WHY ARE NIGERIAN WOMEN DYING IN CHILDBIRTH?

I am still in shock. The tragic death of the spouse of my friend in Lagos recently has left me in a state of mourning. It is one death that should never have happened. It is one of those needless deaths that expose the deplorable state of our health care system. It is unfortunate and unacceptable that many of the labour rooms in our health institutions have become death chambers where expectant mothers go to die. Visiting a hospital has become a necessary risk. For the ordinary citizen who cannot afford to travel abroad for medical reasons, being left to die in the hands of quacks and disgruntled incompetent health workers in our broken health institutions is a hard choice they have to make.

While our political elite can seek quality health care services in some of the best hospitals abroad, while their spouses can afford to give birth in choice American and British hospitals, Nigeria’s bottom poor are left to die in our run-down public hospitals under perpetually irritated medical workers who often vent their frustrations on their patients. In recent times, I have heard and witnessed enough maternal deaths that have left me wondering why life means nothing to us as a people. Experiencing those tragedies have left me scared and scarred. This latest one was painful because I witnessed the couple’s wedding three years ago.

I remember the joy of the bride and groom. The bride was the happiest on her wedding day but now she lies in a morgue, a victim of Nigeria’s decayed health system. With her death, she has become another victim in the endless statistics of maternal death that stalks Nigerian women. The story was as pathetic as it is shocking. On a certain night when my friend’s wife began to experience the signs of labour pain, they headed for the hospital where she registered where she was wheeled into the labour room. But she did not return home alive. In the labour room, events took a different turn.

After several hours of trying to deliver her baby, the woman died in the process. What went wrong? How did a woman who walked to the hospital on her feet end up being wheeled to the morgue with an unborn baby? The husband told me that after several hours of trying to be delivered of the baby, his wife became too weak that she could push no more. But the nurses kept admonishing her to push until she became weakened from the long hours of prodding.

He lamented that in spite of the pleas by family members that his wife be allowed to deliver the baby through Caesarean section, the nurses reprimanded them for attempting to teach them their job. And in any case, there was no gynaecologist in sight. After several hours, the labour room went quiet as her cries stopped. The nurses emerged wearing long faces and avoided breaking the news of his wife’s demise. He stormed into the labour room and only to meet the lifeless body of his wife–with the baby also dead. He passed out momentarily and was only revived later.

He is still devastated.

In recent years, more Nigerian women are dying from childbirth. The worst cases are those that also affect the babies. Unfortunately, no one seems to be paying attention. Hapless and helpless Nigerian women are dying every day in various hospitals and maternity homes across the country. While only a few cases are reported, many maternal deaths never make the headlines. When women die from childbirth, children are orphaned and families are devastated. I have heard stories of women who die with their unborn babies. Yes, people die, some deaths are inevitable, but statistics of maternal mortality points to negligence, unprofessional conduct and in some cases ignorance by the victims.

Across the country, there exist clandestine delivery homes and rogue maternity homes operated by charlatans. Some of these privately run so-called health facilities are known to health regulatory agencies. Our public hospitals are also some of the worst places for pregnant women today. Expectant mothers often have to endure the negligence of abusive and aggressive nurses and other health workers. I have been in a public hospital where agonising heavily pregnant women were left unattended to for hours. Once, I heard a nurse yell at a heavily pregnant woman, “Madam, stop shouting here, na me give you belle?”

Maternal death is also caused by other factors. According to experts, severe bleeding and infections (usually after childbirth), High Blood Pressure during pregnancy known medically as pre-eclampsia and eclampsia, complications from delivery, unsafe abortion, HIV and malaria pose great risks to expectant mothers. But these conditions are preventable if well-managed. According to a study by Boniface Oye-Okediran et al, published in the Annals of Tropical Medicine and Tropical Health, risks such as obstructed and prolonged labour, which killed my friend’s wife, also account for over a third of the deaths that occur during childbirth.

