Thursday 26 July 2012

SEX STUPID?



Peter Ebeigbe recently published results of his study into the ‘knowledge and use of contraception by rural in-school adolescents in Delta State’. The article appeared in the recent edition of the Nigerian Journal of General Practice (March 2012). It makes disturbing reading and I believe every adult especially teachers and general practitioners should read it. He wanted to find out the knowledge and use of contraception by adolescents in randomly selected rural secondary schools. He distributed questionnaires to 233 children, and found that only about half had had any information about how to prevent pregnancies. The information was from doctors and nurses in 17.2%, school teachers in 16.7% and a family member (relatives/elder sister) in 11.2%.  My first question is: what is the input from fathers and mothers? Are we shirking our responsibilities?

In the article, Dr Ebeigbe further noted that about 65% had had sex at age 15 years. But, perhaps more worrying is that only 31% (31 in 100) used a condom consistently, 39% practiced coitus interruptus while 25% relied on ‘washing the private parts’ to prevent pregnancies and diseases! The high level of ignorance highlighted by this study is incredible, especially in this age of the internet and wider availability of information. The second question I have is this: What is the policy on sexual education in our schools and when is such education delivered to the children?

Sex Stupidity
Exposure to sex and early sexual debut in teenagers is a risky behaviour and counter measures must tackle this aggressively. In one report, a substantial proportion of adolescents reported not being able to communicate with their parents about HIV/AIDS, abstinence, or condoms. There is very low level of sexual communication between children and parents and an uncomfortable silence is common across all socio-demographic subgroups. Previous studies suggest that mothers can help adolescents make responsible sexual decisions by talking with them about sexual health.

Yet, it is not clear how and when mothers make decisions about talking with their adolescents about sex. Studies are needed to determine how mothers make decisions about talking with their adolescents about sex, as well as to examine to what extent and in what instances mothers can reduce their adolescents' sexual risk behaviour by providing comprehensive, developmentally appropriate sex education well before adolescents are likely to debut. Information must be provided to children early emphasizing the importance of abstinence and delay in sexual experimentation. With the booming spread of HIV throughout the World, a sex education program in schools is urgent. The government has a duty to our future generations.

Abstinence and remaining a virgin must be promoted as desirable societal qualities. American Academy of Pediatrics recommends counselling teenage children on sexual behaviour and postponing sexual activity. Educated parents are still resistant to impart healthy knowledge and practice of sex with their adolescent children. Most teenagers use their peer groups as the sole responsible guides: to inform them about their sexuality and most of the time, may be driven to the wrong practices. As AIDS is spreading like fire in every part of the World, educating teenagers is an urgent need before HIV makes its way through among the innocent teen children. Parents cannot and should not be ashamed to discuss sexual matters with their children. Do not leave them sex stupid!

Condom use by all
Despite recent reports that there is increasing condom use, generally resistance to condom use is still high. There are studies, carried out between 1990-2004, showing that young people assess a potential partner’s disease risk, and the need for a condom, by their appearance and how well they know them socially. Factors inhibiting condom use and exploring issues of responsibility for safe sex practices to prevent infection must be discussed openly. We need to reinforce the thoughts that safe sex practices (specifically condom use) should be everybody's responsibility. It is not the 'other' persons’ responsibility. Each individual must be equipped with condoms and so eliminate the pressure associated with decisions whether to proceed with unsafe sex or not. With the real risk of such dangerous diseases as Hepatitis and HIV/AIDS on the horizon, you cannot afford to be complacent. It is wise to have a stack of condoms at home and in your wallet. It is foolish not to have one if there is even a remote possibility you might be having sex.
Sex is a dangerous game
With the exception of the few who engage in sexual marathons, most people agree that sex lasts on average about 5 minutes. Thereafter, the effect can last a lifetime with pleasure, pain or death to follow. In this regard, the pleasure could last for a short time afterwards, then followed by more pleasure on the background of a happy relationship, or be trailed by pain in unrequited love and the many tragedies related to unhappy liaisons. Or sex can be followed by tragedy, misery and even death. The question remains: Has attitudes to sex changed over the past decade? Do people now realise that sex is not just a passive pastime and more importantly, that ‘sex is a dangerous game’.  This of course, since the 80’s, is mostly because of the scourge of HIV and AIDS. HIV/AIDS has grown to become the biggest epidemic in modern history.

