I just watched a movie – Spare Parts and I can vividly relate with the story.

It reminds me of the days when we struggled to set up a University of Ibadan chapter of SIFE (now ENACTUS).

I remember the politics around registration with the students’ affairs, the recruitment process and boy, the participation in the National competition for the first time.

Initially, my cofounder and I had a disagreement on whether to participate or not. While I believed the debut would entrench the team within the University and in SIFE Nigeria, my partner felt we should wait another year as we were barely few months old.

I insisted and together with a few disciples, we set out to implement some projects that could be presented at the nationals. My sense was that the feedback, success and challenges would prepare us for the bigger stage in the coming years. I remember going to visit my grandfather whose house is within the hilly Oke Aare area of Ibadan. While I was willing to say hello to grandpa, I actually needed the shots from his balcony to introduce our presentation from the premier university located in the brown roof city of Ibadan.

The Squad!

The next hurdle was to secure the university’s permission to participate in the competition. We needed a travel permit and a waiver for the participants who would miss their examinations scheduled for the same dates of the competition. After long negotiations in the DSA’s office, none of our requests were granted. By this time, it was almost 4pm, the even of a competition that was to commence in Abuja by 8am the next day. Not even the intervention of the Country Director would change Prof’s mind.

Thankfully at 5:30pm, we left NNPC mega station in Ibadan having filled the tank of a students’ bus which I secured with a strong face (ogboju) and we were headed for Abuja. Let me add that I’m the only one on the bus who has been to Abuja before (just once though).

Some minutes before midnight, we got to a dead end within what I believed to be Kogi State. The only set of ‘creatures’ (who appeared to be human beings) we saw could neither speak English nor Yoruba. How then do we retrace our steps to the road? The bus was drenched in rain and the leaky roof was already exposing some occupants to the cold temperature of rain water.

As though I had a map in my head, I requested that we make a detour and in no time, we were in Obajana- a more familiar terrain. Sitting in the front passenger seat, I observed that the fuel gauge blinked the first orange light. Fuel don enter reserve!

All through this, I tried not to imagine that our co-competitors would either be enjoying sound sleep in their hotel rooms or rehearsing their presentations. How do I wake people who have almost twist their necks in a bid to catch some sleep in the cold rain to rehearse their scripts? On an empty stomach? No way! The urgent task at hand was to get some fuel to continue the journey so I chose to focus on that. Meanwhile, I instructed the driver to park by the roadside so we don’t exhaust the fuel before securing more.

After wandering for a long time in the ‘wilderness’, luck shone on us as we were directed to a black market where we bought 30 litres for some ridiculous amount(about 5 times the normal price). We resumed the journey at about 3 am and by 6 o clock (2 hours) to the kick-off time, we were at the venue.

Did we participate in the competition? Yes

Did we win? No

Were we fulfilled? Yes

Did we die? No

Are we better for it? Yes

PS: the picture might not do justice to how we felt being at the SIFE Nationals. The look might betray the joy in our hearts. However, the joy, the smiles, the laughter and jubilations of any UI ENACTUS team member that stands on the podium at the National competition is the reason we endured that pain.

I recently received a notification that this year’s competition would be held online and I just smiled, filled with the nostalgia of our sojourn, 12 years ago.

Can there be any of my reader who has never had caffeine? I doubt it, as it is not limited to coffee drinks alone. It’s everywhere, beautifully packaged, in varying quantities, from certain soft drinks, to tea, some over the counter pain relievers, to bitter Kola, not sparing chocolate and it products. Yes, that chocolate in your hand contains caffeine beat that!

Caffeine addiction like most other addictions starts gradually often relating to an initial genuine use. With time, tolerance develops and higher quantities are required to give desired results. One thing is however common to most caffeine addictions-it begins with a desire to stay awake or active. It then leaves the victim to wonder, how did I get here? The subject gets gradually and later excessively dependent on it to meet need-basically to remain active.

In essence, nobody sets out on a mission to caffeine addiction; it begins with increasing workloads, demands in personal life, school or at work. It comes handy in coping with pressures.

How do I know when I am getting addicted to caffeine? Watch out for the following signs which I must say are not limited to caffeine addiction though. They are however, only strong pointers: restlessness, disturbed sleep, rapid heart rate, and feeling of heart pounding, shakiness and stomach upset.

Getting rid of Caffeine addiction can be as simple as A-B-C and can as well be as demanding as learning A-B-C. It requires first and foremost, a sincere determination to end the scourge.

First, you are advised to start by cutting down on caffeine intake. Attempts to suddenly stop may be health-challenging if not absolutely impossible. Ever heard about caffeine withdrawal symptoms? They can be devastating.

In addition, you must watch out for other common sources of caffeine and avoid them. This is necessary so that you don’t dump a caffeine source for another out of ignorance. You may have to read the contents of every packaged product before you take them. This becomes more important when you notice a sudden love for a particular product.

You may also dilute your coffee with say water or milk. This in a way helps you cut down on your body concentration in a gradual fashion.

Try out on caffeine-free beverages; they are going to serve as ready replacements to your addictive caffeinated beverages. They still meet your needs in certain ways.

Exercise often, especially when you feel your energy level is going low. Take a walk for about 5-10 minutes.

Very importantly, seek medical intervention promptly. You don’t have to wait till the situation becomes unbearable. A stitch in time they say saves nine.

Hamid Adediran is Medical Doctor+Broadcaster=Medicaster, follow @hamid_doctalk on twitter

PS: This write up was started about 2 months ago, delayed due to circumstances beyond my control (in Nigerian parlance) but revived due to my further experience; by fate design in the Nephrology unit-the medical speciality that deals with Kidney-related health problems.