According to the study, skilled practitioners can recognise and deal with slow progress before labour becomes obstructed and if necessary, ensure that Caesarean section is performed on time to save the mother and the baby. But for women to benefit from those cost-effective interventions, they must have antenatal care in pregnancy, and in childbirth they must be attended to by skilled health providers. But a majority of women could hardly afford quality antenatal care and these conditions degenerate or are not detected during childbirth. In many public hospitals, the Obstetrics and Gynaecology section is chaotic with only a few gynaecologists on hand to attend to pregnant mothers. The attitudes of hostile nurses in public hospitals who abuse and harass mostly poor expectant mothers also drive them into the hands of charlatans.

The Maternal Mortality Rate report 2013 updated in 2014 by the World Health Organisation rated Nigeria among five countries in sub-Saharan Africa with the highest number of maternal death in the world. According to WHO, there were an estimated 289,000 global maternal deaths in 2013 with sub-Saharan Africa accounting alone for 62 per cent (179,000) of the deaths. Africa is considered the riskiest region in the world for dying of complications in pregnancy and childbirth.

The MMR was calculated by taking into consideration the deaths of women while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by the pregnancy or its management. India and Nigeria are reported to account for one thirds of global maternal deaths in 2013. About 40,000 pregnant women died in Nigeria in 2013. It is worse in Northern Nigeria. Maternal deaths occur particularly in areas where women have many babies in short time spans under malnutrition, poor hygiene conditions and lacking access to medical treatment. The last National Demographic Healthy Survey placed the National Maternal Mortality rate at 545 per 100,000 live births. UNICEF’s estimation of the incidence of maternal mortality in Nigeria is from 800 per 100,000 to 1,100 per 100,000 live births. Most maternal deaths are preventable, as the health care solutions to prevent or manage complications are well-known.

Nigerian women need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth. Government and stakeholders in the health sector must work to end maternal mortality in the country.

 

By Bayou Olupohunda

FGN: Ebola Trouble Not Over Yet

The Federal Government said on Tuesday that the country was still under Ebola alert and surveillance.



The government’s fresh warning is coming one year after the World Health Organisation certified Nigeria free of the Ebola Virus Disease.

The Permanent Secretary, Federal Ministry of Health, Mr. Linus Awute, said this at a press briefing on Tuesday evening in Abuja.

The press conference was held to commemorate the WHO certification one year ago.

According to Awute, Nigeria cannot rest until when “transmission of the disease in human population reaches zero in West Africa.”

He said, “In the past one year, Nigeria has not lowered her guard. We remain vigilant through enhanced surveillance, not only for Ebola but also for all diseases that constitute public health emergencies.

“This was demonstrated by the numerous responses and investigations of the Ebola scare, particularly the recent one at the University of Calabar Teaching Hospital. Within the same year, Nigeria availed her resources to the ongoing response to EVD outbreak in West Africa.”

While warning citizens, Awute stressed that the disease could still be transmitted sexually by survivors.

He said, “Since Nigeria was declared Ebola free, the global Ebola control environment has changed based on new evidences around care for Ebola in pregnancy, survivors related symptoms, discovery of Ebola vaccine, relapse of the disease by survivors carrying the virus in their semen and vaginal secretions.

“These recent developments have changed our understanding of the clinical and epidemiological characteristics of this disease. This poses a stronger challenge to us and our neighbours who have these survivors in their thousands and also signifies that the fight is far from being over. Volunteers shall serve as our foot soldiers, which deserve national recognition for meritorious service to the nation.”

He praised the sacrifice of late Dr. Stella Adadevoh and the medical team at the First Consultant Hospital, Lagos, where the Liberian-American, Patrick Sawyer, died and infected some of the health workers.

The permanent secretary also commended the contributions of President of Dangote Group, Alhaji Aliko Dangote; Founder, Tony Elumelu Foundation, Tony Elumelu; the US government, WHO, UNICEF, Japan, Bill and Melinda Gates Foundation, National Primary Healthcare Development Agency and other international organisations.

The Project Director, National Centre for Disease Control, Prof. Abdulrahman Nasidi, pledged that survival clinic would be established to carry out surveillance functions.

He said that the clinic would act as a resource centre to equip health officials with the technical expertise to address challenges relating to the Ebola virus.

