HIV/AIDS, malaria, tuberculosis and other emerging infectious diseases and supporting Nigeria's leadership role in resolving regional conflicts.
Tonight, however, I have focused my thoughts squarely on what I deem our most important bilateral policy priority - strengthening democratic practices and institutions.
To rephrase another wise American president, Abraham Lincoln, democratic governance, with its commitment to accountability and transparency, represents the 'last best hope' for Nigeria's future.ii
The benefits of liberty, however, come at a price.
President Kennedy said '(l)et every nation know… that we shall pay any price, bear any burden, meet any hardship, support any friend, oppose any foe, to assure the survival and the success of liberty.'
I have been fortunate to live and work among you.
Nigerians are among the most resourceful, talented, engaging, dynamic people on this planet.
Thus, I am persuaded that Nigeria, led by people such as you, will secure the dividends of democracy.
An independent judiciary that applies the law 'without fear or favor' must form the foundation of the edifice we call the Federal Republic of Nigeria.
An electoral system that conducts 'free and fair' elections where the results reflect the will of the people must be the bedrock of 21st century Nigeria.
That is why with rights come responsibilities; these are core democratic values.
Indeed, ladies and gentlemen, they are non-negotiable because a society that has no respect for the rule of law cannot move forward.
Let me end by telling you the story of the two area boys and the wise man.
Two area boys decided to play a trick on the wise old man who lived next door.
They collected a small bird and went to the old man asking "Baba, is the bird dead or alive"?
You see, they had already decided to shame the old man.
If he said the bird was alive, they would crush it and show him the lifeless body.
If the old man said that the bird was dead they would release it to fly away.
The old man thought for a while and then answered, "my sons, whether the bird is dead or alive I do not know but, there is one thing I can tell you - it (the bird) is in your hands".
Will Nigeria take her true place of leadership as a full member of the community of democracies?
I think yes.
By employing the creative energy of the crucible we call Nigeria, you can forge the requisite tools to ensure that peace and prosperity flourish.
But as the wise old man told the area boys so I tell you - the choice is in your hands.
Let's not forget ray deer's lessons either - the truth shall set you free. As you continue your journey along the path of national development - don't take short cuts.
Thank you.
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