The people who should know
In 1997, at the Davos International Economic Forum, Nelson Mandela stated that "the poor, the vulnerable, the unschooled, the socially marginalized, the women, and the children, are the sectors of society which bear the burden of AIDS". Nearly a decade later, that statement still holds true, especially in Mr. Mandela's home country, South Africa.  In the same country, former South Africa health minister, Manto Tshabalala-Msimang, nicknamed, Dr Beetroot, was ridiculed for promoting garlic and beetroot rather than antiretroviral drugs for treating the HIV/AIDS. The tragedy was that she managed to persuade her government to apply these beliefs in national health policy, with disastrous consequences. South African politicians, including President Thabo Mbeki bought into such ‘lunatic thoughts’ and tens of thousands of South Africans lost their lives because of their ridiculous policies on HIV/AIDS.

You have heard, of course, seemingly sane people promoting herbal cures of HIV/AIDS in Nigeria. Radio and Television stations, because of the revenue, carry advertising of untested and possibly dangerous remedies. How many people are they killing, inadvertently?

There are huge gaps in the HIV/AIDS knowledge of the people in Nigeria especially the marginalised, rural and uneducated. It is often the fact that many hear of HIV/AIDS after the ‘horse has bolted from the stable’. Peoples’ sexual behaviours are affected by the environment they live in and influenced by thoughts and actions of peers and other people.
Accepted behaviour is reinforced within the community and is difficult to change by external interests or even health personnel. But we must try. Doctors, nurses, the educated and those in government should have up to date knowledge of best sexual health practices and the risks inherent in unsafe sexual practices.

No street cred
The point to note is that HIV/AIDS has no street credibility. You cannot be proud to have AIDS. It is not like cancer which is acceptable in the community and which can even be ascribed to a spiritual attack. It is currently not a disease to be proud of, despite the number of high profile cases in the news. HIV/AIDS is not fashionable and is regardless of how you contracted the disease. It could be you were infected by your loved one, or via a needle stick injury in a hospital or blood transfusion. It may even be after your very first sexual experience. It does not matter. Nobody truly cares about the history and how many people are you going to tell? As always, prevention is better than cure.

Sex is a dangerous game: it has always been, but more so now than ever.


Friday 20 July 2012

Spinal cord injury: What you need to know

As Published in Blueprint Newspaper Thursday 19th July 2012 
I find it rather amusing and unbelievable that anyone can have a road traffic collision on Sunday afternoon in Abuja. I mean the roads are great to drive on and often quiet with little traffic. So, I am always amazed that people still have head on collisions and fatal crashes on a day of rest! Monumentally stupid to be rushing around on a lazy Sunday!
The fact is that driving skills are abysmal and many people seem to lose their heads once behind the steering wheel. Now, with such accidents, some people also lose their necks. Spinal cord injury is all too common in Nigeria, that I am considering going around with a hard neck collar: so I can apply it on the next accident victim.
Prevention is cheaper
I got into a taxi cab to travel a short distance. I usually sit in front and with the seat belt fastened. On this day, the driver said, ‘Oga, no need for seat belt, na short distance we dey go’. I looked at him and asked him whether he thought I trusted his driving. He laughed, nodded his head in understanding and promptly put on his own seat belt. When I seat in front like this, I am also driving with the driver, watching the road and cautioning about care on the road and speed. It is the least you should do.
You know, in the past, farmers and palm wine tapers, falling off trees, were the people who sustained spinal injuries. Nowadays, road traffic accidents account for the majority. Many patients have been involved in accidents where the vehicle somersaults several times. The injuries occur often at the time of the accident or subsequently during extrication or transfer to hospital. Most patients present with partial or complete paralysis of the arms or legs or both. This includes loss of sexual function and loss of the ability to urinate or pass stool normally. This is because the spinal cord carries all the nerves that supply movement and sensation to the rest of the body. If the cord is severely damaged, the paralysis may be permanent.
A costly business
In the past, most patients with neck injuries in Nigeria were managed conservatively (without operation). This was because of the paucity of experts trained in managing such injuries, lack of specialised equipment and of course the cost of treatment. Even then, the cost of not operating is significant. The cost in managing a paralysed person includes the hospital bills, costs of a carer to look after the person, loss of income and long term rehabilitation costs. This could easily run into millions of Naira. There are also significant material and emotional costs.

