by chikwe ihekweazu
The 25th of April just gone was the World Malaria day.
But I spent most of that day reflecting on my time on a paediatric ward, 12 years ago at the Abia State University Teaching Hospital in Aba, Abia State in South-Eastern Nigeria. These experiences I am sure are shared by any physician that has worked in paediatric ward in Nigeria…
In all these 12 years …the memories have lingered of children…mostly below 5 years brought into the paediatric emergency unit with a history of fever for well over a week, almost paper white with anaemia, in the arms of some desperately poor mother at a loss as to what to do. The medical history is classic….with the onset of fever, she attends different alternative sources of health care ….often a Patent Medicine Dealer, who “mixes” a concoction of medicines. This mixture probably contains some paracetamol (which initially relieves the fever) and some antimalarials (but not in the appropriate dose). The lethal consequence is that there is some temporary relief but the parasites rebuild very quickly and destroys red blood cells…leading to acute anaemia. The heart responds to the stimulus of insufficient haemoglobin (the carrier-cells for oxygen) by pumping more rapidly…and this precipitates the features of heart failure. This is usually the point where the mother gets scared and comes to the hospital…Many times…it was too late
The race would start at this point.
With a haemoglobin level of less than 5, weak, tired,…the one measure that will save that life and buy some time for the antimalarials: blood transfusion. The poor parent who has just paid for “card”, paid a deposit for admission, bought gloves for the clinicians…is now told that he/she has to go to the blood bank and get blood (obviously it has to be paid for). I remember vividly their looks of distress as they often explained that they will now have to run into town to look for any relatives that can lend them some money (this was before the mobile phone phenomenon in Nigeria).
I remember our “Blood Bank”!. The old, squeaky fridges… in a room with 2 wooden tables and chairs. I think of the rarity of our electricity supply. The epileptic existence of “HIV Kits”. The hungry-looking regular blood “donors” milling around outside waiting to be paid to make their 3rd blood donation of the week!
Sometimes the father came back on time, sourced the blood, and with appropriate anti-malarials…the child would improve radically, often within a few hours. The parents will thank us profusely and go home to face their huge dept burden….They were the lucky ones. These days I hear a National Blood Bank service has been launched and the need for blood has also declined with the recent advances in antimalarial chemotherapy especially intravenous artesunate.
Many would not make it…many! Either too late, too poor or a combination. I remember their faces…of the children…and of the mothers…but especially of the fathers. Men would not normally be emotionally explicit in our culture…so it shook me to my foundations seeing these men break down and weep….weep at loss of their children and at weep at failing in their role to protect and nurture them to adulthood.
In the early days of housemanship, one was very emotional too….and ran around to help every parent, often contributing financially. But sadly…and almost inevitably the trauma was “normalised”. The cries from the paediatric wards became a routine. Counselling the parents with “Ndo…, Ji si Ike, …”…became more rhetoric than real….and as usual we took solace in the phrase “O ka Chukwu choro ya” (it was destined to happen)
The frustration of realising that there is so little one can do at the point of the paediatric emergency department was overwhelming. If a parent does not have the knowledge and tools to prevent malaria, if he cannot afford the treatment, if the medicines are fake, if the blood bank has no blood, if the doctors are on strike…what real chance does that child have? What can the father or mother do? Can you imagine the feeling?
12 years ago….I was a fresh houseofficer, full of energy and enthusiasm for the profession…and proud to be called “Doc!”. The paediatric ward brought me face-to-face with the limitations of my recently acquired title. Despite all the children with malaria that died on the wards where I worked…I never quite came to understanding the pain until the past 3 years that I have spent trying to raise my own son…(things not taught in medical school).
On the 25th of April and since….I cannot help but think how we have all failed so many children. We assume that Malaria is a simple illness…and it is indeed. But only simple in the context of a well educated, resourced and organised society, which sadly we are not.
3000 children die from malaria every day world wide and a good many of them are inevitably Nigerian. Do not think of this World Malaria Day in the context of these figures…think of it in the context of your own child, brother, nephew or niece.
Next time you are going home to the village, maybe rather than buying clothes for your relatives or “dashing” them cash…load your boot with bed nets. Teach them how to use it. Yes, it is difficult in the heat (thanks to our ever epileptic power supply) and sometimes cumbersome. But compare that to the alternatives…
But maybe most importantly…join hands in holding our Ministers, and Commisoners of Health accountable.
Ask NOT how many MRI machines VAMED has installed in the Hospital, but how many deaths from malaria they prevented. Let us hold those responsible for “health” accountable in “health terms”.
Picture courtesy of www.doctorswithoutborders.org
Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead