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.
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