Helpers do more harm
Ideally, treatment should start at the site of trauma. Safe and careful extrication, safe transportation and immobilisation in hard neck collar are crucial. It is known that following neck trauma, stabilization using a hard collar reduces movement of the neck. These patients cannot and should not be moved without adequate protection and care. I cringe when I see members of the public attending an accident and pulling the victim without due care. Please just call 122 to summon the Federal Road Safety Corp.

Initial care
Spinal cord injury with paralysis is often associated with lifetime morbidity, so early active management is crucial. The initial care of patients with acute injury to the neck (cervical spine) is of paramount importance. Function of the nerve and spinal cord can be adversely affected by excessive motion of the unstable spine.

Diagnosis
Early diagnostic and clinical evaluations are important in determining the severity of the injury and making plans for subsequent management. Timely and appropriate imaging studies using x-rays, CT and MRI scans are essential to the cervical spine evaluation. Hospitals must be able to offer early neurological evaluation, investigation, diagnosis and surgical management to the majority of patients.

Management, manpower and resources
Because of the inadequacies of many of our hospitals and lack of equipments to perform the operations and rehabilitation, it has become very expensive to treat patients with this kind of condition. This is why many patients with spine problems get abandoned by their relatives because they could not afford the cost of treatment. Some families also take their patients home, where many of them later die.

Rehabilitation?
Prolonged survival has resulted from better understanding of the effects of spinal cord injury. All over the world, spinal injury centers have done much to increase the survival of and quality of life of cord injured patients. Rehabilitation is also very important whether the patient has been operated or not. The importance of the role of post-injury rehabilitation cannot be over emphasised.

No rehabilitation centres!
There is need to congregate these patients in spinal rehabilitation centres where dedicated experts and facilities exist for improving the outcome of treatment through physical and mental rehabilitation. The establishment of rehabilitation centres would go a long way in improving the social rehabilitation and survival of the patients. Some of my patients travelled abroad for rehabilitation. This cost on average about N20 million for 3 months of rehab. I am yet to see the benefit and that money is better spent creating similar units here in Nigeria.

Know the facts
The high morbidity associated with spinal cord injury could be reduced through public enlightenment on road safety measures and personal awareness. Wear a seat belt, drive carefully and be cautious, wary of other road users. Do not let anyone drive you crazily (this includes public and private vehicles).You cannot be too careful. You cannot afford to have a spinal cord injury. It’s your neck so protect it by using your head!

Seriously, we need to establish or refurbish spinal and trauma centres that are equipped to function. Improved outcomes can be achieved with a careful approach and multidisciplinary integrated care including improvements in intensive care and effective rehabilitation centres.

Protect children
Children are transported in pretty dangerous manners in cars on our roads. Many times, I see children unrestrained in cars and this is not right. There must a law against this and it must be actively enforced. This is child abuse and should be stopped. It is even worse when you see that the driver (mom or dad) is wearing a seat belt!

BASIC LIFE SUPPORT
Recently, I asked Chief Medical Directors, “Can your hospital save your life?” Do you have staff trained in the basic life support skills: such that if YOU are taken to your own hospital, they will give the best and necessary care, to save your life? This is an important question and hopefully will push CMD’s to review their hospital’s delivery of vital life saving services in emergencies. Same goes for all organizations involved in medical care and resuscitation. If needed, there is a course on basic life support and trauma care coming up in Abuja next week.   

This provides an opportunity to equip yourself and staff for life. Please call me for more information.