The PUNCH reports that Nigeria has not recorded any case after it was declared free of Ebola in October last year by the WHO, although there have been some levels of resurgence of EVD in Guinea, Sierra-Leone and a relapse case in the United Kingdom.

There were 19 confirmed cases in Nigeria, with eight deaths and 11 survivors.

Awute said that the success recorded in the fight against Ebola “has become a pivot for how our beautiful country should tackle problems proactively and in times of emergencies.”

http://www.punchng.com/news/ebola-trouble-not-over-yet-says-fg/

Labels: Nigeria

How we plan to stop Nigerians from foreign medical trips

prof chukwu

How we plan to stop Nigerians from foreign medical trips

The nation’s Health Minister, Prof Onyebuchi Chukwu, has many worries. One of the tasks before him is how to stop the outflow of foreign exchange in the name of medical trips abroad. He says in this interview with EMMA UJAH that some Nigerians, including public officers, travel abroad for treatments for which Nigeria has expertise and technology to effectively handle and that such waste must stop. Excerpts:

What was your first challenge upon assuming office as Minister of Health?

From time to time, I have been looking at issues regarding the Nigerian health sector. The first thing that I understood about the Nigerian health sector is that certainly, the minister, the minister of state and indeed the Federal Ministry of Health cannot do it alone because health is supposed to be on the concurrent list. I said it is supposed to be because under the current constitution, it’s not mentioned there at all.

It’s neither on the concurrent list nor the exclusive list. So, that tells you how we appreciate health matters in this country. But going by the 1979 constitution, it was clearly on the concurrent list. So what it means is that the Honourable Minister of Health alone cannot pretend to be responsible for the healthcare of Nigerians. He has to be sure that various local governments and commissioners of health, work with him. This means that he has to work very hard to get the cooperation of all stakeholders.

There is a body called the National Council on Health, which meets once or twice in a year. But it is a consensus, advocacy and collaborative body and not just one where only the minister forces his instructions on the members.

What is the issue at the federal level? In the health sector, it is the responsibility of the federal government to ensure that epidemics are prevented, managed and taken care of. That is the only area that is the exclusive responsibility of the government when it comes to public health and epidemics.

How then are you collaborating with the two tiers of government to provide for efficient health services for Nigerians?
We operate from three levels: primary, secondary and tertiary. The federal government concerns itself only on the tertiary. What it does in the primary health care is to show the way for other tiers of government to follow. So, it is an instigator, a catalyst and promoter of primary health to ensure that it remains the bedrock of healthcare in the country.

We have five priority areas in the health sector. The first is leadership, followed by governance and stewardship.

The second priority has to do with meeting the Millennium Development Goals, MDGs. The third priority is disease prevention, surveillance and control, by the federal government. The fourth one, given the background of what we met on ground where people were not working together in the health sector, especially the heads, professionals and groups working differently without harmony. It was clear that team work was the major mandate which Mr. President has given to the Minister of Health.

Finally, why do Nigerians still have to go outside the country to access health care and sometimes even what you may regard as ordinary healthcare? So, those are the five priorities which the government wants to tackle in the health sector.

One major health challenge in Nigeria is malaria. What are you doing in this regard?
Malaria remains an endemic in Nigeria. Malaria is being fought with what we called integrated vector management, which is what we all agreed under the World Health Organisation, WHO. We are integrating this by ensuring that all pregnant women must take preventive drugs to assist them maintain malaria free period. We are saying that they need to sleep under the net just like the children and other people who are vulnerable to malaria. These nets must not be ordinary ones.

Then Nigeria did what no country has ever done in the world by distributing almost 15 million nets from 2009 to date. Our target as at the end of 2010 was to distribute 63 million nets and we will get to that figure this year, but the population has increased and we need to do more than that. Everybody acknowledged that we have improved even though we can still do better.

Those nets are treated ones being distributed free, but people can buy them from shops. We distribute free to people who are vulnerable to malaria and can protect them for up to two years. We also do the indoor residual spraying, which we have been doing and it is still going on, but we have only been able to cover about 80 per cent of households. The spraying protects for about three months after which one needs to repeat it.

Is there the possibility of mankind having a vaccine for malaria?