As far as my memory can carry me, I first heard about Kidney failure in 1996 thereabouts when the case of one Augustine Adoroh was broadcast on our local television in Ibadan (BCOS that is). There was a clarion call to come to the aid of this young man in his 20s (or 30s, I can’t precisely remember).
His problem;his kidneys were said to be damaged, he has since been washing his blood to remove wastes through a machine (what I later grew to know is called dialysis). The ultimate solution to this his medical problem was a Kidney transplant where a donor (usually a relative) would donate one of his/her functional kidneys. It was an amazing revelation to me then that one could cope with just one kidney.
The mother had volunteered to donate the kidney but they needed huge funds to refer him abroad for the transplant. The ‘blood washing’ also costs him a fortune,something he had to do on a regular basis.
Trust you would wish to know where he is now and perhaps how he is doing? Well, quite sadly his death was announced a few weeks later, after the required amount had been completed but the pre requisite tests and procedures were still being carried out here in the country when he gave up the ghost.
I felt very bad and sad, I cried for the life of the young man cut short. I sobbed for the mother who would have to watch her son being lowered down the grave despite having volunteered one of her kidneys.

As a medical student in the University College Hospital, UCH, Ibadan, I heard about the first Kidney Transplant in UCH. It was meant to be a ‘coded’ attempt more because the first recepient was a quite popular man. I heard a few more information that I would not be sharing on this platform as they were only privileged information.*puffs chest*
Yes, I was quite close to some of my lecturers and consultants (on a number of grounds).
I felt glad, I saw a ray of hope for patients with chronic kidney disease, I saw a better chance of survival especially for the young people who battle with this critical clinical condition.

Another sad event on this kidney-related issue was when I sighted a friend in the Intensive Care Unit (ICU) of the hospital. He looked lifeless, rather unconscious. Fola had been more than a friend; a medical school colleague and in fact, he was a Secondary School classmate with whom I jostle for prizes, he had always got more than me and alas, yet again, he got the ultimate prize before me-Death!
Yes, a few hours after I spotted him in ICU,news of his death filled my BlackBerry Messenger, at such a tender age of 25.
I had seen him weeks earlier while he was being prepared for the Kidney transplant as donated by his Sister. The surgery was said to have been successful but how events took a twist remained a mystery which I am sincerely not willing to dissect here.

As a House Officer, I have had to manage quite a number of patients with Chronic Kidney Disease. Disturbing however is it that most of these cases would be of young people between ages 19 and 32, and I mean those figures the way they are.

Common causes of kidney diseases/failure have been listed as hypertension,Diabetes mellitus,Genetic,infection(including HIV),drug abuse,alcohol usage(including alcohol-based mixtures),kidney stones,heavy blood loss,to mention a few.

It must however be noted that majority of these causes can be avoided, while others can be promptly managed if detected early.

The question unfortunately is how many young people present themselves for testing? How many of us go for regular medical check ups? How many of us promptly treat ourselves when we are sick or merely short of good health? How many of us are aware of all these risk factors? How many of us who are aware avoid all these risk factors?

Those are posers for us all to reflect upon and amend our ways.

Let us all take our life very seriously and stop deceiving ourselves that life begin at forty when we actually see people around us ending their lives before the said forty years. Or well,may be it means they never lived.

A healthy life starts with you and me.
Those bean-shaped organs are to be treasured and nurtured,protect them from unnecessary pressure.

Hamid Adediran is Medical Doctor+Broadcaster=Medicaster, follow @hamid_doctalk on twitter

These days (and even from time past) we see them hawking it in bottles, different types, various constituents, diverse diluents especially at spots where we have predominantly male folk as well as areas of ‘activity’.

They carry cars with megaphone attached speaking different languages showing various pictures all to entice and convince their unsuspecting potential customers.

Technological advancement has also affected the market positively as they now come in ‘tush’ forms,well bottled and sometimes as capsules.

A friend once asked me what I feel about Afrodisiacs and my answer was very simple ‘it can be helpful but it can be dangerous’. The question then is ‘Do you need help?’ If yes, how much help? The next question is ‘at what level is it dangerous?’
All these questions put together make me feel one is perhaps safer without them.
You may not quite agree with me,but wait till you read about this our 32 year old young man and I bet you’ll stone the next ‘jedi’ seller in your hood.

He came into the Emergency room clad in ‘agbada’, I was going to ask if he thought he was going for a social function in the hospital. He didn’t even wait for me to ask, he simply pulled up the agbada for me to see the erect ‘rod’ underneath. In a low tone, he said ‘Doctor,it has been like this for 16 days’!
As a physician, the responsibility is on me to hold back(or at least pretend to be holding it back) my emotion-in this case utter surprise!

As a man, I asked him to cover it up quickly (if only to preserve the dignity of manhood) then I adjusted my chair properly to listen to his history.

Our Superman is a young traditional healer (Babalawo) a profession he inherited from his father. He recently took up a new wife who he said was always complaining about his sub optimal performance in bed. As a custodian of authentic herbs and shrubs,he felt insulted and then came up with a very powerful afrodisiac concoction.
Even his father,who doubles as his teacher and mentor attested to the fact that the son used thrice the normal dose of the Afrodisiac.

“Physician,heal thyself” so the saying goes. He battled with a persistently erect straight ‘rod’ for 16 days but when things didn’t get any better,he had to seek for intervention the ‘oyinbo’ way.

This condition is medically known as Priapism and the teaching is that it is caused by failure of blood to return properly in penile circulation. This may be due to obstruction within the penile blood vessels usually with blood clots.
The solution is therefore simple, get the circulation back to normal and everything will be fine. This procedure is called Shunting.
Simple as this procedure is,it is not without its attendant risks and likely complication,commonest of which is Impotence.
Isn’t it then amazing that the solution to ‘extra super potency’ could lead to impotence? Rebound effect right? That is it!

We took this our Superman for the procedure, however, 24 hours later, things have not yet come to normal. We had no choice than to further take him in for another round of the procedure which further heightens the risk of impotence in this young man just in his early thirties.

The bewildered new wife (who I suspect to be in her mid twenties) once worked to me and whispered ‘Doctor, is it going to be like that forever?’ I smiled back and simply replied ‘Madam, we will try our best’. As much as I would have loved to say more than that, the ethics of my profession would not permit me.
She wanted a Superman,she got a Superman but I’m afraid he might have now become a sub-man(if there’s a word as such) or even a woman- feminisation sort of.

I actually don’t blame the poor woman, she just wanted to be satisfied. I only expect the man to have been more reasonable in his attempt to satisfy her at all cost.
Needless to say this woman would simply find her way once the man becomes a mere woman, afterall its all man for himself,God for us all,that’s what they say.

A lot of young people (and some old ones) now feel the need to go extra mile to satisfy their women, by hook or by crook. Afrodisiacs come readily to rescue especially the ones from roots and herbs- Afrodisiac Africana. They are cheap and readily available but the price to pay when it backfires may be ultimate and sometimes eternal.

The message is simple; think twice before you buy! A few minute pleasure may truncate eternal pleasure.

Hamid Adediran is Medical Doctor+Broadcaster=Medicaster, follow @hamid_doctalk on twitter

You may have witnessed or even be involved in a Road Traffic Accident at one time or the other.

The simple text below will help broaden your horizon as per possible intervention before the arrival of a Physician or an expert.

PRE-FIRST AID EVALUATION
ASSESSMENT OF VICTIM’S CONDITION

INTRODUCTION
First Aid is the initial intervention given to a victim to save his/her life before the arrival of the Physician.
Not so easy as it appears
Skill required, that’s why you are here
The first rule of first aid and the primary concern is SAFETY

AS A FIRST AIDER
First aiders are never required to place themselves in a situation which might put them in danger. Remember, you cannot help a victim if you become a victim yourself.
When a first aider is called upon to deal with a victim, they must always remember to safeguard themselves in the first instance and then assess the situation. Only after these steps are completed can treatment of the victim begin.
When called to a scene, remember that your own personal safety is above all else
Goes without saying
Before you enter a scene, put on personal protective equipment, especially impermeable gloves.
As you approach a scene, you need to be aware of the dangers which might be posed to you as a first aider, or to the victim. These can include obviously dangerous factors such as traffic, gas or chemical leaks, live electrical items, buildings on fire or falling objects. While many courses may focus on obvious dangers such as these, it is important not to neglect everyday factors which could be a danger.

There are also human factors, such as bystanders in the way, the victim not being co-operative, or an aggressor in the vicinity who may have inflicted the injuries on the victim. If these factors are present, retreat until the police are able to control the situation.
Always remember the big D for Danger.
Once you have assessed the scene for danger, you should continue to be aware of changes to the situation or environment that could present danger to you or your victim until you have left the scene.
Never put yourself in harm’s way

Unless the victim is in a life-threatening situation, he or she should NOT BE MOVED
If there are suspected spinal injuries, do not move the victim (except when the victim is in a life threatening situation).
How do you suspect spinal injuries?

What has happened?

Ask anybody, even a child, a mad man, the information might just be all you need
Preferably the most responsible-looking by-stander
Assess the Scene: Does this area have motor vehicle traffic? Is this area known for violent crime? What time of day is it? What are the weather conditions?
Look for Clues

Get some History – If there are witnesses, ask them what’s happened “Did you see what happened here?” and gain information such as how long ago it happened “How long have they been like this?”, but be sure to start your assessment and treatment of the victim simultaneous with your history taking
Be sure to Listen – While working on a victim you may overhear information from witnesses in the crowd.
Responsiveness
This can be started with an initial responsiveness check as you approach the victim. This is best as a form of greeting and question, such as:
“Hello, I’m here to help you. Are you alright?“
Or, “Are you okay?”
The best result would be the victim looking at you and replying. This means that the victim is alert at this time
AVPU
In an emergency setting, the level of responsiveness is categorized by using what is called the AVPU scale, AVPU stands for the four possible categories they can fit into. They are either “Alert”, “Verbal”, alert to “Pain”, or “Unresponsive”‘
If the victim looks at you spontaneously, can communicate (even if it doesn’t make sense) and seems to have control of their body, they can be termed Alert.

KEY INDICATORS
Eyes – Are they open spontaneously? Are they looking around? Do they appear to be able to see you? Do they look “glassed over”?
Response to voice –
Do they reply?
Do they seem to understand?
Can they obey commands, such as “Open your eyes!”?
Do they know where they are or what happened to them?

RESPONSE TO PAIN
The first, and most gentle stimulus to use is a tap/shake of the shoulder
Sternal rub – This is performed by grinding the knuckles of your clenched fist vertically up and down the victim’s sternum (or breastbone).
Nail bed squeeze – Using the flat edge of a pen or similar object, squeeze in to the bottom of the victim’s fingernail or toenail.
Ear lobe squeeze – using thumb and forefinger, squeeze or twist the victim’s ear.

Any of the responses A, V or P, mean that the victim has some level of consciousness. If they are not alert, you should always summon professional help – call an ambulance.
If they are only responsive to Voice or Pain, then consider using the Recovery position to help safeguard them if they need to vomit.

GO DR SHAVPU
A First Aider should have
GO – Put their gloves on
D – Checked for danger
R – Checked for responsiveness
S – Looked at the scene for clues about what has happened
H – Gained history on the incident
AVPU – Assessed to see how responsive the victim is.

VISUAL ASSESSMENT
Visually determine whether there are life-threatening or other serious problems that require quick care.
Breathing
Bleeding
Shock
Burn
Choking
Heart Attack
Fractures

CLINICAL ASSESSMENT
ABCH
Airway: Use your finger to sweep the mouth to remove any seen object.
Breathing: Look, listen and feel by watching the chest and placing your cheek a few inches above the mouth of the victim to sense any movement of air. If the victim is not breathing, they may need their head repositioned
Circulation: check the PULSE. The best place to check for a pulse is the carotid artery along the side of the neck along the windpipe
Haemorrhage: If the victim is bleeding, then provide the necessary care.