It is difficult but not impossible. A few months ago I was specially invited by think-thank groups in the UK to lead a discussion at a forum. It was a two-day meeting where the strategies for fighting malaria were to be discussed. And also the vaccine candidate that has the greatest promise. We call them vaccine candidates because they have not been proved to have universal protection against malaria.

The best of all of them is the RTSS which is being produced by GSK. Preliminary trial shows that it can reduce the number of episodes of malaria when someone has been vaccinated with that particular one by 50 per cent.

So if you used to suffer about six episodes of malaria a year, it reduces it to three. It still has not been zero. We came to discuss the development. It is most promising. It is not easy to produce vaccines because of the nature of the genetic make-up of the parasite.

There is hope now and the target is that by 2020 more work would be done by GSK. Now it can help us to reduce child mortality. We discussed the modalities for introducing the vaccine to tell people that it cannot protect for ever but it can reduce malaria.

Another one is tuberculosis, TB. It also remains a problem in Nigeria, but what has made it worrisome is the fact that we have more drugs resistance in the country.

Unfortunately, the facilities for treating them are just being developed. During the TB Day on March 24, this year, we went to Lagos to open a new facility, which is a joint effort of the federal government, Lagos State government, WHO and the United States which has been committing a lot of funds to TB control by establishing the facility in addition to what we already have. Presently we have centres in Ibadan, Calabar and before the end of this year; the one in Zaria will be opened. And hopefully, that of Kano will also come on stream as we have started developing them.

This year, the federal government will buy the second line drugs to treat the multi-resistance TB. What we have been doing is team work; we have set up a Presidential Committee on Harmonious Relationship among professionals in the health sector.

It took the committee almost a year to submit its report, but we have reviewed it at the ministry and would soon be taken to the Federal Executive Council, but most of their recommendations have been accepted by the ministry.

Again, the present administration has cleared all the arrears of salaries of health workers in the federal government service. This is a major achievement in the area of staff welfare in the country, though there was a problem when the administration came on board, we have been able to pay all the arrears, so we do not owe workers. For sometime now, the federal health workers have not been on strike, but at a time, it was like an everyday show. We are into months now without having any strike by the health workers at the federal level. We hold meetings with them regularly where we interact and discovered that team work is better for all.

Then still on the issue of disease control and surveillance, we are doing well. WHO says Nigeria is one of the best countries that are doing well in terms of integrated disease surveillance. But we want to do it better; we have a system that is working though not up to our standard as Nigerians. This present administration of President Goodluck Jonathan, for the first time in the country established the Nigerian Centre for Diseases Control with a director, Professor Ola Sidi in charge.

We are also working with the United States which has the original centre for disease control to further develop it.

Also, we have been able to introduce new vaccines for meningitis that can last for 10 years instead of the usual two years, but the introduction to cover the whole country is in phases.

Don tasks doctors on service delivery

FORMER Chief Medical Director, University of Benin Teaching Hospital (UBTH), Prof. Eugene Okpere, has urged medical doctors across the country to put service to humanity first before financial gains.

He also admitted that it was morally wrong for doctors to go on strike as strikes have always put lives of patients in danger.

He stated this at a lecture he delivered in a ceremony organised by the University of Benin Medical Students Association (UBEMSA) in collaboration with Ashanti Graham Health and Education Initiative Foundation (AGHIEF) where the foundation’s founder, Douglas Okor said there was need for the Federal Government to invest in manpower development that could rule the medical world in 15 to 20 years from today.

“Our vision is 21st century healthcare for Nigeria, like the kind of healthcare you have in developed countries and by our projections, in the next 15 to 20 years, we will have that kind of healthcare.

“We have all it takes in Nigeria to get to where we want to be, but what is lacking is the people to get us there. We lack the people for direction and that is what we are now preaching that we need leaders.”

Okpere in his lecture said doctors needed to develop passion for their jobs adding that for the over 37 years he has been practicing he had maintained the vow he made when he was inducted as doctor “never to turn down any patient because of money or refuse to attend to any patient.”

He said administration has also been a bane of Nigeria’s hospitals just as he said he increased the daily revenue generated at the UBTH when he became the CMD from N3 million to N20 million four years after.

source: guardiannews