NEXT STEP – INTERVENTION
The last step is to actually provide care to the limits of the first aider’s training — but never beyond. In some jurisdictions, you open yourself to liability if you attempt treatment beyond your level of training.
Treatment should always be guided by the 3Ps:
Preserve life
Prevent further injury
Promote recovery

Primum non nocere
Above all, do no harm
Thank you

‘Young shall grow’ so the saying goes, but a quick addition to that should have been, ‘if they survive’. Yes,young shall grow if and only if they survive the rigors of growth and development through the stages of life. It is also apt to add that growing is not just important as growing well and growing very well.
The World Health Organisation, WHO as well as its arm-United Nations Children Emergency Fund, UNICEF have developed standard measures and criteria to grade and monitor this growth and development especially in children. However, Nigeria along with other developing have fared so poorly in this regard. Even the figures often quoted cannot be taken hook line and sinker.
Many thanks to our friends; donor agencies and individuals from across the world who have constantly been there for us to ensure that we move up from this precarious situation. I therefore think it is left more to us, to tidy our end and play our own role effectively as individuals, groups or government as it were.
Talking about groups, we have so many of them around based on certain common factors; religion, tribe, social status, occupation, just name it, we have them in numbers. The big question however is, how do they influence us positively? Or negatively? Permit me to be biased here, have we ever considered these groups as veritable means of passing across salient PUBLIC HEALTH information? Do we see it as a possibility? Have you ever been caught in any of these groups with such useful information, campaign or orientation as the case may be?

A drift away from the role distribution. Let’s share the case in point.
I met this child, less than 3 yrs of age first in the isolation room of the Children emergency.
Isolation room, as the name suggests is a room where we keep children with rapidly communicable/infectious disease away from other children.
The child was taking in artificial oxygen via a tube connected to the Oxygen cylinder and passed into her nostrils.
She was breathless and restless. She has numerous dark spots all over her body. She was semi conscious with her eyes shut, not because she is asleep but because she just helplessly couldn’t open them. She isn’t dead either, at least not yet.
She had presented the day before with a history(in medical parlance) of cough,catarrh,fever and rash of two week duration. Mother had geniusely made a diagnosis of Measles in this child and had been managing her child at home with herbal concoction (agbo) which she force-feeds the child and bath her with.
She had been sternly warned by friends and neighbours that measles patients must not be taken to the hospital, they are best managed at home.
By the time she presented at the Children Emergency, the child has developed bronchopneumonia(a super-imposing medical condition) and she is currently unconscious.
The child I saw was lying helplessly, unconscious, very weak with numerous dark spots all over the skin. The lips had numerous blisters which could have been from a probable insertion of spoon and other metallic materials when the child lost consciousness.
We tried our best, doctors and nurses, but after 3 days of admission, the most unfortunate happened, we lost this poor two-year old child.
Most worrisome of this whole story is the fact this child died of a disease that could have been prevented by merely volunteering the child for immunisation.
While I am not going to absolutely campaign for the politically-influenced, poorly managed, free and mobile door-to-door immunisation. The one administered by people of questionable skill (as long as they belong to the ruling party). The one whose vaccine-potency is questionable concerning the way and manner these vaccines are preserved. Yes, we see them on certain days (and the plus days) carrying boxes on their shoulders, some of them in tartarred aprons, signifying them as ‘injectors’ or do we call them vaccinator?
However, I still feel strongly that availing the child of such an opportunity would have been a better idea. There are various other options to being adequately immunised according to the immunisation schedule, they are not expensive, they are readily available (I believe) but the lackadaisical attitudes of many Nigerian mothers to the health of their children is quite disheartening.

I wonder if they forget so quickly, the pain they went through in pregnancy, at labour, backing the child at infancy and so on. I still find it hard to understand why such simple, absolutely essential health measures such as Immunisation would be taken for granted to the extent of losing a whole precious child.

Measles is a vaccine-preventable disease, in fact, it can be eradicated completely reason being that man is the only known reservoir so all we need to do is stop the spread in man.
However, in Nigeria, we have failed to do what is right. Now within one month, I have seen four children coming down with measles, leaving 2 dead, 1 left with the very likely possibility of being blind (for life) and the other still on admission, the fate not yet decided.
I must also not fail to chastise the mother for leaving the care of her child to hear-says and rumours from friends and neighbours who apparently are not skilled medical personnels.
Nigeria and Nigerians will get there one day, may be sooner than later depending on how we want it as individuals, as groups, and as government.

This time,we are not discussing any clinical case in particular. We are just talking about the World Health Day as it were.

To start with, I know most of us are used to celebrations and parties and so on, but I find it rather a misfit to bid me Happy World Health Day! To me, such days are set aside for us to reflect on certain aspects of our lives, in this case Health. The World Health Organisation has chosen a beautiful theme for this year- High Blood Pressure.
In the past, high blood pressure (and by extension) Hypertension used to be seen as a disease of the rich, of affluence, of the elderly, in fact of the ‘whites’.
However, recent studies and clinical experiences have shown clearly that there is now a change in the trend of events with young people of ages as low as 22 and 28 years reported to have died of Stroke- a complication of high blood pressure here in Nigeria.

According to the WHO, 46 per cent of Africans above age 25 are said to have high blood pressure while 7.3 million people are reported to die of high blood pressure-related diseases annually.

The issue of high blood pressure is best tackled with the maxim “Prevention is better than cure”. The reason is very simple,once it happens its a life long ailment; at best, you manage it.
Preventing high blood pressure is quite simple,starting from the food we eat-a balanced diet is healthier and costs less than junk-feeding; lifestyle modification- stress-free life and regular exercise; regular medical check up, and so on.

All the above are with the background understanding that there is a high genetic relationship with high blood pressure but then, it can be better managed.

My concern with health management especially in Nigeria is that most of us fail to realise that the poor health index in our country is multifactorial with each individual contributing greatly.
How does this happen? Each person knows where the shoes pinch the most. Government will not tell you that you have headche, they won’t tell you when to seek for medical attention or where, in fact, they won’t tell you to live healthy. Its you, your life, your health.

Granted we need the government to provide a formidable, accessible and affordable health care service plan but you must realise that living healthy begins with YOU.

Hamid Adediran is a Medical Doctor+Broadcaster=Medicaster. He tweets from @hamid_doctalk

I hope its not too early to discuss this woman, since we just recently discussed a case of infertility. Anyway, I believe my esteemed readers are well aware of the fact that the world is created in pairs often in extremes.

We’re discussing a woman who is abundantly blessed with child-bearing. Clinically speaking, Grand multipara.
A bit of medical tutorials will go a long way in simplifying the term just mentioned.
Parity (or Parous experience) and its derivative para – is a term used to describe a woman’s delivery experience, that is any pregnancy carried beyond 28 weeks (which is tropically taken to be the age of viability)

We count the number of parous experience in ordinance fashion. When a woman has delivered for the first time, she is primipara, up to 2 times is multipara and up to 5 parous experience is grand multipara.

This woman we’re talking about has had 6 previous experiences and has come to us with the 7th pregnancy.
Expectedly, she is elderly, her age as at booking being 45 years and obviously of a large size.

What initially got me concerned about this woman is her level of literacy. She is a graduate and works in the Civil Service, so one would expect all these to rub off on her to inform her decision and protect her from avoidable risks and dangers.

However, my clinical experience and social interaction has shown that often times, too much “book reading” and “I know so much” mentality adversely affects a lot of the “alakowes” as far as certain professional issues are concerned, such is family planning. Most literates having read so much about all forms of contraception (which sincerely are almost not error free at all) consider the few, surmountable disadvantages more than the enormous indispensable advantages.
They talk about getting excessively fatter, dislodgement, irregular menstruation and all sorts ignoring the very important benefit of fertility control.
They also are not aware (or probably just ignore) the fact that there are numerous methods of contraception/family planning that there is always one method safe enough for everyone.

A ‘sovereign’, permanent method of contraception with little or no adverse effect is Bilateral Tubal Ligation (BTL). This is just appropriate for any woman who is sincerely not desirous of any more pregnancy.
However, talk–about gist of a certain woman who lost all her kids to inferno, or toad traffic accident and couldn’t bear anymore because of the BTL she did would not make most women consider this invaluable method. Then, I put it to them, what if she lost all her children after menopause, what would she do?
Please don’t get me wrong, I’ m not trying to sound cynical here but how does it feel when people have to pay such grievous prices for their inability to weigh risk-benefit in whatever action they’re about to take despite stern warnings and series of advice.

This Grand Multipara presented at ante-natal clinic at 27 weeks 5 days (almost 7 months) this again, is a challenge with most multi-para (not to talk of a grand multipara). They feel they have all the experience to deal with pregnancy and childbirth. They therefore tend to present late for ante-natal service (if at all they do) they often present only when they have some health challenges in pregnancy. They also have a tendency to be poorly cooperative or even uncooperative with medical personnel. They query every advice offered, sometimes jettison them, argue vehemently and sometimes don’t comply with drug regimen or visit schedules.

Fortunately for this woman, at presentation, she was discovered to have been hypertensive and diabetic. This necessitated her to be placed on admission for further observation and management.

Swiftly, the medical team was invited to properly manage these two often chronic medical conditions complicating her pregnancy. Their advice was strictly enforced (since she is on admission). The drug regimen was also adhered to for maximum outcome to ensure the viability of the fetus as well as the survival of the mother.

However, the primary aim of management in such condition is to deliver the baby at the safest period for both the mother and the child. Should need be, such pregnancies can be brought to an end especially as soon as the fetus reaches age of self-sustainability ( usually after 34 weeks).

At gestational age of 35 weeks and a day, the woman started having on and off contractions (known as labour pains) the options were weighed by the team of doctors managing her, and a caesarian section was considered best for her and as soon as possible.
She was prepared for the theatre; blood was secured, grouped and crossmatched for possible transfusion and off she went to the theatre.
In no time, the baby was out. My duties in the theatre on that day included liaising with the Pediatric team (Doctors who specialize in the care of children) monitoring the child, assessing her and giving feedback to the surgeons as soon as possible (while they close up).

I drew the attention of the pediatrician to what I saw as some unusually irregular (dysmorphic) features in the new born child albeit the struggle to resuscitate the child who wouldn’t cry immediately after birth. Heads put together, we agreed that the child has suspected Down’s syndrome (never mind us, we are almost quite sure though but it takes some specific laboratory investigations including chromosomal studies to particularly confirm our diagnosis).

Well, good enough, she has signed all the necessary documents requesting that her tubes be tied at delivery (BTL). Hence, the surgeons proceeded to tie only the right tube which was still visible (whatever had happened to the left one, we’re not sure).
The surgery was concluded, the mother wheeled from the resuscitation room to the ward and the baby, to the neonatal unit for further observation and management.

The essence of this blog is to learn from other people’s mistakes, possibly amend our ways and avoid taking such steps in life.
The import in this case of our grand multipara is clear, the concept of family planning is explicit, and it’s for all.

As we can also see literacy is not always the same as being educated. You can be learned and yet be uneducated with simple issues such as this. The consequences may however be irredeemable.

The government of Nigeria has institutionalized family planning such that it is quite affordable and readily available. It is not a one size fits all though but everyone has a size that would definitely be fitting.

Ranging from the permanent methods; the easily reversible contraceptive devices; the pills (emergency and long-term) to even the common barrier methods such as condoms. It is almost impossible for anyone to be intolerant to all methods; I don’t want to believe that has ever occurred.

Patients should be free, open-minded and learn to trust their health care givers, while the health care providers should also try as much as possible to be patient with patients. The need for tolerance, calmness and empathy in clinical practice can not be over-emphasized. This sets forth a better Doctor-patient rapport.
This woman, like it or not would be left with 6 (possibly healthy children) and a Down’s syndrome child to cope with for the rest of her life.
I wish her all the best.

Hamid Adediran is a Medical Doctor+Broadcaster=Medicaster. He tweets from @hamid_doctalk

Dead-Hand: Not just a Tale

By the time I saw him, he smelt awful. Smells is all in the life of medical personnel: Smell of antiseptics; of disinfectants; of drugs and, of dying or dead flesh. In this particular case, it was the smell of a dead flesh. I guess that’s one of the hazards I have to cope with as a Doctor, though.

His offensive odour had an ironic but welcomed plus: His malodorous ‘perfume’ had assisted the nurses in chasing away a fair number of patients’ relatives, who are often, in the habit of loitering around their sick ones, all in the name of rendering care. But here I am, staying as close as the word ‘close’ can ever permit, examining every system in his body, including the source of the mal-odour -his gangrenous hand (the simplest way to describe this is to call it the dead hand).

The Dead-Hand Man had been a victim of a robbery attack. Certain ‘good’ highwaymen of the night had come unannounced, uninvited and in a very rude manner to his home. Our good highwaymen of the night, who had announced their foul presence with sickening brutal force to others were unwelcomed, unwanted, undesired, unsought, unsolicited, unasked-for guests to the Dead-Hand Man.

Being a butcher by profession, he had attempted to defend himself (or, maybe, attack his unwanted guests). He had a way with the tools of his trade but his way was dwarfed by the tools of our good –GUNS- highwaymen of the night. His uncommon zealousness had been duly paid back with a gun shot to his upper right arm (his dominant hand). A ghastly, garish and major wound became his lot from the gunshot.

His relatives had come to his rescue, after ‘his’ vile guests had left him in a pool of his blood. In their haste to save his life, they took him to a nearby ‘medical centre’ where they met an untrained (ill-trained, perhaps) fellow who used a tourniquet on the arm. He must have been daunted by the extent of wound and the rate of blood loss that he was rather too anxious to arrest the bleeding at all cost, apparently unwary of the repercussions.

Tourniquets are not bad in and of themselves, misuse and zero-monitoring was the bane herein as it is used, frequently, every day. From its first ‘crude’ use by the Romans in 199 BCE-500 CE to Jean Louis Petit’s, Joseph Lister’s to James McEwen’s patents, tourniquets have saved many a-life either during surgical procedure or emergencies.

In our sad case, an emergency was criminally mismanaged.

By the time Dead-Hand Man got to the centre where I work (3 days after the ugly incidence), the whole of the hand from the level of tying down to fingers was numbed: no blood supply, no nerve supply, all tissues therein-muscles, bone, skin are perhaps all dead!

We are therefore left with no other choice than to amputate the length of the hand.

Days after the amputation, our patient was terribly depressed; he still found it hard to believe that his limbs would never come back to him. His dominant hand, now no more, meant unemployment (and perhaps death by installment)

He now had to call on anybody, just anybody nearby before he could successfully lift a bottle of water to his mouth to quench his thirst.

He lost so much blood that he was being transfused day in day out in other to keep his packed cell volume at the barest optimal level. At this time, he was only interested in being sure that he wasnt going to lose his life.

How did he find himself here?

Was he wrong to have challenged the armed robbers? Was his approach wrong? Has it even been predestined that he would lose one of his arms (in fact the dominant one) before the age of 30?

His betrothed actually stood by him all the while,
are we sure things would still continue the way it was? Would she still want to marry an amputee? Would he be able to cope with his new life? What happens to his profession? These are questions begging to be answered. But to me, the paramount question still is ‘could this have been prevented?’

PS: Rushing down the aisle of the clinic a few days ago and a young man tapped my shoulder, our eyes met and there he extends his left hand (for a handshake). I quickly grabbed it and shook it as fervently as I could. Our Dead-Hand Man (having been discharged) is back for follow up. With a radiant smile on his face, he said ‘Doctor, e se gan ni’ (Doctor, thank you very much). I smiled back and gave all thanks to God -thats what my name stands for.

Hamid Adediran is a Medical Doctor+Broadcaster=Medicaster. He tweets from @hamid_doctalk

As a medical student, I had a challenge: Infertility.

Don’t get me wrong; I was not diagnosed as infertile neither did I have a problem with understanding it as a topic. I had the nebulous challenge with coming to terms that infertility, like most other medical terms (though English), can not be replaced by another English word, like, sterility.

While infertility is a surmountable health challenge, sterility refers to a permanent irreversible state. General definition explains infertility as the inability to achieve pregnancy despite regular, unprotected intercourse over a period of time, usually, at least, one year.

Infertility is classed into two major divide: Primary and Secondary.

Infertility is primary when no pregnancy has ever been achieved (so far in life) or secondary, when previous pregnancies have resulted irrespective of the outcome – abortion or ectopic pregnancies.

In Nigeria, the incidence ranges between 20-30% wherein genital infection has been ranked high among its cause.

I, personally, have experienced too many cases of infertility far beyond what I used to imagine the prevalence to be. At the teaching hospital and clinics, the number of patients astounds and considering the cultural importance attached to child bearing, it is sometimes even seen as a curse.

Often, lifestyle exacerbates infertility.

A case in point, which I will be sharing with you, is that of a 38 year old woman who presented with 9 years history of secondary infertility -by this I mean she has actually had some pregnancies (which she, voluntarily, terminated earlier before marriage).

Questioned further, her first marriage was in 2002 (at 27 years) which ended in 2006 when her husband died. She remarried in 2007 but the marriage crashed in 2010 due to her inability to conceive. Divorced, she got married to another husband in 2011; she is yet to conceive, prompting her to seek medical attention in our clinic.

In short, 3 different husbands within the space of eleven years have led to no pregnancy. Little wonder she was quick to halt me when I tried to question the fertility tendencies of the husbands. Not much was said about the first husband, but the second husband now has a child from another lady (after they divorced). The current husband is a polygamist who has 5 children from 2 (senior) wives.

While experience has shown that the current husband can not be absolutely trusted for paternity (I mean it’s actually possible for the two other wives to have had kids outside wedlock.( Yes, it happens!), all fingers now point more at our woman patient who is desperate more than ever to have kids.

But there are twists: historical and existing.

Her history of abortion is a Sisyphean twist. Another twist to her story is the fact that the last ultrasounds scan done announced fibroid occupying her uterus (womb). Fibroid makes it more difficult for babies to be formed. Or if a baby forms, jeopardizes its survival in the womb, if not properly managed.

Third twist, at 38 years, her chances of having healthy viable eggs for conception is reduced, the ability of the body to cope with the various physiological changes in pregnancy drops and I am saving this for the last, the likely compromised integrity of the womb and fallopian tubes (those structures that link the ovaries to the uterus/womb where fertilization occurs) due to her previous terminations of pregnancies.

She procured previous abortions from some ‘quack’ health practitioners who don’t know their onions well as par evacuating the uterus. Several sequelae must have followed which the woman would almost likely not remember or she might have even taken such for granted leading her to where she is today.

I’m writing this piece with the utmost conviction that someone reading this piece right now must have either been a victim of unsafe abortion, helped someone to procure unsafe abortion or who knows, might have even attempted abortion in an unsafe fashion. Caution!

Many thanks to science, that has provided a number of possible options to successfully attain conception even in conditions like this. But I must be quick to add that these assisted reproductive techniques cost a fortune and are not easy to come by. This is in addition to the recorded failed attempts in a number of cases.

Maybe the woman would still have luck smile on her face. Maybe someday and somehow, she would be carrying a baby of her own. Maybe the current husband will be financially buoyant enough to go the extra mile for this poor woman by procuring assisted reproductive technology. Maybe the husband will actually be convinced enough to ‘help out’ this 3rd wife despite having had 5 happy children from 2 other senior wives.

Just maybe she should have played safe and not have had those previous pregnancies. Maybe she would have procured abortion from a skilled medical practitioner.

I mean, maybe the Nigerian government would have liberalized abortion just the way her colonial masters did some decades back to safeguard the vulnerable populace from patronising ‘quacks’.

We can go on and on, asking questions and wondering what would have happened if the story had not gone the way it went, but then, the sincere though saddening truth to it is, it could have been prevented, the woman could have lived a happy life, if only she had not been too eager, to ‘enjoy the forbidden fruit’ before the appointed time.

Hamid Adediran is a Medical Doctor+Broadcaster=Medicaster. He tweets from @hamid_doctalk

This blog is an avenue to share with you some very interesting medical cases I encounter in my practice. Their stories are discussed with the spectacle of Preventive and Social Medicine/Public Health.

I leave you with enough to learn and ponder upon as a healthcare seeker, government official, healthcare provider or even as a citizen.

It is also aimed at promoting preventive medicine by learning from other people’s cases since it is often said, prevention is better (and often cheaper) than cure. I shall welcome any contribution, criticism, or question all within the confines of medical ethics.
Welcome.

President Muhammadu Buhari’s style of settling disputes is predictable and familiar. He appears to me like those leaders who believe you should have enough sense to manage crises better among yourselves. If you now continue fighting till he has to intervene, you both would most likely pay for it.

As a young lad especially during secondary school days, I made a commitment never to fight again after my fight with Adeleke Adeniyi in JSS1. Niyi and I were friends, quite close that he would be enlisted among my top 3 classmate-friends. He was actually more aggressive than I was. I’ve seen him clench fists a couple of times. I, on the hand would rather preach peace or walk away, most times. This is partly because I was much younger than most of my classmates, Niyi inclusive. I was barely 9 years when I got into secondary school. Then came this day when we had a minor misunderstanding. He went on boasting about how he would beat the hell out of me, that I was a weakling. I thought to show him I really wasn’t as weak as he thought. I actually looked better fed than he was and was confident I could handle him. We got into a brawl, I committed myself to slam him the WWE style. And yes, I succeeded! Well, you may need to note that whoever slams is declared winner of a fight regardless of how many punches you took like I did that day. We were both punished in the INTRO TECH workshop by hanging on to the serrated burglar proof railings. That was unforgettably painful and I began to ask myself why I gave in to that temptation. We returned to the class having served our sentence and I was crowned winner while Niyi kept lamenting, “ajibu nikan l’o mo” -meaning “he only knows how to bend-slam!” Whatever the case may be, I defeated him. I only had to take care of my swollen lips in private.

Even when I moved on to another school in SS1, I held on to my resolve never to get into a physical fight with anyone, friend or foe. I enjoyed so much peace thereafter. It got to a point that I didn’t even have to defend myself whenever anyone was up to trouble with me. An army would always be on deck to warn the troublemaker not to take advantage of my no-fight rule.

That said, it’s interesting to look back and see how many times people including classmates had beaten me back during my secondary school days. I wouldn’t run away from trouble and troublemakers. Neither would I tolerate bullies or cheats. The one thing I may never stop doing is using my mouth where necessary. Often times, the mouth would only shut when a few punches have enlarged the upper and lower lips and they feel too heavy to move. On all these occasions, I resisted the provocations and made sure never to return these hits no matter what.

If you ever have a manager, parent, teacher or any leader like Bubu, I advise you to device a workable method to avoid or settle disputes that may involve you as you may never come out as a victor nor vanquished when he intervenes. Ask Victor himself. Unfortunately, mischief makers find this style subprime and never fail to take advantage of it even at the expense of the innocent fellows and the nation at large.

Since the advent of the novel corona virus named SARS-CoV2 and the disease COVID-19, the world has witnessed a near total shift in attention.

Hardly would you find a news article without a touch of COVID-19 in it. People, especially Nigerians kept vigil to check what we now jocularly refer to as ‘live scores’ from the Nigerian Center for Disease Control (NCDC).

The latest report showed a total confirmed case of 49,485 cases with 36,834 discharged and 977 deaths.

What killed them? COVID? No! An immediate take away from this is that death from the virus may not be as alarming as the noise about the virus. A further twist to this is that majority of people who died with the virus did not in fact die of the virus. Instead, they died of complications associated with underlying illnesses predating the discovery of SARS-COV2 itself.

This gets me worried of the gradual neglect of other health challenges which have always been with us. It appears we have all caught the bug of the COVID-19 rave so much that other lethal health conditions now appear less of a monster to us.

Diarrheal diseases have always been a major cause of deaths in our communities. It’s reported that proper hand washing can curb this menace by as much as 50%. COVID came and everyone ‘suddenly’ realised the importance of hand washing. The radio and TV are awash with jingles about hand washing. Why wait till now? What changed? What will change?

It’s generally known that most cases of hypertension are accidental findings during clinic visits for other health complaints, some related to hypertension itself. Worse is that most hypertensive patients are less compliant with their management which leads to life long complications and sometimes death.

COVID-19 has come to worsen this trend but my people are more worried about COVID than the real killer itself. Who would help tell them the truth?

The case is similar with diabetes. Rather than focus on glycemic controls and prevention of diabetic complications, most patients prefer to look for shortcuts; in the process they over-flog their livers and kidneys with wonder drugs that would rather hasten organ failure.

A diabetic patient would rather drink COVID-prevention potions than stick to his routine medications to keep the diabetes under control. Who is to blame?

What happens in the hospitals? Every patient is seen and treated as a potential COVID patient until otherwise confirmed through test. Even the doctors attend to patients with palpable fear of contracting the virus since the required Personal Protective Equipment is either inadequate or outrightly not available.

As a sexual and reproductive health professional, I have watched these vital services take the back seat because of this virus. The effect is especially worse in Nigeria, a country where several women die everyday from birth-related complications. The government, donors and many stakeholders now have their focus on the ‘deadly’ virus at the expense of other raging causes of mortalities among Nigerians.

It’s interesting to see how the world is beginning to move on with what is now termed the ‘new normal’. I hope the abnormality of other health conditions that are of debilitating effect will not be swept along with the ‘normalcy’ we now see in COVID-19.

I was hanging out with some friends in a lounge when he walked up to me. As usual we exchanged pleasantries in a quite dearly way. Courtesy demands (or so I think) that I introduce him to my friends…”this is Shekau (not his real name) he’s a friend”, and then he snapped “don’t mind him o, I’m not his friend, I’m his patient”. I instantly went into some sort of spontaneous silence.

Truly, we met when I was in the medical school, and he was my patient in the Psychiatry Department. I actually took it further with him and we became rather personal friends ever since. Yes, I see him more as a friend.

It all started on a Saturday morning when he came knocking on my door in Alexander Brown Hall, UCH Ibadan. “Who is there?” I inquired. “Your fellow friend!” He answered.
This reply really got me interested and I curiously opened the door to see who this ‘fellow friend’ was. Alas, a young man stood there in a paramilitary uniform, looking quite dirty like he just came from a jungle operation.

Further chat with him convinced me that he was indeed mentally challenged. I cunningly took him to the Psychiatric ward amidst his suspicion of my ‘salvation’ moves. At last, I handed him over to the Doctor-on-call who immediately recognised him as an old patient who had absconded. The treatment was then to recommence.

He was later being managed on outpatient basis but frequents the hospital environment where I see him quite often and we had lengthy chats on most occasions.

I realised so many things about him during these chats, some interesting, some astonishing, and most times expository.

He is in his early thirties, the first child of his father, he used to be very brilliant, had very beautiful Secondary School certificate result, was employed into the paramilitary organisation through his father’s ‘connection’ and in fact has since been retained there despite his mental challenge basically because of his very strong connection.

Retaining him even without significant input at work was a means to support and help him out of his medical condition but nay, this was not to be. He spends his monthly salaries rather lavishly, spending on both the needy and the needless (the later most times). A friend who works in the bank where he transacts attested to the fact that he even goes as far as spraying the money on the floor as soon as he withdraws.

Interestingly, I get to run into this my friend almost each time I travel down to Ibadan. From the shopping mall, to the cinemas, to the lounges and clubs; I see him practically everywhere, roaming and wandering aimlessly.

On each of these occasions, it’s always easy to assess his financial status; he would ask for money when in need while offering to buy you anything when his purse is full.

I think about him very often, I wish I could help. In fact, he is one of the reasons I ever consider mental health as a choice of speciality. I just wish I could help him, I know he urgently needs help, he cannot afford to continue this way.

However, our institution isn’t such as could cater for him.
It’s a known fact that social medicine in Nigeria is next to zero. There’s little or no provision for these helpless vulnerable fellows. As a Doctor, you get to see the patients, diagnose appropriately and prescribe relevant drugs for possible cure. This however, I must say is not enough! A lot still needs to be done, by our social workers. We need to get them off the streets, prompt them to go for treatment, and support them after discharge. The role of effective follow-up system in mental health cannot be over-emphasised. A default in medication compliance results in relapse with its attendant complications taking the patients father from eventual cure.

We must also not forget that a good number of young people walk around peacefully with a wide range of mental illnesses. Early detection, prompt refferal and immediate treatment would go a long way in significantly pruning down this social menace.

Campaigns against drug abuse should be taken to every doorstep and taken with utmost seriousness required.

This indeed has been an established link to a various mental health challenge especially among the Nigerian youth.

I have a vision of a world of good health, where mental health is given significant priority and the youth are specifically focused for care.

So help us God!

Hamid Adediran is a Medical Doctor and Broadcaster. You can follow me on twitter @hamid_doctalk